Physicians Must Possess Proper Licensing and Go

Physicians must possess proper licensing and go through a myriad of processes in order to qualify to practice medicine. The state of California as it pertains to physicians does not have a specific language within its state statute, neither its administrative regulations. This means that physicians have some leeway when registering and licensing. Due to the nature of statutes of California, certain physicians have been known to conduct shady business within the borders of this popular state. One such case is Milos Klvana who demonstrated what should not be done while practicing medicine.

In order to report doctors like Milos Klvana, patients/consumers must undergo a series of actions. These actions will aid in gathering evidence of malpractice, present the problem of the patient, reimburse patient for medical expenses, and produce charges against the suspected physician. Typically, a patient must make a complaint concerning a physician to the Medical Board of California where they will enforced the provisions of the Medical Practice Act. The Medical Practice act provides: "Any person who practices or attempts to practice, or who holds himself or herself out as practicing...[medicine] without having at the time of so doing a valid, unrevoked, and unsuspended certificate...is guilty of a public offense"(State of California, 2010, p. 1).

The initial step of filing a complaint is then followed by the Medical Board obtaining all copies of relevant information pertaining to the treatment and complaint, including medical bills, patient information, etc. If a person does not an "Authorization for Release of Medical Records" at the time of filling out the complaint form, then the patient must do so as soon as possible. This step is crucial in continuing the process. The medical providers will summarize their treatment of the person as well as release all medical records of said person.

There is a time limit however for complaints. Seven years or more from the time of the incident/treatment, and the case cannot be opened. "Business and Professions Code section 2230.5 states that any accusation (or formal charges against the physician's license) filed against a licensee shall be filed within seven years after the act or omission/incident" (State of California, 2010, p. 1). Also of note is that the medical consultant in charge of reviewing the case has to find evidence of foul play in order to keep the case open and eventually take it to court if necessary. If there is no evidence of substandard care or foul play, the case is closed. Cases that allege sexual misconduct or negligible death receive the highest priority and will normally be forwarded to the Board's investigative offices. If the investigative offices find evidence of foul play, the information will be sent to the Attorney General's office who will then file charges against the accused physician.

All complaints are kept anonymous even when agencies request medical record from accused physician. In regards to respective regulatory agencies, the Department of Consumer Affairs in California provides licensing for doctors as well as other professional categories. This department is responsible for the Medical Board of California's actions involving physician licensing, registering, and investigations. The unit responsible for handling complaints is the Central Complaint Unit.

Criminal liabilities for healthcare providers consist of a number of things. Most importantly are: no drinking alcohol or being the under the influence of controlled substances while working and no practicing of medicine without proper licensing. Presently, the laws are modified to include warnings of possible criminal implications as well as potential loss of their licenses. In December of 2003 new bills were passed stating what criminal action might be taken on physicians who participate in criminal/illegal behavior: "Bills 4656 and 4655. HB No. 4656, which is Public Act 235, changes the criminal code to provide that a licensed healthcare professional is guilty of a misdemeanor if he or she engages in the practice of his or her profession:

1) with a bodily alcohol content of .05 or more grams per 100 milliliters of blood, 210 liters of breath, or 67 milliliters of urine, or

2) under the influence of a controlled substance that visibly impairs his or her ability to safely and skillfully practice his or her profession. The law also gives a "peace officer" the authority to require the individual to submit to a breath, blood, or urine test. Although the law gives the peace officer the authority to try to get a court order, it does not indicate what the consequences will be if the health care professional refuses to take the test" (Miller, Johnson, Snell & Cummiskey, P.L.C., 2004, p. 1).

Physicians who have not done any bodily harm to the patient, but have been reported and had complaints successfully filed against them in violation of the same law, may receive probation. Probation normally involves required participation in a health professional recovery program. Fines for violations consist of imprisonment for not more than 6 months and/or a fine of $1,000 or less if it is a first offense and imprisonment for not more than one year and/or a fine of $1,000 or less if there is a second and subsequent offense.

Fines and imprisonment are two things physicians cannot afford to have so they try to implement strategies to minimize and control the possibilities of risks and participate in quality assurance programs to evaluate and monitor performance. Risks are generally controlled by elimination of said risk, elimination of activities that may produce undue risk, paying for insurance that will fund and safeguard against uncontrollable risk, informed and signed consent, as well as an establishment of standards, controls and regulations. Quality assurance programs involve:

1) "Development of practice guidelines/standards of clinical care

2) Continuing medical education

3) Quality Assessment;

4) Practice review;

5) Medical doctor evaluation

6) Medical doctor enhancement

7) Remediation of behaviour or remarks of a sexual nature by a member towards a patient" (Glasner, 2007, p. 1).

In case risk management and quality assurance still do not work and a physician ends up like Milos Klvana who "on December 18, 1989, Milos Klvana was convicted on nine counts of second degree murder"(Monico, Kulkarni, Calise, & Calabro, 2013, p. 3), physicians will have their case brought to the Attorney General office where they will face criminal charges. Usually cases involving negligence and wrongful death that result in a conviction consider monetary loss of wronged party as well as potential risk for society if the doctor is not convicted. All the evidence gathered from the Medical Board will then be granted to the attorney general along with testimony from the wronged party. All in all, court procedure takes time and compliance by not only the patient or patient's family, but also the physician.