California Medical License Regulation - What Agency Really Controls a Medical License?
Medical License - What State Agency Regulates Physicians?
The best California medical license defense requires a deep understanding of the physician regulation structure in this state. It may seem factuous to ask, “What Agency Really Controls a California Medical License?” The obvious answer is the Medical Board of California or the Osteopathic Medical Board. This is correct but only to a point.
Daniel Horowitz knows that the actual structure and hierarchy of the California medical boards is intertwined with law enforcement and the Attorney General. His defense of your license is informed by knowledge of your opponents, their strengths, motivations and internal structures. This knowledge can be the difference between success and failure.
While a California Medical license is issued either by the Medical Board of California or the Osteopathic Medical Board of California these boards are captives to a hierarchy of supervision that most physicians are unaware of. A medical board attorney routinely interfaces with the enforcement or licensing divisions of the direct agencies but above these boards is the Department of Consumer Affairs.
Experienced California Medical Defense Attorneys Can Make a Difference
Understanding the complexities of the system can matter in providing the most creative and effective defense. Daniel Horowitz has over 40 years experience representing physicians and he works with Dr. Mark Ravis (lawyer and doctor). They think in the box and out. There are many defenses that require a deep understanding of the disciplinary and regulatory structure that are too complex to outlined here.
And each case is different. As an example, we have raised issues of “underground regulations” as a defense to a disciplinary action. This defense required obtaining communications between the Attorney General's office and the Board and analyzing public meeting data as well.
The best physician defense attorneys see these issues and raise them. It is not necessarily below the standard of care for other law firms to miss these issues but the best license attorneys look for creative issues and incorporate them in your defense.
Why is Law Enforcement Control of the MBC & OMBC Important?
The influence of the Department of Consumer Affairs is both political and operational. Both medical boards are advised by Deputy Attorney Generals. These are lawyers who work for the State of California Attorney General (not hard to figure that out!) This is not to be ignored because their legal advice, policy positions and “grey area” judgments are politically driven by Attorney General. In other words there is a funnel and medical license enforcement is administered by the MBC and OMBC but controlled by the political appointees to the boards and the supervising (law enforcement) agencies. The Governer controls the boards, the AG controls the lawyers. Public policy (called Consumer Protection) puts your license in the hands of politicians.
The Attorney General is a highly politically motivated person. Vice President Harris occupied this position and you can be certain that her eyes were trained on Washington D.C. at that time. This had to influence her choices, her appointments, her interoffice promotions and policies.
Daniel Horowitz litigated against Vice President Harris.
The Corporate Practice of Medicine (via the State of California Regulation)
It is strange to think about this. Your medical license is ultimately controlled by law enforcement. The spate of California Opioid license actions against physicians in California is an example of a politically motivated attack which was then dialed back. Our physician lawyers fought against that political takeover of the medical boards by politicians. The revised opioid rx guidelines came out in 2023 and reflect a major retreat from the onerous, medical practice destroying policies of the past. How many medical careers were damaged and how many patients suffered in pain under the old, politically driven guidelines?
Is the DOC Control Over Medical License Regulation a “Secret”?
The Department of Consumer Affairs is very open about its control of California Medical License grants and regulation. Their website describes their responsibilities as including:
“Licensing Licensing only those professionals who pass specialized examinations and meet experience and education requirements ensures that only qualified individuals are legally permitted to provide services. Licensing also ensures that practitioners perform their duties to a certain standard and provides consumers with a means of recourse if a service is not delivered fairly or competently. Note: Certain occupations are registered or certified, rather than being licensed. Registration and certification do not require passing a test. The Department also helps licensees maintain high standards of competence, quality, service, and ethical behavior through licensee education programs. Educating licensees and consumers also reduces fraud and lessens the need for (and costs of) investigation and prosecution of violators and other enforcement actions. The Department believes that combining education with enforcement is the most effective approach to making the marketplace safe for consumers.
Enforcement Enforcement of consumer laws is one of DCA's primary responsibilities. The Department's enforcement staff works with the Office of the Attorney General and local district attorneys to reduce fraud in the marketplace. Resulting disciplinary actions may include Temporary Restraining Orders; Interim Suspension Orders; and license probations, suspensions, or revocations. The Department also has the authority to assess fines and issue Citations, Notices of Violation, Letters of Reprimand, and Cease and Desist orders. In less severe cases, enforcement staff works with licensees to eliminate or prevent performance problems."
The relationship is right on the paperwork. Here is a recent Medical Board Accusation. It is filed (see the stamp) by the Medical Board. The caption reads “Xavier Beccera, Attorney General of California”. (Ron Bonta is now the AG.) The complainant is Maureen Forsyth who is the Executive Director of the Physician Assistant Board. (The Medical Board of California regulates PA’s). So again, it is no secret, the Board and the Attorney General work together but strangely, the lawyer for the Board is by any fair analysis ABOVE the board :] because the Dept. of Consumer Affairs is an arm of the Attorney General!
As you read the above, did you think you were reading from the site of the medical boards? Remember you weren't. This was the Department of Consumer Affairs!
The Medical Board Prosecutor is Also the Judge
Most license attorneys realize that medical board hearing system is not a justice system as we understand the term. This unfairness does not apply just to medical license defense, all regulated licenses suffer from the same fundamental unfairness. To understand how an administrative license hearing would be considered completely corrupt if it were a criminal trial, follow the basic process (and focus on the decision making portion).
The basic hearing process proceeds this way:
Demanding an Administrative Hearing
1. An Accusation is served on the doctor.
2. The doctor is entitled to dispute the charges and demand an administrative hearing. There is a 15 day period to file the request. (Government Code Section 11506) The name of the official form is “Notice of Defense” and this has to be sent to the Board and also to ...... (you can guess) ... the Deputy Attorney General.
So far there is no major problem.
A Fair Administrative Hearing?
The hearing is held before an Administrative Law Judge. That sounds good, the doctor gets a hearing in front of a judge. Your medical experts can testify. Your medical lawyer can cross examine. Truth will prevail …. But, if the doctor wins, does the doctor win?
Who Makes the Final Decision?
In a crazy, circular route, the Administrative Law Judge submits a proposed decision. The proposed decision is the Board. This is the same Board that brought the charges and the Board is advised by the Attorney General who prosecuted the charges. The Board then issues a final decision can be a verbatim adoption of the judge’s ruling, a complete rejection or anything in between. So the judge is an advisor and a fact gatherer. The same group that led the prosecution makes the decision. It is not quite a Stalin show trial but it is not a “fair trial” as we generally understand the concept. (To paraphrase Grace Slick in one of her Jefferson Airplane offshoot songs, “A fair trial is no trial at all”.)
Access to a fully powerful court and judge is available only after the Board issues its “final decision”. Then physician can then challenge the decision before a Superior Court judge. This is a long, expensive and stress filled process.
Clearly avoiding the process is the only best choice. If you are unable to escape the Accusation process, Daniel Horowitz is one of the leading trial attorneys in California. He can make a strong record to convince the Administrative Law Judge to rule in your favor. He can argue to the Board that the case has “played out” in your favor and they should adopt the decision. If this fails, he will have established a clear factual record supporting your position. There are no guarantees except that the best possible presentation by an experienced trial lawyer is necessary to give you the best chance of success in protecting your medical license.
Is There Any Medical Board, Osteopathic Board Independence?
There is some independence depending upon how political the appointees are and how much push back they give to the Attorney General control. It is also true that the CMB and the OMBC have specific tasks that are influenced by but independent of the Department of Consumer Affairs. A critical task that remains somewhat independent is review of medically based complaints.
Business & Professions Code section 2220.08 (Independent Medical Review of Complaints)
Business and Professions Code § 2220.08
This critical law relates to complaints against a physician involving the quality of medical care. Unless these are complaints lodged under Business & Professions Code sections 801.01 or 805 a physician cannot be investigated until there is a medical review of the case and cause found to further investigate the matter. Both the Medical Board of California and the Osteopathic Medical Board of California have individuals who qualify and are paid to conduct these examinations. This is an important gatekeeping function as it protects a person holding a California Medical License from scrutiny (in quality of care matters) by non-licensed, non-medical personnel. However, an experienced medical license defense attorney will tell you that both boards have increasingly reduced or lessened the level of medical scrutiny and that a very large number of medical complaints do proceed to investigation.
Medical Consultant Programs
The MBC and the OMBC us a Medical Consultant Program to recruit and train reviewers who act as "consultants" to the Board's Consumer Protection Unit (CPU). Business and Professions Code section 2220.08 (See above) The application to serve as an OMBC consultant is here.
What are the Current “Hot Button” Enforcement Issues?
The Enforcement section of the OMBC lists the names and types of discipline are linked here:
The Medical Board of California lists its enforcement actions here:
QUALIFICATIONS OF THE HOROWITZ PHYSICIAN DEFENSE TEAM
Our California Medical License lawyers look far beyond the simple paperwork and assess MBC/OMBC complaints based upon the political and social forces driving the investigation. Why does one complaint get swept under the rug and another pursued by an investigative dog refusing to drop a bone? What are the “hot button” issues that the politicians are pursuing through the political channels. Daniel Horowitz and Dr. Mark Ravis (doctor and lawyer) address the medical issues, technical issues and political issues to provide you with the best medical license defense possible. Call our office if you need help. Daniel Horowitz' office is located in Lafayette, California (Contra Costa County). Dr. Mark Ravis is in Calabasas (an hour from Los Angeles). We represent doctors throughout California.
Physician Lawyer Dr. Mark Ravis is currently licensed as both a physician and attorney. He works with trial lawyer Daniel Horowitz to protect physician licenses.
Our offices are in Lafayette, California which is in Contra Costa County. We provide physician license defense throughout California.
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