California Administrative Law

California Administrative Law Articles

May 11, 2012

The Medical Board of California has a form entitled Petition for Penalty Relief, which is used for three purposes:

(1)   Petition for reinstatement of a revoked or surrendered medical license;

(2)   Petition for early termination of probation; and

(3)   Petition for modification of probation terms.

The simplicity of the form is misleading in light of the complexity of the process, which can take one year and always requires a formal administrative hearing.

Step 1: Determine Eligibility and the Waiting Period

For a physician who has been convicted of a crime, eligibility requires completion of the sentence, including termination of parole or court-ordered probation.  Pending disciplinary action also makes a doctor ineligible for penalty relief.

The next step is determining when a petition for reinstatement (or termination of probation) can be filed, which is governed by Business & Professions Code section 2307.

As shown in the table below, the waiting period is either one, two or three years from the effective date of the disciplinary order.

Minimum Waiting Period Type of Petition for Penalty Relief
3 Years Reinstatement after discipline based on unprofessional conduct
2 Years Early termination of probation of three years or more
1 Year Modification of a condition of probation
Termination of probation of less than three years
Reinstatement after discipline based on mental or physical impairment

Step 2: Prepare and File the Petition

The Medical Board requires submission of its form entitled Petition for Penalty Relief.  The three-page form is straightforward, and the following documents must be attached:

  • A narrative statement explaining the events leading to the disciplinary action and rehabilitation, and the reasons for the petition. In petitions for reinstatement, the narrative statement must explain the following: (1) what the doctor has been doing and how he or she has earned a living since the license revocation or surrender; (2) how rehabilitation will prevent recurrence of the conduct leading to discipline; and (3) the details of practice plans upon reinstatement,
  • Two letters of recommendation from physicians, licensed in any state, who have personal knowledge of the activities of the doctor since the imposition of discipline.  (Bus. & Prof. Code § 2307 (c).); and,
  • A curriculum vitae or resume.

CA administrative law attorneys recommend, in addition to the required documentation, that applicants provide additional information such as documents showing: 

  • Board certification, CME or special training;
  • Proof of completion of criminal probation, drug/alcohol programs, etc.; and,
  • Correction of practices that led to disciplinary action such as revised forms for patient charting or improved office policies related to billing.

Step 3: The Investigation

The Medical Board will forward the petition application to an investigator for verification.  The Medical Board’s investigator will telephone the physicians who wrote recommendation letters and conduct a brief interview of the applying physician to verify the narrative statement.  These interviews are often conducted at the closest district office of the Medical Board.  For out-of-state applicants, the interview will be conducted by telephone.

Step 4: Administrative Hearing

The Medical Board does not settle petitions for penalty relief, which means that every case proceeds to an administrative hearing before an administrative law judge in Sacramento, Oakland, Los Angeles or San Diego.  The hearings are not held before the members or staff of the Medical Board itself.  In fact, it would be rare for any representative of the Medical Board to be present--except for its counsel, a Deputy Attorney General.

At an average hearing, the Medical Board’s attorney presents the original Accusation and disciplinary decision or stipulation and the petition for penalty relief as evidence.  The applicant seeking license reinstatement or termination of probation should present witness testimony, whenever possible.  Sometimes the Office of Administrative Hearings will grant advance permission for out-of-state or distant witnesses to testify by telephone conference.  If there are new documents since the petition was filed, such as a court record showing expungement of a criminal conviction, these documents should also be offered at hearing. Of the course, the most important witness is always the doctor applying for penalty relief.  The testimony of the doctor should be focused on rehabilitation so the Medical Board can feel confident that reinstating the medical license or terminating probation will not threaten public safety.

CA administrative law attorneys at Slote & Links defend physicians in Medical License cases before the California Medical Board

Permanent Link | Medical Board, Probation, Reinstatement
May 7, 2012

Physicians, including recent medical school graduates and physicians from other states or countries seeking a California medical license must fill out a state application which includes pages L1 C and L1D, each of which asks a question pertaining to criminal actions.  Question #23 on page L1 C asks "Have you ever been convicted of, or pled guilty or nolo contendere to ANY offense in any state in the United States of foreign country?"  Question 24 on page L1 D asks "Is any criminal action pending against you?"

These questions appear straight forward; however, it is amazing how often physician applicants are confused about what must be reported, or not reported, as part of their California medical license requirements. They end up receiving a letter from the Medical Board asking for a narrative explanation of an arrest and/or conviction and why the application "failed to disclose" the matter relative to questions 23 and 24.

For example, many people, including doctors, assume that if probation from a criminal conviction is completed and the matter is officially "expunged" from their record under California Penal Code Section 1203.4, they need not report the conviction on the license application.   The state, however, as part of their California medical license requirements, has a specific statute requiring such convictions to be reported on license applications notwithstanding expungement.  See California Business and Professions Code Section 480(a)(1).

On the other hand, California has a Penal Code provision, Section 1000, that allows a court to impose what initially appears to be a non-reportable "Deferred Entry of Judgment" for first offenders charged with certain drug offenses, including:

Possession of Controlled Substances/Solvents/Marijuana/Concentrated Cannabis – Health and Safety Code sections 11350, 11357 and 11377, Penal Code section 381, and Business and Professions Code section 4060;

-       Possession of Drug – Paraphernalia Health and Safety Code section 11364

-       Aiding and Abetting in the Use of Certain Drugs – Health and Safety Code section 11365

-       Being Under the Influence of Illegal Drugs – Health and Safety Code section 11550  and Penal Code section 647(f);

-       Cultivation of Marijuana – Health and Safety Code section 11358 (only if the marijuana planted, cultivated, harvested, dried, or processed is for personal use);

-       Forging or Using a Forged Prescription to Obtain Drugs – Health and Safety Code section 11368 (only if the drugs were for personal use);

-       Driving While Possessing Marijuana – Vehicle Code section 23222(b);

-       Soliciting Drug-Related Acts – Penal Code section 653f(d) (only if the acts were directed at personal use).

When a defendant is given deferred entry of judgment, he or she must plead guilty, but the conviction is "deferred" from eighteen months to three years, while the defendant undergoes a treatment program and supervision.  Once the specified period and treatment is completed, the matter is deemed a nullity and it is as if the arrest and plea of guilty never occurred.

That is, unless you are a physician or nurse or other medical professional.  Then Business and Professions Code Section 492 pops up to say:

"Notwithstanding any other provision of law, successful completion of any diversion program under the Penal Code, or successful completion of an alcohol and drug problem assessment program under Article 5 (commencing with Section 23249.50) of Chapter 12 of Division 11 of the Vehicle Code, shall not prohibit any agency established under Division 2 (commencing with Section 500) of this code, or any initiative act referred to in that division, from taking disciplinary action against a licensee or from denying a license for professional misconduct, notwithstanding that evidence of that misconduct may be recorded in a record pertaining to an arrest. This section shall not be construed to apply to any drug diversion program operated by any agency established under Division 2 (commencing with Section 500) of this code, or any initiative act referred to in that division."

The California Department of Justice reports arrests to state licensing agencies like the Medical Board, including case disposition, so the hapless physician can anticipate some sort of Medical Board disciplinary action despite a Penal Code Section 1000 deferred entry of judgment program completion.

In New York State (and at least one other, Alabama) there is a provision for something called Adjournment in Contemplation of Dismissal (ACD) of criminal charges.  See New York Criminal Procedure Law, Section 170.55. This first offender program for generally non-violent offenses offers the defendant the chance to complete certain terms or conditions such as community service, and if he or she faces no new charges or arrests and the prosecutor does not refile based on failure to complete a term or condition, after six months the matter is deemed a nullity.  The arrest and court record are sealed. California law does not address this procedure, so after the six months has run from the court appearance where ACD was offered, a California physician or license applicant need not report this matter or answer "Yes" regarding convictions.  During the six months of adjournment prior to dismissal, however, he or she must answer "Yes" to questions about pending criminal actions. (See Question 24 on the California Physician's license application).

When in doubt about whether to answer "Yes" or "No" to license questions pertaining to convictions or pending criminal actions, medical license applicants would do well to consult an attorney familiar with these provisions.  In addition, currently licensed California physicians must still report any felony charges (indictments or filed information) and any felony or misdemeanor convictions to the Medical Board in writing within thirty (30) days under Bus. and Prof. Code Section 802.1.

Stephen M. Boreman represents physician license applicants before the Medical Board of California.

Permanent Link | Medical Board, License Applications / Renewals
May 4, 2012

California's Medical Board maintains a website www.mbc.ca.gov with a host of information, including a list of all approved medical schools, in the U.S. and Canada as well as throughout the world.  It is easy to check whether a particular medical school has received Board recognition: simply go to http://www.mbc.ca.gov/applicant/schools_recognized.html and the list will appear.

It is amazing to me then, that significant numbers of foreign medical school graduates end up frustrated, angry and desperate after completing the expensive, time-consuming and often grueling coursework leading to a foreign medical degree, only to find they cannot train postgraduate or become licensed in California because they attended a disapproved school.  The actual list of officially disapproved schools is rather small:

1. CETEC University, Santo Domingo (closed) 05-19-83 2. CIFAS University, Santo Domingo (closed) 11-16-84 3. UTESA University, Santo Domingo 07-13-85
disapproval reaffirmed 02-07-97 4. World University, Santo Domingo (closed) 12-01-89 5. Spartan Health Sciences University, St. Lucia 06-13-85 6. University of Health Sciences Antigua, St. John's 07-28-95 7. Universidad Eugenio Maria de Hostos (UNIREMHOS), Dom. Rep. 11-01-96 8. Universidad Federico Henriquez y Carvajal, Dom. Rep. 07-31-98 9. St. Matthew's University, Grand Cayman 02-18-05 10. Kigezi International School of Medicine, Cambridge, England and Uganda 11-02-07

On the other hand, the number of unrecognized yet not disapproved foreign medical schools may be significantly larger, and may be approved at some time in the future but not recognized at the time the graduate applies for California medical board licensing. One such school I recently learned of by way of contact from a Californian studying in Australia is Bond Medical School.  Because no Bond graduate had previously applied for a California license and the school has not yet undergone the approval process, Bond remains unrecognized, despite the fact that its faculty and curriculum more or less mirrors eleven Australian medical schools which are recognized.   Bond, once it applies, will probably be approved.  Until then, however, my hapless potential client remains out of luck.

To determine whether a foreign medical school is unrecognized (assuming it is not on the disapproved "short list") the Medical Board suggests you simply check the country and schools listed on its website roster of approved schools. If your school does not appear, it is either disapproved or yet unrecognized.

I recall when I was serving as a Deputy Attorney General assigned to the Licensing Division of the California Medical Board that we were informed that the Medical School of the Americas, an institution set up by Fidel Castro in Cuba as an "in your face" to the American medical school establishment was about to graduate its first Californian who would no doubt be seeking a California license.  This set in motion discussion about the recognition process and a debate about how and whether an on-site visit to Cuba  might be required.

At any rate, if you are pursuing a medical education and there is a chance you may end up in a foreign medical school, it would behoove you to visit the California Medical Board's website and check its list of recognized for state-side and foreign medical schools if you wish to avoid heartache and aggravation later on when seeking a postgraduate training authorization letter (PTAL) or California Medical License.  Make sure the school you attend is recognized before investing the time, effort and money in a foreign medical education.

If  you have questions or need legal advice on foreign medical degrees and getting licensed or authorized to train in California, contact the author.

Permanent Link | Medical Board, License Applications / Renewals
April 26, 2012

 

Physicians must have a state license to practice in California.  Allowing sufficient time and providing a complete application with full documentation to the Medical Board can make a difference.  Failure to do so may result in delay, denial or the filing of a Statement of Issues and an administrative hearing. Lately (2012) the process has been taking about seven or eight months.

The California Medical Board issues licenses (Physician's and Surgeon's Certificates).  It can deny, offer probationary licenses, or allow a physician to withdraw an application.  Without preparation the process can be daunting.

1. How Does the Medical Board Process A California Medical License Application?

When the Medical Board initially reviews a California medical license application, an analyst reads the application and supporting documents to ensure that basic qualifications have been met, including education, USMLE scores, board examinations, postgraduate training, and experience.  The application also asks whether the applicant has any criminal convictions, pending criminal actions, terminations from training programs, or out-of-state discipline.  For a criminal conviction to result in license denial, it must be “substantially related to the duties, functions or qualifications of a physician and surgeon”.  This requirement has been broadly interpreted by the courts.  For example, DUI convictions have so far been deemed substantially related to virtually all California licenses, as are tax violations and dishonest acts.  Criminal assault or domestic violence may also be disqualifying.  Omitting required information from your license application is often viewed by Medical Board staff as a dishonest act, and may result in denial or a probationary license offer of three or more years probation with terms and conditions including substantial community service and completion of an Ethics course.  This can be economically devastating, since some large HMO organizations such as Blue Shield are known to exclude physicians while on probation.

When the Board intends to deny an application for a California physician license, it issues a letter advising the applicant and the reasons for denial.  Denial usually follows prior informational requests or phone inquiries. The applicant is most often afforded an opportunity to provide information demonstrating that the deficiency or conviction cited is erroneous or mitigated.   An exception may be a serious a criminal conviction or dishonesty in the application itself.  In many instances of license denial the applicant is given the opportunity to withdraw.  Withdrawal means there will be no record of denial. The board might also offer a probationary license if it appears the applicant might benefit from supervised education, counseling, additional training or monitoring.

2. How Long Does the California Medical License Process Take?

The Medical Board’s website previously claimed that applications would be reviewed within ninety days and the applicant then advised of any problems or requests for additional information, so that the process could be completed on a relatively timely basis.  Those timelines, however, have changed drastically in recent years.  Since 2008-2009, the Board has advised applicants to expect at least six to nine months to process a license application.   When medical program appointments or job offers are at stake, these delays can be significant.  It is best, therefore, to prepare for an extended process and, again, to make sure the initial submission is complete as well as accurate. 

3. What If My California Physician License Application Is Denied?    

If your application for a California medical license is denied and you decide not to withdraw or accept a probationary license if offered, you may request that a Statement of Issues be filed with the Office of Administrative Law and an administrative hearing held to determine whether the license should be issued.  A Statement of Issues is a document prepared by a Deputy Attorney General. It describes the application, includes supporting documents, and alleges the reasons for denial.  A hearing is scheduled before an Administrative Law Judge (ALJ). The ALJ will write a proposed decision that the Medical Board may adopt, modify or reject.

4.  Common reasons for denial: Criminal record; criminal conviction or pending matter not reported on application (questions # 23 and 24); out of state disciplinary history; program or education deficiencies, including a medical degree from an institution not recognized by California's Board.

4. Can I Appeal After Losing at an Administrative Hearing?

Yes. The applicant may accept the Board’s final decision, or file a Writ of Mandate in Superior Court to overturn the decision.  The applicant must demonstrate that the Board engaged in an “abuse of discretion” in denying the application—a relatively steep burden.  If the court affirms the Board’s decision, an appeal can still be made to the California Courts of Appeal or even the State Supreme Court.  However, the Board may also appeal an adverse Superior Court decision. Conclusion: A physician applicant should submit his or her license application to the California Medical Board as far in advance of any appointment or employment as possible.  Completeness and accuracy help avoid inordinate delays. Even if everything is submitted on a thorough and timely basis, however, government bureaucracy can still make the process a long and difficult one.  Many applicants find having licensing counsel helpful.

For additional information, inquiries, or legal representation, contact the author.

Permanent Link | Medical Board, License Applications / Renewals
May 26, 2011

In Blaich v. West Hollywood Rent Stabilization Department, a landlord sought to overturn a decision of the West Hollywood Rent Stabilization Commission ("the Commission") by petition for writ of mandate (aka writ of administrative mandamus). The issue is whether the Blaichs' appeal was timely.

California Code of Civil Procedure section 1094.6 establishes time limits for judicial review of the decision of a local agency and requires a petition to be filed “not later than the 90th day following the date on which the decision becomes final.”  (§ 1094.6, subd. (b).)  If a petitioner files a request for preparation of the administrative record “within 10 days after the date the decision becomes final,” however, the time to file the petition is extended “to not later than the 30th day following the date on which the record is either personally delivered or mailed to the petitioner or his attorney of record . . . .”  (§ 1094.6, subd. (d).)  WARNING: Unlike local agency cases, the time limit for filing writ petitions in a state licensing agency cases is only 30 days. See Government Code section 11523 below.

The Blaiches filed a timely request for preparation of the administrative record, and the Commission sent the record to counsel for the Blaiches by a private overnight delivery service rather than by overnight mail through the U.S. Postal Service.  The Blaiches did not file their writ petition until 30 days after receipt.  The Commission sought to dismiss the appeal on the grounds that the Blaiches failed to file their petition within 30 days of mailing, but the Court of Appeal found that the Blaiches had 30 days from receipt because the Commission failed to use the mail. 

In conclusion, the Blaiches got lucky that the Commission hadn't simply dropped the administrative record in a mail box.

The decision was filed by the California Court of Appeal on May 16, 2011 in case number B224142 and is attached below.

California Government Code section 11523 governs appeals from state licensing agency decisions as follows:

"Judicial review may be had by filing a petition for a writ of mandate in accordance with the provisions of the Code of Civil Procedure, subject, however, to the statutes relating to the particular agency. Except as otherwise provided in this section, the petition shall be filed within 30 days after the last day on which reconsideration can be ordered. The right to petition shall not be affected by the failure to seek reconsideration before the agency. On request of the petitioner for a record of the proceedings, the complete record of the proceedings, or the parts thereof as are designated by the petitioner in the request, shall be prepared by the Office of Administrative Hearings or the agency and shall be delivered to the petitioner, within 30 days after the request, which time shall be extended for good cause shown, upon the payment of the cost for the preparation of the transcript, the cost for preparation of other portions of the record and for certification thereof. The complete record includes the pleadings, all notices and orders issued by the agency, any proposed decision by an administrative law judge, the final decision, a transcript of all proceedings, the exhibits admitted or rejected, the written evidence and any other papers in the case. If the petitioner, within 10 days after the last day on which reconsideration can be ordered, requests the agency to prepare all or any part of the record, the time within which a petition may be filed shall be extended until 30 days after its delivery to him or her. The agency may file with the court the original of any document in the record in lieu of a copy thereof. If the petitioner prevails in overturning the administrative decision following judicial review, the agency shall reimburse the petitioner for all costs of transcript preparation, compilation of the record, and certification."

Permanent Link | Writ of Mandate
May 6, 2011

The California Department of Real Estate (Real Estate Commissioner) suspended the real estate broker’s license of the Grubb Company based on a civil fraud judgment arising from a dispute between the buyer and seller of a residence. 

Business and Professions Code section 10177.5 authorizes discipline based on a civil judgment for misrepresentation, fraud or deceit.  The Department of Real Estate suspended Grubb’s real estate broker’s license based solely on the court record showing the judgment.  Grubb appealed.

On May 4, 2011, the California Court of Appeal overturned the license suspension because the constitution requires proof of misconduct by clear and convincing evidence before a government agency can revoke, suspend or impose other discipline against a licensed business or professional.  In civil actions, the standard of proof is lower—by a preponderance of the evidence.  Therefore, a licensing agency cannot generally rely on a civil judgment as a basis for discipline.  Instead, the agency has to prove the alleged misconduct by clear and convincing evidence.

See The Grub Company, Inc. v. Department of Real Estate, California Court of Appeal Case No. A125875, decided May 4, 2011.

Permanent Link | Civil Judgments, Insurance, Department of, Real Estate, Department of
April 20, 2011

Medical license applicants in California may have the option to withdraw their applications before a final license denial.  Here is how it works:

The process starts when a medical resident or physician licensed in another state (or foreign jurisdiction) applies for a medical license in California.  The license application is made to the Medical Board of California where a medical license is formally called a physician and surgeon’s certificate. 

Inquiries or investigations will often be triggered in the medical licensing process if the applicant has been convicted of a crime or disciplined in another state.  Medical residents who have been disciplined or terminated from a residency program, or who left a residency (or fellowship program) under unfavorable circumstances will also face further inquiry or investigation. 

If a license application or criminal record check triggers an investigation, the California Medical Board may request a written statement from the applicant and obtain files from criminal courts, police agencies, residency programs and other state medical boards where the applicant is licensed.  Upon conclusion of the investigation, the Medical Board will typically take one of the following actions:

  1. Issue a clear medical license;
  2. Offer the applicant a probationary license; or 
  3. Notify the applicant of its intention to deny the license.

If situtations where the Medical Board does not issue a clear medical license, the applicant is typically afforded the opportunity to withdraw his or her license application prior to formal license denial.  This presents an important decision for the applicant because the potential consequences may include a permanent record of discipline and reporting to future employers through the National Practitioners Data Bank (NPDB).  License applicants facing this critical decision should seek the advice of an administrative law attorney with experience in California medical license defense.

Permanent Link | Medical Board, Criminal Convictions, Investigations, License Applications / Renewals, National Practitioner Data Bank
January 25, 2011

Medical Board investigations are generally triggered in the following ways:

  1. Complaints by patients, employees, co-workers or insurance companies;
  2. Reporting of malpractice settlements or judgments by insurance companies and attorneys;
  3. Reporting of the termination of employment or hospital privileges (Business and Professions Code section 805 reports); and
  4. Self-reporting of criminal charges or a criminal conviction or disciplinary action disclosed on a license application

The interview will take place in a conference room at one of the Medical Board's regional offices. The investigator and a physician consultant to the Medical Board will be present. The interview will be recorded. An experienced license defense attorney may instruct a client not to answer some questions on topics that are irrelevant and/or unnecessarily invade the doctor's right to privacy. Examples of questions that may be inappropriate include questions on habits related to the drinking of alcoholic beverages and questions on the physician's medical history and prescription drug use. The investigator may also ask the doctor to provide a urine sample for drug and alcohol screening. Providing a urine sample may be appropriate for a physician with a history of drug or alcohol abuse who wants to show that he or she is clean. On the other hand, declining to provide a sample is a valid exercise of the right to privacy.

Permanent Link | Medical Board, Osteopathic Medical Board, Podiatric Medicine, Board of, Investigations
January 25, 2011

California license law attorney or lawyer is a common search phrase. The proper area of law, however, is administrative law. Professional license defense, or license law, is one area of administrative law. Searching for a California administrative law attorney may help you find the right “license law” attorney. Note: While the caption for your case may state that it is “before” an agency (e.g., Before the Medical Board of California), this is confusing as cases are actually tried before the Office of Administrative Hearings--an administrative law court system for professional licensing cases. Proceedings before the Office of Administrative Hearings (OAH) are governed by the California Administrative Procedures Act which can be found at Business and Professions Code section 11500. Find a California lawyer who is familiar with administrative law practice and procedures.

Permanent Link | Acupuncture Committee, Administrative Law vs. License Law, Alcoholic Beverage Control, Department of, Athletic Commission, Automotive Repair, Bureau of, Behavioral Science Examiners, Board of, Chiropractic Examiners, Board of, Clean-piping, Commission on Teacher Credentialing (CTC), Contractors State License Board, Dental Board of California, EMSA (Emergency Medical Services Agency), Health Care Services, Department of, Insurance, Department of, Medical Board, Nursing, Board of Registered, Occupational Therapy, Board of, Optometry, Board of, Osteopathic Medical Board, Pharmacy, Board of, Physical Therapy Board, Podiatric Medicine, Board of, Psychology, Board of, Public Health, Department of, Real Estate, Department of, Respiratory Care Board, Social Services, Department of, Veterinary Medical Board, Vocational Nursing and Psychiatric Technicians, Board of
October 20, 2010

In October of 2010, the California Court of Appeal upheld the revocation of a professional boxer's license based on the action of his trainer.  Before a match, Athletic Commission inspectors discovered that the boxer's hands were wrapped with gauze wetted with a plaster-like substance. 

In legal proceedings, the boxer admitted the hand wraps were illegal, but he claimed no knowledge and blamed the trainer who wrapped his hands.  The trainer and boxer had worked together for 11 years.

The primary issue on appeal was whether the boxer could be held responsible based on the doctrine of strict liability.  The Court of Appeal decided that, based on the language of the particular regulations, it was reasonable to hold the boxer strictly liable for his trainer's violation of boxing regulations.

Margarito v. State Athletic Commission, California Court of Appeal Case B220649, Filed October 14, 2010.

Permanent Link | Athletic Commission, Strict Liability