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FAQ - Physicians

Frequently asked questions received by Physicians.

Who is on the Board of Medicine?

Who is on the Medical Review Subcommittee?

What does the Board of Medicine do?

What is the process to obtain a written verification of my license?

What happens initially after a complaint or suit reaches the Board?

What is the range of recommendations the MRSC might make to the Board?

What happens after the Medical Review Subcommittee makes its recommendation?

What is the range of Actions which the Board might take?

What does a Public Disciplinary Hearing or Settlement mean and what is involved?

Do I have the right to legal counsel at any point in this process?

What is reported to the Data Bank?

What is made public?

Is a Confidential Letter of Concern (LOC) truly confidential?

Is a Confidential Letter of Concern reported to the Data Bank?

How can I defend myself against a complaint?

Can I appeal a decision of the Board?

If a complaint is made against me, but there is no action, no discipline, and not even a letter of concern, does this complaint stay on my record?

What Actions are taken by the Board, and what is the statistical breakdown?

Can I prescribe medications for myself or my family?

Where can I View the AMA Code of Ethics?

How can I properly manage chronic pain patients who are on narcotic analgesics?

Must a hospital report to the Board a disciplinary action relating to a physician?

What is New Hampshire law and Board policy regarding a "Disruptive Physician"?

What is the Board's position on a physician having a sexual relationship with a patient?

What is the Board's policy regarding retained sponge, needle or instruments despite normal counts by the surgical team?

What happens if I'm late renewing my license and what is the process of license renewal?

Can I be disciplined for prescribing, administering, or dispensing long-term antibiotic therapy for a patient clinically diagnosed with Lyme disease?

back to topWho is on the Board of Medicine?

The Board of Medicine is composed of 11 volunteer members: six physicians, one physician assistant (PA), three non-physician public members, and the Commissioner of Health and Human Services or the commissioner's designee. Board members are appointed by the Governor with the advice and consent of the Executive Council and serve up to two five-year terms.

back to topWho is on the Medical Review Subcommittee?

Complaints are sent to a subcommittee, called the Medical Review Subcommittee or MRSC. The MRSC is comprised of different members than the Board, and is composed of 11 volunteer members: six physicians, one physician assistant (PA), three non-physician public members and the vice-president of the Board. MRSC members are appointed by the Governor with the advice and consent of the Executive Council and serve up to two three-year terms.

back to topWhat does the Board of Medicine do?

The Board of Medicine has regularly scheduled monthly meetings during which:

  • The Board evaluates physicians and physician assistants who apply for licensure; the Board licenses those who are found to be qualified.
  • The Board investigates and evaluates existing licensees through the MRSC; the Board commences disciplinary action accordingly.
  • The Board investigates and prepares reports that are necessary under the law.
  • The Board takes action against persons engaged in the unauthorized practice of medicine.
  • The Board promulgates administrative rules.
  • The Board assesses fees.

back to topWhat is the process to obtain a written verification of my license?

In order to obtain a written verification of your license, the Board requires a written request and a fee of $20, made payable to Treasurer, State of New Hampshire. Your request must indicate the address in which to send the written verification. Written verifications are prepared and sent out daily.

Please mail your request and the fee to the following:

Victoria Hebert, License Clerk
NH Board of Medicine
121 South Fruit Street, Suite 301
Concord, NH 03301-2412

back to topWhat happens initially after a complaint or suit reaches the Board?

  • If the Board receives a complaint, or if a lawsuit or reservable claim is reported to the Board, the Board staff triage the complaint or suit to the Medical Review Subcommittee (MRSC). The MRSC members meet once a month for regularly scheduled meetings. The MRSC then assigns that case to one of its members, who is responsible for examining relevant documents (hospital or office records, billing records, pharmacy and prescription records, etc.)
  • If necessary, the Board investigator (a State employee assigned to the Board of Medicine) may interview witnesses, visit an office, or conduct other appropriate investigations.
  • Also if necessary, the MRSC may ask a physician, deemed by the MRSC to have an expertise in the appropriate specialty, to review the case, render an opinion, and draft a Report of Investigation.
  • Of great importance, the physician against whom a complaint or suit is brought is asked to respond. That response is crucial, because it allows the physician to explain in detail what happened and answer the complaint directly. Some physicians choose to have a lawyer respond, but the majority write the letter themselves. The Board appreciates a detailed and explanatory letter covering all aspects of the case or complaint.
  • The case is then presented to the entire MRSC, which, by majority vote, makes a recommendation to the Board.

back to topWhat is the range of recommendations the MRSC might make to the Board?

  • The MRSC might recommend "no further action," which means the allegations presently based on information received do not rise to the level that warrants further disciplinary proceeding, remedial action, or Board intervention. Additionally, it must be noted that the Board has the ability to review patterns of conduct – or a cumulative effect of conduct without time limitation. As such, the Board has the discretion to reexamine allegations in a complaint, pursuant to RSA 329:18-a,III, even if it has previously declined to conduct a disciplinary proceeding. The Board keeps the information gathered during an investigation on file in the event that further information is received for review.
  • The MRSC might recommend a Letter of Concern (LOC) which is a non-disciplinary confidential letter to the physician warning him/her that his actions in that case are questionable, and he/she needs to modify those practices which led to the problem. An LOC is non-public and does not require a hearing before the Board can issue it. (New Hampshire Revised Statutes Annotated 329:17,VII-a). The LOC is not reported to the National Practitioners Data Bank, and its issuance is not disclosed to the complainant.
  • The MRSC might recommend a hearing for discipline (explained in next faq)

back to topWhat happens after the Medical Review Subcommittee makes its recommendation?

  • That recommendation is considered by the Board at its next regularly scheduled meeting.
  • Prior to each Board meeting, the Board receives a packet of information, including a stack of Reports of Investigations. Each Board member is charged with reading each ROI, which includes the summary of the case from the MRSC, along with the complaint, suit or claim and the response letter from the physician/ licensee. Thus, a timely response letter from the physician or physician assistant against whom the complaint or suit is brought is crucial, in that the entire Board reads this information.
  • The Board then decides by majority vote on a course of action.

back to topWhat is the range of Actions which the Board might take?

The Board may decide:

  • That the complaint is unfounded or frivolous, in which case no action is taken. Examples are when the complaint does not fall within the jurisdiction of the Board or does not relate to the actions of the licensee.
  • That no further action is necessary, which means the allegations presently based on information received do not rise to the level that warrants further disciplinary proceeding, remedial action, or Board intervention.
  • That a confidential Letter of Concern be issued to the licensee. As described above, an LOC is non-disciplinary and confidential. The Board uses it when there is insufficient evidence to support disciplinary action but where the Board believes that a continuation of the activities which led to the information being submitted to the Board may result in Board disciplinary action. A LOC is not reported to the Data Bank, requires no public hearing, and its issuance is not divulged to the patient or complainant. An LOC is a warning from the Board to the licensee that the physician or physician assistant needs to look carefully at his/her practice and modify or eliminate certain practices to avoid another similar problem or complaint.
  • That because of the allegations of professional misconduct or of violations of the Board's statutes, rules or the AMA Code of Ethics, a public disciplinary hearing or settlement is necessary.

back to topWhat does a Public Disciplinary Hearing or Settlement mean and what is involved?

  • The Board votes to initiate an adjudicatory proceeding if it believes, based on the MRSC Report of Investigation, that professional misconduct or a violation of the Board's statutes, rules or the AMA code of Ethics may have occurred. Pursuant to this vote, the Board's Hearing Counsel will present a draft Notice of Hearing to the Board. The Board then votes on issuing the draft Notice of Hearing. At that point the matter becomes public.
  • At the Board's meeting, on the dates specified in the Notice of Hearing, a hearing is held to determine facts of the case. There are usually two sides to the hearing: the Board's Hearing Counsel presents evidence and witnesses to prove the charges; the licensee may present evidence and witnesses to disprove them. It is a fair hearing: the licensee has notice of the charges against which he/she is defending, the licensee has the opportunity to respond, present evidence, cross-examine witnesses and submit arguments before the Board.
  • After a hearing, the Board deliberates in non-public session. The Board's decision does not become final or public until it is reduced to writing and served upon the parties. The Board may find that Hearing Counsel has not proved its case by a preponderance of the evidence or the Board may make an affirmative finding that the licensee has committed unprofessional conduct or a violation of its statutes, rules or the AMA Code of Ethics. If the Board finds the latter, it may impose disciplinary action. Disciplinary action may be anything listed in RSA 329:17,VII, including the following: a reprimand, a fine, a suspension of license, a revocation, a requirement for remedial education, or any combination of the above.
  • If the physician wishes to avoid a public hearing and settle the complaint, he/she may sign a settlement agreement that is negotiated with the Board's Hearing Counsel and may include any of the items listed in RSA 329:17,VII. This settlement agreement is then presented to the Board to accept or reject. If the Board accepts it, the settlement agreement becomes public.

Do I have the right to legal counsel at any point in this process?

Yes. You may retain legal counsel from the very beginning, when the MRSC is gathering facts before making a recommendation. Or, you may involve your lawyer later in the process. Any party in an adjudicatory proceeding may be represented by counsel, but an attorney appearing on behalf of a party shall first file a letter announcing the fact of representation at the earliest date practical. Parties shall retain counsel at their own expense and requests for appointment of counsel shall not be entertained.

back to topWhat is reported to the Data Bank?

A disciplinary action resulting from either a public hearing or a settlement is reported to the National Practitioners Data Bank, which is a federal entity which the Board is mandated to report to by law. The Division of Practitioner Data Banks (DPDB) is responsible for the implementation of the National Practitioner Data Bank (NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB). The NPDB and HIPDB are alert or flagging systems intended to facilitate a comprehensive review of the professional credentials of health care practitioners, providers, and suppliers.

back to topWhat is made public?

A disciplinary action resulting from either a public hearing or a settlement is posted on the Board of Medicine website, is available from the Board of Medicine, and is posted in the Board's newsletter. As a state agency, unless otherwise protected by law, all the Board's actions are public under the Right-to-Know Law, RSA chapter 91-A. The proceedings, records, findings and deliberations of the MRSC, including all ROIs, are exempt from public disclosure. Certain information provided to the Board is also exempt from the public disclosure provision, except to the extent such information is the subject of a public disciplinary hearing. Accordingly, application denials, modifications, and settlement agreements are all public records.

back to topIs a Confidential Letter of Concern (LOC) truly confidential?

Yes. Only you and the Board know of the confidential LOC. Even the complainant (patient, family member, etc.) is told only that the Board has investigated the complaint and that investigation did not result in formal disciplinary action against the doctor; and that the complaint will remain in the doctor's file and may be re-reviewed in the future for a pattern of conduct. However, the Board takes no position on whether you must report receipt of this letter to any other health licensing agencies in this state or in any other jurisdictions (e.g. in any other state you have a license).

back to topIs a Confidential Letter of Concern reported to the Data Bank?

No

back to topHow can I defend myself against a complaint?

Upon receipt of a complaint, the Board's investigator forwards the complaint to the licensee for a response. Within the timeframe indicated in the investigator's letter and the Board's administrative rules, the licensee must respond to the complaint. A defense starts with a thorough and organized letter to the MRSC explaining the circumstances which led to the complaint, claim or lawsuit and all mitigating and exculpatory factors. Referencing specific portions of relevant medical records are helpful.

back to topCan I appeal a decision of the Board?

  • A Letter of Concern cannot be appealed. However, the Board will consider retracting a LOC only upon a licensee's showing of clear and convincing evidence.
  • Disciplinary action imposed pursuant to the Board approving a proposed settlement agreement may not be appealed as it is presented to the Board only after it is signed by the licensee.
  • Disciplinary action resulting from a public hearing may be appealed directly to the New Hampshire Supreme Court.

back to topIf a complaint is made against me, but there is no action, no discipline, and not even a letter of concern, does this complaint stay on my record?

  • If the complaint is determined by a Board vote to be unfounded pursuant to law (New Hampshire Revised Statutes Annotated 329:17,XIII), the Board may destroy all information collected during the investigation after three years. The Board will retain a record only that an investigation was conducted, and the Board determined the complaint to be unfounded.
  • If the complaint is legitimate, but the Board deemed that no further action was necessary (i.e., the Board had voted to take No Further Action or issue a Letter of Concern), then the information and the Report of Investigation are kept indefinitely by the Board and may be reviewed and used at a later date if further complaints are received.

back to topWhat Actions are taken by the Board, and what is the statistical breakdown?

July 1, 2014 through June 30, 2015 (Fiscal Year 2015)

A total of 446 consumer (patient) complaints, notice of malpractice suits, reservable claim reports from insurance companies and/or complaints from other sources were opened between July 1, 2014 and June 30, 2015.

A total of 436 consumer (patient) complaints, notice of malpractice suits, reservable claim reports from insurance companies and/or complaints from other sources were closed between July 1, 2014 and June 30, 2015. Of those total matters closed, 33 were unfounded pursuant to RSA 329:17,XIII, which deems a complaint is unfounded if it does not fall within the jurisdiction of the Board, does not relate to the actions of the licensee, or is determined by the Board to be frivolous; 156 were voted on by the Board for no further action; 57 confidential Letters of Concern were issued, pursuant to RSA 329:17,VII-a. These confidential Letters of Concern advise the licensee that while there is insufficient evidence to support disciplinary action, the Board believes the physician should modify or eliminate certain practices, and that continuation of the activities which led to the information being submitted to the Board may result in action against the licensee's license. 117 confidential Letters of Concern were issued, pursuant to RSA 329:17,VII-a and RSA 329:16-f,I. These confidential Letters of Concern advise the licensee that any change in business or home address shall be reported to the Board no later than 30 days from the date of the change. 37 confidential Letters of Concern were issued, pursuant to RSA 329:17,VII-a and RSA 329:16-f,II. These confidential Letters of Concern advise the licensee that they shall provide the Board with a copy of any notice of complaint, action for medical injury, or claim received from or disciplinary action taken in a jurisdiction outside of this state within 30 days of receipt of such notice or action. The Letters of Concern are not released to the public or any other licensing authority, except that the letters may be used as evidence in subsequent disciplinary proceedings by the Board. Also during this time frame, the Board imposed disciplinary action in 17 matters: nine Settlement Agreements for professional misconduct, one Voluntary Surrender of License, one denial of application for licensure, three Preliminary Agreements for Practice Restrictions, two suspension of licenses, and one order issued pursuant to a Disciplinary Hearing.

July 1, 2015 through June 30, 2016 (Fiscal Year 2016)

A total of 441 consumer (patient) complaints, notice of malpractice suits, reservable claim reports from insurance companies and/or complaints from other sources were opened between July 1, 2015 and June 30, 2016.
A total of 490 consumer (patient) complaints, notice of malpractice suits, reservable claim reports from insurance companies and/or complaints from other sources were closed between July 1, 2015 and June 30, 2016. Of those total matters closed, 24 were unfounded pursuant to RSA 329:17,XIII, which deems a complaint is unfounded if it does not fall within the jurisdiction of the Board, does not relate to the actions of the licensee, or is determined by the Board to be frivolous; 201 were voted on by the Board for no further action; 60 confidential Letters of Concern were issued, pursuant to RSA 329:17,VII-a. These confidential Letters of Concern advise the licensee that while there is insufficient evidence to support disciplinary action, the Board believes the physician should modify or eliminate certain practices, and that continuation of the activities which led to the information being submitted to the Board may result in action against the licensee's license. 99 confidential Letters of Concern were issued, pursuant to RSA 329:17,VII-a and RSA 329:16-f,I.

back to topCan I prescribe medications for myself or my family?

The AMA Code of Ethics states that a physician should not under ordinary circumstances prescribe medications for himself or a family member. Exceptions are made for emergencies. For more information, see the AMA Code of Medical Ethics, Opinion on Practice Matters 8.19.

back to topWhere can I View the AMA Code of Ethics?

The AMA Code of Ethics can be viewed on the AMA website.

How can I properly manage chronic pain patients who are on narcotic analgesics?

The Board has a policy statement on the management of chronic pain patients, which includes the elements of an established physician-patient relationship, appropriate follow-up appointments, use of consultants, use of a pain contract, and urine testing. This policy statement can be found on the Board's website. The Board recommends the following book: "Responsible Opioid Prescribing" by Scott M. Fishman, M.D., published by Waterford Life Sciences, Washington, D.C., under the auspices of the Federation of State Medical Boards.

back to topMust a hospital report to the Board a disciplinary action relating to a physician?

New Hampshire law (RSA 329:17,IV), requires every hospital, surgicenter or other health care facility to report to the Board any disciplinary or adverse action taken against a physician, including situations in which allegations of misconduct are settled by voluntary resignation without adverse action.

back to topWhat is New Hampshire law and Board policy regarding a "Disruptive Physician"?

New Hampshire law (RSA 329:13-b,II) defines disruptive behavior as "abusive conduct, including sexual or other forms of harassment, or other forms of verbal or non-verbal conduct that harms or intimidates others to the extent that quality of care of patient safety could be compromised." The reporting requirements of a hospital or other health care facility include instances in which a physician is required to undergo counseling or be subject to any policy with regard to disruptive behavior.

back to topWhat is the Board's position on a physician having a sexual relationship with a patient?

The Code of Medical Ethics of the American Medical Association (2008-2009 Edition) states that, "Sexual contact that occurs concurrent with the patient-physician relationship constitutes sexual misconduct. Sexual or romantic interactions between physicians and patients detract from the goals of the physician-patient relationship, may exploit the vulnerability of the patient, may obscure the physician's objective judgment concerning the patient's healthcare, and ultimately may be detrimental to the patient's well being." In addition, New Hampshire Statues Criminal Code (632-A:2,I(g) states: "A person is guilty of the felony of aggravated felonious sexual assault if such person engages in sexual penetration with another person under any of the following circumstances: When the actor provides therapy, medical treatment or examination of the victim and in the course of that therapeutic or treating relationship or within one year of termination of that therapeutic or treating relationship."

back to topWhat is the Board's policy regarding retained sponge, needle or instruments despite normal counts by the surgical team?

Recently there have been several cases in which sponges, needles or instruments have been left in patients, leading to significant or potential postoperative morbidity.

Routinely, the Operating Room team does sponge, needle and instrument counts at the end of the case to ascertain that nothing is left behind. It is still the surgeon's responsibility and not entirely the nurses' responsibility for retained foreign materials even if the counts at the end of the case are correct. There are clearly types of cases where there is a higher probability of retaining foreign materials at the time of surgery, even after the assurance of a normal sponge count.

The risk of retained foreign material after surgery significantly increases in emergency cases, cases with unplanned changes in procedure, and/or cases with high blood mass index. Indeed, in those cases where foreign materials were left behind and there was a sponge, needle and instrument count, 88% of the time the sponge, needle and instrument count is listed as being correct.

There is an excellent special review article in the New England Journal of Medicine, January 16, 2003.

back to topWhat happens if I'm late renewing my license and what is the process of license renewal?

  • The Board sends out renewal applications on or before March 1 of each licensee's renewal year which are due by June 30th.
  • The renewal applications must be filled out completely and the completed renewal must be either in the hands of the Board or postmarked by June 30th of the year in which your license renewal is set to occur.
  • The renewal application is not considered complete until all Continuing Medical Education ("CME") requirements are fulfilled. The NH Medical Society ("NHMS") handles CME reporting. The NHMS sends the Board a list of all physicians who have not completed their CME requirements. If you are on this list (i.e., delinquent in fulfilling CME requirements) but you file a completed renewal application, your application is considered incomplete. The application will be returned to you unprocessed. If your CME is incomplete, you will not be renewed.
  • If you have not renewed by June 30 of the year in which your renewal is set to occur, you cannot lawfully practice medicine in New Hampshire and your license is expired.
  • There is typically a rush of applications in the last week of June, which the Board cannot possibly process. However, if the renewal application, including up-to-date CME, is in the Board's hands or postmarked by June 30 of the year in which your license renewal is set to occur, you may practice lawfully while the application is being processed. However, the implications here are obvious: if the application is received June 30, but found on July 1 or later to be incomplete, you will be considered to have an expired license. If you have been practicing on July 1 and later, you will have been practicing without a license. One Board member who runs a NH hospital requires his physicians to renew in plenty of time to present a current license card well before June 30 for exactly this reason.
  • The "90 day extension" in the Board's rules do not allow a physician to practice lawfully after June 30 of the year in which the licensee's renewal is set to occur if the license renewal is incomplete. It does allow the physician to complete the renewal process by filling out the same application and paying double the renewal fee. After 90 days, the physician must fill out a reinstatement application, which includes references, a criminal background check, and multiple other requirements.
  • Please be sure to have your completed renewal application in the Board's office well before June 30 of the year in which your license renewal is set to occur so as not to risk practicing medicine without a license in New Hampshire.

Can I be disciplined for prescribing, administering, or dispensing long-term antibiotic therapy for a patient clinically diagnosed with Lyme disease?back to top

Pursuant to Chapter Law 157, “No licensee may be subject to disciplinary action solely for prescribing, administering, or dispensing long-term antibiotic therapy for a patient clinically diagnosed with Lyme disease, if diagnosis and treatment has been documented and monitored in the physician’s medical record for that patient."

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Office of Professional Licensure and Certification
121 South Fruit Street |  Concord, NH 03301
Main Telephone: (603) 271-2152