By Leigh Page

When a complaint has been filed against a doctor at the state medical board, it can sometimes be the beginning of a long nightmare. Often, physicians initially aren't told much about the complaint, and even if they think the charges are overblown, they may plead guilty because they fear worse consequences if they insist on a full hearing. But doctors then end up with a black mark on their record, which can lead to more adverse actions.

It sounds like something out of The Trial, the novel by Franz Kafka, which begins this way: "Someone must have falsely accused Josef K., for he was arrested one morning, even though he had done nothing wrong." Josef K. is unable to find out the details of his case. He is never jailed, but having to wait for the decision to come down is punishment in itself—slowly wearing him down and making it hard to focus on work.

To be sure, there are distinct differences between Josef K.'s experience and what doctors go through with a complaint. Kafka's story, like an actual nightmare, gets increasingly surreal, and it ends in murder. A medical board action, on the other hand, follows a clearly laid-out set of rules.

And physicians who are prepared are then able to fight the situation, protect themselves, and take steps to make sure the situation turns out better than it potentially could have. Physicians can hire attorneys to help them at every step of the way, and the vast majority of complaints are dismissed with no action taken against them.

However, a small percentage of complaint investigations can get quite aggressive, according to attorneys who represent physicians in board cases. Over the course of the investigation, the allegation against the physician can completely change, and in some cases, the board can summarily remove the doctor's license without a hearing. The board's final decision has ripple effects, such as a permanent mark on their records, loss of hospital privileges, and potentially being dropped by health insurance carriers.

The attorneys say that bad investigations vary widely, depending on the state and even the individual board members who are involved. But the fact is that all boards have a great deal of potential power over physicians, and their actions can ruin careers. Boards can subpoena records, suspend licenses without a hearing, pressure doctors to sign self-incriminating settlement agreements, and withhold certain information at the hearing.