Investigations & Misconduct
The Board investigates complaints against licensees and (Q)ACSC holders, determines if there are grounds for discipline, and may bring charges against the license or (Q)ACSC.
Conduct of Investigations
- All written complaints are reviewed and, to the extent necessary, investigates each.
- Most complaints are from patients. Except for extremely unusual circumstances, all complaints for investigation must be in written form.
- When received, a complaint is assigned to one of the Board’s experienced law enforcement investigators, all of whom have been trained in medical investigations.
- The complainant is contacted, and, on occasion, an explanation from the investigator satisfies the complainant and the case is closed.
- The complaint is provided to the named physician(s), a written response is provided, collateral materials from hospitals, pharmacies, etc., are obtained, and the information is provided to the Board.
- The Board may decide that the issue was a misunderstanding or an unfortunate, but recognizable, event that did not compromise patient safety. In this case, the physician is notified in writing that no basis for action was found and the case was closed.
- The Board may decide that there was some degree of medical practice below the desired level, but which did not affect the patient’s safety. In this case, it may notify the physician through a confidential Letter of Concern that there may be areas of the physician’s practice that need attention.
- If the level of the incident is more severe or if there is a pattern of practice that could lead to further problems, the Board may confidentially order remedial education by attendance at a specific post-graduate course.
- If there is conduct that the Board believes is dangerous to public safety, it may file formal allegations with the Commission and request restrictions, revocation or other action against the physician’s license. Depending upon the urgency of the situation, the Board can request a summary suspension of the physician’s license until the case can be heard.
- The patient and physician are notified of the final disposition of the matter.
Please see Ala. Code § 34-24-360 for full text of the law.
The Commission has the power and duty to suspend, revoke, or restrict any license to practice medicine or osteopathy in the State of Alabama or place on probation or fine any licensee whenever the licensee shall be found guilty on the basis of substantial evidence of any of the following acts or offenses:
(1) Fraud in applying for or procuring a certificate of qualification to practice medicine or osteopathy or a license to practice medicine or osteopathy in the State of Alabama.
(2) Unprofessional conduct as defined herein or in the rules and regulations promulgated by the commission.
(3) Practicing medicine or osteopathy in such a manner as to endanger the health of the patients of the practitioner.
(4) Conviction of a felony.
(5) Conviction of any crime or offense which reflects the inability of the practitioner to practice medicine or osteopathy with due regard for the health or safety of his or her patients.
(6) Conviction for any violation of a federal or state law relating to controlled substances.
(7) Use of any untruthful or deceptive or improbable statements concerning the licensee's qualifications or the effects or results of his or her proposed treatment.
(8) Distribution by prescribing, dispensing, furnishing, or supplying of controlled substances to any person or patient for any reason other than a legitimate medical purpose.
(9) Gross malpractice or repeated malpractice or gross negligence in the practice of medicine or osteopathy.
(10) Division of fees or agreement to split or divide the fees received for professional services with any person for bringing or referring a patient.
(11) Performance of unnecessary diagnostic tests or medical or surgical services.
(12) Charging fees determined by the commission to be grossly excessive or intentionally filing or causing to be filed false or fraudulent claims, as defined by the commission, for medical or surgical services to any private or government third party payor having a legal or contractual obligation to pay such claims on behalf of a patient.
(13) Aiding or abetting the practice of medicine by any person not licensed by the commission.
(14) Conviction of fraud in filing Medicare or Medicaid claims or conviction of fraud in filing claims to any third party payor.
(15) Any disciplinary action taken by another state against a licensee to practice medicine or osteopathy, based upon acts by the licensee similar to acts described in this section.
(16) Refusal to appear before the State Board of Medical Examiners after having been formally requested to do so in writing by the executive director of the board.
(17) Making any fraudulent or untrue statement to the commission or to the State Board of Medical Examiners.
(18) The termination, revocation, probation, restriction, denial, failure to renew, suspension, reduction, or resignation of staff privileges of a licensee by a hospital in this or any other state when such action is related to negligence or incompetence in the practice of medicine, moral turpitude, sexual misconduct, abusive or disruptive behavior, or drug or alcohol abuse.
(19)a. Being unable to practice medicine or osteopathy with reasonable skill and safety to patients by reason of illness, inebriation, excessive use of drugs, narcotics, alcohol, chemicals, or any other substance, or as a result of any mental or physical condition.
(20)a. Being unable to practice medicine or osteopathy with reasonable skill and safety to patients by reason of a demonstrated lack of basic medical knowledge or clinical competency.
(21) Excessive prescribing, dispensing, furnishing, or supplying of a Schedule II controlled substance.
(22) Failure to maintain for a patient a medical record which meets the minimum standards stated in the rules and regulations promulgated by the commission.
(23) Failure to comply with any rule of the Board of Medical Examiners or Medical Licensure Commission.
Alabama Controlled Substances Certificate (ACSC)
Please see Ala. Code § 20-2-54 for full text of the law.
An ACSC may be restricted, suspended, or revoked upon a finding that the physician:
(1) Has furnished false or fraudulent material information in any application filed under this article;
(2) Has been convicted of a crime under any state or federal law relating to any controlled substance;
(3) Has had his federal registration suspended or revoked to manufacture, distribute or dispense controlled substances;
(4) Has violated the provisions of Chapter 23 of Title 34; or
(5) Has, in the opinion of the certifying board, excessively dispensed controlled substances for any of his patients.
Physician Assistant License
Please see Ala. Code § 34-24-302 for full text of the law.
The Board may, within its discretion, deny the issuance of a license to any person or, after notice and hearing in accordance with board regulations, shall, within its discretion, suspend, revoke, restrict, or otherwise discipline the license of a person who shall be found guilty on the basis of substantial evidence of any of the following acts or offenses:
(1) Conviction of a felony.
(2) Conviction of any crime or other offense, felony, or misdemeanor, reflecting on the ability of the individual to render patient care in a safe manner.
(3) Conviction of any violation of state or federal laws relating to controlled substances.
(4) Termination, restriction, suspension, revocation, or curtailment of licensure, registration, or certification as an assistant to physician by another state or other licensing jurisdiction on grounds similar to those stated herein.
(5) The denial of a registration, a certification, or a license to practice as an assistant to physician by another state or other licensing jurisdiction.
(6) Being unable to render patient care with reasonable skill and safety by reason of illness, inebriation, addiction to, or excessive use of alcohol, narcotics, chemicals, drugs, or any other substance, or by reason of a mental or physical condition or disability.
(7) Revocation, termination, suspension, or restriction of hospital privileges.
(8) Knowingly submitting or causing to be submitted any false, fraudulent, deceptive, or misleading information to the board in connection with an application for licensure or registration as an assistant to physician.
(9) That the assistant to physician has represented himself or herself or permitted another to represent him or her as a physician.
(10) That the assistant to physician has performed otherwise than at the direction and under the supervision of a physician approved by the board.
(11) That the assistant to physician has been delegated or has performed or attempted to perform tasks and functions beyond his or her competence.
(12) That the assistant to physician has performed or attempted to perform tasks beyond those authorized in the approved job description.
(13) Practicing or permitting another to practice as an assistant to physician without the required license and registration from the board.
(14) Prescribing by an assistant to physician in violation of statutory authority or board rules or guidelines.
(15) Intentional falsification of a certification of compliance with the continuing medical education requirement for assistants to physicians established in the board rules.
Qualified Alabama Controlled Substances Certificate (QACSC) (PA/CRNP/CNM)
Pursuant to Ala. Code §§ 20-2-64 and 20-2-254, the Board may deny an application of a PA requesting a QACSC, deny a request for a renewal of a QACSC, or initiate disciplinary action against a PA possessing a QACSC based on the following grounds:
(1) Fraud or deceit in applying for, procuring, or attempting to procure a Qualified Alabama Controlled Substances Registration Certificate in the State of Alabama.
(2) Conviction of a crime under any state or federal law relating to any controlled substance.
(3) Conviction of a crime or offense which affects the ability of the assistant to physician to practice with due regard for the health or safety of his or her patients.
(4) Prescribing a drug or utilizing a Qualified Alabama Controlled Substances Registration Certificate in such a manner as to endanger the health of any person or patient of the assistant to physician or supervising physician.
(5) Suspension or revocation of the registration number issued to the assistant to physician by the United States Drug Enforcement Administration.
(6) Excessive dispensing or prescribing of any drug to any person or patient of the assistant to physician or supervising physician.
(7) Unfitness or incompetence due to the use of or dependence on alcohol, chemicals, or any mood-altering drug to such an extent as to render the assistant to physician unsafe or unreliable to prescribe drugs or to hold a Qualified Alabama Controlled Substances Registration Certificate.
(8) Any violation of a requirement set forth in this article or a rule adopted pursuant to this article.
Credentials Committee Interviews
In some investigations, the Board will invite the licensee/registrant to a confidential interview before the Credentials Committee. This is part of the investigative process and is not a formal hearing or public proceeding.
The licensee/registrant may have an attorney present but it is not required. Witnesses and documents are not presented as in a formal hearing. The licensee/registrant is not placed under oath, and a court reporter is not present. However, the Board records the interview for its records. The recording is privileged and confidential and may be made available to the licensee/registrant only in cases where formal disciplinary charges are filed.
When the Board determines that sufficient evidence exists to file public, formal charges, a charging document and notice of hearing are served on the licensee/registrant (Respondent”). If the Respondent is unable to attend on that date, a written request for a continuance should be submitted as soon as possible.
Hearings may also be held before the Board and Commission concerning petitions to modify previous orders and petitions to reinstate licenses/registrations.
A hearing is before the Board if the matter concerns an ACSC, QACSC, PA license/registration, or collaborative practice. Hearings concerning medical licenses are before the Commission.
A Respondent is not required to have an attorney present at the hearing. The Respondent has the opportunity to present documents and witnesses and to cross-examine witnesses. The hearing is held in compliance with the Alabama Administrative Procedures Act, Ala. Code §§ 41-2-1, et. seq.
All hearings conducted by the commission are closed. The record in such hearings, including witness testimony, exhibits, and pleadings, is confidential, is not public record, and is not available for court subpoena or for discovery proceedings.
In lieu of a hearing, Respondents may voluntarily surrender their license and/or ACSC. A voluntary surrender is considered a public disciplinary action.
If the Respondent wishes to discuss a possible consent order in lieu of an administrative hearing, the individual should contact the Board’s Office of the General Counsel. If the Respondent is represented by an attorney, the attorney should contact the Board and file a notice of appearance. To represent a Respondent in an administrative proceeding, the attorney must be licensed to practice law in Alabama or be admitted pro hac vice.
If an agreement is reached and a consent order is entered, then the hearing is canceled.
The legal standard of proof in considering whether to find a medical licensee or assistant to physician in violation of the laws governing their respective profession is “on the basis of substantial evidence.” (Ala. Code §§ 34-24-360 and 302)
After a hearing, the Board/Commission can take various actions ranging from dismissing the case, modifying a previous order, approving or denying an initial license application, placing a license/registration on probation, reprimanding the licensee/registrant, assessing an administrative fine, or suspend or revoke a license/registration.
Applicants who are denied a certificate of qualification to practice medicine may appeal the Board’s decision to the Commission. All other appeals of Board or Commission decisions are to the Alabama Court of Civil Appeals.
All administrative complaints, orders to show cause, notices of hearings, and statements of charges, and all amendments thereto, and all orders of the Commission which are dispositive of the issues raised thereby, are public record. Most actions by the Board or Commission are required to be reported to the National Practitioner Data Bank and to other state agencies. Final decisions are also published and available to the public at the Board/Commission website, and listed in the Board/Commission Medical Digest.
Board/Commission public actions are a permanent public record. The public can obtain a copy of public actions through the BME/MLC website Licensee Search or by request to the office.
Medical Licensure Commission Rule 545-X-4-.06 defines unprofessional conduct and provides examples:
Unprofessional conduct shall mean the Commission or omission of any act that is detrimental or harmful to the patient of the physician or detrimental or harmful to the health, safety, and welfare of the public, and which violates the high standards of honesty, diligence, prudence and ethical integrity demanded from physicians and osteopaths licensed to practice in the State of Alabama. Furthermore, without limiting the definition of unprofessional conduct in any manner, the Commission sets out the below as examples of unprofessional conduct:
(1) The refusal by a physician to comply, within a reasonable time, with a request from another physician for medical records or medical information when such request is accompanied by a properly executed authorization of the patient.
(2) Intentionally, knowingly or willfully causing or permitting a false or misleading representation of a material fact to be entered on any medical record of a patient.
(3) Intentionally, knowingly or willfully preparing, executing or permitting the preparation by another of a false or misleading report or statement concerning the medical condition or extent of disability of a patient.
(4) The prescribing, dispensing, administering, supplying or otherwise distributing of any Schedule II amphetamine and/or Schedule II amphetamine-like anorectic drug in violation of Code of Ala. 1975, §20-2-54, as amended in Action No. 83-890, Special Session, 1983.
(5) The failure to report to the Alabama State Board of Medical Examiners any final judgment rendered against such physician during the preceding year or any settlement in or out of court during the preceding year, resulting from a claim or action for damages for personal injuries caused by an error, omission or negligence in the performance of his professional services without consent as required by Code of Ala. 1975, §34-24-56.
(6) The refusal or failure by a physician to comply with an order entered by the Medical Licensure Commission or by the Board of Medical Examiners issued pursuant to Code of Ala. 1975, Section 34-24-360(19) or (20) or pursuant to Code of Ala 1975, Section 34-24-361(h).
(7) Intentionally or knowingly making a false, deceptive or misleading statement in any advertisement or commercial solicitation for professional services and/or intentionally or knowingly making a false, deceptive or misleading statement about another physician or group of physicians in any advertisement or commercial solicitation for professional services.
(8) Failure or refusal of a J-1 physician to comply with waiver service requirements stated in the J-1 Visa Waiver Affidavit and Agreement signed by a J-1 physician.
(9) Conduct which is immoral and which is willful, shameful, and which shows a moral indifference to the standards and opinions of the community.
(10) Conduct which is dishonorable and which shows a disposition to lie, cheat, or defraud.
(11) Failing or refusing to maintain adequate records on a patient or patients.
(12) Prescribing or dispensing a controlled substance to oneself or to one’s spouse, child, or parent, unless such prescribing or dispensing is necessitated by emergency or other exceptional circumstances.
(13) Signing a blank, undated or predated prescription form.
(14) Representing that a manifestly incurable disease or infirmity can be permanently cured, or that any disease, ailment or infirmity can be cured by a secret method, procedure, treatment, medicine or device, if such is not the fact.
(15) Refusing to divulge to the board or commission upon demand the means, method, procedure, modality of treatment, or medicine used in the treatment of a disease, injury, ailment or infirmity.
(16) Knowingly making any false or fraudulent statement, written or oral, in connection with the practice of medicine or osteopathy or in applying for privileges or renewing an application for privileges at a health care institution.
(17) Sexual misconduct in the practice of medicine as defined in Rule 545-X-4-.07.
(18) Representing or holding oneself out as a medical specialist when such is not the case.
(19) Failing to furnish information in a timely manner to the Board or Commission if requested by the Board or Commission.
(20) Failing to report to the board in a timely manner information required to be reported by Code of Ala. 1975, Section 34-24-361(b).
(21) Giving false testimony in any judicial or administrative proceeding.
(22) The violation of any rule promulgated by the Alabama Board of Medical Examiners or the Medical Licensure Commission pursuant to their rulemaking authority as set forth in the Alabama Administrative Procedures Act.
Policy on Cyber Harassment
It is the position of the Alabama State Board of Medical Examiners (“the Board”) that cyber harassment by a licensee constitutes unprofessional conduct.
The Board condemns all forms of harassment. The rising number of incidents of licensees using electronic means, including social media, texting, and email, to harass or intimidate another person requires acknowledgement by the Board.
The Board does not intend to review or regulate all online conduct by its licensees. However, any person who uses his or her status as a physician, physician assistant, or anesthesiology assistant, either express or implied, their professional network, or any information, knowledge, or instrumentality gained from his or her professional practice to harass or intimidate another person is guilty of professional misconduct.
Harassing or intimidating conduct includes, but is not limited to: doxing, mobbing, swatting, flaming, review bombing, cyberstalking, bullying, shaming, and dogpiling.
Such behavior violates the high standards of honesty, diligence, prudence, and ethical integrity demanded from physicians, physician assistants, and anesthesiology assistants licensed in the State of Alabama.
The relationship between a physician and patient is inherently imbalanced. A physician is in a position of power in relation to the patient, and the patient is in a position of vulnerability which is heightened in light of the patient’s trust in their physician.
When there is a violation of mutual trust through sexual misconduct, such behavior and actions can have a profound, enduring, and traumatic impact on the individual being exploited, their family, the public at large, and the medical profession as a whole.
The Board and Commission are committed to addressing sexual misconduct by physicians through sensible standards and expectations of professionalism, including preventive education, as well as through meaningful disciplinary action and law enforcement when required.
540-X-9-.08 Sexual Misconduct in the Practice of Medicine: A Joint Statement of Policy and Guidelines by the State Board of Medical Examiners and the Medical Licensure Commission of Alabama.
(1) The prohibition against sexual contact between a physician and a patient is well established and is embodied in the oath taken by physicians, the Hippocratic Oath. The prohibition is also clearly stated in the Code of Medical Ethics of the American Medical Association. The reason for this proscription is the awareness of the adverse effects of such conduct on patients. The report of the Council on Ethical and Judicial Affairs of the American Medical Association indicates that most researchers now agree that the effects of physician-patient sexual contact are almost always negative or damaging to the patient. Patients are often left feeling humiliated, mistreated, or exploited.
(2) Further, a patient has a right to trust and believe that a physician is dedicated solely to the patient’s best interests. Introduction of sexual behavior into the professional relationship violates this trust because the physician’s own personal interests compete with the interests of the patient. This violation of trust produces not only serious negative psychological consequences for the individual patient but also destroys the trust of the public in the profession.
(3) Sexual conduct with a patient occurs in many circumstances ranging from situations where a physician is unable to effectively manage the emotional aspects of the physician-patient relationship to consciously exploitative situations. Underlying most situations is a disparity of power and authority over a physically or emotionally vulnerable patient.
(4) The prohibition against sexual contact between a physician and a patient is not intended to inhibit the compassionate and caring aspects of a physician’s practice. Rather, the prohibition is aimed at behaviors that overstep the boundaries of the professional relationship. When boundaries are violated, the physician’s patient may become the physician’s victim. The physician is the one who must recognize and set the boundaries between the care and compassion appropriate to medical treatment and the emotional responses which may lead to sexual misconduct.
(5) The Board of Medical Examiners and the Medical Licensure Commission is each charged with responsibilities for protecting the public against unprofessional actions of physicians and osteopaths licensed to practice medicine in Alabama. Immoral, unprofessional or dishonorable conduct is a grounds for discipline the license of a physician or osteopath under the provisions of Code of Ala. 1975, §34-24-360(2). A physician’s sexual contact with a patient is a violation of this statute.
(6) The Board of Medical Examiners investigates allegations of sexual misconduct against physicians. The Medical Licensure Commission makes decisions following a hearing concerning disposition of formal complaints filed with it by the Board of Medical Examiners. It is the goal of each organization to ensure that the public is protected from future misconduct. In some cases, revocation of license is the only means by which the public can be protected. In other cases, the Board or the Commission may restrict and monitor the practice of a physician who has actively engaged in a rehabilitation program. Rehabilitation of a physician is a secondary goal that will be pursued if the Board and the Commission can be reasonably assured that the public is not at risk for a recurrence of the misconduct.
(7) The Board and the Commission remind physicians of their statutory duty to report sexual misconduct or any conduct which may constitute unprofessional conduct or which may indicate that a physician is unable to practice medicine with reasonable skill or safety to patients. It is the individual physician’s responsibility to maintain the boundaries of the professional relationship by avoiding and refraining from sexual contact with patients.
(8) Physicians should be alert to feelings of sexual attraction to a patient and may wish to discuss such feelings with a colleague. To maintain the boundaries of the professional relationship, a physician should transfer the care of a patient to whom the physician is attracted to another physician and should seek help in understanding and resolving feelings of sexual attraction without acting on them.
(9) Physicians must be alert to signs indicating that a patient may be encouraging a sexual relationship and must take all steps necessary to maintain the boundaries of the professional relationship including transferring the patient.
(10) Physicians must respect a patient’s dignity at all times and should provide appropriate gowns and private facilities for dressing, undressing and examination. In most situations, a physician should not be present in the room when a patient is dressing or undressing.
(11) A physician should have a chaperone present during the examination of any sensitive parts of the body for the protection of both the patient and the physician. A physician should refuse to examine sensitive parts of the patient’s body without a chaperon present if the physician believes the patient is sexualizing the examination.
(12) To minimize the misunderstandings and misperceptions between a physician and patient, the physician should explain the need for each of the various components of an examination and for all procedures and tests.
(13) Physicians should choose their words carefully so that their communications with a patient are clear, appropriate and professional.
(14) Physicians should seek out information and formal education in the area of sexual attraction to patients and sexual misconduct and should in turn educate other health care providers and students.
(15) Physicians should not discuss their intimate personal problems/lives with patients.
(16) Sexual Misconduct. Sexual contact with a patient is sexual misconduct and is unprofessional conduct within the meaning of Code of Ala. 1975, §34-24-360(2).
(17) Sexual Contact Defined. For purposes of §34-24-360(2), sexual contact between a physician and a patient includes, but is not limited to:
(a) Sexual behavior or involvement with a patient including verbal or physical behavior which:
1. May reasonably be interpreted as romantic involvement with a patient regardless whether such involvement occurs in the professional setting or outside of it;
2. May reasonably be interpreted as intended for the sexual arousal or gratification of the physician, the patient or both; or
3. May reasonably be interpreted by the patient as being sexual.
(b) Sexual behavior or involvement with a patient not actively receiving treatment from the physician, including verbal or physical behavior or involvement which meets any one or more of the criteria in Section 1 above and which:
1. Results from the use or exploitation of trust, knowledge, influence or emotions derived from the professional relationship;
2. Misuses privileged information or access to privileged information to meet the physician’s personal or sexual needs; or
3. Is an abuse or reasonably appears to be an abuse of authority or power.
(18) Diagnosis and Treatment. Verbal or physical behavior that is required for medically recognized diagnostic or treatment purposes when such behavior is performed in a manner that meets the standard of care appropriate to the diagnostic or treatment situation shall not be considered as prohibited sexual contact.
(19) Patient. The determination of when a person is a patient for purposes of this policy is made on a case by case basis with consideration given to the nature, extent and context of the professional relationship between the physician and the person. The fact that a person is not actively receiving treatment or professional services from a physician is not determinative of this issue. A person is presumed to remain a patient until the patient-physician relationship is terminated.
(20) Termination of Physician-Patient Relationship. Once a physician-patient relationship has been established, the physician has the burden of showing that the relationship no longer exists. The mere passage of time since the patient’s last visit to the physician is not solely determinative of the issue. Some of the factors considered by the Board in determining whether the physician-patient relationship has terminated include, but are not limited to the following: formal termination procedures; transfer of the patient’s care to another physician; the reasons for wanting to terminate the professional relationship; the length of time that has passed since the patient’s last visit to the physician; the length of the "professional relationship; the extent to which the patient has confided personal or private information to the physician; the nature of the patient’s medical problem; the degree of emotional dependence that the patient has on a physician...; the extent of the physician’s general knowledge about the patient".
(a) Some physician-patient relationships may never terminate because of the nature and extent of the relationship. These relationships may always raise concerns of sexual misconduct whenever there is sexual contact.
(b) Sexual contact between a physician and a former patient after termination of the physician-patient relationship may still constitute unprofessional conduct if the sexual contact is a result of "the exploitation of trust, knowledge, influence or emotions" derived from the professional relationship.
(21) Consent. A patient’s consent to initiation of or participation in sexual behavior or involvement with a physician does not change the nature of the conduct nor lift the statutory prohibition.
(22) Impairment. In some situations, a physician’s sexual contact with a patient may be the result of a mental condition that may render the physician unable to practice medicine with reasonable skill and safety to patients pursuant to §34-24-360(19).
(23) Discipline. Upon a finding that a physician has committed unprofessional conduct by engaging in sexual misconduct, the Commission will impose such discipline as the Commission deems necessary to protect the public. The sanctions available to the Commission are set forth in §34-24-361 and §34-24-381, and include restriction or limitation of the physician’s practice, revocation or suspension of the physician’s license, and administrative fines.
Federation of State Medical Boards Report and Recommendations of the Workgroup on Physician Sexual Misconduct
American Academy of Orthopaedic Surgeons’ Opinion on Sexual Misconduct in the Physician-Patient Relationship
American College of Obstetricians and Gynecologists’ Opinion on Sexual Misconduct
American Medical Association Code of Medical Ethics Opinions on Sexual Boundaries