Complaint Department Complaints, Malpractice Reports & Medical Examiner Cases

1. Complaint Department Complaints, Malpractice Reports & Medical Examiner Cases JUDIE CLARK Director

2. Complaint Department Staff • Sherry Hyder, Complaint Summary Coordinator • Amy Ingram, Complaint Coordinator • Carol Puryear, Malpractice/ME Coordinator

3. Our Mission Statement Fair complaint resolution as a service to the public and medical professionals

4. What we do…. • Talk, talk, talk, listen, listen, listen(to educate the public and licensees) • Process written complaints • Process malpractice payment reports • Process medical examiner reports • Verify Licensee Information Page related to all malpractice payments (new addition!!!)

5. A Day in the “Life of Complaints” • We average 45-60 complaint calls per day • Complaints can be filed by requesting a complaint form or filed via the web site • All complaints are reviewed upon receipt and handled as “paper investigations” or referred to Investigations for “field investigations” • Complaints are mailed to licensee for their review and a written explanation to the Board.

7. Malpractice Info • Payment reports are provided by the insurance company as per statute • Licensee also provides payment information via renewal or licensee information update • Explanation of settlement is required from licensee and requested from plaintiff’s attorney

9. Medical Examiner Reports • Reports are provided to the Board from the Office of the Chief Medical Examiner when there is a suspicion that the death could be related to a NC licensee. We receive about 25 reports per year. • Obtain medical records from hospital to determine appropriate licensee to respond • Explanation requested from licensee regarding their involvement in the care/death of the patient

10. The Review Process • The review process averages 6 months • When the response/records are received, the Office of Medical Director (OMD) reviews the complaints, Malp and ME reports and makes a recommendation to the Senior Staff. • Senior Staff (SS) meets two to three times per month to review all cases.

11. The Review Process (continued) • AAI complaints are closed at the Senior Staff level (average 65 per month) • Complaints with recommendations of a PLOC are reported to the Review Committee • Complaints with recommendations of II, PubLOC, Charges, etc. are reported to the Disciplinary Committee • All Malp & ME cases are reported to the Disciplinary Committee

12. Recent Statutory Changes • Licensees are required to report malpractice payments to the Board within 60 days of settlement • The Board is required to complete the initial review process within 6 months or provide written explanation to licensee

13. Past Statutory Changes • Complainants may be provided a copy of the physician’s response to their complaint. Copies are provided based on established criteria. • Complainants are now informed when the licensee receives a private letter of concern.

14. Annual Processes • Query NPDB (National Practitioner Data Bank) and cross reference malpractice payments with our database. Follow-up with licensee when applicable • Write insurance companies and remind them of reporting requirements

15. Questions