The Complaint, the Altered Chart, and the Colleague Who Smells of Alcohol
A 54-year-old patient files a written complaint with the Board alleging that Dr. P billed her insurer for 24 visits when she attended only 9, and that he used a TENS unit on her low back without explaining it. Two weeks later, after receiving the Board’s notice, Dr. P adds late entries to the patient’s chart describing the TENS treatments as “discussed and consented” and changes two visit dates. He then calls the patient and offers a $600 refund if she will withdraw the complaint. When the investigator requests the complete record, Dr. P sends only the progress notes and omits the billing ledger and the original appointment schedule. He tells the investigator the missing items are “not clinical.” During the same interview, Dr. P mentions that another local chiropractor, Dr. Q, smells of alcohol during afternoon treatments and has asked Dr. P to “keep it quiet.” Dr. P asks the investigator not to reveal the source.
1. Evaluate Dr. P’s handling of the complaint and the record request. What violations are presented?
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A Board complaint triggers an investigation; the licensee must cooperate and must not alter records. Dr. P’s late entries and changed dates are record falsification, even if the underlying care was appropriate. The original record must be preserved; corrections should be dated, signed addenda, not retroactive rewrites. Offering a refund conditioned on withdrawal of a complaint can be construed as interference with the disciplinary process. Sending a partial record after a request for the complete record is noncooperation and may itself be a ground for discipline.
The billing discrepancy may support a charge of fraud, misrepresentation, or incompetence. The record alteration supports a charge of dishonesty. Due process requires notice and a hearing, but the Board may impose interim restrictions if patient safety is at risk. Dr. P should immediately stop contacting the patient, preserve all records, and provide a complete, authenticated copy through counsel.
2. What sanctions and aggravating or mitigating factors would the Board likely consider?
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Relevant grounds include fraud or misrepresentation in billing, failure to keep adequate records, dishonesty, and failure to cooperate with the Board. Sanctions are graduated and proportional: reprimand, fine, continuing education, probation, suspension, revocation, and conditions on practice.
Aggravating factors are strong here: alteration after notice of the complaint, direct contact with the complainant, and partial production of records. Mitigating factors might include a refund offer, absence of patient harm, and a long unblemished history-but those do not erase the record integrity problem. The Board may also refer the billing issue for insurance-fraud or criminal review. A licensee who self-corrects early and cooperates often faces lesser discipline than one who continues to conceal.
3. Does Dr. P have a duty to report Dr. Q, and how should he handle the request for confidentiality?
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Delaware imposes a mandatory duty on licensees to report certain conduct-impairment, sexual misconduct, or serious violations-to the Board. Dr. P’s personal observation of alcohol odor and impaired afternoon practice is reportable. “Keeping it quiet” is not an option; confidentiality protects patient information, not a colleague’s impairment.
Dr. P should make a prompt written report to the Board, including dates, observed behavior, and any patient-safety risk, and should not investigate the matter himself. Retaliation against Dr. Q or the patient is prohibited. The investigator should not promise to keep the source secret; the Board can handle source confidentiality within its process, but the duty to report is independent. Dr. P’s own misconduct does not excuse him from reporting Dr. Q, and his report may be considered separately from the sanctions for his record alteration.