Code of Ethics, Record Keeping, and Disciplinary Sanctions
Records
Every visit should generate a contemporaneous note: history, examination findings, diagnosis, treatment plan, informed consent, the adjustment delivered, and the patient's response. Notes must be legible, dated, and authenticated. Maryland's Confidentiality of Medical Records Act (Health-General Article Title 4, Subtitle 3) governs release; HIPAA sets a floor, and stricter Maryland rules control. Records go out on the patient's written authorization, within the statutory time frame, for a copying fee limited by law -- never conditioned on payment of an outstanding balance. Retain records for the period the Board requires, and never alter them after a complaint; a late "clarification" reads as spoliation.
Ethics
Informed consent, honest advertising, no abandonment (give notice, offer transition, supply records), clear professional boundaries, no fee-splitting, and reporting impaired colleagues.
Discipline
Grounds include fraud in obtaining a license, incompetence or gross negligence, unprofessional conduct, substance abuse, criminal conviction, and violating COMAR. Process: complaint, investigation, charges, contested case hearing at the Office of Administrative Hearings, Board decision, and judicial review. Sanctions range from reprimand and CE orders through probation, suspension, revocation, and civil penalties, plus costs.
Worked example
A patient with an unpaid balance requests records. The front desk refuses until payment. Wrong: the statute does not create a lien on records. Release on authorization, charge only the permitted copying fee, and pursue the debt separately.
Traps
- Assuming HIPAA preempts stricter Maryland confidentiality law.
- Withholding records as leverage for payment.
- Editing notes after a complaint is filed.
- Thinking a civil settlement ends the Board's interest -- it does not.