Filing a Complaint

The investigation timeline can vary anywhere from three months to one year based on the volume of complaints received and complexity of the particular investigation. Every case investigated must go before the full Board for review and decision.

In most cases, unless the Board has initiated the complaint to protect an identity of a person(s), then the licensee will not know who filed the initial complaint with the Board.  Complaints are confidential pursuant to statute.  However, in most cases, the licensees are provided with an opportunity to respond to complaints made against them.

The Board is responsible for implementing the Medical Practice Act, which is very specific about what a licensee can be disciplined for. The Board may find that your case does not rise to the level of a violation of the law, and simply close the case. If the Board is concerned about the conduct or competency of a licensee, but it does not rise to the level of a violation, they may issue an advisory letter. If there is evidence of a violation of the law, the Board may take action against the physician’s license, which can range from a reprimand for minor violations, to assessing a fine, imposing terms, conditions and/or restrictions, suspending the license, or even revoking a license. Even if your case does not rise to the level of a violation of the law, the Board tracks patterns of conduct for use in any future case they may bring against that licensee for similar conduct.

Yes. The fact that there has been a complaint suggests that the physician-patient relationship may no longer be viable. However, the Physician must follow the AMA Code of Medical Ethics recommendation for discharging a patient from the practice.

Although the Board maintains a record of all complaints filed, complaint records are confidential. See NMSA 1978, § 61-6-34(B). However, any licensure action the Board has taken against a Physician is public information and may be found on our website under the licensee’s profile.

No. The investigation of billing disputes, costs of services, and referrals by doctors of patients to collection agencies is not within the jurisdiction of the Board. The Board may investigate its licensees who are obtaining a fee by fraud or misrepresentation or employing abusive billing practices.

No. The Board does not investigate medical malpractice cases.  The Board only investigates cases of gross negligence, repeated negligent acts, and incompetency. The Board can only impose disciplinary measures against a practitioner’s license if there is a violation of the Medical Practice Act, Board Regulations, or Rules of Professional Conduct.

Medical records are in the “custody” of the Physician or the Hospital or the Clinic providing service. A patient does not “own” the record, either. Medical records are confidential material, and are protected under strict laws, including HIPAA (Health Insurance Portability and Accountability Act). A patient may request a copy of the record and must sign a release, either to have a copy of that record, or to have that copy sent to another Physician or facility. Special releases may be required for psychotherapy notes and may be withheld from the patient. Drug and alcohol, and HIV/AIDS records also require special releases. According to the NMMB Rule 16.10.17.8, medical records may not be withheld because an account is overdue or a bill for treatment or other services is owed. Also, medical records may not be withheld awaiting payment for the cost of copying the medical records. A reasonable cost-based charge may be made for the cost of duplicating and mailing medical records. A reasonable charge is not more than $30.00 for the first 15 pages, and $0.25 per page thereafter. The records must be provided in a ‘timely manner.’ The Board considers 2 weeks a ‘timely manner’ to provide records unless stored in an offsite location and/or volume of records to be copied. Providing records should not take more than 30 days as continuity of patient care is paramount.

The Medical Board does not license by specialty – physicians are permitted to practice within their own scope of practice, which is defined by their education, training and experience. The Board would only become involved if there were an instance where a physician was practicing in an area in which he or she has no appropriate training, and that would be determined on a case-by-case basis.

HIPAA is a federal law that guarantees the privacy of patient medical information by establishing rules for how that information can be collected, stored and transmitted. It also establishes the circumstances under which a physician does, and does not, need the patient’s permission to release information and guarantees patients the right to access their own medical records. For information about HIPAA, go to their website: www.hhs.gov/ocr/hipaa Complaints about HIPAA violations should be directed to the US Department of Health and Human Services Office of Civil Rights: Region VI – AR, LA, NM, OK, TX Office for Civil Rights U.S. Department of Health & Human Services 1301 Young Street – Suite 1169 Dallas, TX 75202 (214) 767-4056; (214) 767-8940 (TDD) (214) 767-0432 FAX