Tag: LARA Guidance

A Health Professional’s Guide to Navigating the Disciplinary Process: What to Expect If You Are Facing a Professional Licensing Investigation or Administrative Complaint

Health professionals are committed to caring for patients with expertise, compassion, and integrity. However, in the heavily regulated healthcare field, those professionals can sometimes find themselves navigating not just the medical challenges of their patients but licensing issues of their own as well. Licensing issues can arise unexpectedly, and, when they do, they can cause tremendous stress and uncertainty.

As an attorney with years of experience handling professional licensing matters for health professionals, I have witnessed firsthand how professional licensing investigations and Administrative Complaints can disrupt health professionals’ careers and their ability to provide patient care. Let’s explore how to navigate the disciplinary process in Michigan so that you can know what to expect if you are ever faced with a threat to your license.

Understanding the Disciplinary Process

In Michigan, the disciplinary process for the more than 400,000 licensed health professionals is overseen by the Department of Licensing and Regulatory Affairs (LARA) Bureau of Professional Licensing (BPL). This process is designed to uphold professional standards and protect public health while, at the same time, ensuring fair treatment for health professionals.

While each case is unique, there are some common themes in the types of actions or omissions that give rise to investigations and Administrative Complaints in the healthcare field. Being aware of these can help health professionals take steps to prevent potential issues that can lead to investigations and Administrative Complaints. Some of the most common themes involve allegations related to negligence, incompetence, professional misconduct, professional boundaries, lack of good moral character, controlled substances, substance use disorder, impairment, misdemeanor and/or felony criminal convictions, advertising, practice outside the scope of a license, documentation and recordkeeping, and Michigan Automated Prescription System (MAPS) reports.

The Initial Filing of a Complaint

Complaints can be filed by just about anyone: current or former patients, supervisors, subordinates, professional colleagues, and even the licensees themselves. These complaints are taken very seriously by the BPL and will be investigated. You may not even know that you are the subject of a complaint until you have been contacted by the BPL as part of its investigation.

The Investigation Phase

The BPL will conduct a thorough investigation once it has received a complaint and will assign one or more investigators (known as “Regulation Agents”) to the professional licensing investigation matter. It is frequently during the investigation phase that licensees first become aware that one or more allegations have been made against them. Unfortunately, many health professionals are unaware that they have the right to have the assistance of an attorney during the investigation phase. These unrepresented health professionals frequently make statements to the investigators without the guidance of an attorney, and I have seen instances where those statements have ultimately been used to provide the foundation for an Administrative Complaint to be filed against them.

At the conclusion of the investigation, an Investigation Report will be forwarded to the Disciplinary Subcommittee (DSC) of the board that governs that particular profession. If one or more violations of Michigan’s Public Health Code have been substantiated, an Administrative Complaint may be authorized. Thankfully, not all professional licensing investigations result in the filing of an Administrative Complaint, which is why having experienced legal representation behind you is so important during the investigation phase.

Responding to an Administrative Complaint

If the BPL issues an Administrative Complaint against you, you must respond in writing within 30 days from the date that you received the Administrative Complaint. Failure to respond in writing within 30 days will result in the Administrative Complaint being forwarded to the DSC for imposition of a sanction without any input from you.

You will be presented with 3 different options. You may (1) request a settlement, (2) request a compliance conference, or (3) request a formal administrative hearing on the merits of the Administrative Complaint.

It is important to prepare a timely and thoughtful response. This is a stage where legal representation can be critical. A well-prepared Answer to Administrative Complaint can isolate the disputed issues and mitigate the severity of the situation.

The Compliance Conference

If you request a compliance conference, you will have the opportunity to present mitigating information and your side of the story in an informal setting, and an attorney may prepare you for the compliance conference and represent you at the compliance conference. Following the compliance conference, a proposed Consent Order and Stipulation may be prepared to resolve the Administrative Complaint, and it may be revised during the negotiation process that sometimes follows the compliance conference. The Administrative Complaint may also be dismissed by the BPL. However, if the Administrative Complaint is not resolved with a Consent Order and Stipulation or dismissed altogether, the matter will proceed to a formal administrative hearing on the merits of the Administrative Complaint.

The Formal Administrative Hearing on the Merits of the Administrative Complaint

If you proceed to a formal administrative hearing on the merits of the Administrative Complaint, it is essential to understand what this entails. The hearing is similar to a bench trial in court with opening statements, closing arguments, the formal testimony of witnesses under oath, and the admission of exhibits. You will have an opportunity to testify and to share your side of the story in a formal setting. The hearing will be held before an Administrative Law Judge (ALJ), but the ALJ cannot make a decision at the hearing. Instead, the ALJ will issue a Proposal for Decision (PFD). Exceptions to the PFD may be filed by the parties, and the PFD is then forwarded to the DSC for its consideration. The DSC will then issue a Final Order.

A merits hearing may be the only way to obtain the result that you need to continue practicing your chosen profession. However, proceeding to a hearing is a decision that should not be made lightly, and careful preparation in collaboration with legal counsel, including the gathering  and analysis of evidence and the preparation of any witnesses, is key.

Summary Suspension

If it has been found that you pose an immediate threat to the public health, safety, or welfare, your Administrative Complaint may be accompanied by a separate document called an Order of Summary Suspension. If you receive an Order of Summary Suspension, you must stop practicing your health profession immediately and cannot practice again until the summary suspension has been dissolved.

There is more than one way to dissolve a summary suspension. If a Petition for Dissolution of Summary Suspension is filed, an emergency hearing will be scheduled before an administrative law judge (ALJ). If the ALJ determines that there is insufficient evidence that you pose an immediate threat to the public health, safety, or welfare that requires a continuation of the summary suspension, the ALJ is required to dissolve the summary suspension. A summary suspension can also be dissolved by a Consent Order and Stipulation at the conclusion of the Administrative Complaint resolution process or by a Final Order following a formal hearing on the merits of the Administrative Complaint.

Possible Outcomes and Sanctions

A disciplinary action may conclude with a complete dismissal of the Administrative Complaint against you. However, if one or more violations of the Public Health Code have been substantiated, sanctions must be imposed. License sanctions can vary widely depending on the severity of the Public Health Code violation and, pursuant to MCL 333.16226, may include reprimand, fine, probation, restitution, limitation, suspension, revocation, and even permanent revocation.

The Appeal Process

If you disagree with the Final Order, you may appeal it to the Michigan Court of Appeals. The appeal process is complex and requires a strategic approach. Consider the grounds for appeal carefully and consult with an experienced attorney to evaluate the feasibility and potential benefits of an appeal.

Preventative Measures and Best Practices

When it comes to protecting your professional licensing, an ounce of prevention is always worth more than a pound of cure. Adhering to ethical practices, engaging in continuous professional development, and staying informed about regulatory changes can help prevent complaints. A proactive approach to professional conduct is always your best defense.

Conclusion

Facing a professional licensing investigation or an Administrative Complaint can be a very stressful experience for any health professional, but understanding the process and having an experienced attorney by your side can make a significant difference.

This guide serves as a general summary and does not constitute legal guidance. Please contact us with any specific questions.

Attorney Robert J. AndretzFraser Trebilcock Shareholder Robert J. Andretz is an experienced professional licensing attorney with years of experience successfully defending doctors, nurses, and other licensed health professionals across the state of Michigan in professional licensing matters, including professional licensing investigations and Administrative Complaint matters. You can reach him at 517.377.0854 or randretz@fraserlawfirm.com.

Michigan COVID-19 Guidelines for Safely Running a Day Camp in the Summer of 2020

According to the American Camp Association, more than 14 million children attend summer camps across the country every year. Michigan has a long summer-camp tradition, with kids flocking to camp destinations throughout the state to swim, hike, and roast marshmallows around the campfire. Until recently, summer camp in Michigan was in doubt, another potential casualty of the COVID-19 crisis. However, with the case curve continuing to flatten, and more businesses across the state reopening, Governor Whitmer announced that summer day camps in Michigan would be allowed to open — subject to a number of health and safety guidelines.

Executive Order 2020-110, issued on June, 1, 2020, provides that day camps for children are allowed to operate as of June 8, 2020, subject to guidance issued by the Department of Licensing and Regulatory Affairs (“LARA”). On June 2, 2020, LARA issued its “Guidelines for Safe Day Camp Operations During COVID-19 (“LARA Guidance”),” which offers considerations and actions that camp operators must take before opening for the season. The various recommendations and requirements of the LARA Guidance are extensive and should be closely reviewed with legal counsel. What is clear is that it will not be carefree “camp-as-usual” in Michigan, but at least camps now have the guidance they need to get up and running for summer.

COVID-19 Preparedness and Response Plan

Like other businesses conducting in-person work in Michigan, camps must establish a COVID-19 preparedness and response plan. According to the LARA Guidance, a response plan must be available at your camp or camp headquarters, be made available to families and staff, and be part of a camp’s health service policy and meet applicable camp licensing rules.

A plan should include:

  • How a camp will monitor for symptoms of COVID-19
  • How a camp’s programs practice social distancing, as developmentally appropriate
  • How a camp will ensure hygiene (including regular cleaning and disinfecting)
  • How a camp will obtain and use safety equipment
  • Communication and training for staff, parents, and campers related to new
    expectations
  • Isolation procedures in the event of symptoms or confirmed cases onsite
  • How a camp will maintain required staff-to-camper ratios in the event of staff illness

While preparedness and response plans may be subject to review by a LARA licensing consultant, they do not need to be submitted to LARA for approval. LARA strongly recommends that camps (i) discuss plans with staff from the local health department so that all roles and responsibilities are clarified and updated contact information is included, and (ii) that the local health department be provided with a final version of a response plan.

Communication and Training

The LARA Guidance urges camps to engage in proactive communication and training of employees, including discussing any concerns staff members have about returning to work, and sharing steps being taken, including those outlined in a preparedness and response plan, to make camp as safe as possible.

Camps should establish a staffing plan based on a camp’s projected enrollment, the need (based on “strongly recommended” guidance”) to maintain groups of fewer than 10 campers, and the importance of maintaining physical distancing. Staff members should also be trained on the various protocols and procedures of a camp’s preparedness and response plan.

The LARA Guidance also acknowledges that campers and staff, alike, may be impacted emotionally by the return to a social, structured environment like camp, and that plans should be put in place to support their emotional needs. Camps should also proactively communicate with families in order to address concerns, explain health and safety procedures, and help prepare kids for what, for some, may be a difficult transition to the camp environment after months of isolation.

Health Screening for COVID-19

One of the most important and challenging aspects of running a camp this summer will be adhering to health screening protocols. Pursuant to the LARA Guidance, camps are required to check for COVID-19 symptoms when campers and staff arrive daily. While there is no mandated health screening process, the LARA Guidance suggests that camps adopt screening practices including:

  • Daily temperature checks for campers
  • Visual checks for signs of illness
  • Asking campers and parents about contact with COVID-19-positive individuals and general health questions
  • Continuing to monitor campers for symptoms throughout the day and monitor
    temperatures when campers appear ill or “not themselves”
  • Conducting similar daily health screening for staff members

For additional guidance, the CDC offers tips on how to practically conduct health screening checks.

Response to Possible or Confirmed Cases of COVID-19

Beyond screening for illness, camps must respond in accordance with LARA Guidance to the extent a COVID-19 case is suspected or confirmed, including:

  • Identifying a point of contact adult onsite during the camp operation to manage health-related concerns, and ensure that camp staff and families know who this person is and how to contact them
  • Monitoring the health of staff and campers throughout the day
  • Immediately sending home someone who becomes ill
  • To the extent someone becomes sick with COVID-19 symptoms, calling the local health department to report exposure and determine whether those who have been in close contact need to leave camp
  • Reporting exposure that occurs outside of camp to the local health department
  • Determining whether to close the camp based on guidance from the local health department

Camps Must be Vigilant this Summer

Running a day camp in Michigan is never easy, and this summer it will be even harder. This article has addressed a few of the key provisions in the LARA Guidance, but camp operators should carefully review the full extent of the guidance, as well as Governor Whitmer’s various executive orders that impact camp operations. From additional legal and regulatory to compliance requirements, to mandated health screening and safety protocols, there is a great deal of complexity that camps need to review and understand in order to run their operations safely and compliantly. To the extent that you have any questions or concerns, or require assistance in the creation of a preparedness and response plan, please contact Mark Kellogg.

We have created a response team to the rapidly changing COVID-19 situation and the law and guidance that follows, so we will continue to post any new developments. You can view our COVID-19 Response Page and additional resources by following the link here. In the meantime, if you have any questions, please contact your Fraser Trebilcock attorney.

Fraser Trebilcock attorney Mark E. Kellogg is a certified public accountant, and has devoted over 30 years of practice to the needs of family and closely-held businesses and enterprises, business succession, commercial lending, and estate planning. You can reach him at 517.377.0890 or mkellogg@fraserlawfirm.com.