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David J. Goldberg, M.D., J.D.Dr. Poor has run a successful, predominantly medical, dermatology practice for over 20 years. With decreasing managed care reimbursements and the increasing costs of rent, employee salaries and medical supplies, Dr. Poor has found it increasingly difficult to pay his bills in recent times. He has now reached the point that he can no longer pay the rent for his 2000 square foot office. His landlord, Mr. Rent, is also a patient of Dr. Poor. Mr. Rent, after multiple attempts to collect the rent, opted to lock the doors to the office. Dr. Poor was still not able to pay his rent and Mr. Rent has become increasingly frustrated. Because he is a patient of Dr. Poor, he files a complaint with the State Board of Medical Examiners accusing Dr. Poor of abandoning his patients. The Board reaches out to Dr. Poor and accuses him of patient abandonment and threatens to take away his medical license. Can this really happen?
Dr. Poor, now with no income due to his locked office, seeks legal help. He claims that he cannot afford the rent because he’s more of a professional than a businessperson. He suggests that he does not aggressively bill and collect because he serves underserved and unfunded patients and therefore cannot afford to pay his rent. He treats his staff well. Dr. Poor also complains that his landlord has not maintained ventilation, plumbing, roofing, and other aspects of the property that he felt were a part of patient safety. Dr. Poor contends that the role of the State Board of Medical Examiners was to protect patients.
What does the complaint against him have to do with patient protection?
In general, Boards of Medical Examiners investigate practices and/or physicians for allegations related to patient safety. Is there a precedent for such a complaint? This year, Dr. Donovan Dixon received a “public letter of concern” from the North Carolina Board of Medical Examiners. This letter related to a judgement entered against his professional medical services corporation, Dixon Medical Services, PC. The judgement was for $64,000. This occurred because Dr. Dixon breached his lease agreement for his medical office space. The Board’s reasoning was that, although rent payments do not directly involve patient care, it was also possible that patient care could be adversely affected in situations because the judgement concerns a medical practice. The Board also alluded to previous issues from both 2014 and 2015 where Dr. Dixon had been subjected to a “Consent Order” allegedly involving “inappropriately prescribing excessive amounts of controlled substances for the treatment of pain in amounts that raised concerns for abuse and/or diversion of these drugs.”
The reality is physicians are held to a higher standard than other professionals. Under principles of moral turpitude or basic ethics, physicians can have legal problems that have virtually nothing to do with the practice of medicine. These ethics may go beyond the obvious aspects of protecting patients. They may go to the core of protecting the respectability of the medical profession. However, one can ask: How far can this go? It seems quite a stretch to discipline a doctor for violating a lease agreement. What would happen if Dr. Poor failed to remove snow immediately from his parking lot? A patient could fall. What if he was running an hour behind in seeing his patients? A bad on-line review is bad enough, but can a patient file a complaint with the Board of Medical Examiners if the doctor was running behind? Could the complainant allege that he or she was so stressed out that it led to a hypertensive crisis?
The reality is that Dr. Poor’s situation may be very different than that of Dr. Dixon. There may have been much more to the North Carolina Board’s issue with Dr. Dixon than what was publicly stated. The North Carolina Board may have been prohibited by Dr. Dixon’s attorney from making any further comments, which would allow Dr. Dixon to spin this tragedy any way he wished.
It is unlikely that Dr. Poor will see action taken against him for the mere act of not paying his rent. However, if the Board sees this as impacting his patients in a negative fashion, particularly if he has a history of other issues with this Board, they may choose to file an action against him for not paying his rent.
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