State boards must tell Iowans why they investigate doctors and other professionals

If you came across a document about a doctor or other professional headed “Notice of Hearing and Statement of Charges,” wouldn’t you like to know what that charge might be?

Unfortunately, Iowa law prohibits state licensing boards from disclosing the facts that give rise to such charges. Worse, some boards now keep those details secret even after they discipline the professional in question, according to reporting by Clark Kauffman of the Iowa Capital Dispatch.

As written, the law rightly reflects the fact that a single false accusation, if made public, can unjustly destroy a career. Robust disclosure can also sometimes complicate the work of investigators.

But the practices Kauffman describes are becoming the norm in Iowa, and they leave the public—the clients of professionals who provide highly personalized care—almost completely in the dark.

The state can better respond to the conflicting interests and the legislature should take up that challenge.

Why have governments changed the way they work over the past 3 years?

The problem is relatively new. For decades, board members routinely disclosed basic facts about a case when they decided a complaint was sufficiently credible and began disciplinary proceedings. But in 2021, the Iowa Supreme Court agreed with a doctor who said Iowa Code Chapter 272C clearly required confidentiality until a “final written decision” was filed.

Kauffman, who has closely monitored transparency in state government during his long career as a journalist in Iowa, writes that “public access to information from Iowa’s licensing boards has been severely curtailed in the years that followed.”

State employees who are trying to faithfully follow the law’s requirements might understandably think that they’ll get into less trouble for going too far with secrecy than for going too far with disclosure. But that’s the exact opposite of the principle that other laws require when it comes to open government. And things have clearly gotten out of hand when a nurse’s license is revoked and the state refuses to say why.

Because boards are using their discretionary power in a manner that is not in the public interest, the Legislature will have to intervene by revising Chapter 272C.

• At the very least, the law should explicitly state that the underlying conduct that led to serious disciplinary action must be disclosed when the penalty is imposed.

• Better would be to require that a public “charge statement” include summaries of the allegations. In a randomly selected order online, the Iowa Board of Behavioral Science accuses a counselor of “unethical conduct” and “failure to adhere to the minimum standard of acceptable and customary practice” under a block of redacted text. This is not helpful to a current or prospective patient—indeed, it might even lead one to speculate that the transgression is something worse than the truth.

The contrast with the disclosures required in legal proceedings is striking

While it is logical that the rules for licensing authorities and those for the courts differ greatly, in practice the difference here is striking.

Civil lawsuits are immediately made public without any consideration of the veracity of their claims. The criminal justice system pays little attention to the reputation of the accused. In some Iowa licensing cases, it’s possible to read between the lines to understand why something happened, just because a professional has also been charged criminally. Some of those cases help illustrate the stakes here: Doctors, nurses and chiropractors are among the professionals who interact with Iowans when they are at their most vulnerable.

In a similar vein, the Public Records Act’s provision that “the date, time, specific location, and immediate facts and circumstances surrounding a crime or incident shall not be kept confidential” seems like a useful starting point for assessing what the public can be told when a state board finds probable cause to investigate a licensing professional. No, a law can’t specify all the circumstances in advance. Police, prosecutors, and the news media have long wrestled with the precise meaning of the “immediate facts and circumstances” clause, and something similar could happen under a revised licensing board law. But it’s a start.

Kauffman noted that many states provide more information than Iowa at the beginning of the disciplinary action and throughout the process.

At least one board has found that most complaints do not lead to punishment

After the 2021 Supreme Court ruling, the executive director of the Iowa Board of Medicine said it received about 600 confidential complaints against doctors each year, of which 25 to 30 resulted in public action. That suggests the board’s charges are anything but a free pass for wild accusations.

While one benefit of greater disclosure is that the public can better evaluate the work of government, none of these suggestions are intended to call into question the judgments made by the Iowa boards. The point is that, regardless of the quality of the boards’ work, the public would be better served knowing more, and knowing more sooner, when investigating possible misconduct.

We trust these professionals with our physical and mental health, often at times when we or our loved ones are in pain or crisis. When Iowans seek treatment from a licensed health care provider, they deserve to know whether a regulatory board has found credible evidence that the professional has engaged in misconduct. And when the board ultimately imposes penalties, the public deserves the full details.

Lucas Grundmeier, on behalf of the editorial board of the Register

READ FURTHER:Iowa doctor wants access to Board of Medicine research records

This editorial is the opinion of the Des Moines Register Editorial Board: Carol Hunter, Editor in Chief; Lucas Grundmeier, Opinion Editor; and Richard Doak and Rox Laird, Editorial Board Members.

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This article originally appeared on the Des Moines Register: Is Your Doctor Disciplined? In Iowa, Information Is Scarce.