Healthcare Practitioners: Anatomy of an IDFPR Complaint

The Illinois Department of Financial and Professional Responsibility (IDFPR) is the state agency that oversees licensure and discipline of various health care practitioners, including physicians, nurses, and dentists, among others. The IDFPR is charged with overseeing enforcement of the various healthcare practice acts, and it typically investigates matters brought to its attention, primarily from patient complaints. With the advent of electronic communications, dissatisfied patients can pursue complaints with far greater ease. The simplicity of electronically filing a patient complaint against a healthcare provider does not alleviate the responsibility of the Department to do a proper investigation of a complaint, but the advent of electronic filing of complaints does seem to have brought a concomitant rise in the firm's work defending healthcare practitioners in matters before IDFPR.

Once IDFPR receives a patient complaint, the matter usually moves through what is referred to as the investigation stage. That stage usually involves a request from IDFPR to the practitioner to produce the patient’s records and any other relevant or requisite information, such as proof of completion of continuing education hours for the past reporting period, answers to certain questions, or a narrative description of the care and treatment rendered. Following a request for records, it is not unusual for IDFPR to request an in-person hearing, or informal conference, at IDFPR offices. An informal conference is attended by the practitioner, hopefully his or her counsel, and one or a combination of IDFPR Board member(s), a prosecuting IDFPR lawyer, the IDFPR investigator, and possibly others from IDFPR (such as clerks, etc.). The conference is not sworn testimony and is not recorded or transcribed. The patient is not present nor does he or she participate. Following the conference, typically a recommendation is made as to any discipline or not. Once a tentative agreement is made, the agreement must be approved by others at IDFPR to be finalized. Discipline can range from no discipline to suspension and many other forms in between.

If an agreement is not reached or if IDFPR deems a matter to be of such importance that more immediate or urgent action must be considered, then the matter can proceed without a typical investigation phase and go directly to a more formal stage called the complaint phase. In the complaint phase, there is a formal complaint, typically captioned as IDFPR v Dr. X, and that matter proceeds more in the nature of a lawsuit before an administrative law judge. An IDFPR prosecutor pursues the complaint on behalf of IDFPR and formal discovery follows, just as in a civil or criminal lawsuit. Fact witnesses and expert witnesses may be called and or retained. The matter culminates in a trial before the IDFPR administrative judge, and the decision on discipline is decided by that judge. Appeals of that decision can be made to the Circuit Court, and other forms of appeal more typical to a lawsuit can proceed beyond that level.

While this is the most typical type of IDFPR matter we see in our practice, there are other ways that matters can be brought to the attention of IDFPR beyond the simple patient complaint. This, however, is still the most common type of claim we are called upon to defend.

Regardless of the genesis of the IDFPR inquiry against a healthcare practitioner, the common denominator among all of these is that IDFPR exerts great power as to the discipline of licenses of healthcare practitioners. Because of this power and its far reaching potential effect on the livelihood of practitioners, one lesson is clear: IDFPR matters must be addressed immediately and be handled carefully, cautiously, and seriously. Any communication from IDFPR to a practitioner should be immediately reported to a professional liability carrier to determine if there is coverage for defense counsel. If so, counsel should be requested immediately. If there is no coverage, inquiry should be made immediately to assess if counsel can be retained to assist. Deadlines must not be ignored, and every request must be thoroughly assessed and addressed in a manner attempting to achieve amicable resolution of the claim with IDFPR if at all possible.

Our recommendation is that no practitioner should ever attend an IDFPR informal conference without, at the very least, experienced preparation with counsel, followed by attendance at any hearing with counsel. When a practitioner's license is called into question, from whatever means, it must be taken seriously, and assistance of counsel is of the utmost importance to obtaining the best possible result.

  • Linda J.  Hay

    Linda J. Hay focuses her practice on the defense of all types of professionals, including individual healthcare practitioners such as physicians, dentists, and nurses, as well as lawyers. Ms. Hay also defends institutions such as ...

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Kerri Forsythe

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