The responsibility of credentialing health care professionals has received increasing scrutiny from professional licensing boards as a means of protecting the public from substandard medical treatment.  This responsibility has been focused upon the practitioners and institutions that credential and employ these individuals.   

             In North Carolina, the Court of Appeals considered whether a dentist’s license to practice could be suspended for hiring an associate who was not actually licensed to practice in that state.

                In the case of Armstrong v. North Carolina State Board of Dental Examiners, Thomas Armstrong, D.D.S. was licensed to practice in the state of North Carolina.  During September of 1994, Dr. Armstrong hired a dentist to practice as an associate in his office.  The new dentist practiced with Dr. Armstrong from September to October 1994, when Dr. Armstrong discovered that the dentist whom he hired never held a valid license to practice dentistry in the state of North Carolina. (How did the board learn of the individual being unlicensed.)

                After investigating the matter, the North Carolina Board of Dental Examiners suspended Dr. Armstrong’s license for five years for hiring an unlicensed associate.  According to the terms of the suspension, Dr. Armstrong actually had to surrender his license to practice for 14 days and then remain on probation for the remaining 4 years and 48 weeks. The probationary return of his license also required that the perform 160 hours of community service and to pass a written examination.

                Dr. Armstrong challenged the Board’s decision to suspend his license by appealing to the Superior Court of Stanly County.  The Superior Court sided with Dr. Armstrong ruling that it was wrong for the Dental Board to suspend Dr. Armstrong’s license because there was no evidence that he had knowledge that the individual whom he hired was not licensed to practice in North Carolina.  The Superior Court also found that the punishment imposed upon Dr. Armstrong was not rationally related to the purpose of protecting the public from incompetent dentists. The Dental Board appealed the Superior Court’s decision.

                When considering this case, the Appeals Court first looked at the statute under which the Board disciplined Dr. Armstrong.  This statute specifically authorized the Board to sanction a dentist who had employed a person not licensed to practice in the state or who had, aided, abetted, or assisted any such unlicensed person to do or perform any act which could only be lawfully performed by a licensed dentist.  This statute gave the Board the authority to revoke or suspend a license to practice dentistry upon the finding of a violation of the statute.

                After reviewing the language of the statute, the Appeals Court noted that there was no statutory requirement that the employer be shown to have knowledge that the individual was not licensed. The Court determined that the absence of such a requirement meant that an individual could be disciplined regardless of whether he had actual knowledge of the individual’s licensure status.

                The Appeals Court found that the state of North Carolina had a valid public interest in insuring that only qualified persons be permitted to practice dentistry.  The Court held that the statute served the legitimate purpose of protecting the public from treatment by unlicensed individuals and was necessary to maintain the integrity of the licensing system.  The Court also found that it was reasonable to believe that the statute would promote these interests by placing the burden to determine whether employees were properly licensed on the hiring dentist.  The Court pointed out that the hiring dentist is the individual in the best position to determine whether his employees are in fact properly licensed. 

                On Appeal, the defendant also argued that he should not be held liable for violating the statute because the dentist he hired was licensed in two other states and practiced competently during his employment in North Carolina.  The Court rejected this argument.   

                Peer review requires that health care professionals take an active role in assuring that the health care provided by members of there profession is in accord with accepted standards of practice.   Licensing boards are charged with the responsibility of ensuring  that the licensees under its jurisdiction comply with these standards.  Thus, when hiring a professional, these boards will require that the persons employed meet the minimum licensure standards for their state.  The North Carolina decision is consistent with the imposition of this responsibility on individuals and corporations who employ professionals to provide medical treatment.      

                Therefore, professionals who employ other professionals must  take reasonable steps to ensure that the individual they are hiring  has the appropriate license to practice.  This should be accomplished by requesting an actual copy of their license.  In cases of doubt, the employer should also contact the state licensing board to confirm that their employee’s license is in good standing.   These steps should be noted in the employee’s file.  This information would protect the employer from disciplinary action by demonstrating that reasonable efforts were made to ensure that the individual was appropriately licensed. 

                Finally, information is also available today on the internet from most state licensing boards about the individual’s licensure status as well as the individual’s malpractice and disciplinary history.   By checking these sources, the employer would further insulate themselves from claims of improper supervision or credentialing of the professionals they have chosen to care for their patients.

    Credentialing of Health Care Professionals

    by Attorney Frank E. Reardon

    February 1999

    Healthcare Law, Litigation & Public Policy   Medical Licensure & Discipline ♦ Employment Board of Registration

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