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May 31, 2023 Employment Law

A Guide to Sanctions Against Doctors in Virginia

The most significant risk most doctors face in their profession arguably is medical malpractice lawsuits. But not all forms of professional discipline come from injured patients and their attorneys. The Virginia Board of Medicine maintains an internal, quasi-judicial disciplinary scheme whereby doctors may face sanctions for breaking one or more rules of professional conduct. And those sanctions are public information meaning that all current, former, and future patients can see them. If you are facing the prospect of sanctions by the Virginia Board of Medicine, a Richmond employment lawyer can defend your professional reputation. 

Types of Sanctions the Board of Medicine Can Impose 

The Board of Medicine has wide latitude to impose sanctions, with the severity of sanctions generally being commensurate with the severity of the infraction. As such, they are imposed on a sliding scale that ranges from reprimands all the way up to license revocation. Sanctions the Board of Medicine can impose include: 

  • Reprimand: A public reprimand that sets out why the respondent is being reprimanded, including the Board of Medicine’s findings of fact and conclusions of law 
  • Monetary penalty: An order to pay a monetary penalty to the Board of Medicine; may accompany a reprimand 
  • Probation: A type of sanction in which the respondent may have limits placed on their practice for a certain period of time. It may also be accompanied by additional terms, such as requiring a mental or physical evaluation, continuing education, participation in the Health Practitioners’ Monitoring Program, or an audit of their practice. 
  • Suspension: A suspension of the respondent’s license to practice, either for a specified period of time or indefinitely. Suspensions may also be summary or mandatory, such as when the respondent’s behavior poses an imminent threat to the health or safety of the public. 
  • Revocation: The revocation of the respondent’s license, which effectively terminates their ability to practice 

At any time during the disciplinary process, the respondent may also “settle” with the Board of Medicine through a consent order. While a consent order may terminate the disciplinary process, it might not always be in your best interest. If you have been offered a consent order requiring you to accept any of the above actions, have a Richmond employment lawyer evaluate your case before signing it. 

The Sanctioning Reference Points System

Sanctions are determined on a case-by-case basis according to their individual facts and circumstances. Recognizing that such an approach could lead to disparate and potentially unjust outcomes, the Board of Medicine implemented the Sanctioning Reference Points System in 2004. The system attempts to introduce a level of objectivity in what would otherwise be a completely subjective sanctioning system. 

The key advantages of this system are: 

  • Wide sanctioning ranges: The range of sanctions prescribed under the system are broad, and the system allows the Board of Medicine to consider both aggravating and mitigating factors when recommending a particular sanction. 
  • A two-dimensional sanctioning grid: The system considers both the offense itself and the respondent’s history. For example, a respondent with a history of violations may receive a different sanction for a particular offense than a respondent with no history of violations for a similar offense.  
  • Voluntary in nature: Sanctioning under the guidelines is voluntary, meaning that the Board of Medicine uses it more as a roadmap than mandatory instructions. This allows the Board discretion when imposing sanctions. 

Case Types Covered by the Sanctioning Reference Points System 

The Sanctioning Reference Points System is used for most, but not all, types of professional disciplinary actions. The three major categories of cases it covers are as follows:  


These are cases that involve a doctor being impaired in their practice in some way, such as through mental, physical, or medical conditions; substance abuse; drug adulteration; obtaining drugs by fraud; personal use of patient drugs; and other drug-related offenses.  

Patient Care

Patient care offenses involve a wide range of offenses that cause harm to patients, such as: 

  • Sexual assault 
  • Mistreatment
  • Failure to diagnose/treat
  • Improper/unnecessary performance of surgery
  • Improper medical record keeping 
  • Disclosure of confidential patient information
  • Leaving a patient unattended
  • Inappropriate communication 
  • Inappropriate or excessive prescription of drugs
  • Improper management of patient regimen 
  • Unsafe or unsanitary facilities 

Fraud/Unlicensed Activity 

Fraud and unlicensed activity cases generally involve behavior that could compromise public trust in the medical profession, such as: 

  • Practicing without a license 
  • Practicing beyond the scope of a license 
  • False or deceptive advertising 
  • Falsification of patient records 
  • Failure to disclose fees when advertising 
  • Performing unwarranted services
  • Improper patient billing

How the Board of Medicine Uses the Sanctioning Reference Points System 

The Board of Medicine uses the Sanctioning Reference Points System to calculate an offense score and a respondent score and then plugs those scores into a sanctions grid to determine the relevant sanction. Generally, the more severe the violation, the higher the point score. For example, assume that an investigation revealed that a doctor had committed the infraction of failure to diagnose. That would fall under the “patient care” case type. The respondent is then assigned a set of points for each unique aspect of the violation — if there were multiple patients involved, the Board adds 30 points. If the patient died, it adds 100 points, but if the patient was merely injured, it adds 50 points. The Board adds additional points based on the respondent’s history, such as if they have had any prior similar violations. The offense score and the respondent score are then used to determine the appropriate sanction. 

Contact a Richmond Employment Lawyer if You Are a Doctor Facing Sanctions in Virginia 

While sanctions may not necessarily be career-ending, they are public information and can thus cast a shadow over your ability to treat patients for years to come. The best way to minimize the detrimental effects of sanctions is to hire a competent attorney to represent your interests. To get started, please contact a Richmond employment lawyer at Pierce / Jewett by calling 757-304-6655 or using our online contact form.