How to Reduce the Risk of Being Disciplined by the State Medical Board

The tradeoff between quality and quantity of medical regulation
State medical boards are under public pressure to increase their disciplinary rates.

Manuscript Title


How to Reduce the Risk of Being Disciplined by the State Medical Board

Running Title


Medical Board Considerations

Names and affiliations of all contributing authors


Brett Snodgrass, M.D. DrSocial Ltd.

Contact details for Corresponding Author


Brett Snodgrass, M.D.
468N Camden Drive
Suite 200
Beverly Hills, California
Telephone:               1 (916) 893-1722
Fax:                   1 (877) 991-6435

Manuscript words





Medical board, state agency, licensure, competency, assessments

Governance, regulation, physician discipline

Funding statement


The author received no funding.



How to Reduce the Risk of Being Disciplined by the State Medical Board


Even if physicians’ provide good medical care and behave ethically, it does not guarantee that they will avoid discipline by their State Medical Board (SMB).1,2 SMBs are under public pressure to provide protection from “bad doctors,” and they appear to be doing so when they discipline physicians. The majority of research regarding the performance of SMBs is strictly quantitative.

The Missouri SMB tried to punish Dr. Paskon for prescribing opioids and benzodiazepines for chronic pain patients and for providing the standard-of-care to myriad patients.3 After four and a half years of costly litigation, the Honorable Commissioner John J. Kopp, JD, ruled that each of the SMB’s 137 charges vs. Dr. Paskon was unmeritorious.4

This author reports that the Missouri SMB made false claims against him in court regarding (1) the lumpectomy ischemic intervals of more than 20 women with breast cancer, (2) numerous Joint Commission violations, and (3) an unnecessary level of two to four b unilateral neck dissections. As a mere citizen, this author could not obtain the medical records to prove his innocence, and the SMB created a preponderance of false evidence, including perjurious depositions.

In 1985, Arnold S. Relman M.D. wrote, “Physicians brought before a state board for disciplinary actions often do experience ‘a monumentally destructive disruption’ of life. But that doesn’t alter the fact that the proceedings are likely to give the accused physicians every opportunity to clear charges against them. They can also launch legal counteraction which has a powerful dampening effect on the zeal of would-be accusers and judges.”5

The opportunities to prove innocence have dissipated with the change of laws to a lesser burden of proof.6,7 This creates a situation where a preponderance of false evidence and perjury can create a guilty verdict. In addition, physicians no longer have the powerful legal counteractions, which existed in 1985.6

Physicians are encouraged to protect themselves, and their families, from nefarious or reckless SMBs by routinely hiring an attorney when they need to interact with SMBs.

Finally, medical regulation needs to be changed from a sciolistic system, which punishes excellent care to a “just culture.”


  1. Mishler v. State Bd. of Med. Examiners, 849 P. 2d 291 – Nev: Supreme Court 1993. Accessed October 01, 2016.

  1. Snodgrass, B. Novel Insight into the Quality of Assessment of Physicians.

Health Care: Current Reviews. 2016;4:1-4.

  1. State Board of Registration for the Healing Arts v. Paskon, No. 02-1491 HA (Mar. 27, 2007). Accessed October 01, 2016.
  2. State Board of Registration for the Healing Arts v. Paskon, Second Amended Complaint. No. 02-1491 HA (December 27, 2004). Accessed October 01, 2016.
  3. Relman AS. Professional regulation and the state medical boards. N Engl J Med. 1985;312:784-5.
  4. Alan J. Mishler, M.D. v. Nevada State Board of Medical Examiners, 94 F.3d 652 (9th Cir. 1996).
  5. Neil, C. Medical Board Investigations: Legitimate or Kangaroo Courts? Medscape. Mar 15, 2016.
How to Reduce the Risk of Being Disciplined by the State Medical Board