In October 2001, I received a letter from MBC requesting information about my treatment of a patient the previous year. I did not recall the patient and requested details from the Board. They sent a photocopy of a prescription medication label with my name listed as prescribing physician and notice of a complaint that I had prescribed medication without an exam. In December, I wrote MBC a letter explaining that I did not remember the case, but that I must have prescribed an antibiotic for a patient while I was on call. Their response was to issue a citation for two violations: prescribing without performing an exam and failure to maintain proper records. I was told to pay an $850 fine and learned that they would keep the citation on the MBC web site for five years without recourse. They did state I could request an "informal conference" to appeal the citation.

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From the pharmacy on the prescription label, I obtained the name and number of the patient. I called the patient's father and got all the details of the case: As I was the on-call physician for the child's primary care physician, the father had called me as and asked me to prescribe an antibiotic for his five-year-old son. This was for an eye infection that the son had before and that had responded well to this antibiotic in the past. The complaint had been made by the father's ex-wife who had a personality disorder and who, apparently, was out to discredit the father and anyone he dealt with. My memory refreshed, I also remembered a call I had received the year before from a mother asking about my treatment of her son. I did not talk to her, but as I did not recall the patient's name, I had my nurse tell her that I did not know anything about the case. That action of mine was one bad mistake, although it is not clear if I could have forestalled what eventually happened!

From CMA, I got strong advice to obtain an attorney and try to have the citation reversed and removed from the web page.

Buried in the child's file I found the record I had given his primary care physician, to help answer the charge of "failure to maintain records." The father wrote a letter describing the case, the excellent care the child received, and the mother's motivation for filing the complaint. Armed with these facts, I felt certain the MBC would dismiss the case when we went to conference.

Unfortunately, that's not what happened. MBC seems determined to have every complaint result in an action against the physician. They used their own interpretation of a statute, which allows prescribing without an exam, to say it did not apply in this case. They did offer to remove the complaint if I would take a useless course in prescribing, held 500 miles away, lasting three days, and costing $1800.

This action by the MBC was so unfair and so lacking in proper concern for the patient that it needed to be fought. The next legal step was to appeal to an administrative judge, but my attorney advised me that this usually goes the way the MBC wishes, as it is prosecuted by the State Attorney General's office; and the legal costs triple. CMA and CAFP, both of which I had been a member of for many years, became interested in my case because of previous problems with the MBC and the implications of its action on other physicians. On May 15, 2002 the presidents of CMA and CAFP signed a joint letter to the Executive Director of the MBC urging that the citation be withdrawn and citing the statute that protects physicians for prescribing in just this instance. On July 8, the citation and fine were withdrawn without explanation by the MBC. Hallelujah!

This case, which never should have been pursued, was over. It has been a strain on my practice and me for many months, with phone calls, meetings, letters, loss of sleep, and frustration in dealing with an unreasonable board. I do not know if anyone saw the citation on the MBC's web page during the months I was protesting the MBC action, but I am certainly glad it is off now. The important things I have learned from this process are:

• Always respond to a patient complaint, especially if you are not the patient's usual physician. Even though it may not be an obvious liability issue, a patient can complain to the MBC about anything, with dire results.

• Always retain an attorney when dealing with the MBC. I doubt I could have had this outcome without one. My liability insurance has a rider covering the first $25,000 of legal fees in battling boards, with a $1000 deductible that my county medical society's special fund covers. This actually cost my carrier almost $10,000 in legal fees.

• Keep a record of all treatments, including telephone advice and prescriptions.

• Be courteous when talking to anyone from the Board. I probably hurt my case when I was incredulous on the first telephone conversation with a MBC representative. I couldn't believe that their case hung on the fact I prescribed a "dangerous drug" without an exam. Is cephalexin dangerous? Their position is that every prescription medication is dangerous, so they can always interpret a statute to suit their prosecution.

• Belong to your medical and specialty societies. They can go to bat for you, especially if they believe the case may impact other members.

My next step if this didn't work would have been to appeal to our elected representatives in Sacramento. Even if it would happen too late to help me, the statute could be changed to prevent a twisted interpretation by the MBC. I'm glad I did not have to go this route.

I'm certainly glad this is over, and hope my experience can prevent this happening to another physician.