Board Complaints & Peer Review

ADMINISTRATIVE COMPLAINTS

Generally, patients can pursue two types of claims against a healthcare provider. The first type of claim is a civil lawsuit which seeks damages arising from injuries caused by negligence. The second type of claim is an administrative complaint which is a formal complaint against the healthcare provider’s license. A successful outcome to an administrative complaint is the enforcement of disciplinary action against the healthcare provider by the appropriate state agency. To pursue a civil lawsuit, it is highly advisable that a patient retain an attorney because the process is complex and potentially very costly. In contrast, an administrative complaint is a relatively simple process filed through Florida’s Department of Health and an attorney is not necessary. If the Department of Health accepts and agrees with the patient’s complaint, the Department will assign a prosecutor to pursue sanctions against the healthcare provider. The type of sanctions varies widely and may include fines, license suspension or revocation, additional or remedial training, and, in some cases, restitution.

Frequently, a patient may be the victim of a negligent act by a healthcare provider, but, for any number of reasons, a civil lawsuit may not be viable. For example, a civil lawsuit may not be a viable option wherein a dentist delivers a poorly constructed or ill-fitting bridge. Since the expense of a civil lawsuit would cost more than buying a new bridge, no attorney is going to pursue the claim as a civil lawsuit. However, it may be in the interest of the patient to file an administrative complaint seeking a refund for the cost of the bridge. Also, pursuing an administrative complaint may help prevent the medical error happening to somebody else in the future.

A patient can file an administrative complaint by going to the Florida Health Complaint Portal, which is found at www.FLHealthComplaint.gov. Alternatively, you can print out a copy of the complaint form here:

FLORIDA HEALTHCARE ADMINISTRATIVE COMPLAINT FORM

It is strongly recommended that anyone contemplating an administrative complaint have a copy of the pertinent healthcare records available at the time the administrative complaint is prepared. Also, a copy of the pertinent records should be enclosed when the administrative complaint is submitted to the Florida Department of Health. If you need help requesting your healthcare records from the healthcare provider, please review the MEDICAL RECORDS section of our website. It is there that you can download our packet for requesting healthcare records.

It is important to understand that an administrative complaint is processed through the Florida Department of Health. In the case of complaints against a dental provider, the complaint will be reviewed by the Florida Board of Dentistry. If the Board finds “probable cause” for the complaint, the Department of Health shall initiate a public prosecution against the license of the dental provider. However, should the board fail to find “probable cause,” the Department of Health will close the file and the subject of the complaint shall remain confidential. Upon a finding of probable cause, the Department of Health shall assign a state funded prosecutor to pursue the claim. The prosecutor shall have discretion over the direction of the claim and has the authority to enter into settlement agreements with the dentist/healthcare provider. Typically, the prosecutor will consult with the victim before entering into any settlement agreement with the healthcare provider, and any settlement agreement must be approved by the Florida Board of Dentistry. Finally, should the prosecutor and healthcare provider be unable to reach an agreement, there shall be an administrative hearing presided over by an administrative law judge.

The fact that a healthcare provider has been the subject of a formal Administrative Complaint shall be matter of public record, and can be checked on the Florida Department of Health’s website:

FLORIDA DOH - MEDICAL QUALITY ASSURANCE

PEER REVIEW & FLORIDA DENTAL DISTRICTS

As an alternative to litigation, the Florida Dental Association has created a program to assist in resolving patient complaints and claims. This process is known as Peer Review, and it is conducted through one of the six regional offices of the Florida Dental Association. It is important to understand that the Florida Dental Association is affiliated with the America Dental Association and is a private organization funded by its members who are all dental professionals. The purpose of Peer Review is mediate and potentially resolve disputes between dentists and patients in a manner which circumvents the litigation process. Filing a formal lawsuit is very time consuming, expensive, and usually requires the expertise of a medical malpractice attorney. Peer Review is a “lawyer free” mediation process wherein the aggrieved patient presents his or her claim to a panel of dental professionals. The entire process is free to the patient. The goal of the Peer Review process is to bring the parties together to work out a mutually agreeable resolution. If necessary, the Peer Review panel can issue a binding opinion on a dispute and, if appropriate, award damages. However, it is very important to understand that damages in the Peer Review process are limited to economic damages (i.e. a refund of payments or an award of costs to repair/correct a dental problem), as non-economic damages (i.e. pain and suffering) are not considered and never awarded. Peer Review should be considered only in matters which do not involve permanent and/or significant personal injuries. For example, a claim involving a denture which has not been constructed properly would be a proper subject for Peer Review, whereas a claim involving a significant nerve injury due to dental negligence should not be submitted to Peer Review.

While Peer Review may seem like a great alternative to litigation, there is some downside to the process. Patients who submit their claim to Peer Review will be required to agree that any finding by the Peer Review panel is final and binding. Therefore, if a patient receives an unsatisfactory result through Peer Review, a lawsuit can not be filed. Finally, it is important to note that the Florida Dental Association will reject a request for Peer Review when the patient has either filed a lawsuit or an Administrative Complaint against the dental provider.

Below is a map of the six District Dental Associations. Peer Review should be requested in the District where the care at issue was provided. Please feel free to use the links provided below to connect to your local District Dental Association. Please note that more information about the Peer Review process is available under the “PUBLIC” tab on each District’s individual website.

Call us at:
1 (844) 288-6529
(954) 874-3631

Atlantic Coast District Dental Association

Central Florida District Dental Association

Northeast District Dental Association

Northwest District Dental Association

South Florida District Dental Association

West Coast District Dental Association

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