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State of Washington Class Specification

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CLINICAL HEALTH CARE INVESTIGATOR
428I
Category: Legal Services

Class Series Concept

See Health Care Investigator 1.

Definition

The Medical Quality Assurance Commission conducts complex standard of care investigations of allopathic physicians and physician assistants in cases of alleged patient harm, practitioner impairment or other unprofessional conduct under the laws administered by the Medical Commission. This position conducts highly complex clinical investigations and compliance audits of active medical practices for the Commission in order to ensure the standard of care has been met and practitioners are in compliance with disciplinary orders.

Distinguishing Characteristics

Clinical Investigators work under the general direction to provide a medical perspective when investigating complaints against physician and physician assistants regarding allegations of substandard care and compliance with Commission orders. Clinical investigators are expected to use their education, training and experience to arrive at clinical conclusions and recommendations regarding standard of care.

Typical Work

Using medical knowledge and clinical experience, the clinical investigator analyzes patient health records and electronic medical records to discern if patient care conforms to Commission treatment rules and standard of practice. Investigator determines the investigative plan, the types and numbers of medical records to gather and review other peer-review documents needed to ascertain whether the standard of care was met;

Performs a research of patient records, develop case files, gather and preserve documentary or physical evidence;

Conduct complex investigations of physicians and physician assistants to research alleged standard of care violations;

In cases where there are multiple practitioners implicated, review patient records to determine which practitioner was responsible for each step of the patient’s care;

Using good writing skills to develop and synthesize detailed investigative reports, state clinical conclusions and recommendations regarding clinical practice and standard of care for decision by the Commission;

Serves as subject matter expert on individual investigations or cases at Commission meetings and summary procedures;

Obtains and serves subpoenas to compel the attendance of witnesses or the production of records; conducts field surveillance;

Perform audit sampling of patient records in a medical practice to determine if physician or physician assistant is documenting patient care as required by laws, rules and Commission orders;

Conducts complex audits of physicians and physician assistants to ensure their services are compliant with Commission orders;

Perform follow-up audits of physicians and physician assistants on compliance monitoring and provide technical assistance to the practitioner when appropriate;

Performs analysis of standard of care complaints; develops an investigation plan to include a review of all pertinent medical records, peer review documents and other pertinent patient information;

The clinical investigator generates the final written investigative report to communicate findings that may highlight substandard care for further review and decision by the reviewing commission member;

Inspects medical offices or the premises where the physician or physician assistant sees or treats patients to ensure medications are controlled appropriately, prescribed appropriately per any prescribing restrictions as set by action of the Medical Commission and medication wasting records are accurate;

May provide technical assistance during compliance audits to help practitioner understand rationale for review;

Works closely with and assists other law enforcement agencies in the State, including working closely with the Medicaid Fraud Unit, Department of Corrections, Department of Social and Health Services, the Health Care Authority and Washington State Patrol as well as Federal Drug Enforcement Administration in drug related investigations, the Food and Drug Administration, Department of Justice and the Federal Bureau of Investigations;

Serves summary suspensions and license revocations to physician and physician assistants;

Participates in staff meetings and case conferences as needed; assists staff attorneys and Assistant Attorneys General in case preparation; testifies in administrative/ disciplinary hearings or court proceedings as needed; attends case review panels to present/discuss investigations, attends Medical Commission compliance meetings to present/discuss practice audits;

Performs other work as required.

Knowledge and Abilities

Knowledge of: the practice of medicine, including standards of patient care, medication requirements and interactions; ability to read and understand patient records, including electronic medical records; understanding of medical delivery systems;

Knowledge of: statutes regulating practice and licensing of physicians and physician assistants; related laws and court decisions; rules of evidence; court procedures; principles, standards and techniques of investigations; practices, procedures and standards relevant to the health care professions; principles of biological and physical sciences;

Ability to: understand and interpret laws and court decisions relating to the health care professions; focus issues and assess behavior according to standards of practice in the health care professions; conduct complex standard of care investigations regarding highly technical health care issues; gather, preserve and present material relevant and pertinent evidence; write and speak clearly, concisely, accurately and informatively; exercise mature judgment in a wide variety of situations involving contact with the public;

Ability to: utilize various computer systems to retrieve patient records, legal documents Commissioner assessments and case-related information;

Ability to travel to various geographic locations around the state for the purposes of conducting interviews, gathering records or assessing clinical practice locations; travel alone or in groups using state vehicles or standard air travel; conduct overnight trips;

Ability to: investigate complaints; coordinate and monitor a region-wide program; work effectively in situations requiring extreme tact and good judgment; write and speak clearly and concisely.

Legal Requirement(s)

Must hold an active license or be eligible to receive a license in one of the following professions: allopathic or osteopathic physician, physician assistant registered nurse (RN) or advance registered nurse practitioner (ARNP).

Desirable Qualifications

Five years of professional health care experience in a clinical setting as an allopathic or osteopathic physician, physician assistant, RN and/or ARNP.

Class Specification History

New Class; adopted June 30, 2017, effective July 1, 2017.

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