Ms. Smith, who led the presentation, told board members the enforcement process begins when consumers file complaints with the Central Complaint Unit, where staff triage jurisdiction, request missing authorizations and determine whether a complaint should close or be referred for investigation.

The board's complainant liaison unit (CLU), created by statute and implemented in January, interviews complainants on quality-of-care cases before closure, Ms. Smith said. She described consultant medical review as a required step for quality-of-care complaints: contracted physicians in the same specialty review records and issue opinions about whether the standard of care was met.

Ms. Smith described two investigative pathways: the board's non-sworn Complaint Investigation Office, which handles many preliminary matters, and the Health Quality Investigation Unit (HQIU), the sworn field investigators housed under the Department of Consumer Affairs. She said some investigations require subpoenas to obtain records and that cases may be referred to the Attorney General's Office for filing an accusation when the board meets the clear-and-convincing burden of proof.

On discipline, Ms. Smith said the board may issue administrative citations and fines (up to $5,000 as stated in the presentation), public letters of reprimand, probation, suspension or revocation; respondents have appeal rights including an informal conference and administrative hearings. She also outlined impairment procedures and exam authority when a licensee's mental or physical condition raises safety concerns.

Board members focused much of the discussion on operational gaps that affect public trust. Dr. Ayala Rodriguez said many complaints are routed to the wrong licensing board and urged clearer website signage and better triage. "If we already have that flag that directs them to the DCA board, I think that's very, very good visual that could help direct them to the nursing board and to the PA board," she said.

Ms. Smith responded that the Breeze online complaint system currently cannot automatically transfer a submitted complaint to another board; once a complaint is in the Medical Board's system it is assigned a control number and staff must reinitiate referral to the appropriate board. She said staff do notify the filer when a referral is made but acknowledged the process can create delays and frustration.

Public commenters echoed concerns about follow-up communication. Michelle Montserrat Ramos of Consumer Watchdog said a family was told an interview was not final and that their case was later closed. "This is not what the bill the law we advocated for in the sunset bill requires," she said, urging the board to adhere to the statutory interview requirement.

Ms. Smith said the CLU conducts interviews to gather additional information before closure and that complainants referred to investigation are afforded the opportunity to provide a complaint impact statement. She noted materials and notifications are posted publicly once certain filings are made.

Several board members and staff highlighted a new collaborative process implemented in November to better coordinate HQIU investigators, enforcement staff and deputy attorneys general. The change, Ms. Smith said, followed recommendations from the enforcement monitor and is intended to set case categories, clarify roles and establish timelines for DAGs and investigators to reduce supplemental investigations and delays.

The board did not take action on policy changes during the presentation, but multiple members urged staff to pursue system improvements (including raising the issue in next year's sunset review) and to continue monitoring the CLU and complaint-tracking rollout.