What is an 805 Report?
Learn about the 805 report and how it can impact licensing, privileges, and employment for health care professionals.
California law requires certain peer review organizations responsible for reviewing the medical care of physicians to make reports regarding physicians to the Medical Board of California (“Board”). And these reports can trigger Board investigations and even license discipline. This is the often misunderstood – but almost always detrimental – “805 Report.”
The report is named after Business and Professions Code, section 805 which requires such reports. While many physicians complete their entire medical careers without having an 805 Report, the consequences of such a report to the Board can be devastating and are far reaching.
Who Must File and For Whom?
California law requires a “peer review body” to file an 805 Report with the Board under certain circumstances. A “peer review body” is defined in several ways discussed below, but generally involves some sort of medical group, committee of a hospital, clinic or other group of physicians responsible for reviewing the patient care of its staff members or colleagues. Specifically, peer review bodies include the following:
A healthcare facility or a clinic licensed under the Health and Safety Code or an ambulatory surgical center certified to participate in the Federal Medicare Program;
A healthcare service plan or disability insurer that contracts with licensees to perform and provide services;
A medical or podiatric professional society that is a non-profit organization having at least 25% of its members be physicians or podiatrists;
Any committee consisting of or employing more than 25 licensees of the same class which purpose is to review quality of care provided by members or employees.
Those subject to such a report are all those over whom the Board regulates. So, most notably physicians, but also physician assistants, licensed midwives, and podiatric physicians.
Because peer review bodies can suffer a significant fine for failing to report, peer review bodies have strong incentives to report any and all peer review issues. And this is often to the medical care professional’s detriment.
What Must be Reported?
The peer review body must file an 805 Report with the Board when any of the following occurs:
The peer review body denies or rejects the licensee’s application for staff privileges or membership for a medical disciplinary cause or reason;
A licensee’s staff privileges, membership, or employment are revoked for a medical disciplinary cause or reason;
Restrictions are imposed or voluntarily accepted on staff privileges, membership, or employment for a total of 30 days or more within any 12-month period for a medical disciplinary cause or reason;
If the licensee resigns, goes on a leave of absence, withdraws or abandons an application for renewal of privileges or withdraws or abandons an application for renewal of privileges after receiving notice of a pending investigation initiated for a medical disciplinary cause or reason; and
A summary suspension of staff privileges, membership, or employment that is imposed for a period in excess of 14 days.
The report must be filed within 15 days of the occurrence.
What is a Medical Disciplinary Cause or Reason?
California law defines “medical disciplinary cause or reason” as “that aspect of the licentiate’s competence or professional conduct that is reasonably likely to be detrimental to patient safety or to the delivery of patient care.” Simply stated, if the issue involves patient care at all, the peer review body will report it.
While 805 Reports made to the Board from peer review bodies are not public records, the Board investigates them and they can easily turn into disciplinary actions. In fact, the peer review body has often done the Board’s work for it in investigating a patient care issue involving the physician which can easily turn into charges of negligence.
According to statistics released by the Board, for the 2018-2019 budget year, it received 131 reports. So, approximately 11 per month for the entire state of California. Of those received, as of September 2019, 1 resulted in an Accusation being filed, 90 remain under investigation, and the remainder have been closed.
What about other Misconduct?
In addition to competence issues as a professional, peer review bodies are also obligated to report other types of misconduct to the Board. Pursuant to Section 805.01, when a peer review body makes a final decision following a formal investigation of one of the categories of misconduct identified below, it must, similarly, file a report with the Board an “805.01 Report” within 15 days of its final decision.
The investigation findings trigger reporting obligations when the following “may” have occurred:
Incompetence, or gross or repeated deviation from the standard of care involving death or serious bodily injury to one or more patients, to the extent or in such a manner as to be dangerous or injurious to any person or to the public;
The use, prescribing, or administration to himself or herself of any controlled substance, or the use of any dangerous drug or of alcoholic beverages, to the extent or in such a manner as to be dangerous or injurious to the licentiate, any other person, or the public, or to the extent that such use impairs the ability of the licentiate to practice safely;
Repeated acts of clearly excessive prescribing, furnishing, or administering of controlled substances or repeated acts of prescribing, dispensing, or furnishing of controlled substances without a good faith effort prior examination of the patient and medical reason therefor; or
Sexual misconduct with one or more patients during a course of treatment or an examination
According to statistics released by the Board, for the 2018-2019 budget year, it received 9 reports. Of those received, as of September 2019, 1 resulted in an Accusation being filed, 5 remain under investigation, and the remainder have been closed.
When a physician is a member of a peer review body and has an issue involving patient care (or misconduct), the peer review body’s obligation to issue an 805 Report (or 805.01 Report) will likely be triggered. Accordingly, the physician should immediately seek competent and experienced healthcare legal counsel to address these issues at the earliest possible stages of the peer review process. Because peer review involves a direct conduit to the Medical Board and often involves negative findings, expert medical chart review, and other criticisms already investigated before the physician gets a chance to respond, a licensed physician cannot procrastinate dealing with a peer review matter before it escalates into a Board disciplinary action.
Good resources for finding such counsel include the California Academy of Attorneys for Healthcare Professionals or the California Society for Healthcare Attorneys.