To begin their long and rewarding careers, licensed physical therapists (PTs) and physical therapist assistants (PTAs) dedicate a significant portion of their adult lives to education, clinical experience, and maintaining their credentials. Despite building an excellent reputation for therapeutic and rehabilitative services and caring for patients, a single complaint or allegation can jeopardize everything.
The Physical Therapy Board of California (PTBC) has a low tolerance for substandard care and minor departures from the state's practice standards. From miscommunication with patients and lackluster aide supervision to substance abuse and fraudulent advertising, the PTBC reserves the authority to levy discipline, such as:
- Probation conditions that limit or restrict the authority to practice
- License suspension that harms a PT or PTA's professional reputation
- License termination that limits future healthcare career opportunities
Whether licensees are rendering patient care in hospitals in Los Angeles or San Francisco, rehabilitative clinics in Fresno or San Diego, or private practices in Monterey or Sonoma, they deserve the Lento Law Firm to handle their defense. Our Professional License Defense Team ensures PTs and PTAs remain focused on their practice as we build a successful strategy to challenge the PTBC's assertions without a full hearing. Call us at 888-535-3686 now or fill out our confidential consultation form, and we will contact you.
PTBC Scope of Practice
Within California's Department of Consumer Affairs (DCA), the PTBC regulates the practice in the state. In addition to verifying experienced individuals for license issuance and renewal, the seven-member board sets the standards for the scope of practice for PTs, PTAs, and unlicensed PT aides.
In California, only licensed PTs can perform patient evaluations, implement physician referrals, create and carry out care plans, and eventually discharge patients. PTAs have the responsibility of working with a PT in an assistive capacity, always under supervision.
PTAs may not:
- Conduct any patient data collection prior to the PT evaluation
- Document patient evaluations, reevaluations, or discharge summaries
- Establish or change patient care plans
- Write progress reports to another healthcare professional
- Supervise aides performing patient-related tasks
Additionally, PTAs cannot be the sole PT representative in any meeting with other healthcare professionals where a patient's care plan is assessed or modified. They also may not provide treatment in a business or facility where they hold a management position with influence over scheduling, hiring, or firing.
Unlicensed PT aides are normally relegated to administrative work, routine patient assistance, and other tasks that do not require clinical judgment. They serve under the delegation and supervision of PTs and PTAs.
Delegation and Supervision
PTs may delegate to no more than two PTAs at a time—as long as the intervention does not require advanced clinical judgment. PTs must provide "adequate supervision," meaning that the PT is not required to remain physically present on-site but must be continuously available when PTAs perform procedures. Supervisors will maintain an accurate record of the names of the PTAs under delegation and the tasks, functions, or interventions conducted and must regularly meet with them in person.
For unlicensed aides, PTs may only utilize one at a time and must use "immediate supervision," meaning being physically present and immediately available for direct contact with the patient during each visit. PTs, who may not supervise more than three individuals at a time (PTAs and aides), must evaluate patients before delegating tasks and predetermine necessary techniques. At all times, PTs are responsible for the extent, kind, quality, and documentation of all services provided by delegatees.
Physical Therapist Unprofessional Conduct
Although the work of California PTs and PTAs focuses mainly on patient recovery, the scope of the PTBC goes beyond the latest rehabilitative techniques. Licensees are bound to follow numerous professional standards while in the practice of physical therapy services.
Individual facilities may have a code of conduct that PTs and PTAs are accountable to as part of employment agreements. Yet, based on the state's Business and Professions Code, they are beholden to further prohibitions of unprofessional conduct, such as:
- Obtaining, possessing, or using unlawful controlled substances or any dangerous drug (in practice or outside of the practice)
- Failure to use the appropriate credential designations
- Criminal convictions involving controlled substances, dangerous drugs, or moral turpitude
- Fraudulent, dishonest, or corrupt acts substantially related to the qualifications, functions, or duties of licensees
- Engaging in sexual misconduct
- Incompetence
- Failure to respond to board notifications within 30 days
The PTBC also maintains strict regulations governing negligence. Circumstances that constitute negligence include, but are not limited to, a reevaluation of a diagnosis or a change in treatment and departures from applicable care standards. Gross negligence is a levied allegation when there are two or more (repeated) negligent acts or omissions.
PTs and PTAs must also keep accurate, legible records for all services rendered. Patient records are maintained for at least seven years following discharge. For minors, records are held for seven years, plus one year after the patient turns 18.
PTBC Complaint Process
The first step in the grievance process is when a patient, a patient's family member, colleague, assistant, or supervisor files a complaint. Once received, the PTBC's Consumer Protection Services (CPS) performs an initial evaluation to determine if it falls within its jurisdiction, meaning a violation of the state's Physical Therapy Practice Act and state codes promulgated by the board. If an immediate or emergency investigation is required, the board may hand off the matter to DCA's Division of Investigation.
CPS investigators conduct thorough inquiries, relying on interviews with the complainant, the accused licensee (respondent), and named witnesses. The board's inquiry can be wide-ranging, utilizing patient records, billing documents, employment or behavioral history, and any other relevant documentation to substantiate findings. Yet, authorities also call on expert review. If the allegations involve clinical competence, negligence, or departures from care standards, CPS will contract with a PT unrelated to the case to review medical documentation and investigative materials to provide an independent assessment.
Accusations and Administrative Hearings
If the PTBC believes the evidence supports disciplinary action, the Attorney General's Office (AG) files an Accusation, formally charging the licensee with specific violations. The licensee is then:
- Served with the Accusation outlining the allegations and legal basis
- Given the opportunity to respond within a set timeframe (usually 15 days)
Before proceedings before the Office of Administrative Hearings (OAH), the PTBC will attempt to mediate a stipulated agreement with the respondent, meaning an agreement with the board's asserted violations and recommended discipline. The AG may also file a petition on behalf of the PTBC to compel the licensee to undergo a psychiatric, medical, or competence exam or seek an interim suspension order.
Before an Administrative Law Judge (ALJ), licensees and their legal counsel will enter proceedings with the state represented by the AG. The burden of proof lies with the state, but it only needs to prove its case by a preponderance of the evidence—meaning it's more likely than not the licensee is responsible for the official Accusation. After reviewing all testimony and evidence, the ALJ issues a proposed decision outlining their conclusions and recommended disciplinary action.
In a majority vote, the PTBC will issue a final decision, reducing or increasing the imposed penalties or adopting the ALJ's recommendations. The board can also refer the matter to a local district attorney for criminal prosecution in some cases. Otherwise, it will notify the respondent of the results in a letter sent within 15 days.
Sanctions for California PTs and PTAs
For substantiated Accusations, the PTBC and the AG can hand down a myriad of disciplinary provisions. Each will depend on each individual case, but also the PT or PTA's history of board actions.
A “Citation and Fine” is an enforcement method by which the PTBC may address relatively minor violations that would not necessarily warrant discipline in order to protect the public. Critically, they are technically not disciplinary actions but are nevertheless matters of public record. They remain on a licensee's file for five years and are then purged, and payment of a fine is considered a satisfactory resolution.
The board can also impose a public letter of reprimand as a formal admonishment for the substantiated misconduct. Although publicly available on a state database, it does not strip a PT or PTA of duties or authority. The PTBC can also institute a “stayed" revocation, which is effectively probation. It means that professional practice may continue so long as the licensee complies with specific probationary terms and conditions. Violation of probation may result in the revocation that was postponed.
When the PTBC pursues license suspension or revocation, it will analyze the case to determine if the conduct had a "substantial degree," indicating the present or potential unfitness of an individual's ability to practice. The three items the board reviews are:
- The nature and gravity of the offense
- The nature and duties of a license
- Rehabilitative measures taken to address the misconduct
When individuals keep their credentials but are ordered to complete conditions, any departure from them is subject to additional discipline. For those ordered to substance abuse recovery programs, if at any point licensees falsely represent progress, such as misreporting usage or attendance, they are not just subject to additional license discipline—they risk felony charges.
Effects of License Discipline
Even when PTs or PTAs remain licensed and aligned with their practices, any disciplinary action—even a written reprimand—can negatively affect a career long term. Those with a disciplinary record often encounter challenges when renewing their California license or applying for one in other jurisdictions. Although the state has yet to enact the multi-state PT Compact granting license reciprocity with over three dozen other states, all boards review disciplinary history before issuance.
The PTBC often imposes fines or restitution as part of punitive measures, and depending on the number of violations, the penalties will cause financial stress for licensees supporting families. Moreover, the board could implement restitution for victim harm or even recuperate the costs of the investigation. In addition to the costs of fines, any probation conditions—counseling, testing, treatment, etc.—are paid for by the licensee themselves. Financial burdens can continue as sanctions can lead to increased malpractice insurance premiums and, depending on the severity of the violations, denial of coverage altogether.
Reinstating a California Professional License
Fortunately, when California PTs and PTAs are serving discipline, they may petition the board for penalty reduction. It can be aimed at modifying probation conditions, terminating them, or reinstating a revoked license. They must submit the official form and supplementary documentation at least 45 days before the petitioner desires a hearing.
The petitioner bears the burden of proving rehabilitation during a meeting with PTBC members. Evidence is shown through a wide variety of means, such as psychiatric or substance abuse evaluations, among others. Critically, if sanctions were levied because of an offense that forces the licensee to register as a sex offender, the board will not reinstate credentials to practice.
Protect Your California Physical Therapist License
When allegations or complaints arise, there's no need for California PTs and PTAs to stress out about their future. In all matters before the PTBC, licensees may retain legal counsel to protect their rights. No matter how minor misconduct may seem, PTs and PTAs deserve guidance that mitigates discipline and is dedicated to their best outcome.
The Lento Law Firm knows that a disciplinary record can severely weaken a licensee's ability to practice freely, and our Professional License Defense Team stands prepared to protect their investment. We understand how to navigate complaints, Physical Therapy Practice Act violations, and other threats to PTs and PTAs.
A successful defense strategy demands a full comprehension of board-specific procedures, investigation protocols, administrative hearings, and petitioning for penalty reduction. No matter where PTs or PTAs work in California, we will provide the redress needed for them to continue their careers. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our confidential consultation form, and we will contact you.
