You've worked hard your whole life. You've studied for years to enter the medical profession. And you've worked even more diligently since becoming a licensed doctor. Now, you're being subjected to a disciplinary investigation, and it could all go up in smoke.
While the majority of such investigations do not result in a loss of license, you could still be subject to lesser penalties that can adversely affect your career and life. And if you do lose your license, then everything you've worked all your life for will be taken away from you.
Fortunately, there are steps you can take to protect yourself, the most important of which is hiring an experienced attorney. Below, you'll find a detailed resource that provides you with the history of the disciplinary process and the organizations that regulate it, a discussion of the entire scope of that process, information about what you can expect as you go through the investigation, and suggestions about what further steps you can take. None of the information is meant as a substitute for expert legal advice. The best way you can protect yourself is to engage an experienced attorney as soon as you receive notification that you are under investigation.
History of Medical Regulation
In 1845, a physician named Nathan Smith Davis, who practiced in Broome County, New York, and was a delegate to the Medical Society of the State of New York, delivered a report that would shape the course of modern medicine. Serving as chairman of the Society's Committee on Correspondence for Medical Education and Examination, he delivered a resolution expressing concern at the state of medical education in the United States. Without national standards, he worried, professional doctors might not have received the proper education to practice, or worse, might have learned “quack” medicine that didn't adhere to modern scientific principles.
Dr. Davis' report resonated with other medical professionals who took up his suggestion and, two years later, a group of doctors, all affiliated with various state and local medical associations, met in Philadelphia to take their concerns to the national level. The result was the founding of the American Medical Association (AMA), the first national professional medical association in the United States.
Regulation at the State Level
Although today the AMA is a large, powerful, and well-organized institution, numbering over 200,000 members, it proved largely ineffectual at regulating medical practice across the country during the 19th century. Instead, it was mostly left to local state medical boards to enforce what regulation existed in the profession. In 1859, North Carolina became one of the first states to create a medical board, requiring all licensed physicians in the state to be 25 years old and pass a board exam. Other states followed suit, and by 1910, almost all states had their own licensing board.
The movement for states to implement their own licensing standards was given legal justification in an influential Supreme Court case from 1889, Dent v. West Virginia. The case concerned a West Virginia physician named Frank Dent. Dent, whose father and grandfather had also been doctors, had been practicing for six years with his only education coming from apprenticing with his father when West Virginia passed legislation requiring a new set of licensing requirements that Dent did not meet.
Dent continued to work as a physician and was arrested for practicing without a license. After several appeals, the case made its way to the Supreme Court, where it was decided on January 14, 1889. Delivering the verdict for the Court's unanimous opinion, Justice Stephen J. Field upheld the state's licensing requirements. Field wrote that because medicine required such a large body of knowledge and because it dealt with life-and-death circumstances, it was lawful for a state to require physicians to be licensed and that it could legally bar unlicensed doctors from practicing.
The Federation of State Medical Boards
In 1912, the Federation of State Medical Boards (FSMB) was created. Formed from the merger of two previously existing regulatory bodies, the National Confederation of State Medical Examining and Licensing Boards and the American Confederation of Reciprocating Examining and Licensing Boards, the FSMB was an attempt to standardize licensing regulations across the country.
Throughout its existence, the FSMB has expanded, and its influence over the medical profession has grown. Today, it represents all 70 state medical boards (SMBs) in the nation, representing all 50 states, the District of Columbia, and every American territory, as well as separate osteopathic boards in some states. The FSMB’s main goal is to aid these state boards in upholding their oaths to protect public health, safety, and welfare through its licensing and disciplinary actions. To do this, it oversees the national Medical Licensing Exam; creates and maintains the Federation Physical Data Center, a database of physician licensing information; and assists medical boards in creating policy, carrying out their advocacy efforts, and conducting research.
The Changing Role of State Medical Boards
Before the 1960s, state medical boards largely focused their regulatory efforts on both identifying unlicensed medical practitioners and on defending legitimate physicians from incursions onto their field of practice by people in other health professions. The American Medical Association, though, would soon cause a radical shift in this focus.
In 1901, realizing that its efforts at influencing national medical policy had not been effective, the AMA reorganized. Establishing permanent headquarters in Chicago, the association drafted a new constitution that abandoned the focus on state and local chapters and consolidated national origination via a body of elected officials known as the House of Delegates. It also registered itself as a nonprofit corporation.
Under its new structure, the AMA became both increasingly powerful and increasingly effective in raising national standards for medical education. In 1906, it put out its first directory of medical schools as well as its first directory of licensed physicians. It continued to fight against what it perceived as quackery, offering, beginning in 1936, its own Seal of Acceptance for food products that passed certain health standards while refraining from making unproven claims about their medical benefits. And in 1950, it established the AMA Education and Research Foundation to help medical schools and medical students alike meet expenses.
The American Medical Association Steps In
By the early 1960s, then, the AMA had become a well-established organization that had great power in dictating national medical and medical educational policy. In 1961, the organization used this power to weigh in on the responsibilities and achievements of the state medical boards that had been responsible for the licensing and regulation of medical standards. Issuing an official report, the AMA criticized the state boards for their focus on pursuing unlicensed practitioners and defending the scope of physician practice rather than pursuing discipline against licensed physicians that were violating the terms of their professional responsibility.
The AMA called for a shift in their regulatory focus and, especially, for greater transparency in their operations and in their enactment of the discipline process. As a result, over the next couple of decades, the AMA pushed the boards for greater public accountability, and the boards responded. Among the changes made by most state boards included the adding of members of the public to the boards, the formalization of investigative and disciplinary processes, and increased involvement with all aspects of the licensure process, including both the granting and maintenance of licenses.
Today, all 70 state medical boards (including those in Washington, D.C. and the American territories) hold broad powers of regulation and enforcement. Their processes are codified and streamlined, but they are still often subject to criticism from observers. Among the complaints leveled against different boards include a lack of consistency between the different state boards, their allowances for severely disciplined physicians to keep practicing, and the difficulty of navigating their websites and thus of the public's ability to access their findings.
How Do State Medical Boards Work?
Each jurisdiction (state or territory) is governed by an official piece of legislation known as a medical practice act (MPA). These acts are governed and enforced by the jurisdiction's state medical board. There are some differences between the different MPAs—which, as we've seen, is the subject of some criticism by detractors of the system—but they are all subject to the guidelines released by the Federation of State Medical Boards (FSMB).
These guidelines, which are regularly updated, cover all areas of medical oversight, from credentialing to discipline. In recent years, the FSMB has weighed in on such newer issues as social media and electronic communications and the practice of complementary and alternative medicine (CAM) as well. While not all medical practice acts are required to adhere to every aspect of the FSMB's guidelines, there are certain immutable principles that form the basis of every state's MPA. Among these is the administration of the standardized medical license exam in the U.S., the United States Medical Licensing Examination (USMLE), which is carried out in conjunction with the National Board of Medical Examiners (NBME). For osteopathic physicians, an equivalent licensing exam, the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), is administered.
The United States Medical Licensing Examination (USMLE)
First administered in the early 1980s, the USMLE is a three-part examination which “assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.” The goal of the USMLE was to create a standardized test that would be administered by every state medical board. Before the USMLE, there were two major exams that physicians took to gain their licensure, the NBME (National Board of Medical Examiners) Part Examination and the Federation Licensing Examination (FLEX). These were discontinued after the introduction of the USMLE.
The USMLE was created and is owned by two entities, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NMBE). The USMLE is governed by a committee comprised of members of both of those entities, as well as the Educational Commission for Foreign Medical Graduates (ECFMG) and members of the public. The content for the exam is created by special test committees, which include biomedical scientists, educators, and clinicians from every region of the United States. Almost every LCME (Liaison Committee on Medical Education)-accredited medical school has been represented at least once on a test committee.
The USMLE consists of three examinations, called “Steps,” all of which are administered separately. Step 1, known colloquially as “The Boards,” is designed to assess whether the physician candidate can apply concepts of the foundational sciences to the practice of medicine. It consists of up to 280 multiple-choice questions. Step 2 CK (Clinical Knowledge) assesses clinical knowledge through a nine-hour-long multiple-choice exam. Step 3 tests general topics required to understand and practice general medicine. It consists of a combination of multiple-choice questions and clinical case simulations. There was previously another section of the exam, known as Step 2 CS (Clinical Skills), but on January 26, 2021, the FSMB and NBME announced its discontinuation. Once the physician passes all three Steps, they are granted a license and are authorized to practice medicine.
The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA)
The COMLEX-USA is an exam similar to the USMLE, designed for osteopathic physicians (DOs). It is administered by the National Board of Osteopathic Medical Examiners and consists of three examinations, known as “Levels.” Level 1, which is usually taken after completion of the second year of medical school, covers basic medical science. Level 2, taken during the third or fourth year of medical school, has two parts. These are Cognitive Evaluation (CE), which tests knowledge of clinical concepts and medical decision making, and Performative Evaluation (PE), which tests clinical skills. Level 3, which is typically taken after the candidate begins a residency, covers the clinical disciplines of medicine, such as family medicine, emergency medicine, pediatrics, and surgery.
While all osteopathic candidates must take the COMLEX to achieve certification, they may take the USMLE as well. This may give the candidate more opportunities to seek a residency position.
State Medical Boards and Discipline
The Federation of State Medical Board's (FSMB) recommendations about what their member boards should include in their medical practice acts (MPA) has definitively shaped each board's powers of discipline. These recommendations include that the boards have the power to “determine a physician's initial and continuing qualification and fitness for the practice of medicine.” In addition, they recommend that the boards have the power to “initiate proceedings against unprofessional, improper, incompetent, unlawful, fraudulent, deceptive, or unlicensed practice of medicine, and enforce the provisions of the medical practice act and related rules.” Both recommendations have been taken up by the various state medical boards, although some boards have more limited powers of enforcement.
Many of these above-listed categories, especially “unprofessional,” are intentionally vague, and the exact interpretation of this directive is left up to each state medical board to decide. Among the acts that may be considered unprofessional are sexual misconduct, fraud, abuse of alcohol or other legal or illegal substances, felony conviction, performing professional services not authorized by the patient, inadequate record-keeping, failing to meet continuing medical education requirements, deviating from the standard of care, and prescribing drugs negligently.
If a physician commits morally or legally questionable acts not related to his practice, this might also constitute an actionable offense, often designated by the term “moral turpitude.” In the U.S., the term “moral turpitude” refers to “a quality of dishonesty or other immorality that is determined by a court to be present in the commission of a criminal offense.”
Some Differences Between State Medical Boards
Before we deal at greater length with these various offenses and the process by which complaints are carried out, it may be useful to offer a few final notes about some differences and similarities between the various state medical boards. Each state medical board is structured and composed slightly differently. Although nearly all SMBs are comprised of both physicians and public members, the percentages of the makeup vary by state; the FSMB recommends that at least 25 percent of the board be composed of public members, but some boards have a higher percentage.
In addition, some states have separate boards that deal with different functions. In some states, for example, different boards cover licensing and disciplinary functions. In other states, separate SMBs cover medical regulation and osteopathic regulation. These states include Arizona, California, Florida, Maine, Michigan, New Mexico, Oklahoma, Pennsylvania, Tennessee, Utah, Vermont, Washington, and West Virginia.
Finally, the level of autonomy granted to the SMB varies from state to state. While many boards are fully independent agencies, this is not true for all 70 SMBs. Some of them function semi-independently, under the supervision of the state department of health or another regulatory agency. Still others are limited to operating in an advisory capacity.
How the Process Works
The process by which an investigation is launched and carried out is relatively similar in each state. However, the primary difference between different state medical boards, on a practical level, is in how often and severely they choose to discipline physicians. There is some debate as to the usefulness of data released by the FSMB's annual report, which tracks these discrepancies between SMBs, but critics have taken aim at these inconsistencies as one of the flaws of the system.
The actual process follows more or less the same model in every SMB. The processes in New York, Pennsylvania, and New Jersey, summarized below, are typical for the processes in other states.
In New York State, the board is composed of two-thirds physicians and one-third lay members, a percentage which includes physician assistants as well. The physicians are nominated by state, county, and specialty societies, while the lay members are appointed by the Commissioner of Health. The State Board works in conjunction with the New York State Health Department's Office of Professional Medical Conduct (OPMC) to investigate and adjudicate complaints.
The Pennsylvania State Board of Medicine has six physician members, one physician's assistant, two public members, and one member each representing the secretary of health and the board of commissions. The governor appoints all members with state senate advice and consent. The Pennsylvania Department of State, Bureau of Professional and Occupational Affairs helps the Board of Medicine regulate the medical profession in Pennsylvania. The Board of Medicine permits hearing examiners appointed by the Governor's Office of General Counsel to hear disciplinary matters brought before the Board.
New Jersey's Board of Medical Examiners governs both the licensing of physicians in the state and the discipline of licensed physicians. The Board's responsibility is to protect the public's health, safety, and welfare. New Jersey's governor appoints twelve physicians, one podiatrist, three public members, a certified nurse midwife, a physician's assistant, a bioanalytical laboratory director, the Commissioner of Health or his designee, and a government liaison to the Board. The Board establishes practice standards, investigates physician misconduct, and disciplines physicians who violate the Board's requirements. A Medical Practitioner Review Panel appointed by the governor also reviews malpractice actions and hospital adverse-privilege actions against New Jersey-licensed physicians.
The Filing of the Complaint
Complaints can come from several different sources, including a physician's colleagues, their patients, or other members of the public. Public complaints (those filed by patients, their friends, or family members) constitute about half the complaints registered in New York State. Pennsylvania sees around three-thousand complaints against its roughly 50,000 physicians each year, of which around two hundred result in discipline annually. New Jersey sees about a thousand complaints annually against its roughly 27,000 physicians, of which under a hundred result in discipline. While members of the public can choose whether or not to register a complaint, the physician's colleagues (including other physicians, physician assistants, and special assistants) and hospitals offering the physician privileges are required by state law to report practitioners whom they suspect of misconduct. Failure to do so is itself considered an instance of misconduct.
When the complainant decides to submit a complaint, they do so in writing in an official letter. (In some states, the report can be made online.) In New York, the complaint can be directed to several parties. It can be sent directly to the Office of Professional Medical Conduct. If the physician is associated with a hospital, it can be sent directly to the institution's professional practices committee. If they are not associated with a hospital, it can be sent to the county medical society. Both the hospital and the county medical society will then send it on to the OPMC. Pennsylvania complaints go to a Professional Compliance Office in the Department of State. New Jersey complaints go to the Consumer Affairs Division of the Board of Medical Examiners.
If a complainant suspects a practitioner of having problems with alcohol, drugs, or mental illness, they can contact the Committee on Physicians' Health of the Medical Society of the State of New York by phone. This option is reserved for situations where the physician's condition does not impair their ability to practice. Otherwise, a complaint must be made to the OPMC. Pennsylvania and New Jersey have similar intervention programs. Pennsylvania offers a Physician Health Program with its Professional Health Monitoring Program. New Jersey has a Professional Assistance Program and Alternative Resolution Program for impaired physicians. The committee then monitors the physician and helps them find treatment. However, this program is voluntary, and the physician is not required to seek treatment so long as they can still practice without any impairment. Both the call made by the complainant and the identity of any named or participating physician is kept confidential.
What Constitutes Professional Misconduct?
In New York, Article 131-A, section 6530 of the State Education Law is the piece of legislation that officially defines what constitutes professional misconduct. The law outlines a rather lengthy list of the various offenses that meet this definition, a list that totals 50 items. Pennsylvania's State Board of Medicine relies on appointed medical consultants to establish standards of practice but also on 49 Pa. Code section 16.61 et seq. for its list of similar violations. New Jersey's Board of Medical Examiners follows rules at 35 N.J. Admin. Code 13.35-6.1 et seq. proscribing physician misconduct. Among the common offenses are the following:
- Obtaining a license fraudulently
- Practicing the profession fraudulently
- Practicing the profession with negligence on more than one occasion
- Practicing the profession with gross negligence on a particular occasion
- Practicing the profession with incompetence on more than one occasion
- Practicing the profession with gross incompetence
- Practicing the profession while impaired by alcohol, drugs, physical disability, or mental disability
- Refusing to provide professional service to a person because of such person's race, creed, color, or national origin
- Exercising undue influence on the patient, including the promotion of the sale of services, goods, appliances, or drugs in such a manner as to exploit the patient for the financial gain of the licensee or of a third party
- Revealing of personally identifiable facts, data, or information obtained in a professional capacity without the prior consent of the patient, except as authorized or required by law
Examples of Negligence
The list cited above moves from the general to the specific as it progresses. But because the central offenses listed that constitute professional misconduct, such as “negligence” and “incompetence,” are rather abstract concepts, New York State's Department of Health helpfully describes on its website several examples of actions that have warranted legitimate complaints. These include:
- One physician failed to treat a patient with an ovarian cyst, failed to adequately treat another patient with an enlarged thyroid gland, and committed several other offenses revealing his incompetence to practice. As a result, he agreed to surrender his license.
- Another physician prescribed drugs to patients without performing any exams or histories first. This physician prescribed drugs that were too high in number, excessive in dosage, dangerous in their combined side effects, and highly addictive. As a result, this offender's license was revoked.
- Another physician failed to adequately perform ultrasounds on a pregnant patient, failed to perform necessary lab tests, and failed to diagnose an ectopic pregnancy. As a result, her license was revoked for negligence and incompetence.
- Another physician had sexual contact with two patients. This was considered an example of moral unfitness (“moral turpitude”), and he was forced to surrender his license.
- Another physician wrote notes for patients falsely stating they were disabled so they could obtain discount fares for public transportation. She pled guilty in State Supreme Court to fourth-degree criminal facilitation, and her license was suspended for five years.
New York's Medical Board, Pennsylvania's State Board of Medicine, and New Jersey's Board of Medical Examiners will each rely on qualified expert consultants in the specialty field to testify to the standards of practice within each specialty.
What Doesn't Qualify as Professional Negligence?
In many cases, what may seem like negligence, incompetence, or other forms of professional misconduct may arise rather from miscommunication between the physician and the patient. A high number of complaints made to the OPMC concern misunderstandings about diagnoses, treatments, referrals, and billing. These do not constitute professional misconduct and do not warrant an OPMC investigation. Similarly, complaints about a doctor's “bedside manner,” such as that the doctor was rude or indifferent, don't rise to the level of misconduct. Only when the physician willfully harasses, abuses, or intimidates a patient does it become an offense.
The OPMC is also not in the business of adjudicating disputes concerning fees charged by the physician or practice. Overcharging by a physician does not constitute misconduct, but if it rises to the level of outright fraud (such as charging a patient for services not performed), then the OPMC can step in.
Understanding the Process
Once the OPMC receives a complaint, either directly from the complainant or secondhand from a hospital, county medical society, or other institution, it is reviewed by the OPMC's investigative and medical staff. If this staff feels that the actions outlined in the complaint may constitute misconduct, it then assigns the case to an investigator.
Once the investigation is underway, the person assigned to the case typically conducts interviews with the complainant, the physician, and anyone else involved in the case. Physicians under investigation are expected to cooperate fully in the process, both by engaged participation in the interview process and by making available any necessary documents. It is highly recommended that if you are under investigation, you hire an experienced attorney to represent you as soon as you receive notification of the complaint. Legal counsel may be present during interviews or at any other time during the investigation.
If the investigators find sufficient evidence to indicate misconduct, they then present the case to a new committee, known as the investigation committee. This committee will consist of two physicians and one layperson drawn from the board. The committee will then recommend the next course of action, which will be one of the following: a hearing, an additional investigation, a dismissal, or a non-disciplinary warning.
If the committee finds enough evidence to suggest professional misconduct, then the case proceeds to a hearing. The hearing is conducted by another committee, also consisting of two physicians and a lay board member. Both the physician and the state are almost always represented by counsel, and the hearing unfolds in a manner similar to a trial with both sides presenting evidence and calling witnesses. The physician themself is typically called on to testify personally. If the physician does not testify, it generally reflects poorly on them.
After the committee hears and reviews all the evidence from both the physician and the state, it meets together and delivers its ruling, dictating whether a penalty should be assessed and of what it should consist. The decision may be appealed by either the state or the physician. Appeals are then heard by an Administrative Review Board. The Review Board is composed of three physicians and two lay members of the board.
Penalties for Misconduct
If, at the end of the hearing, the committee decides that disciplinary action is warranted, there are a number of different penalties that it may choose to hand out. Although the loss of your license is the most severe of these penalties, it is far from the only, or even the most common, option.
The Federation of State Medical Boards keeps data on the various disciplinary actions taken by the state medical boards. Their most recent statistics date from 2019 and show that the revoking of a physician's license and the voluntary surrender of the license on the physician's part are relatively uncommon occurrences. Out of a total of 8,166 disciplinary actions taken in 2019, only 266 revocations and 548 voluntary surrenders were recorded.
Far more common are less punitive measures that still affect a physician's licensing. The most common of all disciplinary actions is the imposition of a restriction on the license, such as the loss of prescribing privileges. This occurred 1,338 times in 2019. The physician may also face the imposition of a probationary period in which their license is monitored by a state board for a specified period of time (749 occurrences in 2019) or have their license temporarily suspended (710 occurrences).
The committee may also impose lesser penalties that do not affect the physician's licensing. The most common of these is a simple reprimand (1,089 occurrences), followed by administrative actions, non-punitive actions that are issued for minor offenses such as not paying a licensing fee (920 occurrences), the requirement to complete continuing medical education (CME) (773 occurrences), the imposition of specific conditions to avoid further sanction (755 occurrences), and the levying of a fine against the physician (749 occurrences). Community service may also be imposed as a penalty.
Once these penalties are levied, the information is entered into a database that is then made accessible to the public. Any individual can look up their physician or other medical caregiver and see if they had been subject to official discipline.
In addition, the FSMB offers other services that help alert the public to the actions of physicians. Among these is the FSMB Disciplinary Alert Service which is designed to alert a state board when one of its physicians is disciplined in another state. Since many physicians are licensed in more than one state, this service prevents physicians who have been subject to discipline from practicing undetected in another state. Reports from the Disciplinary Alert Service include essential information such as which board took the action, why they took the action, and what the action consisted of.
Facing the Consequences
Any penalty levied by a state board should be taken very seriously. Even if you do not lose your ability to practice medicine, your career may be negatively affected. As mentioned above, even the smallest offense becomes a matter of public record. As a result, any colleague, employer, or patient can search your record in a matter of minutes and see that you have been disciplined. This may result in the loss of patients, the distrust of colleagues, or even the inability to obtain or maintain employment.
Of course, in the case that you do lose your license, either temporarily or permanently, the consequences become far worse. First of all, you are faced with an immediate loss of income. You can no longer earn money as a physician, and you are unlikely to qualify for severance or unemployment benefits. At the same time, your patients are similarly left cold. While you may be able to refer them to another physician, it creates great difficulty for them as well and may lead to a gap in their care.
Other issues that you will face include the difficulty of finding other work. It is certainly not easy seeking employment with the black mark of a lost license on a resume. Eventually, you may be able to get back your license, but it may take several years before you are able to apply for reinstating, and the process can be cumbersome and time-consuming. Then, even if you do get your license back, you may suffer lasting damage to your professional reputation, which can severely affect your livelihood and your ability to perform your job.
An Experienced License Defense Attorney Can Help
For all these reasons, you need an experienced license defense attorney on your side throughout the entire process. A good professional license defense attorney has extensive knowledge of the often highly complex proceedings that you will face and can be an incredible asset to helping save your license from being threatened.
An experienced license defense attorney will serve as your legal representation before the regulatory board at all stages of the complaint, including investigations, hearings, and appeals. Therefore, it is imperative that you hire an attorney as soon as you receive notice that you are under investigation. Your attorney will also provide experienced counsel as to the complaint against you and what it could mean for your career, negotiate with the licensing board directly, prepare your defense if the case goes to a hearing, and coordinate the process of applying for reinstatement if you lose your license.
Don't Gamble with Your Career
You worked long and hard to get where you are today. Simply meeting the demands to obtain a professional license can be grueling in and of itself. Your entire career and livelihood hinge on that license. Don't allow a misunderstanding or lapse in judgment to put that future in jeopardy, and don't take unnecessary chances with your future.
Attorney Joseph D. Lento has helped many clients save their professional licenses from suspension and revocation. He understands the inner workings of the regulatory boards in New Jersey, Pennsylvania, and New York, and he knows how to help you navigate the process to the best possible outcome for you and for your career.
If your license is in jeopardy, every minute counts. Reclaim your life and your career today. Call the Lento Law Firm at (888) 535-3686 today or contact us online to discuss your case and evaluate your options.