# Answering a licensing board complaint without a lawyer can make it worse

By Kevin Stevenson · Published 2026-10-05 · Healthcare on MarketScale
Canonical: https://www.marketscale.com/industries/healthcare/answering-a-licensing-board-complaint-without-a-lawyer-can-make-it-worse
Creator hub: I Don't Care

> Don't respond to a licensing board complaint alone. Learn why the first 24 hours matter and how attorneys prevent damage to your license.

## Key points

- Licensing boards evaluate complaints based on documentation and evidence, not emotional rebuttals or simple denials, so responses require attorney expertise to avoid creating new problems.
- Many complaints against healthcare professionals lack credibility, but boards still require a substantive response with records, making premature or unguided answers risky to your license and career.

A clinician gets a letter from a licensing board. Before an attorney ever sees it, the clinician may already be drafting a response.

The complaint is unfair. The patient misunderstood. The record will explain everything.

That impulse is understandable. It can also make a hard situation worse.

Healthcare attorney Kenda Dalrymple argues that defending a professional license takes more than confidence in the care you provided. You have to know the process, write a careful response and get experienced guidance before frustration takes over. When a livelihood, a reputation and a professional identity are on the line, she says, the first moves count most.

Dalrymple is managing partner of Dalrymple, Shellhorse & Diamond, LLP in Austin. After roughly a decade in medical malpractice defense, she built a practice representing physicians, nurses, pharmacists and mental health professionals before their licensing boards. She made her case on I Don't Care with Dr. Kevin Stevenson, a former hospital CEO and COO. The two have been friends for more than four decades, going back to their college days at Baylor, so the talk about pressure, mistakes and responsibility was unusually blunt.

## The first calls go to the insurer and the lawyer

Stevenson asked the question every licensed professional dreads: what should you do first, and what's the biggest mistake people make in the first 24 hours? Dalrymple's answer starts with something easy to say and hard to do. Don't panic.

Next, call your professional liability insurer. Dalrymple pointed out that anyone with a professional license probably carries this coverage, and reporting a complaint is a condition of that coverage. If you don't report it, the carrier can cancel your insurance.

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After the insurer, call a lawyer. If you already work with one, start there. If you don't, Dalrymple said the insurance company will connect you with someone who handles licensing matters, and that person can explain how the process works. What she warned against most firmly was feeling pressure to answer the complaint right away, or answering it yourself.

"Back in the old days when things were different and the world was young, you could get a complaint you knew was completely bogus, and you could answer it yourself," she said. "Those days are gone. There is a right way and a wrong way to put together a complaint response to any licensing board, and you need somebody with the expertise to walk you through that."

## A complaint does not have to seem credible to require a serious response

Dalrymple described complaints that cover almost anything. A surgeon may face one after a disappointing result. She mentioned a friend on her fourth knee replacement revision, not because anyone did anything wrong, but because her anatomy and the implant parts just don't work well together. A nurse may be accused of doing, or failing to do, something while caring for a patient. A mental health professional may hear that a client didn't like what was said, or felt they weren't believed.

Some complaints barely match anything the clinician remembers. One of Dalrymple's current clients is answering an allegation that bears no resemblance to the single session she recalls having with the complainant three years ago. She suspects the complainant may have her mistaken for someone else. That still doesn't get her off the hook. "You can't file a response with your licensing board that just says, Uh-uh. Didn't happen," Dalrymple said. "It doesn't work that way."

The reason comes down to what a board can actually weigh. Dalrymple pointed to therapists who treat children of divorcing parents. A parent who didn't choose the therapist can file a complaint, and the therapist then has no choice but to end treatment and refer the child elsewhere. In her view, many complaints against mental health professionals are rubbish, and complainants face no downside for lying.

She said a member of the executive staff at the Texas Behavioral Health Executive Council (BHEC), the umbrella agency that licenses all of the state's mental health professionals, has acknowledged publicly that many complainants are not credible. So the board counts on the licensee to show what really happened, with the records to back it up.

That's why an emotionally satisfying rebuttal is risky. A clinician may believe a complaint is completely unfounded, but the board still needs a response it can evaluate. Telling your side of the story can leave key questions unanswered or create problems you didn't see coming.

### Good clinicians, thin records and bad luck

Asked whether most complaints involve bad clinicians, Dalrymple said the pattern depends on the profession. Sometimes good professionals make poor decisions. Often, she said, they're good professionals doing what they should, but their documentation is terrible.

Pharmacy is its own case. Dalrymple called it the single most regulated profession in Texas and described the modern community pharmacy as "literally the sweatshop of the twenty-first century." Pharmacists work twelve-hour shifts, and the smallest lapse can trigger a board inspection. Failing to offer counseling on a new medication used to be a big one. She said that has faded because electronic record systems now won't let pharmacists log out until they click that counseling was offered.

She also said plain bad luck plays a bigger role than people expect. She has seen clients practice for thirty years without incident, then get several complaints in quick succession, the way people say celebrities die in threes. Stevenson added a friend in Waco, a physician he described as meticulous, who has been fighting one case for five years because someone had a bone to pick, kept at it and got traction.

Stevenson also knows how fast an unexpected outcome turns into conflict. Grief, he said, triggers a lot of these complaints, and some people are looking for a payday. Patients and families may be frightened, grieving or searching for an explanation.

He told one on himself. After an emergency laparoscopic appendectomy, still on pain medication, he saw the incisions on his left side, decided the surgeon had operated on the wrong side, and told his wife they were about to be rich. She called him an idiot. The next morning he remembered that the procedure goes in from the other side. Patients who start spinning like that, he noted, are what hospitals and Dalrymple's clients deal with all the time.

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## A regulatory climate she says breeds fear, not safety

Stevenson asked the bigger question behind all this: as healthcare gets more litigious and more regulated, are we creating safer care or clinicians who are afraid to practice? "I think it is much more of the latter," Dalrymple said.

She said she couldn't think of a single administrative regulation from the medical board, the nursing board, BHEC or the pharmacy board that could be credited with saving a particular person's life. She allowed that, taken together, some rules might make something like a drug interaction less likely. Her larger complaint is philosophical. She sees medicine and advanced practice nursing as "one of the last vestiges of art, education, training, and science," and argues that regulators want medicine to be a recipe the clinician follows. That distrust of judgment and intuition, in her view, shapes how heavy an agency's rules become.

She has felt it personally. About seven or eight years ago, after a twelve-hour day at the nursing board that ended with her client's case dismissed, she drove back to the office and told her law partners the nursing cases were theirs from now on. It wasn't the nurses or the clients, she said. It was the regulatory environment. "To say it's unfriendly is an insult to unfriendly people."

Stevenson, who left the C-suite almost a year ago, said the disillusionment he hears from physicians is astounding. They aren't tired of patient care, he said, but of the administrative weight around it, and many are stepping away or going entrepreneurial to get more control over their lives. He put the share of physicians now employed by a health system, insurer or similar organization at 80% and said nurses have been leaving the profession since right before COVID over documentation and litigation.

Dalrymple has lost track of the clients who told her they wouldn't pay a dollar toward their kids' education if they chose medical school. That stings, she said, because some professions run in families. Pharmacists do. Paramedics do. Doctors used to.

Her case for why that matters is a client who bought a medical practice without doing his due diligence ("Boys and girls, you gotta do your due diligence. Gotta call your lawyer") and endured a multiyear medical board case. Afterward he took a job just to decompress. Riding an elevator, he noticed an executive who didn't look well and asked a few questions. He couldn't shake it, researched it that night and the next morning told the man to get blood work. It was a rare leukemia, caught very early. "A really wonderful doctor is still nothing short of a miracle," Dalrymple said.

## AI can help write the note. The clinician still owns it.

If the record is what a board weighs, how the record gets written matters. Technology can cut the administrative work, but it also makes complacency easier. Dalrymple said she hasn't seen a doctor in three or four years who didn't use some kind of scribe. She gets why. A physician can't examine a patient and type notes at the same time, and she said the medical board's rules on what counts as an adequate record are "ridiculously complicated." In her words, the board wants "the great American novel in every client note."

She sees real value in tools that help with transcription and documentation. She described AI built into some therapists' electronic health record systems that records the session and produces a transcript. Once the therapist opens it, the recording is gone and can't be recovered, so the note has to be finished then and there. The therapist can edit the transcript down, and it helps with what she called "white screen syndrome."

She urged anyone using these tools to ask two questions. First, is the vendor collecting, keeping or reselling data from how you and your patients use the platform? Are you, as she put it, making the AI company rich by feeding it a never-ending stream of free data? Second, will you use the tool wisely, or get complacent and let it stand in for your education, training and experience?

The second question is where she sees the biggest problem. She cited a California lawyer losing his license after being caught three times filing AI-written briefs with made-up case citations he never checked, and a judge facing sanctions for an AI-drafted opinion with unchecked citations. She has no objection to lawyers using AI for discovery requests or deposition summaries, which she called boring law clerk work.

But the professional is still the captain of the ship, and you don't set it on autopilot and never check on it. She recalled a line from her practice court professor at Baylor, Louis Muldrow.

> Your clients aren't paying you to trust your secretary. — Louis Muldrow, as recalled by Kenda Dalrymple

In a clinical setting, that means a generated note still needs review. A polished summary can contain an error, and a tool's ability to produce convincing language says little about whether that language matches what happened in the room.

For organizations adopting AI, the work continues after go-live. Clinicians need to understand their tools, check the output and stay accountable for the final record. Leadership needs to make those expectations clear. The time saved is valuable. So is the attention it takes to catch something wrong.

## The response to a mistake can change everything

One of Dalrymple's most telling stories involved a spine surgeon who discovered that a screw had been missed during a lengthy procedure. She said the surgeon told the patient's husband what had happened, took responsibility and explained the plan to fix it. He later spoke with the patient directly, apologized and documented the circumstances.

He could have blamed someone else involved in the procedure. He chose to own the error. Dalrymple said the licensing board dismissed the case after reviewing his care and his response. Later, a physician who had questioned him during the board proceeding brought his own daughter to the surgeon for a consultation. Owning the mistake had earned that physician's trust.

The story makes a point that runs through the whole conversation. An adverse event deserves careful examination, and how the clinician responds matters. Candor, corrective action and documentation give patients, families and reviewers something concrete to assess. It's the opposite of the reflexive rebuttal Dalrymple warns against when a complaint first lands.

## Accountability has to survive the uncomfortable conversation

Stevenson tied the spine surgeon's story to his own experience talking with patients and families after something went wrong in a hospital. Those conversations are hard. Leaders have to say what is known, explain what happens next and resist hiding behind institutional language. Patients and families want answers and want their concerns acknowledged. When an error has happened, they want to know how it will be addressed.

Dalrymple also talked about what clinicians carry after a serious mistake. She described a pharmacist involved in a fatal medication error who examined what had happened, took part in the board process and eventually went on to medical school and a career treating critically ill children. It's a painful story about consequences and resilience. It also asks leaders how they support professionals through an event that may change the course of their lives.

An organization's commitment to accountability shows up in these moments: how thoroughly it investigates, how honestly it communicates, what it changes and how it treats the people involved. Dalrymple kept coming back to the everyday habits that sustain a practice: vigilance, continued learning, professionalism and reliable support. They sound ordinary until the board letter arrives. Then they decide whether the response helps or hurts.

That leaves clinicians and executives with a hard question. When something goes wrong, are they ready to take responsibility and do the work that follows, starting with the call to the insurer and the lawyer instead of the draft written in frustration?

Tags: licensing boards, healthcare compliance, professional license defense, attorney guidance, regulatory defense

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