What should I do if a senior consultant is inappropriately prescribing medications and altering medical records, and the hospital administration has dismissed my concerns?

Report to the Medical Regulatory Authority

You must report this consultant directly to the medical regulatory authority (licensing board) immediately. 1

Why Direct Reporting to the Regulatory Authority is Mandatory

Falsifying medical records and prescribing unnecessary medications constitute clear evidence of unsafe practice that poses an immediate threat to patient safety and requires mandatory reporting to the state licensing board. 1 This is not a discretionary matter—the American Academy of Pediatrics explicitly states that "clear evidence of what constitutes poor or unsafe practice" includes "falsifying medical information" and that "incompetence that poses an immediate threat to the health of [patients] should be reported directly to the state licensing board." 1

Why Other Options Are Inadequate

Remaining Silent is Unethical

• Physicians have an explicit ethical obligation to report colleagues whose behavior falls below minimum standards, particularly when patient safety is at stake. 1
• The primary professional obligation is patient safety, which supersedes concerns about collegiality or institutional politics. 1
• Emergency medicine guidelines reinforce that "when any physician is found deficient in competence or character through appropriate peer review process, it is morally imperative to protect patients." 1

Talking Directly to the Consultant is Insufficient

• While direct communication might be appropriate for minor performance issues or stress-related problems, falsifying medical records is intellectual dishonesty that requires formal reporting. 1
• The consultant's behavior demonstrates deliberate deception rather than inadvertent error, making informal resolution inappropriate. 1

The Hospital Administration Has Already Failed

• You already informed hospital administration and they dismissed the issue, demonstrating institutional failure to protect patients. 1
• Waiting for the hospital to act when they have already declined to do so places patients at continued risk. 1
• The American Thoracic Society guidelines acknowledge that institutional review processes may have "financial or relational conflicts of interest" that prevent appropriate action. 1

The Reporting Process

Immediate Actions Required

• Document all specific instances you have observed, including dates, patient identifiers (if permissible), medications prescribed, and record alterations. 1
• Report directly to your state medical licensing board without delay, as this bypasses the failed institutional response. 1
• Consider also reporting to the hospital's peer-review body and Joint Commission if sentinel events (serious patient harm) have occurred. 1

Protection for Reporting Physicians

• Physicians who conscientiously fulfill this reporting responsibility should be protected from adverse political, legal, or financial consequences. 1
• Most jurisdictions provide legal protection for good-faith reporting of physician misconduct. 1
• The reporting should be done "with discretion and sensitivity, and with a clear intention to help the impaired physician progress toward treatment and recovery," but this does not diminish the obligation to report. 1

Critical Distinctions in This Case

This is Not About Performance Variation

• The guidelines acknowledge reluctance to report colleagues when there is "lack of absolute clinical guidelines" or "acceptable degree of variation in practice." 1
• However, falsifying medical records is not practice variation—it is fraud. 1
• Prescribing medications patients do not need and then altering records to justify this constitutes both patient harm and professional dishonesty. 1

This Requires External Oversight

• Internal hospital mechanisms have already failed by dismissing your concerns. 1
• The regulatory authority exists precisely for situations where institutional oversight is inadequate. 1
• Patient safety cannot be ensured through a system that has already demonstrated unwillingness to act. 1

Common Pitfalls to Avoid

• Do not assume the hospital will eventually address this—they have already shown they will not. 1
• Do not delay reporting while gathering "more evidence"—you have already observed a pattern of falsification. 1
• Do not attempt to handle this through informal channels alone—the severity of the misconduct requires formal regulatory intervention. 1
• Do not be deterred by concerns about being labeled a "whistleblower"—your professional obligation to patient safety supersedes institutional loyalty. 1