In July 2004, the Virginia Board of Medicine adopted what is apparently the first United States sanction reference point system for regulatory disciplinary cases. In preparation, the Virginia Board of Health Professions spent two years collecting and analyzing data on the board's sanctions for a six-year period. Over 100 different factors were collected for almost 500 cases.  Using this historical data, researchers constructed a database of offense and respondent factors which potentially influenced the sanctioning decisions in the cases.  Sanctioning worksheets and grids were then created.  

The Sanctioning Reference Points system is intended as a tool for the Board of Medicine, which maintains full discretion to sanction as it chooses.  The system is not applied for formal hearings, mandatory suspensions, compliance/reinstatements, or action by another board. 

The Sanctioning Reference Points are organized into five offense groups: impairment, patient care, inappropriate relationship/sexual abuse, fraud/deception/misrepresentation, and unlicensed activity. The Sanctioning Reference Points Instruction Manual says the purposes and goals for the new system include:
     - Making sanctioning decisions more predictable
     - Providing an education tool for new board members
     - Adding an empirical element to a process/system that is inherently subjective
     - Providing a resource for the Board of Medicine and those involved in proceedings
     - "Neutralizing" sanctioning inconsistencies
     - Validating board member or staff recall of past cases
     - Constraining the influence of undesirable factors-e.g., board member ID, overall board makeup,   
         race or ethnic origin, etc.
     - Helping predict future caseloads and need for probation services and terms

In every case eligible for scoring, the Board will complete the worksheet for the appropriate offense.  Based on the results of the worksheet, the sanctioning grid will indicate the recommended sanction range which is representative of 70% of past cases.  The Board is free to depart form the recommended sanction if aggravating or mitigating factors are involved.  The worksheets are open to appropriate revision to reflect current Board practice if a particular reason for deviating from the recommendation is continually cited.  The general sanctioning outcomes available are recommend formal or accept surrender, reprimand, treatment/monitoring, or no sanction.  The Board then establishes a more detailed sanction based on the individual case circumstances.  

This is the first of what will eventually be 13 sets of different reference points, one for each departmental board since, as Elizabeth Carter, Executive Director of the Virginia Board of Health Professions says, "Each health regulatory board hears different types of cases, and as a result, considers different factors when determining an appropriate sanction." Questions about the model may be addressed to Elizabeth A. Carter.

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