State Medical Boards vs. COVID-19 Misinformation, an Update

During the early COVID-19 years, state medical boards found themselves in a strange new job description: part patient-safety regulator, part emergency-response referee, and part unwilling bouncer at the world’s loudest online debate club. Physicians were not only treating patients in clinics and hospitals; some were also broadcasting sweeping claims about vaccines, masks, ivermectin, hydroxychloroquine, hospital protocols, government motives, and miracle cures. Some claims were careful and evidence-based. Others were the medical equivalent of juggling chainsaws in a crowded waiting room.

The result was a high-stakes question that still matters today: when a licensed physician spreads COVID-19 misinformation, should a state medical board step in? The updated answer is more complicated than “yes” or “no.” State medical boards have authority to protect patients from incompetent, negligent, deceptive, or unsafe medical practice. But they also operate in a constitutional environment where free speech, scientific debate, due process, and political pressure all collide. In other words, the boards are not simply moderating a Facebook thread with a stethoscope emoji. They must prove misconduct under state law.

This update explains where things stand now: the rise of board warnings, the limited number of actual disciplinary cases, the California law that came and went, the Washington cases that tested the line between speech and medical practice, and the practical lessons for physicians, patients, health systems, and regulators.

Why COVID-19 Misinformation Became a Medical-Board Issue

Medical misinformation is not new. Snake oil had excellent marketing long before social media discovered hashtags. What changed during COVID-19 was speed, reach, and credibility. A false claim from an anonymous account is one thing; the same claim from a licensed physician, wearing a white coat and using professional credentials, lands differently. Many patients understandably assume that “doctor said it” means “science said it.” That is why state medical boards and professional organizations became concerned when some clinicians publicly contradicted established evidence on vaccines, treatments, and prevention.

The Federation of State Medical Boards warned in 2021 that physicians who generated and spread COVID-19 vaccine misinformation or disinformation could risk disciplinary action, including suspension or revocation of a medical license. In 2022, the FSMB adopted broader professional expectations on medical misinformation and disinformation, emphasizing that truthful, scientifically grounded communication is central to informed consent and public trust.

Those statements did not create a single national rule. In the United States, medical licensing is state-based. Each board works under its own medical practice act, procedures, definitions, evidentiary standards, political environment, and disciplinary tools. That is why the national response has looked less like one clean federal policy and more like a 50-state potluck dinner: some boards brought strong policy statements, some brought case-by-case enforcement, and some brought awkward silence next to the potato salad.

What State Medical Boards Can Actually Do

State medical boards generally do not punish physicians for being unpopular, contrarian, or politically inconvenient. Their core job is to protect the public from unsafe medical practice. In misinformation cases, discipline is usually strongest when the speech is tied to patient care, medical records, prescribing, informed consent, fraudulent advertising, or clear departures from the standard of care.

Common grounds for discipline

Boards may act when a physician’s conduct involves negligence, gross negligence, incompetence, false or misleading advertising, inappropriate prescribing, failure to keep adequate records, failure to obtain informed consent, or refusal to cooperate with an investigation. That distinction matters. A doctor saying something reckless on a podcast may raise ethical concerns, but a doctor telling a high-risk patient to skip evidence-based treatment while prescribing an unsupported drug without proper consent gives regulators a much clearer patient-safety case.

In short, boards usually prefer a paper trail: patient charts, prescriptions, documented advice, complaints, expert testimony, and evidence of harm or unreasonable risk. A viral clip can start a complaint, but it rarely finishes the case by itself.

The California Experiment: AB 2098 and Its Repeal

California became the national lightning rod with Assembly Bill 2098, a law that made it unprofessional conduct for physicians to provide COVID-19 misinformation or disinformation to patients under their care, when that information conflicted with the standard of care. Supporters argued that doctors with public trust should not be free to mislead patients during a deadly pandemic. Critics argued that the law was vague, chilled legitimate medical discussion, and allowed the state to police scientific disagreement.

The law quickly faced lawsuits. A federal court challenge raised First Amendment concerns, and the legal battle became a symbol of the broader fight over public health authority. Then California repealed the specific COVID-19 misinformation provision through SB 815. In 2024, the Ninth Circuit treated the challenge as moot because the law had been repealed and there was no clear indication that California would reenact the same statute.

The key lesson from California is not that boards lost all authority. They did not. California’s medical board, like other boards, still has traditional power to discipline physicians for standard-of-care violations, negligence, fraud, improper prescribing, poor records, and other professional misconduct. What disappeared was the special COVID-19 misinformation statute. Regulators were effectively pushed back toward the older, more familiar tools of medical discipline.

Washington’s Approach: Treat COVID-19 Like Other Medical Care

The Washington Medical Commission took a different approach. It stated that COVID-19 prevention and treatment should be assessed like any other disease process and that misinformation about treatments, vaccines, and preventive measures could endanger patients and erode trust. That framing avoided creating a separate “COVID speech crime” and instead placed COVID-related advice inside existing medical-practice standards.

Washington cases also show how regulators try to connect misinformation to clinical conduct. In one major dispute involving COVID-19 claims, ivermectin, patient advice, and online medical statements, the issue was not simply whether a physician had unpopular views. The regulatory focus included whether advice was directed to patients and health consumers, whether the physician failed to provide appropriate informed consent, whether treatments lacked support, and whether patients faced unreasonable risk. Courts examining these matters have paid close attention to whether the conduct was part of the practice of medicine rather than a purely private opinion shouted into the internet void.

The Enforcement Reality: Far Fewer Cases Than Headlines Suggest

For all the noise, actual medical-board discipline for misinformation has been rare. A JAMA Network Open study of disciplinary proceedings in the five most populous states found that misinformation-related discipline represented less than 1% of identified disciplinary offenses. Spreading misinformation to the community was especially uncommon as a basis for discipline, while patient-directed misinformation appeared more often but still rarely. Negligence, record-keeping problems, and inappropriate prescribing remained far more common grounds for discipline.

This finding cuts both ways. Public-health advocates see a serious enforcement gap: physicians can reach huge audiences with harmful claims, while boards move slowly and discipline only a tiny fraction of cases. Civil-liberties advocates see the same data and say, “Goodthat is how it should be,” because licensing boards should not become roving speech police. Both sides have a point. The hard part is designing a system that protects patients without making honest clinical debate feel like stepping on a legal landmine.

Specific Examples That Show the Pattern

Ohio: investigation cooperation mattered

One Ohio physician became nationally known after making highly controversial claims about COVID-19 vaccines, including claims involving magnetism and cell towers. The state medical board received hundreds of complaints and opened an investigation. Her license was later suspended not because the board completed a full misinformation finding, but because she failed to cooperate with the investigation. The license was later reinstated after she agreed to cooperate and pay a fine. That case shows a recurring board strategy: when the speech issue is legally messy, failure to comply with lawful investigative procedures may become the cleaner disciplinary hook.

Arkansas: civil litigation and board inaction can coexist

In Arkansas, former jail inmates settled a lawsuit involving ivermectin allegedly given for COVID-19 without adequate consent. The physician denied wrongdoing, and the state medical board took no action after complaints. The lawsuit settlement and the board’s inaction demonstrate that civil claims, public controversy, and professional discipline do not always move together. A board may decide that a case does not meet its disciplinary threshold even when patients pursue separate legal remedies.

Connecticut and Texas: boards focus on care, records, and protocols

More recent disciplinary examples involving ivermectin and COVID-19 show boards focusing on clinical justification, documentation, vaccine-exemption letters, patient follow-up, hospital privileges, and interference with care. That pattern is important. Regulators are more likely to succeed when they can show that the physician’s conduct created a concrete patient-care problem, not merely that the physician expressed a controversial belief.

Free Speech vs. Professional Duty

The First Amendment does not disappear when someone earns a medical degree. Physicians can criticize agencies, debate studies, question policy, and discuss uncertainty. Science advances through challenge, correction, replication, and occasionally someone saying, “Wait, are we sure?” That process should not be criminalized or professionally punished simply because it is inconvenient.

At the same time, a medical license is not a magic shield for false, deceptive, or dangerous professional conduct. When a physician gives individualized medical advice, sells services, advertises treatments, issues exemptions, prescribes drugs, or presents unsupported claims as established medical fact, the board’s patient-protection role becomes stronger. The line is not always bright, but it is real: public commentary receives more constitutional breathing room; patient-directed professional conduct receives more regulatory scrutiny.

The Ivermectin Problem: Off-Label Use Is Not the Same as Evidence

Ivermectin became one of the most controversial symbols of the pandemic. The drug has legitimate approved uses for certain parasitic infections. But federal regulators have not authorized or approved it for preventing or treating COVID-19, and major infectious-disease guidelines have recommended against its use for COVID-19 outside appropriate research settings. This distinction is often lost in online arguments. “A drug is real” does not mean “a drug works for every condition mentioned in a viral post.” Aspirin is real too, but nobody should use it to fix a broken staircase.

Boards generally do not discipline physicians merely because they prescribe a medication off-label. Off-label prescribing is common in medicine and can be appropriate. The regulatory concern arises when prescribing is unsupported by evidence, not clinically justified, not properly documented, not accompanied by informed consent, or used in a way that delays evidence-based treatment for a patient at risk of serious illness.

Why Boards Have Moved Slowly

There are practical reasons discipline has been limited. Boards are complaint-driven and often understaffed. Investigations require records, witnesses, expert review, due process, and time. Many complaints involve public statements rather than identifiable patients. A board may receive a screenshot of a social-media post but have no patient name, no chart, no prescription, and no evidence that anyone relied on the claim. That makes enforcement difficult.

Boards also face political pressure. Some lawmakers have criticized boards for pursuing physicians who challenge public-health consensus. Other lawmakers and health advocates have criticized boards for doing too little. In several states, “medical freedom” movements have pushed laws designed to protect clinicians from discipline for certain COVID-related opinions or treatments. The boards are standing in the middle, holding a clipboard, while everyone throws tomatoes from opposite balconies.

What a Better Regulatory Approach Looks Like

The most defensible approach is narrow, evidence-based, and patient-centered. Boards should not punish doctors for good-faith debate, uncertainty, or evolving scientific interpretation. They should act when a physician uses professional authority to mislead patients, sell unsupported treatments, falsify records, ignore informed consent, or create unreasonable risk of harm.

Clear standards help everyone

Boards should define misinformation carefully, focus on verifiable claims, and distinguish between public commentary and patient care. They should rely on expert review, current clinical evidence, and established standards of care. They should also explain decisions plainly. A good disciplinary order should show exactly what conduct violated professional rules, why it fell below accepted standards, and how it put patients at risk.

Education should come before punishment when possible

Not every wrong statement deserves a career-ending penalty. Some clinicians repeat outdated information, misunderstand early studies, or fail to update guidance as evidence changes. Corrective education, ethics courses, record-keeping requirements, monitoring, and public clarification may be appropriate in less severe cases. Discipline should be stronger when conduct is repeated, intentional, financially motivated, patient-specific, or linked to harm.

What Physicians Should Do Now

Physicians can reduce risk by practicing the same habits that make medicine trustworthy: cite evidence, acknowledge uncertainty, update recommendations, document informed consent, avoid miracle-cure language, and separate political opinion from clinical advice. If a patient asks about a controversial treatment, the best answer is not a slogan. It is a careful discussion of risks, benefits, alternatives, evidence quality, and what major guidelines say.

Online, physicians should remember that credentials travel with them. A casual post can look like professional advice to the public. Humor is fine. Debate is fine. But declaring unsupported claims as settled truth while selling a protocol, supplement, webinar, or telehealth service is where the ice gets thin.

What Patients Should Take Away

Patients should not assume every licensed physician online represents mainstream medical evidence. Credentials matter, but so do context, specialty, transparency, and whether the advice matches reputable guidelines. If a doctor recommends a treatment that major medical organizations do not support, patients should ask: What is the evidence? What are the risks? What are the alternatives? Is this approved or recommended for my condition? Will delaying standard care make me worse?

The best medical conversations are not built on blind trust or reflexive suspicion. They are built on questions, evidence, and humility. A trustworthy physician does not need to pretend that science is perfect. A trustworthy physician explains what is known, what is uncertain, and what decision makes sense for the patient sitting in front of them.

Field Notes: Experiences From the COVID-19 Misinformation Era

The most practical experience from the past several years is that misinformation rarely arrives wearing a villain costume. It often sounds caring, confident, and simple. A patient hears, “They are hiding the cure,” and the sentence feels less frightening than “You have risk factors, the virus is unpredictable, and we need to act quickly.” Simplicity is emotionally powerful. Unfortunately, simple is not always safe.

Clinicians who worked through the pandemic often describe the same pattern: patients came in with screenshots, podcast clips, family group-chat warnings, and lists of medications they wanted before anyone had checked oxygen levels or kidney function. Many doctors and nurses did not experience misinformation as an abstract “public discourse” problem. They experienced it as delayed care, refused vaccination, arguments at the bedside, and families torn between a medical team and an influencer with studio lighting.

State medical-board staff faced a different kind of frustration. Complaints poured in, but many were difficult to investigate. A member of the public might report a physician’s viral video, but the board still needed jurisdiction, patient records, evidence, and a legal theory that matched state law. People expected instant action. Boards moved at the speed of subpoenas, hearings, expert reports, and administrative procedure. That gap made boards look passive even when investigations were quietly underway.

Patients learned hard lessons too. Some discovered that a confident online doctor may not know their medical history, medication list, pregnancy status, immune condition, or oxygen saturation. A 90-second video can feel personal, but it is not a medical exam. The pandemic reminded many families that individualized care matters, especially when risk factors are involved.

Hospitals and medical groups also learned that internal policies matter. Clear rules on public communication, credential use, treatment protocols, informed consent, and social-media conduct can prevent confusion before it becomes a board complaint. Physician leaders found that silence was not neutral when misinformation affected patient decisions. They had to communicate better, not merely discipline harder.

For responsible physicians, the experience was sobering. Many wanted space to discuss changing evidence without being accused of misinformation. That concern is legitimate. Public health guidance did evolve, sometimes clumsily. But the strongest clinicians responded by becoming more transparent: “Here is what we thought then, here is what we know now, and here is why the recommendation changed.” That kind of honesty builds trust better than pretending science never updates its software.

The final experience is perhaps the most useful: trust is slow to earn and fast to spend. Medical boards cannot rebuild public trust alone. Neither can courts, agencies, hospitals, or professional societies. Trust grows when physicians communicate with accuracy, humility, and accountability. It grows when boards discipline real misconduct without overreaching into legitimate debate. And it grows when patients are treated as partners, not targets in an information war.

Conclusion

The update on state medical boards vs. COVID-19 misinformation is not a story of sweeping crackdowns. It is a story of cautious enforcement, legal pushback, uneven state action, and a continuing struggle to define professional responsibility in the age of viral medicine. California’s repealed law showed the danger of broad, contested statutes. Washington’s patient-care approach showed how boards can rely on traditional standards. Research showing very low discipline rates reveals how hard enforcement can be, especially when misinformation spreads publicly rather than through documented patient encounters.

The best path forward is not censorship, and it is not professional anarchy. It is disciplined accountability: protect scientific debate, but act when licensed professionals use medical authority to mislead patients, sell unsupported treatments, or create unreasonable risk. In medicine, words can be part of treatment. When those words are false, careless, or deceptive, they can also become part of the harm.