TMA Opposes Proposed Overreaching Agency Rules

TMA President Stephen L. Brotherton, MD, wrote formal comment letters for the association opposing two state agencies' proposed rules that go too far.

TMA and the Texas Neurological Society wrote a formal letter opposing a Texas State Board of Dental Examiners' (TSBDE's) proposal to allow dentists to diagnose and treat sleep apnea. 

"If a dentist practices outside the scope of dentistry, such as diagnosing or independently treating a sleep disorder, he or she is, by definition, practicing medicine unlawfully," Dr. Brotherton wrote. "It is imperative that diagnoses of the presence or the absence of sleep disorders, including but not limited to benign snoring and sleep apnea, be made by a qualified Texas-licensed physician, in order to protect the health and safety of Texas' patients."

In the letter, TMA cites a 2012 joint policy issued by the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM). The policy asserts, "The evaluation and diagnosis of sleep apnea must be made by a physician, and therapies for sleep apnea, including positive airway pressure and oral appliance therapy, must be prescribed by a qualified physician."

The letter concludes: "The rules as proposed would be in violation of the Texas Medical Practice Act and the Texas Dental Practice Act. We urge the TSBDE to consider these comments and modify its proposed rules as recommended in this letter, in conformity with the Texas Dental Practice Act, the Texas Medical Practice Act, and the policy statements of the Texas Medical Board (TMB), AASM, and AADSM."

Also, TMA wrote a letter to oppose a TMB rule that would require the supervisor of a physician assistant temporary license holder to not only be a Texas-licensed physician with an unrestricted license but also not to have been the subject of a disciplinary order, other than one administrative in nature. 

"A Texas-licensed physician who holds an unrestricted medical license is, by the TMB's own assessment, authorized to perform any medical service or procedure that falls within the scope of his or her license in the state of Texas," Dr. Brotherton wrote. "Thus, he or she should be capable of providing 'adequate supervision' of a physician assistant temporary license holder. The fact that a physician once, perhaps many years ago, had a disciplinary order does not change this assessment."

The letter states that "establishing a requirement that the supervisor must have never been the subject of a disciplinary order is not the appropriate way to measure the physician's current basic competency." 

TMA urges the medical board not to adopt the proposed amendment and adds, "Should the TMB choose to move forward with its proposal over TMA's objection, TMA recommends that the TMB, at a minimum, limit the rule's language regarding ineligibility based upon the supervisory physician's past disciplinary order to disciplinary orders that occurred within the past year."

Action, May 2, 2014


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