Licensure Should Stay Intact

TMA Testimony by Gary Floyd, MD

Sunset Advisory Commission
Testimony on Sunset Staff Report: Department of State Health Services

July 25, 2014

Good afternoon, Madame Chair and members of the commission. My name is Dr. Gary Floyd. I am a pediatrician, and I serve as chief medical officer at the John Peter Smith Hospital in Fort Worth and the Tarrant County Hospital District. I am board certified in pediatrics. I’m also a member of the Texas Medical Association (TMA) Board of Trustees and represent more than 47,000 members. My comments today will focus on the regulation of various health care providers under DSHS Sunset Recommendation No. 3.

We definitely agree with the suggestion of sunset staff to reduce the size and footprint of DSHS and that shrinking the regulatory tasks of DSHS is needed. 

However, TMA and JPS are concerned about the proposal that would eliminate licensure of critical health care professions such as medical physicists, radiologic technologists, perfusionists, and respiratory care practitioners. Each of these health care providers has a specialized and unique role in patient care. They each administer medications to patients, they make entries into patients’ medical records, and they are valuable members of physician-led health care teams.  

Hospitals and the physicians who staff these facilities — rely upon the state to verify the license and qualifications for each of these skilled providers. I was dismayed by testimony yesterday that this is a very cursory process. While a number of them do indeed have national certification, it is helpful — if not critical — that an appropriate state licensure process be in place to ensure each and every professional group maintains its qualifications, upholds standards of practice … and ultimately ensures safe, high quality patient care.  

What we really need are standardized processes for licensing similar to medical, dental, and nursing boards for ALL health care providers. Otherwise the burden of proof falls on facilities which employ or contract with these providers and many of those facilities do not have the infrastructure to carry out such investigations.

Perfusionists are a good example – anesthesiologists use to be trained on the workings of the heart-lung bypass machines, but now, the complexitites of the machines have increased and this is no longer part of their training. Everyone the CV suite is dependent on the Perfusionists knowing their jobs – the patient’s very life depends on the Perfusionist’s expertise. 

Our state should help ensure accountability for all providers who have the privilege of delivering direct patient care in our state.  

If it’s not possible to keep the licensure and regulatory functions of these providers in their current location, TMA and JPS would oppose placement at the Texas Department of Licensing and Regulation (TDLR). TDLR does not have appropriate leadership, resources, or background in health care policy or public health matters. We would suggest a more relevant location would be the Texas Medical Board (TMB). Each type of provider could maintain its independent board of review similar to our Texas physician assistants and acupuncturists. In the case of medical radiologic technologists, this would align with the noncertified technologist regulation already maintained at TMB. 

A number of behavioral health professions are recommended to move to the TLDR, such as licensed counselors, marriage and family therapists, chemical dependency counselors, and social workers. These might be better aggregated under the Board of Psychologists, which handles similar investigation needs. It is likely a name change could occur to accommodate adding these professions.  

An even stronger concern for TMA and JPS is moving the licensure of lay midwives to TDLR. We question placing oversight of those who assist with the birth of child under the same agency that supervises refrigerator repairs. 

We would suggest the commission consider placement alternatives for midwives – perhaps under the Texas Board of Nursing. We realize they are not nurses but the nursing board already has standards for midwifery.

Madame Chair and members, I appreciate the opportunity to share the thoughts of the TMA and JPS on the DSHS Recommendation No. 3 today.  We would like to offer any assistance needed as you make important decisions impacting patient care in Texas.

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