TMA's letter acknowledges informal show compliance proceedings and ISCs provide an alternative to costly, more formal hearings for resolving physician complaints. But TMA stresses ISCs should give physicians a "fair and meaningful opportunity to be heard and to present their defense."
TMA's letter describes TMB's current, more formal, prescriptive, regulated ISC process that is in "dire need of reform and redefinition" and that has run afoul of legislative intent, having "fallen into a grey area." The problem, TMA contends, "is that ISCs, under the guise of an 'informal conference,' allow TMB to avoid the hassle of due process or even fundamental fairness." The situation, the letter states, results in physicians "feeling forced to participate in an 'informal' conference that has no guarantees of fairness."
Specifically, TMA says the proposed rules raise questions of fairness in regard to the presentation of witness testimony in an ISC. TMA says the proposed rule limits physicians’ rights to present witness statements and removes physicians’ rights to present oral testimony by witnesses. The association adds the nature of permitted witness testimony also weighs heavily against physicians.
TMA also has concerns about the broad discretion representatives of the board have in determining what evidence to consider in an ISC. TMA says board representatives’ broad discretion could “allow bias or prejudice to be a factor,” adding panelists could employ “discretion to exclude evidence for any reason ranging from the personal disliking of a licensee to the panelist’s desire to go home early after a long day. TMA’s point is that, without some governing standard other than the board’s discretion, there is simply no way of ensuring a fair hearing.”
For these reasons and more, TMA "strongly encourages TMB to withdraw these rules" and asks the board to organize a stakeholder meeting to "formulate a more appropriate and, frankly, fair redefinition of the ISC process."
The Texas Department of State Health Services (DSHS) confirmed an infant who recently died in Harris County had microcephaly linked to the Zika virus. The baby died shortly after birth and is the first Zika-related death reported in Texas, according to DSHS.
DSHS says the mother was in Latin America during her pregnancy. She became infected with the virus there, and the baby acquired the infection in the womb. Recent test results confirmed the baby's condition and link to Zika, DSHS says, adding that there is no additional associated risk of Zika transmission in Texas.
Last month, Texas reported the state's first case of microcephaly linked to Zika, also a Harris County infant.
With local Zika virus cases detected in Florida and increased travel to Brazil for the Summer Olympics, DSHS says Texas is on high alert for local Zika transmission by mosquito bites. The department is urging everyone to follow precautions strictly.
DSHS says it is spending more than $6 million in state and federal funds on disease surveillance, expanded lab testing capabilities, public education and awareness, Zika prevention kits, and other efforts to build a strong infrastructure to help protect Texans from Zika. Texas Medicaid announced earlier this month it will cover the cost of mosquito repellent for eligible women who are between the ages of 10 and 45 or pregnant.
DSHS has identified and exercised eight state public health Zika response teams that are ready to deploy upon local transmission of the virus in Texas. These teams, DSHS says, will be able to help local entities investigate possible cases, evaluate environments for mosquito activity, provide door-to-door education, and offer other response efforts.
While local transmission in Texas remains likely at some point, DSHS says public health officials do not expect widespread transmission across large geographic areas of the state. Small pockets of cases are more likely. DSHS bases this assessment on the state's past experience with dengue, a similar virus spread by the same mosquitoes, and on the prevalent use of window screens, air conditioning, insect repellent, and other mosquito control efforts in Texas.
DSHS says it has approved more than 1,200 human specimens for Zika virus testing by the DSHS laboratory and the U.S. Centers for Disease Control and Prevention (CDC). Other labs across the state now have the ability to test for Zika. In late July, DSHS added the more complex serologic testing for human specimens to detect Zika infection in people who may not have had symptoms. Texas also has the capability to test mosquito specimens for Zika, as warranted for identified high-risk areas, though DSHS says the best indicator of Zika prevalence is human case detection.
Zika poses a serious threat to unborn children, and protecting pregnant women is a central concern, the department says. Texas has reported individual casess to the CDC's Zika Pregnancy Registry.
CDC says physicians can participate in the Zika pregnancy registry by reporting information about pregnant women with laboratory evidence of Zika to their local health department or DSHS.
In updated guidance to health care professionals caring for pregnant women with possible exposure to Zika virus, CDC now recommends a longer testing period — up to 14 days — after symptoms begin in pregnant women. The guidance, released on July 25, also applies to pregnant women with no symptoms.
New research indicating the Zika virus can remain in pregnant women's blood longer than the prior seven-day testing time frame after the onset of symptoms spurred CDC to update its guidance. "Even pregnant women without symptoms can have evidence of the virus in their blood and urine," CDC's guidance states.
As of July 27, 1,658 U.S. Zika cases and 4,750 in the U.S. territories had been reported to CDC.
As of Aug. 2, Texas had 90 reported cases of Zika virus disease, including three pregnant women, one infant infected before birth, and one person who had sexual contact with a traveler, according to DSHS.
To get ahead of this year's highest-profile potential public health threat, TMA formed a workgroup to strategize prevention and response to Zika. The workgroup provides experts a forum to share what they're seeing in the field with regard to Zika and an opportunity to discuss concerns surrounding the disease. The workgroup, made up of physician members from TMA's various boards, councils, and committees, helps the association provide relevant information to physicians about Zika.
David Lakey, MD, chief medical officer and associate vice chancellor for population health in The University of Texas System and former DSHS commissioner, is the workgroup's chair. Dr. Lakey, who is also the chair of TMA's Council on Science and Public Health, will take part in a panel discussion on Zika at the TMA 2016 Fall Conference, Sept. 23–24, at the Hyatt Regency Lost Pines.
Congress has been dragging its feet on approving a Zika funding package. In a letter to the Texas congressional delegation, TMA President Don Read, MD, stresses the need for federal money to bolster monitoring travelers, keeping Texans informed about the state of the disease, and lab testing — especially of pregnant women. "We already have waited too long," Dr. Read wrote. "We need that action now. Several months from now will be too late."
On Aug. 5, Governor Abbott sent a letter to President Obama urging his administration to immediately approve the expenditure of funds for Zika virus preparedness and response. In the letter, Governor Abbott expressed concern that money for Zika preparedness and response is not flowing quickly enough to the state and local health departments. He asked the president and his administration to dispense a meaningful portion of the approximately $400 million available to sufficiently combat against the growing threat of Zika in Texas.
"In light of the mosquito-to-human transmission of the Zika virus in Florida — and rising concerns about Zika in Texas — it is imperative that the federal government act now to free up whatever funds are available to combat Zika," Governor Abbott wrote. "I express this sentiment not only on behalf of the State, but also on behalf of local government leaders seeking relief and protection from Zika. We request that immediate aid be provided to combat the spread of Zika and, in turn, protect our fellow Texans."
For more information, read "Zika: Fighting a Potential Epidemic" in the August issue of Texas Medicine.
TMA Zika screening guidance for physicians
General information about Zika virus
Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016
Information for clinicians
Protection against mosquitoes
Zika virus travel notices
DSHS Zika toolkit
Effective Sept. 1, you will no longer be able to log in to the Prescription Access in Texas (PAT) website with your login information. That's because the Texas prescription monitoring program will transfer from the Texas Department of Public Safety (DPS) to the Texas State Board of Pharmacy (TSBP) and will transition to a new type of software. TSBP advises there will be a delay in prescription history of up to two weeks during the transition.
Additionally, effective Aug. 21, DPS will no longer accept orders for Schedule II prescription pads. However, official prescription forms issued by DPS before Sept. 1, 2016, will be considered valid prescription forms. Official prescription pad orders received after Aug. 21, 2016, will be returned to customers.
When you log in to the new system for the first time, you will be prompted to update your profile information. TSBP says missing or incorrect demographic information (address or phone number) on your PAT profile will not prevent your account from being preloaded.
TSBP has these important reminders regarding access to the new system:
- You will have access to the new system beginning Sept. 1.
- You will receive an email on Sept. 1 that includes a short training tutorial on how to perform a query, along with instruction on how to log in.
- Do not register for a new account.
If you have any questions or concerns, call (844) 489-4767. Technical assistance is available Monday through Friday, 7 am to 7 pm CT.
For more information about the transition to TSBP, call (512) 305-8050, or email texaspmp[at]pharmacy[dot]texas[dot]gov.