Principles for Sunset of Texas Medical Board: General guidelines adopted for advocacy during sunset review of the Texas Medical Board are:
1. TMB should regulate all functions that affect or evaluate the practice of medicine or medical care rendered within Texas. These functions include the licensure and review of expert witness testimony as well as the review and opinion provided by a physician who makes a determination of medical necessity. The determination of the application of appropriate standards of care and/or the lack of meeting such standards should be part of the definition of the practice of medicine and enforceable by the board.
2. Basic due process rights should be afforded to accused physicians, including the presumption of innocence, the right of access to details of the complaint against them, the right of discovery, the right to present evidence and witnesses in their defense, the right to cross-examine opposing witnesses, and the right of appeal. A physician expert panel that meets and deliberates as a body is an essential component in the evaluation and prosecution of a disciplinary case.
3. The roles of the administrative law judge and licensure boards with respect to their discretionary acceptance or rejection of the findings of an administrative law judge after a contested hearing should be closely reviewed. Fundamental civil rights must be honored.
4. Licensees should be able to appeal decisions and defend their ability to practice medicine without fear of retribution or relentless prosecution.
5. The Texas Medical Practice Act and TMB shall retain a reasonable statute of limitations that limits TMB from pursuing old allegations against a physician.
6. Mandatory reporting of peer review actions to TMB beyond those currently required by statute would be counterproductive and should not occur.
7. TMB shall not discriminate against a physician for any history of psychiatric or other medical illness or for any treatment received by the physician for such illness unless the board has determined that as a result of such psychiatric or other medical illness, the physician is unable to practice medicine in a professionally acceptable manner.
8. TMB shall consider matters of chemical dependency and mental health problems as medical illnesses rather than as a basis for disciplinary action (Policy 105.005).”
9. It is the ethical duty of all physicians to prevent impaired colleagues from practicing medicine that endangers patient care. Physicians should be encouraged to report possible impairment, not for punitive measure, but with every assurance that the reported physician will receive due process and a fair assessment of possible impairment.
10. TMB should focus on violations of the Medical Practice Act and reach out to its licensees and the organizations representing them not only to help determine and evaluate violations but also to establish a fair and consistent manner and method for administering the enforcement process.
11. An open and receptive stakeholder process should be required when TMB seeks input and comment from interested parties, providing an opportunity for meaningful, interactive advice and consultation prior to publication of proposed rules in the Texas Register. New rules and substantive changes should be communicated to licensees in multiple media. TMB should institute a streamlined stakeholder process with full participation of medical schools and residency program directors to assure that unnecessary delays for issuing residency permits are avoided. The board needs to better educate the public and physicians of its process for discipline, including its use of disciplinary guidelines.
12. Licensure experts and Texas medical schools should be consulted and made an integral part of the review and evaluation process used to improve the licensure system.
13. TMB should evaluate physicians without subdelegating that effort to other entities or other state physician licensing agencies. TMB should make its own determination as guided by Texas law rather than abdicate its responsibilities to other states.
14. Membership qualifications for the service on TMB should be enhanced to require noted and distinguished service in the various fields of medicine. Demographic and geographic requirements should be maintained.
15. The definition of the practice of medicine in the Medical Practice Act is broad and well tested in Texas courts and should remain unchanged but must allow for the regulation of expert witnesses and individuals who perform medical necessity reviews.
16. The prohibition of the corporate practice of medicine in Texas should continue unchanged to ensure treatment for patients in the manner best able to avoid undue influence by corporate interests.
17. TMB must have the legal authority and mandate to investigate and enforce the exclusive use of the descriptive terms “physician” or “surgeon” by licensed medical doctors and doctors of osteopathic medicine.
18. Should additional boards be placed under the broad umbrella of TMB, they should have authority to act in an advisory role only rather than as separate boards, with TMB ratifying or modifying their proposed actions. Further, the composition of TMB should not be expanded to include representatives of the other healing arts. Any advisory boards should have voting physician members.
19. The Texas State Board of Physician Assistant Examiners and the Texas State Board of Acupuncture Examiners should remain as advisory boards to TMB, with TMB ratifying those boards’ regulatory and licensure actions.
20. The Medical Practice Act grants physicians broad authority to delegate medical acts and should remain unchanged.
21. TMB should continue to monitor the continuing education of physicians (AHCM-TMB Rep. 1-I-04; amended BOC Rep. 6-A-14).