Sunset Review of TMB Fails to Address Disciplinary Process Improvements

In comments to the Sunset Advisory Commission on its 2016–17 review of the Texas Medical Board (TMB), TMA says one important matter is disappointingly absent from the agency's thorough and detailed report: improving TMB's disciplinary process. While TMA generally supports the sunset staff's report, the association says more could be done to ensure effective operations at the medical board. 

In the comment letter, TMA asks the sunset staff to reexamine the board's disciplinary process and provides these specific recommendations for improvement:

  • Require the board to remove publication of a physician's remedial plan after the passage of time. TMA says publishing the information for an indefinite amount of time has a "punitive effect, because something as simple as an administrative error becomes a permanent blemish on a physician's profile."
  • Remove the lifetime limitation of remedial plans. TMA says doing so would "allow both the licensee and the board to avoid the expense of protracted investigations for minor administrative violations …."
  • Require the board to provide all available information to the licensee prior to informal meetings, especially exculpatory evidence. TMA says this requirement "would ensure that a licensee has all available information when preparing a case or when making the determination to agree to an agreed order" while ensuring the board considers all information "when making a decision relating to the physician's license to practice."
  • Ensure that the board does not provide any information directly or indirectly identifying the expert physician reviewer to the physician who is the subject of the review. TMA says revealing a reviewer's identity could discourage physician participation, which the board relies upon heavily. 
  • Provide express authorization for the board to file a complaint against a license holder who maliciously makes a complaint the license holder knows to be false. TMA says legislative authorization "will do more to remove the incentive to make malicious complaints and will reduce the likelihood that physicians and the board staff are hassled with baseless complaints."
  • Require the State Office of Administrative Hearings to expedite cases involving a physician's temporary suspension.  

Attorneys and medicine alike have long been concerned about the evolution of TMB's informal show compliance and settlement conferences (ISCs). Former TMB Executive Director Mari Robinson told Texas Medicine the hearings have "become more formal in nature." In scathing written comments TMA submitted to TMB in July in response to the board's proposed ISC rules, TMA said ISCs have become "more and more formal, prescriptive, and regulated," without giving physicians a fair forum to defend themselves. The proposed rules appeared to be a clarification of how the board already conducts ISCs. But after critical comments from TMA and other stakeholders, TMB chose not to adopt the rule amendments. 

While the sunset commission's report failed to address TMB's disciplinary process, it does include these findings: 

  • Statutory licensing provisions and board procedures do not follow model licensing practices, presenting unnecessary hurdles to applicants and reducing the efficiency of TMB operations.
  • The process for authorizing qualified physicians from other states to practice in Texas is not streamlined.
  • The medical board's pain management clinic inspection program does not follow best practices to make efficient use of the board's limited investigatory resources.
  • Limited medical radiologic technologist certification is unduly complicated and creates administrative inefficiencies.
  • The unclear relationship between the Texas Physician Health Program and TMB contributes to organizational instability. 

The state has a continuing need to regulate the practice of medicine and the allied health professions housed at TMB. That means the sunset staff is recommending another 12 years of life for the medical board.

Visit the Sunset Advisory Commission website to access the full report and the agency's recommendations. For more about TMA's call for fair TMB informal disciplinary hearings, read "On Trial" in the November issue of Texas Medicine.  

Action, Dec. 1, 2016

Last Updated On

December 01, 2016

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