Don’t Override Physicians’ Professional Judgment in Child Welfare Cases

Testimony on Senate Bill 11

House Committee on Human Services
Testimony on Senate Bill 11 by Senator Schwertner
Texas Medical Association

April 17, 2017

Chairman Raymond and members of the committee. On behalf of the 50,000 physician and medical student members of the Texas Medical Association (TMA), we applaud this committee’s work to protect the children of our state. Many members of this committee have devoted countless hours to the task of reforming and improving our child welfare system. It is a difficult but worthy goal you seek. 

TMA strongly supports Senate Bill 11 by Sen. Charles Schwertner. TMA has a long history working with the legislature to improve medical care for children in foster care, including working with lawmakers and the Department of Family and Protective Services to devise evidenced-based algorithms for the administration of behavioral health medications to children in foster care in order to receive the drugs are the most appropriate for their age and condition. Over the interim, TMA collaborated with the Texas Pediatric Society to ensure all children entering state custody receive an initial evaluation within 72 hours, a best-practice recommended by the American Academy of Pediatrics (AAP).  This initial exam requires a physician to assess a child’s physical and psychological needs and then refer them to the appropriate services.  An initial exam within 72-hours is particularly important to assess a child’s behavioral health needs since children subject to abuse or neglect may show no outward physical trauma but manifest depression, anxiety or other mental illnesses.  Early identification and treatment of these disorders is essential to promoting better outcomes and stability in the child’s life. 

In accordance with AAP guidance, SB11 adds a requirement that children receive a medical examination within the first three days after the child enters the conservatorship of the state. In order to assist physicians in performing the medical examination, the bill also provides for guidelines to be developed that will aid physicians in performing these examinations. TMA wishes to request a minor, non-substantive clarification in this provision to ensure the bill’s intent is fully carried out.  

To be specific, TMA believes it is necessary to add clarification that these guidelines will not create a standard of care and make it mandatory to rigidly follow these guidelines in every exam, which would replace the physician’s professional medical judgment. A physician may use these helpful guidelines, but the physician should still have the flexibility to vary from the guidelines on a case-by-case basis when, according to the physician’s medical judgment, such variance is appropriate to meet the needs of each child. Clarifying that a physician may use these guidelines in conjunction with the physician’s medical judgment ensures that the bill stays true to its intent of enabling physicians to provide tailored medical care that each individual child needs. 

Thank you for considering this clarifying change that will ensure each child receives the most appropriate medical care for his or her specific needs. We urge you to support SB 11 and we stand ready to work with the chairman and this committee to assist in further efforts to improve child welfare in our great state.

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Last Updated On

April 17, 2017