TMA Urges TMB to Adopt More Transparency in Its Operations Sunset Advisory Commission

TMA Testimony by Carlos J. Cardenas, MD

Texas Sunset Advisory Commission

April 25, 2018

Good morning, Chairman Birdwell and members. I am Dr. Carlos Cardenas. I am a gastroenterologist from Edinburg and president of the Texas Medical Association. On behalf of our 52,000-plus physician and medical student members —– on behalf of all my physician colleagues across the state — we thank you for the opportunity to share our thoughts on the sunset report before this commission. 

In general, we support the recommendations made by the sunset commission staff — for the second time in two sessions. It is our understanding that three recommendations not in their initial report will be considered today. These are items discussed and added prior to last session. We continue to support them: 

  1. TMA supports increasing the availability of remedial plans for minor administrative violations and the elimination of the limitation of only ONE lifetime remedial plan. Remedial plans are useful to promote settlement of minor administrative violations and are an opportunity to provide for an educational and corrective process for the physician. We believe there does not need to be a limit to the number of remedial plans because they already are provided solely at the board’s discretion.
  2. TMA supports providing each licensee involved in an informal settlement conference with a complete copy of each expert report with the redaction of the reviewer’s identity, providing the reviewer’s specialty credentials are included. Providing licensees with each expert report is a fair requirement that allows physicians to have complete information in settling cases, and protecting expert reviewers’ identities encourages physicians to serve on expert panels.
  3. TMA supports the Interstate Medical Licensure Compact as we have for the previous two sessions. But at the same time, we recognize that the compact has drawn fire for a number of reasons. From a realistic standpoint, TMA also would support an alternative to the compact that would establish an expedited, streamlined licensure process for certain qualified out-of-state physicians to help address Texas’ physician shortages. TMA would gladly work with the commission and the Texas Medical Board to develop such an expedited process.   

In terms of new items, TMA would ask your consideration of the following. 

  1. Last session, the legislature passed House Bill 2950 — the Texas Nursing Board sunset bill — that allowed the removal of certain disciplinary actions from a nurse’s public profile in certain circumstances. TMA recognizes that information on a physician’s public profile is for public information, but in some circumstances, its usefulness diminishes over time. Eventually, something as simple as an administrative error becomes a permanent blemish on a physician’s profile, and is published in a way that reflects negatively on the physician and can impact that physician’s ability to practice. TMA encourages the commission to recommend for physicians the same sort of removal provisions that the legislature enacted last year for nurses.
  2. We also ask that you provide for an expedited hearing before the State Office of Administrative Hearings (SOAH) when the board temporarily suspends or restricts a physician’s license. When the board acts to temporarily suspend or restrict a license holder’s license in certain situations, it is mandated by law to go through required procedural steps only “as soon as practicable.” Unfortunately, there have been instances where “as soon as practicable” meant months or even years. Such a delay can be crippling and may completely destroy a physician’s practice. The legislature has set for most other licensing agencies a fixed number of days — some as soon as 30 days after a suspension — to go through required procedural steps before moving on to SOAH. Fairness would require that this apply also to the medical board, so that the SOAH process begins within 30 days of the issuance of a suspension or restriction. 
  3. Finally, we ask that you clarify that performing utilization review is the practice of medicine. We have learned there are physicians who perform utilization review and who make medical necessity determinations for cases involving Texas patients, but who are not licensed in Texas. We are concerned that any failure by these physicians to perform these medical necessity determinations appropriately would be outside the disciplinary authority of the Texas Medical Board. As a result, patients could have limited recourse when necessary treatment or care is wrongfully denied because of an inadequate or improper review performed by an unlicensed, out-of-state physician. Thus, utilization review should be considered the practice of medicine and should fall under the regulation of the medical board. 
There are several other considerations outlined in our letter of April 18. But I will stop here and express our thanks for the opportunity to testify today. I am happy to answer any questions you might have. 

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Last Updated On

April 25, 2018