TMA: Medical Board Should Stop Hiding Experts’ Reviews of Complaints
By Joey Berlin

Sunset_TMBThe Texas Medical Board should provide more information to physicians when it investigates complaints against them and needs more flexibility when imposing sanctions, the president of the Texas Medical Association said yesterday.

Testifying before Wednesday’s Sunset Advisory Commission hearing in Austin, TMA President Carlos J. Cardenas, MD, said TMA supports providing physicians with a complete copy of expert evaluations of the complaints against them. 

Those reports are written for standard-of-care cases prior to meetings between a licensee and board representatives to promote case settlements. An expert writes a preliminary report, which is then reviewed once or twice before a final report is issued. But TMB is required to give a licensee only the final report, which in some cases could leave out evidence that favors the physician. 

“Providing licensees with each expert report is a fair requirement that allows physicians to have complete information in settling cases,” Dr. Cardenas testified.

Under the TMA-supported proposal, each reviewer’s identity still would be redacted.

TMA also supports eliminating the board’s limitation of imposing only one remedial plan throughout a physician’s lifetime, and instead making remedial plans for minor administrative violations more available.

Dr. Cardenas told the commission TMA generally supports the recommendations Sunset staff already has made for the agency, which the Texas Legislature renewed through September 2019 during last year’s special session. The action during the special session only extended TMB’s sunset (automatic termination) date; lawmakers did not take up any of the substantive recommendations to improve the agency. The Sunset Commission’s recommendations for TMB will go before the legislature when it convenes in January 2019.

Dr. Cardenas asked Sunset to also consider several new items not in its recommendations: 

  • The ability to remove certain disciplinary actions from a physician’s public profile in certain circumstances, something the legislature included for nurses in the Nursing Board sunset bill last year. “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 that physician and can impact that physician’s ability to practice,” Dr. Cardenas testified.
  • Providing for physicians to receive an expedited hearing before the State Office of Administrative Hearings (SOAH) when the board temporarily suspends or restricts a physician’s license. Dr. Cardenas noted most other licensing agencies set a fixed number of days for a board to go through procedural steps before a case moves to SOAH, but current law mandates TMB do so only “as soon as practicable.” Unfortunately, he said, there have been “instances where ‘as soon as practicable’ can mean months or even years. Such a delay can be crippling and may destroy completely a physician’s practice.”
  • Clarifying that performing utilization review is the practice of medicine. Some physicians who aren’t licensed in Texas are making medical necessity determinations on Texas patients, Dr. Cardenas noted, raising concerns that inappropriate determinations by those physicians would fall outside the TMB’s disciplinary authority. 

Wednesday’s hearing was part of Sunset’s deliberation phase in its evaluation of TMB. The commission will meet again to decide which changes to recommend to the Texas Legislature and update its previous staff report. TMA previously weighed in on the staff review of TMB with written comments submitted earlier this month. 

Last Updated On

April 27, 2018

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Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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