If you think federal
election laws have no impact on medicine, think again. If you think abuses by
public and private payers and their regulators can’t be checked, think again.
And if you think new liability, scope-of- practice, or peer review protections are
out of reach … well, you get the picture.
you think of one person who’s had a hand in the intricacies of all of these
kinds of complex legal issues and precedent-setting accomplishments for
medicine, that person should be Texas Medical Association General Counsel
Donald P. Wilcox – or “Rocky” as he’s known around the legal and legislative
halls of Texas.
nearly five decades of service to organized medicine, this man behind TMA’s
storied history of advocating for physicians and their patients through the
legal and legislative systems is retiring. But the legacy he leaves behind has
put physicians in Texas – even across the nation – on solid legal ground.
through the courts, the Capitol, or the regulatory rule-writing that follows,
“I don’t think [members] understand how much our legal team is involved with
all of our advocacy efforts,” said TMA President-Elect Gary Floyd, MD. “Rarely
is there an issue that comes up that we’ve discussed at the board level that we
don’t say, ‘What’s legal think about it?’ There’s probably not a TMA council or
committee they don’t touch. And Rocky has built a very formidable legal team.
They are there to protect physicians taking care of patients, and Rocky has
always been the epitome of that.”
Indeed, Mr. Wilcox
essentially founded TMA’s now-robust legal department when he became its first
in-house attorney in 1979. He has seen the association through 20 legislative
sessions, seven governors, four sunsets of the Medical Practice Act, four TMA
executive vice presidents, and too many court cases to quantify. Not to mention
the enduring publications Mr. Wilcox himself has authored to help guide
physicians in their day-to-day medical practice.
decorum and humility of this soft-spoken attorney belie the fact that he has
been making a difference for medicine his entire career.
earning his law degree from Southern Methodist University in 1968, Mr. Wilcox
joined the U.S. Air Force, where he began his legal career counseling physicians,
hospitals, and medical staffs. His foray into organized medicine began with the
American Medical Association, where he served in the general counsel office for
six years, including as director of the AMA Health Law Department and legal
counsel to AMA’s political action committee, AMPAC, which works to elect
that time, Mr. Wilcox ushered AMPAC through new federal election laws enacted
to correct abusive activities such as those uncovered in the Watergate scandal.
Also during that time, he met TMA’s then president, executive vice president,
and TEXPAC director – fortuitous encounters that helped bring him to TMA as the
association’s first general counsel.
seemed like every physician in Texas called me every week,” Mr. Wilcox recalled
of his early days with TMA.
first years with the association, and many beyond, would be marked by what he
described as “successful skirmishes with payers.”
instance, with Mr. Wilcox’ guidance, TMA in the mid-1980s sued the Texas
Department of Insurance (TDI) over its determination that an insurer could
steer patients to hospitals it owned in conflict with state laws. That suit led
to the adoption of the first PPO rules in Texas in 1986 – rules that limited
such financial incentives that favored insurers.
in the late 1980s, Mr. Wilcox helped secure federal reforms after the U.S.
Health and Human Services Department Office of Inspector General (OIG) started
kicking physicians – many of them rural – out of Medicare without providing due
process. That success was achieved with the help of the newly formed TMA
Patient-Physician Advocacy Committee, which to this day evaluates and advises
on regulatory, legislative, and legal matters involving the standard of care.
TMA and AMA President Nancy Dickey, MD, was the committee’s first chair and
likened its early work to that of a peer review committee.
sounds pretty straightforward now, but 35 years ago it was a novel concept,”
she said. “Without Rocky’s able leadership, we couldn’t possibly have
[challenged OIG] because it required us to challenge the [de]selection process.
So, the Patient-Physician Advocacy Committee was created to get a second look
at those charts and to try to provide a vehicle whereby people who had some
experience and knowledge of what the standard of care was could provide input.”
Wilcox also knew that one physician’s anecdote wasn’t going to be enough to
make an impact, Dr. Dickey observed.
would ask, ‘Where else is this happening?’ He’s been very good at helping TMA
move from anecdotes to collecting data to inform policy, to inform regulation,
to inform legislation,” she said. “Rocky is one of those wonderful souls that
understands that he has an important task of trying to take care of the
physician-patient dyad in a way that protects good patient care.”
big coup against payers under Mr. Wilcox’ leadership was the massive collection
of 2003-05 settlements in the civil anti-racketeering lawsuits TMA launched
with four other state medical societies alleging the nation’s health plans
routinely and without justification denied, delayed, and downcoded claims.
Those settlements resulted in more than 100 pages of enforcement provisions, $2
billion dollars in relief for physicians, and wholesale changes in health
plans’ business practices.
legacy from a portion of those monies was the creation of The Physicians
Foundation and the Physician Advocacy Institute (PAI), whose missions of
advocating for physicians and patients carry on today, and with whom TMA
remains closely involved.
Yet another pinnacle in
TMA’s long legal history was Mr. Wilcox’ involvement in the creation of the
Texas Alliance for Patient Access (TAPA) in 2001 and the coalition’s work to
enact medical liability reform in Texas in 2003. Despite numerous attacks over
the years, that constitutional amendment establishing a fixed $250,000
noneconomic damages cap in medical liability cases still stands strong.
fact that we have been able to maintain those reforms in the courts and still
had support in the legislature for addressing needed corrections in our tort
system in 2021 are meaningful accomplishments for the TMA, TAPA, and its
coalition allies,” he said.
clear, there isn’t enough room in this article let alone the pages of this
magazine to cover the decades of other legal victories Mr. Wilcox has
contributed to when it comes to scope of practice, peer review, corporate
practice, and myriad other protections for physicians and patients in effect
today – and yet to come. As this article went to press, a federal court
had just dealt TMA a win in its lawsuit challenging an arbitration provision in
the federal surprise billing rule, and on the way were TDI’s regulations
implementing the “gold card” legislation TMA’s legal and lobby teams helped
craft to rein in prior authorizations. (See “TMA Win on Surprise-Billing Rule,”
should be noted that staying out of the courts is a feat in and of itself, and
much of the offensive work Mr. Wilcox initiated in the regulatory realm has
accomplished just that, for example by keeping careful tabs on rules
promulgated by nonphysician boards. When TMA has landed in the courts or the
legislature over scope-of-practice battles, TMA’s track record is a winning
just one symbol of the scope of Mr. Wilcox’ accomplishments, in 2016 he was
awarded the Distinguished Service Award by the State Bar of Texas Health Law
Section, which he at one time chaired. He is also a past chair of The Litigation
Center of the AMA and State Medical Societies Executive Committee.
the greatest symbol is the lasting change he’s helped bring to Texas physicians
knew that if we wanted tort reform, you go for the constitutional amendment,
you get it on the ballot, and if anyone tries to reverse it, they’re going to
have to change the constitution. He stayed ahead of the game,” Dr. Floyd said.
Wilcox won’t – or perhaps can’t – leave it all behind completely. He said he
plans to “remain active” with The Physicians Foundation where he has served as
legal counsel, “and, if asked, being available for special projects and
meaningful causes affecting patients and physicians.”
have worked with incredible physician leaders and staff, many brilliant and
caring individuals with education, training, and demonstrated competence
matched by few. I have had the opportunity to be part of many successful
efforts to make medical practice better for patients and physicians. I thank
those who have given me the opportunity to serve and help TMA make a difference
in the practice of medicine.”
What a difference Rocky
Wilcox has made.
Tex Med. 2022;118(3):10-12
April 2022 Texas Medicine Contents Texas Medicine Main Page