The Texas Medical Board’s Mission Statement is:
“to protect and enhance the public’s health, safety, and welfare by establishing and maintaining standards of excellence used in regulating the practice of medicine and ensuring quality health care for the citizens of Texas through licensure, discipline, and education.”
Every one of the 7,000 complaints the TMB receives a year (filed by patients, patient’s family members, health care professionals, and other sources) are reviewed by the board in order to determine if sufficient evidence exists demonstrating a violation of the Medical Practices Act.
The TMB has legal control only over those it licenses, therefore limiting jurisdictional complaints to those against physicians, physician assistants, acupuncturists and surgical assistants. If the complaint is against one of these four types of medical professionals, the board may begin the process of determining if there is evidence to support an allegation that there has been a violation of the Medical Practices Act; it is their concern to protect the public, not the professional.
Within the first 45 days of receiving a jurisdictional complaint, the board must conduct an initial review. During the initial review, the Board may attempt to contact both the complainant and the licensee. If you are a licensee and have been contacted, it is imperative that you hire an attorney to protect your license and in turn, your livelihood.
Complaints involving administrative matters (such as requests for medical records) are reviewed by a TMB attorney-investigator, while complaints involving medical care issues are reviewed by a TMB physician-investigator. If the information does not give a specific allegation concerning the licensee that would constitute a violation of the Medical Practice Act, no investigation is opened and the complaint is labeled “Jurisdictional, not Filed.”
If the TMB determines that a violation of the Medical Practice Act may have occurred, an investigation is opened. At this point, the licensee (the “respondent”) is informed of the alleged violation(s) and asked to provide additional information; it is important that a respondent have all communications go through their hired counsel; the investigative process is not a conversation with the respondent, it is an examination of their practice for potential violations of the Medical Practices Act. During the investigation, the TMB may obtain information from sources such as hospitals and pharmacies and is authorized under HIPPA to obtain Medical Records without a patient’s consent. If the allegations involve standard care or treatment violations, the case is then reviewed by at least two members of the TMB Expert Panel who are Board-Certified in the same or similar medical specialty as the respondent. If the Expert Panel Report finds the respondent acted inconsistently with public health and welfare, the complaint is then forwarded to the Litigation Section for further action; if the panel does find that the standard of care was met, the case is recommended for dismissal.
END OF INVESTIGATION
At the end of the investigation, the complaint will either be referred for dismissal to the board’s disciplinary process review committee (DPRC) or for further evaluation by a Quality Assurance Panel (QA). The QA is a panel of up to five board reps. The QA may request that an additional investigation be conducted, refer the case to the Litigation Department for a possible informal settlement conference (a hearing before a disciplinary panel), refer the case to the board’s disciplinary process review committee for dismissal, or offer the licensee a remedial plan.
Once a case is moved to the Litigation Section, it is assigned to a Staff Attorney and scheduled for an Informal Settlement Conference (ISC). An ISC will be before a panel composed of two representatives of the appropriate board (Medical, PA, Acupuncture etc). A Medical Board panel will almost always include one physician and one public member. The ISC Hearing is intended to provide an informal forum for the panel to review the information and for the licensee to show that they are in compliance with the Medical Practices Act. A licensee should not attend an ISC without legal representation, as 90% of all disciplinary actions that TMB takes are resolved through the informal process. The panel will either find no violation of the Medical Practice Act, in which event they will send the case to the board’s disciplinary process review committee for consideration of dismissal, or the panel will find a violation, in which case they will offer an Agreed Order. This Proposed Agreed Order will set out the sanctions and terms to be imposed of the respondent. We highly recommend these Proposed Agreed Orders be presented to the respondent’s legal counsel to undergo thorough review with the respondent and a formal negotiation process with the Board.
If a resolution cannot be reached at the ISC, then the case moves to the State Office of Administrative Hearings (SOAH). There, the case is heard before an Administrative Law Judge (ALF). After the SOAH Proceedings, the ALJ will submit a Proposal for Decision to the TMB.
The TMB will then issue an order that either includes disciplinary action or dismiss the case. Once the TMB enters its final Order, the licensee has the right to appeal the decision to District Court.
If you are the target of a healthcare investigation, you need to act quickly to retain competent counsel. The sooner you take the steps necessary to prepare, the more efficient your defense will be. We are a team of former prosecutors and experienced attorneys with in-depth knowledge regarding healthcare and licensure. Our goal is to defend our clients vigorously out of court and in trial if necessary to protect our client’s license, reputation and livelihood.