TOMA Issues Suggestions For Change

TOMA Resolution
Number 2008-05

SUBJECT: Position Statement of the Texas Osteopathic Medical Association
Regarding the Texas Medical Board

SUBMITTED BY: TOMA Board of Trustees

REFERRED TO: Professional Affairs

WHEREAS, Osteopathic physicians in the State of Texas strongly support the Texas Medical Board
(TMB), and believe it is important for Texas to have a strong, effective medical board acting not
only as an advocate for the citizens of Texas but also as an advocate for the physicians of Texas ; and,

WHEREAS, the Texas State Senate passed in the 2003 Texas Legislative session Senate Bill 104, (SB104)
which outlines the statutory responsibility for the TMB as it specifically relates to disciplinary
matters, which are as listed: 1. Quality of care issues, 2. Sexual misconduct, and 3. Impairment issues; and,

WHEREAS, the TMB is critical to the ongoing maintenance of the tort reforms passed in the 2003 Legislative
session; and,

WHEREAS, the Texas Osteopathic Medical Association ( TOMA ) and its membership encourages the
TMB to maintain a level playing field of fairness and to focus on the issues outlined in SB104
with openness and transparency utilized in the disciplinary process; and

WHEREAS, the Texas Osteopathic Medical Association ( TOMA ) realizes that the TMB has been under
increasing scrutiny and that TOMA appreciates the service that the members of this board
voluntarily give to the citizens of our state; and,

WHEREAS, any functional organization will always have an opportunity for improvement as a normal
process and due course; and,

WHEREAS, Texas Osteopathic physicians want to support the TMB but may find it hard to do when the
perception is that there is unfairness or uneven-ness in the system; and,

WHEREAS, in the light of the many issues and questions Texas osteopathic physicians have with the
disciplinary process, and that physicians desire a fair and balanced focus on openness and
transparency in that process; now therefore be it,

RESOLVED, that the Texas Osteopathic Medical Association supports the Texas Medical Board; and be it
further

RESOLVED, that TOMA supports the statutory law amendments that would be effected by the Texas
Legislature as specifically listed in the TOMA White Paper Attachment.





POSITION STATEMENT OF THE TEXAS OSTEOPATHIC MEDICAL ASSOCIATION TO THE TEXAS MEDICAL BOARD

In response to a growing concern and outcry from osteopathic physicians across our state, Texas Osteopathic Medical Association (TOMA) developed a position statement for the association concerning the activities of the Texas Medical Board (TMB).

There are several points to consider. These include maintaining the tort reform measures passed in 2003 and an assortment of issues concerning the transparency of TMB operations and proceedings. These include anonymous complaints, disciplinary procedures, State Office of Administrative Hearings findings, deferred adjudication, case review and the listing of physicians’ names in news releases for minor infractions.

To encourage the continuance of a strong board which operates in a balanced manner, the Texas Osteopathic Medical Association offers the following recommendations for TMB reform:

1. The Texas Medical Board should look back to Senate Bill 104 also passed in the 2003 legislative session and re-focus its investigative and disciplinary efforts on those allegation priorities highlighted in that legislation: sexual misconduct, impaired physicians, and quality of care. The resources of the Board are not unlimited and therefore should be focused on those areas where the most can be done to protect public safety.
2. TOMA supports the Board’s efforts to continue to improve the efficiency and timeliness of the licensing process. Everyone in Texas benefits from a faster process, particularly since our state is now such an attractive place in which to practice medicine.
3. So many complaints about the Board and its processes, particularly in licensing, can be summarized as a single deficit: customer service. We urge the board and leadership to thoroughly revamp its communication, responsiveness, and timeliness with which the Board relates to its physician stakeholders. The board should be as effective in physician service and licensing as it is in pursuing disciplinary action.
4. TOMA suggests a fair and balanced focus on openness and transparency in its processes of dealing with physicians. Discipline where appropriate; warning where it can resolve the issue; educate where necessary; support where needed, and facilitate a win-win culture for both the public and the physicians.
5. TOMA asks the Board to recognize that disciplinary action against any license-holder threatens not only his or her livelihood but also his or her professional and personal standing. Discipline, even in cases not related to patient care or safety, should never be taken lightly or for financial reasons.
6. TOMA suggests that there are a significant number of legal, operational, and administrative changes and additions that merit serious consideration by the Legislature and by the Board. These changes listed in Addendum A would greatly enhance the fairness and transparency of the current operations and restore confidence in the Board by those it licenses.
7. TOMA recommends that the Legislature provide for an increased budget of $12,000,000 or similar amount that would allow for the TMB to comply with the provisions of SB 104 and the efficient handling of licensure.

The osteopathic physicians of Texas support the TMB. However, we believe that the TMB should and can conduct itself with more effectiveness, efficiency, and transparency. Physicians find it difficult to support a board which they perceive to be unfair. It is imperative that the TMB is a strong and effective body, concerned primarily with the health and safety of the citizens of Texas . Therefore, the TMB should utilize its resources efficiently, by focusing its efforts on issues of sexual misconduct, impaired physicians and quality of care, where the Legislature has already given direction and where public safety would be well-served. TOMA physicians are, however, pleased with the TMB’s efforts to expedite the licensing process which benefits all citizens of Texas and is an example of how effective the TMB can be.

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Addendum A:
Suggested Legal, Operational and Administrative Changes to the Texas Medical Board

An Administrative Law Judge at the State Office of Administrative Hearings should be made the final decision maker on contested licensing and disciplinary cases.

Allow for pre-filing mediation at the State Office of Administrative Hearings and establish a deferred adjudication system for minor violations and/or first time offenders.

Disclosure of Board experts to defendant physicians and defendant physician's counsel prior to Informal Settlement Conference (ISC) to allow for possible impeachment or demonstration of bias, so as to present a more fair defense.

Reinstitute the private reprimand or adopt a warning mechanism that does not constitute disciplinary action and establish a pre-approval system for advertising to lower the number of complaints on this subject and give physicians a higher comfort level for this aspect of their business.

Create a statewide privately operated impairment diversion program to take needless burden off the agency and to make impaired doctors more likely to seek help without fear of disciplinary action.

Allow defense attorneys, defendant physicians and license applicants a special right of access to their respective files so that they can properly and thoroughly present their cases. It is a basic legal right for the accused to face their accuser(s) in legal proceedings against them.

Establish an Open Records and Open Meetings monitor from the public to oversee and report on open government issues of the Texas Medical Board. Establish a statute of limitations on certain types of cases such as record-keeping and minor violations, but not on more serious matters which involve criminal activity. Establish a legislative mechanism for oversight of the Texas Medical Board Executive Director such as confirmation by the Senate at the first opportunity.


Board of Trustees Action Taken: House of Delegates Action Taken:
__X___ Approved _X____ Approved
_____ Disapproved _____ Disapproved
_____ Amended _____ Amended & Approved