An interesting study was published today regarding mortality rates at hospitals. This is interesting information, but it can certainly be misused and lacks the contextual realities of patients at hospitals.
CNN did a nice job with the story. The link is below.
http://www.cnn.com/2008/HEALTH/08/20/hospital.deaths/index.html
Thursday, August 21, 2008
Tuesday, August 19, 2008
First Round of Fast Track Had “Issues”
First Round of Fast Track Had “Issues”
At the meeting in June, the first batch of so-called Fast Track Agreed Orders were considered by the Board. There were some problems. The doctors who chose to have their written material only considered actually did not get it considered. It got sent to a Board committee that was unable to give this material the appropriate review. As a result, those Orders will be resubmitted for appropriate consideration and any appellate timetable is on hold until the doctors hear further from the TMB.
When one submits writing material for consideration, you are waiving your rights for a hearing. What is critical when you waive your right to an ISC, it appears based on the rules, one also waiving the right to an appeal at the State Office of Administrative Hearing. Therefore, if the Board still wants to issue a punishment and the doctor does not wish to accept it, the next step in the appeal process for this is district court. If you elect to do the fast track and have your written material only considered, you are waiving your right to ISC and SOAH. That sure seems to be what rule 165.005 is saying. This is not explained in the material that I have seen thus far from the Board.
If you think you have a good defense, you should opt out of fast track and choose the ISC option. The middle option of staying in fast track and having the Board review written materials is not a good option at this stage until the Board works out this serious flaw in the system.
At the meeting in June, the first batch of so-called Fast Track Agreed Orders were considered by the Board. There were some problems. The doctors who chose to have their written material only considered actually did not get it considered. It got sent to a Board committee that was unable to give this material the appropriate review. As a result, those Orders will be resubmitted for appropriate consideration and any appellate timetable is on hold until the doctors hear further from the TMB.
When one submits writing material for consideration, you are waiving your rights for a hearing. What is critical when you waive your right to an ISC, it appears based on the rules, one also waiving the right to an appeal at the State Office of Administrative Hearing. Therefore, if the Board still wants to issue a punishment and the doctor does not wish to accept it, the next step in the appeal process for this is district court. If you elect to do the fast track and have your written material only considered, you are waiving your right to ISC and SOAH. That sure seems to be what rule 165.005 is saying. This is not explained in the material that I have seen thus far from the Board.
If you think you have a good defense, you should opt out of fast track and choose the ISC option. The middle option of staying in fast track and having the Board review written materials is not a good option at this stage until the Board works out this serious flaw in the system.
Monday, August 18, 2008
TMB Overrules Acupuncture Rule Changes
Acupuncture Rule 183: Notes from the June 2008 Texas Medical Board Meeting
183.4- Was modified to allows for 5 exam attempts and the JP exam was modified to match that of the Medical Board.
183.10 (a) (2)- Was modified by the Standing Orders committee to include height, weight, and respiratory rate in the definition of vital signs.
183.19 (d)- This rule was modified to clarify when an acupuncturist could use the title of “Dr.”, “OMD” or “DOM”. The Standing Orders committee moved to remove all changes made in this section.
My Thoughts: Most acupuncturists don’t know this, but all rules passed by its Board are subject to the approval of the Texas Medical Board. Thus, the Texas Medical Board has t he power to veto rules changes. They did in this case.
183.4- Was modified to allows for 5 exam attempts and the JP exam was modified to match that of the Medical Board.
183.10 (a) (2)- Was modified by the Standing Orders committee to include height, weight, and respiratory rate in the definition of vital signs.
183.19 (d)- This rule was modified to clarify when an acupuncturist could use the title of “Dr.”, “OMD” or “DOM”. The Standing Orders committee moved to remove all changes made in this section.
My Thoughts: Most acupuncturists don’t know this, but all rules passed by its Board are subject to the approval of the Texas Medical Board. Thus, the Texas Medical Board has t he power to veto rules changes. They did in this case.
Thursday, August 14, 2008
Eight New or Returning DRC Members Appointed by Perry
Gov. Rick Perry has appointed eight members to the Texas Medical Board district review committees. Committee members evaluate medical practice and professional competency and make recommendations on investigations conducted by the board.
District Two Review Committee
David Baucom of Sulphur Springs is president of Baucom Insurance Services, Inc. He is a member of the Independent Insurance Agents of Texas and an advisory director to Guaranty Bond Bank. Baucom received a bachelor’s degree from Baylor University. He is reappointed for a term to expire Jan. 15, 2012.
Carlos Gallardo of Frisco is manager of recruitment and selection at Texas Woman’s University. He is a member of the Frisco YMCA board of directors and the City of Frisco Urban Forestry Board. He is also a member of The Colony Chamber of Commerce, Rotary International and the Knights of Columbus. Gallardo served in the U.S. Air Force. He attended Webster University and received a bachelor’s degree from Texas Tech University. He is reappointed for a term to expire Jan. 15, 2014.
Hari Reddy of Fairview is a physician with Allergy and Asthma Associates of Allen and clinical assistant professor at the University of North Texas Health Science Center. He is a member of the American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology; and the American Academy of Allergy, Asthma and Immunology. He is also district five secretary for the Texas Osteopathic Medical Association and a member of the Texas State Board of Medical Examiners. Reddy received a bachelor’s degree from the University of Miami and a medical degree from the University of North Texas Health Science Center. He replaces Rodney Wiseman of Tyler for a term to expire Jan.15, 2012.
Melissa Tonn of Dallas is a physician and president of OccMD Group. She is a member of the American Academy of Disability Evaluating Physicians, American and Texas colleges of Occupational and Environmental Medicine, Texas and American Medical Associations, and Dallas County Medical Society. She is also a volunteer with Texoma Youth Camp and Armstrong Elementary. Tonn received a bachelor’s degree and a master’s of business administration from Rice University, a medical degree from the University of Texas Health Science Center in San Antonio and a master’s degree in public health from the University of Texas Health Science Center in Houston. She replaces Allan Shulkin of Dallas for a term to expire Jan. 15, 2012.
District Four Review Committee
Noe Fernandez of McAllen is president of Dos Rios Textiles Corp. He is a past member of the University of Texas Pan American and Texas State Technical College boards of regents, past vice chairman of the Texas Water Development Board and Texas Water Resources Finance Authority. Fernandez received a bachelor’s degree from the University of Texas Pan American. He is reappointed for a term to expire Jan. 15, 2014.
Chevy Lee of McAllen is a physician in the solo practice of ophthalmology. He is a member of the Texas Medical Association, a past president of the Hidalgo-Starr County Medical Society, past president of the Texas Ophthalmological Association and an American Academy of Ophthalmology fellow. Lee received a bachelor's degree from the University of Texas at Austin and a medical degree from the University of Texas Medical Branch at Galveston. He is reappointed for a term to expire Jan 15, 2014.
Richard Newman of San Antonio is a surgical oncologist with San Antonio Head and Neck Surgical Associates. He is a member of the American Society of Head and Neck Surgery, Society of Air Force Clinical Surgeons, Texas Medical Association, Bexar County Medical Society, Texas Surgical Society and American Academy of Otolaryngology, and is an American College of Surgeons fellow. He is also a founding member of M.D. Anderson Associates, a past board member of the Holmgren Children’s Shelter, a member and volunteer surgeon for South Texas Physicians Outreach and a member of Antonio Children’s Service Bureau board of directors. Newman received a bachelor’s degree from Texas A&M University and a medical degree from the University of Texas Health Science Center. He replaces Peter Scholl of Austin for a term to expire Jan. 15, 2012.
Russell Parker of Austin is a land developer in the Austin and San Antonio areas. He is a member and chairman of the Center for Child Protection building committee. Parker replaces Lorna Kithil of Marble Falls for a term to expire Jan. 15, 2010.
District Two Review Committee
David Baucom of Sulphur Springs is president of Baucom Insurance Services, Inc. He is a member of the Independent Insurance Agents of Texas and an advisory director to Guaranty Bond Bank. Baucom received a bachelor’s degree from Baylor University. He is reappointed for a term to expire Jan. 15, 2012.
Carlos Gallardo of Frisco is manager of recruitment and selection at Texas Woman’s University. He is a member of the Frisco YMCA board of directors and the City of Frisco Urban Forestry Board. He is also a member of The Colony Chamber of Commerce, Rotary International and the Knights of Columbus. Gallardo served in the U.S. Air Force. He attended Webster University and received a bachelor’s degree from Texas Tech University. He is reappointed for a term to expire Jan. 15, 2014.
Hari Reddy of Fairview is a physician with Allergy and Asthma Associates of Allen and clinical assistant professor at the University of North Texas Health Science Center. He is a member of the American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology; and the American Academy of Allergy, Asthma and Immunology. He is also district five secretary for the Texas Osteopathic Medical Association and a member of the Texas State Board of Medical Examiners. Reddy received a bachelor’s degree from the University of Miami and a medical degree from the University of North Texas Health Science Center. He replaces Rodney Wiseman of Tyler for a term to expire Jan.15, 2012.
Melissa Tonn of Dallas is a physician and president of OccMD Group. She is a member of the American Academy of Disability Evaluating Physicians, American and Texas colleges of Occupational and Environmental Medicine, Texas and American Medical Associations, and Dallas County Medical Society. She is also a volunteer with Texoma Youth Camp and Armstrong Elementary. Tonn received a bachelor’s degree and a master’s of business administration from Rice University, a medical degree from the University of Texas Health Science Center in San Antonio and a master’s degree in public health from the University of Texas Health Science Center in Houston. She replaces Allan Shulkin of Dallas for a term to expire Jan. 15, 2012.
District Four Review Committee
Noe Fernandez of McAllen is president of Dos Rios Textiles Corp. He is a past member of the University of Texas Pan American and Texas State Technical College boards of regents, past vice chairman of the Texas Water Development Board and Texas Water Resources Finance Authority. Fernandez received a bachelor’s degree from the University of Texas Pan American. He is reappointed for a term to expire Jan. 15, 2014.
Chevy Lee of McAllen is a physician in the solo practice of ophthalmology. He is a member of the Texas Medical Association, a past president of the Hidalgo-Starr County Medical Society, past president of the Texas Ophthalmological Association and an American Academy of Ophthalmology fellow. Lee received a bachelor's degree from the University of Texas at Austin and a medical degree from the University of Texas Medical Branch at Galveston. He is reappointed for a term to expire Jan 15, 2014.
Richard Newman of San Antonio is a surgical oncologist with San Antonio Head and Neck Surgical Associates. He is a member of the American Society of Head and Neck Surgery, Society of Air Force Clinical Surgeons, Texas Medical Association, Bexar County Medical Society, Texas Surgical Society and American Academy of Otolaryngology, and is an American College of Surgeons fellow. He is also a founding member of M.D. Anderson Associates, a past board member of the Holmgren Children’s Shelter, a member and volunteer surgeon for South Texas Physicians Outreach and a member of Antonio Children’s Service Bureau board of directors. Newman received a bachelor’s degree from Texas A&M University and a medical degree from the University of Texas Health Science Center. He replaces Peter Scholl of Austin for a term to expire Jan. 15, 2012.
Russell Parker of Austin is a land developer in the Austin and San Antonio areas. He is a member and chairman of the Center for Child Protection building committee. Parker replaces Lorna Kithil of Marble Falls for a term to expire Jan. 15, 2010.
Lifetime Learning
Lifetime Learning: Notes from the June 2008 Texas Medical Board Meeting
At the Board meeting, there was an expression to further the educative aspect of the Board. Thus, the Board is planning at least ten more Town Hall meetings have been planned accompanied with legislator visits and Licensure Orientations. To help with these projects a new staff member has been hired to focus entirely on community outreach meetings. The Texas Medical Board is reaching out to reopen the lines of communication with the public and the licensees. Many Board members discussed favorably the idea of the Board as a source of lifetime learning.
My Thoughts: The town meetings are nice, but real learning requires holding CME course, using the newsletter and web site to better educate the doctors on rules that affect their daily practice. That is real learning. This is not being adequately done by the Board, in my opinion. Several Board members have been talked about this for years. I hope there is a movement towards this. This would be a win-win for both sides.
At the Board meeting, there was an expression to further the educative aspect of the Board. Thus, the Board is planning at least ten more Town Hall meetings have been planned accompanied with legislator visits and Licensure Orientations. To help with these projects a new staff member has been hired to focus entirely on community outreach meetings. The Texas Medical Board is reaching out to reopen the lines of communication with the public and the licensees. Many Board members discussed favorably the idea of the Board as a source of lifetime learning.
My Thoughts: The town meetings are nice, but real learning requires holding CME course, using the newsletter and web site to better educate the doctors on rules that affect their daily practice. That is real learning. This is not being adequately done by the Board, in my opinion. Several Board members have been talked about this for years. I hope there is a movement towards this. This would be a win-win for both sides.
Tuesday, August 12, 2008
Finance Committee: Notes from the June 2008 Texas Medical Board Meeting
Finance Committee: Notes from the June 2008 Texas Medical Board Meeting
The Finance committee introduced two new accountants, but the budget analyst position remains vacant. The mileage reimbursement rate was increased and may be increased again to compensate travel expenses for Board members. The Medical Board has spent 72% of its $6.4 million budget and has revenue of $2 million of which 69% has been spent.
The Finance committee introduced two new accountants, but the budget analyst position remains vacant. The mileage reimbursement rate was increased and may be increased again to compensate travel expenses for Board members. The Medical Board has spent 72% of its $6.4 million budget and has revenue of $2 million of which 69% has been spent.
Monday, August 11, 2008
Pill Mills and Rehab Committees (Not Related!)
Miscellaneous: Notes from the June 2008 Texas Medical Board Meeting
“Pill Mills” are an ongoing problem in the southern region of Texas. The Medical Board has been working with the DPS to crack down on these “Pill Mills” which are prescribing 3-5s because these are not reported. There is a plan on the table to make all 3-5s reported to the DPS but it would be administratively burdensome on the pharmacists.
My Thoughts: Only a fool would be involved in a pill mill. These are the bad doctors the Board is rightly focusing on. However, the notion of having to report all controlled substances is likely overkill for both pharmacists and law enforcement.
The Board is continuing to work with the TMA on physician rehabilitation issues.
The Board directed staff to look at language and wording for a proposal requiring a statutory change allowing doctors to prescribe medication to partners of patients with STDs without first seeing them. It was mentioned that other states have rules accommodating these patients.
My Thought: John Jackson, M.D. is the TMA Chair for the PHRC Committee. He has worked tirelessly for a rehabilitation committee that will allow doctors to report their addition problems without fear of the Board taking action. This would be a positive step in the right direction as physician with such issues have been driven under ground by the current actions of the TMB, in my opinion. Most states have a program like this. In fact, nurses in Texas have a program like this that is very successful. It is time for this. It is good to see the Board working with the recovery community in this way.
“Pill Mills” are an ongoing problem in the southern region of Texas. The Medical Board has been working with the DPS to crack down on these “Pill Mills” which are prescribing 3-5s because these are not reported. There is a plan on the table to make all 3-5s reported to the DPS but it would be administratively burdensome on the pharmacists.
My Thoughts: Only a fool would be involved in a pill mill. These are the bad doctors the Board is rightly focusing on. However, the notion of having to report all controlled substances is likely overkill for both pharmacists and law enforcement.
The Board is continuing to work with the TMA on physician rehabilitation issues.
The Board directed staff to look at language and wording for a proposal requiring a statutory change allowing doctors to prescribe medication to partners of patients with STDs without first seeing them. It was mentioned that other states have rules accommodating these patients.
My Thought: John Jackson, M.D. is the TMA Chair for the PHRC Committee. He has worked tirelessly for a rehabilitation committee that will allow doctors to report their addition problems without fear of the Board taking action. This would be a positive step in the right direction as physician with such issues have been driven under ground by the current actions of the TMB, in my opinion. Most states have a program like this. In fact, nurses in Texas have a program like this that is very successful. It is time for this. It is good to see the Board working with the recovery community in this way.
Wednesday, August 6, 2008
Texas Medical Board Still Looking for an Executive Director
New Executive Director - Notes from the June 2008 Texas Medical Board Meeting
The search for a new Executive Director is in full swing. Board members were assigned various other independent Medical Boards in other states to determine what kind of Executive Director would work best. Of all the Medical Boards in the country only 24 are Independent and of those only two Executive Directors are MDs. The rest of the Executive Directors are individuals with experience in administration. Soon after the Board meeting four candidates will be interviewed. These candidates include a pair of MD/JDs, an MD, and a JD. The JD candidate is the current Director of Enforcement Mari Robinson. She is also the current interim Executive Director.
My Thoughts: My money is that Mari Robinson will be named as the new Executive Director. This goes against history as the Board has historically been run by a physician. This will also mean, by law, the Board will need to hire a medical director to assist the Executive Director. However, this does not have to be a full time job. Time will tell if I am right or if I am wrong.
- Jon Porter
The search for a new Executive Director is in full swing. Board members were assigned various other independent Medical Boards in other states to determine what kind of Executive Director would work best. Of all the Medical Boards in the country only 24 are Independent and of those only two Executive Directors are MDs. The rest of the Executive Directors are individuals with experience in administration. Soon after the Board meeting four candidates will be interviewed. These candidates include a pair of MD/JDs, an MD, and a JD. The JD candidate is the current Director of Enforcement Mari Robinson. She is also the current interim Executive Director.
My Thoughts: My money is that Mari Robinson will be named as the new Executive Director. This goes against history as the Board has historically been run by a physician. This will also mean, by law, the Board will need to hire a medical director to assist the Executive Director. However, this does not have to be a full time job. Time will tell if I am right or if I am wrong.
- Jon Porter
Tuesday, August 5, 2008
Dr. Anderson Resigns from the TMB
Lawrence Anderson, M.D., a dermatologist from Tyler, Texas resigned as a member of the Texas Medical Board. Dr. Anderson was an active member of the Board and served on various committees of the Board, including, but not limited to the Executive Committee and the Ad-Hoc Search Committee for a new Executive Director. I am grateful for his service on the Board. There was no public statement to given for his resignation.
By law, there are 19 members of the Board, nine must be allopathic physicians (MDs), three must be osteopathic physicians (DOs) and the remaining seven are public members.
The Governor must appoint a new MD member, but there is no timeline to do so. If you are interested in becoming a member of the Board or wish to nominate someone, you can do so by completing an application from the governor's web site at www.governor.state.tx.us/divisions/appointments
By law, there are 19 members of the Board, nine must be allopathic physicians (MDs), three must be osteopathic physicians (DOs) and the remaining seven are public members.
The Governor must appoint a new MD member, but there is no timeline to do so. If you are interested in becoming a member of the Board or wish to nominate someone, you can do so by completing an application from the governor's web site at www.governor.state.tx.us/divisions/appointments
Web Site Re-Launched
Our law firm's website re-launched today. I think it looks great. I encourage you to check out the site. It has lots of useful information.
Check us out at http://www.healthlicensedefense.com/
Check us out at http://www.healthlicensedefense.com/
Monday, August 4, 2008
Computers and Keeping Staff Still a Weakness for the Board
Internal Audit and Staffing - Notes from the June 2008 Texas Medical Board Meeting
An internal audit was conducted concerning risk and probability for the Texas Medical Board and the two highest areas of risk were found to be the IT infrastructure and the salary structure for staff. There are many very old programs making it difficult to repair them if something should happen. The staff compensation levels have proved to be too low to even compete with other government agencies.
My Thoughts: These are two long standing issues for the Board and it is unlikely these matters will be solved anytime soon.
An internal audit was conducted concerning risk and probability for the Texas Medical Board and the two highest areas of risk were found to be the IT infrastructure and the salary structure for staff. There are many very old programs making it difficult to repair them if something should happen. The staff compensation levels have proved to be too low to even compete with other government agencies.
My Thoughts: These are two long standing issues for the Board and it is unlikely these matters will be solved anytime soon.
Friday, August 1, 2008
Recording ISCs?
Recording ISCs - Notes from the June 2008 Texas Medical Board Meeting
There have been some serious allegations concerning ISCs that have been brought to the legislature of things that have been said and done at ISCs. However, neither the Board members nor the lawyers are able to recall these events to respond to the allegations. In order to defend themselves against such allegations it was proposed that all ISCs be recorded. These recordings would be releasable to the legislature but not the public. Although it is still up to the Board how this recording process will be implemented, the recordings will not be discoverable. Settlement agreements are not admissible in trial. These recordings will also be kept confidential in much the same way the current disciplinary files are. These recordings will also be made available to Board members so they can review them before Board meetings. It may even be possible to defer a Board decision until a recording can be consulted. Although the conversation leaned towards audio recordings, video may still be possible. A proposal will be drafted and addressed in the August meeting.
My Thoughts: The basis of the discussion appeared to be more of an issue to protect the Board than as a method of recording to for the purposes of fairness. But what is most disturbing to me is that, based on the discussion, it did not appear that recording would be made available to the doctor. This is simply unfair and grossly unreasonable. If a recording is made, the recording must be made available to both parties. Otherwise, it is just a sham. Some attorneys, including myself, would consider not attending ISCs at all if recordings of ISCs are made but not available to both parties. This is just the fair and right thing to do.
There have been some serious allegations concerning ISCs that have been brought to the legislature of things that have been said and done at ISCs. However, neither the Board members nor the lawyers are able to recall these events to respond to the allegations. In order to defend themselves against such allegations it was proposed that all ISCs be recorded. These recordings would be releasable to the legislature but not the public. Although it is still up to the Board how this recording process will be implemented, the recordings will not be discoverable. Settlement agreements are not admissible in trial. These recordings will also be kept confidential in much the same way the current disciplinary files are. These recordings will also be made available to Board members so they can review them before Board meetings. It may even be possible to defer a Board decision until a recording can be consulted. Although the conversation leaned towards audio recordings, video may still be possible. A proposal will be drafted and addressed in the August meeting.
My Thoughts: The basis of the discussion appeared to be more of an issue to protect the Board than as a method of recording to for the purposes of fairness. But what is most disturbing to me is that, based on the discussion, it did not appear that recording would be made available to the doctor. This is simply unfair and grossly unreasonable. If a recording is made, the recording must be made available to both parties. Otherwise, it is just a sham. Some attorneys, including myself, would consider not attending ISCs at all if recordings of ISCs are made but not available to both parties. This is just the fair and right thing to do.
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