At the Board meeting, it was reported that Board had nine visits from legislators this year. The Board reports it has met with several key legislators, including: Dole, Nelson Reynolds, Brown Allen, and Hartmann. On February 23rd, Mari Robinson, the Executive Order is meeting with the Senate finance committee. She asked for Board member to attend if they could. Rep. Brown has several bills that Board staff plan to closely monitor.
Ms. Robinson reports that staff is in general agreement with the Sunset review report. She also reports that Licensure meet is goals and states that staff is resolving applications in well under 51 days. However, she also reports that the amount of investigations threatens to overload the system.
Ms. Robinson reported the Board staff are working with DEA and DPS regarding pain clinics. They attempting to ensure that any pain management clinic will need the owner to be a licensed physician and the clinic will need to be registered with the board. There will be a fee with the registration. The hope is to reduce overdose deaths coming out of that area in East Texas.
Ms. Robinson reports that the Board is playing an active role on physician health and rehabilitation legislation. Again, the purpose is to move impairtment into a quasi-governmental status where physicians who self-report do not have go through the investigation and disciplinary process. If the doctors follow the guidelines, they will not be subject to action. They are hoping it will increase the numbers of physicians who will seek rehabilitation.
Ms. Robinson reports that AAPS have drafted a bill, which contains items such as: Expert panel will not be confidential; establish an oversight committee for the Board; no anonymity for complainants; the doctor in an investigation can have access to the investigative file; and the Board could not discipline a doctor without a jury trial. Board staff is working on a line by line response to the proposal. Jane McFarland is heading up the effort.
The staff reports the budget they have submitted. They are deleting rider regarding the Executive Directors salary. A Funding analysis determined areas to bring in $2Million more dollars this biennium. The goal is to have the “extra” money to pay for exceptional items in the budget. These are:
1) 11 new staff to deal with increase in investigations and prosecutions. Among the 11 individuals would be hire at least one more attorney and a physician to assist with internal reviews and likely support for the enforcement staff.
2) Information technology,
3) security, updating systems,
4) outreach program to speak to med students, pod casts,
5) merit money for staff.
Board members were encouraged to talk with legislators to get this money.
On the other hand, the Board was directed to cut 2.5 % of 2009 budget as directed by Lieutenant Governor and Speaker of the House. This means $235,000 from the budget. Cuts include:
1. $49,000 saved by not mailing out newsletters;
2. $16,000 out of staff travel;
3. $?? Document storage going to go state library;
4. $27,000 not replacing computers this fiscal year;
5. $8,000 cancelled 1 PA & 1 Acupuncture board meeting;
6. $1,200 not mailing paper license only letter to new physicians;
7. $5,000 not advertising vacant positions;
8. $10,000 not microfilming;
9. $ ?? not using ATT wireless modems;
10. $5,000 eliminating FAX lines for field staff by combing phone line and Fax line in one;
11. $8,000 in travel for management training;
12. $1,200 prior out of state travel (received a scholarship)
13. $ ?? Freeze hiring in licensure, PRC Administrative, enforcement, lawyer enforcement; and
14. $ ?? Putting off SOAH case till next year;
Of the specific cuts it equals: $122,400, thus the ?? will need to add up to $112,600.
There are two other possible cuts that may be considered:
1. $9,00 for not updating the security system; and,
2. $10,000 to cut remaining a TMB board meeting in this year.
Asking to extend the period of time from 30 to 45 day on initial processing of a complaint to avoid docs from reporting to insurance companies and peer review. Inquiry about doing teleconference for simple ISC’s to save money and speed the process
A lawsuit was filed against LMFT Board, wherein the LMFT Board authorized their practitioners the ability to “diagnose” mental illness. This allegedly allows non-licensed physicians to practice medicine. TMA is requesting that the TMB be listed as a party in the lawsuit. Dr. Michael Arambula commented that the diagnosis is based on the DSM, which LMFT practitioners use, however, some conditions such as Delirium is a physical ailment and leads to psychotic behavior. He agrees with the TMA. Consensus of the Board to join with TMA. The Board directed staff to inform TMA they will join the suit.
In late 2007, the AAPS filed a federal lawsuit against the Board. Currently, the judge abated all discovery pending rulings on certain motions.
There are also two open records issues pending in court. TMB has appealed 2 cases in the area of compliance files. There is still a question of whether these documents are open record. Open records division ruled physician monitor reports are confidential. Drug and Compliance reports would be open if this succeeds. The hearing is scheduled for March 4.
Proposal for Decision
Judge Susan Marshall from SOAH spoke on the Dr. Mark Van Wormer case. Dr. Van Wormer was convicted of a felony in New Mexico for misbranding a drug. He served time for the offense and his license was revoked upon incarceration. Judge Marshall concluded his license should be revoked due to operational law. Motion to accept ALJ’s proposal, motion carried.
Approval of Board Orders
8 Orders were pulled and discussed. Several were changed based on discussion.
Rule Changes:
a. Section 162 Rule Change must have active and unrestrictive license to supervise PA’s and APN’s. Motion passes
b. Section 171 Postgraduate training permits. Omitting these. Motion passed
c. Section 172.4 clean up of the reference . Motion carried Section 172.8 substantive change to delete institution with a program of education. Statutory cleanup from a mistake originally made. Three pubic presenters from the Methodist Hospital System. Dr. Gabor asked that the Board not delete this provision. Expand the rule from fellowships to residency programs. Osama Gabor director of Methodist Hospital is in favor of faculty temporary license. This Enables schools to recruit well qualified individuals to do research without a Texas Medical License. His license took 8 months to obtain, as he attended Medical School in Egypt and worked in many different places in the US, which took much time to get the paperwork together. Motion to pull 172.8 to bring to the work group with the intention to widen the circle of accepting qualified reputable individuals to Texas with an FTL. If there is legislation regarding this, it will make it much easier. Staff is currently putting all FTL under this rule on hold. Direction to staff to continue doing what they are doing. Vote for publication in April and adopt at June meeting
d. Section 175.1 and Section 175.3 changing penalty fee, motion passes
e. Section 185.2 PA cannot be supervised by a physician with a restriction on license. Motion passes
f. Section 189.1 statutory changes to the rule, changes to names of the boards
Section 189.4 D same issues on supervising PA’s. Motion passes.
Rule changes to Acupuncture Rule, motion passes.
Thursday, February 19, 2009
Thursday, February 12, 2009
Notes From Disciplinary Process Review Committee 2/5/09
For reasons under know, Board staff isolated those seeking to appeal a dismissal of their complaints. They all waited in a room off from where the meeting is held. All appeals are heard in Executive Session, thus away from the public. It is important to note that physicians are not advised that their cases are under appeal.
Board staff reported that for this fiscal year (runs from September 1 to August 31), the number of investigations opened and generally equal to last year. Last year, the Board opened 2725 investigations.
What is interesting, and we did not hear an explanation for this, but the number of Informal Settlement Conferences (disciplinary hearings) are up from last fiscal year. In all of fiscal year 2008, the Board held 521 Informal Settlement Conferences, which 19% of the total investigations. This year, 1/3 of they way through the year, the Board has already held 224 Informal Settlement Conferences.
Staff advised Board members, the Board five to six Informal Settlement Conferences for each hearing date. The Board staff is restricting the granting of continuances.
Mari Robinson, the Executive Director, recommended to the Board members that the agency should pursue federal law changes that permit all physician licensing agencies agree to share all files regarding physicians. Also, she wants the agencies to retain the confidentiality protections they had in its original board. The reason for this is Texas has stricter rules regarding confidentiality than many other states. The concerns is that releasing information to sister agencies may compromise Texas records. As an example, in Iowa, their hearings similar to that of Informal Settlement Conferences are open to the public. Any information that Texas may supply to the Iowa Board would be released in Iowa, but would be completely restricted in Texas.
The Board members voted to have staff purse a recommendation to Federation of State Medical Boards to have confidentiality laws conform across state lines.
Dr. Alan Moore, the Medical Director, reported that he is working hard to get more panelists to review records for the Board. He has recruited 14 new physicians so far. He reported that doctors are just not responding to the request letters. Lots of letters have been sent out to doctors across Texas. He reports the Board is in dire need of neurosurgery monitors.
A Board member asked Dr. Moore whether Texas Medical Foundation (TMF) was guarding its list of expert. Dr. Moore stated TMF has a new medical director and they had talked. It appears TMF will share its list with the Board.
Dr. Moore shared an idea to award Board consultants CME hours for reviewing cases.
Kim Barron was introduced as the Board staff member who is handling the recruitment of panelists. Dr. Moore reported that he trying to increase his exposure to the reviewers and monitors.
My Take:
1. I take issue with the appeals process for complaints. I feel that the practitioners should receive notice. I also feel that a strict standard should be established to re-open a closed investigation. Currently, there is not a strict standard of when an investigation is re-opened.
2. The numbers disciplinary continue to increases. If the disciplinary hearings trend continued and the number if investigations continue to remain strong, but flat, that means that a quarter of investigations will result in ISC if these numbers hold true. Therefore, I believe it is critical that people get help as soon as possible in the investigative process and not wait until and hearing is set to get expert assistance. Self-serving I know, but the numbers don’t lie.
3. Rather than continue to make everything confidential, I think the Board, and the government in general, needs to work on transparency; not secrecy.
4. The lack of consultants for the Board has resulted in a serious backlog of cases. I wish Dr. Moore good luck locating consultants. The key is, however, there needs to be better training and mentoring of these individuals. I cannot tell you how many reports that can be distilled down to: I would not do it that way; therefore, it’s below the standard of care. Sorry, that is not the measure. Medicine is as much art as science. Individual physicians need to have the flexibility to use their judgment to care for patients.
Board staff reported that for this fiscal year (runs from September 1 to August 31), the number of investigations opened and generally equal to last year. Last year, the Board opened 2725 investigations.
What is interesting, and we did not hear an explanation for this, but the number of Informal Settlement Conferences (disciplinary hearings) are up from last fiscal year. In all of fiscal year 2008, the Board held 521 Informal Settlement Conferences, which 19% of the total investigations. This year, 1/3 of they way through the year, the Board has already held 224 Informal Settlement Conferences.
Staff advised Board members, the Board five to six Informal Settlement Conferences for each hearing date. The Board staff is restricting the granting of continuances.
Mari Robinson, the Executive Director, recommended to the Board members that the agency should pursue federal law changes that permit all physician licensing agencies agree to share all files regarding physicians. Also, she wants the agencies to retain the confidentiality protections they had in its original board. The reason for this is Texas has stricter rules regarding confidentiality than many other states. The concerns is that releasing information to sister agencies may compromise Texas records. As an example, in Iowa, their hearings similar to that of Informal Settlement Conferences are open to the public. Any information that Texas may supply to the Iowa Board would be released in Iowa, but would be completely restricted in Texas.
The Board members voted to have staff purse a recommendation to Federation of State Medical Boards to have confidentiality laws conform across state lines.
Dr. Alan Moore, the Medical Director, reported that he is working hard to get more panelists to review records for the Board. He has recruited 14 new physicians so far. He reported that doctors are just not responding to the request letters. Lots of letters have been sent out to doctors across Texas. He reports the Board is in dire need of neurosurgery monitors.
A Board member asked Dr. Moore whether Texas Medical Foundation (TMF) was guarding its list of expert. Dr. Moore stated TMF has a new medical director and they had talked. It appears TMF will share its list with the Board.
Dr. Moore shared an idea to award Board consultants CME hours for reviewing cases.
Kim Barron was introduced as the Board staff member who is handling the recruitment of panelists. Dr. Moore reported that he trying to increase his exposure to the reviewers and monitors.
My Take:
1. I take issue with the appeals process for complaints. I feel that the practitioners should receive notice. I also feel that a strict standard should be established to re-open a closed investigation. Currently, there is not a strict standard of when an investigation is re-opened.
2. The numbers disciplinary continue to increases. If the disciplinary hearings trend continued and the number if investigations continue to remain strong, but flat, that means that a quarter of investigations will result in ISC if these numbers hold true. Therefore, I believe it is critical that people get help as soon as possible in the investigative process and not wait until and hearing is set to get expert assistance. Self-serving I know, but the numbers don’t lie.
3. Rather than continue to make everything confidential, I think the Board, and the government in general, needs to work on transparency; not secrecy.
4. The lack of consultants for the Board has resulted in a serious backlog of cases. I wish Dr. Moore good luck locating consultants. The key is, however, there needs to be better training and mentoring of these individuals. I cannot tell you how many reports that can be distilled down to: I would not do it that way; therefore, it’s below the standard of care. Sorry, that is not the measure. Medicine is as much art as science. Individual physicians need to have the flexibility to use their judgment to care for patients.
Wednesday, February 11, 2009
Notes from the Executive Committee of the Texas Medical Board from February 5, 2009
The biggest news and least surprising was the Board made Mari Robinson the Executive Director, removing the “interim” tag that she has carried for the past several months.
The Board also approved Dr. Moore to be the full-time Medical Director.
An issue that will dominate the Board and government in general due to the country’s economic crisis is the budget. Thus, the Board is looking at ideas to generate income for itself. Some of the ideas are as follows:
1) A proposal to have the Board offer on-line CME, in such areas as ethics and chart monitoring online. The Board does not have to be certified through a CME group to offer CME. They will have to change the rules to say the Board will accept any Board produced course. Ms. Robinson mentioned that the Board has the authority to change the language. In order to further study this, a subcommittee was formed. Those volunteering include: Dr. Margaret McNeese, Dr. Melinda McMichael, Mr. Timothy Webb, Dr. Charles Oswald and Ms. Annette Raggette.
2) License verification by hospitals, peer review committees or other states will be charged for the verification beginning Sept 2009.
3) Wall certificates – currently applicants receive a letter and an 8 x 10 piece of paper stating they are licensed. They are considering offering (not requiring) a larger, higher quality licensure certificate for a cost of between $30 - $50. This cost range is comparable to other states and Texas is one of the few states that do not offer this.
4) JP Exam questions – currently the Board drafts questions for the exam without charging. They are considering drafting questions and publishing them online with a guide to process the answer results. There will be a charge for this. The Board wants the physicians to KNOW the answers to these questions, not use the exams as a way to “get” them.
The next issue of note was a discussion on how to categorize complaints coming into the agency through Board members. Currently, such complaints are merely labeled “TMB” without identifiers on who specifically requested the investigation opened. This practice has been questioned by some. There is a concern that this is perceived as unethical. Ms. Robinson defended the practice.
There was a discussion that if Board members make complaints, should they be under TMB or under the Board member name. There was agreement that there is nothing wrong with a Board member reporting illegal behavior. Mr. Robert Simpson, the General Counsel, agreed that it was legal for Board members to do so.
Dr. Irvine Zeitler, the Board president, expressed that he has received numerous complaints from all over the state. It is his practice to encourage people who communicate to him to make the complaint themselves. Ms. Paulette Southard also stated that she also directly receives complaints. She states some of the people fear retribution, thus do not make the complaint themselves. Mr. Simpson agreed that it is a “cleaner situation” to have the person make the complaint, but if the person is just not willing, then it may be accept to have the Board member make the complaint.
Ms. Julie Attebury suggested sub-categorizing such complaints. For example, if staff opens a complaint based on information found during the course of an investigation versus a complaint made by a Board member.
The Board members directed staff to allow board members submitting complaints to decide on an individual complaints basis how to classify.
My Take:
1. I sincerely wish Ms. Robinson and Dr. Moore the best of luck. I hope they continue to do outreach and work with all parties, including the defense bar to make this system work for everyone.
2. I have no problems with the Board attempting to generate income. I especially like “giving” the answers to the jurisprudence test. It does not make any sense to play “hide the ball” with those questions, as it benefits everyone to know all the answers to the test. You know the answers to the test; hopefully the licensee will learn the law.
3. On the issue of Board members making complaints, m feeling is that the Board is currently suffering from a serious perception problems on this specific topic. The fact of the matter it does not matter if all complaints made by Board members are wholly legitimate, it does appear to be an abuse of power. As with many things in life perception is reality. Therefore, the Board members need to be careful in this regard. I believe that Dr. Zeitler is correct in his efforts to encourage people who complain to him to report their concerns to the Board. That is the proper method of dealing with this matter. Moreover, if a Board member has a legitimate, factually based concern regarding a practitioner, I do not have a problem with them reporting this. However, I believe the Board member should also sign a waiver to disclose that he or she made the complaint. That transparency will help the Board and the image of the Board. This will diminish the allegations of abuse of power. Note that I said legitimate, factually based concern. I strongly do not believe any Board member or Board staff should file a complaint against a licensee based solely on comments made by someone…that is hearsay, plain and simple. If there is objective evidence that’s one thing; subjective, unsupported comments are another. Whether that has been done or not in the past, I don’t honestly know. But is it the perception that it has that has hurt the image of the Board in the physician community. Transparency is the solution to this issue.
The Board also approved Dr. Moore to be the full-time Medical Director.
An issue that will dominate the Board and government in general due to the country’s economic crisis is the budget. Thus, the Board is looking at ideas to generate income for itself. Some of the ideas are as follows:
1) A proposal to have the Board offer on-line CME, in such areas as ethics and chart monitoring online. The Board does not have to be certified through a CME group to offer CME. They will have to change the rules to say the Board will accept any Board produced course. Ms. Robinson mentioned that the Board has the authority to change the language. In order to further study this, a subcommittee was formed. Those volunteering include: Dr. Margaret McNeese, Dr. Melinda McMichael, Mr. Timothy Webb, Dr. Charles Oswald and Ms. Annette Raggette.
2) License verification by hospitals, peer review committees or other states will be charged for the verification beginning Sept 2009.
3) Wall certificates – currently applicants receive a letter and an 8 x 10 piece of paper stating they are licensed. They are considering offering (not requiring) a larger, higher quality licensure certificate for a cost of between $30 - $50. This cost range is comparable to other states and Texas is one of the few states that do not offer this.
4) JP Exam questions – currently the Board drafts questions for the exam without charging. They are considering drafting questions and publishing them online with a guide to process the answer results. There will be a charge for this. The Board wants the physicians to KNOW the answers to these questions, not use the exams as a way to “get” them.
The next issue of note was a discussion on how to categorize complaints coming into the agency through Board members. Currently, such complaints are merely labeled “TMB” without identifiers on who specifically requested the investigation opened. This practice has been questioned by some. There is a concern that this is perceived as unethical. Ms. Robinson defended the practice.
There was a discussion that if Board members make complaints, should they be under TMB or under the Board member name. There was agreement that there is nothing wrong with a Board member reporting illegal behavior. Mr. Robert Simpson, the General Counsel, agreed that it was legal for Board members to do so.
Dr. Irvine Zeitler, the Board president, expressed that he has received numerous complaints from all over the state. It is his practice to encourage people who communicate to him to make the complaint themselves. Ms. Paulette Southard also stated that she also directly receives complaints. She states some of the people fear retribution, thus do not make the complaint themselves. Mr. Simpson agreed that it is a “cleaner situation” to have the person make the complaint, but if the person is just not willing, then it may be accept to have the Board member make the complaint.
Ms. Julie Attebury suggested sub-categorizing such complaints. For example, if staff opens a complaint based on information found during the course of an investigation versus a complaint made by a Board member.
The Board members directed staff to allow board members submitting complaints to decide on an individual complaints basis how to classify.
My Take:
1. I sincerely wish Ms. Robinson and Dr. Moore the best of luck. I hope they continue to do outreach and work with all parties, including the defense bar to make this system work for everyone.
2. I have no problems with the Board attempting to generate income. I especially like “giving” the answers to the jurisprudence test. It does not make any sense to play “hide the ball” with those questions, as it benefits everyone to know all the answers to the test. You know the answers to the test; hopefully the licensee will learn the law.
3. On the issue of Board members making complaints, m feeling is that the Board is currently suffering from a serious perception problems on this specific topic. The fact of the matter it does not matter if all complaints made by Board members are wholly legitimate, it does appear to be an abuse of power. As with many things in life perception is reality. Therefore, the Board members need to be careful in this regard. I believe that Dr. Zeitler is correct in his efforts to encourage people who complain to him to report their concerns to the Board. That is the proper method of dealing with this matter. Moreover, if a Board member has a legitimate, factually based concern regarding a practitioner, I do not have a problem with them reporting this. However, I believe the Board member should also sign a waiver to disclose that he or she made the complaint. That transparency will help the Board and the image of the Board. This will diminish the allegations of abuse of power. Note that I said legitimate, factually based concern. I strongly do not believe any Board member or Board staff should file a complaint against a licensee based solely on comments made by someone…that is hearsay, plain and simple. If there is objective evidence that’s one thing; subjective, unsupported comments are another. Whether that has been done or not in the past, I don’t honestly know. But is it the perception that it has that has hurt the image of the Board in the physician community. Transparency is the solution to this issue.
Subscribe to:
Posts (Atom)