Full Board Meeting: February 6, 2009

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.