Monday, January 26, 2009

Perry Names A New Board Member and New DRC Member

Gov. Rick Perry has made two new appointments to the Texas Medical Board. The first is Scott Holliday, D.O. of University Park to the Texas Medical Board for a term to expire April 13, 2013. He replaces Dr. Roberta Kalafut.

Dr. Holliday is an anesthesiologist at Pinnacle Partners in Medicine and chairman of the Arlington Memorial Hospital Department of Anesthesiology. He is a member of the American Society of Anesthesiologists, Texas Osteopathic Medical Association, and Texas Medical Association. He is also an American Board of Anesthesiology Diplomate, and the Texas Society of Anesthesiologists District 2 State Delegate. Holliday received a bachelor’s degree from the University of Texas at Austin and a doctorate of osteopathic medicine from Kansas City University of Medicine and Bioscience. He completed his anesthesiology residency at the University of Texas Health Science Center at San Antonio.

John Guerra, D.O. was named to the Texas Medical Board District Four Review Committee for a term to expire Jan. 15, 2012. He replaces Bobby Howard.

Dr. Guerra is a board certified obstetrician/gynecologist, and a member of the American Osteopathic Association, Texas Osteopathic Medical Association, and American College of Osteopathic Obstetricians and Gynecologists. He is a member of St. Paul’s Catholic Church where he volunteers as a medical youth educator. Guerra received a bachelor’s degree from the University of Texas Pan American and a doctorate of osteopathy from the Texas College of Osteopathic Medicine.

Thursday, January 22, 2009

December TMB Board Meeting

TMB Executive Committee: 12/11/08

There was discussion on policies and procedures regarding individuals wanting to speak before the Board as there has been an increase the individuals wanting to address the Board. Ms. Robinson, the executive director, expressed a concern that if people are set on the Board’s agenda it may appear those people have been asked to appear and address the Board. Dr. Larry Price suggested a 30 minutes open forum, with a sign in sheet for those showing up the morning of. It was suggested that this time period go from 12:00 pm to 12:30pm. Those signing up to speak will provide a summary. This policy was approved.


Finance Committee: 12/11/08
Based on the report, there was approximately $100,000 left for the prior year’s budget. There may be some small outstanding receipts that need to pay from this reminder. Board staff estimated that in the first quarter of the fiscal year (which starts September 1st) the Board has spent 23% of its total budget.

Disciplinary Process Review Committee: 12/11/08
The Board heard four appeals of jurisdictional complaints, with one case re-opened. It also reviewed two non- jurisdictional complaints, with one opened to an investigation.
The Board discussed adopting a rule allowing doctors treating patients with STD’s to prescribe medication to their spouses and partners, as this is a public health issue. Some partners refuse to seek treatment due to lack of insurance and other reasons.

Dr. Melinda McMichael has query on limiting this to Gonorrhea and Chlamydia, as they do in other states. Ms. Robinson offers that the more specific you make the rule; the more often it will need to be changed. The Board motioned to adopt this new rule for publication.

Ms. Robinson thanked the Board members for their many nominations for expert panel suggestions, as the Board has experienced a shortage of experts willing to review cases. An appeal was sent out to all the specialty boards requesting nominations. Board member questioned whether it would help to advertise in a publication like Texas Medicine. Dr. Charles Oswalt mentioned that they needed to be careful of advertising in a widespread fashion as it could allow doctors with their own agenda to get their foot in the door and trying to change the way the board operates. Ms. Robinson will speak with Dr. Alan Moore, the Board’s Medical Director, regarding advertising for the panel positions. She is also considering having Dr. Moore begin an auditing program to review the panelist reports. Motion regarding approval of list of panel experts. One individual was removed from the list because his ex-wife was a lawyer on the board. Board approved the list with the one exception


Full Board Meeting: DECEMBER 12, 2008
Arrived 8:12 am
Directors Report: National Federation of State Medical Board -- Board wants to bring resolutions that would allow sharing of information between states. They specifically spoke about Applicants withdrawing applications and then applying in other state. The thinking is that if they withdraw, they may have something to hide and the state boards should be able to communicate this to each other.

Discussion on deleting the set of guidelines regarding anesthesiology assistants. This information will be removed. Board will continue to enforce Rule# 157 regarding physicians delegating to adequately trained assistants. This covers anesthesiologists as well.
Agenda item # 6 No order on this. A discovery motion was filed by Bob Simpson.
Consent Agenda – approved by motion.

Non Public Rehabilitation Orders. One Order was pulled and discussed. The Order was approved with deletion of a duplicate paragraph. Respondent changed specialty to ER medicine. Dr. Kalafut questioned whether this change was to avoid the stipulations of the Agreed Order. He passed the JP exam, and the Order is completed, but then could go back to the prior area of practice. Dr. Kalafut wanted to be sure that this individual would need to come before the Board in order to go back to previous area of practice. And if so, he would be under the original 5 year term of the Order.

8:30AM Senator Armbruster addresses the Board.

Various Proposed Orders were pulled, reviewed and discussed:

One Order was pulled by Paulette Southard regarding a doctor whose patient saw nurse practitioner 9 times from August to September. As x-ray done and found a tumor. Under the Order, the doctor can still able to supervise subordinates. Dr. McMichael proposes a fine for not adequately supervising the nurse practitioner and removing supervisory ability. It was discussed to place a three year restriction. It was proposed to issues a 3 years Order, removing supervisory delegation. Issue a $5,000 penalty and chart monitor. Also the Board directed staff to report the nurse practitioner to nursing board.

One Order was pulled by Julie Attebury as she did not see term for order. Respondent has a PIT and will have to present the order during the licensure process.

Ms. Southard pulled another Order. She questioned an Order regarding a physician who was already under an Order from 2005. She wanted to know why the new Order is only a one year term? Tim Turner explained that there was a specific reason for the one year term. The Order was approved with no changes.

Ms. Southard pulled another Order and expressed her opinion that there should be a fine. Only thing in the order is a requirement to comply with CME requirements. This was a from a fast track order. Sign this order and become compliant on CME immediately. The Order was approved without the change.

Ms. Southard asked about an Order in which a doctor prescribed medications to his son. She was not sure the whole story based on the Findings of Fact. She expressed a concern that when the Order is published in the newsletter, it brings up many questions because there is not enough detail. Rule 198 states -- standard of care – not allowed to prescribe to family member except in emergency and not to exceed 72 hours. It should clarify the board rule governs this controlled substance to a family member in amounts exceeding what is allowed. The drug in question was for ADHD and period was for one month. The Findings of Fact will delete that this was the doctor’s son and state it was an immediate family member and that the drug was on the controlled substance list. This doc was previously disciplined by the board. The first order was for CME violation. Several board members wanted to include the rule violated in the Findings of Fact. Ms. Robinson pointed out it was cited in Conclusions of Law.

Dr. Jose Benevides questioning the period of time for family prescriptions in the current Rule. Costs are same for 3 days of medications versus 30 days of medication. Ms. Robinson directed staff look into changing rule.

All Administrative Orders passed.

All Modification Requests passed.
All Nunc Pro Tunc Orders passed.

All Mediated Settlement Agreed Orders passed.

All Termination of Suspension Orders passed.

The Board reported that if they receive funding , the Board will continue with education outreach for physicians. The report sent to the Board members includes all notes from the town hall meetings. They did 13 meetings in 14 weeks and will not do that again as that was too many. The Board expressed that communication is important and continue to work at outreach. The format will change in the future. Plan to continue to pursue different communication efforts. It was expressed that the Board should take an active approach with informing the medical community.

In terms of outreach, it was express to make regular written submissions through TMA and county newsletters. It was opined as almost no one reads the disciplinary items on the Boards newsletter. Establishing better communication with different stakeholders and having information available at health fairs. Ms. Robinson asked Board Members to thoroughly read the report and give feedback. Dr. McNeese offered that TMA has blast email, which might be an avenue to use for educational items.

Dr. McMichael was named to be liaison during this legislative session.

479 physicians’ licensure applications were approved.

RULE CHANGES
Chapter 163.5 163.5 approved

Chapter 165 161.5 & 161.1 approved

Chapter 166 166.2 & 166.6 will be republished in final form with changes. Robert Simpson, general counsel, recommends passing. Republishing language of established rule approved.

169 – 169.7 approved

Chapt 173 approved

Chapt 178 Complaints approved

Chapt 179 approved

Chapt 180 approved

Chapt 182 Use of Experts – Public comments Elizabeth Naugle. Asked Board to consider changing statutes to include Experts from outside of Texas. She will bring the issue to Legislature. Approved

Chapt 187 approved

Chapt 190 disciplinary guidelines Board looks at AMA guidelines, suggested that they should publish this , but AMA asked them not to, as it can be used as a sword by patients.
Ms. Robinson suggested they approved everything but point # 8 and make adjustments to that point with input from the stakeholders. Approved 190.1 and 190.14.

Motion on 190.8 to direct staff to make amendments

Chapt 192

Changes delete 191.2 which talks about standards for anesthesia services, level one. Regarding certain drugs being available in every O.R. in pre-measured doses. The problem and feedback is they do not come in premeasured form. Dr. Kalafut suggests change “pre-measured doses” to “have on hand” . Specific stakeholder group came up with the initial set of guidelines, but now that it has been implemented, changes need to be made. Will be removing pre-measured. Approved

Shirley Pigott, MD asked to address the Board. Elizabeth Naugle asked to address the Board.

Sorry for Not Writing

Ok. I have not written in a while. Sorry about that. I am going to try to get back into the habit of writing. My goal is no less than two posts per week. I should have information on the last Board meeting up soon.