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Texas medical board disciplinary process

The Texas Medical Board receives about 6,000 complaints a year. Of these, about 2,800 are opened for investigation, and those investigations result in 350-400 disciplinary actions ranging from public reprimands, administrative penalties, education, restrictions, to licensure suspension or revocation.

This is what you need to know if a complaint is filed against you: During the first 30 days, before a complaint is formally filed for investigation, TMB staff attempts to contact the complainant and the licensee. If you receive notice that a complaint has been filed against you, you have 14 days to submit information to the board. If the information shows there is no violation, there will be no investigation. The timeline is statutory, and responses received after the deadline will be considered after the investigation is opened.

If an investigation is opened and the allegations are serious, you may consider hiring an at-torney.

Whether you do or not, open and keep any correspondence from TMB. Communication between licensees (and/or their attorneys) and the agency is essential to resolve complaints fairly and efficiently.

only by a fine, with no other allegation, are eligible for fast-track consideration. You may choose to participate in this system by agreeing to the charges and paying a fine rather than going through a full investigation. A licensee who disputes the charges can contest the violation in writing and the case will be reviewed by a board committee, or a physician may contest the charges through TMB’s investigation and litigation process. Eligible minor violations include failure to provide medical records in a timely manner, failure to file a change of address with TMB, failure to sign a death certificate in a timely manner, failure to obtain required continuing medical education, and other administrative violations. Standard of care or unprofessional

conduct violations are not eligible for fasttrack. A licensee may opt for fast-track no more than three times, and only once for a given violation.

Investigations

Once an investigation is opened, the licensee is informed of the alleged statutory violation, asked to provide additional information, and may receive a subpoena for records. TMB is authorized under HIPAA to obtain medical records without a patient’s consent. Failure to provide subpoenaed records within the set time is a violation of the Medical Practice Act.

Write a complete, objective and thoughtful response. Include references to key notes in the medical record. Explain the critical medical reasoning. Your response will be reviewed in the process of determining whether the alleged action or conduct violates the Medical Practice Act.

If the investigation involves standard of care, your response and the records will be reviewed by at least two board certified experts in the same or similar specialty. If the Expert Panel finds the standard of care was not met, the case will go to TMB’s litigation section. Otherwise, it will be recommended for dismissal.

Informal resolution

Once a case goes to Litigation, it is assigned to a staff attorney and scheduled for an Informal Settlement Conference/Show Compliance Hearing. The ISC is held in Austin before a panel of two Board representatives. You and/or your attorney will typically be notified of that date about 45 days before

For cases that proceed to an Informal Settlement Conference, a packet of information and evidence for the ISC, including the Expert Panel Report, is sent out 30 days before the hearing.

You may respond in writing to the information in the ISC packet, including the Expert Panel Report. The deadline for your response is five business days before the scheduled ISC so that the ISC panel may prepare. If the information arrives after the deadline, the panel may refuse to consider it.

If TMB receives your rebuttal early enough, staff will attempt to have it reviewed by the expert panel. This process allows the medical reasoning and information from experts from both sides to be considered, and it may result in a recommendation of dismissal.

An ISC hearing is an informal forum for the panel to review the information and for the physician to provide evidence of compliance with the Medical Practice Act. Each hearing is generally scheduled for one hour. The ISC is not a contested case hearing.

TMB Rule 187.7 requires respectful behavior of all participants in ISCs. Although you may have your attorney in the ISC, the panel wants to hear from you. Be prepared to make a brief opening statement and to respond to tough questions. If you feel that essential information has not been introduced, you may follow up after the panel has asked questions.

After the panel hears from board staff and the respondent, the panel will deliberate and then inform the respondent of their recommendation of one of several possible outcomes: an agreed order, filing at the State Office of Administrative Hearings, a temporary suspension, further investigation, or dismissal.

If the panel recommends an Agreed Order, please work with the staff attorney in a timely manner. Substantive changes are presented to the panel members for approval. Even though the attorneys may think the changes are appropriate, the panel members may not agree.

If you decide not to accept the Agreed Order, inform the staff attorney. After an Agreed Order is signed, it is presented at the next Board meeting for approval, modification, or denial. You and your attorney will be notified of the outcome after the meeting. The effective date is the date the Board President signs the order.

TMB reports to the National Practitioner Data Bank all Agreed Orders or Board Orders that place restrictions on a license. This includes suspension, revocation, or a restriction that prevents the licensee from performing a procedure. TMB does not report to the NPDB any Agreed Orders or Board Order that place only requirements on the licensee. This includes participation in the TMB chart monitoring program, extra CME, or an administrative fine. It is important to understand the differences because it may affect your decision to accept an Agreed Order.

Formal resolution at the State Office of Administrative Hearings If resolution cannot be reached through an Agreed Order, the case will be assigned to a TMB attorney who will handle the case at the State Office of Administrative Hearings. This is a full trial, with rules of evidence, discovery and other aspects of a trial. After the Administrative Law Judge hears the case and deliberates, the ALJ recommends a final resolution to the Board, which may accept or reject the ALJ’s recommendation. If the respondent wishes to appeal the board’s decision, the next step is to file in Travis County District Court.