Five Ideas to Improve the Texas Medical Board
The following are five ideas that I believe based on my experience with the Board that would improve the process. I encourage all readers to share these ideas with their state representatives, senators and professional organizations. I also would encourage readers to debate this ideas and think of other methods. The Board has an important job. I believe it can be done better.
1. Give Final Decision-Making Authority to the State Office Of Administrative Hearings. The point of this is to provide true due process to the system. After an Informal Settlement Conference (ISC), if a decision is not agreed to, the Board will file a complaint at the State Office of Administrative Hearings (SOAH). After a full blown trial, an administrative law judge (ALJ) issues a proposal for decision (PFD). The reason it is a proposal is the full Board votes on the proposal despite the fact the Board members were not involved in the hearing in any way. They can accept the PFD, modify it, or even reverse it. The Board has done just this on occasion. As a result, some people are reluctant to exercise their rights as there is a justifiable fear that the Board will merely reverse the decision of the ALJ if there is a positive finding for the doctor.
2. Change the Standard of Review on Appeal. Currently the standard of review is called “substantial evidence” this means to challenge the Board’s decision on appeal requires an extraordinary outcome to reverse the Board. Under the standard of review, the vast minority of cases are reversed.
3. Statute of Limitations. There are currently no statute of limitations on complaints to the Board. Two years like malpractice is likely unreasonable, but seven years since the time of the incident is a reasonable statute of limitation on complaints.
4. Investigation/Application File. Under the law the application and investigation file is considered confidential, thus the Board will not release any information to the physician unless they want the physician to see the information. The Board’s investigation file should be released to the doctor so they can see the evidence in the file, both the good and the bad. That is what is done in criminal trials, why should criminals get more rights than doctors? This should equally apply to the Licensure file. Other agencies do this and it does not negatively impact their job.
5. Know your Accuser. Other agencies disclose who filed the complaint. I believe doctors should know. Many accusers are competitors, insurance companies, and other parties. Many times it is not the patient. It is true the majority of the complaints are patients and their families. The rationale for the confidentiality of the complaint is patients may not be treated if the doctor knows who filed the complaint. My personal belief is: if a patient filed a complaint, the patient is not likely to continue to see the doctor.
These five steps will help in making the process fairer and more cost effective for both the doctor and the Board.
Great ideas but change has to start at the top. We have all seen the hearings or at least read about them but I have not heard of any action being taken. There is too much at stake for the system not to be fair to both physicians and patients but unless there is true change in the direction and leadership the status quo will be exactly that.
To date, nothing has resulted from the October 23rd meeting. In fact, Rick Perry called the Board at the last Board meeting on November 30th lending support to the Board. Gov. Perry suggested that only a few “bad” doctors are causing this issue. It is my humble opinion that the Gov. Perry has not spoken to doctors about the concern that generally is out there regarding the Board today. There is a lot of fear right now. The people should not fear its government. The Board should take a leadership role and educate more and punishless, especially on the minor offenses that it spends a great deal of time and money on.
On sports teams, the problem is sometimes the coach. The problem here is the Executive Director. He has caused a culture of fear inside the agency and outside the agency.
It seems it will be very difficult to change what essentially controls us. If I am correct you were at one time on the inside. What is your perspective on any realistic change?
If people get organized things can change. Some law makers are very intersted in this matter. Change is possible, but it will take time and effort.