Sep. 14, 2007

Gov. Perry Reappoints Kalafut to Texas Medical Board

AUSTIN – Gov. Perry reappointed Dr. Roberta M. Kalafut of Abilene to the Texas Medical Board and as presiding officer. The board serves to protect and enhance the public’s health, safety and welfare by establishing and maintaining standards of excellence used in regulating the practice of medicine and ensuring quality health care for the citizens of Texas.

Kalafut is a physician and owner of SpineAbilene. Kalafut is a member of the Texas Osteopathic Medical Association, the Texas Medical Association, and the American Academy of Physical Medicine and Rehabilitation. She is double boarded in Physical Medicine and Rehabilitation as well as Pain Medicine. She is a lector and a Eucharistic minister for Holy Family Catholic Church in Abilene.

Kalafut received her bachelor’s degree from Youngstown State University and her medical degree from the Ohio University College of Osteopathic Medicine. Her residency was through Sinai Hospital of Baltimore and Johns Hopkins Hospital. Her term will expire April 13, 2013.

 Should you have questions or concerns, about any information on this blog, please contact Jon Porter at www.healthlicensedefense.com

Information provided through Jon Porter at www.healthlicensedefense.com 

 This information is from the August 23rd and 24th, 2007 Texas Medical Board Meeting in Austin, Texas.  The next meeting will be held October 4th and 5th Austin. 

We were not permited into the Executive Committee as it went into Executive Session upon our arrival. 

Report by Mari Robinson, Director of Enforcement

According to Ms. Robinson, more jurisdictional complaints have been opened in Fiscal Year 2007 (FY07) than in the entire history of the Board. However, the Board is also closing 10% fewer cases within the 180 days statutory mandate. Ms. Robinson expressed worry about being able to keep up with the increasing case load.

Licensure should be fine because they have been receiving FTEs every session.

The current Case load is 536 cases. That is 200 more than at the same time last year.

The current amount of ISCs undergone is 414 in FY07. Ms. Robinson believes the board will near 500 total ISCs for the year. It is very interesting to note that 12-14 of the 22 working days a month are spent in ISCs.

Ms. Robinson expressed a degree of worry about the current case load and allocation of the Board’s scarce resources. She proposed an idea which the Board places more resources towards cases “that are more likely to harm the public” such as impairment and standard of care cases. In her plan cases of a more administrative nature need not go all the way to an ISC. Among these less important cases will fall cases that involve only medical records issues. It seems that many cases have been going to ISC when it is really not necessary. Rather than going to an ISC, Ms. Robinson proposed that they can be discussed in a DPRC meeting saving much of the Board’s time. She wanted these cases to be voted on by the complete DPRC and not by specific members preventing Board members with “hot button” issues such as DUIs from kicking cases back to ISC.  Her plan is to also find a way to evaluate doctors who are repeat offenders in a more meaningful way. She discussed these new plans further in the full Board meeting.

The Board wants to focus on educating doctors about proper advertising. The Board decided to emphasize advertisement issues for the next 6 months or so.

There was some confusion as to whether or not electronic records that are either burned on to a CD, or emailed still require the same per page fee. The Board sent this to a stakeholder group to look at.

The Board is reinstating its practice of fingerprinting all medical license applicants. The Board has set up a deal with a vendor, Identix, who supposedly has 30 locations in the state of Texas . The system is digital and will only cost $20.40. Doctor’s just need to drop by a vendor location, have their fingerprints scanned and they are done. As this is a digital system, the vendor states the turn around time on the background checks involved with the fingerprints will only take 2-3 days. There was some discussion as to whether in the future all doctors in the state of Texas will be required to get fingerprints on file. This may take the form of requiring all doctors to include fingerprints in their renewals. It took Florida 2 years to fingerprint their doctor population.

The Board now releases a bulletin to the legislature. It is a one page document that is short and to the point. This will be a monthly bulletin. 70% of the calls from legislators are on calling on behalf of a licensure applicant. Another 20% call with questions about policies, data, or issues on rural doctors.

This rule, which was discussed at the June meeting, states that all materials for an ISC are due 5 business days prior to the ISC. This rule has been in place but not enforced for some time now. Staff was directed to begin enforcing this rule and to send out a letter to all defense attorneys to let them know. These letters were sent out. Hopefully this rule will prevent “one of the key defense practices… to delay delay delay.”

This doctor was given 10 hours of CME and a $2,500 fine. Dr. Kalafut believes that this case deserved a public reprimand. The patient in this case ended up being a c3, c4 quadriplegic. This means that the patient has no life without ventilator support. The patient had gone in for a herniated disk. The patient deteriorated after the surgery and the hospital was unable to get a hold of Dr. Ward. A public reprimand was added to this order.

This doctor prescribed to one patient an average of 18 Hydrocodine per day with no medical records. This doctor also prescribed Methadone in high quantities to a patient for 6 months prior to actually seeing said patient. Somehow this doctor managed to retain all of his prescribing abilities. Board moved to remove prescribing of 2s and 3s and to add a public reprimand.

John Langley is the latest addition to the law staff at the Board.

In addition, the staff hired 7 additional employees.

Defendant: Robert Cuin MD, Richardson Texas

Defendant’s Lawyer: Frank Walker

Judge: Wendy Harvall

This case involved a $42 billing mistake for medical records. Dr. Cuin charged $81 which is the standard for hospitals but $42 for doctors. The patient did not pay this bill. Dr. Cuin did not release the records within 15 days of the request. He did however release the records for free within 2 days of the 2^nd request made by the patient. The main issue at stake was the interpretation of a statute that states the Board may not go after someone who has an unwilling or unknown billing error. Subsection A of this statute says that it only pertains to bills for treatment; however this distinction is not made in subsection E. The judge decided that the language was clear and the Board according to this statute could not prosecute this accidental billing error. The Judge suggested dismissal for this case. The Board lawyer believed that it is the duty of the physician to know how much he is supposed to bill for records. The Board overruled the PFD for dismissal.  Instead the Board adopted a Final Order proposed by Board Staff.

All new rules proposed by the Board passed on a voice vote with no decision or deliberation. 

Two Board members resigned.  Dr. Keith Miller and Dr. John Pate.  Below is the article on Miller's resigning from the Austin-American Statesman. 

Medical board member resigns, cites expert witness law

Miller angered some doctors as head of enforcement committee.

Click-2-Listen

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Saturday, September 08, 2007

A member of the Texas Medical Board has resigned, telling Gov. Rick Perry that a new law forbidding board members from being expert witnesses in malpractice lawsuits was the cause.

Dr. Keith Miller of Center, whom Perry appointed in 2003, said he has served as an expert for both sides in malpractice cases and believes he should step down to avoid any conflicts of interest.

Miller, 50, wrote in his Aug. 30 resignation letter to Perry: "I feel that it is important for all physicians to participate in this process to ensure that courts will have available to them expert witnesses of such integrity and character that they will always give nothing but accurate and fair opinions."

Unfortunately, he said Friday, being on the 19-member board and working as an expert witness "don't mix well."

Miller had told the American-Statesman earlier this year that he planned to abide by a board rule restricting expert witness work by board members.

It would have allowed board members to act as experts, provided at least a board committee approved it.

But a law passed by the Legislature later this year went further, banning the practice altogether. The board adopted the law as a rule last month.

With permission from at least a board committee, board members can still act as experts in cases that don't involve malpractice, said Bob Simpson, the board's general counsel.

As former chairman of the board's enforcement committee, which hears disciplinary matters involving doctors, Miller has been a target of some doctors who said he was harsh, rude and "out to get" certain kinds of doctors.

Among the critics is Andy Schlafly, general counsel for the Association of American Physicians and Surgeons - which he said has 4,000 doctors as members - and the son of the famous conservative Phyllis Schlafly. He cheered Miller's resignation.

Miller said the criticism was off-base and added that the complaints by several doctors, including a few who had been disciplined by the board, had no bearing on his leaving. Doctors involved in reviewing their peers can expect such accusations, he said.

Simpson, the board's lawyer, said: "The vast majority of our investigations and disciplinary actions are based on complaints we received. We are not targeting anybody we conduct investigations against."

There are four new members to the Texas State Board of Physcian Assistant Examiners.  The following is a press release from the Governer's Office today. 

Gov. Perry Appoints Four to Texas Physician Assistants Board

AUSTIN – Gov. Rick Perry appointed four to the Texas Physician Assistants Board. The board establishes and maintains standards of excellence used to regulate physician assistants and ensure quality health care for Texans.

Teralea Davis Jones of Beeville is the rural health clinic coordinator of Beeville Family Practice. She is a member of the Texas and American Academies of Physician Assistants. She is a member of the Fellowship of Christian Physician Assistants, the Christian Medical and Dental Association and Alpha Eta, the physician assistant honor society. She is a recipient of the Physician Assistant of the Year award from the Texas Academy of Physician Assistants. Jones received a bachelor’s degree from the University of Texas Medical Branch at Galveston. Her term expires Feb. 1, 2013.

Felix Koo of McAllen is the clinical coordinator of the Physician Assistant Studies Program at the University of Texas-Pan American. He is a volunteer medical director of Hope Medical Clinic and a volunteer pediatrician for the Alton Church of Christ Health Projects. Koo also serves as a board member of the Children’s Defense Fund-Rio Grande Valley. He received a doctorate degree from the University of Texas Medical Branch at Galveston and a doctorate of medicine from the University of Texas Health Science Center at San Antonio. His term expires Feb. 1, 2011.

Michael Mitchell of Henrietta is a physician and partner of the Clinics of North Texas. He is being reappointed to the board. He is a member of the American Osteopathic Association and Texas Osteopathic Medical Association District 16. Mitchell is in full time family practice in Wichita Falls with emphasis on care and treatment of diabetes. Additionally, he serves as an adjunct faculty member of the University of Texas at Arlington and the Family Nurse Practitioner Program. He served in the United States Army Reserve, 2nd Batallion 12th Special Forces Group (Airborne) and received a bachelor’s degree from Central State University, and doctoral degree from Oklahoma State University School of Osteopathic Medicine. His term expires Feb. 1, 2013.

Abelino “Abel” Reyna of Waco is a partner of Reyna and Reed L.L.P. He is president of the Association of Good Government and a board member of the Freeman Center. Reyna is a member of the City of Waco Planning Commission, State Bar of Texas and McLennan County Bar Association. Additionally, he is a member of the National Association of Criminal Defense Lawyers and the Texas Criminal Defense Lawyers Association. Reyna received a bachelor’s and law degree from Baylor University. His term expires Feb. 1, 2013.