Sunset Staff Reports of Other Boards: Texas Medical Board
Written by Editor   
Thursday, November 10, 2016 12:01 AM

“In the world of healthcare professionals, the physician reigns supreme. No other healthcare practitioner has greater autonomy or authority over patient care than a physician.”  Thus begins the Sunset Commission Staff Report on the Texas Board of Medical Examiners.  But lest you think that the report venerates TMB licensees at demigods, note the very next sentence, “consequently, no other healthcare discipline poses a greater risk to patient and public safety than the practice of medicine.”

The government report notes that “given the enormous potential risk posed by physicians, the Medical Board is not an ordinary occupational licensing agency.”  This is especially true when compared to the statement in it’s review of the TBCE where they note “unlike hospitals, ambulatory surgical centers, or pharmacies, the services provided in chiropractic facilities do not pose significant risk to the public, and “the vast majority of the violations cited in facility complaints do not pose harm to the public because they are administrative in nature.”

And just why are physicians so risky?  “One especially high-risk activity that physicians perform is prescribing highly addictive and dangerous drugs, particularly drugs designed for patients with chronic pain, as some of these drugs have contributed to an epidemic of addiction and overdose throughout the country.”

The TMB has a long history since 1907, and it has been growing in size ever since.  “In 1993, the Legislature created and housed under the board regulatory programs for physician assistants and acupuncturists, and did the same in 2001 for surgical assistants.  The Legislature, in 2005, changed the board’s name to the Texas Medical Board. In 2015, the Legislature transferred the regulation of medical physicists, medical radiologic technologists, perfusionists, and respiratory care practitioners from the Department of State Health Services to the Medical Board.” The TMB oversees seven other healthcare professions, for a total of almost 132,000 licensees.

Housed under the Texas Medical Board are four other boards and three advisory committees, with the Medical Board exercising policymaking for the board and oversight over the rulemaking of the associated boards and committees.  The full Medical Board consists of 19 governor-appointed members: 12 Texas-licensed physicians, nine with a degree of doctor of medicine and three with a degree of doctor of osteopathic medicine, and seven members who represent the public. Additionally, the Board of Acupuncture Examiners, Board of Medical Radiologic Technology, and Board of Respiratory Care each consists of nine members appointed by the governor while the Physician Assistant Board has 13 governor-appointed members.

With a staff of 201 “the medical board received 7,510 written complaints in fiscal year 2015 and opened 1,853 investigations during the same year. Of those investigations opened, 1,675 concerned physicians. … For all license types the board approved 332 disciplinary actions and 261 remedial plans.”  Stated another way, of the 131,802 licensees of the TMB, written complains were filed against nearly 6% of the licensees, the TMB opened investigations on 25% of the complaints.  22% of total complaints were against physicians, a group that comprises nearly 60% of TMB licensees.  Of the disciplinary actions approved, 90% were against physician licensees, 8.4% against physician assistants, and 0.6% each for acupuncturists, and surgical assistants.

Sunset staff have listed six issues with the TMB.

  1. “Untargeted inspections and unclear statutory authority limit the effectiveness of pain management clinic regulation.”  Said the staff report “The Medical Board’s pain management clinic inspection program does not follow best practices ….10 of the board’s more than 40 enforcement actions and lawsuits stemming from its pain management clinic inspections resulted in a judge questioning the board’s statutory enforcement authority.”  Among the staff recommendations are “clarify statute to authorize the Medical Board to inspect an unregistered pain management clinic.”

  2. “Key elements of the Texas Medical Board’s licensing and regulatory functions do not conform to common licensing standards.”  Much as they did in the TBCE report, it seems that the Sunset staff desire to conduct fingerprints for ALL Texas licensees, not just new licensees.  They also want boards to be able to set their own fees rather than have the legislature do it for them.

  3. “Streamlining the medical radiologic technology program would increase fairness to licensees and administrative efficiency.” While the recommendations call for the abolishment of the limited medical radiologic technologist (LMRT) certification and removing dual registry requirements for noncertified technicians (NCT) which sounds like a good thing, it is important to note that while “rules allow MRTs to perform all radiologic procedures, including those designated by rule as dangerous or hazardous” the NCT category “prohibits an NCT from performing any procedures defined by rule as dangerous or hazardous.”  It is important to note that “pelvic girdle radiographs” and “sternum radiographs” are listed as “hazardous procedures” and may necessitate an LMRT to study to become a MRT.  This recommendation may directly effect some number of chiropractic offices.  There are currently some 25,000 MRTs while there are 945 LMRTs and some 4000 NCTs.

  4. “The current process for authorizing qualified physicians to practice in Texas does not maximize mobility within the profession.”  The recommendation is to adopt the Interstate Medical Licensure Compact “increasing the administrative ease with which a physician can be authorized to practice in Texas.”

  5. “An undefined structure and few funding sources limit the Texas Physician Health Program’s Success.”  The recommendation is to allow the program that assists TMB licensees with “potentially impairing conditions” to accept gifts, grants, and donations.

  6. “The state has a continuing need to regulate the practice of medicine and the other allied health professions at the Texas Medical Board.”  Sunset staff found that “the review of the Medical Board found that no substantial benefits would result from transferring the board’s functions to another agency at this time, as regularly consolidation has already occurred under the Medical Board.”  While staff also recognizes that “no other healthcare discipline poses a greater risk to patient and public safety than the practice of medicine,” they recommend that the TMB continue for an additional 12 years.

There are, of course, many more details to be found at the Sunset Staff Report found here.