Position Statement of the Texas Osteopathic Medical Association

to the Texas Medical Board

In response to a growing concern and outcry from osteopathic physicians across our state, Texas Osteopathic Medical Association (TOMA) President, Dr. Jack McCarty, has appointed a select committee to develop a position statement for the association concerning the activities of the Texas Medical Board (TMB). 

There are several points to consider.  These include maintaining the tort reform measures passed in 2003 and an assortment of issues concerning the transparency of TMB operations and proceedings.  These include anonymous complaints, disciplinary procedures, State Office of Administrative Hearings findings, deferred adjudication, case review and the listing of physicians’ names in news releases for minor infractions.

            To encourage the continuance of a strong board which operates in a balanced manner, the Texas Osteopathic Medical Association offers the following recommendations for TMB reform:

            1.  The medical board should look back to Senate Bill 104 also passed in the 2003 legislative session and re-focus its investigative and disciplinary efforts on those allegation priorities highlighted in that legislation:  sexual misconduct, impaired physicians, and quality of care.  The resources of the Board are not unlimited and therefore should be focused on those areas where the most can be done to protect public safety.

            2.  We support the board’s efforts to continue to speed up the licensing process.  Everyone in Texas benefits from this, particularly since our state is now such an attractive place in which to practice medicine.

            3.  So many complaints about the Board and its processes, particularly in licensing, can be boiled down to a single deficit:  customer service.  We urge the board and leadership to thoroughly revamp its communication, responsiveness, and timeframes with which the Board relates to its physician constituency.  The board should be as effective in customer service and licensing as it is in pursuing disciplinary action. 

            4.  We suggest a fair and balanced focus on openness and transparency in its processes of dealing with physicians.  Discipline where appropriate; warning where it can resolve the issue; educate where necessary; support where needed, and facilitate a win-win culture for both the public and the physicians.

            5.  We ask the board to recognize that disciplinary action against any license-holder threatens not only his or her livelihood but also his or her professional and personal standing.  Discipline, even in cases not related to patient care or safety, should never be taken lightly or for financial reasons.

            6.  We suggest that there are a significant number of legal, operational, and administrative changes and additions that merit serious consideration by the Legislature and by the Board.  These changes listed in Addendum A would greatly enhance the fairness and transparency of the current operations and restore confidence in the board by those it licenses.

            7.  We recommend that the legislature provide for an increased budget of $12,000,000 or similar amount that would allow for the ability to comply with the provisions of SB 104 and the efficient handling of licensure.

            The osteopathic physicians of Texas support the TMB.  However, we believe that the TMB should and can conduct itself with more effectiveness, efficiency, and transparency.  Physicians find it difficult to support a board which they perceive to be unfair.  It is imperative that the TMB is a strong and effective body, concerned primarily with the health and safety of the citizens of Texas.  Therefore, the TMB should utilize its resources efficiently, by focusing its efforts on issues of sexual misconduct, impaired physicians and quality of care, where the legislature has already given direction and where public safety would be well-served.  TOMA physicians are, however, pleased with the TMB’s efforts to expedite the licensing process which benefits all citizens of Texas and is an example of how effective the TMB can be.

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Addendum A:

Suggested Legal, Operational and Administrative Changes To the Texas Medical Board

An Administrative Law Judge at the State Office of Administrative Hearings should be made the final decision maker on contested licensing and disciplinary cases.

Allow for pre-filing mediation at the State Office of Administrative Hearings and establish a deferred adjudication system for minor violations and/or first time offenders.

Disclosure of Board experts to defendant physicians and defendant physician's counsel prior to Informal Settlement Conference (ISC) to allow for possible impeachment or demonstration of bias, so as to present a more fair defense.

Reinstitute the private reprimand or adopt a warning mechanism that does not constitute disciplinary action and establish a pre-approval system for advertising to lower the number of complaints on this subject and give physicians a higher comfort level for this aspect of their business

Create a statewide privately operated impairment diversion program to take needless burden off of agency and to make impaired doctors more likely to seek help without fear of disciplinary action.

Allow defense attorneys, defendant physicians and license applicants a special right of access to their respective files so that they can properly and thoroughly present their cases.  It is a basic legal right for the accused to face their accuser(s) in legal proceedings against them.

Establish an Open Records and Open Meetings monitor from the public to oversee and report on open government issues of the Texas Medical Board.  Establish a statute of limitations on certain types of cases such as record-keeping and minor violations, but not on more serious matters which involve criminal activity.  Establish a legislative mechanism for oversight of the Texas Medical Board Executive Director such as confirmation by the Senate at the first opportunity.