Testimony for Texas House Appropriations Subcommittee on Regulatory

Steven F. Hotze, M.D.
October 23, 2007

The Texas Medical Board (TMB) is a poster child for a governmental agency gone berserk. Like a mad dog it is wounding and destroying the lives of hundreds of capable and caring physicians as well as the lives of their patients.

The corrupt leadership of the TMB is driving a wedge between patients and physicians. Malicious anonymous complaints are filed against physicians, anonymous so called experts are hired by the TMB to discredit them and secret proceedings are conducted without due legal process. The physicians are intimidated and forced to sign agreements under the threat of license revocation.

These tactics were used by the Gestapo in Nazi Germany. Communist regimes intimidate and silence individuals by using Star Chamber tactics cloaked in secrecy.  The accusers and witnesses are anonymous, and the decisions are predetermined.  This is the way the TMB investigates and disciplines physicians.

The Texas Medical Board (TMB) is denying physicians the constitutional right of due process, destroying their lives and the lives of the patients who rely upon them for care. 

The TMB allows anonymous complaints by insurance companies. These anonymous complaints target physicians who oppose the insurance companies’ “standards of care” which limit treatment options, deny claims and increase insurance company profits. The TMB then destroys the physicians whom the insurance companies have targeted. This is meant to teach a lesson to any physician who would dare challenge the insurance companies’ policies on patient care.

It is unconscionable that the TMB would be working to advance the insurance companies’ agenda at the expense of the patient-doctor relationship.

Dr. Keith Miller, the notorious henchman and former member of the TMB’s Executive, Finance and Public Information Committees, also served for Blue Cross-Blue Shield on the Texas Medical Advisory Committee, which is adversarial to physicians who care more about their patients than insurance company profits.  This was clearly a conflict of interest. Dr. Miller is described by physicians and attorneys who have appeared before him as arrogant, abusive and disdainful of the patients of the physicians over whom he sits in judgment. It was Dr. Miller who presided over the Informal Settlement Conference of Dr. William Rea.

Dr. Rea is a board certified cardiovascular surgeon who established the Environmental Health Center in Dallas, Texas in 1974. Dr. Rea provides innovative treatment to patients plagued with environmental illnesses stemming from exposure and adverse reactions to chemical toxins and allergens. He has published over 135 medical journal articles and has written the definitive four volume textbook on environmental illnesses. Since 1974 he has served over 30,000 patients from around the world.

In 2005 Dr. Rea was informed by the TMB that an anonymous complaint had been filed against him for his treatment of five patients, all living in Manhattan and all covered by Oxford Medical Insurance.  It became obvious that Oxford, an out-of-state insurer, filed the anonymous complaint to shut down Dr. Rea so that it didn’t have to reimburse his patients.

When the patients were informed about the anonymous complaint, they were appalled. Each wrote letters to the TMB praising Dr. Rea’s treatment. Two of the patients credited him with saving their lives. As in other cases, the TMB completely disregarded the patients’ testimony.

Why is the TMB doing the dirty work for a New York insurance company?

Dr. Rea presented written exoneration from 18 physicians in his field. The TMB’s anonymous “expert”, ignorant of environmental medicine, reviewed the patients’ cases and condemned him. That’s 18 experts for Dr. Rea and one (1) anonymous non-expert against him.

At the Informal Settlement Conference hearing, lasting less than one hour, Dr. Miller refused to consider Dr. Rea’s extensive rebuttal documents and told him that he would make sure that his license was revoked. That’s insurance company justice, executed by unelected officials at the TMB. It creates a stifling atmosphere in Texas which discourages innovation and fosters mediocrity.

It’s incredible that insurance companies are permitted to interfere with the relationship between patients and doctors. Frequently, insurance company clerks deny physicians’ recommendations.

Now insurance companies are using the Texas Medical Board (TMB) as their rifle to target physicians who refuse to submit to their dictates. The insurance companies want to force doctors into compliance or drive them out of practice.

The TMB was originally established to protect citizens from physicians who engaged in disreputable conduct or whose treatments were overwhelmingly harmful, not to guard insurance companies’ profits.

Historically, plaintiff attorneys have provided a check on bad doctors by representing patients in lawsuits. In 2003, the Texas Legislature enacted tort reform which limited the damages a doctor could be required to pay for a patient’s injuries.  This dramatically reduced the number of lawsuits.  In response to the opposition from consumer groups to tort reform, the legislature increased taxpayer funding of the TMB so it could investigate more physicians.

When an insurance company finds itself at odds with a physician who places his patients’ interests above the profits of the insurance company, it can file an anonymous complaint with the TMB, claiming that the physician did not meet the “standard of care.” This triggers a TMB investigation.

This happens without a patient filing a complaint. The patients are unaware that their insurance companies are interfering with their medical care. When they become aware of the situation, most patients sign affidavits stating they are pleased with their doctor’s treatment. Amazingly, the affidavits are disregarded by the TMB.

The TMB pays so called “expert” doctors to review the records of the patients whose treatments are under question. This also presents a conflict of interest since these so called expert witnesses are paid by the TMB for their evaluations. Invariably, these hired guns find fault with the doctor. In the cases I have studied, the findings of these anonymous reviewers demonstrate an ignorance of the treatment provided and a prejudice against the physician.

The physician is denied due process. His accuser and the witnesses against him remain anonymous. The physician is not permitted to cross examine them.

It costs a physician $25,000-$200,000 to defend himself against an anonymous complaint. Under financial duress and the TMB’s strong arm tactics, the physician is often forced to change the way he treats his patients in order to satisfy the insurance companies’ interests.

The results of these unjust investigations are 1) the reputation and the livelihood of the accused physician has been destroyed, 2) the TMB adds another physician to the list of those it has disciplined, justifying its need for increased funding, and 3) the insurance company has used the TMB to force another doctor into submission.

If the TMB is allowed to continue its Star Chamber tactics, then we will only be left with physicians who place the insurance companies’ interests above those of their patients.

Goals for Reforming the Texas Medical Board

Texans for Patients’ and Physicians’ Rights recommends for consideration by members of the Texas Legislature the following goals for adopting legislation which would reform the Texas Medical Board.

The elimination of the following:  1) anonymous complaints, especially from insurance companies, hospitals, pharmaceutical companies, attorneys, competitors, and fired or disgruntled employees 2) anonymous "expert" witnesses, 3) Star Chamber proceedings held in secret, 4) prohibition of notes and recordings in hearings, 5) denial of due process to physicians, 6) discipline for menial and trivial records' findings, 7) intimidation tactics, 8) manipulation of assignments to the Informal Settlement Conference (ISC) panels rather than a fair system of random assignments, 9) forced settlements, and 10) conflicts of interest of the TMB members.

We are advocating:  1) the sacredness of the patient/doctor relationship, 2) transparency of charges and proceedings, 3) accountability of TMB members for their actions and the removal of blanket immunity for members of the TMB, 4) integrity of the board members in carrying out their responsibilities, and 5) the acceptance of and giving equal weight to evaluations of a physician's care by physicians other than those chosen as so called expert witnesses by the TMB.

We are also recommending that the Texas Legislature establish an independent, public Texas Medical Board Oversight Committee, the members of which would be appointed by the Texas Legislature, to ensure that that the above legislative changes are enacted by the TMB. This committee would report its findings to the Texas Legislature. This committee would also receive and evaluate complaints from patients and physicians who feel that the TMB has acted unjustly.  

Finally, there can be no true reform of the Texas Medical Board without the removal of the current leadership. Don Patrick, Executive Director, Mari Robinson, Director of Enforcement, and Roberta Kalafut, President of the TMB, must be removed from office.

Thank you for your consideration of my recommendations.