Physicians complain about board enforcement procedures

Harvey Kronberg/The Quorum Report
October 23, 2007

The Texas Medical Board’s director of enforcement told a legislative panel today that the agency responsible for disciplining physician can do a better job of communicating its procedures to doctors.

"I think the board has not done a good job of communicating our process and what the laws are and what they can expect," said Mary Robinson, the TMB’s enforcement director. "I think there is a lot of mystery surrounding the process."

That process was the focus of the House regulatory subcommittee today. Besides a series of tough questions from lawmakers on the board’s policy of taking anonymous complaints and on a TMB board member serving as an expert witness in cases, the panel heard testimony from physicians who described lengthy and costly battles with the board.

The TMB was scrutinized heavily earlier this decade after a series of newspaper articles uncovered what appeared to be a pattern of lax oversight of doctors’ behavior. That led to legislative action aimed at creating a new process to ensure that doctors who violate medical standards are dealt with.

But lawmakers today wondered whether if before the TMB was not doing enough to protect good people from bad doctors before, it was now not doing enough to protect good doctors from bad people. Several representatives, including Reps. Robert Talton, Corbin Van Arsdale and Debbie Riddle (all Houston Republicans), questioned why the TMB accepts anonymous complaints against doctors.

TMB representatives, including board president Roberta Kalafut, defended the practice, saying that a co-worker or nurse would not feel it was safe to complain if they weren’t afforded anonymity.

Tom Banning of the Texas Academy of Family Physicians said that doctors sometimes face lengthy disciplinary proceedings over what are largely administrative violations. In some cases, doctors are out more than $10,000 and can spend up to two years in fighting an accusation, he said.

The statutory framework underlying the TMB is largely solid, he said, but procedures need to be modified to ensure that the board can devote its resources to the most egregious violations of proper medical procedures. The Legislature must also commit to providing more resources to the TMB so that alleged violations can be better investigated, he said.

Robinson told the panel that the agency is in the process of introducing a new fast track procedure that would make the process for dealing with administrative penalties much quicker. She said that the goal would be to dispose of the purely administrative violations within 30 to 60 days.

Alex Winslow of Texas Watch said that he wanted to remind lawmakers that any reform of the TMB disciplinary process must not forget the patient. With tort reform now in place, patients are more and more reliant on the TMB to better police its profession. Every policy decision about the board "should be filtered through the lens of public safety – not physician convenience and not administrative expediency," he said.

Mary Elizabeth Herring, a lawyer and instructor at the Texas A&M Health Science Center, acknowledged the difficulty of coming up with fair due process procedures within the medical profession. She noted that doctors differ significantly from attorneys in that doctors are used to working in a collegial system and that they have a natural distrust of having to follow a manual of rules such as a statutory set of medical practices.

"Nobody wants to force physicians to spend $12,000 to $15,000" during a process that leads to dismissal of charges, she said. "But we have to have a process of determining facts."