Texas Medical Board Thursday, April 2, 2009
The Committee heard an interesting study on of Quick Med.com performed at the University of Utah. Dr. Munger conducted the study after he heard the presentation from QuickMed while he was head of the Pharmacy Board in Utah. In the study he compared the online assessment to the brick & mortar clinic care in how care for erectile dysfunction is handled. What he found was the on-line care was better in findings possible adverse interaction.
FINANCE COMMITTEE @ 9:48
For the fiscal year (September 1st to August 31st) the Board has spent 3.2 million dollars or 48.6% of there annual budget.
Regarding the 2.5% cuts they were asked to make, they do not know if the money will be taken or the funds will b e left in the budget. May be waiting to see how the stimulus money will be used.
DISCIPLINARY PROCESS REVIEW COMMITTEE 10:12 AM. EXECUTIVE SESSION @ 10:14 Reconvene at 2:02
According to February’s numbers, the Board is still experiencing in tremendous growth in the number of complaints and investigations. Half way through year and already the Board surpassed the number of investigations from last year. Ms. Robinson estimates the Board will open more than 2800 investigations. However, the Board has completed about 1/3 the number of investigations as compared to last year. Ms. Robinson states the Board does not have enough investigators and panelists to close them out. The Board has conducted 376 ISC this year, at half way through the year; whereas 482 ISC’s were done in 2007.
Ms. Robinson reports the Board has asked for money from the legislature to hire a physician to do some initial front end analysis. This would help to weed out complaints that need to be dismissed. They cannot control the number of complaints coming in. The temporary suspension system still works and the fast track is available.
Joe Tabarraci reported to the committee about Rule 22 T.A.C. 165.3 regarding patient access to diagnostic imaging studies from physician’s office. This rule does not address non-static images. The amount charged for second films was in question. This is updated non-static versus static records. The maximum charge can be $8. This came about from an inquiry about charging $50 for a CD of an angiogram.
The Board can only regulate the physician charges; they cannot regulate any charges made by hospitals. Motion made to re-write the rule.
Review of Probationer’s Appearances. People who are in 100% compliance it is recommend probation appearance be waived for both public and non-public order.
FRIDAY, APRIL 3, 2009 TM BOARD MEETING
Executive Director Report: Risk Management – Ms. Robinson will approve courses that help improve doctor’s practice. She will not approve course that cover “What do I do if I am sued?”
Mr. Williford wants sheet of commonly approved and suggested CME at the ISC. Mary has Master list. Once she approves a course it goes on the list and the list will get updated. The list will be put on micro-fiche for Board members.
CME must have a post test to be approved.
LEGISLATIVE UPDATE – Robinson
101 bills are being tracked. This legislative year 18-26% more bills filed. The Appropriations did pass out of Senate. The Board did get everything they asked for. They Board is still determining if they will be required to off-set that cost by generating additional income. The House bill did not adopt fees for new staff. If they need to raise fees, they will only be raised a maximum of $25 but it will probably be more like $10.
A couple of the bills will add responsibility to the Board these encompass anesthesiology assistants and genetic counselors.
PHR Bill working with TMA. This is going to committee next week. It is fiscally neutral for the Board. The participant will pay.
The Bill for Pain Management clinic registration will likely be modified. The Board will have the authority to inspect these if they suspect they are a “pill mill.” They may create a task force, especially for the Houston area. There will be an increase in chart monitoring and number of hours of oversight for the overseeing physician. Senator Williams is the sponsor.
SOAH bill went reasonably well. They were able to give them the impact on the Board from the legislation.
Bills coming up
Removing the requirement for eligibility to practice in the country of Med School graduation and don’t have to prove substantial equivalent if they are Board Certified. April 14th the bill is up in Committee. This bill is supported by the TMB stake holders.
Watching the AAPS bill which asks for change to complainants not be confidential and the expert identify revealed. Ms. Robinson felt that this would make it impossible to retain expert reviewers. If bill passed, they would have to fire her, as it requires the Ex Director to be a physician. April 14th is the hearing.
Many bills on prescriptive authority. May increase the number of people doctors can delegate to, the number of miles away and amount of time to review charts.
Methodist Hospital backing bill on Faculty license – passed out of senate
Shapley bill states not does not have to fulfill exam requirements if you go to underserved area.
Hartnett Bill affects physician profile data. The material is removed after period of time 3 to 5 years. Any complaint filed at SOAH if dismissed that complaint will no longer be on profile after the time period expires.
Medical Director Security update. Violent individuals that may pose risk to ISC members will be evaluated. Put together with Dr. Arambula’s input. (i.e. Respondents with head injuries, substance abuse, etc.) Trigger events listed that may precipitate something. Policy: once individual is identified will notify panel members of potential problems and why this may occur. If they want security measures after receiving the assessment, they can request it. Suggestion to leave handbags or briefcases outside the ISC room. There was an individual who showed up for ISC and didn’t get what he wanted and had an outburst. Overall assessment to determine threats. Direction to staff to continue process.
Med Director report ETG and ETS testing process. Use has increased across country. Number of articles have been published and they have been able to learn more. ETS companion can be used in conjunction to identify alcohol consumption. ETS testing may be added to test panels. No additional cost. Reviewed Dec Jan Feb, 2009 results and positive test results. There were 3329 tests and 0.7% were positive. 200 people per month tested. 9 individuals that had at least one positive result. Bacteria can produce ETG in the urine after it is collected. Individuals with Geaubere syndrome don’t make ETG. They are considering having a screen for this. ETG is detectible from 1-7 days after ingested. ETS cannot be produced by bacteria in the urine. Looking at everyone who had a positive result (9 individuals). Anticipating ETG will be eliminated in the future. McMichael would like a sheet in the ISC room to refer to. Considering getting a billirubin on everyone which will indicate Geaubere’s. Would only have to be done once or twice. He will report in the May meeting on having a targeted approach to assigning the people to handle the cases who have the experience in certain fields.
STAFF Introductions Rick Romoff is the new Manager of Compliance.
Licensure is now full. Only 2 FTE open. Administrative Asst for Rui and one investigator.
Current litigation AAPS lawsuit – no action. Good news on Rodriquez-Aguiro case. Appeal the decision and heard by district judge and he has affirmed the decision of the board.
2 lawsuits regarding open records requests which included Compliance Files requested from the Attorney General’s office.
# 6 Non-Public Rehabilitation Orders
Approved all but 2 of these. McMichael wants change to Finding of Facts. Order states that Respondent may have impairment to cognitive ability. Respondent fell from a hot air balloon while in Med School. Dr. Arambula heard the case. The Board is getting psych reports on a regular basis. The language is standard admission of the Respondent to having a problem rather than a concern of the Board.
McMichael wants reminder on who is able to have a confidential order. When previously on Order and then in trouble again and getting another confidential order. The prior Order was actually a Public one – a public reprimand for a DWI that was unreported. So they are eligible for a Non-public Order, as the Respondent self-reported.
#7 Approval of Agreed Board Order
Remaining 43 Orders were approved
Pulled from the group for discussionWilliford : Med Director of Colonic Hydrotherapy clinic for perforated colon. Please be aware of this as a real problem. Order passes
Attebury: Order was written in a way that the patient could be identified from the wording in the Order. Motion to remove language regarding patient’s 5 children.
McMichael: Physician who didn’t have the Board notice posted in the office. Why was this not a fast track case? Because the physician’s office kept referring the patient to the county medical society rather than the TMB
McMichael: In the Military and had court marshal. 164.051 (a)( 9) violation of the Act to have action taken by another Board or the Military. Order passes. Leaving language in about adultery under the UCMJ will make it clearer to the public what the underlying crime was, as the Order was for obstructing justice.
McNease : Found in their car and spouse did not know what they were doing. Change language to “altered mental status” and that Methadone was prescribed in addition to other drugs Order approved
Attebury: Concerned about the repetition in the behavior. Wants to add a Chart Monitor. Shulkin was on the panel and in favor of four monitoring cycles completed and after two clean reports the Order terminates with completion of CME. Order passes
#9 Approval of Modification Request/ Termination Request Orders
One pulled by Benevides: Issues with this case falling through the cracks. This individual was last seen at the Board in March 2008. Has lots of Standard of Care issues. Respondent appeared before the Board many times and connected with the same type of issues. Wondering if they have a benign group of attorneys at the Board . (WENT INTO EXECUTIVE SESSION TO DISCUSS)
Determination: File at SOAH and ask for revocation in order to protect the public based on long history with the Board and failure to comply with current order. Motion to revoke passes
Mediated Settlement Agreed Order Moved to approve all
Approval of Termination of Suspension Orders Moved to approve the one pending
#Suspension by Operation of Law none
Temporary Suspensions: info item Those 2 people have been suspended Dr. Ramahi and Dr. Paiget
McFarland suspended due to violation of Order
Public comments none
# 20 regarding Rule Change by Department of Health regarding prescribing of controlled substances/dangerous drugs for the partners of patients that have been diagnosed with STI’s
Jennifer Kaufman presented an emergency rule. The rule will be in effect for six months. Will be posted to public comment. McMichael: Concern that they are leaving things open to abuse of avoiding real treatment Want language like “episodic treatment or something like that. Must still meet the standard of care with this rule change. This rule change dose not remove their adherence to standard of care. Approved as written. And Approve to publication
# 21 Rules published for Public Comment
No public comments
Chapter 166.2 CME credit motion to approve
Chapter 183 Acupuncture Allowing more exam attempts. JP exam language. Approved as written
Chapter 189 Limitations on Physician Probation’s Practice the adoption of this was delayed. TMA approved
Can a physician supervise a PA while under an Order. Mr. Simpson is working on language to make it clearer. It will be presented at a later time. . What is the distinction between restrictions and terms and conditions. Restriction is a provision that restricts a physician authority to practice medicine . There are guidelines by the NPDB where the TMB must report. They only want to know if the physician cannot practice medicine in the same way as an unrestricted practitioner. Attempting to make clarification for supervision of PA’s only. Motion to approve language change as written. Approved.
a. DPRC Ten experts added to Expert Panel Approved
b. Finance Doing well on budget Approved
c. Licensure : 3 applicants be granted restricted. 1 ineligible 1 deferred for mini residency 3 apps granted license for permanent as outlined. 8 Order proposed and accepted 565 applicants for permanent licensure 1 Accudetox TMB Rules 162.1 & 173.1 changes be approved
Average time through the licensure process is down to 30 days on turn around, which is remarkable. Staff is to be congratulated on their work. Approved
d. Telemedicine 174.1 – 174.6 changes to rules and PCMI Pharmacy. The presentation came from recommendation of the Pharmacy Board.
ADJOURNED at 12:17 PM