WHAT NOT TO DO:  answer the Board without having an attorney review your response.  It is so sad when a health care professional receives a disciplinary order due to an incorrect answer to a renewal question; so often, these violations are easy to avoid.  Sometimes a health care professional answers a renewal question in a manner which causes Board action on the answer but not on the original criminal issue.  In addition, you need someone on your side advising you regarding what actions to expect from the Board and making sure you do not agree to a disciplinary action which is not warranted.  DO NOT rely upon advice from your criminal attorney, your family, your co-workers, your boss etc.  This is not a time to risk talking to inexperienced people.  Some Board do not take action on minor criminal incidents as long as you do not try to hide the criminal incident from the Board.  For example, the Texas Board of Nursing will typically not take action on a one time shoplifting case, but if you do not disclose the criminal incident to the Board you will be deemed as being deceptive and the Board is more likely to require some type of remediation (once again there are various Board responses and which is used depends on the information provided to the Board).

WHAT TO DO:  Obtain the criminal court records and contact an administrative lawyer with experience before that particular Board.  When you call the lawyer, is the lawyer able to answer your questions or do they say they have to do research?  If an attorney practices frequently before a Board, the lawyer will know the types of questions asked by the Board and what is required to be disclosed.  This type of legal advice is not usually expensive as long as the case does not progress to an investigation before the Board and an attorney can give you estimated costs when you speak to the lawyer.

I know this response looks like an advertisement for hiring lawyers, but seeking appropriate legal advice is the best action to take to protect your license and the risk of possible disciplinary action is too great not to at least speak to a lawyer.

Anna A. Chapman of Del Rio is deputy city secretary for the City of Del Rio. She is the health issues chair of the Del Rio Hispanic Chamber of Commerce, and regent and district deputy of Catholic Daughters of the Americas. She is also a research committee member of Cemeterio De Los Amigos, and recording secretary for the Pan American Round Table. Chapman received a bachelor’s degree from Sul Ross State University and a Master of Business Administration from Regis University in Denver.

Felix Koo of McAllen is clinical coordinator of the University of Texas-Pan American Physician Assistant Studies Program, and a volunteer medical director of Hope Family Health Center in McAllen. He is vice president of the Nuestra Clinica Del Valle Inc. Board of Directors. Koo received a bachelor’s degree and a master’s degree in microbiology from Brigham Young University, a doctorate degree from the University of Texas Medical Branch at Galveston, and a medical degree from the University of Texas Health Science Center at San Antonio.

Richard Rahr of Texas City is a professor and department chair of Physician Assistant Studies at the University of Texas Medical Branch School of Health Professions. He is a member of the Physician Assistant Education Association, Academy of Master Teachers, Texas Society of Allied Health Professions, and American Registry of Radiologic Technologists. Rahr received a bachelor’s degree from the University of Texas at Austin, a bachelor’s degree from the University of Texas Medical Branch at Galveston, a master’s degree in health care administration from the University of Houston at Clear Lake, and a doctorate degree in education in allied health from the University of Houston.

These appointments are subject to Senate confirmation.

 However, the Texas Medical Board and the Texas Physician Assistant Board have formed an Ad-Hoc Committee to see if this issue needs to be prohibited, curtailed, regulated or ignored.  They recently had their first meeting.  The Boards well-know that such clinics currently exist.  The fear for the Board’s is the relationship between the mid-level provider, who is the owner and employer and the supervising physician, who is the employee (actually independent contractor) in this relationship. 

 Such a relationship is currently, and technically legal as long as the physician is an independent contract who maintains independent medical judgment.  The argument is a physician cannot maintain independent medical judgment and supervise a mid-level provider while also reliant upon the mid-level provider for a pay check.  One Texas Medical Board member expressed a concern that “fringe” doctors are more likely to enter into this relationship than other physicians. 

 There was a lot of brain-storming on possible regulation that could occur.  The Executive Director, Mari Robinson, correctly informed the members of the Boards that regardless of the direction the Boards take they are likely to get sued.  She also pointed out to the PA Board that they are obviously limited to Physician Assistants, thus any regulation they put into place; it does not affect Nurse Practitioners.  Likewise, with the Medical Board, the regulation only affects the supervising physician. 

 Nothing was resolved at this first meeting of the ad-hoc committee.  The next meeting will be February 3^rd.

 For FY 2012 and 2013, the Governor, the Lt. Governor, and the Speaker of House told agencies to offer budget 10% less than their FY 2011 budgets.  This will mean lost of more staff, slower time to process new licenses and slower time to investigate cases.  The Texas Medical Board reports it believes it will generate less income for the state for due to its budget cuts.  The Board did not explain how this would occur. 

 It is possible, the further cuts will occur.  It is even more likely professional renewal fees will increase as will new licensure application fees.  The reason these things will occur is the projected budget deficit is 23 billion dollars.  Even if the legislature ends all state programs other than education, prisons, roads, law enforcement, and Medicaid, there will still be deficit; therefore, it seems logical to assume more cuts and larges fees are a matter of when, and not if.

 The two big issues that are still unsettled is how to deal with licensees who agree to cease their practice altogether.  The Medical Board and the Texas Physician Health Program are working on finding a method that permits a physician to cease practicing without a form a public disciplinary action.  The second issue is how to appropriate deal with people who have “dual issues:” An impairment issue that is more appropriately handled by the Texas Physician Health Program and some other issue that the licensing Board wants to handle with public disciplinary action.  Again, this is something that agency staff and the Texas Physician Health Program are attempting to determine the best method to proceed.  Some resolution to these issues should be determine in early February.

 (1) The mid-level providers can obtain there own certification with the DEA and DPS.  Their individual certification number must appear on their prescription pad and they are required to have a supervisor relationship with a licensed physician.  This person is viewed as a “sponsor.”

 (2) There must be a standing protocol for the mid-level provider to prescribe using the physician’s prescription pad for the listed symptoms and only prescribe medications that are listed in the protocol for the symptoms. 

 The parties meet to discuss creating a field on the Texas Medical Board’s Physician Profile that will list all of the mid-level providers under the physician’s sponsorship who have prescriptive authority.

 The Texas Medical Board’s Standing Delegation Committee voted to create a sub-committee with the Physician Assistant Board and the Nursing Board to look into the guidelines for supervising physicians over PA’s and APN’s who have prescriptive authority under the physician’s supervision.   Their goal is to have everyone on the same page as to what the rules are and the risks involved in prescriptive delegation.

 My Take: First, physicians and mid-levels need to be sure they are in full compliance with current level and the correct paper work is in the Board denoting the supervisor relationship.  Second, look for the rules to be changed in the future.  If you have three boards get together, I can assure you the rules will change.  Given the current regulatory climate, I suspect that rules will tighten-up.  I just hope that before the Boards publish any rule changes, they talk and meet with “stake holders” in this area as any changes to mid-level prescriptive authority will have significant affect over thousands of providers.  Please continue to monitor this blog for changes.