Based on a report by the Executive Director on Thursday, November 5^th, the Board trend on investigations appears to be a little less than last year.  In October 2009, the Board opened 50 fewer cases than it did in October 2008.  The Executive Director, Mari Robinson, attributes this change to due more careful initial review, which is now conducted by a physician and an attorney. 

 However, this does not mean that there are only a handful of cases.  There are currently 1875 open investigations with the Board.  Moreover, the Legal Division of the Board is extremely active.  There are 719 active legal cases with the Board.  Of those 101 cases are pending before SOAH.  That is a record number, and means 17.5% of all cases in Legal are at SOAH. 

 Ms. Robinson reports that the Board is experiencing a watermark situation with numbers and she does not see it going down anytime in the future. 

 Additionally, from the discussion held by the full Board on Friday, November 6^th, it appears to me that the Board members are only seeking to become more forceful with people who they deem have violation the Act.

By Andis Robeznieks
Posted: November 4, 2009 – 4:45 pm EDT

Behavior problems between doctors and nurses were reported by more than 97% of the nurses and doctors who participated in an American College of Physician Executives’ survey, which found that the most common complaints were degrading comments, yelling, cursing, inappropriate joking and refusing to work with one another.

The survey results paint a picture of “treachery and backstabbing” as doctors and nurses try to undermine each other, often right in front of bewildered patients, according to the ACPE. The organization e-mailed the survey to some 13,000 nurse and physician executives, with roughly a 67% to 33% split between the two factions, and 1,428 nurses (67.2% of respondents) and 696 doctors (32.8%) responded between July 9 and Aug. 10, 2009.

In addition to those mentioned above, other complaints included refusing to speak to each other, spreading malicious rumors, trying to get someone unjustly disciplined or fired, throwing objects and sexual harassment. Actual physical assaults, however, were reported by only 2.8% of the respondents.

When asked who most often exhibits behavior problems, 47.9% said it was an even mix; 45.4% said doctors; and 6.8% said nurses. Also, 61.2% reported having nurses terminated at their organization for behavior problems, while only 22.2% said the same of doctors.

Behavior problems arise several times a year, said 30.9% of the respondents, with 30% saying it happens weekly; 25.6% saying monthly; 9.5%, daily; 2.9%, once a year; and 1.2% saying less than once a year.

The most common complaint involved degrading comments or insults, with 85.5% (1,493) of the respondents reporting that this happened at their organization. Yelling was the next-most common, at 73.3% (1,294). A degrading comment highlighted in the survey was a physician telling a nurse: “You don’t look dumber than my dog. Why can’t you fetch what I need?”

My Take:  It is critical the professionals understand their limits and who and how they are interacting with people in the workplace.  Some may be ok with what you are saying and doing; others may take the same comment and turn you into the hospital or the boards.  Be aware of your professionalism in the workplace.

 The AMA states that under no circumstances may a physician place their own financial interests above the welfare of their patients.  The purpose of this section specifically discusses performing unnecessary medical care for financial gain, but this flows in financial entanglements with patients.  There is the potential for abuse for both the patient and the physician to harm each in the blending the relationship.

 There is no statute that forbids economic relationships between a physician and patient.  However, the Board as proffered a guideline suggesting that in some circumstances, such a relationship is a violation of the Medical Practice Act.  Specifically, 22 Texas Administrative Code §190.1(c)(2)(G), states that it is unprofessional conduct when a physician becoming financially or personally involved with a patient in an inappropriate manner.

 The question is what constitutes an “inappropriate manner?”  In my professional opinion means any activity that does or reasonably could compromise the professional boundary between the patient and physician.

The total number of complaints against physicians was 6968, up from 6514 in 2008.

The total number of jurisdictional complaints (complaints the board has legal authority over) was 5278, up from 4585 in 2008.

The total number of full investigations was 2873, up from 2725 in 2008.

The total number of ISCs held was 775, up from 521 in 2008.

The total number of disciplinary order was 411, up from 352.

My Take:  The number are going to continue to increase for the foreseeable future.  Practice smart, document, and use good common sense.