Disciplinary actions by the Texas Medical Board

Texas Medical Board is the state agency that regulates the practice of medicine in Texas.

The Texas Medical Board receives, reviews, and investigates complaints against physicians.

Once the board determines that the complaint alleges a violation of the Texas Medical Practice Act, it initiates the process of collecting and analyzing the evidence.

The board notifies the physician of the complaint received and asks the physician to provide medical records and related documents to investigate the complaint. The board is also authorized to request and review documents from other sources such as hospitals and credentialing organizations.

Most providers have coverage for license related disciplinary action through their medical liability insurance carrier and should notify the carrier immediately. The liability insurance carrier usually appoints an attorney to defend the physician.

It is important not to delay consulting a qualified attorney. The response requires evaluating the complaint, and developing a legal defense. In most cases it require a preliminary review of medical records … which takes time. Giving the attorney adequate time will facilitate an adequate and prompt response.

Occasionally the liability insurance provider determines that the alleged complaint is not covered by the policy … then the licensee will need to find an attorney on his own.

Even if the medical liability insurer covers the policy holders license defense, it has a dollar limit … usually $25000, which can be quickly exhausted in reviewing medical records, finding medical experts, submitting reports, and interacting with the attorneys of the Texas Medical Board.

It is prudent to consult an attorney who is familiar with medical terminology, medical records, and medical issues … this facilitates appropriate and prompt action and lowers the cost of representation.

The common areas of complaints to the medical board relate to:

  • Quality of care
  • Medical record keeping
  • Failure to meet standard of care
  • non therapeutic prescribing
  • Improper prescribing
  • Unprofessional conduct
  • Failure to comply with medical board and state regulations
  • Impairment due to mental health and substance use issues

Some actions by the medical board are automatically triggered by:

  • Medicare/Medicaid fraud conviction
  • Felony convictions
  • License related actions in other jurisdictions
  • Peer review actions and restriction of medical privileges
  • Not fulfilling mandated CME requirement

The vast majority of the cases are related to complaints about quality of medical care. The defense of those cases requires review of medical records, seeking opinion of medical experts, and providing a reasoned explanation of actions taken or not taken.

The provider is required to disclose the final disciplinary action on all future applications for medical license, staff privileges, and liability insurance … and on applications for credentialing, for participation with medicare, medicaid, and other insurance networks.

This disciplinary action is also a public record.

This has significant negative implications for the provider … and it is important to defend these accusations in the best possible way and prevent or minimize the effect of disciplinary action.

Even if you have retained an attorney it is still useful to have a second opinion from another qualified attorney. In the overall scheme of things the cost of doing so is insignificant and may provide additional insight and a different approach to defense.