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Physicians prescribe controlled substances as part of their legitimate medical practice. But when a doctor fails to properly document the medical records, if he or she fails to have a monitor absent, or the doctor issues the prescription without proper evaluation, the TMB may characterize the conduct as illegally dispensing controlled substances. That is what happened in a case we explain in this article.
At Gardner Employment Law, we represent physicians facing investigations by the TMB. This recent case highlights how the Board analyzes these matters – and why documentation is often the deciding factor.
A 2025 Case Study: What Happened?
In a 2025 TMB (Texas Medical Board) Order, the Board alleged that a physician illegally dispensed controlled substances to a single patient over a two-year period.
According to the Board’s allegations:
- Controlled substances were prescribed without adequate medical necessity.
- Dosages were increased without sufficient examination or documentation.
- Prescriptions were issued without patient contact or updated interim history.
- No documented mental status evaluations were performed despite ongoing prescribing.
- Treatment progress was not recorded.
- Billing records were absent.
The Board asserted that the physician prescribed the drugs, increased the dosages, and diagnosed the patient without adequate examination and documentation, in violation of the Texas Medical Practice Act and Board rules.
How Does the TMB Decide Sanctions Against a Physician?
When determining sanctions, the TMB evaluates aggravating and mitigating factors. In the case at hand, the TMB escalated sanctions against the doctor because multiple aggravating factors were present and no mitigating factors were identified.
Mitigating factors, circumstances that may lead to more lenient sanctions, include the physician taking corrective action, trying to remedy the harm, or demonstrates insight. In this case we’re analyzing, no the doctor could present no mitigating factors.
Also, when a physician has a history of other disciplinary measures, the TMB will view a new prescribing violations more harshly. And, yes, this doctor had a history of improperly prescribing unnecessary controlled substances.
Due to the seriousness of the allegations and prior disciplinary history, the Board attorney requested that the matter proceed to a contested case hearing at the SOAH (State Office of Administrative Hearings).
What Does “Illegally Dispensing Controlled Substances” Mean Under Texas Law?
Illegally dispensing a controlled substance under Texas law means prescribing or providing controlled substances in a manner that violates the Texas Medical Practice Act or Board rules. Under federal law, it means dispensing a controlled substance outside the usual course of professional medical practice for an illegitimate medical purpose.
Under Texas Occupations Code Chapter 164, the TMB may discipline a physician for:
- Non-therapeutic prescribing
- Prescribing without proper medical indication
- Failing to meet the standard of care
- Inadequate documentation
- Failure to maintain proper medical and billing records
Importantly, these cases do not require proof of criminality. The Board may view “illegal dispensing” when prescriptions lack:
- Documented medical necessity
- Adequate patient evaluation
- Ongoing monitoring
- Clear clinical justification
Good recordkeeping is important. If the medical record does not support the prescription, the TMB may treat it as unlawful dispensing.
A physician can be sanctioned by the TMB even if he or she did not intend wrongdoing. The issue is whether the act of prescribing the drug met professional standards.
What Can Physicians Learn From This Case?
Physicians must follow the guidelines found in the Texas Medical Practice Act. Just as one example, documentation is often the difference between appropriate prescribing and alleged illegal dispensing, even if treatment was clinically appropriate.
To summarize, prescribing controlled substances requires:
- Proper evaluation
- Clear medical indication
- Documented patient contact
- Ongoing assessment
- Thorough and accurate medical records
If your records cannot independently justify the prescription, you may face exposure – even if your intent was appropriate.
Bottom Line
Illegally dispensing controlled substances does not always mean criminal conduct, but it does carry serious professional consequences.
Controlled substance cases remain one of the most aggressively pursued categories before the TMB. The earlier a physician recognizes risk areas and responds strategically to an inquiry, the more options remain available.
If you have questions about a TMB investigation involving prescribing practices, we can help.