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With over 9,000 complaints filed annually with the TMB, even the best physicians find themselves caught up in the TMB enforcement process. In this article, we explain how the TMB QA (Quality Assurance) Panel screens complaints to dispose of frivolous claims.
At Gardner Employment Law, we understand the TMB enforcement process and we have published articles on the entire process. If you are in the midst of a TMB investigation, we can help.
How Does the TMB Screen Complaints through the QA Panel?
The TMB Quality Assurance Panel screens complaints in order to assess whether the basic standard of care was breached. Based on their findings, the panel decides whether or not the case will proceed to the next phase of investigation or be dismissed for lack of evidence.
The QA panel consists of up to five board representatives, who are physicians, laypeople, and attorneys. These representatives bring diverse perspectives and expertise to the evaluation process, ensuring a balanced review. Usually, a physician who has agreed to participate on this Panel will be highly motivated to ensure that the other panel members are well informed on the particular standard of care at issue. Typically the attorneys who participate as a member of this Panel know the Medical Practice Act inside and out. During the screening, the Panel may also call upon additional medical experts to provide further insight into the complexities of the care provided. This comprehensive approach helps maintain high standards of medical practice in Texas.
What Happens Before a Complaint Reaches the QA Panel?
Before a case reaches the QA Panel at the TMB, several preliminary steps are taken to evaluate the validity and severity of the allegations. As explained more fully in previous articles, when a complaint is filed against a physician, the TMB sends the case to a preliminary investigation. Once this is complete, the QA Panel screens the complaint. If the Panel finds no violation, this can short-circuit a very long and drawn-out process.
Initially, TMB staff conducts a review within the first 45 days of receiving a complaint to determine its nature—whether it pertains to administrative issues or involves medical care—and thus which type of investigator, attorney, or physician should be assigned.
If the initial review reveals that the complaint doesn’t specify any violation of the Texas Medical Practice Act or the physician’s response negates the possibility of a violation, no investigation is pursued, and the case is categorized as “Jurisdictional, not Filed.” However, if the complaint is found to have merit, an investigation is launched, categorized as “Jurisdictional, Filed,” and the licensee is notified to provide further information. The TMB can subpoena additional records as needed and is authorized to obtain medical records without patient consent under HIPAA.
In cases involving standard of care, the gathered information is examined by a TMB Expert Panel. Should the Expert Panel find the licensee’s actions to be in conflict with public health and welfare, including any failure to meet the standard of care, the case is escalated to the Litigation Section for possible disciplinary action. Otherwise, it may be recommended for dismissal. When the investigation concludes, if the case is neither dismissed nor remediated, it moves to the QA Panel.
What Happens After the QA Panel Screening?
After the TMB QA Panel screens the physician complaint and reviews the evidence collected, several outcomes could occur:
- Referral to the litigation department for an ISC (Informal Settlement Conference): If the case is referred for an ISC, this means that the case has been moved to the litigation department of the TMB. The case is now assigned to a staff attorney and a proceeding occurs before a panel composed of two representatives of the appropriate board. The Medical Board panels always include one physician and one public member, unless the respondent waives that requirement. The purpose of the ISC is to provide an informal gathering for the panel to review the information presented and for the physician to show that they are in compliance with the Texas Medical Practice Act. After the ISC reviews a case, one of three outcomes can happen. First, the panel might find that there was no violation of the Medical Practice Act. In this case, they can refer the case to the board’s Disciplinary Process Review Committee for dismissal. Second, if the panel does find a violation, they can offer an agreed order. To learn more about agreed orders, read our blog, “Negotiate an Agreed Order with the TMB”. This order outlines the sanctions and terms that the respondent must follow. Lastly, for less serious violations, the panel may suggest a remedial plan.
- Offering the licensee a remedial plan: A Remedial plan is a corrective action that is considered to be non-disciplinary. Usually, remedial plans are only offered to physicians who commit minor violations. The most common actions taken by the TMB are:
– Restricting the licensee from performing certain procedures or practices
– Requiring additional training or medical education
– Requiring compliance appearances before members of the board
– Requiring participation in rehabilitation or behavioral health programs
– Requiring drug testing
– Prohibiting a licensee from treating certain types of patients
– Assessing an administrative penalty (a fine)
– Issuing a public reprimand - Referral of the case to the board’s disciplinary process review committee for dismissal: If the case is referred to the board’s disciplinary process review committee for dismissal, this means that no violation of the Texas Medical Practice Act was found. In this case, the physician will not undergo any repercussions
Contact a TMB Expert
If you are caught up in the TMB enforcement process, you need an expert TMB attorney to fight the case with you. At Gardner Employment Law, we have the necessary experience to assist physicians fight their TMB complaints. We are here for you.