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If you have just lost at the TMB formal resolution stage, it is natural to feel alarmed. Your medical license, professional reputation, and ability to continue practicing medicine may suddenly seem at risk.
We have previously discussed the TMB Formal Resolution stage and how to prepare to help you to succeed if possible. If you find yourself unable to reach a resolution at that stage, it does not mean that all is lost. At Gardner Employment Law, we can help you strategize as you move forward in the process.
What Is the Formal Resolution Stage?
Formal resolution begins when the TMB files a formal complaint with the SOAH (State Office of Administrative Hearings). The case is assigned to an ALJ (Administrative Law Judge) and proceeds much like a trial, but without a jury. This stage often is called the “ALJ hearing” or the “SOAH hearing.”
The ALJ does several things:
- Receives evidence in the form of documents and sworn testimony by witnesses.
- Evaluates whether the Medical Practice Act was violated.
- Issues a recommendation to the TMB.
This is the only stage where evidence can be fully presented and challenged. Once the hearing concludes, the evidentiary record is closed.
After the record is closed, the ALJ then issues a Proposal for Decision, which is a recommendation. The Proposal for Decision includes the ALJ’s findings of fact, i.e., what happened, and conclusions of law, whether the law was violated. The Texas Medical Board relies heavily on this proposal when issuing its final order.
What Does It Mean If You Lose At The TMB Formal Resolution?
Losing at the Formal Resolution stage does not mean your license has been revoked or that discipline is final. It means that the ALJ, who is a state employee, was not persuaded by your evidence presented during the hearing. You still have options.
First, you can continue negotiations with the TMB attorney to settle the matter. You may want to reconsider the TMB attorney’s offer to settle the dispute, even if you think that the TMB attorney is requesting excessive probation, unfair monitoring requirements, or overly harsh sanctions.
Second, you can file a motion for rehearing with the TMB. Point out facts that the ALJ misstated or how the ALJ’s conclusion of law is incorrect.
Third, you can appeal the TMB’s Final Order to the Travis County Court of Appeals. ALJs are human and sometimes make mistakes. Sometimes they are biased.
You can still save your career on appeal if the ALJ made a critical mistake either on the facts or the law. Remember: The ALJ hears all types of disputes from 50 different state agencies. The ALJ is not an expert in medicine, but you are.
In one example that we discussed in a previous blog, “What Happens at the TMB Formal Resolution,” Dr. Van Boven filed a lawsuit challenging the TMB’s decision to report the disciplinary actions to the NPDB (National Practitioner Data Bank), a repository of information for adverse actions taken against healthcare practitioners. Although Dr. Van Boven lost at the Court of Appeals stage, he won when he appealed to the Texas Supreme Court.
What Happens After the TMB Formal Resolution Stage?
The post-formal resolution timeline may look something like this.
| Stage | Who Decides | What Can Be Reviewed | Can New Evidence Be Added? |
| Texas Medical Board Final Order | Texas Medical Board | ALJ’s Proposal for Decision | No |
| Motion for Rehearing | Texas Medical Board | Legal and procedural issues | No |
| Court of Appeals of Travis County | Three-Judge Panel | Administrative record only | No |
| Texas Supreme Court | Nine Supreme Court Justices | Appellate Record | No |
Did you notice that in the last column on the right, all answers are “no”? That means that at the ALJ hearing, you must enter into evidence everything that is relevant.
Courts do not retry the case. They review whether the Board followed the law and whether its decision is supported by substantial evidence already in the record.
How Does Evidence Presented at the Formal Resolution Stage Matter?
The major point about the ALJ hearing to keep in mind is this: Only the evidence presented to the ALJ can be used later in the courts. Once a case reaches Formal Resolution, there are no add-ons and no do-overs. The outcome depends almost entirely on:
- The evidence admitted before the ALJ: Courts and reviewing bodies cannot consider new testimony, documents, or explanations later. If evidence is not introduced at the hearing, it is generally lost forever.
- How alleged violations of the Texas Medical Practice Act are framed: Many cases turn not on whether something went wrong, but on whether the conduct legally qualifies as a violation under the Act. How those issues are defined and argued at the ALJ stage shapes every later decision.
- Whether issues are properly preserved for appeal: Arguments not raised or preserved during formal proceedings are generally waived. Appeals courts focus on legal error – not fairness or hindsight – and only preserved issues can be reviewed.
The post-formal resolution stage also has real-world consequences beyond the legal outcome. A final order can affect:
- Hospital privileges and credentialing
- Insurance panel participation
- Reporting to the National Practitioner Data Bank
- Employment and contract opportunities
- Your reputation in your field
Evidence at the formal resolution stage often determines whether a license is protected or permanently affected. Experienced counsel at this point can make the difference between dismissal, discipline, or long-term restrictions on your ability to practice.
Protect Your License.
Losing at the Texas Medical Board formal resolution stage is serious, but it is not the end of your case or your career. Contact us today if you find yourself similarly situated.