TX Medical Board Rapped for Poor Oversight

Consumer safety advocate group Public Citizen has a difference of opinion with the Texas Medical Board.

Public Citizen says its review of data from two decades shows that physician oversight in Texas is weak. The spokeswoman for the board disagrees and says comparative data with other states suggest the board is among the strongest in the nation.

In a letter and report sent Wednesday to Texas Gov. Rick Perry, Public Citizen urged him "initiate immediate action to improve the performance of the Texas Medical Board … and thereby protect patients in Texas from physicians who should have been, but were not, disciplined."

Public Citizen said it analyzed 21 years of data from the National Practitioner Data Bank and found that 459 physicians in Texas who were sanctioned by hospitals, HMOs and other healthcare facilities, for posing a serious risk to patient health, and in some cases for multiple infractions, have yet to be disciplined by the state medical board.

"These violations are not minor," Sidney Wolfe, MD, director of Public Citizen's Health Research Group, said in a media release accompanying the report. "In our investigation we've identified physicians who have committed gross breaches of medical and ethical standards, yet they have not been sanctioned by the state medical board, the institution whose primary duty is to make sure practitioners taking care of Texas patients are qualified to do so."

In his letter to Perry, Wolfe blamed the board's problems mostly on underfunding and understaffing.

"Currently, the Medical Board brings in about $60 million from licensing and renewal fees over a two-year budget period. Because of a state legislature policy decision, the Medical Board gets to keep only one-third, $20 million, of the licensing and renewal fees over the two-year period, while two thirds, or $40 million, is turned over to the state general revenue fund," Wolfe said in the letter.

From 2006 to 2011, Wolfe said that there has been a 57% increase in the number of complaints to the board. "But during this interval, the board's budget, adjusted for inflation, increased only 12%, and the number of staff increased by only 16%," the letter said.

Texas Medical Board spokeswoman Leigh Hopper disputed Public Citizen's findings.

"Public Citizen's findings do not track with any of our current concerns. We are not understaffed. We are not underfunded," Hopper told HealthLeaders Media. "The talk about funds being diverted into the General Fund is how it always works. I don't know how other state agencies operate but at least in Texas this is how it is done with the Medical Board. Our funds and fees that we bring in through licensing go into the General Fund and we write an appropriation request to get back what we need to run the agency."

"Like anybody, of course we would always like more money. But we haven't been dealing with a budget crisis so the agency is healthy and it's effective," she says. "Does that mean there is room for improvement? There is always room for improvement. There are always public hearings that we would welcome Public Citizen to participate in."

Hopper says the 459 physicians cited by Public Citizen "is not a figure that we are tracking."

"We get roughly 7,000 complaints a year and we are complaint-driven, which mean we don't launch investigations in the absence of a complaint to our agency," she says. "When hospitals take an action against one of their own physicians they are supposed to report that to us and we will decide whether or not we are going to pursue it. The same is somewhat true with medical malpractice cases. We get that information as well but it doesn't automatically translate into a Texas Medical Board case."

Rather than being a laggard, Hopper says that Texas Medical Board is "considered a leader" among state medical boards with "processes (that) are emulated by others." She says the Federation of State Medical Boards data puts Texas at the top of the list when it comes to doling out discipline.

"I hate to say we are No. 1 because it makes it sound like we are competing which we are not," she says. "But when you look at the number of disciplinary actions in the physician population we've taken the last couple of years Texas has taken more action per physician than other states."

Public Citizen urged Perry to:

• Allow the medical board to keep all—not just one-third—of the revenue it generates so it can hire more staff and complete more investigations in a timely manner.
• Appoint an independent medical board enforcement monitor to evaluate the disciplinary system and the board's enforcement procedures, as well as play an active role in maintaining integrity of these processes into the future.
• Institute random practice audits of physicians, as recommended by the Health and Human Services' Office of the Inspector General, to identify practice deficiencies.

HealthLeaders Media's calls to Perry's office seeking a response were not returned on Wednesday.