Saturday, August 20, 2005
Accountability is required of this Texas Medical Board if you are to protect patients!
November 1, 2004
Dear Interested Reader,
I would like to update you regarding recent scrutiny of the TSBME. Please note that the Austin American Statesman recently wrote an article regarding how the Governor has created a new agency to oversee the TSBME. Why do we have to create a new watchdog to oversee an existing agency unless they (TSBME) are not really doing what they are supposed to do? See attachment.
Secondly, I wanted to make you aware of Nancy Selinger who is a public member of the TSBME and is also its Secretary Treasurer. According to the TSBME’s own rules, any member of the Board who is related to a state legislator (in this case she is married to Kel Selinger of Amarillo) is supposed to step down to avoid a conflict of interest. Why hasn’t Anderson or Patrick removed her by now? Kel Selinger has been a legislator for several years, but his wife has yet to resign from the TSBME.
Thirdly, I hope that you have reviewed the Sunset Staff report on the TSBME, which is on-line, as well as the recommendations from the Texas Medical Association. I am attaching several letters/reports. I draw your attention to pages 112 and 113 of the Sunset report, which are graphs from the TSBME’s data. Out of 1,713 complaints, the TSBME took 256 actions with a total of 1,481 dismissed. That is not to say that the TSBME has to meet a quota, but would it not be nice to know exactly what criteria and whose criteria was used for these dismissals? REMEMBER, the Sunset Committee brought up the fact that one reviewer can either dismiss or move a case forward to the Informal Settlement (ISC). Talk about too much power between the reviewer and Patrick. Also, Sunset stated that the TSBME has 300 reviewers but uses the same 45, 38 of whom are in Austin. Essentially, 256 disciplinary actions took place out of 1,717 complaints or 15% of complaints were actually disciplined. That does seem low, especially when you look at the categories of the types of complaints and the money being used by this agency to prosecute these complaints.
On page 112 of the report, the Informal Settlement Conference (ISC) is discussed. In 2004, 402 ISC’s were deemed appropriate by Dr. Patrick which yielded the following; 152 Dismissed (38%), 295 Agreed Orders (73%), and 43 SOAH (11%). The most penalized cases were: discipline by another state (50%), peer review (32%), misdemeanors involving moral turpitude (39%), and impairment (50%). In all four of these categories, the majority of work was already completed by another agency, state, hospital, or law enforcement. All the TSBME had to do was “rubber stamp” the information. Complaints of proper medical care investigations disciplined were 9% while unprofessional conduct disciplines were 13%. Investigating and disciplining doctors with a significant malpractice history who paid out significant judgments was 17%. This is interesting since Dr. Patrick made a big deal about “50% of all malpractice to Texas citizens are committed by 6% of Texas’s 50,000 physicians”! If you calculate this, approximately 3,000 doctors should have been investigated but were not. Only 12 doctors were, in fact, investigated and 10 of these 12 investigations were dismissed (83%). Of those 1067 doctors investigated for “practice inconsistent with public welfare,” 973 were dismissed (91%). This does not make any sense especially if the TSBME is getting medical complaints about doctors. Either the public is not getting hurt by Texas doctors or the TSBME is allowing too many “byes.” The 38% dismissal rate is also disappointing since you would think that the TSBME would have “truly” investigated a physician properly before proceeding with its complaint. The TSBME staff should be responsible to have a conviction rate of >90%. The fact that another 11% of those who had an ISC chose to go to SOAH for an objective look at the investigation is also troubling since the TSBME is trying to strong arm an Agreed Order (which it has a history of attempting in a majority of cases) or is attempting to punish a practitioner beyond what is reasonably appropriate. You should get a list of those doctors going to SOAH to see exactly what the TSBME is alleging the practitioner to have committed. The Sunset report made note of the fact that a doctor reviewer for the TSBME has too much power, which can force the accused doctor to spend additional money defending an investigation that should never have occurred in the first place. They, Sunset, also stated that that same TSBME reviewer can give a doctor a “bye” which is also not fair. Physicians need to be investigated regarding medical issues and the “standard of care,” not based on personal knowledge, or possible bias. You should also get a list of the 295 Agreed Orders to see exactly what the allegations were and how they affected the health and welfare of Texans.
Finally, 232 doctors of 1713 (14%) actually received discipline from the TSBME. Twenty-six (26) received revocation/surrender. Not withstanding the revocation/surrender total (26), the TSBME will only monitor 206 doctors (12%) of the 1,713 it investigated and found to be a “threat to Texans.” Investigations by the TSBME revealed that 14% were disciplined in its investigations. This does not take into account those doctors who are appealing the TSBME decisions in District Court. The TSBME in fact does not keep records of these “appeals” for the public and only records decisions made at TSBME Board meetings. Administrative penalties are fines paid by the accused doctors. This is an extremely low number (58 of 1,713) investigations.
There is a disconnect between the residents of Texas initiating a complaint against a doctor and the TSBME actually finding a doctor guilty of wrong-doing. The numbers don’t make any sense in light of the fact that doctors are still losing malpractice claims yet not being disciplined by the TSBME. At the same time, areas including “peer review” dismissals and repeated malpractice cases also appear to demonstrate a disconnect as to which doctors, if any, are in fact not following the medical practice act. Are the citizens of Texas just making up their complaints of physical injury by a doctor or improper practice, (1,067 complaints with 973 dismissed (92%))? or is the TSBME not doing an adequate job investigating and disciplining these doctors? The residents of Texas must demand ACCOUNTABILITY from Dr. Patrick and his TSBME. Dr. Patrick must not be allowed to “blame the system”, or cry out for additional funding but must take responsibility for this disconnect.
Another interesting statistic deals with peer review. A total of 38 investigations were started on Texas doctors with 26 dismissed (68%). This does not reflect well on the hospitals and the doctors who are instituting adverse actions on these doctors. A more interesting question I pose is “what happened to the doctors who gave this doctor an adverse action leading to a secondary investigation by the TSBME?” Obviously, the TSBME “cleared” the doctor, but what about the finger pointers who obviously either committed fraud by lying about this doctor in the hospital action or worst, demonstrate that they need additional medical education since they have removed a good physician from the medical staff and his/her patients. The TSBME must protect legitimate doctors from the frivolous doctors responsible for unfair, sham peer review by disciplining those doctors who were responsible for initiating the adverse action. Additionally, the hospital should be forced to take the doctor back on staff and any “adverse comments” to the National Practitioner Data Bank needs to be removed. The Health Care Quality Improvement Act (HCQIA) was a law enacted to promote good quality health care by physicians in the hospital setting, not be used as a sword to cut out ones competition or for personal vendetta.
In conclusion, this synopsis is meant to demonstrate how an agency which in 2002 pleaded for increased funding to make itself more effective in protecting the public has failed miserably in 2004-despite receiving an additional 5 million dollars from the legislature. The irony is that funding will not improve the TSBME; accountability will, but that has not been the goal of those who make up the Board. The TSBME’s own statistics are appalling and obviously demonstrate a disconnect between its mission to protect the public and its Executive director who is protecting those very doctors who need to be investigated and require medical/surgical remediation. This Board has shown bias in its investigative pursuits and discipline of many doctors. This agency is not capable of launching good investigations and relies on other agencies and hospitals to do the Board’s investigative legwork. Additionally, since the TSBME is Judge, Jury, and Executioner, any Texas physician who has been identified by this board as being “problematic” puts him- or herself at risk for being harassed in perpetuity for daring to question the Board’s leadership, motives, and activities.
Sincerely
Dear Interested Reader,
I would like to update you regarding recent scrutiny of the TSBME. Please note that the Austin American Statesman recently wrote an article regarding how the Governor has created a new agency to oversee the TSBME. Why do we have to create a new watchdog to oversee an existing agency unless they (TSBME) are not really doing what they are supposed to do? See attachment.
Secondly, I wanted to make you aware of Nancy Selinger who is a public member of the TSBME and is also its Secretary Treasurer. According to the TSBME’s own rules, any member of the Board who is related to a state legislator (in this case she is married to Kel Selinger of Amarillo) is supposed to step down to avoid a conflict of interest. Why hasn’t Anderson or Patrick removed her by now? Kel Selinger has been a legislator for several years, but his wife has yet to resign from the TSBME.
Thirdly, I hope that you have reviewed the Sunset Staff report on the TSBME, which is on-line, as well as the recommendations from the Texas Medical Association. I am attaching several letters/reports. I draw your attention to pages 112 and 113 of the Sunset report, which are graphs from the TSBME’s data. Out of 1,713 complaints, the TSBME took 256 actions with a total of 1,481 dismissed. That is not to say that the TSBME has to meet a quota, but would it not be nice to know exactly what criteria and whose criteria was used for these dismissals? REMEMBER, the Sunset Committee brought up the fact that one reviewer can either dismiss or move a case forward to the Informal Settlement (ISC). Talk about too much power between the reviewer and Patrick. Also, Sunset stated that the TSBME has 300 reviewers but uses the same 45, 38 of whom are in Austin. Essentially, 256 disciplinary actions took place out of 1,717 complaints or 15% of complaints were actually disciplined. That does seem low, especially when you look at the categories of the types of complaints and the money being used by this agency to prosecute these complaints.
On page 112 of the report, the Informal Settlement Conference (ISC) is discussed. In 2004, 402 ISC’s were deemed appropriate by Dr. Patrick which yielded the following; 152 Dismissed (38%), 295 Agreed Orders (73%), and 43 SOAH (11%). The most penalized cases were: discipline by another state (50%), peer review (32%), misdemeanors involving moral turpitude (39%), and impairment (50%). In all four of these categories, the majority of work was already completed by another agency, state, hospital, or law enforcement. All the TSBME had to do was “rubber stamp” the information. Complaints of proper medical care investigations disciplined were 9% while unprofessional conduct disciplines were 13%. Investigating and disciplining doctors with a significant malpractice history who paid out significant judgments was 17%. This is interesting since Dr. Patrick made a big deal about “50% of all malpractice to Texas citizens are committed by 6% of Texas’s 50,000 physicians”! If you calculate this, approximately 3,000 doctors should have been investigated but were not. Only 12 doctors were, in fact, investigated and 10 of these 12 investigations were dismissed (83%). Of those 1067 doctors investigated for “practice inconsistent with public welfare,” 973 were dismissed (91%). This does not make any sense especially if the TSBME is getting medical complaints about doctors. Either the public is not getting hurt by Texas doctors or the TSBME is allowing too many “byes.” The 38% dismissal rate is also disappointing since you would think that the TSBME would have “truly” investigated a physician properly before proceeding with its complaint. The TSBME staff should be responsible to have a conviction rate of >90%. The fact that another 11% of those who had an ISC chose to go to SOAH for an objective look at the investigation is also troubling since the TSBME is trying to strong arm an Agreed Order (which it has a history of attempting in a majority of cases) or is attempting to punish a practitioner beyond what is reasonably appropriate. You should get a list of those doctors going to SOAH to see exactly what the TSBME is alleging the practitioner to have committed. The Sunset report made note of the fact that a doctor reviewer for the TSBME has too much power, which can force the accused doctor to spend additional money defending an investigation that should never have occurred in the first place. They, Sunset, also stated that that same TSBME reviewer can give a doctor a “bye” which is also not fair. Physicians need to be investigated regarding medical issues and the “standard of care,” not based on personal knowledge, or possible bias. You should also get a list of the 295 Agreed Orders to see exactly what the allegations were and how they affected the health and welfare of Texans.
Finally, 232 doctors of 1713 (14%) actually received discipline from the TSBME. Twenty-six (26) received revocation/surrender. Not withstanding the revocation/surrender total (26), the TSBME will only monitor 206 doctors (12%) of the 1,713 it investigated and found to be a “threat to Texans.” Investigations by the TSBME revealed that 14% were disciplined in its investigations. This does not take into account those doctors who are appealing the TSBME decisions in District Court. The TSBME in fact does not keep records of these “appeals” for the public and only records decisions made at TSBME Board meetings. Administrative penalties are fines paid by the accused doctors. This is an extremely low number (58 of 1,713) investigations.
There is a disconnect between the residents of Texas initiating a complaint against a doctor and the TSBME actually finding a doctor guilty of wrong-doing. The numbers don’t make any sense in light of the fact that doctors are still losing malpractice claims yet not being disciplined by the TSBME. At the same time, areas including “peer review” dismissals and repeated malpractice cases also appear to demonstrate a disconnect as to which doctors, if any, are in fact not following the medical practice act. Are the citizens of Texas just making up their complaints of physical injury by a doctor or improper practice, (1,067 complaints with 973 dismissed (92%))? or is the TSBME not doing an adequate job investigating and disciplining these doctors? The residents of Texas must demand ACCOUNTABILITY from Dr. Patrick and his TSBME. Dr. Patrick must not be allowed to “blame the system”, or cry out for additional funding but must take responsibility for this disconnect.
Another interesting statistic deals with peer review. A total of 38 investigations were started on Texas doctors with 26 dismissed (68%). This does not reflect well on the hospitals and the doctors who are instituting adverse actions on these doctors. A more interesting question I pose is “what happened to the doctors who gave this doctor an adverse action leading to a secondary investigation by the TSBME?” Obviously, the TSBME “cleared” the doctor, but what about the finger pointers who obviously either committed fraud by lying about this doctor in the hospital action or worst, demonstrate that they need additional medical education since they have removed a good physician from the medical staff and his/her patients. The TSBME must protect legitimate doctors from the frivolous doctors responsible for unfair, sham peer review by disciplining those doctors who were responsible for initiating the adverse action. Additionally, the hospital should be forced to take the doctor back on staff and any “adverse comments” to the National Practitioner Data Bank needs to be removed. The Health Care Quality Improvement Act (HCQIA) was a law enacted to promote good quality health care by physicians in the hospital setting, not be used as a sword to cut out ones competition or for personal vendetta.
In conclusion, this synopsis is meant to demonstrate how an agency which in 2002 pleaded for increased funding to make itself more effective in protecting the public has failed miserably in 2004-despite receiving an additional 5 million dollars from the legislature. The irony is that funding will not improve the TSBME; accountability will, but that has not been the goal of those who make up the Board. The TSBME’s own statistics are appalling and obviously demonstrate a disconnect between its mission to protect the public and its Executive director who is protecting those very doctors who need to be investigated and require medical/surgical remediation. This Board has shown bias in its investigative pursuits and discipline of many doctors. This agency is not capable of launching good investigations and relies on other agencies and hospitals to do the Board’s investigative legwork. Additionally, since the TSBME is Judge, Jury, and Executioner, any Texas physician who has been identified by this board as being “problematic” puts him- or herself at risk for being harassed in perpetuity for daring to question the Board’s leadership, motives, and activities.
Sincerely
// posted by texas shammed @ 7:21 PM 
