a medical makeover---an article about the texax medical boar

[azskeptic]

http://msnbc.msn.com/id/4401849/

A medical makeover
Doctors' watchdog makes strides, but naysayers still not satisfiedBy Colin Pope
The Business Journals
Updated: 7:00 p.m. ET Feb. 29, 2004Dr. Donald Patrick remembers vividly the day he was called on the carpet by state legislators in March 2002.

advertisement

Just a few months after taking the $97,000-a-year job as executive director of the Texas State Board of Medical Examiners -- the state agency that disciplines doctors -- Patrick found himself on the receiving end of a barrage of questions and concerns coming from an appropriations subcommittee.

Inside the Capitol, lawmakers' eyes and fingers were pointed directly at Patrick.

Outside, a flurry of news reports were lingering on a national level, each of them illustrating appalling examples of how bad doctors slipped past an impotent Board of Medical Examiners.

They were "horrible articles about the work we did," Patrick says. "The problem is, the facts were generally true."

The stories detailed the most disturbing incidences. A doctor was trading prescription pills for sex. Another molested patients. A few had blatant histories of medical mishaps and questionable patient deaths. After each vignette, the media pointed out that the Board of Medical Examiners often did little, if anything, to curtail the misdeeds.

Patrick, who says he naively took the board's reigns just months earlier based on a rosier picture, was galvanized by the publicity. So, too, were state lawmakers. At the end of the appropriations subcommittee's hearing, legislators planted a resonating message in Patrick's head: If the board isn't put on track -- and fast -- the state would pull the plug on the agency in 2003.

Work began immediately.

"We did more [disciplinary actions] in the first four months than we did in the previous 12," Patrick says. "We impressed legislators by demonstrating what we could do when the board and the agency work together to be vigilant."

Adding bite to the bark
Today, less than two years after the board's existence was threatened, the agency has quickly become one of the state's darling agencies. As other agencies struggle with budget cuts and layoffs, the board's staff and budget are bigger than ever, and new laws have been passed to give the agency's enforcement arm more muscle. However, some critics say the board is too strong and has the power to strip doctors of their right to due process.

But the revamped agency says it now is able to accomplish its goal: More bad doctors are being punished than ever before -- and at a faster rate.

From fiscal 2002 to 2003, informal settlement conferences between doctors and the board jumped from 172 to 477. The total number of disciplinary actions during the same period went from 187 to 277. The amount of annual administrative penalties went from $175,880 to $393,500.

Halfway through the fiscal year, Patrick says 2004's numbers remain as strong.

Houston urologist Dr. **** Handel, whom the Texas Medical Association recently named head of a committee studying the medical examiners board, says the state agency has done a good job walking the fine line between coming down hard on bad doctors and ensuring their rights remain intact -- especially as they relate to due process.

Much of the progress is attributed to the increase in funding. Patrick claims it was the lack of funding that made the board so ineffective in the past.

Washington, D.C.-based watchdog group Public Citizen says adequate funding and staffing of state medical boards are the most important factors for doing a good job of disciplining physicians.

Between 1993 and 2002, Texas' medical board consistently grabbed mediocre spots on the group's annual list of the country's best and worst states for disciplining doctors. During that time, the Texas medical board's ranking fluctuated between 19 and 38.

During that time span, the board -- which licenses about 51,000 physicians in Texas -- was criticized harshly by physicians and by patient advocates for losing cases, taking too long to investigate complaints, handing out overly lenient punishments or not taking action at all.

As part of the response, the state recently allocated 20 more full-time jobs to the agency -- all of which are going into the enforcement division. By raising licensing fees paid by doctors, a move that required legislative approval, the board has increased its two-year budget by 60 percent, or more than $3 million, allowing it to add even more strength to the enforcement section.

When Patrick was scolded by lawmakers two years ago, the board's three litigation lawyers were stretched among 100 cases. Today, the board has 12 litigators to handle the caseload.

The board's enforcement area -- which includes investigators, compliance officers, lawyers and support staff -- houses almost 70 people. The agency, as a whole, employs about 125.

The current enforcement team hails from a variety of backgrounds. Typically with some sort of history in the medical industry, the group of former law enforcement officials, investigators and courtroom-savvy lawyers allow the agency to turn the heat up on the minute percentage of bad doctors, board spokeswoman Jill Wiggins says.

One Austin attorney who represents doctors, who declines to be identified because of an ongoing relationship with the board, says the heat has been turned up too high.

"The investigation and discipline process can be fair, but it can be unfair," says the attorney, adding that the board's disciplinary action often is too harsh.

"There is an attitude that the doctor is guilty until proven innocent ... and when you start with a bias, the bias continues. I think they have to find fault in anything that comes before them to prove to legislators that they're doing their job."

Money and power
Equally as important as the state agency's beefed-up workforce is the new power it carries, which has drawn critics out of the woodwork.

Before this year, members of the board's enforcement team found their hands were tied in some cases, such as the one a few years ago when an enraged doctor shot up an associate's house. The incident flew in the face of the Hippocratic oath, but because the targeted victim was not a patient, a state judge ruled the board had to back out of the case.

Last year, the board persuaded legislators -- through Senate Bill 104 -- to rewrite the law saying that the medical board can pursue only someone who constitutes a "real and present danger to the health of the physician's patient."

Now, the board can go after any doctor who is "a real danger to the health of a physician's patients or the public."

Also through SB 104, the board now wields the authority to suspend a doctor's license immediately and without notice, Wiggins says. That disconnects the doctor from patients and reduces the chance that a bad doctor will alter or dispose of incriminating office and medical records. The accused doctor could wait up to 10 days for a hearing.

Critics, including the Louisiana-based Center for Peer Review Justice, say the board's power to pluck a doctor's license in that manner robs them of due process.

But the medical association's Handel says a bad doctor sometimes needs to be pulled immediately from a medical setting.

"Sure, on occasion there's always the possibility that someone will be unjustly accused," he says, "but it's worth it to take that risk."

© 2004 The Business Journals

[wcb22]

and why did i want to practice in TX?

[azskeptic]

Originally Posted by wcb22

and why did i want to practice in TX?

1. you like the traffic in Dallas?
2. you enjoy the quiet in Amarillo?
3. you miss McAllen Texas?

[tRmedic21]

I love Texas, but man....

Traffic in Houston creeps during rush hour every day.
Traffic in Austin creeps if there's a fender-bender.
Traffic in Dallas FLIES 24/7, bumper-to-bumper at 80MPH+!

Gimme San Antonio any day of the week, and twice on Sundays. It just gets so damn HOT there!