Physicians hope a state law helps improve medical competency review.

By Damon Adams, AMNews staff. July 21, 2003.

A new law is designed to boost the Texas State Board of Medical Examiners by providing more funding through physician licensing fees and establishing an expert panel to review medical competency.

The law, signed June 10 by Texas Gov. Rick Perry, also calls for speedier handling of complaints, especially those dealing with sexual misconduct.

Many physicians said the legislation would greatly improve the board, allowing it to do a better job of regulating doctors and protecting patients.

"There had been criticism of [the board] for not having enough vigor in its investigations. We think they are suffering from underfunding that this bill will go a long way to correct," said Spencer Berthlesen, MD, a Houston internist and chair of the council on legislation for the Texas Medical Assn., which supported the measure.

For more than a decade, the TMA has called for more funding for the board. While past initiatives fizzled, this year the governor's health care proposals calling for medical liability and medical board reforms helped renew interest.

Physicians and legislators said a stronger board would better monitor and discipline doctors who are responsible for medical liability claims. The day after he signed the medical board legislation, the governor signed a law adopting a $250,000 cap on noneconomic damage awards in medical malpractice lawsuits.

Texas adopted a $250,000 cap on noneconomic damage awards in malpractice lawsuits.

"We don't need a court of law to decide if a doctor is good or bad. We'll be doing it ourselves, and that's the way it should be," said Del Chumley, MD, a gastroenterologist in San Antonio and board member of the Texas Academy of Internal Medicine.

The medical board legislation gives the board new authority to temporarily suspend without hearing the license of a doctor whose practice is a threat to public welfare. On June 20, the board used the new measure to suspend the license of Dallas physician Daniel Andrew Maynard, DO, whose clinic was raided by state and federal authorities investigating the deaths of 11 patients.

"A lot of our criticism from doctors is that we punish doctors too severely for mild things and don't discipline the doctors who are really doing bad things. One of the things we really want to do is change that," said Donald W. Patrick, MD, the board's executive director.

Prior to the bill's enactment, Texas doctors paid a $334 annual registration fee on their medical license, board officials said. Of that, $85 went to the medical board. Now doctors will pay the fee every two years, meaning a $668 base cost. They also will pay an $80 biennial surcharge that will go entirely to the board.

Board officials said the surcharge would add more than $3 million to the board's $5 million budget. That will help to hire 20 more employees, including investigators.

The law is getting mixed reviews.

The law will add $3 million to the Texas board's $5 million budget.

"Nobody likes to pay any more fees or taxes, but the amount of it was not unreasonable," said Robert Hogue, MD, a family physician in Brownwood and president of the Texas chapter of the American Academy of Family Physicians. "Asking for more money [from the state] would have been like asking Martians to come and give us their home movies."

Some doubt money will help.

"They really haven't fixed the problem. It's just a little bit more goes to the board. You're just taxing doctors more," said neurosurgeon Roland Texas NeurosurgeonJr., DO, of Southlake. His license was temporarily suspended a year ago after the board took issue with the doctor's care in more than a dozen cases. The case is before a state administrative law judge.

Other critics of the board said doctors are not given due process.

"The Texas board is not helping to get rid of bad doctors. They are putting skins up on the wall," said Richard Willner, president of The Center for Peer Review Justice, based in Louisiana, which advocates for doctors it believes were wrongly disciplined by boards. "You give them more money for investigations, it means they'll nail more people for imaginary stuff."

The new law requires the board to give priority to complaints involving sexual misconduct, quality of care and impaired-physician issues.

"This law enhances the ability of the board to ensure quality health care," said Lloyd Van Winkle, MD, a family physician in Castroville. "The potential benefits far outweigh any increased burden that might be placed on doctors."