Dos and don’ts of renewing your Texas medical license
By Franklin Hopkins
Every two years, physicians licensed by the Texas Medical Board are required by law to renew their medical license either online or by regular mail. During registration, physicians must answer questions regarding any status changes since their last renewal. However, certain answers or omissions can trigger an investigation by the Board, and physicians may find themselves explaining their answers before an Informal Settlement Conference.
Two of the six questions in the “Professional History” section of the renewal application are routinely misunderstood and are often the cause of a Board investigation. To illustrate the dos and don’ts of renewing your Texas Medical License, these two questions (questions 2 and 3) are presented below along with an examination of where misunderstandings may occur and a hypothetical example of how a physician may consider responding.
Question 2 — Investigations and disciplinary actions
“Since your last registration or submission of your license application, not including investigations and disciplinary actions by the Texas Medical Board, are there pending investigations, pending disciplinary matters, or final disciplinary actions against you by any licensing agency or health-care entity?”
Where misunderstandings may occur
To answer this question, the physician must fully understand the definitions of “licensing agency” and “health-care entity.” The meaning of “licensing agency” is pretty clear. If the physician is licensed in another state and that state’s board is investigating the physician, or has pending (or final) disciplinary action against that physician, that physician must report it.
But the scope of what constitutes “health-care entity” is less clear. Section 151.002 (5) of the Medical Practice Act defines a health care entity to include a hospital, clinic, practice group, health maintenance organization, medical school, professional medical association, and the like. Such entities’ investigation and disciplinary process is ordinarily known as a “peer review.” Peer review may take many names, such as a credentialing committee, performance review committee, performance improvement committee, etc. No matter what title the hospital gives to its peer review type committee, investigations and actions taken by it are subject to TMB reporting requirements.
The Medical Practice Act also defines “disciplinary action” broadly. Reportable actions may include seemingly routine actions by credentialing committees. For example, if a physician voluntarily relinquishes his or her privileges or decides not to renew privileges while an investigation is pending, that constitutes a reportable disciplinary action.
Keep in mind, the Board does not automatically accept a hospital’s peer review action. The Board is required by law to independently verify any allegation found by a health care entity.
In March, Physician A, an orthopedic surgeon, performed spinal stimulation surgery on a patient. Unfortunately, the patient had complications that prompted the hospital to initiate a peer review proceeding. That June, with a peer review pending, Physician A renewed his license and failed to disclose the pending peer review.
What should Physician A have done?
It would have been better for Physician A to report the pending peer review. Within the renewal, Physician A would have the opportunity to explain the circumstances of the review. In addition, Physician A may supply letters of support from hospital supervisors and peers and inform the Board if the review allegation is determined to be “unfounded.” Physician A could even submit an independent expert report verifying that there were no violations of the standard of care.
Question 3 — Criminal conduct
“Since your last registration or submission of your license application, have you been arrested, fined, charged with or convicted of a crime, indicted, imprisoned, placed on probation, or received deferred adjudication? (Unless the offense involved alcohol or drugs, you may exclude: 1) traffic tickets; and 2) violations with fines of $250 or less).”
Where misunderstandings may occur
Physicians must report these events. It doesn’t matter whether the local prosecutor has dismissed or dropped the charges.
In January 2014, Physician B was arrested for DUI. The prosecutor did not pursue the case, and the charges were dismissed shortly thereafter. In February 2015, Physician B renewed her license, but did not report her arrest since the DUI was dismissed.
What should Physician B have done?
Reporting the arrest from January 2014, along with the dismissal in September, would have been appropriate. She may have also supplied the Board with letters of support from supervisors, family, and friends, along with a personal letter explaining what happened. Physician B would also be wise to obtain an examination by a substance abuse counselor to show the Board that she does not have an alcohol problem.
The best approach to these Board questions is to disclose with explanation. The Board may be more concerned about a failure to report than the subject of the omission. Failing to report creates an impression that you have something to hide.