C.S.H.B. 6
By: Allen
Public Health
Committee Report (Substituted)

The Texas State Board of Medical Examiners (board) currently licenses and
enforces licensure requirements of physicians in Texas.  The board's
mission is to protect and enhance the public's health, safety, and welfare
by establishing and maintaining standards of excellence used in the
practice of medicine and ensuring quality health care for the citizens of
Texas through licensure, discipline and education.  In response to a
growing crisis in the cost and availability of medical liability insurance
for physicians, efforts were begun to improve the quality of medical care
provided in Texas.  In May of 2002, the Office of the Governor Trusteed
Programs made an emergency appropriation to the board of $200,000 to
improve the investigation and resolution of medical malpractice claims and
to reorganize and improve the medical malpractice claims division.
Additionally, the board began implementing improvements to their
licensure, business practices, investigations, and discipline procedures.
This legislation is in response to concerns raised by the board and
stakeholders regarding physician licensure and discipline procedures.    

It is the committee's opinion that rulemaking authority is expressly
modified or granted to the Texas State Board of Medical Examiners in
SECTION  4 (Section 154.056(a) and (e), Occupations Code), SECTION 7
(Section 156.001(c)(3), Occupations Code), SECTION 8 (Section 156.002 (b),
Occupations Code), SECTION 9 (Section 156.003 (a), Occupations Code),
SECTION 19 (Section 164.001(f), Occupations Code),  SECTION 20 (Section
164.003(b), Occupations Code) of this bill. 
C.S.H.B 6 changes the licensure for physicians from an annual process to a
biennial process.  The bill makes changes to the fee schedule, the
registration and the renewal processes to reflect the biennial licensure
process.  The bill also clarifies that the registration renewal
application can only be issued if, in addition to holding a current
license, the license holder has met current continuing medical education
requirements and has filed a physician profile with the board. 

The bill establishes a new registration permit surcharge of $30 which
shall be used to strengthen the board's enforcement division and for the
expert panels. 

The bill increases the penalty and renewal fees for physicians who are
renewing their license after their current license has expired. 

The bill requires the board to prioritize complaints involving sexual
misconduct, quality of care, and impaired physicians.  Additionally, the
board is required to advise the license holder who was the subject of the
complaint by explaining the action taken on the complaint. 

The bill authorizes the creation of an expert panel of physicians of a
same or similar specialty to assist with reviewing complaints relating to
medical competency.  The board by rule shall describe the composition,
responsibilities, and qualifications for the expert panel.  The expert
panel is required to prepare a report regarding the facts of the case and
the panel's determination of the case.    
The bill updates the qualifying specialty board certifications that can be
approved by the board to reflect changes to the name and organization of
those specialty boards. 

The bill requires that the board by rule shall adopt a schedule of
disciplinary sanctions appropriate to the severity of the actions. 
The bill requires the board to conduct the informal proceedings within 180
days, unless the board can show good cause for delay, and requires the
board to provide 30 days notice of those proceedings to the physician.
Additionally, the bill clarifies the rights of the license holder
participating during the informal proceedings.  The bill clarifies the
information required to be provided to the license holder during the
informal proceedings.  Proceedings for license holders previously
disciplined are expedited. 

The bill establishes the process for the board to dismiss a baseless
complaint and to record that dismissal in the license holder's record. 

The bill clarifies that the due process requirements of the board include
providing the license holder with a statement of the allegation of the
standard of care violated by the physician and other information required
to be provided to the license holder during the due process requirements. 

The bill requires that the board immediately investigate license holders
who violate disciplinary orders or have an additional complaint filed when
under a disciplinary order. 

The bill clarifies the board's responsibility and the judicial process
when a license holder is found to be a danger to the public. 

The bill allows the board the ability to refuse to issue a license to a
person who is convicted of, or is placed on deferred adjudication
community supervision, or deferred disposition of certain offenses. 

The bill requires the board to revoke the license of a license holder who
has had his license revoked in another state. 

The bill includes in the definition of unprofessional or dishonorable
conduct the violation of any state or federal law. 

The bill requires the board to revoke the license of a license holder who
has been convicted of a misdemeanor under Chapter 22, of the Penal Code,
other than an offense punishable by a fine only.   
The bill clarifies that the board shall adopt guidelines for use in
issuing a temporary suspension of a license when it is determined that a
physician's continuing practice presents a real danger to the physician's
patients.  Additionally, the bill directs the board and the State Office
of Administrative Hearings to expedite the due process requirements once a
license has been temporarily suspended. The bill also clarifies that the
board, when seeking a temporary suspension, must have new information if
the first attempt at temporary suspension has failed. 

The bill allows the board to receive information about the violation of a
workers' compensation law by a license holder. 

This act has immediate effect if it receives a vote of two-thirds of all
members elected to each house, as provided by Section 39, Article III,
Texas Constitution.  If this Act does not receive the vote necessary for
immediate effect, this act takes effect September 1, 2003.   
CSHB 6 modifies the original HB 6 by removing language from the original
regarding the creation of a physician education and assistance program.
The substitute changes the licensure process and fee schedule from an
annual to a biennial process.  The substitute provides that the board give
priority to cases involving sexual misconduct, quality of care, and
impaired physician issues. The substitute provides for the establishment
of expert physician panels to assist with investigations involving medical

The substitute modifies the original by allowing the board by rule to
create and adopt disciplinary sanctions that are appropriate to the
violation of the act.  The substitute differs from the original by
requiring that informal complaint proceedings begin within 180 days and
requires 30 days notice of  those proceedings.  The substitute clarifies
the process and notice required for due process requirements.  The
substitute defines due process requirements and regulates the use and
provision of evidence and information provided to a physician under
investigation.  The substitute clarifies the process by which a baseless
complaint is dismissed.  The substitute modifies the original by
specifying certain offenses under Chapter 22, Penal Code rather than a
"violent crime" for revocation of a license. 

The substitute also modifies the original by changing the standard for the
board to process a complaint for temporary suspension or restriction of a
physicians license from a "continuing threat to the public welfare" to a
standard of "real danger to the health or safety of the person's
patients". Finally the substitute allows the board to use information
regarding a license holder's violation of a workers compensation law in
their complaint investigation process.