pendent medical judgment. We also protect physicians advo- cating for patients’ medical needs against discipline from the hospital. And, we make sure that independent doctors and employed doctors are treated exactly the same with regard to credentialing and privileges.” The bill also requires the hospital’s chief medical officer to
report to TMB any instance of administrative interference in clinical or patient care decision making. That means if inde- pendent physicians are required to take call to maintain staff privileges, employed physicians also must take call. A handful of urban county hospital districts also received
approval to employ physicians, with protections for clinical autonomy and independent medical decision making similar to the rural hospital bill. Those hospital districts are in Harris, Tarrant, Bexar, and El Paso counties. Their ability to employ physicians is limited to fulfilling their statutory mission to pro- vide indigent care. Dallas County Hospital District won similar ability in 2009, and its enabling legislation served as the tem- plate for the others that passed this year. Local county medical societies were involved in the negotiations.
While those bills expand the ability of hospitals to employ physicians, TMA leaders say they will affect few physicians. The rural hospital bill, for example, applies to fewer than 150 hospitals, so the number of physicians employed under that bill likely will be small. Legislation that could have much greater positive impact for physicians was Senate Bill 1661 by Senator Duncan and Rep. Todd Hunter (R-Corpus Christi). It provides protections for the thousands of physicians employed by hospital-run non- profit health care corporations, or 501a corporations. SB 1661 makes the physician board of directors responsible for all clini- cal matters within these organizations, and gives physicians important liability protections within a 501a. Dr. McCoy says SB 1661 is the big win in protecting the clinical autonomy of employed physicians because it impacts thousands of doctors who work for 501a corporations. “In passing Senate Bill 1661 and the rural hospitals bill — even the big urban hospital districts bills — we have enacted in Texas the first statutory protections on clinical autonomy and independent medical decision-making anywhere,” he said.
“We protected the ban on the corporate practice of medicine by ensuring that those doctors who are employed have protec- tions on their independent medical judgment.”
TMB improved Another hard-fought issue in which TMA emerged victori- ous was the battle over a series of reform bills designed to make TMB’s disciplinary processes fairer for physicians, while maintaining the ability of the board to protect the public. (See “TMB Reform,” July 2011 Texas Medicine, pages 18–27.) “Despite the efforts of some of TMB’s harshest critics, TMA fought off an effort to strip the medical board of much of its ability to protect patients from really bad doctors,” Dr. Malone said. “Instead, we enacted a trio of reform bills that mean phy- sicians will face less bureaucratic hassles from TMB’s disciplin- ary processes. These three bills provide much needed due pro-
cess protections for physicians without endangering the 2003 medical liability reforms that have meant so much to Texas.” Thanks to TMA’s defeat of opponents with anti-TMA and
anti-TMB agendas, the bills the legislature passed prohibit the filing of anonymous complaints. But they also:
• Require TMB to notify the physician when insurance com- panies, pharmaceutical companies, or third-party adminis- trators file a complaint;
• Increase the time for a physician to respond to a complaint notice from 30 days to 45 days;
• Allow physicians to record the proceedings of a TMB infor- mal settlement conference;
• Allow TMB to require a remedial action plan rather than impose a fine for a minor administrative violation;
• Institute a seven-year statute of limitation on bringing a disciplinary action, mirroring the TMB rule on how long doctors need to keep a patient’s medical record; and
• Bind TMB to the ruling of an administrative law judge in a proceeding supervised by the State Office of Administrative Hearings (SOAH).
In mid-June, Governor Perry vetoed SB 191, which con- tained the SOAH provision stating that he was concerned about overreliance on SOAH in contested care hearings before TMB. Identical language, however, was contained in HB 680, a broader TMB reform bill sponsored by Rep. Charles Schwert- ner, MD (R-Georgetown). Despite his concerns over the SOAH provision, Governor Perry signed that bill into law.
Scope bills stopped cold In just about every session, midlevel practitioners push a num- ber of bills to allow them to practice medicine without a medi- cal school education. This session was no different. The good news, Dr. Floyd said, “is that not one single scope bill passed this session that would affect you or your patients. To me, that’s an amazing feat considering how much energy these groups put behind their lobbying efforts.” Nurse practitioners backed at least three bills that would have allowed them to independently diagnose, prescribe drugs, and order tests. None of them passed. At the end of the session, Rep. Garnet Coleman (D-Hous- ton) modified his nurse practitioner bill to simply authorize a study of independent practice. That bill went nowhere. Meanwhile, physical therapists sought direct access to patients without a physician’s referral; optometrists wanted authority to perform certain surgeries and prescribe or admin- ister oral and other medications; chiropractors tried to pro- tect their licensing board against lawsuits from other health licensing agencies when their rules intruded on the practice of other health professionals; and podiatrists sought to push their scope of practice beyond the foot.
TMA leaders say the association was willing to work with
the podiatrists to allow podiatrists with specific training to work on the ankle. “Ultimately, the podiatrists were not inter- ested in coming to an agreement on that bill,” Mr. Finch said.
August 2011 TEXAS MEDICINE 29
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76