Physician Assistant License Defense Attorneys
As a physician assistant (PA), you serve a vital role in providing medical care across Texas. You have likely made major investments and dedicated much of your life to develop and refine your skills.
Physician assistants continue to take pressure off an overstressed healthcare system, but will undoubtedly face stricter regulation and more attentive governmental oversight as PAs shoulder more of the health care workload. Getting and keeping an unrestricted license as a PA is essential to your practice and continuing to be able to help the most people as efficiently as possible.
Allegations of misconduct or a single acknowledged mistake can derail your career and keep you from providing the best possible care. Defending your hard-earned license can seem intimidating, but much of the burden can be carried by a committed and experienced physician assistant license defense attorney. Contact McDonald, Mackay, Porter & Weitz, LLP to find out how we can help you.
About the Texas Physician Assistant Board
Overseeing the licensure and regulation of Texas physician assistants is the primary responsibility of the Texas Physician Assistant Board (TPAB or the PA Board). Due to the close relationship between doctors and physician assistants, the PA Board is co-located with the Texas Medical Board in Austin and shares TMB staff and resources. TPAB procedures, as well as the governing law for handling PA complaints and regulating the profession, are patterned after those of the Texas Medical Board.
The legislative and societal compromises to address tort reform in Texas have led to tougher regulation of healthcare professions, including PAs. With the TMB taking an increasingly hard-line approach to physician regulation, PAs can expect to be interacting with the PA Board through shared agency staff with a similar mindset. PAs need to be prepared for the possibility of multiple complaints over the course of a career, along with protracted investigations, and challenging enforcement proceedings.
Texas Physician Assistant Licensure Process
If you are planning on getting your Texas Physician Assistant license, you may want to start now, especially if you are facing any time constraints like a pending job. The licensing process can be slow and sometimes frustrating. It often takes many months to obtain a PA license and it may even require a trip to Austin to appear before a licensure committee of the Texas Physician Assistant Board. If you are poorly organized or have something unusual in your record (i.e., criminal record, mental health issues, etc.), you can expect the process to drag out considerably longer than just a few months, and it could take well over a year.
The application form itself is relatively straightforward and can be completed online in approximately an hour. Once the application is submitted, it will be evaluated by agency staff and assigned to an analyst or investigator. This process can take a significant amount of time and additional information is often requested. Required disclosures of previous malpractice, a prior criminal record, or issues with substance abuse, will lead to delays and an extended review. However, it is essential to remain honest during the process. Answering “no” when you should answer “yes,” on the application can lead to delays, embarrassing apologies, committee appearances, costly fines and restrictions, and even the denial of your application. If you are not sure about an answer, you need to find out what the correct answer is before submitting an incorrect application. The Board will typically refuse a license to a person who they think was untruthful or omitted important information.
If you are thinking about applying, there are a few steps you can take to keep delays at a minimum:
- Be organized. Get your material together before you apply.
- Apply early. If you think you might want to work in Texas, start the process as soon as possible.
- Read the directions carefully. A minor mistake will derail your application for months.
- Follow-up. The application requires documents be sent by third parties. Follow-up on people and entities to ensure that documents have been submitted. It is also critical to follow-up with the Board on a regular basis.
- Retain Documents. Keep a copy of your application, material submitted to the Board and all the correspondence between you and the Board.
- If you have a problem, get help. If you have significant issues, you need to get professional assistance from someone with experience before the Texas State Board of PA Examiners. Some of the rules, the process, and just getting prepared require the time and attention of someone who has expertise with the system.
Investigations, Hearings & the Disciplinary Process
Individuals working in the medical field know all too well the pressures and challenges that a PA faces on every shift. People depend on Physician Assistants for quality treatment and often life-saving care. Consequently, the state of Texas takes any accusation of negligence, misconduct, or unethical behavior very seriously. Complaints can be made anonymously or come from competitors, other health care providers, disgruntled employees, insurance providers, law enforcement agencies, other state agencies, and patients or their family members. Possible reasons for an investigation and disciplinary action can include:
- Negligence and medical malpractice
- Inappropriate patient relationships / contact
- Violating patient confidentiality
- Practicing while under the influence of alcohol or drugs
- Being convicted of a criminal offense
- Improper billing practices
- Performing unnecessary procedures
It is important to note that complainant’s name is kept confidential from the subject PA unless the complainant waives this confidentiality or chooses to show up at certain proceedings. If the Texas PA Board receives a credible complaint from a complainant who is anonymous or who wishes to remain anonymous, the PA Board will pursue the complaint so long as there is enough information initially provided.
The disciplinary process typically starts with a basic letter to the PA, generally stating that an allegation has been made and there is a possible violation of the Physician Assistant Licensing Act or agency rule. This letter is an “inquiry letter” or “preliminary investigation letter.” This letter also asks for a response by a specified date. If no response is received by the deadline, the opening of an investigation is almost a certainty. Responding on time and in a meaningful way is important to show respect for the process and to hopefully set out your side of the case. Unfortunately, the inquiry letter is almost always rather vague, which makes drafting a response very difficult. An experienced physician assistant license defense attorney can sometimes navigate the agency’s system to get a more detailed explanation, but many times information will be limited. Ultimately, the response must be carefully drafted to show good faith cooperation, clarify the case to the extent possible, and at the same time avoid creating any additional problems.
After the Physician Assistant has responded to the inquiry letter, the case may be dismissed based on lack of evidence to show a violation. If concerns remain after the response to the inquiry letter, an investigation will be opened. The Physician Assistant will receive a notice of investigation with the name and contact information of the assigned field investigator. This letter asks for a narrative explanation to general allegations, even if one was provided in response to the initial inquiry. It also asks for completion of a medical practice questionnaire (MPQ) and for any pertinent records that the Physician Assistant chooses to provide along with corresponding records affidavits. Deadlines vary, but a licensee can expect to have two to three weeks to provide this information. While the investigator can sometimes provide more detail and grant an extension, some licensees tend to say too much when talking to the investigator. Legal counsel from a medical license defense lawyer at this stage is recommended. The case materials eventually undergo physician, PA, or other expert reviews for possible dismissal or further processing. If the matter is dismissed, the Physician Assistant will be notified in writing. If not dismissed, the case is typically set for either an Informal Settlement/Show Compliance Conference (ISC) or a Temporary Suspension/Temporary Restriction Hearing.
Informal Settlement / Show Compliance Conference
If there appears to be a violation, the PA will be notified in writing that an Informal Settlement/Show Compliance Conference (ISC) will be held. Notice can at times be short, but even with mail delays the physician usually has over a month to prepare. The ISC requires the licensee, with or without counsel, to meet with TMB representatives in Austin. These representatives have an advising attorney to help guide them, and an agency staff attorney to present the allegations and related evidence. After an exchange of information, questions, answers, and discussion, the ISC panel members will deliberate and issue a recommendation. The recommendation can be to defer a decision to get more information, refer the case to a temporary suspension/temporary restriction hearing, refer it to the State Office of Administrative Hearing (SOAH) for a contested hearing, or resolve the case through a non-disciplinary remedial plan or a disciplinary action by an Agreed Order. Most cases are resolved either by an agreed order or dismissal, but an experienced physician assistant license defense lawyer can usually negotiate the best possible language in regard to findings of fact, conclusions of law and the range of possible sanctions.
Temporary Suspension/Temporary Restriction Hearings
If a Physician Assistant is thought to pose a continuing threat to the health and safety of patients, they can be subject to an expedited process that may result in a temporary license suspension or temporary restrictions on their practice. The process varies and the action can be imposed without notice or hearing if the case is serious enough. Thereafter, the PA and their license defense attorney can litigate the matter through the agency and the State Office of Administrative Hearings (SOAH). Unfortunately, the PA usually remains restricted or suspended during this process. In some instances, the PA is given advance notice and permitted to attend and respond at a temporary suspension/restriction hearing. The hearing panel is usually comprised of three board members including at least one PA and one public member. Rules of evidence are less stringent than in a formal SOAH hearing. While it is a formal hearing following the expected format of most trials or hearings, the panel has some latitude in how to proceed. If not suspended or restricted, the case goes through the regular investigation channels and possible scenarios for resolution. If suspended or restricted, an agreement can sometimes be worked out to resolve the issues, and if not, the Physician Assistant must litigate at SOAH or seek appropriate relief from the Travis County District Court. Oftentimes, the only option is a contested SOAH hearing. In such a scenario, the Physician Assistant remains suspended or restricted until a final decision is reached.
If the case is not resolved at an earlier stage of the process, it will be transferred to the State Office of Administrative Hearings (SOAH). Discovery is initiated much like in a malpractice suit or other civil litigation to include depositions, interrogatories, requests for production of documents, requests for admissions, and requests for disclosures. Although the disciplinary actions include the possibility of being fined, and assessed hearing costs, the case is more about whether the physician violated the standard of care, their ability to continue to practice, and, if so, under what terms and conditions. An Administrative Law Judge (ALJ) is assigned and the proceeding is like a bench trial without a jury. Witnesses are called to testify, records are put into evidence, and legal arguments are made. After the hearing, the ALJ will issue a Proposal for Decision (PFD) analyzing the evidence and recommending a decision to the TMB. The parties may exchange additional pleadings advocating their respective positions after receiving the PFD. The Board will then hold a hearing and counsel for both sides will be allowed short oral argument. The Board either votes to adopt the PFD, adopt a proposal from one of the parties, adopt something different of their own creation, dismiss the case, or appeal some aspect of the PFD to district court. If a disciplinary order is issued, the Physician Assistant has a very short time to file a motion for rehearing to exhaust administrative remedies and preserve the right to appeal to district court. If the motion for rehearing is granted, the case is reconsidered by the Board at the PFD presentation level and another appealable decision is rendered. If a motion for rehearing is denied, the licensee must act quickly to timely file an appeal in district court. During the appeal, the licensee usually remains subject to the imposed disciplinary action until the appeal is final.
It is possible to resolve a SOAH case through SOAH mediation rather than going through the contested process. Mediation usually occurs very early in the SOAH process.
Compliance & Reporting of Disciplinary Actions
Once under a disciplinary order of any kind from the PA Board, the licensee must cooperate with the agency’s Compliance Department. Compliance representatives often check up on licensees much like probation officers to make sure they are living up to the terms of the agency order (i.e., drug screens, record keeping, chaperones, prescribing limitations, etc.). Probation appearances are also sometimes called for and the licensee can periodically ask for modifications and early termination of the order. These proceedings operate very much like an ISC. Apparent violations of an order can result in another ISC or a temporary suspension/temporary restriction hearing and a subsequent SOAH hearing. Sometimes, the order itself provides for additional disciplinary action if it is violated.
Most disciplinary actions, with very limited exceptions, are reported to the public through official websites and Texas Medical Board newsletter. Reports are also sent out to other PA licensing boards, and the media is kept informed through press releases.
Contact Our Physician Assistant License Defense Attorneys
There are rigorous standards that Texas Physician Assistants must follow. While meant to protect the health and safety of patients, they can pose stumbling blocks for practitioners. While regulations are unquestionably necessary, innocent PAs can sometimes get caught up in a difficult to understand and rigid administrative system that does not always have their best interests in mind.
Complaints to the Texas Physician Assistant Board and Medical Board are on the rise and each complaint is carefully reviewed. Even if a baseless claim is made against your license, it should be treated seriously. The Board investigating you and ultimately making decisions about your ability to provide care and earn a living will have experts and attorneys reviewing the case. A licensee is best advised to have a capable physician assistant defense attorney as well.
When you reach out to a highly skilled professional license defense attorney from McDonald, Mackay, Porter & Weitz, LLP, you will find an experienced and reliable professional is on your side. Contact us for a consultation with one of our physician assistant license defense attorneys.