Streamlining Speech-Language Pathology Licensing and Enforcement with TDLR

Transcript

Speaker 1: 0:01

This podcast is for educational purposes only, does not constitute legal advice and does not create an attorney-client relationship. If you need legal assistance about a legal problem, contact an attorney. Welcome back to another episode of Know your Regulator, the podcast that inspires you to engage. I’m your host, simone Murphy, and co-hosting with me today is Senior Associate LaJuana Acklin. Hello, lj, hello, how are?

Speaker 2: 0:29

you Good, I’m glad to be here.

Speaker 1: 0:30

Good, we’re glad to have you. We’ve got another great episode lined up for our viewers. We’re going to be talking about licensing and enforcement for speech-language pathologists, and joining us for this exciting discussion is Ron Foster, director of Enforcement, and Katie Bryce, deputy Director of Licensing. Thank you, guys, both so much for being here. I would like to start off at the beginning of the process for a licensee. Katie, can you tell us about? You know what you’re seeing in the licensing division. How many applications are y’all getting in? You know a six to 12 month timeframe.

Speaker 3: 1:09

Well, so I want to start with a little background, because at TDLR we regulate six different license types under the speech language pathology and audiology program and those include the speech language pathologist, the SLP intern, the SLP assistant, the audiologist, audiology intern and audiology assistant licenses. And so for this segment I’m just going to discuss the SLP-related licenses. So for fiscal year 2024, we received a total of 13,185 applications. That includes the initial applications and renewals for those three license types. The SLP population is our largest population in this program, so for them we had a total of about 9,000, let’s say 9,444 applications. The SLP interns are a smaller group. They were at 1,013 applications and the SLP assistants were at 2,728 applications.

Speaker 1: 2:15

Wow, so a good portion of those, like you said, were speech language pathologists. And how many licenses were granted to SLPs and their interns and assistants at that time?

Speaker 3: 2:28

So during that same time period we issued 13,136 licenses. So it’s really just a difference of I want to say about 50 between the number we’ve received, of applications received, and the number of licenses issued.

Speaker 1: 2:45

Well, that’s good. That sounds like generally your applicants don’t really have a hard time obtaining a license. Can you tell us maybe some of a little bit of some of those nuances that applicants could experience that may prolong this process for them?

Speaker 3: 3:02

At TDLR.

Speaker 3: 3:05

Even within this program, there are varying levels of complexity with the applications.

Speaker 3: 3:10

So, for example, if someone holds their certificate of clinical competence, which is issued by the American Speech Language Hearing Association, we call ASHA if they hold their C’s, it’s a very straightforward application process because we waive things we waive like the passing test score and proof of their internship and things like that, so that application is really straightforward and easy. For other licenses, like the SLP assistant license, it gets a lot more complicated because there are a lot of additional supporting documents that they have to also submit, like supervision forms that are filled out by them and their supervisor. All of the applications include having to submit a completion of certificate, I mean, excuse me, a certificate of completion of the jurisprudence exam, which is a test covering the laws and the rules for the program. They also all require a transcript, which they can send in an official transcript or it can come electronically from the university, and they all also have to pass fingerprint background check. And so you know there are just different levels of complexity within this program depending on what they’re applying for.

Speaker 1: 4:30

You know, I guess it would be fair to say my next question was going to be how long does this process take? But it sounds like it’s different, for you know, each each license, that maybe there are some of the same things that you need to submit, but, depending on the license that you’re trying to obtain, one process could take a little bit longer than the other.

Speaker 3: 4:49

Yeah, generally, if we receive a complete application meaning it has all of the supporting documents, we have the transcript and they’ve done the fingerprints it is generally processed within two weeks of us getting it. If it is a peak graduation time from May to maybe end of June and then again at the end of August when people are finishing up summer school classes those may take a little bit longer because that’s just a huge peak, may take a little bit longer because that’s just a huge peak time for this program. Yeah, we will pull people in from other teams to try to help process those applications during those peak times so that it doesn’t get too backlogged. But generally within two weeks. And if it’s a renewal and they apply online for the renewal, those should renew within 48 hours. Apply online for the renewal those should renew within 48 hours. There are a few instances that might delay that, but generally, you know it’s a pretty quick turnaround.

Speaker 1: 5:51

Can you walk us through just a typical application for a speech-language pathologist, sure.

Speaker 3: 6:01

Generally, we try to encourage everyone to apply online. Applying through a paper application just delays everything because of mail routing and the clearing of checks and money orders, things like that. So we encourage everyone to go online. They’ll log on, create an account on our program I think it’s called Versa Online and they will be able to provide their contact information, answer some criminal history questions. There are some disciplinary action questions basically wanting to know have you ever held a license in another state or held a different type of license where there was a disciplinary action taken? So we have those types of questions and then they attach all of the supporting documents that we need and can upload those to the online application and then they’ll submit it. And once they submit it, we will, you know, process it and then we’ll send them an email with their fingerprint instructions, and so it’s really important that they look for their email with those instructions to go get their fingerprints done and then, once that’s done and those are cleared, then we are able to issue the license.

Speaker 1: 7:14

Nice, awesome. Some programs have like a gosh. What is it called, like sort of an eligibility or criminal? I forgot the name of it. Is this the criminal history? Eligibility Criminal history evaluation. Yes, criminal history evaluation Is that something that you know prospective SLPs can use? Is there something like that for them to use as well?

Speaker 3: 7:41

Absolutely. That’s available on our webpage under other forms. There’s a criminal history evaluation form that you can fill out and submit if you have anything in your past that you want to have reviewed before you apply.

Speaker 1: 7:57

I know that that can when we’re talking about preparing and submitting all of your documentation and just making sure that you fully understand the application process and that you’re providing all of that documentation, like you said, to complete your application, because that I can imagine would if you guys are having to go back and forth and requesting additional documents that could prolong you being able to be granted your license.

Speaker 3: 8:26

Right, we always tell people to double-check their forms, make sure everything is signed, because we get a lot of forms that are filled out but they’re missing a signature or some section is left blank or the whole form is missing, and so, yeah, just double-check and make sure you have everything complete, Okay.

Speaker 1: 8:48

Absolutely, and is that a big issue that you’re seeing in the application department?

Speaker 3: 8:54

It is in this program just because of the number of additional forms that are necessary with the application, because the assistant and the intern license types both require supervision plans In addition to, like, verification of training hours. So there are a lot of additional forms, and so that is one of the biggest issues. And so another thing is just people not opening their emails or mail that we send, because in this program you know, if we review the application and they’re missing something, we will send them an email we call it a request for information which outlines what they’re missing. But if they don’t ever open it, then they don’t know that they are still pending. You know some documents. That’s another issue for people who are renewing their license, because in this program we currently have a continuing education audit system and if they’re flagged for audit they are sent a notification. But if they don’t get the notification or they don’t open it, then they don’t know that they need to complete that process upon renewing their license.

Speaker 1: 10:10

So well, that’s really really good, Great takeaway for our viewers Check your emails, their license so Well, that’s really really good. A great takeaway for our viewers Check your emails.

Speaker 3: 10:16

Yes, yes, and update it when you move. Yes.

Speaker 1: 10:19

Yes.

Speaker 4: 10:20

Yeah.

Speaker 1: 10:20

Absolutely To your point. Make sure that you have your most current contact information up to date with your governing agency.

Speaker 3: 10:28

Yes, we have a lot of students who apply as they’re about to graduate, and they will provide a email address associated with your university and after a certain amount of time, they no longer have access to that and they forget to update it, and so they quit receiving information that they need.

Speaker 1: 10:45

That’s a big one. Yeah, the issues that applicants are facing in your division. Are these usually disclosed by the applicant themselves? Are they usually, you know, initiated by TDLR investigation?

Speaker 3: 11:02

I don’t have the statistics on the number who self-disclose I would let Ron answer that but I think generally you know if we have an application that is flagged for missing the fingerprints or they check that yes, they’ve had a disciplinary action taken in another state or against another license, we would refer those to our enforcement division.

Speaker 1: 11:25

And so it’s too distinct. You guys just handle the applications and granting the license. Anything that has to do with disciplinary action or investigation then goes to Ron’s division, correct? Okay, gotcha. Well, before we switch over to enforcement, do you have any advice for applicants who are preparing to submit their applications, Katie?

Speaker 3: 11:48

My advice is really just to double check everything. Try to attach everything that they can to the application when they submit it, instead of sending forms in one at a time. You know, after they submit the application, that makes it much harder for us to match it with the application. So try to have everything ready when they’re applying, upload it, make sure it’s all correct and then check their emails once they submit it Nice.

Speaker 1: 12:17

I think that’s some great takeaways. Definitely keep your ducks in a row and look out for correspondence.

Speaker 2: 12:23

Yeah, absolutely. I think Katie’s her comments regarding self-disclosure is an excellent segue to speak with Ron about enforcement. So, ron, I just want to start there. How many complaints do you receive for speech and language pathologists in the six to 12-month period, and how many of those complaints are connected to self-disclosure for applicants attempting to obtain their license.

Speaker 4: 12:57

Thank you, luana. Let me start off by giving a plug again for our website. I want to make sure people know to go to tdlrtexasgov to look up all the licensing information. There’s another tab for complaints and enforcement. So any of these statistics that I’m throwing around you can go and verify it. We put that out there on our website for all of our programs. So the self-disclosure piece of it.

Speaker 4: 13:25

I actually don’t have that statistic readily available, luana, but what I can tell you is that in the last year we received about 1,384 complaints. But what I want you to know is that that seems like a big number but actually only 54 consumer complaints were opened and only eight department initiated complaints based upon those audits that Katie mentioned are open. So the other 1,322 are the reviews of applications that we do for criminal history. This is a very highly trained and very educated group of applicants. That number represents a very small percentage. I believe it’s probably less than 5% of the number that Katie mentioned that applied for a license. So I just want to throw out there that out of those 1,322 cases that we reviewed that had a criminal history, we only opened up nine cases against applicants in this program. So this is a very highly trained, highly educated and non-criminal group of people.

Speaker 2: 14:42

Oh, that’s excellent. That’s what we like to hear from our speech language pathologists. So my next question is with the cases that are open, how many cases are resolved? How long does it take to resolve those cases?

Speaker 4: 14:57

Yeah, you know, on general it takes about 171 days to resolve cases. My statistics show that we close about 63 percent of the cases within six months, which is our kind of performance measure that we have. As you can imagine, some of these might involve medical-related questions or issues and it takes a little bit longer when you start getting medical records involved and you need to review that type of standard of care type of thing. So some of these can be closed really quickly and other ones they just take a little bit longer.

Speaker 2: 15:35

All right, and you already discussed with us in the statistics what categories produce the most complaints. Just to tag along with that, what are the biggest issues licensees face when it comes down to the complaints that are open due to the criminal background, criminal history?

Speaker 4: 15:55

Thank you, luana. Let me go into some of those complaints because the criminal history part of it is really so small. I don’t think we really need to worry too much about that. The part that we see the biggest complaints on from consumers, which is the vast majority of the cases. It usually has to do with billing for services not provided People thinking they paid for something and they didn’t get what they thought they paid for.

Speaker 4: 16:21

The other thing we might get is records that are not matching. That might come from our audits that we do or when we request documents in an investigation where the records are not matching up with what they tell us. And you know there is a more broad category of just ethical type of violations that we see where we might be making some kind of request from them and they don’t disclose protocols or testing methods that are used or they don’t provide us the supervisory documentation that they’re supposed to for their subordinates as part of the process. Sometimes patients do get injured. You know their standard of care issues that come up. So those are the type of violations that we tend to see on the complaint side.

Speaker 2: 17:09

Wow, that’s very interesting, especially with the billing for services not paid for. So in those types of cases, how, if you can put a percentage on it, how many of those cases are actually like billing cases versus ethical complaints?

Speaker 4: 17:29

Let me see, I’m going to let me look at my statistics, because that’s a pretty specific number. I’m thinking maybe about a third of the cases. About a third of the cases that I see that come in are billing related cases from consumers. That’s a pretty high percentage and overall a pretty low number of complaints, though, for the whole program.

Speaker 2: 17:55

Okay, and since those cases are coming in from consumers, is there anything that the licensing can do to expedite the resolution process?

Speaker 4: 18:06

Yes, you know the most common issue that we have is that people ignore our attempts to contact them. When we’re reaching, we usually will try to call you. We might send emails to your email address of record that we have and request information. So the biggest challenge we have is to get a response. You know there can be complex issues at play with investigations. We are talking about medical stuff, so you might have HIPAA laws that come into play other privacy laws in Texas that might apply. So sometimes there has to be conversations about what documents they can provide to us. As the state regulator, we’re entitled to all of those documents, even though they might not understand that. So I think the biggest challenge is for us just to be able to get them to give us the documents we need so that we can verify whether or not that allegation is true or not.

Speaker 2: 19:05

And that leads me to my next question. It sounds like not producing documents may slow down the resolution of the case. So what are some other factors that can either make a case move faster or slower than average?

Speaker 4: 19:21

Absolutely, you know. So, as I mentioned, these cases might involve a standard of care and in in all of our programs, we do have expert witnesses that we use on our cases. Some of them are in-house experts and some of them are third-party experts, and so on occasion Luana, when we have a complicated case involving standard of care, we may need to get an expert opinion. It takes time to get that opinion, get that report. We may need then to have some kind of negotiated settlement conversation with the person regarding the violations and the evidence we have and the opinions that we have, and that can slow down the process, and I will tell you that what really slows down the process is if it ends up going to litigation. Right, if we go to a contested case, then you’re talking about something that, instead of being resolved in a matter of weeks, might take months. Now.

Speaker 2: 20:25

And you brought out some excellent information that you know I can use in my practice with defending my clients. So with that, with the standard of care case, how often does law enforcement get involved and is law enforcement with those cases? Could they be a factor that may make a case?

Speaker 4: 20:46

resolve slower than average. So I’m going to answer the second part of the question first. Yes, if law enforcement does get involved it will slow down cases. We’ve had cases where there was perhaps injury to a patient, injury to a client which was part of the allegation, and you know, if that is serious enough it could be a criminal act. But that is very rare. That’s not happening a lot in this type of program, right? What you have, I think, mostly is more of the paperwork billing error type of violations with people honest mistake type of things like that, I think, where they need to improve their business practices a little bit. You know not intentional doing something you know wrong type of situation that would involve law enforcement. This program has very little involvement of law enforcement. I would say that we have other programs that have a lot more law enforcement involvement in those cases have a lot more law enforcement involvement in those cases.

Speaker 2: 21:53

Well, how do speech-language pathologists proactively avoid complaints? What can a speech-language pathologist do so the Texas Department of Licensing and Regulation is not sending a notice to them regarding allegations of any misconduct.

Speaker 4: 22:10

Well, I’m going to tell you, I’m going to give a plug to our licensing division and our compliance division. They are there to help people and you don’t have to wait for enforcement to get involved. Right, you can reach out to TDLR that website, tdlrtexasgov. There’s a wealth of information there and you can call us. You can call our customer service line. You can speak to someone in our compliance division. They’ve got people there on staff that are very knowledgeable about this program. They can answer questions about all sorts of things and help you to stay out of the hot water.

Speaker 2: 22:49

Absolutely, absolutely, as a lifelong water run. I really appreciate you coming and speaking with us today, so I have one more question for you, and that is is there anything unique about your division compared with other divisions within TDLR or any other departments within the agency?

Speaker 4: 23:10

I’m going to give a plug. We do always need third party experts and we do pay for our experts. Just so everybody knows that, we do have contracts that we sign, and if you want to go to the TDLRTexasgov website and you want to be an expert witness for the department on cases, we will do a conflict of interest application and all kinds of stuff. But we really need the help of our licensees and our experts out there. So I would urge folks that are interested in this video and this content to go to our website and see if maybe they qualify as an expert on one of our and we can use them on our cases. It doesn’t hurt to have too many experts.

Speaker 2: 23:58

Oh, absolutely Well, Simone. I think we’ve had a really great conversation with both Katie and Ron about speech language pathologists and what it takes to obtain a license and then what it takes to maintain the license, and I’m really appreciative of this.

Speaker 1: 24:18

Yeah, no, definitely, and thanks for you know, kind of highlighting some of those resources that you guys provide as well, because that can be. So I have had multiple calls. I got a call this week of someone looking for interpretation of TDLR guidelines, and where did I direct them? The TDLR website, you know. So there is information that’s out there that’s helpful to licensees. Again, thank you, ron and Katie, for joining us this afternoon. We really appreciate you guys taking the time out of your day to be transparent and informative and educate our license holders, because that’s what this is really all about is just making sure that these license holders are equipped to go out into the world and practice while maintaining compliance. Thank you, simone.

Speaker 4: 25:07

I really appreciate the opportunity to share our perspective with you. Know your Regulator the podcast that inspires you to engage.