The Texas Medical Board (TMB) licenses and regulates physicians and other medical professionals. As part of its duties, the TMB receives and investigates complaints about these medical professionals, including complaints about inappropriate relationships with patients.
The TMB also brings formal disciplinary action against those professionals if there is sufficient evidence to believe they have violated the rules or laws that govern their professions.
Obtaining experienced legal counsel to represent your interests in disciplinary proceedings before the TMB can be a substantial step in reaching a positive outcome in your case.
Therefore, if you are facing disciplinary investigations, complaints, or formal proceedings before the Board, you should consult a medical license defense lawyer for help.
Violations Stemming From a Doctor’s Relationship with a Patient
While doctors certainly can be polite and even friendly with patients, the laws and rules relating to the practice of medicine make it clear that any “unprofessional and dishonorable conduct” is prohibited.
Therefore, if a doctor crosses the line between a professional and personal relationship with a patient, they could face disciplinary proceedings and resulting sanctions.
Under 22 Tex. Admin. Code §190.8(2), “unprofessional and dishonorable conduct” include any actions that are “likely to deceive, defraud, or injure the public.” This section goes on to list some specific examples of “unprofessional and dishonorable conduct.” These examples include:
- §190.8(2)(E) – “engaging in sexual contact with a patient”
- §190.8(2)(F) – “engaging in sexually inappropriate behavior or comments directed toward a patient”
- §190.8(2)(G) – “becoming financially or personally involved with a patient in an inappropriate manner”
- §190.8(2)(K) – “behaving in an abusive or assaultive manner towards a patient or the patient’s family or representatives that interferes with patient care or could be reasonably expected to adversely impact the quality of care rendered to a patient”
Engaging in any of these behaviors, which can develop between a doctor and patient with a personal relationship could result in the Texas Medical Board (TMB) finding that the doctor committed “unprofessional and dishonorable conduct.
Potential Sanctions for Committing Unprofessional and Dishonorable Conduct
The sanctions that doctors can face for engaging in an inappropriate personal relationship with a patient can be severe. Still, a range of potential penalties are available, depending on the seriousness of the violation.
Remedial Plans
In some disciplinary proceedings, the TMB will offer a remedial plan to resolve an investigation into a complaint. A remedial plan permits a doctor to avoid formal disciplinary proceedings by following the plan’s terms.
However, under Tex. Occ. Code §164.0015(c)(1)(C), a remedial plan is not an option to resolve “a matter in which the physician engaged in inappropriate sexual behavior or contact with a patient or became financially or personally involved with a patient in an inappropriate manner.” Therefore, a doctor in this situation should not expect to avoid a formal sanction by participating in a remedial plan.
Disciplinary Sanction Guidelines
22 Tex. Admin. Code §190.14 provides for disciplinary sanction guidelines. According to the state legislature, the purpose of these guidelines is “to protect the public, deter future violations, offer opportunities for rehabilitation if appropriate, punish violators, and deter others from violations.”
The TMB is not limited to the recommended sanctions outlined in its disciplinary sanction guidelines matrix. Each violation contains a “low sanction” and a “high sanction” that may vary according to applicable aggravating and mitigating factors.
Furthermore, the TMB can apply any relevant aggravating or mitigating factors listed in §190.15 to reduce or increase a sanction beyond the guideline recommendation.
Multiple violations also can result in an aggravated or more severe sanction. However, if a panel of the TMB imposes a sanction that falls outside the guidelines, the TMB must vote on the sanction individually at the next regular board meeting.
Furthermore, each violation is a separate offense, even if it arises from the same set of facts or incident and is a separate violation for each day it continues.
For violations not addressed in this section, the TMB must impose a sanction that generally follows the basic scheme of sanctions applying to similar violations. The maximum sanction is a license revocation, and an administrative penalty is $5,000 per violation.
Sanction Ranges for Boundary Violations with Patients
The disciplinary sanction guidelines matrix provides a specific range of penalties for the instances of unprofessional and dishonorable conduct listed above, as follows.
Engaging in sexual contact with a patient or engaging in sexually inappropriate behavior or comments directed towards a patient
The low sanctions for this violation, which primarily involve verbal remarks and behavior, but no touching, can include an Agreed Order, a public reprimand, completions of the Vanderbilt or PACE boundaries course, passing the jurisprudence exam, completing CME in ethics, and having a chaperone present when seeing patients.
On the other hand, the high sanctions, while apply when physical contact is involved, can include an Agreed Order, completion of an independent medical examination (IME), a prohibition on treating patients of the affected gender, and license suspension or revocation.
Becoming financially or personally involved with a patient in an inappropriate manner
Recommended low sanctions for a single violation include an Agreed Order, passing the jurisprudence exam, completing CME in ethics, restitution if appropriate, and an administrative penalty.
High sanctions for multiple violations include an Agreed Order, a public reprimand, completion of the Vanderbilt or PACE boundaries course, passing the jurisprudence exam, completing CME in ethic, an administrative penalty, and license suspension or revocation.
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Aggravating and Mitigating Factors
22 Tex. Admin. Code §190.15 outlines the aggravating and mitigating factors that the TMB may rely on determining the appropriate sanction for a violation.
Aggravating factors, which may warrant more severe sanctions than those prescribed by the disciplinary guidelines, include the following:
- harm to one or more patients;
- the severity of patient harm;
- one or more violations that involve more than one patient;
- economic harm to any individual or entity and the severity of such harm;
- increased potential for harm to the public;
- attempted concealment of the act constituting a violation;
- intentional, premeditated, knowing, or grossly negligent act constituting a violation;
- prior similar violations;
- previous disciplinary action by the board, any government agency, peer review organization, or health care entity;
- violation of a board order; and
- other relevant circumstances increasing the seriousness of the misconduct.
Mitigating factors, which may warrant less severe sanctions than those prescribed by the disciplinary guidelines, include the following:
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We Can Advocate for Your Interests in TMB Disciplinary Proceedings
The medical license defense lawyers of Bertolino LLP can help guide you through the disciplinary complaint process. Regardless of the allegations you face, we are here to represent your interests and work to minimize the negative effects of a complaint on your medical professional license and career.
We can help resolve the case against you and maintain your licensure or certification. Call us today at (512) 980-3751 to reach the offices of Bertolino LLP or contact us online.
Call or text (512) 476-5757 or complete a Case Evaluation form
