Report card: How Texas protects patients from sexually abusive doctors

Transparency: 90
Is complete and accurate information on physician discipline provided to help patients protect themselves? More...
The best states make it easy for the public to find comprehensive information on physicians, including whether they have been disciplined for sexual abuse or other violations. To assess transparency, the AJC used five measures. Top grades went to states where medical regulators posted disciplinary orders on websites going back at least 15 years; fully detailed the acts that led to sanctions; avoided private orders, reprimands or letters; provided easy web access to clearly labeled doctor information including disciplinary documents; and listed any hospital sanctions, criminal convictions and out-of-state disciplinary actions for each physician.
- Are all orders posted?: 20 of 20
  
  Yes
- Do orders or other information online detail violations that led to sanctions?: 20 of 20
  
  Yes
- Does doctor profile information include hospital sanctions, criminal charges and orders from other states?: 10 of 20
  
  Hospital sanctions are not listed.
- Is it easy to find all doctor information on the website?: 20 of 20
  
  One of the nation's best sites.
- Can boards issue private orders or letters?: 20 of 20
  
  All board orders are public

Duty-to-report laws: 52
Are colleagues and institutions that are aware of potential physician misconduct required to notify regulators? More...
To break the code of silence that can shield abusive doctors, the best states have laws requiring all physicians and health care institutions to notify regulators of potential violations. To assess these laws, the AJC used five measures. Top grades went to states where a broad range of health care facilities, not only hospitals, are required to notify regulators of alleged physician misconduct; where there is a deadline of no more than 30 days for making those reports; where penalties for failing to report are clear and significant; where doctors are required to report fellow practitioners; and where courts or law enforcement agencies must notify regulators when a doctor is criminally convicted.
- Which health care facilities must report doctors to medical regulators?: 20 of 20
  
  Hospitals and other health care entities are required to report the results and circumstances of a medical peer review that adversely affects the clinical privileges of a physician longer than 30 days. They also are supposed to report when a doctor surrenders clinical privileges while under investigation or in return for not conducting an investigation.
- Does the law set a deadline for them to notify regulators?: 4 of 20
  
  No deadline in state law
- Does the law establish penalties for failure to comply?: 4 of 20
  
  None specified
- Are physicians required to report peers?: 20 of 20
  
  Physicians must report acts of a fellow doctor who they believe poses a continuing threat to the public welfare through the practice of medicine.
- Are courts or prosecutors required to notify regulators of physicians’ criminal convictions?: 4 of 20
  
  State law doesn't require courts to notify the board of doctors' criminal convictions.

Board composition: 70
Are consumer members included to balance physicians’ tendency to identify with their colleagues? More...
A blueprint developed by The Federation of State Medical Boards recognized the importance of having independent public members on physician-dominated medical regulatory agencies. To assess the composition of disciplinary agencies, the AJC used three measures, with the most weight given to consumer representation. Top grades went to states where public members make up at least 40 percent of the board; where those members represent consumers and where neither they nor their family members have professional or financial ties to health care; and where women hold at least 40 percent of the board seats.
- Is the public well represented?: 40 of 50
  
  The 19-member board has seven public members and 12 physicians.
- Are public members independent and do they represent consumers?: 20 of 25
  
  Public members and their spouses cannot have direct connections with the practice or business of medicine.
- Are women well represented on the board?: 10 of 25
  
  Three women served on the 19-member board in September.

Criminal acts: 96
Are medical regulators and law enforcement made aware of doctors’ criminal conduct? More...
The medical profession has long recognized the power imbalance between doctors and patients. But only in recent years have states enacted three key laws to try to protect vulnerable patients from dangerous doctors. The AJC considered two of these laws the most important. Top grades went to states where physicians must undergo criminal background checks, with fingerprints, at initial license application and periodically; and where doctor-patient sexual contact has been made a criminal offense in recognition that patients cannot give meaningful consent. In addition, the AJC also rated states on whether medical boards that learn of allegations of criminal conduct must alert law enforcement.
- Are physicians required to undergo criminal background checks?: 44 of 40
  
  Required at initial application, with fingerprints, and the board periodically monitors criminal records.
- Is board required by law to notify law enforcement?: 20 of 20
  
  State law requires reporting
- Has the state criminalized sexual misconduct involving doctors and patients?: 32 of 40
  
  A mental health services provider or a health services provider who causes the patient or former patient to submit or participate by exploiting the other persons emotional dependency is guilty of sexual assault. Consent is not a defense.

Discipline laws: 90
Do state laws strengthen oversight and discipline of problem physicians? More...
Abusive physicians can be protected by laws that limit regulators’ ability to investigate cases and don’t require permanent revocation of doctor licenses for egregious offenses. To assess the legal environment for doctor discipline, the AJC examined four key laws. Top grades went to states that require permanent revocation of doctor licenses for some violations; where physicians who have been convicted of felonies or who have lost their licenses in other states cannot be licensed; where medical regulators are entitled to records and other proceedings of hospital peer review committees that examine doctor misconduct; and where there is a reasonable standard of proof required for disciplinary action against physicians, especially in sexual misconduct cases where there may be no independent witnesses.
- Does state law require revocation for some violations? Can revocation be permanent?: 20 of 25
  
  The board must revoke doctors' license for final felony convictions. It also must revoke the licenses of doctors who are on deferred adjudication for offenses related to sexual abuse or assault of a child. But revocation is not permanent unless a doctor agrees or when a doctor permanently surrenders his or her license in lieu of further investigation. State law allows physicians who are otherwise revoked to reapply after one year.
- Do medical regulators have the legal right to hospital peer review records and proceedings?: 20 of 25
  
  The board may obtain by subpoena all peer review documents or information.
- Does state law mandate that regulators deny licenses to physician applicants who have committed certain violations?: 25 of 25
  
  An applicant is not eligible for a license if he or she is currently restricted, cancelled, suspended for cause or revoked by another jurisdiction or if an investigation or a proceeding is pending; or if a prosecution is pending for any offense that under Texas laws would be either a felony or a misdemeanor involving moral turpitude.
- What is the standard of proof for regulators to impose disciplinary sanctions?: 25 of 25
  
  The standard of proof required to discipline a doctor is preponderance of evidence. It basically means "more likely than not." That's also the typical standard for most lawsuits.

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