http://www.statesman.

com/blogs/content/shared-gen/blogs/austin/health/entries/2009/04/
22/how_tough_is_the_texas_medical.html

How tough is the Texas Medical Board?

By Mary Ann Roser | Wednesday, April 22, 2009, 11:37 AM

With some doctors complaining the Texas Medical Board is too harsh and several lawmakers
saying it’s time to rein in the board, you might think it’s one of the tougher boards in the
country. So do you think Texas ranks among the top 10 toughest board in the U.S.? Guess
again. Top half? Not even.

Based on rankings released this week by Public Citizen, a nonprofit that ranks boards every
year based on the rate of serious disciplinary actions taken, Texas falls in the bottom half of
the states when it comes to meting out serious discipline. Texas was 33rd among the 50
states and the District of Columbia based on how often it has revoked a medical license, had
a doctor surrender a license, suspended a licensed or restricted a license, according to the
rankings.

Minnesota had the lowest number of serious disciplinary actions against doctors, while
Alaska had the most. But because Alaska has a small population, it didn’t take many actions
to be No. 1, just 11 in 2008, the report says. Looking at the rest of the top five is a little
more useful: Kentucky, Ohio, Arizona and Oklahoma.

Overall, however, medical boards are less aggressive than they were in 2004, when the
number of serious disciplinary actions peaked, the report says.

“The overall national downward trend of serious disciplinary actions against physicians is
troubling because it indicates many states are not living up to their obligations to protect
patients from bad doctors,” Dr. Sidney Wolfe, Public Citizen’s acting president and director
of its Health Research Group, said in a statement. “State lawmakers must give serious
attention to finding out why their states are failing to discipline doctors and then they need
to take action — either legislatively or by applying pressure on medical boards. Otherwise,
they will continue to allow doctors to endanger the lives and health of their residents
because of inadequate discipline.”

It will be interesting to see what the Texas Legislature does with pending legislation (House
Bill 3816) to curtail the powers of the medical board.

Comments

Click here to report comment abuse.

By TexanOkie
April 22, 2009 12:45 PM | Link to this
Couldn’t it be that doctors are behaving better, not that state medical boards are being
more lax? After all, fewer bad doctors or bad medical decisions would indicate less need for
disciplinary action.
By mama
April 22, 2009 2:27 PM | Link to this
This doesn’t surprise me at all. I had TMB investigate my OB because of wrong doing and of
course she covered her a$$ on the case and TMB found nothing in their investigation. As a
result of my complaint I was banned by ARC! Doctor’s cover there tracks very well. The TMB
needs to uncover better.

By Bill Duff
April 22, 2009 3:16 PM | Link to this
. Texans expect due process and fair treatment from our state government. The Texas
Medical Board has failed to deliver these minimum civil rights to physicians. Every physician
group in the Lone Star State has expressed grave concerns with the procedures and
practices of the TMB. There have been numerous complaints and, if memory serves,
criminal referrals.
A recently removed commissioner from Abilene appears to have had a clear conflict of
interest in certain hearings. The physician’s spouse wrote anonymous complaints about local
physicians in the same specialty. The commissioner then sat in judgement on these cases.

Anonymous complaints, from out of state insurance companies have been used against
Texas medical practitioners. This is a clear violation of the right to confront an accuser. The
insurance companies in question had a vested financial interest in filing the accusations.

There is a long litany of TMB abuses across the state. Reform is overdue. The rights of
Texas patients and physicians must be respected by the TMB. Texan lives depend on it. .

By Bill Duff
April 22, 2009 3:26 PM | Link to this
The TMB has been accepting anonymous complaints from insurance companies and
competing physicians. The patients named in the anonymous complaints were unaware of
them.
The TMB conducts its activities behind closed doors. Only the physicians who have been
brought before its courts of inquisition understand the injustices which the board has been
perpetrating.

Dr. Keith Miller, who has served as a member of the TMB’s disciplinary committee, has also
served for Blue Cross Blue Shield on the Texas Medical Advisory Committee. Dr. Miller has
been accused of using his position to discipline physicians with whom Blue Cross Blue Shield
was displeased. This appears to be unethical at best, and corrupt at worst.

Anonymous “experts” are used by the board to discredit physicians accused of not following
the insurance companies’ self-serving views of medical care. In its secret hearings, where
the accused physician is interrogated, neither recordings nor documentation of the
proceedings are permitted. The TMB acts as prosecutor, judge, jury and executioner. The
decision is predetermined. Scores of physicians’ reputations and livelihoods have been
ruined and their patients left holding the bag. There appears to be collusion between the
insurance companies and the TMB.

By Bill Duff
April 22, 2009 3:31 PM | Link to this
The outrageous case against Dr. Bill Rea, a prominent Dallas physician, founder of the
Environmental Health Center in Dallas and leader in the field of Environmental Medicine, has
catalyzed the opposition of patients and legislators to the TMB’s Star Chamber tactics. Dr.
Rea has treated over 30,000 patients at his center since 1974.
In 2005 an anonymous complaint was filed with the TMB regarding Dr. Rea’s treatment of
five patients, all of whom lived in Manhattan, and who had experienced illnesses due to
chemical exposure after the 9/11 attack. All the patients were pleased with Dr. Rea’s care,
as were their referring physicians. The only common thread in the anonymous complaint
was that all five patients carried Oxford Medical Insurance. Apparently, Oxford had filed the
anonymous complaint in order to keep from reimbursing the patients’ medical bills.

The TMB’s attorney informed Dr. Rea’s attorney that it didn’t matter what was said or what
evidence was presented, Dr. Rea’s license would be revoked. Despite the fact that 18
physicians evaluated and approved of Dr. Rea’s treatment, one hired board expert
denigrated it. At the end of the sham review hearing, Dr. Miller recommended that Dr. Rea’s
license be revoked.

Upon learning about this injustice, several prominent Texas state senators and
representatives have called for an investigation of the TMB. These legislators were aware of
numerous cases of doctors who had been railroaded by the TMB.

By Bill Duff
April 22, 2009 4:10 PM | Link to this
. Evidence Piles Up Against Medical Board President
The evidence piled up high against Roberta Kalafut, D.O., the former president of the Texas
Medical Board, for the abuse of power she apparently used against her competitors in
Abilene.
Dr. Kalafut and her husband, Dr. Ed Brandecker, moved to Abilene in 1992. They were
employed by The Hendrick Medical Center Hospital in the mid 1990s to develop the
rehabilitation center. According to sources in Abilene, Dr. Kalafut was later fired by the
hospital, and has held a grudge ever since. In 1997, Kalafut and Brandecker founded Spine
Abilene, a physical medicine and rehabilitation practice.

While Kalafut was on the Board, nine physicians in direct competition with her had
anonymous complaints filed against them with the TMB. The entire Medical Executive
Committee of the Hendrick Medical Center has had anonymous complaints filed against
them. These complaints appear to have been initiated by Kalafut and Brandecker. .

By Bill Duff
April 22, 2009 4:13 PM | Link to this
. A physician and former partner of Kalafut and Brandecker who worked with them between
2000 and September 2004, when he decided to leave their practice. Because of a one-year
non-compete agreement, this former partner was forced to work out of the area and
ultimately went to work for the St. Louis University Medical School from May 2005 - June
2006. . Having grown up in Abilene, this physician decided to return in 2006 as a partner
physician at Abilene Sports Medicine and Orthopedics which competes with Kalafut’s clinic.
Upon learning of their former partners plans to return to Abilene, Kalafut’s husband,
Dr.Brandecker, sent him a letter which appears to be a veiled threat: “I suppose had you
not considered returning, I would not have given this much additional thought. I would have
let bygones be bygones.” . Lo and behold, the physician and former partner of Kalafut has
had two anonymous complaints filed against him with the TMB since returning to Abilene.
His physician’s assistant, a former employee of Kalafut, has had one anonymous complaint
filed. .

By Bill Duff
April 22, 2009 4:20 PM | Link to this
. Kalafut’s former partner related that she dealt with her competition by having her
husband, Dr. Brandecker, file anonymous complaints with the TMB and then she would work
inside of the Board to make sure that her competitors were disciplined. It appears that
Kalafut’s intention was to drive her competitors out of business.

Kalafut admitted under oath, during the October 23, 2007 Texas House Appropriations
Subcommittee on Regulatory Agencies hearing on the TMB, to having her husband file an
anonymous complaint. Does this violate the Texas Penal Code, Section 39.03 prohibiting
official oppression? Does this activity violate the federal anti-racketeering RICO Act?

A formal complaint was filed with former Travis County District Attorney, Ronnie Earle. The
TCDA office has jurisdiction over criminal cases dealing with state officials. .

By mc
April 22, 2009 4:33 PM | Link to this
Just to point out the obvious, but most of Bill Duff’s comment about Kalafut involves
questionable practices by physicians against other physicians.

It stands to reason that a (powerful) medical board is needed to investigate physicians, who
may be both the accused and the accuser.

By mc
April 22, 2009 4:38 PM | Link to this
I do not know anything about Dr. Rea’s case. But it sounds suspiciously like alternative
treatments being coded as accepted treatments for billing purposes.

By Lee Spiller
April 22, 2009 4:47 PM | Link to this
The Texas Medical Board seems to have no problem allowing convicted felons to practice
medicine. In at least one case, they allowed a doctor who was convicted in the sexual
assault of a young girl to remain in practice until he voluntarily surrendered his license.

The legislature needs to require that doctors convicted of felonies aren’t allowed to remain n
practice. The legislature also needs to mandate in law that sexual liberties taken with
patients are reported to law enforcement.

It’s obvious that we cannot trust the medical board to protect patients.

By Bill Duff
April 22, 2009 4:49 PM | Link to this
.. Accused witches were subjected to a medieval trial by ordeal. The accused was stitched
into a gunnysack full of rocks; and heaved into the river. If the accused drowned, they were
innocent of the charge of being a witch. If they did not drown, they were guilty of being a
witch. The convicted witch was dredged from the river, tied to a stake and burned. The TMB
appears to have adopted similar trial procedures.
..
By crunchy frog
April 23, 2009 12:58 AM | Link to this
Dr. Duff - If the complaints are anonymous, then how do you know they were filed by
insurance companies? Sounds like maybe the insurance companies put their names on the
ones they filed and were up front about it. And shouldn’t they have the right to file
complaints just like anyone else? Since they are the main ones paying the bills these days
(outside of the government who you know would NEVER file a complaint or even catch it if
they paid the same bill twice), aren’t they in the best position to catch fraudulent billing
practices and bad docs who are consistently over-charging both consumers and the
insurance companies? It’s absurd to single them out and say they shouldn’t file complaints.
Sounds like the fox watching the henhouse - “everyone can file anonymous complaints,
except for the insurance companies who pay 50% of the claims….” Hmmmmm, that’s fair.

By Bill Duff
April 23, 2009 6:43 AM | Link to this
. Let’s follow the TMB money.
Texas has the highest cost medical licenses in the USA. The average annual renewal cost is
approximately $1,000.00. TMB licenses over 60,000 physicians per year as well as several
allied healthcare professionals such as physician assistants. License renewal collections are
over $60M per year.

By contrast, the TMB annual budget is under $10M.

Thus TMB is a Cash Cow for the Lone Star State. This increases the cost of medical care,
while constraining the funds available to properly discipline the Texas medical profession
and protect the public.

By Bill Duff
April 23, 2009 6:47 AM | Link to this
The article references the Public Citizen Report. If memory serves, Texas has the highest
annual medical license cost in the USA. The Number 1 item on the Public Citizen list for
“What Makes a Difference” is Adequate funding (all money from license fees going to fund
board activities instead of going into the state treasury for general purposes)
However, Texas medical license fees go to the Texas General Fund.

By Bill Duff
April 23, 2009 6:58 AM | Link to this
Unfortunately, the clear priority of the Texas State Government is to “Milk the Cow”, rather
than to promote excellence in medical care and patient treatment. It appears that less than
15% of Texas physician license fees are dedicated to medical discipline and professional
development. The rest is skimmed off for “other purposes”.

Texans end up paying for Cadillac medical investigations and receiving jalopy enforcement.
The Lone Star State has the worst of all possible worlds, with the “Star Chamber”
proceedings of the TMB.

By Bill Duff
April 23, 2009 7:18 AM | Link to this
Unfortunately, the article above, by Mary Ann Roser only bothered to reference the
Common Cause report. There are many additional and perhaps superior sources of
information. Other important and original sources are available such as the Texas Sunset
Advisory Commission Report - 3w.sunset.state.tx.us/81streports/tmb/tmb_sr.pdf, American
Medical Association (AMA) - 3w.ama-assn.org/amednews/2007/11/26/prsc1126.htm
Association of American Physicians and Surgeons (AAPS) - 3w.aapsonline.org/
newsoftheday/004 Also, the TMB has significant resources available on the web
3w.tmb.state.tx.us/ as does the Federation of State Medical Boards 3w.fsmb.org/ Matters,
including the statistics regarding anonymous and insurance company reports are easily
available, should one care to look.

By Bill Duff
April 23, 2009 7:23 AM | Link to this
. James N. Thompson is president and chief executive of the Federation of State Medical
Boards. Last year she wrote an article for the Los Angeles Times. 3w.latimes.com/news/
opinion/la-oew-thompson28apr28,0,7771411.story in the BLOWBACK Section, titled:
“Keeping state medical boards alive” . Medical boards are typically funded by the licensure
fees they collect when physicians renew their licenses. Unfortunately, in some states these
revenues are diverted into a general fund, rather than going directly back to the medical
board. Medical boards then must compete with other state programs to obtain adequate
funding, too often receiving a diminished share of physician licensing fees. As a result,
many medical boards do not have enough investigators, attorneys and support staff to
properly carry out investigations — significantly impeding their ability to prosecute cases in
a timely manner.

By Bill Duff
April 23, 2009 7:29 AM | Link to this
The LATimes article by James N. Thompson CEO of the FSMB article included several
proposals to Common Cause. These included,
Don’t just tally how many doctors were disciplined. Boards need adequate funding and
staffing to investigate physician competency. By limiting their reports to “serious” actions,
these ranking reports miss the much larger picture of how medical boards protect the
public. A less serious disciplinary action is still action. It still requires medical board
resources and can be just as effective a tool in protecting the public. Medical boards also
frequently preempt future disciplinary action through education and rehabilitation programs.
These methods effectively protect the public while often salvaging an increasingly valuable
commodity — physicians — for our communities. These forms of discipline aren’t reflected in
annual ranking reports. Ironically, a medical board that reduces the number of “bad”
doctors in a state through highly effective remediation and education would rank low in a
ranking report — because it had so few bad doctors to “seriously” discipline.

By Bill Duff
April 23, 2009 7:32 AM | Link to this
Several additional first person accounts of TMB Star Chamber Proceedings may be located
at:
3w.medlicense.com/2007/10/texas-medical-board-new-updates.html

By Bill Duff
April 23, 2009 7:42 AM | Link to this
Readers of the Austin American Statesman and Texans generally would benefit from more
insightful reporting. Regurgitation of a Common Cause position paper is hardly an adequate
treatment of the subject matter at hand. Blindly quoting a couple of medical discipline
statistics does not appear to meet any known investigative reporter ideals.

Patient health, physician reputations and the public’s business deserve a more thorough and
balanced approach. TMB faces some serious challenges ahead. It is sincerely hoped that the
Texas Legislature has developed a prescription for significant performance improvement.

By Bill Duff
April 23, 2009 7:58 AM | Link to this
The right to face an accuser is a fundamental civil right. This right is enshrined in the Bill of
Rights of the US and Texas Constitutions for criminal proceedings. This right is equally
important in civil proceedings. Our system is founded on Due Process Rights. Anonymous
complaints generally violate the rights of the accused. They have no legitimate place in
formal proceedings conducted under color of office. Such distasteful methods egregiously
violate the American sense of fair play. Physicians, and indeed all Texans, deserve the right
to review the evidence and to confront their accuser.

By Bill Duff
April 23, 2009 9:53 AM | Link to this
Ah, insurance company rights; that is an interesting consideration. How can a just society
neglect to consider insurance company rights? Insurance companies ADD a layer of
bureaucracy and cost. They subtract their overhead, variable costs and profit from the pot.

The Texas state government adds still another layer, by taxing insurance companies. The
federal government does likewise. Forced medical care for illegal aliens, faux poor and other
favored groups will further milk the cow. The crony and buddy system will generally staff
these enterprises according to Murphy’s Law. The reimbursement rates to hospitals and
doctors drops year by year. Real services suffer. The uninsured will be hit for retail prices,
businesses and other private insured payers are charged wholesale, while insurance and
government programs drastically underpay.

Political contributions will hide the numbers from public view. This will leave Texas
businesses and consumers saddled with 200% of the actual healthcare costs and 50% of
the benefits. The burden is heavy during good times. Atlas does not shrug, he is crushed in
hard times such as today.

By anonymous
April 27, 2009 11:02 PM | Link to this
We aren’t complaining that they are too harsh, we are complaining that they are unfair,
practice conflict of interest, have their family members lodge anonymous complaints against
their physician competitors and totally forego due process. This is very different. If you are
going to author a blog you should educate yourself about the issues. See AAPS lawsuit
against the TMB.

By Ray Fulp,DO
May 11, 2009 11:45 AM | Link to this
The TSMB is out of contoll. Unless Gov. Perry does something about these anonymous
complaints,Tx. will lose many good physicians! I am in an impoverished area of Tx, very
under served medically,but I am tired of defending my medical records and NOT seeing
patients! I have spent well over $40,000 to defend myself…..enough is enough!

By Red Hot
May 16, 2009 2:40 PM | Link to this
I too was a “victim” of retaliation by doctors after I turned one in b/c he experimented on
me. The doctors who told me to my face that the doc tried to kill me and they had never
heard of such a thing but told me if I turned the doc in and sued him they would blackball
me and they did so anonymous complaints should be taken but perhaps they should be
verified from the source by TMB AND to be fair to the docs keep the name out but state the
nature. As for Rea’s case, look at his record he has been sued for med mal so it is not ALL
about insurance. Why all this protection for one doctor?

By Harmed
June 22, 2009 11:28 PM | Link to this
I was harassed for over 2 years by the board. A patient claimed I billed a wrong date on her
insurance. They made my life a living hell. I have quit practice and will move elsewhere.

By Harmed
June 22, 2009 11:45 PM | Link to this
The complaints doctors have about the board have nothing to do with quality of care. The
board harasses you for trivial things. They are supposed to resolve these things within 6
months, per statute. They find ways to drag it out for years. The entire time you are under
the threat of losing your license/livelihood.
You have a “hearing”, which amounts to a kangaroo court. You are supposed to prove your
innocence. They do not listen to you and assume the accuser is completely honest and you
are the liar.

I was fined more for a paperwork complained than some people are for killing patients. Tell
me how that makes sense? I spent $10K defending myself.
The board acts like a Communist Party. You have no rights and they are going to sock it to
you as much as they can.

By Shirley Pigott MD
August 9, 2009 5:12 PM | Link to this
I have been investigating the TMB and attending board meetings nonstop since April, 2006.
At that time the TMB opened a full fledged investigation of me because I failed to release a
single lab report to a single patient when she refused to allow me to interpret it for her as
she had originally agreed.

I discovered that Doug Curran MD, president of the Texas Academy of Family Physicians,
had bribed buddy Keith Miller MD to go after me because I exposed his conflict of interest
with Blue Cross Blue Shield.

Miller was chairman of the TMB Disciplinary Process Review Committee.

Then I started investigating Keith Miller. His nurse, Bridget Yvette Hughes, was under a
NON-disciplinary order with the nursing board because she forged over 50 Schedule II
Narcotics prescriptions in Shelby County.

In Shelby County, Texas, Department of Public Safety Officers Rodney Mahan and Ron
Fields refused to investigate or arrest her. No one in DPS all the way up to Executive
Director Colonel Thomas Davis responded to my complaints about the officers.

[Shelby County is where Tenaha, Texas, is the town that recently made the national news
for confiscating the cash and automobiles of out-of-towners who drive through.]

Until…Sept 29, 2007, finally a response. …not the one I was looking for, however. I was on
my way to a medical meeting in Chicago where I was scheduled to confront Curran with my
charges against him. At 8:15 PM on Hwy 59 North between El Campo and Wharton, I was
stopped for speeding nine mph over the speed limit. DPS Officer Alfred Ochoa turned on his
lights and siren while tailgating me at 74 mph. When he came up to me, I asked to go to
the next lighted, populated area.

On the way, Officer Daniel Terronez pulled me over. I again asked to go to the next town,
but he started breaking into my car with his heavy flashlight. I haltingly drove away from
him to see if he would stop assaulting me. He only beat my car harder, forcing me into the
path of a speeding 18-wheeler, which he must have seen, but I didn’t. The truck came
within a few feet of plowing into me. I fled the scene. For 93 seconds I drove as fast as I
could, then slowed down and stopped at the next town. I was arrested and spent the night
in jail.

The TMB refused to investigate Dr. Doug Curran for bribing Dr. Miller. It refused to
investigate Dr. Miller for accepting his bribe. The nursing board refused to discipline Bridget
Hughes.
DPS refused to investigate Mahan and Fields for their roles in letting Dr. Miller and nurse
Hughes go free. DPS refused to investigate my charge that Officer Ochoa perjured himself
on his affidavit about me: he said I tried to run him down when I drove away as Terronez
was breaking into my car. DPS refused to investigate Terronez for bashing my car window in
and causing me to flee into the path of a speeding 18-wheeler.

On February 6, 2009, I recited a litany of felonies to the whole medical board committed by
Mari Robinson, Executive Director of the Texas Medical Board.

A couple weeks later, they sent me a notice telling me they planned to suspend my license.
The medical practice act required them to have a probable cause affidavit citing the
event(s) which was supposed to make me an continuing danger to the public. There was no
such event and they had no affidavit.

On March 24, 2009, their expert William H Reid MD, upon viewing the TMB’s version of the
2007 chase, gave testimony which persuaded a panel of three medical board members, that
I was “mentally impaired”, that my conduct was “disloyal and unprofessional”, and that my
practice of medicine was a continuing threat to the public and so they suspended my
license.
Mari Robinson authorized TMB staff to copy only my “flight” from the second officer, and
duplicate it repeatedly and showing their altered copy to the board’s expert and the board
panel who was to suspend my medical license.

I stand trial for “aggravated assault of a law enforcement officer in the line of duty with a
deadly weapon”, the car I was driving, later this month. If convicted, I could face life
imprisonment.

The state has seized my car without a warrant and still has it.

You might say I’m at war with Mari Robinson at the TMB. This is what she does to people
she’s really mad at. I have hard evidence on half a dozen or more felonies I believe she has
committed. So far, no one in state government will take any action against her.

In our ongoing dispute, you might say the TMB has temporarily pulled ahead, but we
haven’t crossed the finish line yet.

Keith Miller resigned from the board in August, 2007. Exec Director Donald Patrick resigned
in August, 2008. President Roberta Kalafut resigned in December, 2008.
I have personally told Mari Robinson, “YOU ARE NEXT TO GO!”