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incident-based peer reviewEvery nurse works hard to earn and maintain a state license to practice nursing, and should be aware of the various disciplinary measures and procedures that can be used when patient care is in question. Peer review for nurses is a mechanism for evaluating the services being provided by a nurse, the nurse’s qualifications, the quality of care delivered to patients, and the validity of a complaint. Peer review can be conducted at the request of the nurse (“Safe Harbor peer review”) or commenced by the facility (“Incident-based peer review”).

Incident-based peer review is used to determine whether a nurse’s conduct should be reported to the Texas Board of Nursing (BON). Nursing peer review procedures must contain certain due process and good faith requirements. Due process requirements must include, at a minimum:

  • Notification of the date the peer review committee will meet at least 21 days but not later than 45 days from the date the notice is given;
  • Receipt of a copy of the facility’s peer review policy;
  • Receipt of information about the event being evaluated;
  • Information about where to send a response;
  • The ability to review pertinent documents at least 15 days before appearing before the committee;
  • The opportunity to appear before the committee, including making a statement, call and question witnesses, and ask and answer questions;
  • Completion by the peer review committee within 14 days of the hearing;
  • Receipt of written notification of the committee’s conclusions within 10 days of completion; and
  • The opportunity, within 10 days of notification, to rebut the committee’s findings in writing.

The peer review committee must report to the BON if it believes in good faith that the nurse has violated the rules subject to reporting under the Nursing Practice Act. These rules include standards of practice and unprofessional conduct. If the event qualifies as a minor incident, it may not be reportable to the BON unless the nurse:

  • Ignored a significant risk of harm to the patient;
  • Was not conscientious or accountable in his or her practice;
  • Was not knowledgeable or competent to act appropriately; or
  • Constitutes a pattern of repeated minor incidents that, if allowed to continue, could harm patients.

Nurses should be aware that a nursing peer review committee cannot take actions relating to a nurse’s employment or discipline. The facility may, however, take the committee’s decision into account in making employment or disciplinary decisions.

Any nurse who is notified of an event giving rise to the peer review process should immediately contact an attorney for assistance in preparing for and attending the peer review hearing. Having an experienced Texas professional license defense attorney on your side could make all the difference in continuing in your job and livelihood. Contact Oscar San Miguel, Attorney at Law, for a consultation today.

texas medical board suspensionInvestigations by the Texas Medical Board (TMB) can have a serious effect on a physician’s career and medical license. It’s critical for physicians to understand the process and the need for strong legal representation.

Physicians should be aware that the TMB can hold a temporary suspension hearing without giving any notice to the physician. Such a hearing can result in the temporary suspension of a physician’s license, effective until further action is taken. A temporary suspension hearing with notice is then held to determine whether a temporary suspension should continue.

A temporary license suspension either with or without notice means that the physician cannot practice medicine. It may also mean, based on the duration of the suspension and other factors, that the physician can also lose his or her Medicare billing privileges and DEA controlled substances registration. Therefore, license suspensions are very serious and can have a dramatic impact on the physician’s career.

Temporary suspensions, as a result of hearings both with and without notice—are typically limited to cases in which the disciplinary panel finds the continued practice of medicine would constitute a continuing threat to the public welfare. Recent cases include ones in which the TMB panel found evidence that the physician posed a threat to himself or others constituting a potential threat of harm to patients; the physician was unable to safely practice medicine due to a physical or mental impairment; and the physician, based on a screen of his cognitive abilities, was deemed unsafe to practice medicine and presented a real and imminent threat to the safety of patients.

If you have been notified of a complaint against you or the issuance of a temporary license suspension after a hearing without notice, you should seek the help of an experienced Texas medical license defense attorney as soon as possible. Oscar San Miguel, Attorney at Law, can help mitigate the damage from a temporary medical license suspension.

professional license attorneyFor a licensed professional, your license is everything, and protecting your license is of the utmost importance. Each of the state boards regulating professional licenses—including medical, nursing, pharmacy, dental, and psychologists, to name a few—has specific rules for obtaining and maintaining a license, and strict disciplinary procedures. The Texas Medical Board alone receives over 7,000 complaints each year. At a recent meeting, the Board disciplined 45 physicians for violations, including:

  • quality of care,
  • unprofessional conduct,
  • inadequate medical records,
  • violation of Board rules,
  • failure to properly supervise or delegate, and
  • inappropriate prescribing.

These actions included one revocation, five voluntary revocations, five voluntary surrenders, and two suspensions.

Licensing guidelines have become stricter, and licensed professionals are humans who sometimes make mistakes. If your license is jeopardized, what should you do? Do you really need to hire a professional license defense attorney?

One of the biggest mistakes made by licensed professionals upon receiving a Notice of Complaint or Investigation is to assume that they will be treated fairly and therefore they should speak freely to the disciplinary board. Others make the mistake of waiting until late in the investigation process, when the initial response has already been made and opportunities for successfully dealing with the disciplinary board have been missed. Sometimes serious consequences are on the horizon before an attorney is called.

The best time to hire an attorney is as soon as you receive notice so that the attorney can help to frame the evidence in the most favorable light for the license holder and can introduce mitigating evidence. The attorney can help in all phases of the disciplinary process, from informal conferences to administrative hearings.

Look for an attorney whose primary—or only—practice area is professional license defense. Many attorneys who claim to specialize in professional license defense do it as a sideline to their main practice area. An attorney whose focus is on professional license defense will provide the most effective legal representation at a time when so much is on the line. Contact Austin professional license attorney Oscar San Miguel, Attorney at Law, for a consultation with an experienced Texas professional license defense attorney before it is too late.

social media misuseSocial media can be a valuable tool for medical professionals to find and discuss medical information, such as articles in medical journals or clinical research. But while social media can have important positive uses by members of the medical community, it can also carry risks.

According to a 2011 survey by QuantiaMD, over 65 percent of physicians use social media for professional purposes, and 28 percent of them use professional physician communities to learn from others. In addition, 87 percent of physicians use social media for personal use. One third reported that a patient has tried to friend them on Facebook. This leads to questions of professional boundaries, confidentiality, and patient privacy.

The American Medical Association has issued an opinion on Professionalism in the Use of Social Media, and physicians would be wise to review the opinion to ensure that they do not cross the line between positive use and misuse of social media. According to AMA Opinion 9.124, physicians should:

  • Maintain standards of confidentiality and patient privacy, and must not post information to identify a patient;
  • Use privacy settings to safeguard personal information, while remaining cognizant that privacy settings are not absolute. Posted content must be accurate and appropriate;
  • Maintain appropriate boundaries while interacting with patients online;
  • Consider keeping personal and professional content separate;
  • Bring inappropriate content to the attention of the medical professional who posted it, and if it significantly violates professional standards and is not rectified, report the incident to the appropriate authorities; and
  • Be cognizant of the negative impact that social media can have on their reputations and professional careers.

While it is important for physicians to be cautious in the use of social media, sometimes errors in judgment are made that can lead to a complaint against the physician’s license. If you have received notice of a complaint, you need experienced Texas professional license attorney, Oscar San Miguel by your side to help you protect your reputation and your career.

advertising medical licenseFor a physician, the use of the term “board certified” in advertising can lend a distinct air of authority and expertise that is very attractive to prospective patients. However, unregulated use of the term can lead to confusion among the public, as well as a watering-down of the positive impact on a licensed medical professional.

To protect the public, the Texas Medical Board (TMB) has standardized what the term “board certified” means when used in advertising by physicians. Under TMB rules, use of the term in advertising of a physician’s practice is allowed if any of the following apply:

  1. The specialty board and certifying organization is a member of the American Board of Medical Specialties (ABMS), the American Osteopathic Association Bureau of the Osteopathic Specialties (BOS), or is the American Board of Oral or Maxillofacial Surgery;
  2. The physician holds a certification that was granted before September 1, 2010, by a certifying board that was approved by the TMB for advertising before that date; or
  3. The certifying organization has certification requirements that are determined by the TMB to be substantially equivalent to the ABMS or the BOS at the time of application to the TMB.

In the case of option 3 above, physicians (or the certifying boards on behalf of their members) must apply to the TMB and demonstrate all of the following:

  • The organization requires all physicians seeking certification to pass an exam, which may be delegated to a testing authority, that is written, oral, or both, and that tests the physicians’ knowledge and skills in the specialty or subspecialty. The exam must be validated by a psychometric evaluation.
  • The organization has been determined to be tax-exempt by the IRS under Internal Revenue Code section 501(c).
  • The organization has a permanent staff and headquarters.
  • The organization has at least 100 licensed members, fellows, diplomates, or certificate holders, from at least one-third of the states.
  • The organization requires all physicians seeking certification to have successfully completed postgraduate training that is accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association, and that provides comprehensive training in the specialty or subspecialty, and the organization uses peer review.
  • The organization provides an online member certification lookup for use by the public.
  • The organization can provide a complete explanation of its certification process and membership on request.

The use of similar terms, such as “board eligible,” “board qualified,” or any other word or phrase intended to convey the same meaning as “board certified,” is prohibited. Any such use constitutes misleading or deceptive advertising.

If you have reason to believe that your medical license is in jeopardy, contact the qualified Texas professional license defense attorneys at Oscar San Miguel, Attorney at Law for the expert advice you need to protect your license.

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Austin, Texas Professional License Defense Attorney Oscar San Miguel represents clients who are located in Austin, Houston, Dallas, San Antonio, El Paso, Fort Worth, Arlington, Amarillo, Lubbock, Brownsville, Laredo, Harlingen, McAllen, Round Rock, Longview, Travis County, Harris County, Dallas County, Tarrant County, Bexar County, Fort Bend County, Montgomery County, Cameron County, Nueces County, El Paso County, Potter County, Lubbock County, Grayson County, Collin County and throughout Texas.
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