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pain management prescribingControlled substances prescribing is an area filled with potential pitfalls that, if not avoided, can lead to serious disciplinary action for physicians licensed by the Texas Medical Board. Each month the press releases published by the TMB detail disciplinary actions involving nontherapeutic and inappropriate prescribing as well as actions involving the proper operation of pain management clinics.

Instances of inappropriate and nontherapeutic prescribing that have resulted in disciplinary actions in the recent past include the following:

  • Prescribing controlled substances to relatives and other persons with whom the physician has a close personal relationship;
  • Prescribing without adequate documentation of a clinical diagnosis;
  • Prescribing for periods of time exceeding the current needs of the patient;
  • Prescribing without conducting a physical examination;
  • Prescribing without making a proper medical record;
  • Failure to look for and respond to aberrant drug use; and
  • Self-prescribing.

These matters have resulted in sanctions including various combinations of the following:

  • Restriction from prescribing certain drugs;
  • Losing the authority to treat patients for chronic pain;
  • Completion of a physician prescribing course;
  • Completion of a specified number of hours of CME in risk management and ethics;
  • Payment of administrative penalties;
  • Passing the Medical Jurisprudence Exam within a specified time period;
  • Following all recommendations of the Texas Physician Health Program; and
  • Not obtaining DEA or DPS Controlled Substances Registrations without TMB approval.

Repeat offenses and failure to comply with the terms of any disciplinary action are met with even stiffer penalties.

Pain management and the prescription of pain medications must be undertaken in compliance with DEA requirements, Texas law, TMB rules, and ethical standards. Physicians must take the utmost care adhere to procedures that include appropriate documentation and delegation policies, as well as procedures to detect indications of patient misuse or addiction.

Physicians should be aware of the potential consequences of noncompliance with pain management rules and requirements. Even physicians with the best of intentions can run afoul of the law. If you find yourself facing charges of inappropriate or nontherapeutic prescribing, having an experienced Texas professional license defense attorney at your side can significantly increase the likelihood of a positive outcome. Contact Oscar San Miguel, Attorney at Law, at the first sign of a problem.

student loan defaultAfter rising for several consecutive years, the student loan default rate has recently fallen, but it is still at the high rate of 13.7 percent. Many recent graduates are finding that they are unable to repay their student loans due to the weak economy and job market. Among the many consequences of student loan default is the risk of nonrenewal of a professional license.

Under Texas law, your professional license will not be renewed if you are in default on your Texas Guaranteed Student Loan Corporation (TGSLC) student loans, unless you can provide certification that you have either entered into a repayment agreement on the defaulted loan or you are not currently in default.

The Texas Board of Nursing states on its website that nurses may use an online renewal procedure unless, among other things, the nurse has defaulted on a Texas Guaranteed Student Loan. As recently as July 2014, the Texas Medical Board publicly reprimanded a physician and required him to present proof that he had cured his student loan default with the TGSLC.

In addition to the law requiring nonrenewal of licenses on default of student loans, the various state licensing boards may have additional rules. For example, the Texas Board of Dental Examiners has rules applicable to those who have breached a student loan repayment contract or other scholarship contract.

Professional license holders in Texas must comply with a large number of requirements in order to maintain their professional licenses. These requirements include educational, administrative, and standards of conduct requirements, as well as many others. Professional license holders need to be aware that their professional license may be at risk if they default on federal student loans.

If you are a professional license holder and your license is at risk for any reason, you need the assistance of an experienced Texas professional license attorney. Contact Oscar San Miguel, Attorney at Law, for a consultation.

Texas board of nursing complaintsHaving a complaint filed against you is one of the most stressful and upsetting things that can happen in a nurse’s career. But complaints are routinely filed. According to the Texas Board of Nursing (TBN), over 16,000 confidential complaints are received each year.

Thankfully, not every complaint results in a disciplinary action or even an investigation. Some complaints do not adequately identify the nurse, are not within the TBN’s jurisdiction, are too minor to warrant an investigation, or if proven would not warrant a violation of the Nursing Practice Act (NPA).

The TBN notifies a nurse of an investigation and allegations unless such notification would compromise the investigation. The nurse is given the chance to respond to the complaint and to demonstrate compliance with the NPA. The TBN gathers evidence and contacts witnesses, and on occasion will conduct an on-site investigation if mail and phone are insufficient. Investigations typically take between five and 12 months to complete.

After the investigation is complete, the case is either closed or the TBN determines that a sanction is needed to protect the public. If the case is closed, the complaint and evidence are expunged. If it is determined that sanctions are needed, an order will be issued that includes both the sanction and requirements for retention of the nurse’s license. Sanctions may include remedial education, fines, warning, reprimand, suspension, probation, and/or revocation. Orders are generally public information, and will remain permanently in the nurse’s licensure records except in the case of a deferred disciplinary order that has been fully completed.

Both informal and formal settlement processes are available to a nurse against whom an order has been imposed. An informal settlement occurs when the nurse is offered a proposed agreed order that inform the nurse of the findings, conclusions, sanction, and requirements for continued safe practice. The nurse can agree to the order, which then is put to the TBN for ratification. Most agreed orders are so ratified, but occasionally the Board may modify or reject the order. If the nurse does not agree with the order, he or she may suggest revisions to the order, which may be accepted by the TBN.

In some cases informal settlement conferences may be held. Most of the time the conference ends with a recommended disposition of the case; if necessary, new orders are mailed to the nurses. As with other proposed orders, the nurse can agree or suggest revisions. Once the TBN ratifies an order, it becomes final and the terms take effect. Both the nurse and the last known employer receive a copy of the final Board order, and the complainant is notified of the result. The result is also written about in the TBN quarterly newsletter and reported to the National Practitioner Data Bank and the National Council of State Boards of Nursing, Inc.

If the nurse and the TBN do not reach an agreement after an informal settlement attempt, the Board files official charges to which the nurse is required to respond in writing. If the nurse does not respond, the Board may proceed toward a default revocation of the nurse’s license. If the nurse does respond, negotiations continue until a hearing before an Administrative Law Judge is held. After the hearing, if a settlement is not reached, the judge proposes a decision that contains a finding of fact and conclusion of law. The TBN may then impose penalties or close the case with no action.

Clearly, the complaint process is a long and difficult one, and a nurse against whom a complaint has been filed should consult with an expert attorney as soon as notification of the complaint is received. If a complaint has been filed against you, you need experienced Austin professional license defense attorney Oscar San Miguel on your side to represent your interests. Call 512-228-7946 to make sure your rights are protected.

professional dentist license lawyerFor a dental professional, protecting your license and reputation is critical to maintaining your successful practice. And facing a review board, with the potential for disciplinary or enforcement action, can be a harrowing experience. Complaints may be based on a number of issues, including administrative matters involved in running a sanitary dental office and compliance with licensing and other requirements.

The Texas State Board of Dental Examiners’ (SBDE) Enforcement Committee has released a Self-Monitoring Checklist that can be used as a reminder of the administrative requirements for operating a dental office. The checklist is a useful reference to the Dental Practice Act and SBDE's rules and regulations.

The Self-Monitoring Checklist is as follows: 1. Infection Control; Applies to persons involved in treating patients (Rules 108-20 et seq.); 2. Immunizations, specifically evidence of immunization against Hepatitis B virus, or of other immunity; 3. Universal barrier techniques, including:

  • Disposable, non-sterile gloves
  • Protective eyewear and respiratory protection
  • Protective gowns or other clothing
4. Sterilization and disinfection—proper disposal of waste, including:
  • Contaminated waste
  • Sharp items;
5. Proper sanitation (Rule 108.21) 6. Proper training, certificates, licenses, and permits:
  • Satisfy all relevant continuing education requirements (Rules 104.1 et seq.)
  • Maintain a current license (Rules 101.1 et seq.)
  • Maintain current certification in cardiopulmonary resuscitation (Rule 108.7)
  • Hygienists maintain certification to place pit and fissure sealants and monitor nitrous oxide (Rule 115.2)
    • Hygienists maintain competency to place site-specific subgingival medicament (Rule 115.4)
    • Assistants maintain certification to perform radiology procedures (Rule 114.10)
    • Assistants maintain certification to monitor nitrous oxide levels (Rule 108.34)
7. Administrative matters:
  • Maintain dental records, including patient medical histories (Rule 108.32), and dispensation of drugs
  • Maintain a centralized drug inventory (Rule 108.8)
  • Display of license to practice
  • Display of information for consumers (Rule 108.3)
  • Listing of trade name (Rule 108.4)
  • Existence of contract for management services (Rule 108.71)
  • Lease or rental payments for office (Rule 108.70)

Dental professionals must always remain mindful of the various laws and regulations governing their practice, and the Self-Monitoring Checklist is a good way to stay on top of legal and administrative requirements. If you are facing a complaint to the SBDE, you need the help of a skilled and experienced Texas professional licensing attorney. Call Oscar San Miguel, Attorney at Law to get the help you need to keep your dental 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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