These disciplinary sanction guidelines are designed to provide guidance in assessing sanctions for violations of the Medical Practice Act. The ultimate purpose of disciplinary sanctions is to protect the public, deter future violations, offer opportunities for rehabilitation if appropriate, punish violators, and deter others from violations. These guidelines are intended to promote consistent sanctions for similar violations, facilitate timely resolution of cases, and encourage settlements. (1) - (2)(No change.) (3)The standard and minimum sanctions outlined below are based on the conclusion stated in Section 164.001(j) of the Act that a violation related directly to patient care is more serious than one that involves only an administrative violation. An administrative violation may be handled informally in accordance with Section 187.14(7) of this title (relating to Informal Resolutions of Administrative Violations). Administrative violations may be more or less serious, depending on the nature of the violation. Administrative violations that are considered by the board to be more serious are designated as being an "aggravated administrative violation". (4)[(3)] The maximum sanction in all cases is revocation of the licensee's license, which may be accompanied by an administrative penalty of up to $5,000 per violation. In accordance with §165.003 of the Act, each day the violation continues is a separate violation. (5)[(4)] Each statutory violation constitutes a separate offense, even if arising out of a single act. (6)[(5)] If the licensee acknowledges a violation and agrees to comply with terms and conditions of remedial action through an agreed order, the standard sanctions may be reduced. (7)[(6)] The following standard sanctions shall apply to violations of the Act: (A)Failure to timely provide copies of medical or billing records upon written request is an administrative violation. (i)Violation of: (I)Section [§]159.006 - information furnished by licensee; and (II)Section [§]164.052(a)(2) - violation of Board Rule, to wit: §165.2 (relating to Medical Record Release and Charges). (ii)Standard Sanction: (I)furnishing medical records requested; (II)restitution; and (III)administrative penalty of $1,000 per violation. (B)Failure to timely comply with a board subpoena or request for information is an administrative violation. (i)Violation of §160.009 and board rule §179.4 (relating to Request for Information and Records from Physicians). (ii)Standard Sanction: (I)public reprimand; (II)compliance with the subpoena or request; and (III)administrative penalty of $500 for each day of noncompliance. (C)Conviction or deferred adjudication for [ of] a felony may be either an aggravated administrative violation or a patient care violation, depending on the facts underlying the offense [criminal offense]. (i)Violation of §164.051(a)(2)(A) of the Medical Practice Act, §204.303(a)(2) of the Physician Assistant Act, and §205.351(a)(7) of the Acupuncture Act. (ii)In accordance with §164.057(a)(1)(A) of the Medical Practice Act, the board shall suspend a licensee's license on proof that the licensee has been initially convicted of any felony . [, or a misdemeanor under Chapter 22 (other than a misdemeanor punishable by fine only), §25.07, or §25.071 of the Texas Penal Code; a misdemeanor in which the defendant is required to register as a sex offender under Chapter 62, Code of Criminal Procedure; an initial finding by the trier of fact of guilt of a felony under Chapter 481 or 483 of the Health and Safety Code; or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. §801 et. seq.)] (iii)In accordance with §164.057(b) of the Medical Practice Act [On final conviction for a felony or misdemeanor described in this chapter], the board shall revoke the licensee's license on final conviction for a felony. [(iv)A conviction of misdemeanor involving moral turpitude, for which suspension or revocation is not mandated by the Medical Practice Act] [(I)If the conviction is related to the practice of medicine, the standard sanction shall be revocation of the license.] [(II)If the conviction is not related to the practice of medicine, the standard sanction shall require:] [(-a-)compliance with all restrictions, conditions and terms imposed by any order of probation or deferred adjudication;] [(-b-)public reprimand; and] [(-c-)administrative penalty of $2,000 per violation.] [(v)A conviction includes an adjudication of guilt or an order of deferred adjudication.] [(vi)In accordance with §164.058 of the Act, the board shall suspend the license of a licensee serving a prison term in a state or federal penitentiary during the term of the incarceration regardless of the offense.] (D)Conviction or deferred adjudication for a misdemeanor involving moral turpitude may be either an aggravated administrative violation or a patient care violation, depending on the facts underlying the offense. (i)Violation of §164.051(a)(2)(B) of the Medical Practice Act and §205.351(a)(7) of the Acupuncture Act. (ii)Standard Sanction: (I)If the offense is related to the duties and responsibilities of the licensed occupation, the standard sanction shall be revocation of the license. (II)If the offense is not related to the duties and responsibilities of the licensed occupation, the standard sanction shall require: (-a-)Suspension of license, which may be probated after 90 days; (-b-)compliance with all restrictions, conditions and terms imposed by any order of probation or deferred adjudication; (-c-)public reprimand; and (-d-)administrative penalty of $2,000 per violation. (E)Conviction of a misdemeanor that directly relates to the duties and responsibilities of the licensed occupation may be either an administrative violation or a patient care violation, depending on the facts underlying the offense. (i)Violation of §53.021, Tex. Occ. Code. (ii)Standard Sanction: (I)If the offense involves patient care, the standard sanction shall be revocation of the license. (II)If the offense does not involve patient care and is an administrative violation only, the standard sanction shall require: (-a-)compliance with all restrictions, conditions and terms imposed by any order of probation or deferred adjudication; (-b-)public reprimand; and (-c-)administrative penalty of $2,000 per violation. (F)Conviction of Certain Misdemeanors may be either an administrative violation or a patient care violation, depending on the facts underlying the offense. (i)In accordance with §164.057(a)(1)(B), (C), (D), and (E) of the Medical Practice Act, the board shall suspend a licensee's license on proof that the licensee has been initially convicted any of the following misdemeanors: (I)a misdemeanor under Chapter 22, Penal Code, other than a misdemeanor punishable by fine only; (II)a misdemeanor on conviction of which a defendant is required to register as a sex offender under Chapter 62, Code of Criminal Procedure; (III)a misdemeanor under Section 25.07, Penal Code, or (IV)a misdemeanor under Section 25.071, Penal Code. (ii)In accordance with §164.057(b) of the Medical Practice Act, the board shall revoke the licensee's license on final conviction of any of these misdemeanors. (G)[(D)] Failure to obtain/document continuing medical education is an administrative violation. (i)Violation of §164.051(a)(3) or violation of board rule §166.2 (relating to Continuing Medical Education). (ii)Standard Sanction: (I)directed CME; and (II)administrative penalty of $1,000 per violation. (H)[(E)] Impairment of ability to practice may be either an aggravated administrative violation or a patient care violation, depending on the whether a violation of the standard of care has resulted from the impairment. (i)Within the meaning of §164.051(a)(4) - inability to practice medicine with reasonable skill and safety to patients because of [off] illness, drunkenness, excessive use of drugs, or a mental condition. (ii)Standard Sanction: suspension of license until such time as the licensee can demonstrate that the licensee is safe and competent to practice medicine. (iii)Alternate Standard Sanction: probation of suspension for 10 [5] years under terms and conditions, including, but not limited to: (I)drug testing; (II)restrictions on practice; (III)alcoholics anonymous/narcotics anonymous attendance; (IV)psychiatric/psychological evaluation and treatment; and (V)proficiency testing. (iv)Chapter 180 of this title (relating to Rehabilitation Orders) provides guidance on whether a licensee is eligible for and should be placed under a confidential rehabilitation order. (I)[(F)] Failure to maintain adequate medical records may be either an administrative violation or a patient care violation, depending on whether a patient was harmed because of the failure . (i)Violation of: (I)Section [§]164.051(a)(6) - professional failure to practice medicine consistent with the public health and welfare; (II)Section [§]164.054 - additional requirements regarding drug records; (III)Section [§]164.053(a)(2) - failure to keep complete and accurate records of purchases and disposals of controlled substances and dangerous drugs, and (IV)Section [§]164.051(a)(3) - violation of board rules, including: (-a-)board rule §165.1(a) (relating to Medical Records) - failure to maintain adequate medical records; and (-b-)board rule §170.3 (relating to Authority of Physician to Prescribe for the Treatment of Pain) - prescribing guidelines for the treatment of pain. (ii)Standard Sanction: probation for 2 years under terms and conditions, including, but not limited to: (I)competency testing; (II)directed CME; (III)monitoring of practice; and (IV)administrative penalty of $2,000 per violation. (J)[(G)] Quality of Care is a patient care violation. (i)Violations of: (I)Section [§]164.051(a)(6) - failure to practice medicine in a professional manner consistent with the public health and welfare; and (II)Section [§]164.051(a)(8) - repeated and meritorious medical malpractice claims. (ii)Standard Sanction: (I)The standard sanction, which shall apply in the case of a single patient with no substantial patient harm and no other aggravating or mitigating circumstances, shall be one or more of the following: [(I)suspension of license for 3 years;] [(II)suspension probated after 90 days under terms and conditions, including, but not limited to:] (-a-)limiting the practice of the person, or excluding one or more specified activities of medicine; (-b-)proficiency testing; (-c-)directed CME; (-d-)monitoring of the practice; [and] (-e-)public reprimand; and (-f-)[(-e-)] administrative penalty of $3,000 per violation. (II)Standard sanction in a case involving patient harm or other aggravating factors shall be: (-a-)suspension of license for 3 years; (-b-)suspension may be probated after 90 days under terms and conditions similar to those described in subclause (I) of this clause, immediately preceding. (K)[(H)] Discipline by peers may be either an administrative violation or a patient care violation, depending on the facts underlying the disciplinary action. (i)Within the meaning of §164.051(a)(7). (ii)Standard Sanction: See the applicable standard sanction for the violation of the Texas Medical Practice Act that most closely relates to the basis of the disciplinary action by peers. In addition, the licensee shall comply with all restrictions, conditions and terms imposed by the disciplinary action by peers. (iii)Alternate Standard Sanction: (I)public reprimand; (II)comply with all restrictions, conditions and terms imposed by the disciplinary action by peers; and (III)administrative penalty of $1,000 per violation. (L) [(I)] Disciplined by another state or military may be either an administrative violation or a patient care violation, depending on the facts underlying the disciplinary action. (i)Within the meaning of §164.051(a)(9). (ii)Standard Sanction: See the applicable standard sanction for the most similar violation of the Act. In addition, the licensee shall comply with all restrictions, conditions and terms imposed by the other state or military. (iii)Alternate Standard Sanction: (I)comply with all restrictions, conditions and terms imposed by the other state or military; and (II)administrative penalty of $1,000 per violation. (iv)The standard sanction for a licensee whose license has been revoked by another state or who has voluntarily surrendered his license while an investigation or disciplinary action is pending shall be revocation of the license. (M)[(J)] Improper prescribing, dispensing, or administering of drugs is a patient care violation. (i)Violation of: (I)Section [§]164.053(a)(3) - prescribing or dispensing drugs to a drug abuser; (II)Section [§]164.053(a)(5) - prescribing or administering drugs in a non therapeutic manner; and (III)Section [§]164.053(a)(6) - prescribing or administering drugs in a manner inconsistent with the public health and welfare. (ii)Standard Sanction: The standard sanction, which shall apply in the case of a single patient with no substantial patient harm and no other aggravating or mitigating circumstances, shall be: (I)suspension of license for 2 years. (II)suspension probated after 60 days under terms and conditions, including, but not limited to: (-a-)restrictions on practice, including prescribing, administering controlled substances and dangerous drugs; (-b-)proficiency testing; (-c-)directed CME; and (-d-)administrative penalty of $2,000 per violation. (N)[(K)] Writing false or fictitious prescriptions is a patient care violation. (i)Violation of §164.053(a)(4). (ii)Standard Sanction: (I)suspension of license for 4 years; (II)suspension probated after 90 days under terms and conditions, including, but not limited to: (-a-)restrictions on practice including restrictions on prescribing, administering controlled substances and dangerous drugs; (-b-)proficiency testing; (-c-)directed CME; and Cont'd...
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