No Dogs Allowed!

October 26, 2008 in Medicine by RangelMD

The Texas Medical Board is entrusted in part to safeguard the medical care of the public by oversight of medical professionals. Every few months they go through thousands of complaints (usually filed anonymously) to discipline a handful of physicians. Apparently, complaints with any merit what-so-ever are hard to come by given that the board felt compelled to pursue the following little gem among 34 discipline cases from its October 16th meeting.

According to the TMB’s own documentation, a patient identified only as “C.B.” was seen by Dr. Vijesh Patel in his office in November 2004. A dog accompanied CB during this visit and CB claimed that she had a history of seizure disorder and that the dog was a “seizure alert dog”. CB had no documentation of a history of seizure disorder and was not on any anti-seizure medication. CB did not provide documentation identifying the dog as a service animal and Dr. Patel felt that the patient did not have a history of seizure. CB was informed that dogs are not usually allowed per office policy.

CB returned in August 2005, again with the dog and was again informed that dogs are not allowed. CB was told that she could be seen with her dog at a time when other patients were not in the office (apparently one or more patients complained about the dog) but she left without being seen. CB filed a complaint and rather then contest this further, Dr. Patel agreed to a $250 “administrative penalty” imposed by the TMB.

There were no accusations nor any evidence that this issue adversely affected CB’s access to or quality of health care received. Contrary to the name, “seizure alert”, these dogs do not help their owners prevent seizure but rather are trained to recognize  and assist in the event of a seizure. This ability to assist is significant if the patient is alone or with people who are unable or unwilling to assist the patient. The importance of a service animal in the setting of an office of a medical professional is dubious at best. So, what was the problem?

The TMB claimed jurisdiction in this case under a provision of the Texas Medical Practice Act that allows for disciplinary action to be taken against a physician who violates “any state or federal law if the act is connected with the physician’s practice of medicine.“  The law in question is the Americans with Disabilities Act (ADA) which allows (with very few exceptions) disabled people to be accompanied by a service animal into any business without the need for identification or documentation that the animal is actually a required service animal.

Even though certain states can impose criminal penalties if someone falsely claims to have a disability requiring a service animal, the Federal ADA apparently does not have any such provisions and prohibits businesses from requiring documentation of the need and certification of the service animal. This has lead to concern that these loopholes could easily be exploited.

But all of these pertinent issues were ignored by the TMB in it’s robotic interpretation of a poorly written, vague, and overly reaching Federal law and their interpretation of “connected to medical practice” to extend even further to mean allowing animals into the office. Given that most businesses (including most health care facilities and health care professionals) do not realize the implications of the American with Disabilities Act with regard to service animals, it’s clear that Dr. Patel’s actions were neither intentionally malicious nor “likely to deceive or defraud the public” (as stated in section 164.053 defining Unprofessional or Dishonorable Conduct in the Texas Medical Practice Act). In short, this case is not at all adherent to the spirit and intent of the law!

This simple case could have been easily resolved with better effort on the part of patient and physician to clear up this misunderstanding . . OR . . a simple letter of warning and clarification to Dr. Patel from the TMB regarding this issue. However, the TMB (apparently) is not allowed to send out warning letters and instead is allowed to spend thousands of tax payer dollars in pursuit of a $250 fine in an effort to fill what appears to be an unofficial quota of discipline cases per meeting. Now Dr. Patel’s name appears on the same list as physicians disciplined for sexual abuse, fraud, assault, substance abuse, and gross negligence.

Without any reforms to the Texas Medical Practice Act on the horizon we can expect this sort of harassment of Texas physicians to continue and to grow in severity for the foreseeable future.  The TMB will continue to try and expand its power and control (and funding) via its jurisdiction over any possible conceivable thing “connected to the practice of medicine”. If you are a physician considering a move to another state to practice, I would advise that you avoid Texas like the plague.

At least for now.

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