22 Tex. Admin. Code § 80.5 - Peer Review Process

(a) During the investigation of a complaint, the Enforcement Committee may order the outside peer review of a licensee's standard of patient care or billing practices.

(b) To qualify as a peer reviewer, a person shall:

(1) have an active license with the Board or appropriate professional credentials;

(2) have no prior violations of Board statutes or rules;

(3) have no open complaints;

(4) have no felony convictions or misdemeanor convictions for a crime of moral turpitude;

(5) show sufficient training or experience to offer an informed opinion;

(6) show knowledge of accepted standards of chiropractic care in Texas or other professional standards related to the alleged violation; and

(7) have an acceptable malpractice complaint history.

(c) A peer reviewer may not review a complaint if the peer reviewer has:

(1) a direct financial interest or relationship with any party or witness to the complaint that gives the appearance of a conflict of interest;

(2) a familial relationship within the third degree of affinity with any party or witness;

(3) personal knowledge of any information about any party or witness related to the complaint; or

(4) any other reason where the peer reviewer could not fairly and impartially consider the complaint.

(d) The Board shall maintain a list of peer reviewers and shall periodically audit the list to confirm their qualifications.

(e) Board staff shall select a peer reviewer when an investigator identifies a standard of care or other professional standard beyond the expertise of staff in the complaint.

(f) Board staff shall randomly select a peer reviewer from the list based on the peer reviewer's qualifications to review the type of complaint.

(g) The executive director shall remove a peer reviewer from the list for:

(1) failure to maintain the required qualifications;

(2) failure to timely complete reports;

(3) failure to inform the Board of potential or apparent conflicts of interest; or

(4) failure to maintain the confidentiality of any matter.

(h) The Board shall provide to the peer reviewer:

(1) the complaint;

(2) the investigator's report;

(3) the Board's peer review report form; and

(4) a contract for services.

(i) The peer reviewer shall review all relevant information to determine if a licensee violated the applicable standard of care in Texas or other professional standard and prepare a written report.

(j) The peer reviewer's report shall include:

(1) the peer reviewer's qualifications;

(2) the relevant facts of the complaint;

(3) the applicable standard of care or other professional standard;

(4) an application of the standard of care in Texas or other professional standard to the facts;

(5) a finding of whether the standard of care or other professional standard was met; and

(6) the clinical basis for the findings, including the use of any peer-reviewed journals, studies, or reports.

(k) A peer reviewer may not offer a legal opinion as to whether a particular statute, Board rule, or other law was violated.

(l) A peer reviewer may not offer an opinion on the legal liability of any individual for an injury sustained by a patient.

(m) The peer reviewer shall complete and return the review to the Board within 30 days, unless the peer reviewer requests more time due to the complaint's complexity.

(n) The Board shall give the peer reviewer's report to the licensee within 30 days of receipt.

(o) The Enforcement Committee shall consider the report and the licensee's response in determining if a violation occurred.

(p) The Enforcement Committee may order additional peer reviews if necessary.

Notes

22 Tex. Admin. Code § 80.5

Former section transferred to 22 TAC § 82.5 by Texas Register, Volume 43, Number 42, October 19, 2018, TexReg 6963, eff. 11/1/2018; current section adopted by Texas Register, Volume 40, Number 04, January 23, 2015, TexReg 379, eff. 1/29/2015; Adopted by Texas Register, Volume 43, Number 12, March 23, 2018, TexReg 1861, eff. 3/29/2018; Transferred from 22 TAC § 78.12 by Texas Register, Volume 43, Number 42, October 19, 2018, TexReg 6963, eff. 11/1/2018; Adopted by Texas Register, Volume 44, Number 39, September 27, 2019, TexReg 5623, eff. 10/3/2019; Adopted by Texas Register, Volume 48, Number 34, August 25, 2023, TexReg 4663, eff. 8/31/2023