Texas Medical Board SOAH Defense

The situation

Dr. Michael Rodriguez, 52, is a family medicine physician in Houston operating an independent practice. In March 2026, the Texas Medical Board sent Dr. Rodriguez a Notice of Proposed Disciplinary Action citing 22 TAC § 190.8(1)(A) (failure to meet the standard of care) and 22 TAC § 170.3 (prescribing violations, failure to document PMP checks).

The TMB's allegations: Dr. Rodriguez managed 28 patients on chronic opioid therapy. An audit of 12 patient charts found that: (a) In 8 charts, there was no documented PDMP (Texas Prescription Monitoring Program) check within the 90-day required window before opioid renewal; (b) In 5 charts, there was no updated treatment goal or functional improvement assessment for the current opioid regimen.

Dr. Rodriguez has two options: (1) Negotiate an Agreed Order with the TMB (consent, accept discipline terms); or (2) Request a SOAH contested case hearing to contest the proposed action.

What Dr. Rodriguez needs to understand: (a) The PDMP documentation failure (22 TAC § 170.3) is the stronger TMB allegation, it's a clear, documented regulatory requirement with an identifiable gap. However, the defense is: the PDMP checks were conducted (Dr. Rodriguez ran them through the PMP Aware portal), but were not documented in the EMR. If PMP Aware logs show the checks were actually performed on the relevant dates, the allegation is a DOCUMENTATION failure, not a substantive compliance failure. The defense is to produce the PMP Aware access logs. (b) The standard-of-care allegation (§ 190.8) is more complex. Whether the treatment goals were adequate depends on the clinical context for each patient. A SOAH hearing would require Dr. Rodriguez to present expert testimony about what a reasonable Texas physician would document for long-term opioid therapy. This is where professional representation has the most value. (c) Agreed Order vs. SOAH hearing decision. If the TMB offers an Agreed Order with relatively mild terms (reprimand, CME requirement), it may be more efficient than a SOAH hearing. If the proposed terms include probation or significant restrictions, a SOAH hearing is worth contesting. The decision framework is a structured analysis the tool can provide. (d) SOAH self-representation guide is procedural only. SOAH tells Dr. Rodriguez HOW to file documents; it does not help him understand WHAT arguments to make. That strategic analysis is the tool's primary value.

Second portrait: Dr. Lisa Thompson, 44, is a psychiatrist in Dallas. The TMB filed a Notice of Proposed Action citing Tex. Occ. Code § 164.051(a)(5) (unprofessional conduct) and § 164.052(a)(18) (exploiting a patient), specifically, allegations that Dr. Thompson entered into a personal friendship with a former patient of 3 years, after formally terminating the therapeutic relationship, and that this post-termination relationship constituted exploitation.

What Dr. Thompson needs to understand: (a) The termination-of-treatment boundary is the critical analysis. Texas law (22 TAC § 165.12) requires physicians to properly terminate a therapeutic relationship before engaging in non-professional relationships. If Dr. Thompson formally terminated the patient relationship in writing, provided transition of care resources, and waited the appropriate time period, the "exploitation" allegation may not be supported. (b) The factual timeline is the defense. Dr. Thompson needs to document: the formal termination letter; the date and method of termination; any transition of care referrals; the date the personal friendship began; the nature of the relationship. (c) Psychiatric professional boundaries are more complex than general medicine boundaries. Psychiatry-specific guidelines (APA ethics, Texas Medical Association) distinguish "dual roles" from "exploitation", if Dr. Thompson can show the post-termination friendship was between two autonomous adults with proper termination of the clinical relationship, the "exploitation" characterization is contestable. (d) Agreed Order risk. A probation order in psychiatry with patient-contact restrictions could be career-ending. Dr. Thompson should strongly consider a SOAH contested hearing to contest the exploitation characterization.

Who receives this

Texas-licensed physicians (MDs, DOs) who received a Texas Medical Board Notice of Proposed Disciplinary Action and are evaluating whether to pursue an Agreed Order or a SOAH contested case hearing. Primary segments: (1) Physicians with prescribing-documentation allegations where PMP compliance can be demonstrated through system logs; (2) Physicians facing standard-of-care allegations where the clinical record supports the care provided; (3) Physicians evaluating Agreed Order terms who want to understand their SOAH hearing rights before accepting. Scale: Texas has ~80,000 active physician licensees; TMB receives 5,000-8,000 complaints per year; a meaningful subset proceed to formal proposed action.

Why the agency will not advise you

TMB cannot advise physicians how to defend against its own proposed actions. SOAH provides procedural information (self-rep guide) but not strategic defense analysis. 15-day deadline to request SOAH hearing (varies by notice type). The Agreed Order vs. SOAH hearing decision is high-stakes, a physician who accepts an unfavorable Agreed Order without evaluating SOAH options may be accepting unnecessary license restrictions.

Key facts, with sources

• The Texas Medical Board (TMB) is the state agency that licenses and disciplines Texas-licensed physicians (MDs and DOs) under the Texas Occupations Code (Ch. 151-167). When the TMB proposes disciplinary action (revocation, suspension, probation, reprimand, or remedial plan), the physician may request a contested case hearing before the Texas State Office of Administrative Hearings (SOAH). SOAH was created by the Texas legislature (Tex. Gov. Code Ch. 2003) as an independent central hearing authority for all Texas state agencies, SOAH ALJs are employees of SOAH, NOT of the Texas Medical Board, and are entirely independent from the TMB's investigative and disciplinary functions. After the SOAH ALJ conducts the contested case hearing, the ALJ issues a Proposal for Decision (PFD). The TMB reviews the PFD and issues a Final Order, accepting, modifying, or rejecting the PFD. The Final Order is appealable to the Travis County District Court and further to the Texas Court of Appeals (Third District). If the physician does not contest the proposed action, the TMB and the physician may enter an Agreed Order (consent order) that specifies the disciplinary terms without a SOAH hearing. SOAH publishes a self-representation guide for parties in contested case hearings, confirming that physicians may represent themselves before SOAH, but the guide provides procedural information only, not substantive defense analysis. Source: Texas State Office of Administrative Hearings · Representing Yourself in General Hearings Cases — SOAH · Texas Medical Board Procedures — TexasMedicalLaw.org
• Texas is the second-largest physician workforce state in the US with approximately 80,000 active physician licensees. The TMB receives approximately 5,000-8,000 complaints per year from various sources (patients, hospitals, insurers, mandatory reporters). The most common TMB disciplinary grounds: (1) Standard of care violations (22 TAC § 190.8), allegations that the physician's diagnosis or treatment fell below the standard of care practiced by similar physicians in Texas; (2) Prescribing violations, the Texas Prescription Monitoring Program (PMP), enforced through the TMB's 'Responsible Opioid Prescribing' rules (22 TAC § 170.3), requires specific documentation for opioid and controlled substance prescribing; (3) Unprofessional conduct (Tex. Occ. Code § 164.051-052), boundary violations, inappropriate relationships, exploitation; (4) Criminal convictions (Tex. Occ. Code § 164.052(a)(7)), crimes involving moral turpitude or patient harm. Texas physicians facing TMB disciplinary action have two primary options: (a) negotiate an Agreed Order (consent order) directly with TMB; or (b) request SOAH contested case hearing to contest the proposed action. Professional defense attorneys: Belo Law (belolaw.com), Lyped Est & Smith, Texas Medical Law, charge $8,000-$40,000+ for SOAH proceedings. No self-serve Texas Medical Board SOAH defense preparation tool was found. Source: Texas Medical Board Investigations — Belo Law · SOAH Hearings — Administrative Hearings at SOAH · Texas Medical Board Discipline — What Happens at SOAH

When to bring in a professional

Self-serve responses fit routine cases: clear facts, amounts a business can absorb, and a deadline still ahead of you. Bring in a licensed professional when the amount at stake is large relative to their fee, the facts are genuinely disputed, criminal exposure is possible, or the deadline has already passed. A short paid consultation to sanity-check your plan is often worth it even when you handle the filing yourself.

All sources for this guide

1. Texas State Office of Administrative Hearings
2. Representing Yourself in General Hearings Cases — SOAH
3. Texas Medical Board Procedures — TexasMedicalLaw.org
4. Texas Medical Board Investigations — Belo Law
5. SOAH Hearings — Administrative Hearings at SOAH
6. Texas Medical Board Discipline — What Happens at SOAH