Welcome to Volume Five of your TDLR Health Monitor! For those of you who are new to TDLR, I’m Brian Francis, Executive Director.

As our year draws to a close, and we get ready for the holiday season with our families and friends, I want to share some of our highlights from 2018 and briefly discuss the year ahead:

Strategic Planning. The biennial Strategic Planning Sessions we held across Texas in April were the highlight of our year at TDLR. We held five Strategic Planning Sessions in Arlington, Austin, El Paso, Houston and McAllen. During each session participants were asked to respond to the following questions about TDLR:

• What are we doing well?
• If you were king or queen for a day, what changes would you make to TDLR’s laws, rules, or processes?
• During the next five years, what major changes do you expect in your profession or industry, and in the state of Texas?
• What changes should we make to prepare for the next catastrophic event, such as Hurricane Harvey?

At these sessions, we had the opportunity to hear directly from you, our licensees, and the public about how we’re doing and how we can improve. Your feedback during these open and interactive sessions helped us chart the course for TDLR’s future, which can be found in our 2019-2023 Strategic Plan: Seeing a Brighter Future with Common-Sense Solutions.

We asked these same questions in an online survey for those who could not attend an in-person session. Participants shared their thoughts about how we’re doing and how we can improve. Ideas and suggestions from these strategic planning efforts make a difference. We make process improvement and rule changes based on your feedback, and we share your feedback with state lawmakers. 

We value your input in helping chart the course for TDLR’s future, and your ideas create real change for Texas. I want to thank everyone who participated, whether in person or online, for sharing their time and energy to help us learn where we can improve.

New Commissioners. In February, Governor Greg Abbott appointed two new commissioners to the Texas Commission of Licensing and Regulation, both of whom have medical and health-related backgrounds. Ray Callas, M.D., F.A.S.A., of Beaumont, and Gary Wesson, D.D.S., M.S., of Bastrop, add valuable clinical knowledge to the broad expertise in civic, community, and consumer organizations already represented on the Commission. It's been a pleasure to get to know both of them this year. Their knowledge and insight, especially into our medical and health programs, is already proving to be a valuable asset to TDLR.

Welcome, Behavior Analysts. In June, we welcomed the newest licensing program at TDLR, Behavior Analysts, which was created by the 85th Texas Legislature in 2017 through the enactment of Senate Bill 589. TDLR began accepting online applications for behavior analysts and assistant behavior analysts on June 15, 2018. By close of business on June 15, we had received 311 applications. One week later, more than 600 licenses had been issued. As of December 1, 2018, the number of licensed behavior analysts and assistant behavior analysts in Texas stands at 1,597.

I am so proud of the work done by our staff and the new Behavior Analysts Advisory Board to get this program up and running well ahead of schedule, and to get these important health professionals licensed quickly and working to help our fellow Texans.

Outreach. Throughout this entire year, our Medical and Health Professions staff have logged countless miles and hours, interacting face-to-face with the professionals they serve at conferences, workshops, and meetings all across the state. From Frisco to South Padre Island, Galveston to Waco, League City to Grapevine, The Woodlands back to Austin, our program specialists and division directors met and spoke with thousands of licensees and industry professionals in 2018.

At TDLR, I strongly encourage these outreach efforts so we can hear directly from the public about how our agency is serving them - or not serving them - as the case may be.  Another way we hear directly from those we serve is through our advisory board meetings. This year, we held a record number of public meetings - 82 in total, 29 of which were for our medical and health programs.

Open and free communication and transparency are central to our agency’s core values, and there’s no greater way to live these values than by talking with and learning from the people we serve. We hope to see you in 2019!

Looking ahead. On January 8, 2019, the 86^th Texas Legislature will convene in Austin for the next 140-day legislative session. As always, we will be working closely with legislators, the Governor's office, and their staff to find ways to make improvements to all our licensing programs. Throughout this upcoming year, our guiding principles will be the five goals and objectives laid out in our Strategic Plan:

1. Continue to effectively consolidate and improve administration of and services for the 16 programs recently transferred to TDLR by the Texas Legislature.
2. Improve efficiencies, lower fees, and eliminate bottlenecks throughout TDLR.
3. Educate and empower consumers by providing them with the tools to make informed choices about the industries TDLR regulates.
4. Prioritize enforcement personnel efforts to resolve complaints involving consumer harm or a threat to public safety.
5. Decrease regulatory burdens on business by removing redundancies and impediments.

Each of these five goals was developed through the Strategic Planning process we undertook - the ideas and feedback we received from our licensees, industry stakeholders, and the public. I look forward to reporting back to you in the spring on our progress in meeting each of these goals. 

In the meantime, rest assured that throughout 2019 and beyond, we will strive to deliver an exceptional customer service experience to you and your fellow health professionals and we will continue to assist you in the best way we know how to ensure the health and safety of our fellow Texans.

Yours in Service,

Brian E. Francis

TDLR Executive Director 

On Saturday, November 10, 2018, the American Medical Association honored TDLR Commissioner Ray Callas, M.D., F.A.S.A., for his selfless commitment to his community last year during Hurricane Harvey.

Dr. Callas received the AMA Medal of Valor for his work on behalf of patients and his Beaumont community in the wake of the Category 4 storm that devastated the Texas coast in 2017. The award recognizes physicians who demonstrate courage under extraordinary circumstances in non-wartime situations. 

“Dr. Callas selflessly put the safety and comfort of his patients and neighbors before all else, working with hospitals and emergency response teams to secure transportation to functioning hospitals for struggling patients,” said AMA President Barbara L. McAneny, MD. “But his tireless work extended beyond medicine and logistics as he also spent days cooking and serving food at a local restaurant while homes were evacuated for flooding.”

“I just did what every other physician in this room would do,” Dr. Callas told the AMA House of Delegates, “and that is take off my white coat, put on any gloves that we could find to help support our families, our friends, and our neighbors.”

He shared the story of a woman who suffered a heart attack in the middle of the storm, her house surrounded by flood water. Dr. Callas arranged for a Black Hawk helicopter to pick her up off of her home and transport her to a hospital, where she had successful heart bypass surgery.

“It’s an honor and a privilege to receive this award from the AMA,” he said. “And on behalf of southeast Texas, we thank you from the bottom of our heart.”

The Texas Medical Association nominated Dr. Callas for the award.

In addition to his work in the aftermath of Hurricane Harvey, Dr. Callas competed in Dancing with the Stars Beaumont to raise money for community charities. 

TDLR congratulates Dr. Callas on this well-deserved recognition!

On October 22, 2018, what seemed like a normal Monday afternoon at Longview High School turned into a life-saving moment for licensed athletic trainer Deirdre Scotter. As practice was wrapping up for the Lobos cross country team, coach Ken Jernigan collapsed without warning. Scotter sprang into action and began life-saving measures. Scotter, with the help of others, was able to stabilize the coach’s condition until EMS arrived. 

TDLR commends the quick action of Deirdre Scotter that led to saving Ken Jernigan’s life. She will be honored at the next meeting of the Advisory Board of Athletic Trainers, currently scheduled for Monday, January 14, 2019 in Austin. 

On January 8, 2019, the Texas Legislature will convene and the 86^th Regular Session will begin. On that day, the Texas House of Representatives and the Senate of Texas will both be “open for business.” 

Although the session doesn’t officially start until January, TDLR staff are already hard at work reviewing pre-filed bills (pre-filing began on November 12, 2018). Based on past sessions, we can expect about 5,500 to 7,000 bills to be filed and about 1,200 to 1,500 bills to pass.

Throughout the session, be sure to check our new 86th Legislature webpage to see a list of the bills filed that, if enacted, would impact TDLR's programs.

The Texas Commission of Licensing and Regulation has adopted new criminal conviction guidelines for the Podiatry program and Massage Therapy program. 

The guidelines describe the process by which TDLR determines whether a criminal conviction means an applicant is an unsuitable candidate for the license, or whether a conviction warrants revocation or suspension of a license that was previously issued. 

For more information on how these guidelines are established, visit TDLR's Criminal Conviction Guidelines webpage. 

Hearing instruments or hearing aids are regulated at the federal level as medical devices by the U.S. Food and Drug Administration (FDA). Changes are being made at the federal level regarding hearing instruments that will affect two of TDLR’s programs, the Hearing Instrument Fitters and Dispensers program and the Speech-Language Pathologists and Audiologists program. These two programs regulate the fitting and dispensing of hearing instruments by Texas licensees.         

In August 2017, the U.S. Congress passed the FDA Reauthorization Act of 2017 (FDARA), which in part defines “over-the-counter hearing aid,” requires the FDA to establish a category of over-the-counter (OTC) hearing aids, and specifies certain requirements that must be included in the FDA regulations. The FDA is in the process of drafting proposed regulations for a new category of over-the-counter hearing aids. The FDA must publish the proposed regulations for public comment by August 18, 2020 and publish the final regulations not later than 180 days after the comment period closes. The FDA has issued a letter clarifying that the over-the-counter category of hearing aids does not exist until the effective date of a published final regulation.

Licensed Hearing Instrument Fitters and Dispensers and licensed Audiologists may wish to visit the FDA’s website on hearing aids or subscribe to the FDA’s email updates for additional information. 

TDLR recognizes the importance of its role in stopping human trafficking. Human trafficking is modern-day slavery and involves the use of force, fraud, or coercion to obtain some type of labor or commercial sex act. Our agency has aligned itself with the Governor’s and Attorney General’s initiatives to end human trafficking in Texas.

To report suspected human trafficking, contact the National Hotline for Human Trafficking at 1-888-373-7888 or text HELP or INFO to BeFree (233733). If the situation is an emergency or you believe someone is in immediate danger, call 911 and alert the authorities.

For resources and more information on human trafficking, including TDLR’s efforts in human trafficking prevention and training, visit our Human Trafficking webpage.

In the coming months, TDLR Medical and Health Professions staff will be available at a number of conferences and meetings across Texas to provide licensing and program information to attendees.

We hope to see you at one of these upcoming events!

• CEAT 34th Annual Business & Education Conference – February 11-16, 2019, El Paso
• Texas Speech-Language-Hearing Association 63^rd Annual Convention & Exhibition - February 28 - March 2, 2019, Fort Worth
• Texas On-site Wastewater Association 2019 Annual Conference – March 11 - 13, 2019, Waco
• Texas Association for Behavior Analysis 2019 Regional Conference - March 14 - 17, 2019, Fort Worth

Katie Brice, Senior Program Specialist, will be conducting school presentations in April for universities with speech-language pathology programs. If a program director is interested in having her stop by and give a presentation to graduating students, please contact her at Katie.Brice@tdlr.texas.gov to schedule.

TDLR is available to provide informational presentations and/or staff booths at your next conference or meeting. If you would like a TDLR representative at your next conference or meeting, contact us at: RPM.Health.Professions@tdlr.texas.gov.

TDLR is pleased to announce that we will host a midwifery conference on Monday, January 7, 2019. The conference will begin at 9 a.m. in the 1st Floor Public Meeting Room of TDLR's North Campus Building, located at 1106 Clayton Lane, Suite 125E, in Austin.

The conference will include panel presentations on aspects related to the practice of midwifery and an overview of TDLR. 

For updates and more information on the midwifery conference, be sure to sign up for email updates and keep an eye on the Midwives webpage.  

The Texas State Board of Pharmacy (TSBP) began issuing new prescription forms on September 1, 2018. New forms are being issued with additional security features to help combat prescription fraud and abuse.

Effective June 1, 2019, all versions of the official prescription form issued prior to September 1, 2018, will no longer be valid. Podiatrists can destroy old prescription forms and submit a Report of Lost, Stolen, or Destroyed Schedule II Official Prescription Forms or tear the old prescription forms in half and mail them to the TSBP.

The TSBP has published on their website that the processing time to receive new prescription forms may exceed 45 days. For questions regarding ordering or destroying prescription forms, please contact the TSBP.

During the 2017 legislative session, the 85th Texas Legislature passed House Bill 2561 which requires podiatrists to check a patient’s prescription history, through the Texas Prescription Monitoring Program (PMP), before dispensing or prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. The requirements go into effect on September 1, 2019; however, podiatrists are encouraged to register and begin using the system now.

Podiatrists can register for the PMP at www.texas.pmpaware.net/login. Visit the TSBP’s PMP webpage for additional information.

The Texas Commission of Licensing and Regulation adopted amendments to existing rules at their meeting on September 25, 2018. Among the rule amendments are revisions to the Orthotists and Prosthetists program rules and the Podiatry program rules.

The Commission also adopted amendments to add behavior analysts and podiatrists to the General Provisions for Health-Related Programs. 

The amendments went into effect on November 1, 2018 and updated rule chapters are now available on the Orthotists and Prosthetists program webpage and the Podiatry program webpage. You can find the updated provisions for the health-related programs by clicking here. 

You can file a complaint online for most TDLR programs at the following link: https://www.tdlr.texas.gov/complaints/. 

You will be asked to choose whether you are filing a complaint against a licensed or an unlicensed person or business. If you are unsure about whether the person or business holds a TDLR license, use the unlicensed link.

Some medical or health-related programs require you to submit a complaint form by fax or mail, due to the risk of electronically transmitting confidential health information. The online system will direct you to print out a complaint form in .pdf format if one is required.

If your complaint does not allege a violation of the law or rules or does not include sufficient information for TDLR to investigate the allegations, TDLR will not open a complaint.

Read more about TDLR's complaint investigation and resolution process.

On October 26, 2018, the Texas Commission of Licensing and Regulation appointed new members to the Massage Therapy Advisory Board and the Registered Sanitarian Advisory Committee.

The Massage Therapy Advisory Board welcomes Roberta Hutson of San Antonio as a new public member.

The Registered Sanitarian Advisory Committee welcomes Erin Dunn of College Station as a new consumer member.

Our advisory boards and committees are vital to the success of TDLR. Members provide invaluable consumer insight and technical and clinical expertise. We look forward to working together with these talented individuals as they help shape the future of the TDLR medical and health professions they represent. 

TDLR currently has vacancies on the Dietitians Advisory Board, the Podiatric Medical Examiners Advisory Board, and the Registered Sanitarian Advisory Committee. If you would like more information or are interested in serving on one of these boards, contact us at advisory.boards@tdlr.texas.gov.

Unless otherwise noted, Commission meetings and all advisory board meetings are held at TDLR's North Campus in the 1st Floor Public Meeting Room. TDLR public meetings are broadcast live and archived on TDLR's YouTube channel. Meeting notices, agendas, and staff reports are posted on the TDLR Meetings page.