Welcome to the eleventh edition of your TDLR Health Monitor. In our April issue, I discussed the challenges we were all facing brought on by COVID-19. Little did I know at that time that three months later we would still be facing these extraordinary challenges. But here we are. 

As you know, my staff and leadership team have continued their work remotely in spite of these circumstances - issuing licenses, answering our phones, and learning to do our jobs in a whole new way. I would like to recognize the small core group of employees that have continued to report to work in person, covering those essential duties that can't be done remotely - opening mail, processing payments and paper applications, and receiving important deliveries.Through their efforts, they have shown bravery and dedication, helping us to continue operating efficiently and effectively and serving our licensed professionals.

Just this week, we learned that one of our own family members has been directly impacted by COVID-19. Dr. Ray Callas, a Beaumont anesthesiologist and member of the Texas Commission of Licensing and Regulation, was diagnosed after many months of non-stop work on the front lines serving the sick. As of this writing, he is doing OK, but he has a message for the public, which he shared on the local news this week:

"My message is don't take this stuff for granted. Don't think you won't get it. It's real. Stay safe, stay protected. I'm so mad. I love being in the trenches caring for people. If you feel you have symptoms, get tested."

Please keep Dr. Callas and everyone serving on the front lines of the pandemic in your thoughts during this unprecedented time.

This continues to be a trying time for all of us, and there is still much uncertainty ahead. I want to extend my heartfelt gratitude to each of you for the important work you are doing keeping our fellow Texans healthy, well, and safe in these difficult times. We will get through it, together.

Yours in Service,

Brian Francis

Executive Director

Have you heard the news? Certain health care practitioners are required to complete an approved human trafficking prevention training course in order to renew their license beginning September 1, 2020. The passage of House Bill 2059 in 2019 added a new training requirement for all individuals who hold a license, certificate, permit, or other authorization under Occupations Code, Title 3 Health Professions.

The human trafficking prevention training course must be approved by the Texas Health and Human Services Commission (HHSC). This is not a one-time training requirement. Licensees must complete a new training course for each renewal cycle after the effective date.

Currently, HHSC has one approved course, free of charge, available on their website. Additional courses will be added as they are approved. You can find more information on the training course on HHSC’s Health Care Practitioner Human Trafficking Training webpage. 

If you hold one of the following TDLR license types, you must comply with the training requirement to renew your license:

Stewart Myrick, Medical and Health Professions Program Specialist, represents the Texas Department of Licensing and Regulation at the State Operations Center (SOC). Since March, he has performed most of his SOC duties remotely and has provided the following update:

Greetings from the (remote) State Operations Center, or SOC. The COVID-19 pandemic has changed our world in many ways. It even affects planning for hurricane season, which officially started June 1 for Texas. Aspects of planning, such as sheltering, supplies, and evacuation, have had to be adjusted to prevent the spread of the virus.  

Since the beginning of June, there have been substantial increases in the number of new positive cases and hospitalizations. The positivity rate for COVID-19 testing has jumped from 5.4% on June 1 to 12.83% as of July 28. The cumulative case count in Texas has grown exponentially during that time, with the count currently at 394,265 confirmed cases as of July 28.

These numbers underscore the need for everyone to follow the preventive measures that have been touted repeatedly – wash your hands, practice social distancing, and wear a face covering when you’re in a public place. If you want to learn more about the different data that is tracked, the Texas Department of State Health Services (DSHS) has a dashboard that is updated daily with case counts, fatality counts, recovery counts, trends and more. You can also see guidance for specific groups on their coronavirus webpage, which can be found here, and on the CDC’s COVID-19 website.

On May 1, the state entered a phased approach to reopening businesses. Governor Abbott and his Strike Force to Open Texas published a set of guidelines for businesses to follow, as they became eligible for reopening. However, due to substantial increases in cases and hospitalizations, some of those guidelines have been revised. You can find the current guidance on the Governor’s Open Texas website. 

On May 13, Governor Abbott announced that license renewal late fees that accrued between March 13 and June 15, 2020, would be waived for occupational licenses issued by TDLR. Additionally, TDLR continuing education requirements were waived for all individual licenses expiring in March, April, May, and June 2020. Licensees still need to submit their renewal applications, pay the required fees, and have their criminal histories checked by TDLR, but they will not need to complete any TDLR-required continuing education this licensing cycle. For licensed midwives, TDLR will recognize any grace period recommended in response to the COVID-19 crisis by an entity providing certification in cardiopulmonary resuscitation (CPR) or neonatal resuscitation.

TDLR will continue to have staff serve at the SOC throughout the COVID-19 pandemic and will bring you important updates as they become available. For more information on TDLR’s response and efforts during the pandemic, please visit our COVID-19 response webpage.

This past spring, the Texas Commission of Licensing and Regulation (Commission) and TDLR Advisory Boards began holding virtual meetings. While the meetings are virtual, they are still open public meetings and anyone may provide public comment.

There are two ways to provide comment: written and verbal. Those wishing to comment must email Public.Comments@tdlr.texas.gov by 12 p.m. the day before the scheduled meeting and must include the following:

• meeting for which the comment is being submitted;
• if the comment is written, or if you would like to speak during the meeting;
• agenda item or specific topic on which the comment is being made;
• commenter’s name;
• commenter’s telephone number;
• whom you are representing; for example: attorney, yourself, name of professional association or other; and
• if the comment is written, include the full written comment.

Written comments are provided to Commission and Advisory Board members but are not read aloud during the meeting. Those who wish to verbally address the Commission or Advisory Board members during a meeting will either receive an email with a link to join the meeting or be contacted by phone during the meeting. Persons providing public comment will have up to three minutes to speak.

Meetings are hosted through Webex and broadcast on TDLR’s YouTube channel.

The Texas Commission of Licensing and Regulation (Commission) adopted amendments to existing Podiatry program rules at their meeting on May 19, 2020.

The Commission also adopted rules to existing program rules at their June 30, 2020 meeting for the following programs:

• Athletic Trainers
• Behavior Analysts
• Dietitians
• Dyslexia Therapy
• Midwives
• Orthotists and Prosthetists
• Speech-Language Pathologists and Audiologists

Many of the rule amendments incorporated new statutory requirements passed by the 86^th Texas Legislature. To view updated rules, please visit the program webpages.

House Bill 1865 was passed by the 86^th Texas Legislature in 2019 and created a new requirement for students who are enrolled in a massage school to hold a student permit. This new law also requires licensed massage schools to properly account for each student who is attending their school.

TDLR is nearing completion of the development of an online database interface that will implement both requirements. The interface will allow for the permitting of massage therapy students and allow licensed massage schools to track and report completed training program and internship hours.

Please continue to monitor the Massage Therapy program webpage for updates regarding the new requirements.

Many of TDLR’s Medical and Health Professions have telehealth regulations in law, rule or both. A couple of programs, including Behavior Analysts and Podiatrists, allow telehealth with few, if any, exceptions.

However, other programs, like Dyslexia Therapy, Speech-Language Pathologists and Audiologists, and Hearing Instrument Fitters and Dispensers, required rule suspensions to allow citizens to continue to receive needed services during the COVID-19 pandemic.

Governor Greg Abbott granted approval of several rule suspensions. These suspensions will remain in effect until terminated by the Office of the Governor or until the COVID-19 disaster declaration is lifted or expires. Licensees will need to follow current program law and rules once the suspensions are lifted.

Telehealth allowances under the disaster declaration provisions include:

Mark your calendars! TDLR will host the next Midwives Educational Summit virtually on Friday, November 6, 2020.

There are currently two confirmed presentations that will cover managing postpartum hemorrhage in the community birth setting and the importance of identifying and quickly referring ear deformities in newborns. Keep an eye on the Midwives Educational Summit webpage as it will provide presentation updates and additional information including how to join the virtual summit.

Participation in the virtual summit is free and attendance will be tracked for licensees wishing to earn continuing education credits. We look forward to hosting this virtual event and hope to see you there.

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.

Protecting consumers and public health and safety is important to TDLR. Did you know that TDLR publishes a list of recent license revocations, cease and desist orders, and permanent injunctions? Visit our Safeguarding Consumers webpage to see the most recent actions taken by the agency and the Texas Commission of Licensing and Regulation.

You can also search for all violations going back three years - including license revocations, suspensions, and fines - on TDLR’s Administrative Order Database.

On June 10, 2020, TDLR resumed a limited number of safety inspections and enforcement investigations. TDLR is committed to ensuring the safety of the public, regulated individuals, and staff, so all agency employees will continue to observe practices that limit the spread of COVID-19.

TDLR employees will:

• identify themselves and show their TDLR-issued ID;
• make all reasonable efforts to practice social distancing;
• wear masks during all inspections or investigations;
• limit the distribution of paper forms or postings; and
• disinfect any equipment they use before entering and after leaving a facility or place of business.

TDLR employees will not:

• ask any member of the public to remove their mask at any time; or
• require a signature on any document.

These measures will be adjusted as needed based on guidance from state public health officials. For more information on how TDLR is responding to COVID-19, visit the agency’s COVID-19 webpage.

Do you prescribe scheduled substances in your podiatry practice? If you do and you haven’t already signed up for the Prescription Monitoring Program (PMP), it is time to do so now.

All prescribers of controlled substances are required to query the patient’s prescription history before dispensing or prescribing opioids, benzodiazepines, barbiturates, or carisoprodol for possible abuse patterns. Prescribers must also report the prescribing of all scheduled substances to the PMP. The Texas State Board of Pharmacy administers the PMP but TDLR can sanction a podiatrist’s license for not complying with applicable laws and rules regarding standards for prescribing controlled substances and dangerous drugs.

The deadline to sign up was March 1, 2020. Details on how to sign up can be found here. Email correspondence can be sent to: texaspmp@pharmacy.texas.gov