Under investigation by the Texas Medical Board: stages, timeline and your rights
Being under investigation by the Texas Medical Board can drag on for months, and the process has its own distinctive stages. This guide walks through them — how an investigation opens, the expert review, the timeline, the standard of proof, the Informal Settlement Conference, and the rights you hold throughout.
Key takeaways
- If your complaint isn’t resolved in the 45-day review, it becomes a formal investigation; the Board must update you every 90 days.
- Standard-of-care cases are reviewed by at least two board-certified experts in your field.
- The Board’s standard of proof is a preponderance of the evidence — lower than California’s clear-and-convincing.
- Most cases run to an Informal Settlement Conference (ISC) in Austin before a board panel.
- Texas has a 7-year statute of limitations on patient-care complaints (longer for care given to a minor).
How an investigation opens
If the complaint isn’t closed during the 45-day preliminary review, it becomes a formal investigation: you’ll receive a letter naming an investigator and usually asking for specific information, and you can keep submitting information as the case develops. The Board must apprise you of the status every 90 days, unless doing so would jeopardise the investigation.
Expert review of the care
For standard-of-care matters, your response and the records are reviewed by at least two experts board-certified in the same or a similar specialty, who issue a report on the care given. Anything you submit is passed to that panel — which is why a well-evidenced response, ideally with supporting literature, matters so much.
How long does it take?
The Board says investigations are completed on average within about six months, with a goal of one year — but in practice a case can run a year or more, particularly where standard-of-care or criminal issues are involved. The 90-day status updates are your main visibility into progress.
The standard of proof
Here Texas differs from California. To sanction you, the Board must prove a violation only by a preponderance of the evidence — “more likely than not” — not by California’s higher “clear and convincing” standard. It is the same standard a civil court applies, which makes a disciplined, fact-based defence all the more important.
How far back can the Board reach?
Texas has a 7-year statute of limitations on patient-care complaints: the Board generally can’t act on care provided more than seven years earlier. The main exception is care given to a minor, where the period runs to the later of the patient’s 21st birthday or seven years after the care.
Where it heads: dismissal, QA panel, or ISC
At the end of an investigation the case is either referred to the Disciplinary Process Review Committee for dismissal, sent to a Quality Assurance Panel, or set for an Informal Settlement Conference (ISC) — a non-public hearing in Austin before a board panel (at least one physician and one public member). You receive all the material the panel will use 45 days before the ISC, and you may bring counsel and witnesses. About a quarter of cases are dismissed at the ISC.
Your rights — and using them
You can be represented throughout, request copies of the records the Board has gathered, submit rebuttal evidence, and appear at the ISC. Delay and silence are the real risks: engage early, meet every deadline, and build the mitigation record — reflection, targeted CME, corrective changes — that shapes any resolution. Our guide to answering a TMB complaint explains the ISC and beyond; if you are earlier in the process, start with what happens when a complaint is filed.
Related courses
Use the time well: demonstrate insight, competence and reflection with structured ethics and professional-development courses for U.S. physicians:
CourseDealing with a Complaint or Investigation Professionally CourseEnsuring Clinical Competence and Patient Safety CourseInsight for Fitness to Practice CourseReflection for Fitness to PractiseThese are structured ethics and professional-development courses with a certificate of completion. They are not accredited continuing medical education (CME) and are not a substitute for the Board’s mandatory continuing education requirements; confirm with the Board how any completion is recognized.
More Texas physician guides
What happens when a complaint is filed against a physician in Texas Answering a Texas Medical Board complaint: your response and optionsFrequently asked questions
How long does a Texas Medical Board investigation take?
On average about six months, with a goal of one year, though complex cases run longer. The Board must update you on the status every 90 days.
Who reviews a standard-of-care complaint?
At least two experts board-certified in the same or a similar specialty, who issue a report on the care. Anything you submit is given to that panel.
What is the standard of proof?
A preponderance of the evidence — ‘more likely than not’ — which is lower than California’s clear-and-convincing standard.
Is there a statute of limitations?
Yes — generally seven years on patient-care complaints. For care given to a minor, the period runs to the later of the patient’s 21st birthday or seven years after the care.
What is an Informal Settlement Conference?
A non-public hearing in Austin before a board panel (at least one physician and one public member). You receive the panel’s material 45 days beforehand and may bring counsel and witnesses; about a quarter of cases are dismissed there.
Can I keep working during the investigation?
Usually yes. The Board can seek a temporary suspension or restriction only where continued practice poses a continuing threat to the public.
This article is general information for education purposes and is not legal advice. If you have received a complaint, a records request or a notice letter from the Texas Medical Board, seek advice from a Texas attorney experienced in medical licence defence and notify your malpractice carrier. Healthcare Ethics Courses is an independent education provider and is not affiliated with, endorsed by, or acting on behalf of the Texas Medical Board or any state agency; names are used for reference only.