Office of the Medical Advisor
Texas Labor Code (TLC) sections 413.0511 and 413.0512 require the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) to review the quality of health care provided in the workers’ compensation system and take appropriate action as needed. In addition to reviewing health care providers that deliver services, TLC also requires TDI-DWC to review actions of peer review doctors, designated doctors, utilization review agents, and independent review organizations.
The Medical Advisor advises TDI-DWC regarding the adoption of rules and policies. The Medical Advisor reviews complaints on quality of care received through the Complaint Resolution and Customer Services section and serves as chair of the Medical Quality Review Panel (MQRP). The panel reviews the actions of doctors, other health care providers, insurance carriers, utilization review agents, and independent review organizations in the workers' compensation system.
Office of the Medical Advisor Staff | Health Care Quality Review Staff | Medical Quality Review Panel | Medical Quality Complaints and Reviews | Other Resources
Office of the Medical Advisor Staff
- Donald Patrick, M.D., J.D., Medical Advisor
- Edwin Buster III, M.D., Associate Medical Advisor
Health Care Quality Review Staff
- Mary Landrum, Director - 512-804-4814
- Karen Weinstein, R.N. - 512-804-4297
- Kathy Ellis, R.N. - 512-804-4847
- Teresa Barajas, R.N. - 512-804-4851
- Roy Lewis, Program Specialist - 512-804-4873
Medical Quality Review Panel
- The TDI-DWC is seeking qualified individuals to provide professional services as a member of the MQRP. The Request for Qualifications for MQRP member is available from the Electronic State Business Daily at http://esbd.cpa.state.tx.us/bid_show.cfm?bidid=88936.
Medical Quality Complaints and Reviews
- Input Needed for Development of Health Care Providers Pain Management Services (Opioid) Plan-Based Audit (proposed audit, memo)
- Medical Quality Review Procedure effective January 1, 2011
- Medical Quality Review CY 2012 Annual Audit Plan | memo
- Medical Quality Review Annual Audit Plan effective January 1, 2011
- Medical Quality Review Audit Selection Criteria - approved by the Commissioner of Workers’ Compensation
- December 2011 Utilization Review Agent Plan-Based Audit | memo
- September 2011 Treating Doctors - Lumbar Spinal Fusions Plan-Based Audit | memo (PDF)
- May 2011 Designated Doctor Plan-Based Audit (April 2010 Designated Doctor Review, Follow-Up Audit) | memo (PDF)
- February 2011 IRO Plan-Based Audit | memo (PDF)
- April 2010 Designated Doctor Review (Certification of MMI and IR) (PDF)
- Medical Quality Review Audit Selection Criteria - approved by the Commissioner of Workers’ Compensation
Other Resources
Biographies
Donald Patrick, MD, JD joined the TDI-DWC as Medical Advisor in July 2010. Dr. Patrick served as the Executive Director of the Texas Medical Board until August 2008. Prior to this position, Dr. Patrick practiced neurosurgery in Austin from 1969 to 2001. Currently he is a Diplomate of the American Board of Neurological Surgery and a member of the Austin EMS Advisory Committee, the Texas A&M Kingsville Foundation Board and Board of Managers for Central Health (formerly the Travis County Healthcare District). In addition to his distinguished medical career, Dr. Patrick also earned a J.D. from the University of Texas, School of Law in 1996 and is certified to practice law in the State of Texas.
Edwin R. Buster III, MD joined the TDI-DWC as an Associate Medical Advisor in September 2010. Since 1970, Dr. Buster has been in private practice at Capital Neurosurgical Association in Austin. Currently he is a Diplomate of the American Board of Neurological Surgery and a Medical Consultant to the Texas Medical Board. He is also a member of American Medical Association, Travis County Medical Society, Texas Association of Neurological Surgeons, American Association of Neurological Surgeons and Austin Neurological Society.
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Last updated: 04/12/2012
