The Texas Medical Board (TMB) is required by law to review and address every complaint it receives from the public regarding physician conduct — from reports of unprofessional conduct, inappropriate prescribing, poor record-keeping or violations of the standard of care.
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In March 2026, the TMB announced “refinements” to its enforcement of board complaints. These changes are based on a comprehensive internal review that offered solutions to reduce administrative burdens and less punitive, aggressive sanctions for minor offenses. The TMB is trying to amend its responses to minor violations so it can focus resources on more serious patient safety concerns.

The TMB now uses the following two non-disciplinary resolution tools to address minor or isolated violations.

1. ‍Warning letters are “non-disciplinary in nature and provide an informal resolution for … administrative matters such as billing, failure to release medical records, and continuing education audit violations.” (1)
   
   Warning letters are non-disciplinary and non-public and are not reported to the National Practitioner Data Bank (NPDB). However, they are still added to the physician’s confidential TMB record. The warning letter will give the recipient a deadline to correct the issue and report back. If the licensee provides documentation that corrective action was taken, the complaint is dismissed.
   
   Warning letters are only available for first-time violations (no prior warning letter, remedial plan, or agreed order for the same issue). They essentially replace Remedial Plans for minor first-time administrative infractions and are designed to facilitate less paperwork and a faster resolution.
   
   
2. Letters of Concern are also non-disciplinary by nature and used to resolve certain standard of care issues, specifically those that do not involve severe patient harm or death; sexual boundaries; or allegations involving physician impairment. It's a formal acknowledgment of a violation that is determined to be an isolated, limited-harm incident.
   
   Letters of concern are only issued after a full review process is carried out, including initial review by a physician-investigator; formal response from the physician licensee regarding the allegations; and a final review by an outside expert panelist of all documents. If a violation fits the parameters set forth for this resolution tool, the physician receives a letter of concern.
   
   The letter of concern will indicate that the TMB has chosen not to pursue further action, but encourages the licensee to “closely review the care provided in the case, reflect on the experts’ findings outlined in the panelist report, and use it as opportunity to evaluate their current practices to prevent similar issues in the future.” (1)
   
   The letter confirms that the complaint has been dismissed; however, the file remains a part of the physician’s confidential TMB record. A letter of concern may also recommend, but not require, continuing medical education activities relevant to the complaint. The person(s) or entity that brought the complaint is also allowed to appeal the dismissal and request further investigation.

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Both tools were designed by the TMB to be part of a “progressive discipline model” that tracks and documents a licensee’s history to determine patterns of behavior. Repeat violations may escalate to a Remedial Plan or Agreed Order.

It is still very important for TMLT policyholders to contact the TMLT Claim Department if you receive any complaint notice or letter from the TMB, including a warning letter or letter of concern. Additional instructions for what to do in the event of a TMB notice is found here.

Source

1. Zaafran S. Refining TMB enforcement. The Bulletin. Texas Medical Board. March 2026. Available at https://www.tmb.texas.gov/media/1320/download?inline. Accessed April 28, 2026.