The department must require consultation access, refer certain child cases for specialty consultation, share notice and records, use blind peer review in disputed cases, and not block a parent or guardian from getting an alternative opinion.
Sec. 261.3017. CONSULTATION WITH PHYSICIAN NETWORKS AND SYSTEMS REGARDING CERTAIN MEDICAL CONDITIONS. (a) In this section: (1) "Network" means the Forensic Assessment Center Network. (2) "System" means the entities that receive grants under the Texas Medical Child Abuse Resources and Education System (MEDCARES) authorized by Chapter 1001, Health and Safety Code. (b) Any agreement between the department and the network or between the Department of State Health Services and the system to provide assistance in connection with abuse and neglect investigations conducted by the department must require the network and the system to have the ability to obtain consultations with physicians licensed to practice medicine in this state and board certified in the relevant field or specialty, including radiologists, geneticists, orthopedists, and endocrinologists, to diagnose and treat certain unique health conditions, including: (1) rickets; (2) Ehlers-Danlos Syndrome; (3) osteogenesis imperfecta; (4) vitamin D deficiency; and (5) other medical conditions that mimic child maltreatment or increase the risk of misdiagnosis of child maltreatment. (c) During an abuse or neglect investigation authorized by this subchapter or an assessment provided under Subsection (b), the department shall refer the child's case for a specialty consultation if: (1) the department determines the child requires a specialty consultation with a physician; (2) the child's primary care physician or other primary health care provider who provided health care or treatment or otherwise evaluated the child recommends a specialty consultation; or (3) the child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian requests a specialty consultation. (c-1) For a case in which a specialty consultation is required by Subsection (c), the department shall refer the case to a physician who: (1) is licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code; (2) is board certified in a field or specialty relevant to diagnosing and treating the conditions described by Subsection (b); (3) was not involved with the report of suspected abuse or neglect; and (4) was not involved in reviewing the case, including as a member of a review team under Section 261.312 or a multidisciplinary team under Subchapter E, Chapter 264. (c-2) Before referring a child's case under Subsection (c), the department shall provide to the child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian written notice of the name, contact information, and credentials of the specialist. The parent, legal guardian, or attorney, as applicable, may object to the proposed referral and request referral to another specialist. The department and the parent, legal guardian, or attorney, as applicable, shall collaborate in good faith to select an acceptable specialist from the proposed specialists; however the department may refer the child's case to a specialist over the objection of the parent, legal guardian, or attorney. (c-3) Before referring a child's case under Subsection (c), the department shall provide to the child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian all medical records, including radiographs, images, and other documents used by the department and the network during the abuse or neglect investigation. (d) In providing assessments to the department as provided by Subsection (b), the network and the system must use a blind peer review process to resolve cases where physicians in the network or system disagree in the assessment of the causes of a child's injuries or in the presence of a condition listed under Subsection (b). The department shall provide to the child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian the information used to resolve a case described by this subsection, including the names of the physicians, the physicians' opinions, the possible conflicting conditions, all assessments conducted on the child who is the subject of the case, and all medical records related to the child. (e) This section may not be construed to prohibit a child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian from otherwise obtaining an alternative opinion at the parent's, legal guardian's, or attorney's, as applicable, own initiative and expense. The department shall accept and consider an alternative opinion obtained and provided under this section and shall document its analysis and determinations regarding the opinion. (e-1) The department, a referring provider, including a hospital, and the network may not obstruct, prevent, or inhibit a child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian from obtaining all medical records and documentation necessary to request an alternative opinion, including access to the child for that purpose by a health care professional providing an alternative or second opinion or performing diagnostic testing. Added by Acts 2017, 85th Leg., R.S., Ch. 502 (H.B. 2848), Sec. 1, eff. September 1, 2017. Amended by: Acts 2021, 87th Leg., R.S., Ch. 1047 (S.B. 1578), Sec. 1, eff. September 1, 2021. Acts 2025, 89th Leg., R.S., Ch. 345 (H.B. 2071), Sec. 1, eff. September 1, 2025.