Texas Physician Assistant License Defense:

As a physician assistant in Texas, your license represents years of rigorous education, significant financial investment, and your ability to earn a substantial living. A criminal charge doesn’t just threaten your freedom. It threatens your career, your income that averages approximately one hundred forty-three thousand dollars annually, and everything you’ve worked to build.

I’m Pat Ruzzo, and I have been a criminal defense attorney based in Houston, Texas for over thirty-five years. During my career, I have represented  and advised physician assistants in both criminal cases and licensing matters before the Texas Physician Assistant Board and the Texas Medical Board. What I have learned through this experience is that physician assistant licensing is more strictly regulated than nursing or pharmacy licensing. Only physicians themselves face comparable levels of scrutiny and regulatory oversight.

The relationship between criminal charges and physician assistant licensure is complex, nuanced, and often misunderstood. Physician assistants who try to handle these matters themselves almost always make their situation significantly worse.

What’s Actually at Stake When You’re Arrested

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Let’s be clear about what you stand to lose.

Physician assistants in Texas earn an average annual salary of approximately one hundred forty-three thousand dollars. This is substantially more than registered nurses, who average around eighty-five thousand dollars, and comparable to some specialized nursing roles. Over a thirty-year career, you’re looking at potential lifetime earnings exceeding four million dollars.

You have invested years in your education. You completed a rigorous physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant. You passed the Physician Assistant National Certifying Examination, potentially through multiple attempts. You passed the Texas Jurisprudence Examination. You completed the extensive application process with character and fitness requirements. You may have completed a residency in a specialized area of medicine.

A criminal charge puts all of that at risk.

But it’s not just about the money. Your physician assistant license represents your professional identity, your ability to practice medicine under physician supervision, your prescribing authority, and your standing in the medical community. When that license is threatened, everything is threatened.

Before we discuss what happens after an arrest, you need to understand how physician assistant regulation works in Texas.

The Texas Physician Assistant Board was created as an advisory board to the Texas Medical Board. This is a critical distinction from other healthcare licensing boards.

Here is how it works:

The PA Board conducts licensing, investigations, and makes disciplinary recommendations.

The Texas Medical Board has final authority over issuing licenses, imposing discipline and sanctions, approving agreed orders, and making final orders.

The Texas Medical Board also establishes the procedural rules that govern investigations, informal settlement conferences, State Office of Administrative Hearings litigation, and temporary suspensions.

In practical terms, the Texas Physician Assistant Board acts as an arm of the Texas Medical Board that exercises oversight over physician assistants on behalf of the Medical Board.

This structure means that physician assistants are subject to the same rigorous standards and procedures that apply to physicians, but through a specialized board that understands physician assistant practice.

The first question most physician assistants ask me is how the Board will discover their arrest.

They find out in several ways:

Someone reports it. This could be:

• Your employing physician or medical practice
• A hospital where you have privileges
• Coworkers or other healthcare professionals
• Patients
• Law enforcement
• Other licensing boards if multiple healthcare professionals are involved in an incident

You self-report.
When you renew your physician assistant license biennially (every two years), you are asked whether you have been arrested or have pending criminal charges. The rules about what you must report are specific and complex.

Many physician assistants believe they can research these reporting requirements themselves and determine what to disclose. This is a mistake. The rules are nuanced, and failing to report when required is itself a violation that can result in discipline separate from whatever criminal charge you are facing.

The Board discovers it through their own processes.
The Texas Physician Assistant Board and Texas Medical Board have access to criminal databases and law enforcement records. They can discover arrests even without someone specifically reporting them.

Peer review processes.
Hospitals and medical practices conduct peer review of physician assistants. If peer review reveals conduct that must be reported to the Board, that can trigger an investigation.

Cross-reporting from other states or boards.
If you hold licenses in multiple states or if you are involved in an incident with other healthcare professionals, information may be shared between licensing authorities.

The critical point is this: if you don’t self-report properly when required, that failure to report becomes its own violation. You then face discipline not only for whatever conduct led to your arrest, but also for failing to report truthfully.

Here is the typical sequence of events when a physician assistant gets arrested in Texas:

Immediately After Arrest
You are arrested for a criminal offense. Many employers require physician assistants to report any arrest within a specified timeframe, often forty-eight hours, as part of their employment contract. If you work for a hospital, medical group, or institutional employer, check your employment agreement.

Many physician assistants panic at this stage and either say too much to their employer or try to explain what happened. This is often the first critical mistake.

Within Days to Weeks
Your employer may report your arrest to the Texas Physician Assistant Board or the Texas Medical Board. Or you might be approaching your license renewal period and face questions about arrests and pending criminal cases on your renewal application.

Peer Review May Be Initiated
If the arrest relates to your professional practice, your employer may initiate a peer review process. Peer review in the medical context has special confidentiality protections, but outcomes that impact your privileges or membership, and certain specified conduct, must be reported to the Board.

The Board may obtain investigative information from peer review proceedings, subject to statutory limits.

The Notice of Investigation
Eventually, you receive a letter from a Board investigator. This could be weeks or months after your arrest. This is typically when physician assistants contact me.

The letter usually contains:

• A summary of the complaint or allegations
• The specific rules allegedly violated
• Supporting evidence for the allegations
• Rules about timelines for notices and submitting a written response
• Information about the informal resolution compliance panel that will review the case
• A deadline for your response

Most physician assistants do not understand what this letter actually means. It is not a conviction. It is not a formal charge. It is not even necessarily a determination that you have done anything wrong. It is a notice that allegations have been made and the Board is investigating.

But how you respond to this letter can determine whether you keep your license or lose everything.

Understanding the process is critical because at each stage, you have rights you must affirmatively invoke. If you do not invoke them properly and within the statutory deadlines, you waive them permanently.

The disciplinary process for physician assistants is similar to other healthcare licensing boards but with important differences in structure and procedure.

Stage 1: Complaint and Investigation

When a complaint is received, it is processed under the Texas Medical Board’s rules, but there is a physician assistant specific framework for handling these complaints.

The investigation consists of:

• Review of the complaint and supporting evidence
• Collection of relevant records (employment records, medical records, pharmacy records)
• Interviews with witnesses
• Review of any criminal case information

You will be given notice that includes:

• What the allegations are specifically
• Supporting evidence for those allegations
• The rules about timelines and procedures
• Information about submitting a written response before the informal resolution compliance panel reviews the case

Stage 2: Written Response

Your written response is critical. This is not a brief letter. It should be a comprehensive document that addresses each allegation specifically and provides supporting evidence.

I have submitted responses that included:

• Detailed admissions or denials of every factual allegation
• Supporting documentation for each denial
• Employment records showing excellent performance
• Evidence of treatment or rehabilitation if relevant
• Character references from supervising physicians and colleagues
• Documentation showing compliance with all professional obligations
• Any evidence that supports your position

After you submit your response, there are limitations on communications with the panel that are established by rule. You cannot simply reach out to panel members without following proper procedures.

Stage 3: Informal Settlement Conference

The informal settlement conference is usually the best opportunity to resolve a case short of formal litigation. If you are not prepared when you reach this phase because you thought you could handle it yourself, and you wait to hire a lawyer until formal litigation begins, you have made a serious mistake.

At the informal settlement conference:

• You, your attorney, and Board representatives meet to discuss the allegations
• You learn what evidence the Board believes it has
• You understand what sanctions they are considering
• You may be able to negotiate a resolution

Potential outcomes of the informal settlement conference include:

• Dismissal if the Board determines there is no violation
• A remedial plan involving continuing education or corrective actions
• An agreed order with negotiated terms
• Referral to the State Office of Administrative Hearings for formal hearing
• Deferral because more information is needed

You are entitled to legal representation at this conference, and once you have an attorney, the Board is required to communicate only through your attorney.

Stage 4: Formal Administrative Hearing

If no settlement is reached which is agreeable to you and acceptable to the Board, a formal complaint is filed at the State Office of Administrative Hearings.

This is a complex legal proceeding with:

• Formal pleadings
• Discovery procedures
• Evidentiary rules that are somewhat different from criminal or civil trials
• An adversarial hearing before an administrative law judge
• Witness testimony and document presentation

After the hearing, the administrative law judge issues a Proposal for Decision. The Board then reviews this proposal and takes final action.

The burden of proof is preponderance of the evidence, meaning it is more likely than not that you violated Board rules. This is a significantly lower standard than the beyond a reasonable doubt standard in criminal court.

Stage 5: Final Action and Appeals

Once there is a final disciplinary order issued by the Board, strict deadlines apply. The procedures and deadlines for contesting the final order depend on the type of action taken.

Motion for Rehearing. You typically have twenty-five days after the Board signs the final order to file a motion for rehearing. The Board must act by day fifty-five, or the motion is overruled by operation of law. Extensions are possible but not beyond one hundred days from the signed order.

Petition for Judicial Review. If the motion for rehearing is overruled, the next step is to file a petition for judicial review within thirty days after the order becomes final and appealable. This lawsuit must be filed in Travis County District Court unless a statute provides otherwise. There is also a pathway for direct transfer to the Court of Appeals in the public interest at the district court’s request.

These appellate procedures are complex and technical. Missing a deadline can result in permanent loss of your right to appeal.

Potential Sanctions

If the Board finds you violated their rules, the sanctions can range from least to most severe:

• Formal warning or reprimand
• Administrative penalties or fines
• Remedial education requirements or a remedial plan
• Practice restrictions
• Probation with specific conditions
• Suspension for a specified period
• License revocation

Many of these sanctions come with additional requirements:

• Regular drug testing
• Supervised practice requirements
• Participation in treatment programs
• Restrictions on prescribing authority
• Prohibition on certain activities or practice settings
• Mandatory reporting to the Board

In extraordinary circumstances involving imminent danger to patients, the Board may impose a temporary suspension while the investigation and hearing process proceed.

And here is what many physician assistants do not realize: even after a suspension ends, reinstatement is not automatic. You must apply for reinstatement, meet specific requirements, potentially wait through statutory waiting periods, and go through another review process.

Physician assistants face unique issues that do not apply to other healthcare professionals:

Prescribing Authority

Physician assistants can prescribe medications under certain circumstances. You must have a prescriptive authority agreement compliant with Board rules. This agreement must be renewed biennially with your license renewal.

If you are under investigation or face disciplinary charges, there is a possibility of restrictions on your prescribing authority. While the specific circumstances determine what restrictions might be imposed, you could potentially:

• Lose prescribing authority entirely while maintaining your license
• Face temporary restrictions on prescribing controlled substances
• Require additional supervision of prescribing practices

Loss of prescribing authority significantly impacts your ability to work and your value to employers, even if you retain your license.

Physician Supervision Relationship

Physician assistants work under the supervision of physicians. This relationship can create complications during Board investigations:

The supervising physician relationship may break down during an investigation. Your supervising physician may terminate the supervisory agreement, which can affect your ability to practice.

Employment issues often arise when criminal charges or Board investigations become known. These may be more related to employment relationships than licensing, but they can impact your overall situation.

Peer review processes involving both you and your supervising physician can trigger mandatory reports to the Board.

Character and Fitness Requirements

Physician assistants face character and fitness requirements both at initial application and throughout their careers. Criminal charges can trigger review of whether you continue to meet these requirements.

At initial application, there is a two-stage process:

1. You submit the initial application document
2. The Board emails you an individualized document, usually within three business days, with your specific pathway and requirements

If you have criminal history or other issues that may affect eligibility, you need legal counsel before filing your application. I am often contacted by individuals who want to become physician assistants but have criminal history that may create barriers. Seeking legal advice before investing years and significant money in PA school can save substantial time and expense.

Let me provide some Let me provide some general examples that illustrate how these situations can unfold. Because physician assistant cases often involve complex circumstances and the specific details determine outcomes, I will speak more generally than I might with other healthcare professions.from my practice that illustrate how these situations actually unfold.

Case 1: Criminal Charge Successfully Resolved

I have represented healthcare professionals facing criminal charges where we were able to achieve favorable outcomes both in the criminal case and before the licensing board.

The key in these cases was:

• Immediate retention of counsel before any statements were made
• Coordinated strategy between criminal defense and license defense
• Comprehensive evidence gathering showing the full context
• Demonstration of rehabilitation and reduced risk where appropriate
• Strategic negotiation with both prosecutors and Board representatives

In several cases, we were able to resolve criminal charges favorably through dismissal, reduction to lesser charges, or deferred adjudication, while also successfully defending the professional license through Board proceedings.

Case 2: License Preserved Despite Criminal Conviction

I have represented healthcare professionals who were convicted of criminal offenses but were able to preserve their licenses through strategic representation before the licensing board.

This required:

• Understanding which criminal plea agreements would trigger automatic sanctions versus which provided flexibility
• Building a comprehensive record of rehabilitation and treatment
• Demonstrating to the Board that the individual no longer posed a risk to patients
• Negotiating agreed orders that allowed continued practice under specified conditions

These cases illustrate that criminal conviction does not always mean automatic license loss, though the specific offense and circumstances matter significantly.

The Critical Mistakes Physician Assistants Make

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In over thirty-five years of practice, I have represented physician assistants in both criminal and licensing matters. Those who achieve the best outcomes are those who seek competent legal counsel immediately and follow that counsel.

But I have encountered physician assistants who tried to handle these matters themselves or waited too long to get proper representation. Here are the mistakes that hurt them most:

Mistake 1: Talking to Investigators Without Counsel

Physician assistants are highly educated medical professionals. They have completed rigorous academic programs and residencies. They are accustomed to problem-solving and explaining complex medical issues.

This confidence can lead them to believe they can explain their situation to law enforcement or Board investigators and clear up any misunderstandings.

This is almost always a mistake.

You may be told you are not a suspect. You may be told this is routine. You may be told that cooperation will help your case. These statements may or may not be true, and you have no way to know which.

What you say to investigators can be used against you in both your criminal case and your licensing case.

I strongly discourage my clients from speaking with investigators, and if you are my client, I prohibit you from talking to anyone about your case without my approval and presence.

Mistake 2: Not Understanding That Board Investigations Can Become Criminal Cases

If there is not yet a criminal case, but there is a Board investigation, anything and everything you say to the Board can be subpoenaed and used by prosecutors to build a criminal case against you.

This happens. A physician assistant receives a Board investigation notice. There are no criminal charges yet. They provide detailed statements to the Board thinking this will resolve the matter. Then a criminal case is filed, and everything from the Board investigation becomes evidence.

Mistake 3: Writing Their Own Response to the Board

When physician assistants receive a Notice of Investigation letter, many think they can write their own response explaining their side.

That response becomes evidence against you. It is fraught with peril because:

• You do not know what you are legally required to admit versus what you can deny
• You do not understand how administrative rules differ from criminal procedure
• You may inadvertently waive defenses or privileges
• You do not realize that information provided to the Board can be used criminally
• You do not know what supporting documentation helps versus hurts

I have had physician assistants come to me after they already submitted a response to the Board. At that point, I must attempt damage control, which is more difficult and more expensive than if I had been retained from the beginning.

Mistake 4: Hiring the Wrong Attorney

Physician assistant cases require an attorney who understands:

• Criminal law and procedure
• Administrative law and regulatory proceedings
• The specific structure of the PA Board and its relationship to the Texas Medical Board
• Medical peer review processes and confidentiality protections
• How to coordinate strategy between criminal and licensing cases
• The rules governing physician assistants, including prescribing authority and supervision requirements

Very few attorneys have experience in all of these areas. An attorney who handles only licensing matters may not understand the criminal implications. An attorney who handles only criminal defense may not understand how to protect your license.

Mistake 5: Not Understanding Mandatory Sanctions

Certain criminal convictions trigger automatic sanctions under Board rules. For some offenses, the Board must take specific action. There is no discretion.

For other offenses, there may be mandatory waiting periods before you can even apply for reinstatement.

These rules are complex. An attorney who does not understand both criminal law and physician assistant licensing may negotiate a plea agreement that seems favorable from a criminal perspective but results in automatic license revocation or lengthy mandatory waiting periods before reinstatement is possible.

After representing physician assistants in licensing matters for many years, I have learned that what the Board actually cares about may be different from what physician assistants expect.

Physician assistants may think the Board cares about: Whether you made an honest mistake, whether you have learned your lesson, whether you are a good person.

The Board actually cares about: Whether you pose a risk to patients and the public going forward, whether you can safely practice medicine under physician supervision, and whether you can be trusted with prescribing authority.

Because physician assistants are more strictly regulated than most other healthcare professionals except physicians themselves, the Board’s scrutiny is intense and the standards are high.

The Board also cares about:

• Whether you are honest and forthcoming in your dealings with them
• Whether you take responsibility for your actions
• Whether you understand what went wrong
• Whether you have taken concrete steps to address underlying issues
• Whether you respect the profession and its standards
• Whether your supervising physician has confidence in your abilities and judgment

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Can You Beat the Criminal Charge and Still Lose Your License?

Yes. Absolutely yes.

The burden of proof is different. In a criminal case, the state must prove you are guilty beyond a reasonable doubt. That is the highest legal standard in our justice system.

In an administrative licensing proceeding, the burden of proof is preponderance of the evidence, meaning more likely than not, or just over fifty percent.

A jury could find you not guilty because there was reasonable doubt, but the Board could still find that it is more likely than not that you violated Board rules.

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Can You Lose the Criminal Case and Still Save Your License?

In some circumstances, yes, though this depends heavily on the specific offense and circumstances.

Just because you were convicted of a criminal offense does not automatically mean you lose your license for all types of offenses, although certain convictions may trigger mandatory sanctions. The Board may consider:

• The nature of the offense
• How long ago it occurred
• What you have done since, including treatment and rehabilitation
• Whether you pose a current risk to patients and the public
• Your overall professional record

However, physician assistants face stricter regulation than many other healthcare professionals. Only physicians are more strictly regulated. This means standards are high and outcomes may be less favorable than for other healthcare license holders facing similar circumstances.

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Can You Keep Working While Your Case Is Pending?

In most circumstances, yes, because the allegations are merely allegations unless and until there is a finding of a violation.

However, there are exceptions:

Temporary suspension. Depending on the allegations, the Board may impose a temporary suspension if they determine there is an imminent threat to public welfare. This can occur with or without prior notice.

Bond conditions in criminal cases. If you are arrested and released on bond, the judge may impose conditions that affect your ability to practice or prescribe medications.

Employment decisions. Your employer or supervising physician may make decisions about your employment or supervisory relationship independent of what the Board decides.

The specific circumstances determine what restrictions, if any, apply while cases are pending.

Why You Need an Attorney Who Understands Both Criminal Defense and Physician Assistant Licensing

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The overwhelming majority of licensed attorneys never practice criminal law. Even those who represent professional license holders often come from a civil practice background and may not understand how criminal law intersects with physician assistant licensing.

Here is why my background matters:

I understand the impact of every criminal outcome on your license. An arrest, a charge, a grand jury indictment, a deferred adjudication, a conviction for a misdemeanor, a conviction for a felony, probation—each of these has different implications for your physician assistant license. An attorney who practices only licensing law will not understand these distinctions.

I can coordinate strategy between both cases. Your criminal case and your licensing case are happening simultaneously. What you say or submit in one can be used against you in the other. Very few attorneys understand how to protect you in both proceedings.

I have represented clients in over two hundred criminal jury trials. I have handled trials in state court, federal court, and appeals. When I walk into a Board hearing or settlement conference, I am comfortable because I am experienced and comfortable in high-pressure situations.

I understand administrative law and SOAH procedures. I have represented license holders before numerous licensing boards. I understand the State Office of Administrative Hearings process, the rules that apply to administrative proceedings, and how these differ from criminal or civil court procedures.

I draw on experience across multiple licensing boards. I have represented nurses, pharmacists, physician assistants, and other healthcare professionals before their respective licensing boards. While each board has its own specific rules, the fundamental principles of due process and administrative procedure apply across all of them. This breadth of experience informs how I handle physician assistant licensing cases.

What You Should Do If You’ve Been Arrested

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If you are a physician assistant and you have been arrested, here is what you need to do immediately:

1. Stop talking. Do not speak to law enforcement, your employer, your supervising physician, Board investigators, or anyone else about the situation without an attorney present. If someone asks you about it, say: “I need to speak with an attorney before I can discuss this.”

2. Do not try to handle this yourself. Understanding medical practice and understanding the intersection of criminal law and administrative licensing law are completely different skill sets.

3. Contact an attorney immediately. The best time to hire an attorney is right after arrest, before you have said or done anything that could hurt your case.

4. Do not write a response to the Board without legal counsel. If you receive a Notice of Investigation letter, do not write your own response. What you think is helping you is likely harming you.

5. Understand that time is critical. Deadlines in these cases are strict and unforgiving. If you miss a deadline, you may waive important rights.

6. Do not make jail phone calls if you are held in custody. All jail calls are recorded. I have had cases where my clients’ own statements on jail calls were used as evidence against them.

When prospective clients ask me how much this is going to cost, I often ask them: what is your license worth to you?

As a physician assistant in Texas, you earn an average of approximately one hundred forty-three thousand dollars per year. Over a thirty-year career, that is over four million dollars in lifetime earnings. After you have already invested years and tens of thousands of dollars, or more, in your education, can you afford not to protect that investment?

Because physician assistant cases often involve more complex proceedings and stricter regulatory oversight than other healthcare professions, legal fees may be higher than for some other license defense matters. The initial consultation and review will help determine appropriate fees for your specific situation.

Beyond attorney fees, there may be additional expenses that can make a difference in your case:

Drug testing. Hair follicle drug testing from accredited, certified laboratories provides objective evidence of sustained sobriety if substance use is an issue.

Treatment programs. Inpatient or outpatient treatment shows the Board you are addressing underlying issues.

Private investigation. I work with licensed private investigators to obtain records, statements, video evidence, and other documentation critical to building a strong defense.

These are not just expenses. They are investments in protecting your license, your career, and your future.

Sometimes in a consultation, I present options clients have not thought about:

Focus on the criminal case first. In some circumstances where the potential criminal consequences are severe, we might focus primarily on the criminal case and carefully limit engagement with the Board investigation to prevent creating evidence that could be used criminally.

Weighing all options. You need to understand all of your options, the likely outcomes of each, and make an informed decision about how to proceed. Every case is different and requires individual analysis based on your specific circumstances.

I have seen an alarming trend of physician assistants trying to use AI or internet research to figure out how to handle their Board cases.

AI cannot understand the legal framework, the specific context of your situation, or the nuanced interplay between criminal and administrative law. It produces answers that may sound authoritative but could be completely wrong. The internet is full of general information that may or may not apply to your specific circumstances under current Texas law.

Physician assistants are highly intelligent, educated professionals who are accustomed to solving complex problems. But this is not a problem you can solve by reading articles online or consulting AI.

Whatever you think you know about this process based on internet research or AI, it is probably incomplete at best and dangerously wrong at worst.