Senate bill would prohibit foreign medical schools in Texas

By Reeve Hamilton

The Texas Tribune

For more than a year, a foreign medical school has been seeking approval to operate in Texas, and its controversial bid has overcome a number of roadblocks. This legislative session, a recently filed bill will put it to one more high-stakes test.

The American University of the Caribbean, a for-profit medical school owned by DeVry Inc., wants a certificate of authority from the Texas Higher Education Coordinating Board. This would allow it to send some Texas students back to their home state to complete their third and fourth years of medical school, which consist of clerkships and clinical electives.

The school's request, which has met significant opposition from the state's medical schools, was on the schedule to be considered at a Jan. 24 coordinating board meeting. But like its previous effort, it ran into a delay -- this time over whether lawmakers should have the opportunity to weigh in.

"The fact is, this issue has entered the political realm and we have to pay attention to those realities," Higher Education Commissioner Raymund Paredes, who has recommended approval of AUC's proposal, said at the meeting, adding that the board needed to get a sense of whether lawmakers intended to file legislation on the issue.

That they did.

On Jan. 30, state Sens. Judith Zaffirini, D-Laredo, and Robert Duncan, R-Lubbock, filed Senate Bill 301. The legislation would prohibit the coordinating board from granting a certificate of authority to a private institution hoping to offer professional degrees or credits toward a professional degree "if the institution is chartered in a foreign country or has its principal office or primary educational program in a foreign country."

The bill is welcome news for the state's public medical schools, which have opposed AUC's efforts out of fear that, especially with new medical schools in the works in Central and South Texas, there will be too few spots in clinical settings to accommodate their students.

"What extra room there is now has already been spoken for," Dr. Cynthia Jumper, the former head of the Texas Medical Association's Council on Medical Education and the chairwoman of the internal medicine department at Texas Tech University Health Sciences Center, told The Texas Tribune in 2011.

Dr. Bruce Kaplan, AUC's chief academic officer, said he does not understand the point of this latest holdup. "I really did not want an adversarial situation. I really want a collaborative effort," he said.

Kaplan said he has made a number of concessions to alleviate concerns. These including restricting AUC's Texas offerings to a total of 20 students who would have to be Texans. (Texas students accounted for 90 of the school's 1,100 students in 2010.) He also said that no taxpayer dollars would go toward educating those students, and he promised to take steps to ensure that in-state students were not displaced.

AUC officials said they are waiting for coordinating board approval before they begin negotiating with Texas hospitals to see how that could be done.

"The ones that really get hurt here are the citizens of Texas," Kaplan said, noting the state's shortage of primary care physicians. "We can provide students, residents and primary care immediately to help alleviate some of the state's shortage in the near future."

Zaffirini was an early skeptic of AUC's plan and questioned whether the coordinating board had the statutory authority to grant such a certificate. When AUC was up for approval in mid-2011, the board delayed its decision and instead sought an opinion from the attorney general over whether it had such authority.

In November, the attorney general's office issued a ruling finding that nothing in state law prevents the board from allowing foreign medical schools access to training in Texas hospitals.

On Tuesday, Zaffirini said she disagrees with that opinion and looks forward to having a discussion on the topic in the venue she believes it belongs: the Texas Legislature.

"Perhaps they can make a good case," she said of AUC's representatives. "They will have that chance. One thing that has concerned me about this process is, Why the big rush?"

Kaplan said that even if state lawmakers want to close the door on AUC in the future, they should "at least let a pilot study bloom now to see whether or not this makes sense."

Paredes has told the board that the AUC matter could be back on the agenda as early as April but that it would depend on how lawmakers handle SB301. The board is also putting on hold requests from two out-of-state osteopathic schools until it has a better sense of lawmakers' mood.

In the meantime, Kaplan says he won't let the matter rest: "I have Texas students who still want to go back there," he said. "They really want this, and there's no reason they shouldn't have it."

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