Part 5.
STATE BOARD OF DENTAL EXAMINERS
Chapter 102.
FEES
22 TAC §102.1
The State Board of Dental Examiners proposes amendments to §102.1,
Fee Schedule. The amendments are required to comply with funding requirements
to implement new legislation passed by the 77th Legislature and a program
to administer the permitting process for mobile and portable dental services.
The fees for administration of the program for sedation/anesthesia permit
applications are also included in this rule inasmuch as the Board is of the
opinion that it is appropriate to place those fees with other fees in the
Fee Schedule.
Licensing agencies are required to pass along increased operating expenses
to the regulated individuals by increasing fees. Accordingly, subsection (a),
paragraph (2) is amended to increase the annual dental registration fee from
$71 to $88. Similarly, dental hygienists' annual fee is increased, in subsection
(b) paragraph (2), from $42 to $52.
The increases necessary for the 2002-2003 Biennium total $521,048. Appropriations
for one (1) additional FTE and increased payments to the Health Professions
Council total $96,394. Employee salary increases total $67,396. Longevity
increases total $14,800. Senate Bill 539 will require inspections of and advisory
opinions about the procedures of those dental providers who administer enteral
sedation/anesthesia in their offices. The sum of those expenses is $20,000.
House Bill 3507 will require two (2) additional FTE's, expenses for an advisory
committee, extra meetings of the Board and Dental Hygiene Advisory Committee
and upgrades to computer software programs. The increased expenses to develop
this program are $171,965. House Bill 609 requires all state agencies, including
smaller agencies, to retain internal auditors. That expense is estimated at
$24,000. Direct and Indirect Costs, such as employee benefits and bonded indebtedness
will increase from the 2000-2001 Biennium by a total of $126,493.
It is estimated that 10,916 dentists will renew their licenses in Fiscal
Years 2002 and 2003. It is expected that 7,865 dental hygienists will renew
in the same time period. Revenue realized from the increased fees for those
renewals will total $528,444, more than enough to cover the increased expenses.
New §§108.40 - 108.43, of this title (relating to Mobile Dental
Facilities) require that, effective September 1, 2001, every mobile dental
facility and portable dental unit, with certain exceptions, must have a permit.
Subsection (e) provides for an initial fee of $50.00 and renewal fee of $50.00
to recover the cost of administering the permitting program. Implementation
will require enhanced databases and verification methods.
Application fees for sedation/anesthesia permits are presently found in §108.33(e),
of this title (relating to Sedation/Anesthesia Permit). The Board is of the
opinion that it is appropriate to include these fees in §102.1 so that
similar fees are located in the same chapter.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule is that new legislation intended for the protection of the
public will be implemented in a cost-effective manner.
There will be fiscal implications for both large and small dental offices.
The costs of renewing licenses for both dentists and dental hygienists will
increase commensurate with the size of the staff of professionals in each
office. There will be no impact on dental laboratories. There will not be
an adverse economic impact on small businesses compared to large businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512) 463-6400. To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
August 20, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§102.1.Fee Schedule.
(a)
Dentists:
(1)
Application for licensure by examination:
(A)
initial application/examination: $150; and
(B)
initial assessment by the Texas Legislature for deposit
to the General Revenue Fund: $200.
(2)
annual registration:
$88.
[
(3)
Annual peer assistance: $9.00.
(4)
Annual assessment by Texas Legislature for deposit to the
General Revenue Fund: $200.
(5)
Application for licensure by credentials: $2,000.
(6)
Duplicate license: $15.
(7)
Duplicate renewal certificate: $15.
(8)
Reactivate a retired license: $250.
(b)
Dental Hygienists:
(1)
application for licensure by examination: $70;
(2)
annual registration:
$52;
[
(3)
annual peer assistance: $2.00;
(4)
application for licensure by credentials: $475;
(5)
duplicate license: $15;
(6)
duplicate renewal certificate: $15; and
(7)
reactivate a retired license: $250.
(c)
Dental laboratories:
(1)
initial application: $100; and
(2)
annual registration: $100.
(d)
Application for faculty member exception tracking (identification)
number: $75.
(e)
Application for dental intern or resident exception tracking
(identification) number: $25.
(f)
Mobile Dental Facilities or Portable Dental
Units:
(1)
initial application: $50; and
(2)
annual renewal: $50.
(g)
Sedation/Anesthesia Permit Application:
(1)
initial application: $28.75; and
(2)
annual renewal: $5.00.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 10, 2001.
TRD-200103953
Jeffry R. Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 475-0972
Subchapter A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.6
The State Board of Dental Examiners proposes amendments to §108.6,
Report of Patient Death or Injury requiring Hospitalization. The amendment
clarifies that the standard of care used to evaluate death or injury resulting
from the use of sedation/anesthesia will be the standard that applies to the
patient's state of consciousness during the procedure. This language existed
in the former §109.177, which was supplanted by §108.6 and was inadvertently
omitted in the new rule. Paragraph (3) of the rule is amended in two respects.
The first is the addition of new language providing that "In the evaluation
of sedation/anesthesia morbidity or mortality, the State Board of Dental Examiners
shall consider the standard of care necessary to be that applicable to the
patient's state of consciousness during the procedure." The second is that
language in the former paragraph (3) is dropped in its entirety. The paragraph
provided that a report would not be considered as a complaint unless the Board's
Enforcement Committee determines that an investigation should be conducted.
The former paragraph (3) was adopted to address a problem that did not exist;
i.e., marring a dentist's record with a reported complaint when the doctor
was not at fault. Complaints that are dismissed are reported in a fashion
that does not identify the doctor; only complaints resulting in a board order
are reported under a doctor's name.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule will be a clearer understanding of the protocol for review
of any incident involving injury or death of a dental patient as a result
of use of sedation/anesthesia. Dropping the language of former paragraph (3)
will bring this rule into harmony with the manner in which complaints are
handled and it will eliminate a needless complication in the processing of
self-reports.
The fiscal implications for small or large businesses will be minimal or
none at all. Therefore the SBDE has determined that compliance with the proposed
amended rule will not have an adverse economic impact on small businesses
when compared to large businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512) 463-6400. To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
August 20, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.6.Report of Patient Death or Injury Requiring Hospitalization.
A dentist must submit a written report to the Board as provided below:
(1)
The death of a dental patient which may have occurred as
a consequence of the receipt of dental services from the reporting dentist
must be reported within 72 hours of the death, or such time as the dentist
becomes aware or reasonably should have become aware of the death;
(2)
An injury to a dental patient requiring admission to a
hospital, as a possible consequence of receiving dental services from the
reporting dentist must be reported within 30 days of the injury.
(3)
In the evaluation of sedation/anesthesia morbidity
or mortality, the State Board of Dental Examiners shall consider the standard
of care necessary to be that applicable to the patient's state of consciousness
during the procedure.
[
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 9, 2001.
TRD-200103899
Jeffry R. Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 463-6400
22 TAC §108.7
The State Board of Dental Examiners proposes amendments to §108.7,
Minimum Standard of Care, General. The amendment results from an effort by
the Board and several interested entities, including the three Texas dental
schools, the Health and Human Services Commission, and the Texas Department
of Health to develop standards for the contents of records required to be
maintained by dentists in Texas pertaining to the dental services rendered
to patients. The language of paragraph (1) has been modified to drop references
to required records, and to refer to rule 108.8, Records of the Dentist, where
specifics are shown. Paragraph (6) has been changed to add the words "...treatment
plans and..." as well as "...treatment plans or..." to clarify the requirement
for informed consent.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule will be that only one §108.8, defines records keeping
requirements and that an informed consent must include knowledge of treatment
plans.
There will be no fiscal implications for small or large businesses. Therefore
the SBDE has determined that compliance with the proposed amended rule will
not have an adverse economic impact on small businesses when compared to large
businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512) 463-6400. To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
August 20, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.7.Minimum Standard of Care, General.
Each dentist licensed by the State Board of Dental Examiners and practicing
in Texas shall conduct his/her practice in a manner consistent with that of
a reasonable and prudent dentist under the same or similar circumstance. Further,
each dentist:
(1)
Shall maintain
patient records that meet the requirements
set forth in rule 108.8 of this title (relating to Records of the Dentist).
[
[(A)
from which a diagnosis may be made;]
[(B)
which includes a description of treatment
rendered;]
[(C)
includes the date on which treatment
is performed; and]
[(D)
which includes any information a reasonable
and prudent dentist in the same or similar circumstances would include]
(2)
Shall maintain and review an initial medical history and
perform limited physical evaluation for all dental patients to wit:
(A)
The initial medical history shall include, but shall not
necessarily be limited to, known allergies to drugs, serious illness, current
medications, previous hospitalizations and significant surgery, and a review
of the physiologic systems obtained by patient history. A "check list", for
consistency, may be utilized in obtaining initial information. The dentist
shall review the medical history with the patient at any time a reasonable
and prudent dentist in the same or similar circumstances would so do.
(B)
The initial limited physical examination should include,
but shall not necessarily be limited to, blood pressure and pulse/heart rate
as may be indicated for each patient.
(3)
Shall obtain and review an updated medical history and
limited physical evaluation when a reasonable and prudent dentist under the
same or similar circumstances would determine it is indicated.
(4)
Shall, for office emergencies:
(A)
maintain a positive pressure breathing apparatus including
oxygen which shall be in working order.
(B)
maintain other emergency equipment and/or currently dated
drugs as a reasonable and prudent dentist with the same or similar training
and experience in the same or similar circumstances would maintain;
(C)
provide training to dental office personnel in emergency
procedures which shall include, but not necessarily be limited to, basic cardiac
life support, inspection and utilization of emergency equipment in the dental
office, and office procedures to be followed in the event of an emergency
as determined by a reasonable and prudent dentist in the same or similar circumstances;
and
(D)
shall adhere to generally accepted protocols and/or standards
of care for management of complications and emergencies.
(5)
Shall successfully complete a current course in basic cardiopulmonary
resuscitation given or approved by either the American Heart Association or
the American Red Cross.
(6)
Should maintain a written informed consent signed by the
patient, or a parent or legal guardian of the patient if the patient is a
minor, or a legal guardian of the patient if the patient has been adjudicated
incompetent to manage the patient's personal affairs. Such consent is required
for all
treatment plans and
procedures where a reasonable possibility
of complications from the
treatment plan or
procedure exists, and
such consent should disclose risks or hazards that could influence a reasonable
person in making a decision to give or withhold consent.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 9, 2001.
TRD-200103900
Jeffry R. Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 463-6400
22 TAC §108.8
The State Board of Dental Examiners proposes amendments to §108.8
Records of the Dentist. The proposed amendments are the result of several
meetings with representatives from the Texas Department of Health, the Health
and Human Services Commission, the three Texas dental schools, National Heritage
Insurance Corporation and members of the Board and staff to discuss records
keeping requirements for dentists. The effect of the amendments is to provide
more specific rules for dental practitioners to follow in making and maintaining
dental records. Vague and redundant language has been deleted and replaced
with clearer, more definite requirements.
Former subsection (a), with changes, has been relocated to subsection (b).
Former subsection (b) has been relocated, verbatim, to subsection (a). The
new subsection (a) defines the term "dental records" and requires documentation
of information obtained. Language in the former subsection (b) mentioned "x-rays"
and "radiographs." The terms are synonymous making the clause redundant. The
word "x-ray(s)" is deleted where used and the word "radiograph" and its permutations
is substituted.
The new subsection (b) places an affirmative duty upon a practitioner to
make, maintain and keep adequate records. The sentence in the former subsection
which read "...Adequate records are records from which diagnoses can be made
and which clearly and accurately document all of the facts related to the
treatment of a dental patient, including diagnoses, treatments and progress
of care..." has been deleted because of vagueness. Subsequent language in
the new subsection and subsection (c) provides specificity to the elements
that comprise an "adequate" dental record.
New language in subsection (b) clearly sets out what must be contained
in all dental records, whether a patient receives dental services or not.
The language also requires, as a minimum, that vital signs, including, but
not limited to blood pressure and heart rate be obtained unless there is a
reason not to do so. Paragraph (5) requires an explanation if vital signs
are not taken.
New subsection (c) clarifies what must be documented when dental services
are provided. Language of the former rule could be interpreted to require
accounting for all these elements, even though no dental treatment was rendered.
Language in new subsection (c), paragraph (9) repeats verbatim the language
found in the former subsection (c) except that the last sentence has been
deleted. That sentence read "...all such drugs and substances which are kept
in the dental office or under the control of the dentist are to be maintained
by a centralized inventory which shall indicate dates acquired, description
and quantity of drugs, date, method, quantity dispensed, and the patient to
whom the drug is dispensed..." In view of the language of new subsection (c),
paragraph (10), formerly subsection (d), repeated verbatim, the former language
is redundant, because the mentioned requirements are found in the Texas Controlled
Substances Act.
Paragraph (2) subparagraph (B) of new subsection (c) recommends adherence
to guidelines for prescribing dental radiographs. Paragraph (4) now requires
preparation of a treatment plan if dental services are provided. Paragraph
(8) requires that informed consent, conforming to the requirements of §108.7(6)
of this title (relating to Minimum Standard of Care, General), be obtained
in writing. Reading §108.7 (6) in conjunction with §108.8 (c)(4)
and (8) clarifies that a treatment plan is an important part of a patient's
dental records. Paragraph (11) addresses the need to be able to identify the
individual who provided dental services and the person who made the entries
in a dental record. Occasions arise, especially in group practices, where
a patient is seen by more than one provider. It is important to know who provided
dental services to a patient at each visit. Paragraph (12) recognizes that
there may be times when, in the judgment of a dental provider, certain procedures
are not done. In those instances paragraph (12) removes the possibility that
a procedure was done, but not documented.
Former subsection (c) is repeated verbatim in paragraph (9) with the exception
of the last sentence, which has been deleted, as explained above.
Former subsection (d) is repeated verbatim in paragraph (10).
Former subsections (e) (f) (g) and (H) have been redesignated as (d), (e),
(f) and (g) and are repeated verbatim, except for substitution of the word
"radiograph" for "x-ray."
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined for the first five-year period the amended rule is in effect there
will be no fiscal implications for local or state government as a result of
enforcing or administering the rule.
Mr. Hill also has determined that for each year of the first five years
the amended rule is in effect the public benefit anticipated as a result of
amending the rule will be that the standards for dental records will be clearer,
and that the quality of dental records will improve.
There will be fiscal implications for small or large businesses. The Board
cannot assess the magnitude of the impact, but it is not expected to be significant.
Whatever the impact, it will tend to affect large and small businesses at
similar percentages of cost increase, if any. Therefore the SBDE has determined
that compliance with the proposed amended rule will not have an adverse economic
impact on small businesses when compared to large businesses.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas 78701, (512) 463-6400. To be considered, all written
comments must be received by the State Board of Dental Examiners on or before
August 20, 2001.
The amended rule is proposed under Texas Government Code §2001.021
et.seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and enforce
rules necessary for it to perform its duties, and to ensure compliance with
laws relating to the practice of dentistry.
The proposed amended rule does not affect other statutes, articles, or
codes.
§108.8.Records of the Dentist.
(a)
The term "dental records" includes, but
is not limited to documentation of: identification of practitioner providing
treatment; medical and dental history; limited physical examination; radiographs;
dental and periodontal charting; diagnoses made; treatment plans; informed
consent statements or confirmations; study models, casts, molds, impressions;
cephalometric diagrams; narcotic drugs, dangerous drugs, controlled substances
dispensed, administered or prescribed; anesthesia records; pathology and medical
laboratory reports; progress and completion notes; materials used; dental
laboratory prescriptions; billing and payment records; appointment records;
consultations and recommended referrals; and post treatment recommendations.
[(a)
A Texas dental licensee practicing dentistry
in Texas shall make, maintain, and keep adequate records of the diagnoses
made and the treatments performed for and upon each dental patient for reference,
identification, and protection of the patient and the dentist. Adequate records
are records from which diagnoses can be made and which clearly and accurately
document all of the facts related to the treatment of a dental patient, including
diagnoses, services, treatments and progress of care. Records shall be kept
for a period of not less than five (5) years]
(b)
A Texas dental licensee practicing dentistry
in Texas shall make, maintain, and keep adequate records of the diagnoses
made and the treatments performed for and upon each dental patient for reference,
identification, and protection of the patient and the dentist. Records shall
be kept for a period of not less than five (5) years. Records must include
documentation of the following:
(1)
Patients name;
(2)
Date of visit
(3)
Reason for visit;
(4)
Vital signs, including but not limited to blood pressure
and heart rate if taken;
(5)
If not recorded, an explanation why vital signs were not
obtained.
[(b)
The term "dental records" includes, but
is not limited to documentation of: identification of practitioner providing
treatment; medical and dental history; limited physical examination; x-rays
and radiographs; dental and periodontal charting; diagnoses made; treatment
plans; informed consent statements or confirmations; study models, casts,
molds, impressions; cephalometric diagrams; narcotic drugs, dangerous drugs,
controlled substances dispensed, administered or prescribed; anesthesia records;
pathology and medical laboratory reports; progress and completion notes; materials
used; dental laboratory prescriptions; billing and payment records; appointment
records; consultations and recommended referrals; and post treatment recommendations.]
(c)
Further, records must include documentation
of the following when services are rendered:
(1)
Written review of medical history and limited review of
medical exam;
(2)
Findings and charting of clinical and radiographic oral
examination;
(A)
Documentation of radiographs taken and findings deduced
from them, including radiograph films or digital reproductions.
(B)
Use of radiographs at a minimum, should be in accordance
with guidelines set forth on "Dental Radiographic Examinations" published
by the United States Department of Health and Human Services, October 1987,
as amended or reprinted from time to time.
(3)
Diagnosis,(es);
(4)
Treatment plan, recommendation, and options;
(5)
Treatment provided;
(6)
Medication and dosages given to patient;
(7)
Complications;
(8)
Written informed consent that meets the provisions of rule
108.7(6) (of this title relating to Minimum Standard of Care, General);
(9)
The dispensing, administering, or prescribing of all medications
to or for a dental patient shall be made a part of such patient's dental record.
The entry in the patient's dental record shall be in addition to any record
keeping requirements of the DPS or DEA prescription programs.
(10)
All records pertaining to Controlled Substances and Dangerous
Drugs shall be maintained in accordance with the Texas Controlled Substances
Act.
(11)
) Confirmable identification of licensed dentist, and
confirmable identification of person making record entries if different from
provider dentist;
(12)
When any of the items in paragraphs (1) through (11) of
this section are not indicated, the record must include an explanation why
the item is not recorded.
[(c)
The dispensing, administering, or prescribing
of narcotic drugs, dangerous drugs, or controlled substances to or for a dental
patient shall be made a part of such patient's dental record. The entry in
the patient's dental record shall be in addition to any record keeping requirements
of the DPS or DEA prescription programs. All such drugs and substances which
are kept in the dental office or under the control of the dentist are to be
maintained by a centralized inventory which shall indicate dates acquired,
description and quantity of drugs, date, method, quantity dispensed, and the
patient to whom the drug is dispensed. ]
[(d)
All records pertaining to Controlled
Substances and Dangerous Drugs shall be maintained in accordance with the
Texas Controlled Substances Act.]
(d)
[
(e)
[
(f)
[
(g)
[
(1)
A dentist providing copies of patient dental records is
entitled to a reasonable fee for copying which shall be no more than $25 for
the first 20 pages and $0.15 per page for every copy thereafter.
(2)
Fees for radiographs, which if copied by an
radiograph
[
(3)
Reasonable costs for radiographs duplicated by means other
than by
a radiograph
[
(A)
a full mouth
radiograph
series: $15.00;
(B)
a panoramic
radiograph
[
(C)
a lateral
cephalometric radiograph
[
(D)
a single extra-oral
radiograph
[
(E)
a single intra-oral
radiograph
[
(4)
State agencies and institutions will provide copies of
dental health records to patients who request them following applicable agency
rules and directives.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 9, 2001.
TRD-200103901
Jeffry R. Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 463-6400
Chapter 161.
GENERAL PROVISIONS
22 TAC §161.1
The Texas State Board of Medical Examiners proposes an amendment
to §161.1, concerning general provisions. The amendment will update the
Occupations Code cites and clarify responsibilities of certain board committees.
Michele Shackelford, Assistant General Counsel, Texas State Board of Medical
Examiners, has determined that for the first five-year period the section
is in effect there will be no fiscal implications to state or local government
as a result of enforcing the amendment as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the section as proposed is in effect the public benefit anticipated
as a result of enforcing the section will be updated Occupations Code cites
and clarification of certain board committees responsibilities. There will
be no effect on small businesses. There will be no effect to individuals required
to comply with the section as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The Occupations Code, §§152.009, 153.005, and 162.001 are affected
by the amendment.
§161.1.Meetings.
(a)
The board shall meet at least four times a year. It shall
consider such matters as may be necessary.
(b)
Special meetings shall be called by the president of the
board or by resolution of the board or upon written request signed by three
members of the board.
(c)
It is a ground for removal from the board if a board member
is absent from more than half of the regularly scheduled board meetings that
the member is eligible to attend during a calendar year. If the executive
director of the board has knowledge that a potential ground for removal exists
due to a member's failure to attend an adequate number of regularly scheduled
board meetings, the executive director shall notify the president of the board
of the ground. The president shall then notify the governor that a potential
ground for removal exists. A board member shall be considered to have been
absent from a regularly scheduled board meeting if the member fails to attend
at least a portion of either a full board session or a portion of a regularly
scheduled committee meeting to which the member is assigned during such board
meeting. Any dispute or controversy as to whether or not an absence has occurred
shall be submitted to the full board for resolution by a majority vote after
giving the purported absentee an opportunity to be heard and after allowing
discussion by other members of the board.
(d)
Board and committee meetings shall be conducted pursuant
to the provisions of Robert's Rules of Order Newly Revised unless the board
by rule adopts a different procedure.
(e)
All elections and any other issues requiring a vote of
the board shall be decided by a simple majority of the members present. A
quorum for transaction of business by the board shall be one more than half
the board's membership at the time of the meeting. If more than two candidates
contest an election, and if no candidate receives a majority on the first
ballot, a second ballot will be conducted between the two candidates receiving
the highest number of votes.
(f)
At a meeting of the board, the board shall elect from its
membership a vice-president and secretary treasurer.
(g)
The following are standing and permanent committees of
the board, as established by the board in accordance with the Medical Practice
Act. The responsibilities and authority of these committees include those
duties and powers as set forth below and such other responsibilities and authority
which the board may from time to time delegate to these committees. In order
to handle the heavy workload of the Licensure Committee, the President of
the Board or the Chairman of the Licensure Committee may divide the Licensure
Committee into two subcommittees, each of whom will make recommendations to
the Board.
(1)
Disciplinary Process Review Committee:
(A)
oversee the disciplinary process and give guidance to the
board and board staff regarding means to improve the disciplinary process
and more effectively enforce the Medical Practice Act;
(B)
monitor the effectiveness, appropriateness and timeliness
of the disciplinary process and enforcement of the Medical Practice Act;
(C)
make recommendations regarding resolution and disposition
of specific cases and approve, adopt, modify, or reject recommendations from
board staff or board representatives regarding actions to be taken on pending
cases. Approve dismissals of complaints and closure of investigations;
(D)
carry out the tasks and duties set forth in Chapter 187
of this title (relating to Procedure);
(E)
make recommendations to the board staff and the board regarding
policies, priorities, budget, and any other matters related to the disciplinary
process and enforcement of the Medical Practice Act.
(2)
Executive Committee:
(A)
review agendum for board meetings;
(B)
ensure records are maintained of all committee actions;
(C)
delegate tasks to other committees;
(D)
take actions on matters of urgency that may arise between
board meetings;
[(E)
make recommendations concerning reactivation
of licenses for physicians on retired status;]
(E)
[
(F)
[
(G)
[
(3)
Finance Committee:
(A)
review staff reports regarding finances and the budget;
(B)
present budget needs to the Legislature and other state
officials;
(C)
recommend proper fees for the agency to charge;
(D)
consider and make recommendations to the board regarding
any aspect of board finances.
(4)
Legislative/Long Range Planning Committee:
(A)
study and make recommendations to the board regarding changes
to the Medical Practice Act;
(B)
review and make recommendations to the board regarding
proposed legislative changes for the regulation of medicine;
(C)
provide reports and recommendations to the board in regard
to changes or proposed changes regarding the Medical Practice Act and the
laws regulating the practice of medicine;
(D)
establish communication with members of the Legislature;
(E)
assist in the organization, preparation, and delivery of
information and testimony to the Legislature and committees of the Legislature;
(F)
formulate and make recommendations to the board concerning
future board goals and objectives and the establishment of priorities and
methods for their accomplishment;
(G)
study and make recommendations to the board regarding the
role and responsibility of the board offices and committees;
(H)
study and make recommendations to the board regarding the
role and responsibility of individuals retained by the board;
(I)
study and make recommendations to the board regarding ways
to improve the efficiency and effectiveness of the administration of the board;
(J)
study and make recommendations to the board regarding board
rules or any area of a board function that, in the judgment of the committee,
needs consideration;
(K)
make recommendations to the board regarding matters brought
to the attention of the legislative/long range planning committee.
(5)
Licensure Committee:
(A)
review applications for licensure, make a determination
of eligibility and report to the board its recommendations as provided by
the Medical Practice Act;
(B)
review board rules regarding licensure and make recommendations
to the board regarding changes or implementation of such rules;
(C)
determine that the board approves each examination administered;
(D)
report to the board any problems in the administration
of examinations and recommend and implement ways of correcting identified
problems;
(E)
report results of examinations to the board for its approval;
(F)
be available for consultation with representatives of medical
schools regarding issues related to performance on examinations;
(G)
make recommendations to the board regarding postgraduate
training permits and issues concerning physicians in training.
(H)
maintain communication with medical schools;
(I)
be available for assistance with problems relating to medical
school issues which may arise within the purview of the board;
(J)
plan and make visits to medical schools at specified intervals,
with the goal of promoting opportunities to meet with the students so that
they may become aware of the board and its functions;
(K)
develop information in regard to international medical
schools in the areas of curriculum, faculty, facilities, academic resources,
and performance of graduates;
(L)
study and make recommendations regarding documentation
and verification of records from international medical schools;
(M)
coordinate cooperative efforts with the Educational Commission
for Foreign Medical Graduates;
(N)
make recommendations concerning reactivation
of licenses for physicians on retired status;
(O)
[
(6)
Non-Profit Health Organizations Committee:
(A)
review applications for approval and certification of non-profit
health organizations pursuant to the Medical Practice Act,
Tex. Occ.
Code Ann. §162.001
[
(B)
review applications and reports for continued approval
and certification of non-profit health organizations pursuant to the Medical
Practice Act,
Tex. Occ. Code Ann. §162.001
[
(C)
make initial determinations and recommendations to the
board regarding approval, denial, revocation, decertification, or continued
approval and certification of non-profit health organizations pursuant to
the Medical Practice Act,
Tex. Occ. Code Ann. §162.001
[
(D)
review board rules regarding non-profit health organizations,
and make recommendations to the board regarding changes or implementation
of such rules;
(E)
make recommendations to the board regarding matters brought
to the attention of the non-profit health organizations committee.
(7)
Public Information/Physician Profile Committee:
(A)
develop informational brochures for distribution to the
public;
(B)
review and make recommendations to the board in regard
to press releases, newsletters, and other publications;
(C)
exhibit display booths at conventions;
(D)
study and make recommendations to the board regarding all
aspects of public information or public relations;
(E)
study and make recommendation to the board regarding all
aspects of physician profiles;
(F)
make recommendations to the board regarding matters brought
to the attention of the public information committee.
(8)
Standing Orders Committee:
(A)
oversee and make recommendations to the board regarding
any aspect of standing orders;
(B)
review applications for acudetox specialist certification,
make a determination of eligibility and report to the board its recommendations
as provided by the Medical Practice Act;
(C)
review and make recommendations to the board regarding
board rules pertaining to standing orders, acudetox specialist certification,
and continuing auricular acupuncture education;
(D)
make recommendations to the board regarding issues concerning
or referred by the Board of Acupuncture Examiners or other acupuncture issues;
(E)
make recommendations to the board regarding issues concerning
or referred by the Board of Physician Assistant Examiners;
(F)
study and make recommendations to the board concerning
ethical issues related to the practice of medicine;
(G)
draft, revise, and propose written statements, guidelines,
and newsletter articles pertaining to medical ethics;
(H)
make recommendations to the board regarding matters brought
to the attention of the standing orders committee.
(9)
Telemedicine Committee:
(A)
review, study and make recommendations to the board concerning
the practice of telemedicine, including but not limited to licensure, regulation,
and/or discipline of telemedicine license holders or applicants;
(B)
review, study and make recommendations to the board concerning
interstate and intrastate telemedicine issues;
(C)
review, study and make recommendations to the board concerning
board rules regarding or affecting the practice of telemedicine;
(D)
review, study and make recommendations to the board concerning
any other issue brought to the attention of the committee.
(h)
The board shall contract with an executive director to
act as the chief executive and administrative officer of the board. The executive
director's duties shall be to assist in conducting meetings of the board and
to carry out other responsibilities as provided by the Medical Practice Act.
The executive director shall be compensated as provided in the Appropriations
Act. Any responsibilities or authority of the secretary-treasurer of the board
described in any rules of the board may be exercised by the executive director
unless the board assigns specific duties or prerogatives exclusively to the
secretary-treasurer.
(i)
To assist with meetings and functions of the board, the
board may direct the executive director to employ a general counsel for the
Texas State Board of Medical Examiners. He or she shall be a member of the
State Bar of Texas, but may not be a lobbyist registered with the Office of
the Secretary of State of Texas. No person required to register personally
as a lobbyist representing physicians, health care entities, or health care
related professions may be employed by the board in any capacity. The executive
director or secretary-treasurer may employ, compensate, and provide for special
hearings and meetings, administrative hearing officers, and other professionals
as may be found necessary in the executive director's or secretary-treasurer's
opinion to provide for legal services.
(j)
The board shall authorize the executive director or secretary-treasurer
to employ, compensate, and provide administrators, clerks, employees, consultants,
professionals, and other persons as may be found necessary in the executive
director's or secretary-treasurer's opinion, to carry out the duties related
to meetings of the board and other provisions of the Medical Practice Act.
The board shall authorize the executive director or secretary-treasurer to
reimburse the previously mentioned persons for actual and necessary expenses,
including investigation expenses, travel, and other incidental expenses incurred
in the performance of official duties as determined by the executive director
or secretary-treasurer.
(k)
Meetings of the board and of its committees are open to
the public unless such meetings are conducted in executive session pursuant
to state law and the Medical Practice Act,
Tex. Occ. Code Ann. §152.009
[
(l)
Journalists have the same right of access as other members
of the public to board meetings conducted in open session, and are also subject
to the rules of conduct described in subsection (k) of this section. Observers
of any board meeting may make audio or visual recordings of such proceedings
conducted in open session subject to the following limitations. The board's
presiding officer may request periodically that camera operators extinguish
their artificial lights to allow excessive heat to dissipate. Camera operators
may not assemble or disassemble their equipment while the board is in session
and conducting business. Persons seeking to position microphones for recording
board proceedings may not disrupt the meeting or disturb participants. Journalists
may conduct interviews in the reception area of the board's offices or, at
the discretion of the board's presiding officer, in the meeting room after
recess or adjournment. No interviews may be conducted in the hallways of the
board's offices. The board's presiding officer may exclude from a meeting
any person who, after being duly warned, persists in conduct described in
this subsection and subsection (k) of this section.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 9, 2001.
TRD-200103893
Jerry T. Walker
Interim Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 305-7016
22 TAC §§163.1, 163.9, 163.10
The Texas State Board of Medical Examiners proposes amendments
to §§163.1, 163.9, and 163.10, concerning licensure. The proposal
will update Occupation Code cites and clarify requirements relating to relicensure.
Michele Shackelford, Assistant General Counsel, Texas State Board of Medical
Examiners, has determined that for the first five-year period the sections
are in effect there will be no fiscal implications to state or local government
as a result of enforcing the amendments as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed is in effect the public benefit anticipated
as a result of enforcing the sections will be updated Occupations Code cites
and clarification of requirements relating to relicensure. There will be no
effect on small businesses. There will be no effect to individuals required
to comply with the sections as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The Occupations Code, §§152.002, 155.051, 156.005, 156.006, and
164.051 are affected by the amendments.
§163.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings unless, the contents clearly indicate otherwise.
(1)
Acceptable approved medical school--A medical school or
college located in the United States or Canada that was approved by the Board
at the time the degree was conferred.
(2)
Acceptable Unapproved medical school--A school or college
located outside the United States or Canada that was not approved by the board
at the time the degree was conferred but whose curriculum meets the requirements
for an Unapproved medical school as determined by a committee of experts selected
by the Texas Higher Education Coordinating Board.
(3)
Affiliated Hospital--Affiliation status of a hospital with
a medical school as defined by the Liaison Committee on Medical Education
and documented by the medical school in its application for accreditation.
(4)
Applicant--One who files an application as defined in this
section.
(5)
Application--An application is all documents and information
necessary to complete an applicant's request for licensure including the following:
(A)
forms furnished by the board, completed by the applicant:
(i)
all forms and addenda requiring a written response must
be printed in ink;
(ii)
photographs must meet United States Government passport
standards;
(B)
a fingerprint card, furnished by the board, completed by
the applicant, that must be readable by the Texas Department of Public Safety;
(C)
all documents required under §163.5 of this title
(relating to Licensure Documentation); and
(D)
the required fee, payable by check through a United States
bank.
(6)
Eligible for licensure in country of graduation--An applicant
must be eligible for licensure in the country in which the medical school
is located except for any citizenship requirements.
(7)
Examinations accepted by the board for licensure.
(A)
United States Medical Licensing Examination (USMLE), with
a score of 75 or better on each step, all steps must be passed within seven
years;
(B)
Federation Licensing Examination (FLEX), after July 1985,
passage of both components within seven years with a score of 75 or better
on each component;
(C)
Federation Licensing Examination (FLEX), prior to June
1985, with a FLEX weighted average of 75 or better in one sitting;
(D)
National Board of Medical Examiners Examination (NBME)
or its successor all steps must be passed within seven years;
(E)
National Board of Osteopathic Medical Examiners Examination
(NBOME) or its successor all steps must be passed within seven years;
(F)
Medical Council of Canada Examination (LMCC) or its successor,
all steps must be passed within seven years;
(G)
State board examination, before January 1, 1977, (with
the exception of Florida, Virgin Islands, Guam, Tennessee Osteopathic Board
or Puerto Rico after June 30, 1963); or
(H)
One of the following examination combinations with a score
of 75 or better on each part, level, component, or step, all parts, levels,
components, or steps must be passed within seven years:
(i)
FLEX I plus USMLE 3;
(ii)
USMLE 1 and USMLE 2, plus FLEX II;
(iii)
NBME I or USMLE 1, plus NBME II or USMLE 2, plus NBME
III or USMLE 3;
(iv)
NBME I or USMLE 1, plus NBME II or USMLE 2, plus FLEX
II;
(v)
NBOME I, plus NBOME II, plus FLEX II;
(vi)
the NBOME Part I or COMLEX Level I and NBOME Part II or
COMLEX Level II and NBOME Part III or COMLEX Level III.
(I)
An applicant must pass each part of an examination within
three attempts, except that an applicant who has passed all but one part of
an examination within three attempts may take the remaining part of the examination
one additional time.
(J)
Notwithstanding subparagraph (I) of this paragraph, an
applicant is considered to have satisfied the requirements of this section
if the applicant:
(i)
passed all but one part of an examination approved by the
board within three attempts and passed the remaining part of the examination
within five attempts;
(ii)
is specialty board certified by a specialty board that:
(I)
is a member of the American Board of Medical Specialties;
or
(II)
is approved by the American Osteopathic Association; and
(iii)
completed in this state an additional two years of postgraduate
medical training approved by the board.
(8)
Examinations administered by the board for licensure--To
be eligible for licensure an Applicant must sit for the Texas medical jurisprudence
examination administered by the board and pass. A passing score is 75 or better
on the Texas medical jurisprudence examinations. The board shall administer
the Texas medical jurisprudence examination in writing at times and places
as designated by the board.
(9)
Full force--Applicants for licensure who possess a license
in another jurisdiction must have it in full force and not restricted for
cause, canceled for cause, suspended for cause or revoked. A physician with
a license in full force may include a physician who does not have a current,
active, valid annual permit in another jurisdiction because:
(A)
that jurisdiction requires the physician to practice in
the jurisdiction before the annual permit is current; or
(B)
that jurisdiction requires the physician, prior to practicing
in that jurisdiction, to hold a current professional liability insurance policy
before the annual permit is current.
(10)
Good professional character - An Applicant for licensure
must not be in violation of or committed any act described in the Medical
Practice Act,
Tex. Occ. Code Ann. §164.051
[
(11)
One-year training program--Applicants who are graduates
of acceptable approved medical schools must successfully complete one year
of postgraduate training approved by the board that is:
(A)
accepted for certification by an American Specialty board
that is a member of the American Board of Medical Specialties or the Bureau
of Osteopathic Specialists; or
(B)
accredited by one of the following:
(i)
the Accreditation Council for Graduate Medical Education,
or its predecessor;
(ii)
the American Osteopathic Association;
(iii)
the Committee on Accreditation of Preregistration Physician
Training Programs, Federation of Provincial Medical Licensing Authorities
of Canada;
(iv)
the Royal College of Physicians and Surgeons of Canada;
or
(v)
the College of Family Physicians of Canada; or
(C)
a postresidency program, usually called fellowship, for
additional training in a medical specialty or subspecialty in a program approved
by the Texas State Board of Medical Examiners.
(12)
Requisite qualifications--An Applicant who is a graduate
of an unapproved acceptable medical school who:
(A)
has for the preceding five years been a licensee of another
state or a Canadian province;
(B)
is not the subject of a sanction imposed by or disciplinary
matter pending in any state or Canadian province in which the Applicant is
licensed to practice medicine; and
(C)
is either specialty board certified by a board that is
a member of the American Board of Medical Specialties or the Bureau of Osteopathic
Specialists or successfully passes the Special Purpose Examination (SPEX).
(13)
Substantially equivalent to a Texas medical school--A
medical school or college located outside the United States or Canada must
be an institution of higher learning designed to select and educate medical
students; provide students with the opportunity to acquire a sound basic medical
education through training in basic sciences and clinical sciences; to provide
advancement of knowledge through research; to develop programs of graduate
medical education to produce practitioners, teachers, and researchers; and
to afford opportunity for postgraduate and continuing medical education. The
school must provide resources, including faculty and facilities, sufficient
to support a curriculum offered in an intellectual environment that enables
the program to meet these standards. The faculty of the school shall actively
contribute to the development and transmission of new knowledge. The medical
school shall contribute to the advancement of knowledge and to the intellectual
growth of its students and faculty through scholarly activity, including research.
The medical school shall include, but not be limited to, the following characteristics:
(A)
The facilities for basic sciences and clinical training
(i.e., laboratories, hospitals, library, etc.) shall be adequate to ensure
opportunity for proper education.
(B)
The admissions standards shall be substantially equivalent
to a Texas medical school.
(C)
The basic sciences curriculum shall include the contemporary
content of those expanded disciplines that have been traditionally titled
anatomy, biochemistry, physiology, microbiology and immunology, pathology,
pharmacology and therapeutics, and preventive medicine, as defined by the
Texas Higher Education Coordinating Board.
(D)
The fundamental clinical subjects, which shall be offered
in the form of required patient-related clerkships, are internal medicine,
obstetrics and gynecology, pediatrics, psychiatry, and surgery, as defined
by the Texas Higher Education Coordinating Board.
(E)
The curriculum shall be of at least 130 weeks in duration.
(F)
All medical or osteopathic medical education received by
the Applicant in the United States must be accredited by an accrediting body
officially recognized by the United States Department of Education as the
accrediting body for medical education leading to the doctor of medicine degree
or the doctor of osteopathy degree in the United States. This subsection does
not apply to postgraduate medical education or training.
(G)
An applicant who is unable to comply with the requirements
of subparagraph (F) of this paragraph is eligible for an unrestricted license
if the Applicant:
(i)
received such medical education in a hospital or teaching
institution Sponsoring or participating in a program of graduate medical education
accredited by the Accrediting Council for Graduate Medical Education, the
American Osteopathic Association, or the Texas State Board of Medical Examiners
in the same subject as the medical or osteopathic medical education if the
hospital or teaching institution has an agreement with the applicant's school;
or
(ii)
is specialty board certified by a board approved by the
Bureau of Osteopathic Specialists or the American Board of Medical Specialties.
(14)
Three-year training program--Applicants who are graduates
of unapproved medical schools must successfully complete three years of postgraduate
training in the United States or Canada:
(A)
accredited by one of the following:
(i)
the Accreditation Council for Graduate Medical Education;
(ii)
the American Osteopathic Association;
(iii)
the Committee on Accreditation of Preregistration Physician
Training Programs, Federation of Provincial Medical Licensing Authorities
of Canada;
(iv)
the Royal College of Physicians and Surgeons of Canada;
(v)
the College of Family Physicians of Canada; and
(vi)
all programs approved by the board after August 25, 1984;
or
(B)
a board-approved program for which a Faculty Temporary
Permit was issued; or
(C)
a postresidency program, usually called fellowship, for
additional training in a medical specialty or subspecialty in a program approved
by the Texas State Board of Medical Examiners.
(15)
Unapproved medical school--A school or college located
outside the United States or Canada that was not approved by the board at
the time the degree was conferred.
§163.9.State Health Agency Temporary License.
An applicant may elect to apply for a state health agency temporary
license in lieu of licensure.
(1)
The executive director of the board may issue such a temporary
license to an applicant:
(A)
who holds a valid license in another state or Canadian
province on the basis of an examination, that is accepted by the board for
licensure;
(B)
who has passed the Texas medical jurisprudence examination;
(C)
whose application has been filed, processed, and found
to be in order. The application shall be complete in every detail with the
exception of compliance with §163.4(c)(2) of this title (relating to
Procedural Rules for all Licensure Applicants); and
(D)
who holds a salaried, administrative, or clinical position
with an agency of the State of Texas.
(2)
The state health agency temporary license shall be requested
by the chief administrative officer of the employing state agency and shall
be issued exclusively to that agency. The chief administrative officer shall
state whether the temporary license is for a:
(A)
clinical position. This temporary license will be valid
for a one-year period from the date of issuance and will not be renewable.
The temporary license is revocable at any time the board deems necessary.
To practice beyond one year, the holder of the temporary license must fully
comply with §163.4(c)(2) of this title (relating to Procedural Rules
for all Licensure Applicants). During the period that the state health agency
clinical temporary license is in effect, the physician will be supervised
by a licensed staff physician who will regularly review the temporary license
holder's skill and performance. This temporary license will be marked "clinical";
or
(B)
administrative non-clinical position. This temporary license
will be valid for a one-year period from the date of issuance; however, it
is revocable at any time the board deems necessary. The temporary license
shall automatically expire one year after the date of issuance but may be
re-issued annually at the request of the chief administrative officer of the
employing state agency and at the discretion of the Texas State Board of Medical
Examiners. The holder of a state health agency temporary license, not designated
as clinical, shall not practice medicine as that term is defined in
the Medical Practice Act, Tex. Occ. Code Ann. §151.002
[
§163.10.Relicensure.
(a)
If a physician's
annual registration permit
[
(1)
The examinations required by this section are:
(A)
the Texas jurisprudence examination; and
(B)
SPEX, unless the Applicant:
(i)
has passed a licensure examination or has obtained specialty
certification, recertification, or passed an examination of continued demonstration
of qualifications by a board that is a member of the American Board of Medical
Specialties or the Bureau of Osteopathic Specialists within the preceding
ten years; or
(ii)
has been in a training program approved by the board within
six months prior to application for relicensure.
(2)
The additional requirements for this new license shall
be as required within the following sections:
(A)
Section 163.2 of this title (relating to Licensure for
United States and Canadian Medical School Graduates);
(B)
Section 163.3 of this title (relating to Licensure for
Graduates of Unapproved Medical Schools);
(C)
Section 163.4 of this title (relating to Procedural Rules
for all Licensure Applicants); and
(D)
Section 163.5 of this title (relating to Licensure Documentation).
(b)
A person may qualify for renewal of his or her original
license without reexamination if that
person's license is considered
canceled for less than two years.
[
[(1)
held a license previously in this state;]
[(2)
moved to another state;]
[(3)
practiced in that other state for not
more than two years since the expiration of his or her Texas license; and]
[(4)
files an application for relicensure
under subsection (a)(2) of this section.]
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 9, 2001.
TRD-200103894
Jerry T. Walker
Interim Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 305-7016
22 TAC §§166.2 - 166.4, 166.6
The Texas State Board of Medical Examiners proposes amendments
to §§166.2-166.4, and 166.6, concerning physician registration.
The proposal will update Occupation Code cites and clarify which board committee
is responsible for considering a physician's request to return to active status
from retired status.
Michele Shackelford, Assistant General Counsel, Texas State Board of Medical
Examiners, has determined that for the first five-year period the sections
are in effect there will be no fiscal implications to state or local government
as a result of enforcing the amendments as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed is in effect the public benefit anticipated
as a result of enforcing the sections will be updated Occupations Code cites
and clarification of which board committee is responsible for considering
a physician's request to return to active status from retired status. There
will be no effect on small businesses. There will be no effect to individuals
required to comply with the sections as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The Occupations Code, §§156.001, 156.002, 156.003, 156.004, 156.005,
156.006, 156.007, 156.008, 156.009, 156.051, 156.052, 156.053, 156.054, 156.055,
164.051, 164.052, and 164.053 are affected by the amendments.
§166.2.Continuing Medical Education.
(a)
As a prerequisite to the annual registration of a physician's
license, 24 hours of continuing medical education (CME) are required to be
completed in the following categories:
(1)
At least one-half of the hours are to be from formal courses
that are:
(A)
designated for AMA/PRA Category 1 credit by a CME sponsor
accredited by the Accreditation Council for Continuing Medical Education or
a state medical society recognized by the Committee for Review and Recognition
of the Accreditation Council for Continuing Medical Education;
(B)
approved for prescribed credit by the American Academy
of Family Physicians;
(C)
designated for AOA Category 1-A credit required for osteopathic
physicians by an accredited CME sponsor approved by the American Osteopathic
Association; or
(D)
approved by the Texas Medical Association based on standards
established by the AMA for its Physician's Recognition Award.
(2)
Beginning with annual registrations in 1999, at least one
of the formal hours of CME which are required by paragraph (1) of this subsection
must involve the study of medical ethics and/or professional responsibility.
Whether a particular hour of CME involves the study of medical ethics and/or
professional responsibility shall be determined by the organizations which
are enumerated in paragraph (1) of this subsection as part of their course
planning.
(3)
The remaining hours may be composed of informal self-study,
attendance at hospital lectures or grand rounds not approved for formal CME,
or case conferences and shall be recorded in a manner that can be easily transmitted
to the board upon request.
(b)
A physician must report on the annual registration form
if she or he has completed the required continuing medical education during
the previous year. A licensee may carry forward CME credit hours earned prior
to an annual registration report which are in excess of the 24-hour annual
requirement and such excess hours may be applied to the following years' requirements.
A maximum of 48 total excess credit hours may be carried forward and shall
be reported according to the categories set out in subsection (a) of this
section. Excess CME credit hours of any type may not be carried forward or
applied to an annual report of CME more than two years beyond the date of
the annual registration following the period during which the hours were earned.
(c)
A licensee shall be presumed to have complied with this
section if in the preceding 36 months the licensee becomes board certified
or recertified in a medical specialty and the medical specialty program meets
the standards of the American Board of Medical Specialties, the American Medical
Association, the Advisory Board for Osteopathic Specialists and Boards of
Certification, or the American Osteopathic Association. This provision exempts
the physician from all CME requirements, including the requirement for one
hour involving the study of medical ethics and/or professional responsibility,
as outlined in subsection (a)(2) of this section, and this exemption is valid
for one annual renewal period only.
(d)
A physician may request in writing an exemption for the
following reasons:
(1)
catastrophic illness;
(2)
military service of longer than one year's duration outside
the state;
(3)
medical practice and residence of longer than one year's
duration outside the United States; or
(4)
good cause shown on written application of the licensee
that gives satisfactory evidence to the board that the licensee is unable
to comply with the requirement for continuing medical education.
(e)
Exemptions are subject to the approval of the executive
director/medical director and must be requested in writing at least 30 days
prior to the expiration date of the license.
(f)
A temporary exemption under subsection (d) of this section
may not exceed one year but may be renewed annually, subject to the approval
of the board.
(g)
Subsection (a) of this section does not apply to a licensee
who is retired and has been exempted from paying the annual registration fee
under §166.3 of this title (relating to Retired Physician Exception).
(h)
This section does not prevent the board from taking disciplinary
action with respect to a licensee or an applicant for a license by requiring
additional hours of continuing medical education or of specific course subjects.
(i)
The board may require written verification of both formal
and informal credits from any licensee within 30 days of request. Failure
to provide such verification may result in disciplinary action by the board.
(j)
Physicians in residency/fellowship training or who have
completed such training within six months prior to their renewal application
will satisfy the requirements of subsection (a)(1) and (2) of this section
by their residency or fellowship program.
(k)
Unless exempted under the terms of this section, a physician
licensee's apparent failure to obtain and timely report the 24 hours of CME
as required and provided for in this section shall result in nonrenewal of
the license until such time as the physician obtains and reports the required
CME hours; however, the executive director of the board may issue to such
a physician a temporary license numbered so as to correspond to the nonrenewed
license. Such a temporary license shall be issued at the direction of the
executive director for a period of no longer than 90 days. A temporary license
issued pursuant to this subsection may be issued to allow the board to verify
the accuracy of information related to the physician's CME hours and to allow
the physician who has not obtained or timely reported the required number
of hours an opportunity to correct any deficiency so as not to require termination
of ongoing patient care.
(l)
The fee for issuance of a temporary license pursuant to
the provisions of this section shall be in the amount specified for temporary
licenses under §175.1 of this title (relating to Fees); however, the
fee need not be paid prior to the issuance of the temporary license, but shall
be paid prior to the renewal of a permanent license.
(m)
CME hours which are obtained to comply with the CME requirements
for the preceding year as a prerequisite for licensure renewal, shall first
be credited to meet the CME requirements for the previous year. Once the previous
year's CME requirement is satisfied, any additional hours obtained shall be
credited to meet the CME requirements for the current year.
(n)
An intentionally false report or intentionally false statement
to the board by a licensee regarding CME hours reportedly obtained shall be
a basis for disciplinary action by the board pursuant to the Act,
Tex.
Occ. Code Ann. §§164.051 - .053
[
(o)
Administrative penalties for failure to timely obtain and
report required CME hours may be determined by the Disciplinary Process Review
Committee of the board as provided for in §187.39 of this title (relating
to Administrative Penalties).
(p)
Failure to obtain and timely report the CME hours for renewal
of a license shall subject the licensee to a monetary penalty for late registration
in the amount set forth in §175.2 of this title (relating to Penalties).
Any temporary licensure fee and any administrative penalty imposed for failure
to obtain and timely report the 24 hours of CME required for renewal of a
license shall be in addition to the applicable penalties for late registration
or renewal as set forth in §175.2 of this title (relating to Penalties).
§166.3.Retired Physician Exception.
The annual registration fee shall apply to all physicians licensed
by the board, whether or not they are practicing within the borders of this
state, except retired physicians.
(1)
To become exempt from the annual registration fee due to
retirement:
(A)
the physician's current license must be active and in good
standing;
(B)
the physician must request in writing on a form prescribed
by the board for his or her license to be placed on official retired status.
(2)
The following restrictions shall apply to physicians whose
licenses are on official retired status.
(A)
The physician must not engage in clinical activities or
practice medicine in any state.
(B)
The physician must not prescribe or administer drugs to
anyone, nor may the physician possess a Drug Enforcement Administration or
Texas controlled substances registration.
(C)
The physician's license may not be endorsed to any other
state.
(3)
A physician whose license has been placed on official retired
status must obtain the approval of the board before returning to active status
by submitting a written request to the attention of the Permits Department
of the board which indicates the following:
(A)
the physician's Texas medical license number;
(B)
current mailing address;
(C)
proposed practice location;
(D)
intended type of medical practice;
(E)
length of retired status;
(F)
any other medical licenses held;
(G)
any condition which adversely affects the physician's ability
to practice medicine with reasonable skill and safety;
(H)
any current specialty board certifications; and
(I)
any formal or informal continuing medical education obtained
during the period of retired status.
(4)
The request of a physician seeking a return to active status
whose license has been placed on official retired status for two years or
longer shall be submitted to the
Licensure
[
(5)
The request of a physician seeking a return to active status
whose license has been placed on official retired status for less than two
years may be approved by the executive director of the board or submitted
by the executive director to the
Licensure
[
(6)
In evaluating a request to return to active status, the
Licensure
[
§166.4.Renewal of Expired License.
(a)
If a physician's license has expired, the physician may
renew the license without monetary penalty during the first 30 days following
expiration.
(b)
If a physician's license has been expired for longer than
30 days, but less than 91 days, the physician may renew the license by submitting
a completed annual registration form and paying to the board the required
renewal fee and a fee that is one-half of the annual registration fee as established
by the board under the Medical Practice Act,
Tex. Occ. Code Ann. §156.005(a)
[
(c)
If a physician's license has been expired for longer than
90 days but less than one year, the physician may renew the license by submitting
a completed annual registration form and paying to the board all unpaid renewal
fees and a fee that is equal to the annual registration fee as established
by the board under the Medical Practice Act,
Tex. Occ. Code Ann. §156.005(b)
[
(d)
If a physician's license has been expired for one year,
it is considered to have been canceled, unless an investigation is pending,
and the physician may not renew the license.
§166.6.Exemption from Annual Registration Fee for Retired Physician Providing Voluntary Charity Care.
(a)
A retired physician licensed by the board whose only practice
is the provision of voluntary charity care shall be exempt from the annual
registration fee. To qualify for and obtain such an exemption, a physician
must truthfully certify under oath, on a form approved by the board, and received
by the board at least 30 days prior to the expiration date of the license,
that the following information is correct:
(1)
the physician's practice of medicine does not include the
provision of medical services for either direct or indirect compensation which
has monetary value of any kind;
(2)
the physician's practice of medicine is limited to voluntary
charity care for which the physician receives no direct or indirect compensation
of any kind for medical services rendered;
(3)
the physician's practice of medicine does not include the
provision of medical services to members of the physician's family; and
(4)
the physician's practice of medicine does not include the
self-prescribing of controlled substances or dangerous drugs.
(b)
A physician who qualifies for and obtains an exemption
from the annual registration fee authorized under this section shall obtain
and report continuing medical education as required under the Medical Practice
Act,
Tex. Occ. Code Ann. §§ 156.051 - .055
[
(c)
A physician who qualifies for and obtains an exemption
from the annual registration fee authorized under this section shall file
an application for registration with the board on an annual basis as required
under the Medical Practice Act,
Tex. Occ. Code Ann. §§156.001-.009
[
(d)
A retired physician who has obtained an exemption from
the annual registration fee as provided for under this section, may be subject
to disciplinary action under the Medical Practice Act,
Tex. Occ. Code
Ann. §164.053
[
(e)
A physician who attempts to obtain an exemption from the
annual registration fee under this section by submitting false or misleading
statements to the board shall be subject to disciplinary action pursuant to
the Medical Practice Act,
Tex. Occ. Code Ann. §164.052(a)(1)
[
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on July 9, 2001.
TRD-200103895
Jerry T. Walker
Interim Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 305-7016
The Texas State Board of Medical Examiners proposes amendments to §§167.1,
167.2, and 167.4-167.6, the repeal of §167.3, and new §§167.3,
167.7, and 167.8, concerning reinstatement. The proposal will update Occupation
Code cites and clarify criteria to be considered when determining whether
or not to reinstate a medical license following suspension or to reissue a
license following revocation.
Michele Shackelford, Assistant General Counsel, Texas State Board of Medical
Examiners, has determined that there will be a fiscal impact for the first
five-year period the sections are in effect. Due to the changes in the procedure
for reissuing a license following revocation, there will be an increase to
those persons required to comply of $450 for the application fee. Further
impact to those individuals would be dependent upon the physician's individual
qualifications. Revenue increase to the state is estimated at $1350 per fiscal
year.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be updated Occupation Code cites
and clarification in the criteria to be considered when determining whether
or not to reinstate a medical license following suspension or to reissue a
license following revocation.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
22 TAC §§167.1 - 167.8
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The Occupations Code, §§164.003, 164.007, 164.009, 164.101, 164.102,
164.151, 164.152, 164.153, and 164.154 are affected by the amendments.
§167.1.Reinstatement or Reissuance of Medical License Following Suspension or Revocation [
(a)
Reinstatement of Medical License Following
Suspension.
[
(1)
[
(2)
A person may not apply for reinstatement
of a license that was suspended before the first anniversary of the date on
which the suspension became effective.
(3)
Request
[
(b)
Reissuance of License Following Revocation.
(1)
An applicant whose license has been revoked must complete
in every detail the application for reissuance of license, including payment
of the required application fee.
(2)
The applicant whose license has been revoked must appear
before the board to request reissuance of license.
(3)
A person may not apply for reissuance of a license that
was revoked before the first anniversary of the date on which the revocation
became effective.
(4)
Application for reissuance following revocation cannot
be considered more often than annually.
§167.2.Informal Disposition of Requests for Reinstatement .
Pursuant to the Medical Practice Act,
§§154.006, 164.003
and 164.151-.154
[
(1)
The board may make an informal disposition of any request
for reinstatement of a medical license following
suspension
[
(2)
In the event the board makes such a disposition of a request
for reinstatement of a medical license following
suspension
[
(3)
To facilitate the expeditious disposition of requests for
reinstatement following
suspension
[
(4)
If the opportunity for an informal settlement conference
is provided to an applicant, the applicant shall be provided with [
(5)
One or more members of the board or a district review committee
shall conduct the informal settlement conference as the board's representative(s).
When a board member and a district review committee member conduct such a
conference, the board member shall serve as chairman of the conference. In
the event that the representatives consist of two board members or two district
review committee members, the representative who has seniority on the board
or committee shall serve as the chairman of the conference. In the event a
public member of the board or a district review committee member serves as
the only board representative in such a conference, a board consultant or
the board's executive director, if the executive director is a physician,
may serve as a medical advisor to the representative.
(6)
The informal settlement conference shall allow:
(A)
the board staff
to address whether it is in the best
interest of the public and the physician to return to the practice of medicine
by presenting
[
(B)
the applicant to reply to the board staff's presentation
and present facts the applicant reasonably believes could be proven by competent
evidence at a hearing;
(C)
presentation of evidence by the staff and the applicant
which may include medical and office records, x-rays, pictures, film recordings
of all kinds, audio and video recordings, diagrams, charts, drawings, and
any other illustrative or explanatory materials which in the discretion of
the board's representative(s) are relevant to the proceeding;
(D)
representation of the applicant by counsel;
(E)
presentation of oral or written statements by the applicant
or the applicant's counsel;
(F)
presentation of oral or written statements or testimony
by witnesses; and
(G)
questioning of witnesses.
(7)
The board's representative(s) shall exclude from the informal
settlement conference all persons except witnesses during their testimony
or presentation of statements, the applicant, the applicant's attorney or
representative, board members, district review committee members, and board
staff.
(8)
During the informal settlement conference, the board's
legal counsel or a representative of the Office of the Attorney General shall
be present to advise the board's representative(s) or the board's employees.
(9)
Except with the agreement of the applicant, during the
deliberations of an appropriate settlement, the board's representative(s)
at an informal settlement conference shall exclude the board staff which presented
the allegations and facts related to the request for reinstatement following
suspension [
(10)
After an informal settlement conference has been held,
the staff of the board and the board's representative(s) shall be subject
to the ex parte provisions of the Administrative Procedure Act with regard
to contacts with board members and administrative law judges concerning the
case.
[(11)
To the extent possible, board members
and district review committee members are required to serve as representatives
at informal settlement conferences an equal number of times during a calendar
year. In the event a board member or district review committee member has
a complaint regarding the frequency or infrequency of service as a representative
required for any member, the complaint may be routed in writing to the Director
of Hearings for the board who shall then bring the complaint to the attention
of the Disciplinary Process Review Committee for a resolution by a majority
vote of the committee.]
(11)
[
(12)
[
(13)
[
(14)
[
(15)
[
(16)
[
(17)
[
(18)
[
(A)
Upon an affirmative majority vote, the board shall enter
an order approving the proposed settlement agreement. The order shall bear
the signature of the president of the board or of the officer presiding at
such meeting and shall be referenced in the minutes of the board.
(B)
If the board does not approve a proposed settlement agreement,
the applicant shall be so informed and the matter shall be referred to the
board staff for appropriate action to include further negotiation, further
investigation, an additional informal settlement conference or a hearing.
(C)
To promote the expeditious resolution of any request for
reinstatement [
§167.3.Application for Reissuance of a Revoked License.
Pursuant to the Medical Practice Act, §164.151 and the Administrative
Procedure Act, Government Code, §2001.056, the following rules shall
apply to the dispositions of any applications for reissuance of a license
to practice medicine.
(1)
The board may make an informal disposition of any application
for reissuance of a medical license following revocation by stipulation, agreed
order, agreed settlement or default.
(2)
In the event the board makes such a disposition of an application
for reissuance of a medical license following revocation, the disposition
shall be in writing and, if appropriate, the writing shall be signed by the
applicant.
(3)
To facilitate the expeditious disposition of an application
for reissuance following revocation, the board may provide an applicant with
an opportunity to be heard before a committee of the board.
(4)
If an opportunity to appear before a committee of the board
is provided to an applicant, the applicant shall be provided with a copy of
the completed application for reissuance of license by certified mail - return
receipt requested, overnight or express mail, or registered mail to the last
mailing address of the applicant or the applicant's attorney on file with
the board. The applicant shall also be provided with written notice of the
time, date and location of the committee hearing and the rules governing the
proceeding.
(5)
The committee hearing shall allow:
(A)
board staff to present a synopsis of the allegations and
the facts that supported the revocation of the applicant's medical license,
and to address whether it is in the best interest of the public and the physician
to return to the practice of medicine;
(B)
the applicant the opportunity to reply to the board staff's
presentation and offer relevant evidence;
(C)
representation of the applicant by counsel; and
(D)
presentation of oral or written statements by the applicant
or the applicant's counsel.
(6)
At the conclusion of the applicant's presentation, the
committee shall make a recommendation for disposition of the application for
reissuance which may include:
(A)
deferral pending receipt of additional information;
(B)
denial of the request for reissuance;
(C)
reissuance of an unrestricted license; or
(D)
reissuance of a restricted license subject to any reasonable
restrictions or conditions authorized by the Act and any other remedial actions
found to be in the public's best interest.
(7)
An applicant who is offered a restricted license may either
accept or reject the recommendations proposed by the committee. If the applicant
accepts the recommendations, the applicant shall execute the agreement in
the form of an agreed order or affidavit as soon thereafter as is practicable.
If the applicant rejects the proposed agreement, the applicant shall be given
the option of requesting judicial review in the manner provided by §164.009
of the Act.
(8)
Following acceptance and execution by the applicant of
the agreement to restrictions on the applicant's license, the application
for reissuance and the agreed order shall be submitted to the board for approval.
(A)
Upon an affirmative majority vote, the board shall enter
an order approving the proposed reissuance of licensure subject to restrictions
or conditions. The order shall bear the signature of the president of the
board or of the officer presiding at such meeting and shall be referenced
in the minutes of the board.
(B)
If the board does not approve the proposed order or otherwise
denies the applicant's application for reissuance, the applicant shall be
so informed and the board's decision shall be subject to judicial review in
the manner provided by §164.009 of the Act.
§167.4.Best Interests of Physician.
Pursuant to
§164.151 of the Act
[
(1)
understands all issues of competency, technical, educational,
training or ethical limitations as found in the Order which led to the revocation
[
(2)
demonstrates that risk of further disciplinary proceedings
for the revocation[
§167.5.Best Interests of the Public.
Pursuant to
§ 164.151 of the Act
[
(1)
remediation of any competency, technical, educational,
training or ethical limitations as found in the Order leading to revocation[
(2)
that risk of further disciplinary proceedings for the revocation[
(3)
that an adequate practice plan will be in place to reduce
or eliminate the risk of further disciplinary proceedings by the Board; and
(4)
continued medical competency such that the physician is
able to provide the same standard of medical care as any applicant for a license
under Chapter 163 of this title (relating to Licensure). Further, the Board
shall require an applicant for
reissuance
[
§167.6.Final Action.
In any contested case proceeding regarding a reinstatement
request
[
§167.7.Judicial Review.
A decision by the board to deny a request for reinstatement or application
for reissuance of a medical license is subject to review in the manner provided
by §164.009 of the Act.
§167.8.Certain Persons Ineligible for Reinstatement or Reissuance of License.
Except on express determination based on substantial evidence contained
in an investigative report indicating that reinstatement or reissuance of
the license is in the best interest of the public and of the person whose
license has been suspended or revoked, the board may not reinstate or reissue
a license to a person who license has been suspended or revoked because of
a felony conviction under:
(1)
Chapter 481 or 483, Health and Safety Code;
(2)
Section 485.033, Health and Safety Code; or
(3)
the Comprehensive Drug Abuse Prevention and Control Act
of 1970 (21 U.S.C. §801 et seq.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on July 9, 2001.
TRD-200103930
Jerry T. Walker
Interim Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 305-7016
22 TAC §167.3
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas State Board of Medical Examiners or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeal is proposed under the authority of the
Occupations Code Annotated, §153.001, which provides the Texas State
Board of Medical Examiners to adopt rules and bylaws as necessary to: govern
its own proceedings; perform its duties; regulate the practice of medicine
in this state; and enforce this subtitle.
The Occupations Code, §§164.003, 164.007, 164.009, 164.101, 164.102,
164.151, 164.152, 164.153, and 164.154 are affected by the repeal.
§167.3.Reinstatement of Drug Enforcement Agency Registration Following Surrender for Cause.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on July 9, 2001.
TRD-200103896
Jerry T. Walker
Interim Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: August 19, 2001
For further information, please call: (512) 305-7016
Chapter 623.
REGISTRATION AND CERTIFICATION
$71.
]
$42;
]
Chapter 108.
PROFESSIONAL CONDUCT
The receipt of the report shall not be considered
in the nature of a complaint unless the Enforcement Committee determines that
the circumstances surrounding the patient death or injury should be investigated
by the Board.
]
a patient record:
]
(e)
] Dental records are the sole
property of the dentist who performs the dental service. Such records shall
be available for inspection by the patient after and upon appointment with
a dentist. This shall not prohibit the transfer of a copy of records to the
patient, or to an agreed designated consultant for ascertainment of facts,
nor transfer of original records to another Texas dental licensee who will
provide treatment to the patient. The transferring dentist shall retain a
copy of the written record if such original transfer is made.
(f)
] A dentist who leaves a location
or practice, whether by retirement, sale, transfer, termination of employment
or otherwise, shall either maintain all dental records belonging to him or
her, make a written transfer of records to the succeeding dentist, or make
a written agreement for the maintenance of records, and the State Board of
Dental Examiners shall be notified within fifteen (15) days of any such event,
giving full information concerning the dentists and location(s) involved.
A maintenance of records agreement shall not transfer ownership of the dental
records, but shall require: that the dental records be maintained in accordance
with the laws of the State of Texas and the Rules of the State Board of Dental
Examiners; and that the dentist(s) performing the service(s) recorded shall
have access to and control of the records for purposes of inspection and copying.
A transfer of records may be made by agreement at any time in an employment
or other working relationship between a dentist and another entity. Such transfer
of records may apply to all or any part of the dental records generated in
the course of the relationship, including future dental records.
(g)
]Dental records shall be made
available for inspection and reproduction on demand by the officers, agents,
or employees of the State Board of Dental Examiners. The patient's privilege
against disclosure does not apply to the Board in a disciplinary investigation
or proceeding under the Dental Practice Act.
(h)
] A dentist shall furnish copies
of dental records to a patient who requests his or her dental records. Requested
copies including radiographs shall be furnished within thirty (30) days of
the date of the request, provided however, that copies need not be released
until payment of copying costs has been made. Records may not be withheld
based on a past due account for dental care or treatment previously rendered
to the patient.
x-ray
] duplicating service, may be equal to actual cost
verified by invoice.
an x-ray
] duplicating service
shall not exceed the following charges:
x-ray
]: $15.00;
cephalogram
]: $15.00;
x-ray
]:
$5.00;
x-ray
]:
$5.00.
Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
(F)
] review contract negotiations;
(G)
] review staff reports regarding
finances and the budget;
(H)
] make recommendations to the
board regarding matters brought to the attention of the executive committee.
(N)
] make recommendations to the
board regarding matters brought to the attention of the licensure committee.
§5.01
];
§5.01
] ;
§5.01
];
Article 4495b
]. In order that board meetings may be conducted
safely, efficiently, and with decorum, members of the public shall refrain
at all times from smoking or using tobacco products, eating, or reading newspapers
and magazines. Members of the public may not engage in disruptive activity
that interferes with board proceedings, including excessive movement within
the meeting room, noise or loud talking, and resting of feet on tables and
chairs. The public shall remain within those areas of the board's offices
designated as open to the public. Members of the public shall not address
or question board members during meetings unless recognized by the board's
presiding officer pursuant to a published agenda item.
Chapter 163.
LICENSURE
§3.08
].
Texas
Civil Statutes, Article 4495b, section 1.03(12)(A) and (B)
]. This temporary
license will be marked "administrative."
license
] has been expired for one year
due to failure to submit
an application for registration and annual registration fee
, it is considered
to have been canceled
, unless an investigation is pending
, and
the physician may not renew the
annual registration permit
[
license
]. The physician may obtain a new license by submitting to reexamination
and complying with the requirements and procedures for obtaining an original
license.
person:
]
Chapter 166.
PHYSICIAN REGISTRATION
§§3.08(1),
(4), (5), 4.01, and 4.12
]. A licensee who is disciplined by the board
for such a violation may be subject to the full range of actions authorized
by the Act including suspension or revocation of the physician's medical license,
but in no event shall such action be less than an administrative penalty of
$500 and a public reprimand.
Executive
]
Committee of the board for consideration and a recommendation to the full
board for approval or denial of the request. After consideration of the request
and the recommendation of the
Licensure
[
Executive
]
Committee, the board shall grant or deny the request subject such conditions
which the board determines are necessary to adequately protect the public
including but not limited to passage of the Special Purpose Examination (SPEX),
passage of the Medical Jurisprudence Examination, and/or passage of a specialty
board certification examination.
Executive
]
Committee for consideration and a recommendation to the full board for approval
or denial of the request. In those instances in which the executive director
submits the request to the
Licensure
[
Executive
] Committee
of the board, the
Licensure
[
Executive
] Committee shall
make a recommendation to the full board for approval or denial. After consideration
of the request and the recommendation of the
Licensure
[
Executive
] Committee, the board shall grant or deny the request subject to such
conditions which the board determines are necessary to adequately protect
the public including but not limited to passage of the Special Purpose Examination
(SPEX), passage of the Medical Jurisprudence Examination, and/or passage of
a specialty board certification examination.
Executive
] Committee or the full board may require
a personal appearance by the requesting physician at the offices of the board,
and the full board may require a physical or mental examination by one or
more physicians or other health care providers approved in advance in writing
by the executive director, the secretary-treasurer, the executive committee,
or other designee(s) determined by majority vote of the board.
§3.10(b)(7)
].
§3.10(b)(7)
].
Article
4495b, §3.025
] and §166.2 of this title (relating to Continuing
Medical Education).
Article 4495b, §3.01
].
Article 4495b, §3.08(4)
], based
on unprofessional or dishonorable conduct likely to deceive, defraud, or injure
the public if the physician engages in the compensated practice of medicine,
the provision of medical services to members of the physician's family, or
the self-prescribing of controlled substances or dangerous drugs.
Article 4495b, §3.08(4)
], in addition to any civil or criminal
actions provided for by state or federal law.
Chapter 167.
REINSTATEMENT AND REISSUANCE Cancellation for Cause ].
The applicant must complete in every detail the application
for reinstatement of license for cause, including payment of the required
application fee.
]
(b)
]The applicant
whose license
has been suspended
must appear before the board to [
state the
]
request [
for
] reinstatement of license.
(c) Application
]for
reinstatement following
suspension
[
cancellation for cause
] cannot be considered more often than annually
unless otherwise
specified by Order of the Board
.
§§4.02, 4.025, and 4.10
], and
the Administrative Procedure Act, Government Code, §2001.056, the following
rules shall apply to informal dispositions of any requests for reinstatement
of a medical license following
suspension
[
cancellation for
cause, or of any contested case
].
cancellation for cause, or of any contested case
] by stipulation, agreed
order, agreed settlement, consent order, or default.
cancellation for cause, or other matter
], the disposition shall be in
writing and, if appropriate, the writing shall be signed by the applicant.
cancellation for cause
], the board may provide an applicant with an opportunity to attend
an informal settlement conference.
a
copy of the completed application for reinstatement of license for cause,
by certified mail - return receipt requested, overnight or express mail, or
registered mail, to the last mailing address of the applicant or the applicant's
attorney on file with the board. The applicant shall also be provided with
] written notice of the time, date, and location of the conference and
the rules governing the proceeding by certified mail-return receipt requested,
overnight or express mail, or registered mail, to the last mailing address
of the applicant or the applicant's attorney on file with the board.
to present
] a synopsis of the allegations
and the [
facts the
] basis of the
suspension
[
cancellation
] of the applicant's medical license, the facts which the board staff
reasonably believes could be proven by competent evidence at a hearing
, and whether the applicant has complied with the terms and conditions of
the Order suspending his license if applicable
;
cancellation for cause
], the applicant, the applicant's
attorney or representative, any witnesses, and the general public. A board
legal counsel or representative of the Office of the Attorney General shall
be available to assist the representative(s) in their deliberations.
(12)
] At the informal settlement
conference, the board's representative(s) will attempt to mediate disputed
matters, and the board's representative(s) may call upon the board staff at
any time for assistance in conducting the informal settlement conference.
(13)
] The board's representative(s)
shall prohibit or limit access to the board's investigative file by the applicant,
the applicant's attorney or representative, any witnesses, and the public
consistent with the Medical Practice Act,
§164.007
[
§4.05(c)
].
(14)
] Although notes may be made
by the participants, mechanical or electronic recordings shall not be made
of settlement discussions, mediation efforts, and the informal settlement
conference.
(15)
] The settlement conference
shall be informal and shall not follow the procedures established under Chapter
187 of this title (relating to Procedure) for contested cases.
(16)
] At the conclusion of the
informal settlement conference, the board's representative(s) shall make recommendations
for disposition of the request for reinstatement [
following cancellation
for cause
] which may include deferral pending receipt of additional
information, denial of the request, or
in accordance with Board Rule
187.38 of this title (relating to Modification/Termination of Agreed Orders
and Disciplinary Orders), a modification or termination of the agreed or disciplinary
order under which the suspension was originally granted
[
a recommendation
regarding the disposition of the case in the absence of a hearing under the
provisions of applicable law concerning contested cases
]. The board's
representative(s) may make recommendations to the applicant for resolution
of the issues. Such recommendations may include any reasonable restrictions
authorized by the Act and any other remedial actions in the public interest.
These recommendations may be subsequently modified by the board's representative(s)
or staff based on new information, a change of circumstance, or to expedite
a resolution in the interest of protecting the public. These recommendations
may be adopted, modified, or rejected by the duly convened board or through
the duly authorized actions of the board's Disciplinary Process Review Committee.
(17)
] The applicant may either
accept or reject the settlement recommendations proposed by the board's representative(s).
If the applicant accepts the recommendations, the applicant shall execute
the settlement agreement in the form of an agreed order or affidavit as soon
thereafter as is practicable. If the applicant rejects the proposed agreement,
the applicant shall be given the option of requesting a formal hearing. If
the applicant requests a formal hearing, the matter shall be referred to the
board's staff for hearing, as described in Chapter 187, Subchapter C of this
title (relating to Hearing).
(18)
] Following acceptance and
execution by the applicant of the settlement agreement, the agreement shall
be submitted to the board for approval.
(19)
] The following as stated
in subparagraphs (A)-(C) of this paragraph relate to consideration of an agreed
disposition by the board.
following cancellation for cause
], with the approval
of the executive director, a member of the Executive Committee, or the Disciplinary
Process Review Committee, board staff may present a proposed settlement agreement
to the board for consideration and acceptance without conducting an informal
settlement conference. If the board does not approve such a proposed settlement
agreement, the applicant shall be so informed and the matter shall be referred
to the board staff for appropriate action to include further negotiation,
further investigation, an informal settlement conference or a hearing.
§4.10 of
Article 4495b, Texas Revised Civil Statutes
], a physician may be
reissued a medical license or
reinstated to the practice of medicine
only if the physician demonstrates that the
reissuance or
reinstatement
is in the physician's best interests. Best interests of the physician may
include, but not be limited to, an assessment by the Board as to whether the
physician:
,cancellation
] or suspension of a license; and
, cancellation
] or suspension of the license
of the physician will be minimal or minimized if the physician is returned
to the practice of medicine.
§4.10 of
Article 4495b, Texas Revised Civil Statutes
], a physician may be
reissued a medical license or
reinstated to the practice of medicine
only if the physician demonstrates that the
reissuance or
reinstatement
is in the best interests of the public. Bests interests of the public may
include, but not be limited to, an assessment by the Board as to whether the
physician demonstrates:
, cancellation
] or suspension of a license or any competency, technical,
educational, training or ethical limitations found since the entry of the
order;
, cancellation
] or suspension of the license will be minimal or minimized
if the physician is returned to the practice of medicine and the public will
adequately be protected, whether by probationary Order or other terms and
conditions as agreed to by the physician or authorized by
§§164.101-.102
of the Act
[
§ 4.11 and §4.12 of Article 4495b, Texas
Revised Civil Statutes
];
reinstatement
]
to meet the qualifications and requirements set forth in Chapter 163 of this
title, including, but not limited to documentation of completion of the process
of a current application for licensure.
application
], the Order revoking, [
canceling
]
or suspending a license is a final action and shall not be subject to further
litigation as to its findings of fact or conclusions of law, provided, however,
that the Order may be admissible and relevant for purposes of establishing
the basis for the original action and subsequent efforts after the Order by
the physician to demonstrate reinstatement of the license is in the best interests
of the public and the applicant physician.
Part 27.
BOARD OF TAX PROFESSIONAL EXAMINERS