Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
Chapter 175.
FEES, PENALTIES, AND APPLICATIONS
22 TAC §175.1
The Texas State Board of Medical Examiners proposes an amendment
to §175.1, concerning fees, penalties and applications. The proposal
will increase the fee for a physician annual registration permit from $330
to $334. The board is mandated by the 77th Legislature through TexasOnline
Authority to increase its fees to cover the cost for development of an on-line
renewal system.
Michele Shackelford, 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 fiscal implications to state or local government as a result
of enforcing the rule as proposed. The Fiscal impact to those individuals
required to comply is as follows: Increased fee of $4 for physician annual
registration permit. The Increased revenue to state government - estimated
at $4 x 50,000 physicians = $200,000.
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 compliance with the 77th Legislature
regarding the Texas Online Authority. 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 following are affected by the proposed amendment: Occupations Code, §§153.051,
153.054, and 156.001.
§175.1.Fees.
The board shall charge the following fees.
(1)
Physicians:
(A) - (D)
(No change.)
(E)
annual registration permit (includes a $200 surcharge)--
$334
[
(F) - (H)
(No change.)
(2) - (6)
(No change.)
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 April 8, 2002.
TRD-200202154
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 19, 2002
For further information, please call: (512) 305-7016
22 TAC §§184.1, 184.4, 184.6, 184.8, 184.13, 184.15
The Texas State Board of Medical Examiners proposes new §§184.1,
184.4, 184.6, 184.8, 184.13, and 184.15, concerning Surgical Assistants. The
new chapter is proposed as a result of HB 1183 of the 77th Legislature requiring
the board to license and regulate surgical assistants.
Elsewhere in this issue of the
Texas Register
the Texas State Board of Medical Examiners has withdrawn the previously
proposed version of §§184.1, 184.4, 184.6, 184.8, 184.13, and 184.15
which appeared in the March 1, 2002, issue of the
Texas Register
(27 TexReg 1424). Elsewhere in this issue of the
Michele Shackelford, 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 fiscal implications to state or local government as a result
of enforcing the rules as proposed. The Fiscal impact to those individuals
required to comply is as follows: $300 for processing licensure application
and $200 for annual renewal. Revenue to state: FY02 estimated at 500 applications
x $300 = $150,000; FY03 estimated at 500 renewals x $200 = $100,000 + new
applications which we are unable to estimate at this time.
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 the licensing and regulation
of surgical assistants. 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 new sections 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 following are affected by the proposed new rules: Title 3, Subtitle
C, Tex. Occ. Code Ann. Chapter 206.
§184.1.Purpose.
The purpose of these rules is to establish requirements for the education,
training, and professional behavior for persons who identify themselves as
licensed surgical assistants without a financial burden to the people of Texas.
Furthermore, the purpose of these rules and regulations is to also encourage
the more effective utilization of the skills of physicians by enabling them
to delegate health care tasks to licensed surgical assistants. These sections
are not intended to, and shall not be construed to, restrict the physician
from delegating technical and clinical tasks to technicians, other assistants,
or employees who perform delegated tasks in a surgical setting and who are
not rendering services as a surgical assistant or identifying themselves as
a licensed surgical assistant. Nothing in these rules and regulations shall
be construed to relieve the supervising physician of the professional or legal
responsibility for the care and treatment of his or her patients. In addition,
nothing in these rules and regulations shall be construed to require licensure
as a surgical assistant for those individuals who are exempted, including
registered nurses and physician assistants, under §206.002 of the Act.
§184.4.Qualifications for Licensure.
(a)
Except as otherwise provided in this section, an individual
applying for licensure must:
(1)
submit an application on forms approved by the board;
(2)
pay the appropriate application fee;
(3)
certify that the applicant is mentally and physically able
to function safely as a surgical assistant;
(4)
not have a license, certification, or registration in this
state or from any other licensing authority or certifying professional organization
that is currently revoked, suspended, or subject to probation or other disciplinary
action for cause;
(5)
have no proceedings that have been instituted against the
applicant for the restriction, cancellation, suspension, or revocation of
certificate, license, or authority to practice surgical assisting in the state,
Canadian province, or uniformed service of the United States in which it was
issued;
(6)
have no prosecution pending against the applicant in any
state, federal, or Canadian court for any offense that under the laws of this
state is a felony;
(7)
be of good moral character;
(8)
not have been convicted of a felony or a crime involving
moral turpitude;
(9)
not use drugs or alcohol to an extent that affects the
applicant's professional competency;
(10)
not have engaged in fraud or deceit in applying for a
license;
(11)
pass an independently evaluated surgical assistant examination
approved by the board;
(12)
have been awarded at least an associate's degree other
than in a surgical assistant training program at a two or four year institution
of higher education;
(13)
have successfully completed an educational program in
surgical assisting or a substantially equivalent educational program;
(A)
a surgical assistant program or a substantially equivalent
program is limited to the following:
(i)
a surgical assistant program approved by the board. After
September 1, 2003, applicants who wish the board to recognize their education
and training at a surgical assistant program must demonstrate that the program
is accredited by the Commission on Accreditation of Allied Health Education
Programs (CAAHEP);
(ii)
a medical school whereby the applicant can verify completion
of basic and clinical sciences coursework;
(iii)
registered nurse first assistant program; and
(iv)
an accredited surgical physician assistant program.
(B)
The curriculum of the surgical assisting educational programs
must include at a minimum the following courses:
(i)
anatomy;
(ii)
physiology;
(iii)
basic pharmacology;
(iv)
aseptic techniques;
(v)
operative procedures;
(vi)
chemistry;
(vii)
microbiology;
(viii)
pathophysiology;
(ix)
clinical service rotations, that either:
(I)
are each at least 80 hours in length, in the following
areas:
(-a-)
cardiovascular surgery;
(-b-)
trauma surgery;
(-c-)
general surgery;
(-d-)
obstetrics and gynecology;
(-e-)
orthopedics; and
(-f-)
pediatrics or an elective if the applicant affirms that
he or she has no intent to work as a surgical assistant for pediatric surgery;
or
(II)
meet the CAAHEP's supervised clinical preceptorship guidelines.
(14)
demonstrate to the satisfaction of the board the completion
of full-time work experience performed in the United States under the direct
supervision of a physician licensed in the United States consisting of at
least 2,000 hours of performance as an assistant in surgical procedures for
the three years preceding the date of the application.
(15)
be currently certified by a national certifying board
approved by the board; and
(16)
submit to the board any other information the board considers
necessary to evaluate the applicant's qualifications.
(b)
An applicant who submits an application before September
1, 2002 must provide documentation that the applicant has passed an examination
required for certification by one of the following certifying boards:
(1)
American Board of Surgical Assistants;
(2)
Liaison Council on Certification for the Surgical Technologist
(LCC-ST); or
(3)
National Surgical Assistant Association.
(c)
An applicant who submits an application before September
1, 2002 and is unable to meet the educational requirements set out in subsections
(a)(12) and (a)(13) of this section must also provide documentation that the
applicant:
(1)
will complete before the third anniversary of the date
the license is issued under this chapter the following academic courses approved
by the board:
(A)
anatomy;
(B)
physiology;
(C)
basic pharmacology;
(D)
aseptic techniques;
(E)
operative procedures;
(F)
chemistry; and
(G)
microbiology; or
(2)
since September 30, 1995, has practiced full-time as a
surgical assistant in the United States under the direct supervision of a
physician licensed in the United States and has continuously been certified
as a surgical assistant by one of the following national certifying boards:
(A)
American Board of Surgical Assistants;
(B)
Liaison Council on Certification for the Surgical Technologist
(LCC-ST); or
(C)
National Surgical Assistant Association.
§184.6.Licensure Documentation.
(a)
Original documents may include, but are not limited to,
those listed in subsections (b) and (c) of this section.
(b)
Documentation required of all applicants for licensure.
(1)
Birth Certificate/Proof of Age. Each applicant for licensure
must provide a copy of a birth certificate and translation if necessary to
prove that the applicant is at least 21 years of age. In instances where a
birth certificate is not available the applicant must provide copies of a
passport or other suitable alternate documentation.
(2)
Name change. Any applicant who submits documentation showing
a name other than the name under which the applicant has applied must present
copies of marriage licenses, divorce decrees, or court orders stating the
name change. In cases where the applicant's name has been changed by naturalization,
the applicant should send the original naturalization certificate by certified
mail to the board office for inspection.
(3)
Examination scores. Each applicant for licensure must have
a certified transcript of grades submitted directly from the appropriate testing
service to the board for all examinations used in Texas or another state for
licensure.
(4)
Certification. All applicants must submit:
(A)
a valid and current certificate from a board approved national
certifying organization; and
(B)
a certificate of successful completion of an educational
program whose curriculum includes surgical assisting submitted directly from
the program on a form provided the board, unless the applicant qualifies for
the special eligibility provision regarding education under §184.4(c)
of this title (relating to Qualifications for Licensure).
(5)
Evaluations. All applicants must provide evaluations, on
forms provided by the board, of their professional affiliations for the past
three years or since graduation from an educational program, in compliance
with §184.4(a)(13) of this chapter (relating to Qualifications for Licensure),
whichever is the shorter period. The evaluations must come from at least three
physicians who have each supervised the applicant for more than 100 hours
or a majority of the applicant's work experience.
(6)
Temporary license affidavit. Each applicant must submit
a completed form, furnished by the board, titled "Temporary License Affidavit"
prior to the issuance of a temporary license.
(7)
License verifications. Each applicant for licensure who
is licensed, registered, or certified in another state must have that state
submit directly to the board, on a form provided by the board, that the applicant's
license, registration, or certification is current and in full force and that
the license, registration, or certification has not been restricted, suspended,
revoked or otherwise subject to disciplinary action. The other state shall
also include a description of any sanctions imposed by or disciplinary matters
pending in the state.
(c)
Applicants may be required to submit other documentation,
which may include the following:
(1)
Translations. Any document that is in a language other
than the English language will need to have a certified translation prepared
and a copy of the translation submitted with the translated document.
(A)
An official translation from the school or appropriate
agency attached to the foreign language transcript or other document is acceptable.
(B)
If a foreign document is received without a translation,
the board will send the applicant a copy of the document to be translated
and returned to the board.
(C)
Documents must be translated by a translation agency who
is a member of the American Translation Association or a United States college
or university official.
(D)
The translation must be on the translator's letterhead,
and the translator must verify that it is a "true word for word translation"
to the best of his/her knowledge, and that he/she is fluent in the language
translated, and is qualified to translate the document.
(E)
The translation must be signed in the presence of a notary
public and then notarized. The translator's name must be printed below his/her
signature. The notary public must use the phrase: "Subscribed and Sworn this
_______ day of ________, 20___." The notary must then sign and date the translation,
and affix his/her notary seal to the document.
(2)
Arrest records. If an applicant has ever been arrested
the applicant must request that the arresting authority submit to the board
copies of the arrest and arrest disposition.
(3)
Inpatient treatment for alcohol/substance abuse or mental
illness. Each applicant that has been admitted to an inpatient facility within
the last five years for treatment of alcohol/substance abuse or mental illness
must submit the following:
(A)
applicant's statement explaining the circumstances of the
hospitalization;
(B)
all records, submitted directly from the inpatient facility;
(C)
a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up treatment
recommended; and
(D)
a copy of any contracts signed with any licensing authority,
professional society or impaired practitioner committee.
(4)
Outpatient treatment for alcohol/substance abuse or mental
illness. Each applicant that has been treated on an outpatient basis within
the past five years for alcohol/substance abuse must submit the following:
(A)
applicant's statement explaining the circumstances of the
outpatient treatment;
(B)
a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up treatment
recommended; and
(C)
a copy of any contracts signed with any licensing authority,
professional society or impaired practitioners committee.
(5)
Malpractice. If an applicant has ever been named in a malpractice
claim filed with any liability carrier or if an applicant has ever been named
in a malpractice suit, the applicant must:
(A)
have each liability carrier complete a form furnished by
this board regarding each claim filed against the applicant's insurance;
(B)
for each claim that becomes a malpractice suit, have the
attorney representing the applicant in each suit submit a letter to the board
explaining the allegation, relevant dates of the allegation, and current status
of the suit. If the suit has been closed, the attorney must state the disposition
of the suit, and if any money was paid, the amount of the settlement. If such
letter is not available, the applicant will be required to furnish a notarized
affidavit explaining why this letter cannot be provided; and
(C)
provide a statement composed by the applicant, explaining
the circumstances pertaining to patient care in defense of the allegations.
(6)
Additional documentation. Additional documentation may
be required as is deemed necessary to facilitate the investigation of any
application for medical licensure.
§184.8.License Renewal.
(a)
Surgical assistants licensed by the board shall register
annually and pay a fee. A surgical assistant may, on notification from the
board, renew an unexpired licensed by submitting a required form and paying
the required renewal fee to the board on or before the expiration date of
the license. The fee shall accompany a written application that sets forth
the licensee's name, mailing address, residence, the address of each of the
licensee's offices, and other necessary information prescribed by the board.
(b)
The board shall provide written notice to each practitioner
at the practitioner's address of record at least 30 days prior to the expiration
date of the license.
(c)
Within 30 days of a surgical assistant's change of mailing,
residence or office address from the address on file with the board, a surgical
assistant shall notify the board in writing of such change.
(d)
Falsification of an affidavit or submission of false information
to obtain renewal of a license shall subject a surgical assistant to denial
of the renewal and/or to discipline pursuant to §206.301 of the Act.
§184.13.Physician Supervision.
(a)
Supervision shall be continuous, and shall require that
the delegating physician be physically present and immediately available in
the operating room to personally respond to any emergency until the patient
is released from the operating room and care has been transferred to another
physician. Telecommunication is insufficient for supervision purposes.
(b)
It is the obligation of each team of physician(s) and surgical
assistant(s) to ensure that:
(1)
the surgical assistant's scope of practice is identified;
(2)
delegation of medical tasks is appropriate to the surgical
assistant's level of competence;
(3)
the relationship between the members of the team is defined;
(4)
that the relationship of, and access to, the supervising
physician is defined;
(5)
a process for evaluation of the surgical assistant's performance
is established; and
(6)
the physician and surgical assistant comply with the provisions
of Chapter 193 of this title (relating to Standing Delegation Orders) when
applicable.
§184.15.Grounds for Denial of Licensure and for Disciplinary Action.
The board may refuse to issue a license to any person and may, following
notice of hearing as provided for in the APA, take disciplinary action against
any surgical assistant that:
(1)
fraudulently or deceptively obtains or attempts to obtain
a license;
(2)
fraudulently or deceptively uses a license;
(3)
falsely represents that the person is a physician;
(4)
violates the Act, or any rules relating to the practice
of surgical assisting;
(5)
is convicted of a felony, or has imposition of deferred
adjudication or pre-trial diversion;
(6)
habitually uses drugs or alcohol to the extent that, in
the opinion of the board, the person cannot safely perform as a surgical assistant;
(7)
has been adjudicated as mentally incompetent or has a mental
or physical condition that renders the person unable to safely perform as
a surgical assistant;
(8)
has committed an act of moral turpitude. An act involving
moral turpitude shall be defined as an act involving baseness, vileness, or
depravity in the private and social duties one owes to others or to society
in general, or an act committed with knowing disregard for justice, honesty,
principles, or good morals;
(9)
has acted in an unprofessional or dishonorable manner that
is likely to deceive, defraud, or injure any member of the public;
(10)
has failed to practice as a surgical assistant in an acceptable
manner consistent with public health and welfare;
(11)
has committed any act that is in violation of the laws
of this state if the act is connected with practice as a surgical assistant;
a complaint, indictment, or conviction of a law violation is not necessary
for the enforcement of this provision. Proof of the commission of the act
while in practice as a surgical assistant or under the guise of practice as
a surgical assistant is sufficient for action by the board under this section;
(12)
has had the person's license or other authorization to
practice as a surgical assistant suspended, revoked, or restricted or who
has had other disciplinary action taken by another state regarding practice
as a surgical assistant or had disciplinary action taken by the uniformed
services of the United States. A certified copy of the record of the state
or uniformed services of the United States taking the action is conclusive
evidence of it;
(13)
unlawfully advertises in a false, misleading, or deceptive
manner as defined by §101.201 of the Tex. Occ. Code;
(14)
alters, with fraudulent intent, any surgical assistant
license, certificate, or diploma;
(15)
uses any surgical assistant license, certificate, or diploma
that has been fraudulently purchased, issued, or counterfeited or that has
been materially altered;
(16)
is removed or suspended or has disciplinary action taken
by his peers in any professional association or society, whether the association
or society, or is being disciplined by a licensed hospital or medical staff
of a hospital, including removal, suspension, limitation of privileges, or
other disciplinary action, if that action, in the opinion of the board, was
based on unprofessional conduct or professional incompetence that was likely
to harm the public. This action does not constitute state action on the part
of the association, society, or hospital medical staff;
(17)
has repeated or recurring meritorious health care liability
claims that in the opinion of the board evidence professional incompetence
likely to harm the public; or
(18)
sexually abuses or exploits another person during the
licensee's practice as a surgical assistant.
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 April 8, 2002.
TRD-200202163
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 19, 2002
For further information, please call: (512) 305-7016
Chapter 201.
LICENSING AND ENFORCEMENT--PRACTICE AND PROCEDURE
22 TAC §201.8
The Texas Funeral Service Commission (Commission) proposes
an amendment to §201.8, relating to Procedures for the Petition for Adoption
of Rules.
The Commission proposes the amendment to clarify the relationship of persons
involved in the proposal and adoption of rules. In subsection (d) the phrase
O.C. Robbins, Executive Director, has determined that for the first five-year
period this section is in effect there will be no fiscal implications for
state or local government as a result of enforcing or administering the section.
There will be no effect on small businesses. There is no anticipated economic
cost to persons who are required to comply with the proposed section.
Mr. Robbins has also determined that for the first five-year period this
section is in effect the public benefit will be that it defines procedures
on behalf of the consumer for the petition for adoption of rules.
Comments on the proposal may be submitted in writing for a 30 day period
to O.C. Robbins, Executive Director, Texas Funeral Service Commission, P.O.
Box 12217, Capitol Station, Austin, Texas 78711-1440, or faxed to (512) 479-5064,
or submitted electronically to chet.robbins@tfsc.state.tx.us.
The amendment is proposed under §651.152 of the Texas Occupations
Code, which authorizes the Commission to issue such rules and regulations
as may be necessary to effect the provision of this section.
No other statutes, articles, or codes are affected by the proposed amendment.
§201.8.Procedures for the Petition for Adoption of Rules.
(a) - (c)
(No change.)
(d)
When a petition is received that meets the requirements
of subsection (c) of this section, the executive director will forward the
petition to the presiding officer who will either assign the task to staff
or
an appropriate group of interested persons
[
[(e)
The appropriate group will report all
petitions out of committee with a recommendation to the commission regarding
its adoption.]
(e)
[
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 April 4, 2002.
TRD-200202135
O.C. "Chet" Robbins
Executive Director
Texas Funeral Service Commission
Earliest possible date of adoption: May 19, 2002
For further information, please call: (512) 936-2466
$330
];
Chapter 184.
SURGICAL ASSISTANTS
Part 10.
TEXAS FUNERAL SERVICE COMMISSION
appoint an
ad hoc committee
] to study the petition and make a recommendation to
the commission.
(f)
] The commission will consider
[
within 60 days after
] the submission of a petition and may either
deny the petition or instruct the executive director to initiate rulemaking
proceedings in accordance with the Administrative Procedure and Texas Register
Act, §5. In the event a petition is denied, the executive director will
advise the interested person in writing of the denial and will state the reason
for the denial of the commission.
Chapter 203.
LICENSING AND ENFORCEMENT--SPECIFIC SUBSTANTIVE RULES