Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
Chapter 161.
GENERAL PROVISIONS
22 TAC §161.6
The Texas State Board of Medical Examiners proposes an amendment
to §161.6, regarding the Committees of the Board. The proposed amendments
are relating to the status and duties of the Non-Profit Health Organizations
Committee and the Licensure Committee.
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 no fiscal implications to state or local government as a result
of enforcing the rule 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 rules regarding the Non-Profit
Health Organizations Committee and the Licensure Committee. There will be
no effect on small or micro 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: Tex. Occ. Code Ann., §153.005.
§161.6.Committees of the Board.
(a)
Each board committee shall be composed of board members
appointed by the president of the board and shall include at least one physician
member who holds the degree of doctor of osteopathic medicine and one public
member.
(b)
The following are standing and permanent committees of
the board. The responsibilities and authority of these committees shall include
the following duties and powers, and other responsibilities and charges that
the board may from time to time delegate to these committees.
(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
and board rules
;
(B)
monitor the effectiveness, appropriateness
,
and timeliness of the disciplinary process and enforcement of the Medical
Practice Act
and board rules
;
(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
;
[
(D)
approve dismissals of complaints and closure of investigations;
and
(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
and board rules
.
(2)
Executive Committee:
(A)
ensure records are maintained of all committee actions;
(B)
[
(C)
[
(D)
[
(E)
(F)
[
(G)
[
(H)
[
(I)
[
(J)
[
(3)
Finance Committee:
(A)
review staff reports regarding finances and the budget;
(B)
assist in the presentation of budget needs to the Legislature
and other state officials;
(C)
recommend proper fees for the agency to charge;
and
(D)
consider and make recommendations to the board regarding
any aspect of board finances.
(4)
Legislative Committee:
(A)
review and make recommendations to the board regarding
proposed legislative changes concerning the Medical Practice Act and the regulation
of medicine;
(B)
establish communication with members of the Legislature
,
[
(C)
assist in the organization, preparation, and delivery of
information and testimony to members
and committees
of the Legislature
[
(D)
make recommendations to the board regarding matters brought
to the attention of the legislative committee.
(5)
Licensure Committee:
(A)
review applications for licensure and permits, make
determinations
[
(B)
review board rules regarding licensure and make recommendations
to the board regarding changes or implementation of such rules;
(C)
evaluate each examination accepted by the board and develop
each examination administered by the board;
(D)
investigate and report to the board any problems in the
administration of examinations and recommend and implement ways of correcting
identified problems;
(E)
make recommendations to the board regarding postgraduate
training permits and issues concerning physicians in training;
(F)
maintain communication with Texas medical schools;
(G)
develop rules with regard to international medical schools
in the areas of curriculum, faculty, facilities, academic resources, and performance
of graduates;
(H)
study and make recommendations regarding documentation
and verification of records from all applicants for licensure or permits;
(I)
review applications for acudetox specialist certification,
make
determinations
[
(J)
review applications for acupuncture
licensure recommended by the Texas State Board of Acupuncture Examiners, make
determinations of eligibility, and report to the board its recommendations;
(K)
review applications for approval
and certification of non-profit health organizations pursuant to the Medical
Practice Act;
(L)
review applications and reports for continued
approval and certification of non-profit health organizations pursuant to
the Medical Practice Act;
(M)
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;
(N)
review board rules regarding
non-profit health organizations, and make recommendations to the board regarding
changes or implementation of such rules; and
(O)
[
[
[
[
[
[
[
(6)
[
(A)
develop information for distribution to the public;
(B)
review and make recommendations to the board in regard
to press releases, newsletters, web-sites and other publications;
(C)
study and make recommendations to the board regarding all
aspects of public information
and
[
(D)
receive information from the public concerning the regulation
of medicine pursuant to a published agenda item and board rules;
(E)
study and make recommendation to the board regarding all
aspects of physician profiles; and
(F)
make recommendations to the board regarding matters brought
to the attention of the public information/physician profile committee.
(7)
[
(A)
review and make recommendations to the board regarding
board rules pertaining to standing orders;
(B)
study and make recommendations to the board regarding issues
concerning or referred by the
Texas State
Board of Acupuncture
Examiners or other acupuncture issues;
(C)
study and make recommendations to the board regarding issues
concerning or referred by the
Texas State
Board of Physician Assistant
Examiners;
(D)
study and make recommendations to the board concerning
ethical issues related to the practice of medicine; and
(E)
make recommendations to the board regarding matters brought
to the attention of the standing orders committee.
(8)
[
(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;
and
(D)
review, study
,
and make recommendations to the
board concerning any other issue brought to the attention of the committee.
(c)
With statutory or board authorization, the president may
appoint, disband, or reconvene standing, ad hoc, or advisory committees as
deemed necessary. Such committees shall have and exercise such authority as
may be granted by the board.
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 June 17, 2002.
TRD-200203752
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §163.1, §163.5
The Texas State Board of Medical Examiners proposes amendments
to §163.1 and §163.5, regarding definitions and licensure documentation.
The amendments update the definitions of "medical school curriculum" and "substantially
equivalent"; and supervision of medical school students.
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 no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
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 rules. There will be
no effect on small or micro 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 following are affected by the proposed amendments: Tex. Occ. Code Ann., §§155.003,
155.0031.
§163.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicate otherwise.
(1)
Acceptable approved medical school--A medical school or
college located in the United States or Canada that is approved by the
board
[
(2)-(6)
(No change.)
(7)
Examinations accepted by the board for licensure.
(A)
(No change.)
(B)
Federation Licensing Examination (FLEX), after July
1,
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
30,
1985, with a FLEX weighted average of 75 or better in one sitting;
(D)-(K)
(No change.)
(8)
Examinations administered by the board for licensure--To
be eligible for licensure an
applicant
[
(9)
Good professional character--An
applicant
[
(10)
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)-(B)
(No change.)
(C)
a postresidency program, usually called
a
fellowship,
for additional training in a medical specialty or subspecialty in a program
approved by the Texas State Board of Medical Examiners.
(11)
(No change.)
(12)
Substantially equivalent to a Texas medical school--A
medical school or college
that is
[
(A)-(B)
(No change.)
(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,
neuroscience, biology, histology,
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,
neurology, family
medicine, introduction to patient/physical examination,
and surgery,
as defined by the Texas Higher Education Coordinating Board.
(E)-(H)
(No change.)
(I)
Medical education courses must
be
[
(J)
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.
In addition,
all medical or osteopathic medical education received in Texas must also comply
with Chapter 162 of this title (relating to Supervision of Medical School
Students) that requires physicians to register with the board prior to supervising
medical students who are not enrolled at a medical school that has been accredited
by the Liaison Committee on Medical Education or the American Osteopathic
Association.
This subsection does not apply to postgraduate medical
education or training.
(K)
An applicant who is unable to comply with the requirements
of subparagraph (J) of this paragraph is eligible for an unrestricted license
if the
applicant
[
(i)-(ii)
(No change.)
(13)
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
that is
:
(A)-(B)
(No change.)
(C)
a postresidency program, usually called
a
fellowship,
for additional training in a medical specialty or subspecialty
,
[
§163.5.Licensure Documentation.
(a)-(b)
(No change.)
(c)
Applicants for licensure who are graduates of unapproved
medical schools must furnish all appropriate documentation listed in this
subsection, as well as that listed in subsections (a) and (b) of this section.
(1)-(2)
(No change.)
(3)
Certificate of Registration. Each applicant must provide
a copy of his or her certificate to practice in the country in which his or
her medical school is located. If a certificate is unavailable, a letter [
(4)
(No change.)
(5)
An applicant who is a graduate of a medical school that
is located outside the United States and Canada must present satisfactory
proof to the board that each medical school attended
was
[
(A)-(E)
(No change.)
(F)
proof that the institutions
had
[
(G)
proof that the faculty
members
of the medical
school
had
[
(H)
proof that the medical education courses taught in the
United States
complied with
[
(I)
proof that the faculty
members
of the medical
school
were
[
(J)
proof that all education completed
in Texas was under a licensed physician who registered with the board prior
to supervising the applicant as set forth in Chapter 162 of this title (relating
to Supervision of Medical School Students).
(d)-(e)
(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 June 17, 2002.
TRD-200203753
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §164.3
The Texas State Board of Medical Examiners proposes an amendment
to §164.3, concerning Misleading or Deceptive Advertising. The proposed
amendment is regarding testimonials used in advertising.
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 no fiscal implications to state or local government as a result
of enforcing the rule 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 an updated rule. There will be
no effect on small or micro 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: Tex. Occ. Code Ann., §101.201.
§164.3.Misleading or Deceptive Advertising.
No physician shall disseminate or cause the dissemination of any advertisement
that is in any way false, deceptive, or misleading. Any advertisement shall
be deemed by the
board
[
(1)
contains material false claims or misrepresentations of
material facts which cannot be substantiated; [
(2)
contains material implied false claims or implied misrepresentations
of material fact; [
(3)
omits material facts; [
(4)
makes a representation likely to create an unjustified
expectation about the results of a health care service or procedure; [
(5)
advertises or assures a permanent cure for an incurable
disease; [
(6)
compares a health care professional's services with another
health care professional's services unless the comparison can be factually
substantiated; [
(7)
advertises professional superiority or the performance
of professional service in a superior manner if the advertising is not subject
to verification; [
(8)
contains a testimonial
that includes false, deceptive,
or misleading statements, or fails to include disclaimers or warnings as to
the credentials of the person making the testimonial
; [
(9)
includes photographs or other representations of models
or actors without explicitly identifying them as models and not actual patients;
[
(10)
causes confusion or misunderstanding as to the credentials,
education, or licensure of a health care professional; [
(11)
represents that health care insurance deductibles or copayments
may be waived or are not applicable to health care services to be provided
if the deductibles or copayments are required; [
(12)
represents that the benefits of a health benefit plan
will be accepted as full payment when deductibles or copayments are required;
[
(13)
states that a service is free when it is not, or contains
untruthful or deceptive claims regarding costs and fees. If other costs are
frequently incurred when the advertised service is obtained then this should
be disclosed. Offers of free service must indeed be free. To state that a
service is free but a third party is billed is deceptive and subject to disciplinary
action; [
(14)
makes a representation that is designed to take advantage
of the fears or emotions of a particularly susceptible type of patient; [
(15)
advertises or represents in the use of a professional
name, a title[
(16)
claims that a physician has a unique or exclusive skill
without substantiation of such claim; [
(17)
involves uninvited solicitation such as door to door solicitation
of a given population or other such tactics for "drumming" patients; or
(18)
fails to disclose the fact of giving compensation or anything
of value to representatives of the press, radio, television or other communicative
medium in anticipation of or in return for any advertisement, article, or
infomercial, unless the nature, format or medium of such advertisement
makes
[
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 June 17, 2002.
TRD-200203754
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §§165.2 - 165.4
The Texas State Board of Medical Examiners proposes amendments
to §§165.2-165.4, concerning Medical Records. The proposed amendments
are necessary to update fees charged for copies of billing records and general
clean-up of the rules.
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 follows: increased revenue
to the state - none. Cost to those persons requesting copies - $25 for the
first 20 pages plus $.15 per page thereafter plus $15 for an affidavit, if
requested.
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 rules. There will be
no effect on small or micro businesses.
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 following are affected by the proposed amendments: Tex. Occ. Code Ann., §§159.001,
159.002, 159.003, 159.004 159.005, 159.006, 159.007, 159.008.
§165.2.Medical and Billing Record Release and Charges.
(a)
As required by the Medical Practice Act,
§159.006
[
(b)
The requested copies of medical
and/or billing
records or a summary or narrative of the records shall be furnished by the
physician within 15 business days after the date of the request and reasonable
fees for furnishing the information shall be paid by the patient or someone
on behalf of the patient.
(c)
If the physician denies the request for copies of medical
and/or billing
records or a summary or narrative of the records, either
in whole or in part, the physician shall furnish the patient a written statement,
signed and dated, stating the reason for the denial, and a copy of the statement
denying the request shall be placed in the patient's medical
and/or billing
records
as appropriate
.
(d)
For purposes of this section, "medical records" shall include
those records as defined in §165.1(a) of this title (relating to Medical
Records) and shall include copies of medical records of other health care
practitioners contained in the records of the physician to whom a request
for release of records has been made.
(e)
The physician responding to a request for such information
shall be entitled to receive a reasonable fee for providing the requested
information. A reasonable fee shall be a charge of no more than $25 for the
first twenty pages and $.15 per page for every copy thereafter. In addition,
a reasonable fee may include actual costs for mailing, shipping, or delivery.
If an affidavit is requested, certifying that the information is a true and
correct copy of the records, a reasonable fee of up to $15 may be charged
for executing the affidavit.
A physician may charge separate fees for
medical and billing records requested.
(f)
The physician providing copies of requested medical
and/or billing
records or a summary or a narrative of such records shall
be entitled to payment of a reasonable fee prior to release of the information
unless the information is requested by a licensed Texas health care provider
or a physician licensed by any state, territory, or insular possession of
the United States or any State or province of Canada if requested for purposes
of emergency or acute medical care. In the event the physician receives a
proper request for copies of medical
and/or billing
records or
a summary or narrative of the [
(g)
A subpoena shall not be required for the release of medical
and/or billing
records requested pursuant to a proper release for records
under this section and the Medical Practice Act,
§159.006
[
(h)
In response to a proper request for release of medical
records, a physician shall not be required to provide copies of billing records
pertaining to medical treatment of a patient unless specifically requested
pursuant to the request for release of medical records.
(i)
The allowable charges as set forth in this chapter shall
be maximum amounts, and this chapter shall be construed and applied so as
to be consistent with lower fees or the prohibition or absence of such fees
as required by state statute or prevailing federal law.
In particular,
under §161.202 of the Texas Health and Safety Code, a physician may not
charge a fee for a medical or mental health record requested by a patient,
former patient or authorized representative of the patient if the request
is related to a benefits or assistance claim based on the patient's disability.
§165.3.Patient Access to Diagnostic Imaging Studies in Physician's Office.
(a)
Purpose. This section is promulgated to ensure that patients
have reasonable access to films and other static diagnostic imaging studies
maintained in the physician's office and that the practice of medicine by
individual licensees and the delivery of health care to the public shall not
be unduly hindered or interrupted by allowing for such access.
(b)
Request and release.
(1)
Upon receiving a written request and release of information
as provided for in the Medical Practice Act,
§159.005
[
(A)
providing copies of the films or other static diagnostic
imaging studies to the patient or recipient as designated in the request;
or
(B)
releasing the original films or other static diagnostic
imaging studies to the patient or recipient as designated in the request.
(2)
Release and transfer of original films or other static
diagnostic imaging studies may be evidenced by a signed and dated receipt
from a recipient of the original films or other diagnostic imaging studies,
or from their authorized representative, acknowledging receipt of and responsibility
for the original studies.
(c)
Exceptions. As provided for under the Medical Practice
Act,
§159.005
[
(d)
Time for release and denial. The requested copies or access
to films or other static diagnostic imaging studies shall be provided by the
physician within
15
[
(e)
Fees. The physician responding to a request for copies
of films or other static diagnostic imaging studies shall be entitled to a
reasonable fee for providing the copies. A reasonable fee shall be no more
than $8 per copy. In addition, a reasonable fee may include actual costs for
mailing, shipping, or delivery.
(f)
Emergency Request. The physician providing copies of requested
films or other static diagnostic imaging studies shall be entitled to a reasonable
fee prior to release of the copies unless the copies are requested by a licensed
Texas health care provider or a physician licensed by any state, territory,
or insular possession of the United States or any state or province of Canada
if requested for purposes of emergency or acute medical care. In the event
that the physician receives a proper request for copies of films or other
static diagnostic imaging studies for purposes other than for emergency or
acute medical care, the physician may retain the requested information until
payment is received. In the event that payment is not routed with such a request,
within ten calendar days from receiving a request for copies of films or other
static diagnostic imaging studies for purposes other than emergency or acute
medical care, the physician shall notify the requesting party in writing of
the need for payment and may withhold the copies until payment of a reasonable
fee is received. A copy of the letter regarding the need for payment shall
be made part of the patient's medical record. Access to or copies of films
or other static diagnostic imaging studies requested pursuant to a proper
request for release may not be withheld from the patient, the patient's authorized
agent, or the patient's designated recipient for such copies based on a past
due account for medical care or treatment previously rendered to the patient.
(g)
Subpoena. A subpoena shall not be required for access to
or the release of originals or copies of static diagnostic imaging studies
requested pursuant to the provisions of this section.
(h)
Maximum charges. The allowable charges set forth in this
section shall be maximum amounts, and this section shall be construed and
applied so as to be consistent with lower fees or the prohibition or absence
of such fees as required by prevailing state or federal law.
§165.4.Appointment of Record Custodian of a Physician's Records.
(a)
The
board
[
(b)
The records will be considered abandoned if they are without
custodial care for a minimum of two weeks without alternative arrangements
being made by the physician, the physician's legal guardian, or by the executor
of the physician's estate.
(c)
The record custodian appointed by the
board
[
(d)
The appointed record custodian shall provide the records,
or copies of the records, to the patient or to the patient's designee according
to
board
[
(e)
The appointed record custodian shall retain care of the
records for no less than 90 days and shall publish appropriate notice of pending
destruction of the records for no less than 30 days prior to destruction of
the records.
(f)
Destruction of medical records shall be done in a manner
that
[
(g)
The
board
[
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 June 17, 2002.
TRD-200203755
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §166.2
The Texas State Board of Medical Examiners proposes an amendment
to §166.2, concerning Continuing Medical Education. The proposed amendments
relate to CME hours obtained during the 30-day grace period, audit of CME
and CME temporary permit.
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 no fiscal implications to state or local government as a result
of enforcing the rule 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 an updated rule. There will be
no effect on small or micro 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: Tex. Occ. Code Ann., §§156.051,
156.052, 156.053.
§166.2.Continuing Medical Education.
(a)
As a prerequisite to the annual registration of a physician's
permit, 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)
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 permit
application if she or he has completed the required
CME
[
(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 Bureau of Osteopathic Specialists, 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
.
[
(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
,
submitted in writing by the
licensee
,
that gives satisfactory evidence to the board that the
licensee is unable to comply with the requirement for
CME
[
(e)
Exemptions are subject to the approval of the executive
director or medical director and must be requested in writing at least 30
days prior to the expiration date of the permit.
(f)
A temporary exemption under subsection (d) of this section
may not exceed one year but may be requested 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 board
action with respect to a licensee or an applicant for a license by requiring
additional hours of
CME
[
(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 the annual registration
expiration date, will satisfy the requirements of subsections (a)(1) and (2)
of this section by their residency or fellowship program.
(k)
Unless exempted under the terms of this section, a 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 the denial of the annual
registration permit 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 CME license numbered so as to correspond to
the nonrenewed license. Such a temporary CME license shall be issued upon
receipt of a written request and fee for the license made prior to the expiration
of the 30-day grace period for annual registration at the direction of the
executive director for a period of no longer than 60 days. A temporary CME
license issued pursuant to this subsection may be issued [
(l)
The fee for issuance of a temporary CME 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).
(m)
CME hours which are obtained
during the 30 day grace
period after the expiration of the licensee's permit or while under a CME
temporary license
to comply with the CME requirements for the preceding
year as a prerequisite for obtaining an annual registration permit, 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)
A
[
(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 §187.40 of this title (relating
to Administrative Penalties).
(p)
Unless exempted under the terms of this section, failure
[
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 June 17, 2002.
TRD-200203756
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §173.1
The Texas State Board of Medical Examiners proposes an amendment
to §173.1, concerning Profile Contents. The amendment will correct an
error and delete status dates from profiles.
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 no fiscal implications to state or local government as a result
of enforcing the rule 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 an updated rule. There will be
no effect on small or micro 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: Tex. Occ. Code Ann., §154.006.
§173.1.Profile Contents.
(a)
The Texas State Board of Medical Examiners (the "board")
shall develop and make available to the public a comprehensive profile of
each licensed physician electronically via the Internet or in paper format
upon request.
(b)
The profile of each licensed physician shall contain the
following information listed in paragraphs (1)-
(24)
[
(1)
full name;
(2)
place of birth if the physician requests that it be included
in the physician's profile;
(3)
gender;
(4)
ethnic origin if the physician requests that it be included
in the physician's profile;
(5)
name of each medical school attended and the dates of:
(A)
graduation; or
(B)
Fifth Pathway designation and completion of the Fifth Pathway
Program;
(6)
a description of all graduate medical education in the
United States or Canada, including:
(A)
beginning and ending dates;
(B)
program name;
(C)
city and state of program;
(D)
type of training (internship, residency or fellowship);
and
(E)
specialty of program;
(7)
any specialty certification held by the physician and issued
by a board that is a member of the American Board of Medical Specialties or
the Bureau of Osteopathic Specialists;
(8)
primary and secondary specialties practiced, as designated
by the physician;
(9)
the number of years the physician has actively practiced
medicine in:
(A)
the United States or Canada; and
(B)
Texas;
(10)
the original date of issuance of the physician's Texas
medical license;
(11)
the expiration date of the physician's annual registration
permit;
(12)
the physician's current registration, disciplinary and
licensure statuses [
(13)
the name and city of each hospital in Texas in which the
physician has privileges;
(14)
the physician's primary practice location (street address,
city, state and zip code);
(15)
the type of language translating services, including translating
services for a person with impairment of hearing, that the physician provides
at the physician's primary practice location;
(16)
whether the physician participates in the Medicaid program;
(17)
whether the physician's patient service areas are accessible
to disabled persons, as defined by federal law;
(18)
a description of any conviction for an offense constituting
a felony, a Class A or Class B misdemeanor, or a Class C misdemeanor involving
moral turpitude during the ten-year period preceding the date of the profile;
(19)
a description of any charges reported to the board during
the ten-year period preceding the date of the profile to which the physician
has pleaded no contest, for which the physician is the subject of deferred
adjudication or pretrial diversion, or in which sufficient facts of guilt
were found and the matter was continued by a court of competent jurisdiction;
(20)
a description of any disciplinary action against the physician
by the board during the ten-year period preceding the date of the profile;
(21)
a description of any disciplinary action against the physician
by a medical licensing board of another state during the ten-year period preceding
the date of the profile;
(22)
a description of the final resolution taken by the board
on medical malpractice claims or complaints required to be opened by the board
under the Medical Practice Act (the "Act"), TEX. OCC. CODE ANN. §164.201;
(23)
a description of any formal complaint issued by the
board's
[
(24)
a description of a maximum of five awards, honors, publications
or academic appointments submitted by the physician, each no longer than 120
characters.
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 June 17, 2002.
TRD-200203757
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §183.4, §183.20
The Texas State Board of Medical Examiners proposes amendments
to §183.4 and §183.20, concerning Licensure and Continuing Acupuncture
Education. The amendments update evaluating English proficiency and continuing
acupuncture education.
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 no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
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 rules. There will be
no effect on small or micro 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 following are affected by the proposed amendments: Tex. Occ. Code Ann., §§205.202,
205.255.
§183.4.Licensure.
(a)
Qualifications. An applicant must present satisfactory
proof to the acupuncture board that the applicant:
(1)-(6)
(No change.)
(7)
is able to communicate in English as demonstrated by one
of the following:
(A)
passage of the NCCAOM examination taken in English; [
(B)
passage of the TOEFL (Test of English as a Foreign Language)
with a score of 550 or higher on the paper based test or with a score of 213
or higher on the computer based test; [
(C)
passage of the TSE (Test of Spoken English) with a score
of 45 or higher; [
(D)
passage of the TOEIC (Test of English for International
Communication) with a score of 500 or higher; or
(E)
at the discretion of the acupuncture board, passage of
any other similar, validated exam testing English competency given by a testing
service with results reported directly to the acupuncture board or with results
otherwise subject to verification by direct contact between the testing service
and the acupuncture board
.
[
[
(b)
(No change.)
(c)
Licensure documentation.
(1)-(2)
(No change.)
(3)
Additional documentation. Applicants may be required to
submit other documentation, including but not limited to the following:
(A)-(C)
(No change.)
(D)
Inpatient treatment for alcohol/substance abuse or mental
illness. Each applicant that has been admitted to an inpatient facility within
the last
five
[
(i)-(iv)
(No change.)
(E)
Outpatient treatment for alcohol/substance abuse or mental
illness. Each applicant that has been treated on an outpatient basis within
the last
five
[
(i)-(iii)
(No change.)
(F)-(I)
(No change.)
(4)
(No change.)
(d)-(h)
(No change.)
§183.20.Continuing Acupuncture Education.
(a)
Purpose. This section is promulgated to promote the health,
safety, and welfare of the people of Texas through the establishment of minimum
requirements for continuing acupuncture education (CAE) for licensed Texas
acupuncturists so as to further enhance their professional skills and knowledge.
(b)
Minimum Continuing Acupuncture Education. As a prerequisite
to the annual registration of the license of an acupuncturist, the acupuncturist
shall complete 17 hours of continuing acupuncture education (CAE) each year
.
[
(1)
The required hours shall be from courses that are designated
or otherwise approved for credit by the Texas State Board of Acupuncture Examiners
at the time the
courses
[
(2)
At least five of the required hours
shall be
from courses
in
[
(3)
At least two hours of the required hours
shall be
from courses
in
[
(c)-(f)
(No change.)
(g)
Verification of Credits. The board may require written
verification of both formal and informal continuing acupuncture education
hours from any licensee and the licensee shall provide the requested verification
within 30 calendar days of the date of the request. Failure to timely provide
the requested verification may result in disciplinary action by the
board
[
(h)-(i)
(No change.)
(j)
Application of Additional Hours. Continuing acupuncture
education hours
that
[
(k)-(m)
(No change.)
(n)
Approval of Continuing Acupuncture Education. Continuing
Acupuncture Education [
(1)-(8)
(No change.)
(o)
Continuing Acupuncture Education Approval Requests. All
requests for approval of courses, programs, or activities for purposes of
satisfying [
(p)
Reconsideration of Denials of Approval Requests. Determinations
to deny approval of a CAE course, program, or activity may be reconsidered
by the Education Committee or the
board
[
(q)
Reconsideration of Approvals. Determinations to approve
a CAE course, program, or activity may be reconsidered by the Education Committee
or the
board
[
(r)
CAE Credit for Course Instruction.
Instructors of board-approved CAE courses may receive three hours of CAE credit
for each hour of lecture, not to exceed six hours of continuing education
credit per year, regardless of how many hours taught. Participation as a member
of a panel presentation for the approved course shall not entitle the participant
to earn CAE credit as an instructor. No CAE credit shall be granted to school
faculty members as credit for their regular teaching assignments.
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 June 17, 2002.
TRD-200203758
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §§184.17 - 184.24
The Texas State Board of Medical Examiners proposes new §§184.17-184.24,
concerning Surgical Assistants. The new rules are proposed to outline the
disciplinary process relating to surgical assistants and provide instruction
regarding the complaint procedure notification.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the sections are in effect
the increased revenue to the state from administrative penalties cannot be
determined at this time. Impact to those required to comply will be dependent
upon how many administrative penalties are issued.
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 to provide guidance to licensed
surgical assistants regarding the disciplinary process of the board and other
requirements. There will be no effect on small or micro businesses.
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 rules 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: Tex. Occ. Code Ann.,
Chapter 206.
§184.17.Disciplinary Guidelines.
(a)
Chapter 190 of this title (relating to Disciplinary Guidelines)
shall apply to surgical assistants regulated under this chapter to be used
as guidelines for the following areas as they relate to the denial of licensure
or disciplinary action of a licensee:
(1)
practice inconsistent with public health and welfare;
(2)
unprofessional and dishonorable conduct;
(3)
disciplinary actions by state boards and peer groups;
(4)
repeated and recurring meritorious health care liability
claims; and
(5)
aggravating and mitigating factors.
(b)
If the provisions of Chapter 190 conflict with the Act
or rules under this chapter, the Act and provisions of this chapter shall
control.
§184.18.Administrative Penalties.
(a)
Pursuant to §206.351 of the Act, the board by order
may impose an administrative penalty, subject to the provisions of the APA,
against a person licensed or regulated under the Act who violates the Act
or a rule or order adopted under the Act. The imposition of such a penalty
shall be consistent with the requirements of the Act and the APA.
(b)
The penalty for a violation may be in an amount not to
exceed $5,000. Each day a violation continues or occurs is a separate violation
for purposes of imposing a penalty.
(c)
Prior to the imposition of an administrative penalty by
board order, a person must be given notice and opportunity to respond and
present evidence and argument on each issue that is the basis for the proposed
administrative penalty at a show compliance proceeding.
(d)
The amount of the penalty shall be based on the factors
set forth under the Act, §206.351(c) and Chapter 190 of this title (relating
to Disciplinary Guidelines).
(e)
Consistent with the Act, §206.351(e), if the board
by order determines that a violation has occurred and imposes an administrative
penalty on a person licensed or regulated under the Act, the board shall give
notice to the person of the board's order which shall include a statement
of the right of the person to seek judicial review of the order.
(f)
An administrative penalty may be imposed under this section
for the following:
(1)
failure to timely comply with a board subpoena issued by
the board pursuant to §206.308 of the Act and board rules shall be grounds
for the imposition of an administrative penalty of no less than $100 and no
more than $5,000 for each separate violation;
(2)
failure to timely comply with the terms, conditions, or
requirements of a board order shall be grounds for imposition of an administrative
penalty of no less than $100 and no more than $5,000 for each separate violation;
(3)
failure to timely report a change of address to the board
shall be grounds for imposition of an administrative penalty of no less than
$100 and no more than $5,000 for each separate violation;
(4)
failure to timely respond to a patient's communications
shall be grounds for imposition of an administrative penalty of no less than
$100 and no more than $5,000 for each separate violation;
(5)
failure to comply with the complaint procedure notification
requirements as set forth in §184.19 of this title (relating to Complaint
Procedure Notification) shall be grounds for imposition of an administrative
penalty of no less than $100 and no more than $5,000 for each separate violation;
(6)
failure to provide show compliance proceeding information
in the prescribed time shall be grounds for imposition of an administrative
penalty of no less than $100 and no more than $5,000 for each separate violation;
and
(7)
for any other violation other than quality of care that
the board deems appropriate shall be grounds for imposition of an administrative
penalty of no less than $100 and no more than $5,000 for each separate violation.
(g)
In the case of untimely compliance with a board order,
the board staff shall not be authorized to impose an administrative penalty
without an informal show compliance proceeding if the person licensed or regulated
under the Act has not first been brought into compliance with the terms, conditions,
and requirements of the order other than the time factors involved.
(h)
Any order proposed under this section shall be subject
to final approval by the board.
(i)
Failure to pay an administrative penalty imposed through
an order shall be grounds for disciplinary action by the board pursuant to
the Act, §206.302(a)(4), regarding unprofessional or dishonorable conduct
likely to deceive or defraud, or injure the public, and shall also be grounds
for the executive director to refer the matter to the attorney general for
collection of the amount of the penalty.
(j)
A person who becomes financially unable to pay an administrative
penalty after entry of an order imposing such a penalty, upon a showing of
good cause by a writing executed by the person under oath and at the discretion
of the Disciplinary Process Review Committee of the board, may be granted
an extension of time or deferral of no more than one year from the date the
administrative penalty is due. Upon the conclusion of any such extension of
time or deferral, if payment has not been made in the manner and in the amount
required, action authorized by the terms of the order or subsection (i) of
this section and the Act, §206.301(a)(4) may be pursued.
§184.19.Complaint Procedure Notification.
(a)
Methods of Notification. Pursuant to the Act, §206.153,
for the purpose of directing complaints to the board, the board and its licensees
shall provide notification to the public of the name, mailing address, and
telephone number, both regular and toll free, for filing complaints by one
or more of the following methods:
(1)
displaying in a prominent location at their place or places
of business, signs in English and Spanish of no less than 8 and 1/2 inches
by 11 inches in size with the board-approved notification statement printed
alone and in its entirety in black on a white background in type no smaller
than standard 24-point Times Roman print with no alterations, deletions, or
additions to the language of the board-approved statement;
(2)
placing the board-approved notification statement printed
in English and Spanish in black type no smaller than standard 10-point, 12-pitch
typewriter print on each bill for services with no alterations, deletions,
or additions to the language of the board-approved statement; or
(3)
placing the board-approved notification statement printed
in English and Spanish in black type no smaller than standard 10-point, 12-pitch
typewriter print on each registration form, application, or written contract
for services with no alterations, deletions, or additions to the language
of the board-approved statement.
(b)
Approved English Notification Statement. The following
notification statement in English is approved by the board for purposes of
these rules and the Act, §206.153 and is a sample of the type print referenced
in subsection (a) of this section.
Figure: 22 TAC §184.19(b)
(c)
Approved Spanish Notification Statement. The following
notification statement in Spanish is approved by the board for purposes of
these rules and the Act, §206.153, and is a sample of the type print
referenced in subsection (a) of this section.
Figure: 22 TAC §184.19(c)
§184.20.Investigations.
(a)
Confidentiality. All complaints, adverse reports, investigation
files, other investigation reports, and other investigative information in
the possession of, or received, or gathered by the board or its employees
or agents relating to a licensee, an application for license, or a criminal
investigation or proceeding are privileged and confidential and are not subject
to discovery, subpoena, or other means of legal compulsion for their release
to anyone other than the board or its employees or agents involved in licensee
discipline.
(b)
Permitted disclosure of investigative information. Investigative
information in the possession of the board or its employees or agents that
relates to discipline of a licensee and information contained in such files
may not be disclosed except in the following circumstances:
(1)
to the appropriate licensing or regulatory authorities
in other states or the District of Columbia or a territory or country where
the surgical assistant is licensed, registered, or certified or has applied
for a license or to a peer review committee reviewing an application for privileges
or the qualifications of the licensee with respect to retaining privileges;
(2)
to appropriate law enforcement agencies if the investigative
information indicates a crime may have been committed and the board shall
cooperate with and assist all law enforcement agencies conducting criminal
investigations of licensees by providing information relevant to the criminal
investigation to the investigating agency and any information disclosed by
the board to an investigative agency shall remain confidential and shall not
be disclosed by the investigating agency except as necessary to further the
investigation;
(3)
to a health-care entity upon receipt of written request.
Disclosures by the board to a health-care entity shall include only information
about a complaint filed against a surgical assistant that was resolved after
investigation by a disciplinary order of the board or by an agreed settlement,
and the basis and current status of any complaint under active investigation
that has been referred by the executive director or the director's designee
for legal action; and
(4)
to other persons if required during the investigation.
(c)
Renewal of licenses. A licensee shall furnish a written
explanation of his or her answer to any question asked on the application
for license renewal, if requested by the board. This explanation shall include
all details as the board may request and shall be furnished within 14 days
of the date of the board's request.
(d)
Reports to the Board.
(1)
Relevant information required to be reported to the board
pursuant to §206.159 of the Act, indicating that a surgical assistant's
practice poses a continuing threat to the public welfare shall include a narrative
statement describing the time, date, and place of the acts or omissions on
which the report is based.
(2)
A report that a surgical assistant's practice constitutes
a continuing threat to the public's welfare shall be made as soon as possible
after the peer review committee, quality assurance committee, surgical assistant,
surgical assistant student, physician or any person usually present in the
operating room, including a nurse or surgical technologist involved reaches
that conclusion and is able to assemble the relevant information.
§184.21.Impaired Surgical Assistants.
(a)
Mental or physical examination requirement. The board may
require a licensee to submit to a mental and/or physical examination by a
physician or physicians designated by the board if the board has probable
cause to believe that the licensee is impaired. Impairment is present if one
appears to be unable to practice with reasonable skill and safety to patients
by reason of age, illness, drunkenness, excessive use of drugs, narcotics,
chemicals, or any other type of material; or as a result of any mental or
physical condition. Probable cause may include, but is not limited to, any
one of the following:
(1)
sworn statements from two people, willing to testify before
the board, medical board, or the State Office of Administrative Hearings that
a certain licensee is impaired;
(2)
a sworn statement from an official representative of the
Texas Association of Surgical Assistants stating that the representative is
willing to testify before the board that a certain licensee is impaired;
(3)
evidence that a licensee left a treatment program for alcohol
or chemical dependency before completion of that program;
(4)
evidence that a licensee is guilty of intemperate use of
drugs or alcohol;
(5)
evidence of repeated arrests of a licensee for intoxication;
(6)
evidence of recurring temporary commitments of a licensee
to a mental institution; or
(7)
medical records indicating that a licensee has an illness
or condition which results in the inability to function properly in his or
her practice.
(b)
Rehabilitation Order. The board through an agreed order
or after a contested proceeding, may impose a nondisciplinary rehabilitation
order on any licensee, or as a prerequisite for licensure, on any licensure
applicant. Chapter 180 of this title (relating to Rehabilitation Orders) shall
govern procedures relating to surgical assistants who are found eligible for
a rehabilitation order. If the provisions of Chapter 180 conflict with the
Act or rules under this chapter, the Act and provisions of this chapter shall
control.
§184.22.Procedure.
Chapter 187 of this title (relating to Procedural Rules) shall govern
procedures relating to surgical assistants where applicable. If the provisions
of Chapter 187 conflict with the Act or rules under this chapter, the Act
and provisions of this chapter shall control.
§184.23.Compliance.
Chapter 189 of this title (relating to Compliance) shall be applied
to surgical assistants who are under board orders. If the provisions of Chapter
189 conflict with the Act or rules under this chapter, the Act and provisions
of this chapter shall control.
§184.24.Construction.
The provisions of this chapter shall be construed and interpreted so
as to be consistent with the statutory provisions of the Act and the Medical
Practice Act. In the event of a conflict between this chapter and the provisions
of the Acts, the provisions of the Acts shall control; however, this chapter
shall be construed so that all other provisions of this chapter which are
not in conflict with the Acts shall remain in effect.
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 June 17, 2002.
TRD-200203759
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §190.1
The Texas State Board of Medical Examiners proposes an amendment
to §190.1, concerning Disciplinary Guidelines. The proposed amendment
concerns clarification of the definition of practice inconsistent with public
health and welfare and general clean-up of the section.
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 no fiscal implications to state or local government as a result
of enforcing the rule 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 an updated rule. There will be
no effect on small or micro 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: Tex. Occ. Code Ann., §§164.001,
164.051, 164.052, 164.053, 165.001, 165.002, 165.003.
§190.1.Disciplinary Guidelines.
(a)
Purpose. This chapter is promulgated to:
(1)
provide guidance and a framework of analysis in the making
of recommendations in contested licensure and disciplinary matters;
(2)
promote consistency in the exercise of sound discretion
by board members in the imposition of sanctions in disciplinary matters; [
(3)
provide guidance for board members for the resolution of
potentially contested matters;
and
[
(4)
provide guidance as to the
types of conduct that constitute violations of the Medical Practice Act (the
"Act") or board rules.
(b)
Limitations. This chapter shall be construed and applied
so as to preserve board member discretion in the imposition of sanctions and
remedial measures pursuant to the
Act's provisions related to methods
of discipline and administrative penalties
[
(c)
Guidelines. The following acts,
practices, and conduct are presumed to be violations of the Act. A Respondent
may rebut this presumption by providing an adequate explanation and evidence
as to why an act listed below was committed. The following shall not be considered
an exhaustive or exclusive listing.
(1)
Practice Inconsistent with Public Health and
Welfare. Failure to practice in an acceptable professional manner consistent
with public health and welfare within the meaning of the Act includes, but
is not limited to:
(A)
failure to treat a patient according to the
generally accepted standard of care;
(B)
negligence in performing medical services;
(C)
failure to use proper diligence in one's professional
practice;
(D)
failure to safeguard against potential complications;
(E)
improper utilization review;
(F)
failure to timely respond in person when on-call
or when requested by emergency room or hospital staff;
(G)
failure to disclose reasonably foreseeable side
effects of a procedure or treatment;
(H)
failure to disclose reasonable alternative treatments
to a proposed procedure or treatment;
(I)
failure to obtain and document informed consent
from the patient or other person authorized by law to consent to treatment
on the patient's behalf before performing tests, treatments, or procedures;
(J)
termination of patient care without providing
reasonable notice to the patient and a reasonable alternative for the patient's
care;
(K)
prescription or administration of a drug in
a manner that is not in compliance with Chapter 200 of this title (relating
to Standards for Physicians Practicing Integrative and Complementary Medicine
) or, that is either not approved by the Food and Drug Administration (FDA)
for use in human beings or does not meet standards for off-label use, unless
an exemption has otherwise been obtained from the FDA;
(L)
prescription of any dangerous drug or controlled
substance without first establishing a proper professional relationship with
the patient. A proper relationship, at a minimum requires:
(i)
establishing that the person requesting the
medication is in fact who the person claims to be;
(ii)
establishing a diagnosis through the use of
acceptable medical practices such as patient history, mental status examination,
physical examination, and appropriate diagnostic and laboratory testing. An
online or telephonic evaluation by questionnaire is inadequate;
(iii)
discussing with the patient the diagnosis
and the evidence for it, the risks and benefits of various treatment options;
and
(iv)
ensuring the availability of the physician
or coverage of the patient for appropriate follow-up care; and
(M)
inappropriate prescription of dangerous drugs
or controlled substances to oneself, family members, or others in which there
is a close personal relationship that would include the following:
(i)
prescribing or administering dangerous drugs
or controlled substances without taking an adequate history, performing a
proper physical examination, and creating and maintaining adequate records;
and
(ii)
prescribing controlled substances in the absence
of immediate need. "Immediate need" shall be considered no more than 72 hours.
(2)
Unprofessional and Dishonorable Conduct. Unprofessional
and dishonorable conduct that is likely to deceive, defraud, or injure the
public within the meaning of the Act includes, but is not limited to:
(A)
violating a board order;
(B)
failing to comply with a board subpoena or request
for information or action;
(C)
providing false information to the board;
(D)
failing to cooperate with board staff;
(E)
engaging in sexual contact with a patient;
(F)
engaging in sexually inappropriate behavior
or comments directed towards a patient;
(G)
becoming financially or personally involved
with a patient in an inappropriate manner;
(H)
referring a patient to a facility without disclosing
the existence of the licensee's ownership interest in the facility to the
patient;
(I)
using false, misleading, or deceptive advertising;
(J)
submitting billing statements to a patient or
a third party payor that are improper, fraudulent or that are otherwise in
violation of §311.0025 of the Health and Safety Code;
(K)
behaving in an abusive or assaultive manner
towards a patient or the patient's family or representatives that interferes
with patient care or could be reasonably expected to adversely impact the
quality of care rendered to a patient;
(L)
failing to timely respond to communications
from a patient;
(M)
failing to complete the required amounts of
CME;
(N)
failing to maintain the confidentiality of a
patient;
(O)
failing to report suspected abuse of a patient
by a third party, when the report of that abuse is required by law;
(P)
behaving in a disruptive manner toward physicians,
hospital personnel, other medical personnel, patients, family members or others
that interferes with patient care or could be reasonably expected to adversely
impact the quality of care rendered to a patient; and
(Q)
entering into any agreement whereby a licensee,
peer review committee, hospital, medical staff, or medical society is restricted
in providing information to the board.
(3)
Disciplinary actions by another state board.
A voluntary surrender of a license in lieu of disciplinary action or while
an investigation is pending constitutes disciplinary action within the meaning
of the Act.
(4)
Disciplinary actions by peer groups. A voluntary
relinquishment of privileges or a failure to renew privileges with a hospital,
medical staff, or medical association or society while investigation or a
disciplinary action is pending or is on appeal constitutes disciplinary action
within the meaning of the Act.
(d)
[
(1)
patient harm and the severity of patient harm;
(2)
economic harm to any individual or entity and the severity
of such harm;
(3)
environmental harm and severity of such harm;
(4)
increased potential for harm to the public;
(5)
attempted concealment of misconduct;
(6)
premeditated misconduct;
(7)
intentional misconduct;
(8)
motive;
(9)
prior misconduct [
(10)
disciplinary history;
(11)
prior
action,
written warnings or written admonishments
from any government agency or official
peer review organization or health
care entity
[
(12)
violation of a board order;
(13)
failure to implement remedial measures to correct or mitigate
harm from the misconduct;
(14)
lack of rehabilitative potential or likelihood for future
misconduct of a similar nature; and
(15)
relevant circumstances increasing the seriousness of the
misconduct.
(e)
[
(1)
absence of patient harm;
(2)
absence of economic harm to any individual or entity;
(3)
absence of environmental harm;
(4)
absence of potential harm to the public;
(5)
self-reported and voluntary admissions of misconduct;
(6)
absence of premeditation to commit misconduct;
(7)
absence of intent to commit misconduct; [
(8)
motive;
(9)
absence of prior misconduct [
(10)
absence of a disciplinary history;
(11)
implementation of remedial measures to correct or mitigate
harm from the misconduct;
(12)
rehabilitative potential;
(13)
prior community service and present value to the community;
(14)
relevant circumstances reducing the seriousness of the
misconduct; and,
(15)
relevant circumstances lessening responsibility for the
misconduct.
(f)
Use of Administrative Penalties.
An administrative penalty may be imposed upon finding that the person has
violated the Act, a board rule, or an order adopted under the Act in lieu
of or in addition to any other penalty. The board shall consider the following
in determining the appropriate amount of any administrative penalty assessed:
(1)
the amount necessary to deter future violations;
(2)
economic harm;
(3)
estimated cost of the investigation and prosecution
of the case;
(4)
estimated cost of any future monitoring of the
licensee.
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 June 17, 2002.
TRD-200203760
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
22 TAC §193.11, §193.12
The Texas State Board of Medical Examiners proposes new §193.11
and §193.12, concerning Use of Lasers and Delegated Laser Hair Removal
Treatment. The new rules will outline requirements regarding the use of lasers
and supervision requirements.
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 may be fiscal implications to state or local government as a result
of enforcing the rules as proposed. Fiscal implications follow: impact regarding
revenue to state - none. Impact to those required to comply - there will be
training costs for both the supervising physician and non-physician practitioner.
In addition, there will be costs for the non-physician owned business for
physician supervision. The amount of these costs is unknown 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 to provide guidelines for the
use of lasers. There will be no effect on small or micro businesses.
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 rules 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: Tex. Occ. Code Ann., §157.001.
§193.11.Use of Lasers.
(a)
"Surgery" is the practice of medicine and includes any
procedure using instruments, including lasers, scalpels, or needles, in which
human tissue is cut, burned, vaporized, or otherwise altered by any mechanical
means, laser, or ionizing radiation. The term also includes procedures using
instruments that require closure by suturing, clamping, or other device.
(b)
As a form of surgery, the use of lasers is considered the
practice of medicine and cannot be delegated to non-physician employees without
the delegating/supervising physician being onsite and immediately available,
with the exception of laser hair removal as provided in Section 193.12 of
this title (relating to Delegated Laser Hair Removal Treatment). As defined
under the Texas Department of Health's rules, this includes medical devices
that are Class IV and IIIb lasers, as well as Class II and Intense Pulsed
Light machines, or any other light-based medical device.
§193.12.Delegated Laser Hair Removal Treatment.
(a)
Purpose. The purpose of this section is to set forth guidelines
for the delegation of tasks to qualified non-physicians providing laser hair
removal treatment under reasonable physician control and supervision. Nothing
in these rules shall be construed to relieve the supervising physician of
the professional or legal responsibility for the care and treatment of the
physician's patients.
(b)
Laser hair removal. Laser hair removal is a surgical procedure,
whereby an individual uses any medical device based on laser, intense pulsed
light or any other non-ionizing energy, approved by the Food and Drug Administration
(FDA), for the purpose of reducing permanently or temporarily, the amount
or size of hair.
(c)
Delegation.
(1)
A physician licensed to practice medicine in Texas may
delegate to a properly trained person acting under adequate supervision, the
performance of laser hair removal authorized by the physician through the
physician's order, standing delegation order, standing medical order, or other
order or protocol provided for in this section.
(2)
The operation of lasers is considered the practice of medicine
and may not be delegated unless prior to treatment, the delegating physician
either evaluates the patient by reviewing the patient's records or personally
examines the patient and signs the patient's chart. The delegating physician
must remain onsite and/or available within 30 minutes to respond to any untoward
event that may occur.
(d)
Supervision. Supervision by the delegating physician shall
be considered adequate for purposes of this section if the physician is in
compliance with this section and the physician:
(1)
ensures that patients are adequately informed and have
signed consent forms prior to treatment that outline reasonably foreseeable
side effects and untoward complications that may result from the use of lasers
for the purpose of hair removal;
(2)
is responsible for the formulation or approval of a written
protocol and any patient-specific deviation from the protocol;
(3)
reviews and signs, at least annually, the written protocol
and any patient-specific deviations from the protocol regarding care provided
to a patient under the protocol on a schedule defined in the written protocol;
(4)
receives, on a schedule defined in the written protocol,
a periodic status report on the patient, including any problems or complications
encountered;
(5)
is readily available through direct telecommunication for
consultation, assistance, and direction;
(6)
personally attends to, evaluates, and treats complications
that arise; and
(7)
evaluates the technical skills of an assistant performing
laser hair removal by documenting and reviewing at least quarterly the assistant's
ability:
(A)
to properly operate the devices and provide safe and effective
care; and
(B)
to respond appropriately to complications and untoward
effects of the procedures.
(e)
Written protocols. Written protocols for the purpose of
this section shall mean a physician's order, standing delegation order, standing
medical order, or other written order that is maintained on site. A written
protocol must provide at a minimum the following:
(1)
a statement identifying the individual physician authorized
to utilize a medical device for hair removal and responsible for the delegation
of the performance of laser hair removal;
(2)
a statement of the activities, decision criteria, and plan
the delegate shall follow when exercising laser hair removal authority;
(3)
selection criteria for laser hair removal patients;
(4)
identification of devices and settings to be used for patients
who meet selection criteria;
(5)
methods by which the laser devices are to be operated;
(6)
a description of appropriate care and follow-up for common
complications, serious injury, or emergencies as a result of laser hair removal;
and
(7)
a statement of the activities the delegate shall follow
in the course of exercising laser hair removal authority, including the method
for documenting decisions made and a plan for communication or feedback to
the authorizing physician concerning specific decisions made. Documentation
shall be recorded within a reasonable time after each procedure, and may be
performed on the patient's record or medical chart.
(f)
Educational requirements for delegating/supervising physicians.
As part of the delegating/supervising physician's training, the physician
must:
(1)
complete a basic training program devoted to the principles
of lasers, their instrumentation, physiological effects and safety requirements.
The initial program must last at least 24 hours, and include clinical applications
of various wavelengths and hands-on practical sessions with lasers and their
appropriate surgical or therapeutic delivery systems; and
(2)
obtain at least eight hours of continuing medical education
annually regarding the appropriate standard of care in the field of laser
hair removal.
(g)
Educational requirements for delegates. A physician may
delegate laser hair removal procedures to a qualified assistant. The physician
must ensure that the assistant complies with paragraphs (1)- (5) of this subsection
prior to performing laser hair removal in order to properly assess the assistant's
competency.
(1)
The assistant has completed and is able to document clinical
and academic training in the following subjects:
(A)
Fundamentals of laser operation
(B)
Bioeffects of laser radiation on the eye and skin
(C)
Significance of specular and diffuse reflections
(D)
Non-beam hazards of lasers
(E)
Ionizing radiation hazards
(F)
Laser and laser system classifications
(G)
Control measures
(2)
The assistant has read and signed the facility's policies
and procedures regarding the safe use of lasers.
(3)
The assistant has attended at least eight hours of continuing
education annually in the field of laser hair removal.
(4)
The assistant has completed at least ten procedures of
precepted training for each laser procedure and laser type to assess competency.
(5)
The assistant has obtained certification in laser hair
removal by a national certifying organization, unless the assistant is a licensed
registered nurse or physician assistant.
(h)
Quality assurance. The delegating/supervising physician
must ensure that there is a quality assurance program for the facility at
which laser hair removal is performed in order for the purpose of continuously
improving the selection and treatment of laser hair removal patients. An appropriate
quality assurance program shall consist of the following elements.
(1)
A mechanism to identify complications and untoward effects
of treatment and to determine their cause.
(2)
A mechanism to review the adherence of assistants to standing
delegation orders, standing medical orders and written protocols.
(3)
A mechanism to monitor the quality of laser treatments.
(4)
A mechanism by which the findings of the quality assurance
program are reviewed and incorporated into future standing delegation orders,
standing medical orders, written protocols, and supervising responsibility.
(5)
An ongoing training program to improve the quality and
performance of assistants.
(i)
Deviation/Complication Review Reports. A physician that
supervises laser hair removal treatments must write reports regarding the
frequency and seriousness of complications, how often deviations from protocols
occur, the type of deviations encountered, and how deviations and complications
were addressed by the facility. Reports must be written on a quarterly basis
with a copy maintained at the facility and the physician's office (if in a
different location) to be made available to the board upon request.
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 June 17, 2002.
TRD-200203761
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 305-7016
Chapter 850.
TEXAS BOARD OF PROFESSIONAL GEOSCIENTISTS
The Texas Board of Professional Geoscientists ("Board") proposes new
rules §§850.1, 850.10, 850.60, 850.61, 850.62, 850.63, 850.65, 850.80,
850.81, and 850.82 regarding the implementation of the Texas Geoscience Practice
Act.
These rules are necessary to implement Senate Bill 405, Acts of the 77th
Texas Legislature, and to establish procedures and requirements necessary
for the functioning of the Texas Board of Professional Geoscientists.
William H. Kuntz, Jr., Acting Executive Director, has determined that for
the first five-year period the new rules are in effect there will be no cost
to state or local government as a result of enforcing or administering the
new rules beyond that stated in the fiscal note to Senate Bill 405.
Mr. Kuntz also has determined that for each year of the first five-year
period the new rules are in effect, the public benefit will be the provision
of mechanisms to administer and enforce the mandate of Senate Bill 405.
Comments on the proposal may be submitted to William H. Kuntz, Jr., Acting
Executive Director, Texas Board of Professional Geoscientists, P.O. Box 12157,
Austin, Texas 78711, or facsimile 512/475-2872, or electronically: whkuntz@license.state.tx.us.
The deadline for comments is 30 days after publication in the
Texas Register
.
Subchapter A. AUTHORITY AND RESPONSIBILITIES
22 TAC §850.1, §850.10
The new rules are proposed under Senate Bill 405, 77th Texas
Legislature, which authorizes the Board to adopt and enforce rules consistent
with the Act and necessary for the performance of its duties.
The statute affected by the proposed rules is Senate Bill 405, 77th Texas
Legislature, and the code sections in which it may be codified. No other statutes,
articles, or codes are affected by the proposal.
§850.1.Authority.
These rules are promulgated under the authority of the Texas Board
of Professional Geoscientists, Senate Bill 405, 77th Legislature.
§850.10.Definitions.
The following words and terms, when used in this chapter, have the
following meanings, unless the context clearly indicates otherwise.
(1)
Address of record--In the case of a person licensed, certified,
or registered by the Board, the address which is filed by the licensee or
registrant with the Board.
(2)
The Act--Senate Bill 405, 77th Legislature.
(3)
APA--The Administrative Procedure Act (TEX. GOV'T. CODE,
Chapter 2001).
(4)
Applicant--Any person seeking a license from the Board.
(5)
Chairman--The officer referred to in the Act as "presiding
officer".
(6)
Vice-Chairman--The officer referred to in the Act as "assistant
presiding officer".
(7)
Complainant--Any person who has filed a sworn, written
complaint with the secretary-treasurer of the Board against any person whose
activities are subject to the jurisdiction of the Board.
(8)
Contested case or proceeding--A proceeding in which the
legal rights, duties, or privileges of a party are to be determined by the
Board after an opportunity for adjudicative hearing.
(9)
Executive Director--as used in any statute or rule assigned
to the Texas Board of Professional Geoscientists, means the person appointed
by the Board to be responsible for managing the day-to-day affairs of the
Board.
(10)
Final decision maker--The Board, which is the sole body
authorized by law to render the final decision in a contested case brought
under the Act.
(11)
Hearings Examiner, Examiner, Administrative Law Judge--A
person employed by the Board to conduct hearings in contested cases.
(12)
License--The whole or part of any Board registration,
license, certificate of authority, approval, permit, endorsement, title or
similar form of permission required or permitted by the Act.
(13)
Party--A person admitted to participate in a case before
the final decision maker.
(14)
Person--any individual, partnership, corporation, or other
legal entity, including a state agency or governmental subdivision.
(15)
Pleading--A written document submitted by a party, or
a person seeking to participate in a case as a party, which requests procedural
or substantive relief, makes claims, alleges facts, makes legal argument,
or otherwise addresses matters involved in the case.
(16)
Respondent--Any person, licensed or unlicensed, who has
been charged with violating any provision of the Act or a rule or order issued
by the Board.
(17)
Rule--Any Board statement of general applicability that
implements, interprets, or prescribes law or policy, or describes the procedure
or practice requirements of the Board and is filed with the Texas Register.
(18)
T.R.C.P.--Texas Rules of Civil Procedure
(19)
U.S.P.S.--United States Postal Service.
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 June 10, 2002.
TRD-200203633
William H. Kuntz, Jr.
Acting Executive Director
Texas Board of Professional Geoscientists
Earliest possible date of adoption: July 28, 2002
For further information, please call: (512) 463-7348
.
]
(C)
] delegate tasks to other
committees;
(D)
] take action on matters
of urgency that may arise between board meetings;
(E)
] assist in the presentation
of information concerning the board and the regulation of the practice of
medicine to the
Legislature
[
Legislative
] and other
state officials;
[(F)
] review staff reports
regarding finances and the budget;
(G)
] formulate and make recommendations
to the board concerning future board goals and objectives and the establishment
of priorities and methods for their accomplishment;
(H)
] study and make recommendations
to the board regarding the
roles
[
role
] and
responsibilities
[
responsibility
] of the board offices and committees;
(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;
and
(K)
] make recommendations
to the board regarding matters brought to the attention of the executive committee.
;
] trade associations, consumer groups, and related groups;
committees of the Legislature
]; and
a determination
] of eligibility and report
to the board its recommendations as provided by the Medical Practice Act
and board rules
;
a determination
] of eligibility,
and report to the board its recommendations as provided by
Texas Occupations
Code Annotated, §205.303;
[
the Medical Practice Act; and
]
(J)
] make recommendations to the
board regarding matters brought to the attention of the licensure committee.
(6)
Non-Profit Health Organizations
Committee:]
(A)
review applications for approval
and certification of non-profit health organizations pursuant to the Medical
Practice Act;]
(B)
review applications and reports
for continued approval and certification of non-profit health organizations
pursuant to the Medical Practice Act;]
(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;]
(D)
review board rules regarding
non-profit health organizations, and make recommendations to the board regarding
changes or implementation of such rules; and]
(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:
or
] public relations;
(8)
] Standing Orders Committee:
(9)
] Telemedicine Committee:
Chapter 163.
LICENSURE
Board
].
Applicant
] must
sit for
and pass
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.
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-.053.
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:
have
been
] centrally organized, integrated and controlled into a continuous
program which was conducted, monitored and approved by the medical school
which issues the degree.
Applicant
]:
in a program
] approved by the Texas State Board of Medical Examiners.
,
] submitted directly to this board [
,
] from the body governing
licensure of physicians in the country in which the school is located, will
be accepted. The letter must state that the applicant has met all the requirements
for licensure in the country in which the school is located. If an applicant
is not licensed in the country of graduation due to a citizenship requirement,
a letter attesting to this, submitted directly to this board, will be required.
is
] substantially equivalent to a Texas medical school
at the time
of attendance
. This may include but is not limited to:
must have
a
] written
contracts
[
contract
] with the medical
school if the institutions
were
[
are
] not located in
a country where the medical school
was
[
is
] located;
must have a
] written
contracts
[
contract
] with the school if
they taught a course
[
the course is taught
] outside the country where the medical school
was
[
is
] located;
must comply
] the higher
education laws of the state in which the courses were taught; [
and
]
must be
] on the faculty of the program
of graduate medical education when the course
was
[
is
]
taught in the United States
; and
[
.
]
Chapter 164.
PHYSICIAN ADVERTISING
Board
] to be false, deceptive,
or misleading if it:
or
]
or
]
or
]
or
]
or
]
or
]
or
]
or
]
or
]
or
]
or
]
or
]
or
]
or
]
,
] or professional identification that is expressly
or commonly reserved to or used by another profession or professional; [
or
]
or
]
make
] the fact of compensation apparent.
Chapter 165.
MEDICAL RECORDS
§5.08(k)
], a physician shall furnish copies of medical
and/or billing
records requested or a summary or narrative of the records
pursuant to a written release of the information as provided by the Medical
Practice Act,
§159.005
[
§5.08(j)
], except
if the physician determines that access to the information would be harmful
to the physical, mental, or emotional health of the patient[
, and the
]
. The
physician may delete confidential information about
another patient or family member of the patient who has not consented to the
release.
medical
] records for purposes other
than for emergency or acute medical care, the physician may retain the requested
information until payment is received. In the event payment is not routed
with such a request, within ten calendar days from receiving a request for
the release of such records for reasons other than emergency or acute medical
care, the physician shall notify the requesting party in writing of the need
for payment and may withhold the information until payment of a reasonable
fee is received. A copy of the letter regarding the need for payment shall
be made part of the patient's medical
and/or billing
record
as appropriate
. Medical
and/or billing
records requested
pursuant to a proper request for release may not be withheld from the patient,
the patient's authorized agent, or the patient's designated recipient for
such records based on a past due account for medical care or treatment previously
rendered to the patient.
§5.08
], made by a patient or by the patient's guardian or
other representative duly authorized to obtain such records.
§5.08(j),
] as required for the release of medical records, a physician
in possession or control of films or other static diagnostic imaging studies
of a patient shall allow access to the films or other diagnostic imaging studies
through one or more of the following means:
§5.08(j),
] a physician is not
required to release films or other static diagnostic imaging studies directly
to a patient if the physician determines that access to the films or static
diagnostic imaging studies would be harmful to the physical, mental, or emotional
health of the patient. If a physician makes a determination that access would
be harmful to the physical, mental, or emotional health of the patient, the
physician shall, within the time allowed after receipt of a proper request,
provide access to the requested films or static diagnostic imaging studies
to an authorized representative of the patient as provided for in subsection
(b) of this section.
30
] days after the date of receipt
of the request. If the physician denies the request, in whole or in part,
the physician shall furnish the patient a written statement, signed and dated,
stating the reason for the denial. A copy of the statement denying the request
shall be placed in the patient's medical records.
Board
] may appoint a temporary
or permanent custodian for medical records abandoned by a physician.
Board
] shall take custody of and maintain the confidentiality
of the physician's records, to include available medical records and billing
records, according to the provisions of
board
[
Board
]
rules and state statutes.
Board
] rules and state statutes. In addition
to the reasonable copying fee defined in
board
[
Board
]
rules, the appointed record custodian may charge an additional fee of $25.00
per patient record.
which
] ensures continued confidentiality.
Board
] may publish a Request
for Bids for one entity to function as the appointed record custodian for
all areas of the state. If a sole statewide contractor is not selected, the
board
[
Board
] may publish a Request for Bids for entities
to function as regional appointed record custodian or a custodian may be appointed
on a case by case basis.
Chapter 166.
PHYSICIAN REGISTRATION
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.
, and this
]
This
exemption is valid
for one annual registration period only.
continuing medical education
].
continuing medical education
]
or of specific course subjects.
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.
An intentionally
] false report
or
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 Medical Practice Act (the "Act"), TEX. OCC. CODE ANN. §§164.051-.053.
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
].
Failure
] to obtain and timely report the CME hours on an
annual registration permit application 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 CME licensure fee and any administrative
penalty imposed for failure to obtain and timely report the 24 hours of CME
required for an annual registration permit application shall be in addition
to the applicable penalties for late registration as set forth in §175.2
of this title (relating to Penalties).
Chapter 173.
PHYSICIAN PROFILES
(28)
] of this subsection:
and dates of such statuses
];
Board's
] staff against the physician and initiated
and filed with the State Office of Administrative Hearings under §164.005
of the Act and the status of the complaint; and
Chapter 183.
ACUPUNCTURE
or
]
or
]
or
]
; or
]
(F)
an interview conducted in
English with the acupuncture board, a committee of the acupuncture board,
or the executive director of the acupuncture board. Only one interview shall
be granted to each requesting applicant unless that applicant can satisfactorily
demonstrate that a second personal interview is the only remaining opportunity
for the applicant to meet the required ability to communicate in the English
language. Should the applicant fail to adequately demonstrate the ability
to communicate in the English language at the second interview, the applicant
is ineligible for future interviews to determine English proficiency.]
ten
] years for the treatment of alcohol/substance
abuse or mental illness must submit the following:
ten
] years for alcohol/substance abuse
or mental illness must submit the following:
in the following categories:
]
course was
]
were
taken based on a review and recommendation of the Education Committee of the
board
[
Board
]
as described in subsection (n) of this
section
.
shall be
] herbology.
shall be
] ethics.
Board
].
which
] are obtained to comply
with the requirements for the preceding year as a prerequisite for licensure
renewal, shall first be credited to meet the requirements for that previous
year. Once the requirements of the previous year are satisfied, any additional
hours obtained shall be credited to meet the continuing acupuncture education
requirements of the current year.
A licensee may carry forward CAE hours
earned prior to an annual registration report which are in excess of the 17-hour
annual requirement and such excess hours may be applied to the following years'
requirements. A maximum of 34 total excess hours may be carried forward. Excess
CAE hours may not be carried forward or applied to an annual report of CAE
more than two years beyond the date of the annual registration following the
period during which the hours were earned.
(CAE)
] credit hours shall be approved by
the Texas State Board of Acupuncture Examiners based on the recommendation
of the Education Committee of the
board
[
Board
] in regard
to courses, programs, and activities submitted by licensees to satisfy the
CAE requirements of this section. Approval shall be based on a showing by
the education provider that:
Continuing Acupuncture Education (
]CAE[
)
]
credit requirements shall be submitted in writing to the Education Committee
of the
board
[
Board
] on a form approved by the
board
[
Board
], along with any required fee, and accompanied
by information, documents, and materials accurately describing the course,
program, or activity, and necessary for verifying compliance with the requirements
set forth in subsection (n) of this section. At the discretion of the
board
[
Board
] or the Education Committee, supplemental information,
documents, and materials may be requested as needed to obtain an adequate
description of the course, program, or activity and to verify compliance with
the requirements set forth in subsection (n) of this section. At the discretion
of the
board
[
Board
] or the Education Committee, inspection
of original supporting documents may be required for a determination on an
approval request. The Acupuncture Board shall have the authority to conduct
random and periodic checks of courses, programs, or activities to ensure that
criteria for education approval as set forth in subsection (n) of this section
have been met and continue to be met by the education provider. Upon requesting
approval of a course, program, or activity, the education provider shall agree
to such checks by the Acupuncture Board or its designees, and shall further
agree to provide supplemental information, documents, and material describing
the course, program, or activity which, in the discretion of the Acupuncture
Board, may be needed for approval or continued approval of the course, program,
or activity. Failure of an education provider to provide the necessary information,
documents, and materials to show compliance with the standards set forth in
subsection (n) of this section shall be grounds for denial of CAE approval
or recision of prior approval in regard to the course, program, or activity.
Board
] based
on additional information concerning the course, program, or activity, or
upon a showing of good cause for reconsideration. A decision to reconsider
a denial determination shall be a discretionary decision based on consideration
of the additional information or the good cause showing. Requests for reconsideration
shall be made in writing by the education provider, and may be made orally
or in writing by
board
[
Board
] staff or a committee
of the
board
[
Board
].
Board
] based on additional information
concerning the course, program, or activity, or upon a showing of good cause.
A decision to reconsider an approval determination shall be a discretionary
decision based on consideration of the additional information or the good
cause showing. Requests for reconsideration may be made in writing by a member
of the public or may be made orally or in writing by
board
[
Board
] staff or a committee of the
board
[
Board
].
Chapter 184.
SURGICAL ASSISTANTS
Chapter 190.
DISCIPLINARY GUIDELINES
and
]
.
]
Medical Practice Act
(the "Act"), §4.12 (related to Methods of Discipline) and §4.125
(related to Administrative Penalty).
] This chapter shall be further
construed and applied so as to be consistent with the Act, and shall be limited
to the extent as otherwise proscribed by statute and board rule.
(c)
] Aggravation. The following
may be considered as aggravating factors so as to merit more severe or more
restrictive action by the board:
of a similar or related nature
];
regarding statutes or regulations
] pertaining
to the misconduct;
(d)
] Extenuation and Mitigation.
The following may be considered as extenuating and mitigating factors so as
to merit less severe or less restrictive action by the board:
morma
]
of a similar or related
nature
];
Chapter 193.
STANDING DELEGATION ORDERS
Part 39.
TEXAS BOARD OF PROFESSIONAL GEOSCIENTISTS
Subchapter B. ORGANIZATION