EMERGENCY RULES An agency may adopt a new or amended section or repeal an existing section on an emergency basis if it determines that such action is necessary for the public health, safety, or welfare of this state. The section may become effective immediately upon filing with the Texas Register, or on a stated date less than 20 days after filing and remaining in effect no more than 120 days. The emergency action is renewable once for no more than 60 additional days. Symbology in amended emergency sections. New language added to an existing section is indicated by the use of bold text. [Brackets] indicate deletion of existing material within a section. TITLE 22. EXAMINING BOARDS Part IX. Texas State Board of Medical Examiners Chapter 185. Physician Assistants 22 TAC sec.sec.185.1-185.16 The Texas State Board of Medical Examiners adopts on an emergency basis the repeal of sec.sec.185.1-185.16, concerning the practice of physician assistants. Pursuant to House Bill 2498, 73rd Legislature, extensive rewrite of this section was necessary; therefore repeal, with simultaneous new section is proposed. The repeal is adopted on an emergency basis under Texas Civil Statutes, Article 4495b, which provide the Texas State Board of Medical Examiners with the authority to make rules, regulations, and bylaws not inconsistent with this act as may be necessary for the governing of its own proceedings, the performance of its duties, the regulation of the practice of medicine in this state, and the enforcement of this act. Cross Index to Statute-Physician Assistant Licensing Act, House Bill 2498, 73rd Legislature. sec.185.1. Purpose. sec.185.2. Definitions. sec.185.3. Registry. sec.185.4. Grounds for Denial of Registry Certification. sec.185.5. Discipline of Physician Assistant. sec.185.6. Disciplinary Entity. sec.185.7. Enforcement. sec.185.8. Supervising Physician. sec.185.9. Application for Approval to Supervise. sec.185.10. Supervision. sec.185.11. Physician Assistant Scope of Practice. sec.185.12. Tasks Not Permitted to Delegated to a Physician Assistant. sec.185.13. Identification Requirements. sec.185.14. Notification of Termination of Employment. sec.185.15. Employment Guidelines. sec.185.16. Exceptions. Issued in Austin, Texas, on June 30, 1994. TRD-9443265 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: June 30, 1994 Expiration date: October 28, 1994 For further information, please call: (512) 834-7728, Ext. 422 22 TAC sec.sec.185.1-185.29 The Texas State Board of Medical Examiners adopts on an emergency basis new sec.sec.185.1-185.29, concerning the practice of physician assistants. The proposed new sections set forth the requirements for licensure, annual registration, and discipline of those persons practicing as physician assistants. The statute related to physician assistants mandates that all physician assistants must be licensed by September 1, 1994. The new sections are adopted on an emergency basis under Texas Civil Statutes, Article 4495b, which provide the Texas State Board of Medical Examiners with the authority to make rules, regulations, and bylaws not inconsistent with this act as may be necessary for the governing of its own proceedings, the performance of its duties, the regulation of the practice of medicine in this state, and the enforcement of this act. Cross Index to Statute-Physician Assistant Licensing Act, House Bill 2498, 73rd Legislature. sec.185.1. Purpose. The purpose of these rules and regulations is to encourage the more effective utilization of the skills of physicians by enabling them to delegate health care tasks to qualified physician assistants. These sections are not intended to, and shall not be construed to, restrict the physician from delegating technical and clinical tasks to technicians, other assistants, or employees who perform delegated tasks in the office of a physician and who are not rendering services as a physician assistant or identifying themselves as a physician assistant. Nothing in these rules and regulations shall be construed to relieve the supervising physician of the professional or legal responsibility for the care and treatment of his or her patients. sec.185.2. Definitions. The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. Alternate physician -That physician designated by the supervising physician to act in his or her stead. Board-The Texas State Board of Medical Examiners. Council-The Physician Assistant Advisory Council. Physician assistant -A graduate of a physician assistant or surgeon assistant training program accredited by the American Medical Association's Committee on Allied Health, Education, and Accreditation or a person who has passed the certifying examination administered by the National Commission on the Certification of Physician Assistants, and who is licensed as a physician assistant by the Physician Assistant Advisory Council. Supervising physician -A physician licensed by the Board either as a doctor of medicine or doctor of osteopathic medicine who is assuming responsibility and legal liability for the services rendered by the physician assistant, and who has received approval from the Council to supervise a specific physician assistant. Supervision-Overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant. Supervision does not require the constant physical presence of a the supervising physician but includes a situation where a supervising physician and the person being supervised are, or can easily be, in contact with one another by radio, telephone, or another telecommunication device. sec.185.3. Meetings. (a) The physician assistant advisory council shall meet at least four times a year to carry out the mandates of the Physician Assistant Licensing Act. (b) Special meetings may be called by the presiding officer of the Council, by resolution of the Council, or upon written request to the presiding officer of the Council signed by at least three members of the Council. (c) Physician assistant advisory council and committee meetings shall, to the extent possible, be conducted pursuant to the provisions of Robert's Rules of Order Newly Revised unless, by rule, the council adopts a different procedure. (d) All elections and any other issues requiring a vote of the council shall be decided by a simple majority of the members present. A quorum for transaction of any business by the council shall be one more than half the council's membership at the time of the meeting. If more than two candidates contest an election or if no candidate receives a majority of the votes cast on the first ballot, a second ballot shall be conducted between the two candidates receiving the highest number of votes. (e) The council, at a regular meeting or special meeting, may elect from its membership all presiding officer and a secretary for one year. (f) The council, at a regular meeting or special meeting, upon majority vote of the members present, may remove the presiding officer or the secretary from office. (g) The following are standing and permanent committees of the council. The responsibilities and authority of these committees shall include those duties and powers as defined in paragraphs (1)-(3) of this subsection and such other responsibilities and authority which the council may from time to time delegate to these committees. (1) Licensure Committee. (A) Draft and review proposed rules regarding licensure, and make recommendations to the council regarding changes or implementation of such rules. (B) Draft and review proposed rules pertaining to the overall licensure process, and make recommendations to the council regarding changes or implementation of such rules. (C) Receive and review applications for licensure in the event the eligibility for licensure of an applicant is in question. (D) Present the results of reviews of applications for licensure, and make recommendations to the council regarding licensure of applicants whose eligibility is in question. (E) Make recommendations to the council regarding matters brought to the attention of the Licensure Committee. (2) Disciplinary and Ethics Committee. (A) Draft and review proposed rules regarding the discipline of physician assistants and enforcement of sec.18 and sec.19 of the Physician Assistance Licensing Act. (B) Oversee the disciplinary process and give guidance to the council and staff regarding methods to improve the disciplinary process and more effectively enforce sec.18 and sec.19 of the Physician Assistant Licensing Act. (C) Monitor the effectiveness, appropriateness, and timeliness of the disciplinary process. (D) Make recommendations regarding resolution and disposition of specific cases and approve, adopt, modify, or reject recommendations from staff or representatives of the council regarding actions to be taken on pending cases. Approve dismissals of complaints and closure of investigations. (E) Draft and review proposed ethics guidelines and rules for the practice of physician assistants, and make recommendations to the council regarding the adoption of such ethics guidelines and rules. (F) Make recommendations to the council and staff regarding policies, priorities, budget, and any other matters related to the disciplinary process and enforcement of sec.18 and sec.19 of the Physician Assistant Licensing Act. (G) Make recommendations to the council regarding matters brought to the attention of the Disciplinary Committee. (3) Long Range Planning Committee. (A) Formulate and make recommendations to the council concerning future council goals and objectives and the establishment of priorities and methods for their accomplishment. (B) Study and make recommendations to the council regarding the role and responsibility of the council officers and committees. (C) Study and make recommendations to the council regarding ways to improve the efficiency and effectiveness of the administration of the council. (D) Study and make recommendations to the council regarding council rules or any area of a council function that, in the judgment of the committee needs consideration. (E) Study and make recommendations to the Council regarding legislative changes pertinent to the practice of Physician Assistants. (F) Study and make recommendations to the Council regarding financial issues. (h) Meetings of the council and of its committees are open to the public unless such meetings are conducted in executive session pursuant to the Open Meetings Act, the Physician Assistant Licensing Act, or the Medical Practice Act. In order that council meetings may be conducted safely, efficiently, and with decorum, members of the public shall refrain at all times from smoking or using tobacco products, eating, or reading newspapers and magazines. Members of the public may not engage in disruptive activity that interferes with council proceedings, including excessive movement within the meeting room, noise or loud talking, and resting of feet on tables and chairs. The public shall remain within those areas designated as open to the public. Members of the public shall not address or question council members during meetings unless recognized by the council's presiding officer pursuant to a published agenda item. (i) Journalists have the same right of access as other members of the public to council meetings conducted in open session, and are also subject to the rules of conduct described in subsection (h) of this section. Observers of any council meeting may make audio or visual recordings of such proceedings conducted in open session subject to the following limitations: the council's presiding officer may request periodically that camera operators extinguish their artificial lights to allow excessive heat to dissipate; camera operators may not assemble or disassemble their equipment while the council is in session and conducting business; persons seeking to position microphones for recording council proceedings may not disrupt the meeting or disturb participants; journalists may conduct interviews in the reception area of the board's offices or, at the discretion of the council's presiding officer, in the meeting room after recess or adjournment; no interview may be conducted in the hallways of the medical board's offices; and the council's presiding officer may exclude from a meeting any person who, after being duly warned, persists in conduct described in this subsection and subsection (h) of this section. (j) The secretary of the council shall assume the duties of the presiding officer in the event of the presiding officer's absence or incapacity. (k) In the event of the absence or temporary incapacity of the presiding officer, and the secretary, the members of the council may elect another member to act as the presiding officer of a council meeting or may elect an interim acting presiding officer for the duration of the absences or incapacity. (l) Upon the death, resignation, removal, or permanent incapacity of the presiding officer or the secretary, the council shall elect from its membership an officer to fill the vacant position. Such an election shall be conducted as soon as practicable at a regular or special meeting of the council. sec.185.4. Licensure. (a) Except as otherwise provided in this section, an individual shall be licensed by the council before the individual may function as a physician assistant. A license shall be granted to an applicant who: (1) submits an application on forms approved by the council; (2) pays the appropriate application fee as prescribed by the council; (3) has successfully completed an educational program for physician assistants or surgeon assistants accredited by the Committee on Allied Health Education and Accreditation, or by that committee's predecessor or successor entities, or has passed the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants; (4) certifies that the applicant is mentally and physically able to function safely as a physician assistant; (5) does not have a license, certification, or registration as a physician assistant in this state or from any other licensing authority that is currently revoked or on suspension or the applicant is not subject to probation or other disciplinary action for cause resulting from the applicant's acts as a physician assistant, unless the council takes that fact into consideration in determining whether to issue the license; (6) is of good moral character; and (7) submits to the council any other information the council considers necessary to evaluate the applicant's qualifications. (b) The following documentation shall be submitted as a part of the licensure process: (1) Name Change. Any applicant who submits documentation showing a name other than the name under which the applicant has applied must present copies of marriage licenses, divorce decrees, or court orders stating the name change. In cases where the applicant's name has been changed by naturalization the applicant should send the original naturalization certificate by certified mail to the council for inspection. (2) Certification. Each applicant for licensure must submit: (A) a certificate from the National Commission on Certification of Physician Assistants (NCCPA) directly from NCCPA on a form provided by the Council; and/or (B) a certificate of successful completion of an educational program submitted directly from the program on a form provided by the council. (3) Fingerprint Card. Each applicant must complete and submit a fingerprint card. This fingerprint card must be completed through an agency trained in taking fingerprints. (4) Verification from other states. Each applicant for licensure who is licensed, registered, or certified in another state must have that state submit directly to the council, on a form provided by the council, that the physician assistant's license, registration, or certification is current and in full force and that the license, registration, or certification has not been restricted, canceled, suspended, or revoked. The other state shall also include a description of any sanctions imposed by or disciplinary matters pending in the state. (5) State License Registration. Each applicant, if licensed, registered, or certified in another state as a physician assistant, must submit a copy of the license registration certificate to the council. The license, registration, or certificate number and the date of expiration must be visible and the date of expiration must be visible on the copy. (6) Arrest Records. If an applicant has ever been arrested, a copy of the arrest and arrest disposition need to be requested from the arresting authority and that authority must submit copies directly to the council. (7) Malpractice. If an applicant has ever been named in a malpractice claim filed with any liability carrier or if an applicant has ever been named in a malpractice suit, the applicant must: (A) have each liability carrier complete a form furnished by this council regarding each claim filed against the applicant's insurance; (B) for each claim that becomes a malpractice suit, have the attorney representing the applicant in each suit submit a letter directly to the council explaining the allegation, dates of the allegation, and current status of the suit. If the suit has been closed, the attorney must state the disposition of the suit, and if any money was paid, the amount of the settlement. If such letter is not available, the applicant will be required to furnish a notarized affidavit explaining why this letter cannot be provided; and (C) provide a statement, composed by the applicant, explaining the circumstances pertaining to patient care in defense of the allegations. (8) Additional Documentation. Additional documentation as is deemed necessary to facilitate the investigation of any application for licensure must be submitted. sec.185.5. Relicensure. If a physician assistant's license has been expired for one year, it is considered to have been canceled, and the physician assistant may not renew the license. The physician assistant may obtain a new license by complying with the requirements and procedures for obtaining an original license. sec.185.6. Annual Renewal of License. (a) Physician Assistants licensed under the Physician Assistant Licensing Act shall register annually and pay a fee. A physician assistant may, on notification from the council, renew an unexpired license by submitting the required form and documents and by paying the required renewal fee to the council on or before the expiration date of the permit. The fee shall accompany the required form which legibly sets forth the licensee's name, mailing address, business address, and other necessary information prescribed by the council. (b) The following documentation shall be submitted as part of the renewal process. (1) Continuing Medical Education. As a prerequisite to the annual registration of a physician assistant's license, 40 hours of continuing medical education (CME) are required to be completed in the following categories: (A) at least one-half of the hours are to be from formal courses that are designated for Category I credit by a CME sponsor approved by the American Academy of Physician Assistants; (B) remaining hours may be from Category II composed of informal self-study, attendance at hospital lectures, grand rounds, or case conferences and shall be recorded in a manner that can be easily transmitted to the council upon request. (2) A physician assistant must report on the annual registration form the number of hours and type of continuing medical education completed during the previous year. (3) A physician assistant may request in writing an exemption for the following reasons: (A) catastrophic illness; (B) military service of longer than one year's duration outside the United States; (C) medical practice and residence of longer than one year's duration outside the United States; or (D) good cause shown on written application of the licensee that gives satisfactory evidence to the council that the licensee is unable to comply with the requirement for continuing medical education. (4) Exemptions are subject to the approval of the licensure committee of the Physician Assistant Advisory Council. (5) A temporary exception under paragraph (3) of this subsection may not exceed one year but may be renewed annually, subject to the approval of the council. (6) This section does not prevent the council from taking disciplinary action with respect to a licensee or an applicant for a license by requiring additional hours of continuing medical education or of specific course subjects. (7) The council 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 council. (c) Falsification of an affidavit or submission of false information to obtain renewal of a license shall subject a physician assistant to denial of the renewal and/or to discipline pursuant to sec.19 of the Physician Assistant Licensing Act. (d) If the renewal fee and completed application form are not received on or before the expiration date of the permit, the following penalties will be imposed: (1) one to 90 days late-$50 plus the required annual registration fee; (2) 91 days to one year late-$100 plus the required annual registration fee; (3) over one year late-license will automatically be canceled. (e) The council shall not waive fees or penalties. (f) The council shall stagger annual registration of physician assistants proportionally on a periodic basis. sec.185.7. Temporary License. (a) The council may issue a temporary license to an applicant who: (1) meets all the qualifications for a license under the Physician Assistant Licensing Act but is waiting for the next scheduled meeting of the council for the license to be issued; or (2) seeks to temporarily substitute for a licensed physician assistant during the licensee's absence, if the applicant: (A) is licensed or registered in good standing in another state, territory, or the District of Columbia; (B) submits an application on a form prescribed by the council; and (C) pays the appropriate fee prescribed by the council. (b) A temporary license is valid for 45 days from the date issued and may be extended only for another 45 days after the date the initial temporary license expires. sec.185.8. Schedule of Fees. (a) The council shall charge the following non-refundable, non-transferable fees. (1) Processing licensure application-$200. (2) Temporary License-$50. (3) Annual License Renewal-$150. (4) Duplicate license-$45. (5) Reinstatement following cancellation for cause -$200. (b) All licensure fees or penalties must be submitted in the form of a money order or cashier's check payable on or through a United States bank. Fees and penalties are not refundable. If a single payment is made for more than one individual permit, it must be made for the same class of permit, and a detailed listing on a form prescribed by the council must be included with each payment. sec.185.9. Inactive License. (a) A license holder may have the license holder's license placed on inactive status by applying to the council. A physician assistant with an inactive license is excused from paying renewal fees on the license and may not practice as a physician assistant. (b) A license holder who practices as a physician assistant while on inactive status is considered to be practicing without a license. (c) A physician assistant may return to active status by applying to the council, paying the license renewal fee, and complying with the requirements for license renewal under s10 of the Physician Assistant Licensing Act. sec.185.10. Reinstatement of License Following Cancellation for Cause. (a) The applicant must complete in every detail the application for reinstatement of license after cancellation for cause, including payment of the required application fee. (b) The applicant must appear before the council to state the reasons for the request for reinstatement of license. (c) Application for reinstatement following cancellation for cause cannot be considered more often than annually. (d) Reinstatement of a license following cancellation for cause shall be at the discretion of the council upon a showing by the applicant that reinstatement is in the best interest of the public. sec.185.11. Physician Assistant Scope of Practice. The physician assistant shall provide, within the education, training, and experience of the physician assistant, medical services that are delegated by the supervising physician. The activities listed in paragraphs (1)-(9) of this subsection may be performed in any place authorized by a supervising physician, including, but not limited to a clinic, hospital, ambulatory surgical center, patient home, nursing home, or other institutional setting. Medical services provided by a physician assistant may include, but are not limited to: (1) obtaining patient histories and performing physical examinations; (2) ordering and/or performing diagnostic and therapeutic procedures; (3) formulating a working diagnosis; (4) developing and implementing a treatment plan; (5) monitoring the effectiveness of therapeutic interventions; (6) assisting at surgery; (7) offering counseling and education to meet patient needs; (8) requesting, receiving, and signing for professional samples and distributing the samples to patients at a site serving medically underserved populations, as provided by the Medical Practice Act, Texas Civil Statutes, Article 4495b, sec.3.06(d)(5), and its subsequent amendments, or as otherwise authorized by board rule; and (9) making appropriate referrals. sec.185.12. Tasks Not Permitted to be Delegated to a Physician Assistant.
    Except at sites serving medically underserved populations, the supervising physician shall not allow a physician assistant to prescribe or supply medication, except as authorized by law. sec.185.13. Identification Requirements.
      A physician assistant licensed by the council shall keep the physician assistant's Texas license available for inspection at the physician assistant's primary place of business and shall, when engaged in professional activities, wear a name tag identifying the physician assistant as a physician assistant. sec.185.14. Notification of Intent to Practice. (a) A physician assistant licensed under the Physician Assistant Licensing Act must, before beginning practice, submit on a form prescribed by the council notification of the license holder's intent to begin practice. Notification under this section must include: (1) the name, business address, Texas license number, and telephone number of the physician assistant; (2) the name, business address, Texas license number, and telephone number of the supervising physician; (b) A physician assistant must notify the council of any changes in, or additions to, the person acting as a supervising physician for the physician assistant not later than the 30th day after the date the change or addition is made. sec.185.15. Physician Supervision. (a) Supervision shall be continuous, but shall not be construed as necessarily requiring the constant physical presence of the supervising physician at a place where physician assistant services are performed while the services are performed. Telecommunication shall always be available. (b) It is the obligation of each team of physician(s) and physician assistant(s) to ensure that: (1) the physician assistant's scope of function is identified; (2) delegation of medical tasks is appropriate to the physician assistant's level of competence; (3) the relationship between the members of the team is defined; that the relationship of, and access to, the supervising physician is defined; (4) and a process for evaluation of the physician assistant's performance is established. (c) A physician assistant may have more than one supervising physician. (d) Physician assistants must utilize mechanisms which provide medical authority when such mechanisms are indicated, including, but not limited to, standing delegation orders, standing medical orders, protocols, or practice guidelines. sec.185.16. Supervising Physician.
        To be authorized to supervise a physician assistant, a physician must: (1) be currently licensed as a physician in this state by the board; (2) notify the council of the physician's intent to supervise a physician assistant; and (3) submit a statement to the council that the physician will: (A) supervise the physician assistant according to rules adopted by the council; and (B) retain professional and legal responsibility for the care rendered by the physician assistant; and (4) submit the name, Texas license number, and signature of any alternate supervising physician(s). (A) A physician assistant may be supervised by an alternate supervising physician in the absence of the supervising physician consistent with this chapter, Texas Medical Practice Act, Physician Assistant Licensing Act, council rules, board rules, and any standing orders or protocols established in accordance with these statutes and rules. (B) Any alternate supervising physician engaged in the supervision of a physician assistant shall be approved by and registered with the council on a form provided by the council. (C) The council shall require any alternate supervising physician to provide the council with the same information as required of supervising physicians and such alternate supervising physician engaged in the supervision of a physician assistant shall comply with all laws, regulations, statutes, and rules governing the supervision of physician assistants during any period of supervision. sec.185.17. Employment Guidelines. (a) Except as otherwise provided in this section, the equivalent of two full- time physician assistant positions shall be allowed for each supervising physician. A supervising physician may utilize more than two physician assistants to allow part-time employment or the employment of a substitute during the temporary absence of a supervising physician's primary physician assistant. (b) The physician assistant may not independently bill patients for their services except where provided by law. (c) Except at a site serving medically underserved populations, a physician assistant shall not be maintained in an office practice setting separate from that of his or her supervising physician. sec.185.18. Exceptions. Upon written application to the council with the approval of the board, the council may grant exceptions to its rules if such exceptions are in the best interest of the public. sec.185.19. Grounds for Denial of Licensure and for Disciplinary Action. The council may refuse to issue a license to any person and may, following notice of hearing and a hearing as provided for in the Administrative Procedure Act, take disciplinary action against any physician assistant who: (1) fraudulently or deceptively obtains or attempts to obtain a license; (2) fraudulently or deceptively uses a license; (3) violates any provision of these rules or of the Physician Assistant Licensing Act; (4) is convicted of a felony; (5) is a habitual user of intoxicants or nontherapeutic drugs to the extent that the person cannot safely perform as a physician assistant; (6) has been adjudicated as mentally incompetent or has a mental or physical condition that renders the person unable to safely perform as a physician assistant; (7) has committed an act of moral turpitude. An act involving moral turpitude shall be defined as an act involving baseness, vileness, or depravity in the private and social duties one owes to others or to society in general, or an act committed with knowing disregard for justice, honesty, principles, or good morals; (8) represents that the person is a physician; or (9) has acted in an unprofessional or dishonorable manner which is likely to deceive, defraud, or injure any member of the public. sec.185.20. Discipline of Physician Assistant. The council, upon finding a physician assistant has committed any offense described in sec.185.19 of this title (relating to Grounds for Denial of Licensure and for Disciplinary Action), may: (1) refuse to license the physician assistant; (2) order a public or private reprimand; (3) order revocation, suspension, limitation, or other restrictions of a physician assistant's license; (4) require a physician assistant to submit to care, counseling, or treatment by a physician or physicians designated by the council; (5) stay enforcement of its order and place the physician assistant on probation with the council retaining the right to vacate the probationary stay and enforce the original order for noncompliance with the terms of probation; (6) restore or reissue, at its discretion, a license or remove any disciplinary or corrective measure that the council may have imposed; (7) order the physician assistant to perform public service as a part of any disciplinary order; or (8) require the physician assistant to complete additional training. sec.185.21. Disciplinary Entity.
          Hearings on alleged statutory or rules violations by a physician assistant and discipline of a physician assistant shall be conducted by the council in accordance with the rules for such hearings following review of the allegations against the physician assistant by representatives of the Physician Assistant Advisory Council and recommendation of such representatives that a hearing be conducted with regard to such allegations. sec.185.22. Complaint Procedure Notification. (a) Methods of Notification. Pursuant to the Medical Practice Act, sec.2.09(s)(2), for the purpose of directing complaints to the Texas State Board of Medical Examiners, the council and its licensees shall provide notification to the public of the name, mailing address, and telephone number 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 8-1/2 inches by 11 inches in size with the council-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 council-approved statement; or (2) placing the council-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 council-approved statement; or (3) placing the council-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 council- approved statement. (b) Approved English Notification Statement. The following notification statement in English is approved by the council for purposes of these rules and the Medical Practice Act, s2.09(s)(2) and is a sample of the type print referenced in subsection (a) of this section. (c) Approved Spanish Notification Statement. The following notification statement in Spanish is approved by the council for purposes of these rules and the Medical Practice Act, s2.09(s)(2), and is a sample of the type print referenced in subsection (a) of this section. sec.185.23. Investigations. (a) Confidentiality. All complaints, adverse reports, investigation files, other investigation reports, and other investigative information in the possession of, received, or gathered by the council shall be confidential as provided by the Medical Practice Act, and no employee, agent, or member of the council may disclose information contained in such files except in the following circumstances: (1) to the appropriate licensing or regulatory authorities in other states or the District of Columbia where the physician assistant is licensed, registered, or certified; (2) to appropriate law enforcement agencies if the investigative information indicates a crime may have been committed; (3) to a health-care entity upon receipt of written request. Disclosures by the council to a health-care entity shall include only information about a complaint filed against a physician assistant that was resolved after investigation by a disciplinary order of the council or by an agreed settlement, and the basis and current status of any complaint under active investigation; and (4) to other persons if required during the investigation. (b) Request for Records. (1) 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 Physician Assistant Advisory Council. This explanation shall include all details as the council may request and shall be furnished within 14 days of the date of the council's request. (c) Professional Liability Suits and Claims. Following receipt of a notice of claim letter or a complaint filed in court against a licensee that is reported to the council, the licensee shall furnish to the council the following information within 14 days of the date of receipt of the council's request for said information: (1) a completed questionnaire to provide summary information concerning the suit or claim; (2) a completed questionnaire to provide information deemed necessary in assessing the licensee's competency; (3) information on the status of any suit or claim previously reported to either the council or the Board. (d) Impaired Physician Assistants. (1) The council may require a licensee to submit to a mental and/or physical examination by a physician or physicians designated by the council if the council 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. (2) Probable cause may include, but is not limited to, any one of the following: (A) sworn statements from two people, willing to testify before the council, medical board, or the State Office of Administrative Hearings that a certain licensee is impaired; (B) a sworn statement from an official representative of the Texas Academy of Physician Assistants stating that the representative is willing to testify before the council that a certain licensee is impaired; (C) evidence that a licensee left a treatment program for alcohol or chemical dependency before completion of that program; (D) evidence that a licensee is guilty of intemperate use of drugs or alcohol; (E) evidence of repeated arrests of a licensee for intoxication; (F) evidence of recurring temporary commitments of a licensee to a mental institution; or (G) medical records indicating that a licensee has an illness or condition which results in the inability to function properly in his or her practice. (e) Investigation of Professional Review Actions. A written report of a professional review action taken by a peer review committee or a health-care entity provided to the council must contain the results and circumstances of the professional review action. Such results and circumstances shall include: (1) the specific basis for the professional review action, whether or not such action was directly related to the care of individual patients; and (2) the specific limitations imposed upon the physician assistant's clinical privileges, upon membership in the professional society or association, and the duration of such limitations. (f) Other Reports. (1) Relevant information shall be reported to the council indicating that a physician assistant's practice poses a continuing threat to the public welfare and 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 physician assistant's practice constitutes a continuing threat to the public welfare shall be made to the council as soon as possible after the peer review committee or the physician involved reaches that conclusion and is able to assemble the relevant information. (g) Reporting Professional Liability Claims. (1) Reporting responsibilities. The reporting form must be completed and forwarded to the Physician Assistant Advisory Council for each defendant physician assistant against whom a professional liability claim or complaint has been filed. The information is to be reported by insurers or other entities providing professional liability insurance for a physician assistant. If a nonadmitted insurance carrier does not report or if the physician assistant has no insurance carrier, reporting shall be the responsibility of the physician assistant. (2) Separate reports required and identifying information. One separate report shall be filed for each defendant physician assistant insured. When Part II is filed, it shall be accompanied by the completed Part I or other identifying information as described in paragraph (4)(A) of this subsection. (3) Timeframes and attachments. The information in Part I of the form must be provided within 30 days of receipt of the claim or suit. A copy of the claim letter or petition must be attached. The information in Part II must be reported within 105 days after disposition of the claim. Disposed claims shall be defined as those claims where a court order has been entered, a settlement agreement has been reached, or the complaint has been dropped or dismissed. (4) Alternate reporting formats. The information may be reported either on the form provided or in any other legible format which contains at least the requested data. (A) If the reporter elects to use a reporting format other than the council's form for data required in Part II, there must be enough identification data available to staff to match the closure report to the original file. The data required to accomplish this include: (i) name and license number of defendant physician assistant(s); and (ii) name of plaintiff. (B) A court order or a copy of the settlement agreement is an acceptable alternative submission for Part II. An order or settlement agreement should contain the necessary information to match the closure information to the original file. If the order or agreement is lacking some of the required data, the additional information may be legibly written on the order or agreement. (5) Penalty. Failure by a licensed insurer to report under this section shall be referred to the State Board of Insurance. (6) Definition. For the purposes of this subsection a professional liability claim or complaint shall be defined as a cause of action against a physician assistant for treatment, lack of treatment, or other claimed departure from accepted standards of health care or safety which proximately results in injury to or death of the patient, whether the patient's claim or cause of action sounds in tort or contract. (7) Claims not required to be reported. Examples of claims that are not required to be reported under this chapter but which may be reported include, but are not limited to, the following: (A) product liability claims (i.e. where a physician assistant invented a device which may have injured a patient but the physician assistant has had no personal physician assistant-patient relationship with the specific patient claiming injury by the device); (B) antitrust allegations; (C) allegations involving improper peer review activities; (D) civil rights violations. (8) Claims that are not required to be reported under this chapter may, however, be voluntarily reported. (9) The reporting form shall be as follows: [graphic] sec.185.24. Procedure-General. (a) Applicability. These rules shall govern the procedures for the institution, conduct, and determination of all causes and proceedings before the council. The purpose of these sections is to provide for a simple and efficient system of procedure before the council; to ensure uniform standards of practice and procedure, public participation, and notice of council actions; and a fair and expeditious determination of causes. (b) Construction. These rules shall not be construed so as to enlarge, diminish, modify or alter the jurisdiction, powers, or authority of the council or the substantive rights of any party. They shall be liberally construed with a view towards the purpose for which they were adopted. (c) Computation of Time. (1) Computing time. In computing any period of time prescribed or allowed by these sections, Order of the council, or any applicable statute, the period shall begin on the day after the act, event, or default in controversy and end on the last day of such computed period, unless it is a Saturday, Sunday, or legal holiday, in which event the period runs until the end of the next day which is not a Saturday, Sunday, nor a legal holiday. (2) Extensions. Unless otherwise provided by statute, the time for filing any document may be extended by agreement of the parties or order of the secretary, hearings examiner, or administrative law judge upon written verified motion duly filed prior to the expiration of the applicable time period, showing good cause for an extension of time and stating that the need therefor is not caused by the neglect, indifference, or lack of diligence of the movant. A copy of any such motion shall be served upon all other parties of record to the proceeding contemporaneously with the filing thereof. (d) Agreement to be in Writing. No stipulation or agreement between the parties, their attorneys, or representatives with regard to any matter involved in any proceeding before the council shall be enforced unless it shall have been reduced to writing and signed by the parties or their authorized representatives, or unless it shall have been dictated into the record by them during the course of a hearing, or incorporated in an Order bearing their written approval. This section does not limit a party's ability to waive, modify, or stipulate any right or privilege afforded by these sections, unless precluded by law. (e) Expiration of Licenses. When a licensee has made timely and sufficient application for the renewal of a license or a new license for any activity of a continuing nature, the existing license does not expire until the application has been finally determined by the agency, or unless it has been terminated according to statute and rule, and in case the application is denied or the terms of the new license limited, until the last day for seeking review of the council order or a later date fixed by order of the reviewing court. (f) Pleadings. (1) Form. Pleadings shall be typewritten or printed upon paper 8 inches wide and 11 inches long with left and right margins at least one inch wide. Exhibits annexed thereto shall be folded to the same size and conform to subsection (f) of sec.185.26 of this title (relating to Procedure-Hearing). Reproductions are acceptable, provided all copies are clear and permanently legible. (2) Content. Pleadings shall state their purpose, contain a concise statement of the facts in support thereof, and state a prayer for the desired relief. (3) Signature and address. The original of every pleading shall be signed in ink by the party filing the paper, his or her attorney, or by his or her authorized representative. Pleadings shall contain the name, address, and telephone number of the party filing the document or the name, telephone number, and business address of the representative. (4) Certificate of service. A certificate of service by the party, attorney, or representative who files a pleading, stating that it has been served on the other parties, shall be prima facie evidence of such service. The following form of certificate will be sufficient in this connection: "I hereby certify that I have this _____ day of __________, 19___, served copies of the foregoing pleading upon all other parties to this proceeding, by (here state the manner of service). Signature." Service of pleadings on and by parties shall be as specified in subsection (k) of this section. (5) Numbering and Heading. In a contested case the complaint and each pleading shall be numbered with the licensee's license number, centered and underscored six lines down from the top of the first page. In each matter heard before the State Office of Administrative Hearings (SOAH) , the SOAH docket number shall be centered above the licensee's license number. If a SOAH docket number is not available when the complaint or pleading is filed, a space will be provided for its entry at a later date. Double spaced below the number shall be the heading, as follows: [graphic] (6) Other pleadings. All pleadings for which no official form is prescribed shall contain: (A) the name of the party seeking to bring about or prevent action by the council; (B) the names of all other known parties in interest; (C) a concise statement of the facts relied upon by the pleader; (D) a prayer stating the type of relief, action, or order desired by the pleader; (E) any other matter required by statute; and (F) a certificate of service, if required by subsection (k) of this section. (7) Amendments. Any pleading may be amended at any time upon motion or the filing of an amended application, complaint, or petition for which notice, if required, shall be issued pursuant to subsection (g) of this section. (8) Incorporation by reference of agency records. Any pleading may adopt and incorporate, by specific reference thereto, any part of any document or entry in the official files and records of the agency. This section shall not relieve any applicant of the necessity of alleging in detail, if required, facts necessary to sustain his or her burden of proof imposed by law. (9) Classification. Regardless of any error in the designation of a pleading, it shall be accorded its true status in the proceeding in which it is filed. (10) Docketing. Upon receipt of a complaint, an application, or other pleading which is intended to institute a proceeding before the council, the secretary, executive director of the Board, designee, or council staff shall docket the same as a pending proceeding and serve notice thereon as specified in subsection (k) of this section. (11) Filing of documents. All documents relating to any proceeding pending or to be instituted before the council shall be filed with the secretary of the council, the executive director, or Director of Hearings for the medical board. Documents shall be deemed filed only when actually marked with the official stamp of the medical board, accompanied by the filing fee, if any, required by statute or board rules. (g) Notice of Adjudicative Hearing Proceedings. (1) Notice. Before revoking or suspending any license or registration, or denying an application for a license or registration, or reprimanding any licensee or registrant, the council shall afford all parties an opportunity for an adjudicative hearing after reasonable notice of not less than ten days. (2) Content. Such notice of adjudicative hearing shall include: (A) a statement of time, place, and nature of the hearing; (B) a statement of the legal authority and jurisdiction under which the hearing is to be held; (C) a reference to the particular sections of the statutes and rules involved; and (D) a short and plain statement of the matters asserted. (3) More definite statement. If the council is unable to state the matters in detail at the time the notice is served, the initial notice may be limited to a statement of the issues involved. Thereafter, on a timely written application, a more definite and detailed statement must be furnished not less than three days prior to the date set for the hearing; however, the council shall not be required to plead its evidence in its complaint. (4) Service. The notice of adjudicative hearing shall be served as specified in subsection (k) of this section. (h) Conduct and Decorum. Each person, party, witness, attorney, or other representative shall comport himself or herself in all proceedings with proper dignity, courtesy, and respect for the council, the medical board, the secretary, the executive director, the examiner, and all other parties. Disorderly or disruptive conduct will not be tolerated. Attorneys and other representatives of parties shall observe and practice the standards of ethical behavior prescribed for attorneys at law by the Texas State Bar. (i) Classification of Parties. Regardless of errors as to designation of a party, parties shall be accorded their true status in the proceeding. (j) Parties in Interest. Any party in interest may appear in any proceeding before the council or the board. All appearances shall be subject to a motion to strike upon a showing that the party has no justifiable or administratively cognizable interest in the proceeding. (k) Service in Nonrulemaking Proceedings. (1) Personal service. Where personal service of notice by the council is required, the council shall serve in person or by mailing the notice of adjudicative hearing, certified or registered mail, return receipt requested, to the last address filed with the board by the person entitled to receive such notice. (2) Service by publication. Where personal service cannot be made as contemplated in paragraph (1) of this subsection, then service of notice shall be by publication of the notice of adjudicative hearing in a newspaper of general circulation once each week for two consecutive weeks in the county in which the licensee was last known to have practiced; the last publication to be at least ten days prior to the date of the hearing. When the licensee's whereabouts are unknown or his or her last known place of practice is outside the State of Texas, notice by publication is to be made by having published once a week for two consecutive weeks in a newspaper of general circulation published in the county of the last known place of practice in Texas if known, the last publication to be at least ten days prior to the date of the hearing. Return of the service of notice by publication shall be by publisher's affidavit together with a copy of the published notice which shall be introduced into the record at the hearing. (3) Service of pleadings. A copy of any document filed by any party in any proceeding subsequent to the institution thereof shall be mailed or otherwise delivered to all other parties of record by the filing party. If any party has appeared in the proceeding by attorney or other representative authorized under these sections to make appearances, service shall be made upon such attorney or other representative. The willful failure of any party to make such service shall be sufficient grounds for the entry of an order by the presiding officer or hearings examiner striking the document from the record. (l) Appearances Personally or by Representative. Any party may appear and be represented by an attorney at law authorized to practice law before the highest court of this state. This right may be waived. Any person may appear on his or her own behalf or by a bona fide full-time employee. A corporation, partnership, or association may appear and be represented by any bona fide officer, partner, or full-time employee. (m) Filing Fees. Each application, petition, or complaint which is intended to institute a proceeding before the council shall be accompanied by the filing fee, if any, prescribed by law and these sections. (n) Forms. Official forms for use in certain council proceedings are incorporated in the appendix to these sections. The previously-mentioned official forms shall be printed, when appropriate, under the supervision of the secretary or executive director who shall furnish copies thereof to any person upon request. (o) Ex Parte Consultations. Unless required for the disposition of ex parte matters authorized by law, members or employees of the council assigned to render a decision or to make findings of fact and conclusions of law in a contested case may not communicate, directly or indirectly, in connection with any issue of fact or law, with any party or his representative except on notice and opportunity for all parties to participate. sec.185.25. Procedure-Prehearing. (a) Discovery. After the initiation and filing of a formal complaint, or upon the filing of the council's initial pleading in any other contested matter, the following discovery rules shall apply. (1) Preliminary Discovery. Not later than 30 days after receiving a written request from an opposing party, the responding party shall provide to the requesting party the following: (A) a preliminary list of the names and last known addresses of potential witnesses which the responding party reasonably anticipates may testify in its case-in-chief; (B) a list or copy of all documents, records, photographs, moving pictures, films, videotapes, audio recordings, and other such material in the possession of the responding party which the responding party intends to offer in its case- in-chief, and a reasonable opportunity to inspect and copy such items; (C) a list identifying all tangible items in the possession of the responding party which the responding party intends to offer in its case-in-chief, and a reasonable opportunity to inspect such items; and (D) a list of the names and last known addresses of any experts the responding party anticipates calling to testify in its case-in-chief. (2) Experts. Upon written request, a list identifying all of the following documents and tangible items pertaining to the responding party's experts, or copies of such documents and tangible items, shall be provided to the requesting party before the initial deposition of such an expert, or no later than five days prior to the hearing on the case if no deposition of the expert has been taken: (A) documents and tangible items which have been provided to any expert who is expected to testify in the case; (B) documents and tangible items which have been made or prepared by any expert used for consultation if such documents and tangible items form the basis, either in whole or in part, of the opinion of an expert who is expected to testify in the case; and (C) a report from each expert who is anticipated to testify in the case which generally synopsizes the expected testimony of the expert. (3) Inspection and Copying. Documents and tangible items which are identified in a discovery response, but not provided, shall be made available for inspection and copying at a reasonable time and place upon the written request of an opposing party. (4) Depositions. The taking and use of depositions shall be governed by the Administrative Procedure Act or by an agreement between the parties either on the record or in a writing signed by the parties or their representatives. Except by an agreement between the parties either on the record or in a writing signed by the parties or their representatives, depositions shall be conducted and completed no later than five days prior to the scheduled hearing date. Failure of a properly noticed witness who is a party to the case to attend a deposition for the purpose of taking the testimony of that party witness, or the failure of such a witness to attend such a deposition as agreed to by the parties on the record or in a writing signed by the parties or their representatives, may result in the imposition of the sanctions and remedies set forth in paragraph (5) of this subsection. (5) Remedies and Sanctions. A failure to comply with a discovery request to the extent required by council rule, board rule, the Physician Assistant Licensing Act, the Medical Practice Act, or as agreed between the parties in a discovery agreement, may be remedied and sanctioned by ordering any or all of the following: (A) granting of a continuance; (B) limitations or restrictions on the admissibility and use of the evidence, to include exclusion of the evidence; (C) payment by a party of the actual travel, lodging, and court reporter costs, but not attorney fees, incurred by an opposing party as a result of the failure to comply with the discovery requirements under council rule; (D) imposition of a scheduling order providing for discovery deadlines necessary to remedy the failure to comply with discovery requirements under council rules; and (E) remedies and sanctions agreed to by the parties in writing or on the record. (6) Good Cause. Good cause for failure to comply with a discovery request to the extent required by law, council rule, board rule, or as agreed between the parties in a discovery agreement, may justify the imposition of less severe remedies or sanctions which might otherwise be imposed. Good cause shall include but is not limited to the following: (A) lack of knowledge of the existence of the information or material; (B) lack of access to or control of the information or material; and (C) an act of God or providence. (7) Calculation of Deadlines and Time Limits. (A) For purposes of discovery under council rules, board rules, deadlines and time limits shall be based on calendar days; however, when a deadline falls on a Saturday, Sunday, or legal holiday, the deadline shall be extended to the next calendar day which is not a Saturday, Sunday, or legal holiday. (B) Discovery requests promulgated less than seven days prior to the scheduled hearing date shall not require a response unless agreed to by the parties on the record or in a writing signed by the parties or their representatives; however, other discovery requests promulgated at a time prior to the scheduled hearing date which by their timing allow less than the applicable deadline period for a response, shall not require a response until submitted for approval by motion of the requesting party to the administrative law judge and approved in whole or in part by order of the administrative law judge. Any such approval shall provide for one or more of the following: (i) modified response deadlines; (ii) a continuance of the hearing date charged to the party requesting discovery; or (iii) such reasonable requirements which are necessary to minimize any anticipated burden or inconvenience to the responding party as a result of the lateness of the discovery request. (8) Discovery Agreements. Discovery requirements governing council proceedings may be modified by agreement of the parties either on the record or in a writing signed by the parties or their representatives. (9) Ordered Modification of Discovery. Modification of discovery requirements under council rules may be ordered by an administrative law judge pursuant to an agreement of the parties or the discovery provisions under council rules pertaining to remedies and sanctions. (10) Official Notice. No later than three days prior to the date of the hearing, the parties shall exchange lists specifying all matters which each party will seek to have officially noticed at the hearing. (11) Final Witness List. No later than five days prior to the date of the hearing, the parties shall exchange final lists identifying the names and last known addresses of the witnesses each party intends to call to testify in its case-in-chief. (12) Waiver of Privilege/Confidentiality. The provision of any information or material in response to a discovery request which may be the subject of a privilege or confidentiality requirement under the Medical Practice Act or other applicable law shall not constitute a waiver of any such privilege or confidentiality requirement with respect to other such information or material not provided. (13) Supplementation. Upon receiving new information or material, or upon otherwise determining that an inaccuracy exists in a previous discovery response, each party shall supplement such responses as soon as practicable. (b) Subpoenas. (1) Authority. Pursuant to the Medical Practice Act, sec.2. 09(i), the council has the authority, through the medical board, to issue subpoenas to compel the attendance of witnesses and subpoenas duces tecum to compel the production of books, records, or documents when requested by a party or on the council's own motion. (2) Request. A party may request at any time during the pendency of a proceeding, including a contested case, that the council, through the medical board, issue a subpoena or subpoena duces tecum upon a showing of good cause; the relevancy, and necessity of the testimony or documents; lack of undue inconvenience, imposition, or harassment of the party required to produce the testimony or documents; and the deposit of sums sufficient to ensure payment of expenses incident to the subpoenas. (A) The party requesting the subpoena shall be responsible for the payment of any expense incurred in serving the subpoena, as well as reasonable and necessary expenses incurred by the witness who appears in response to the subpoena. (B) The party requesting a subpoena duces tecum shall describe and recite with great clarity, specificity, and particularity the books, records, or documents to be produced. (3) Ministerial Act. When requested by a party to issue a subpoena or subpoena duces tecum, the council is performing a ministerial act and shall do so in accordance with the law; however, the council shall not be responsible for inadequacies, insufficiencies, or lack of pleading by the requesting parties or the consequences thereof. (4) Service and Expenses. A subpoena issued at the request of the staff may be served either by a council or board investigator or by certified mail, return receipt requested. The council shall pay reasonable charges for photocopies produced in response to a subpoena requested by the staff, but such charges may not exceed those billed by the council for producing copies of its own records. (5) Fees and Travel. A witness called at the request of the council shall be paid a fee of $25 per day and reimbursed for travel in like manner as council staff. An expert witness called at the request of the council shall be paid a fee of $300 per day and shall be reimbursed for travel in like manner as council members. (c) Show Compliance Proceeding. Pursuant to the Administrative Procedure Act, sec.2001. 054, the following rules shall apply to show compliance proceedings: (1) Prior to institution of council proceedings to revoke, suspend, or take disciplinary action relating to a license or to involuntarily modify restrictions on a license, the physician assistant shall be given an opportunity to show compliance with all requirements of law for the retention of an unrestricted license either in writing, or through a personal appearance at an informal meeting with three representatives of the council, at the option of the licensee. (2) The opportunity to show compliance under this section shall be extended to a licensee in writing by certified mail, return receipt requested, overnight or express mail, or registered mail, to the last mailing address of the licensee or the licensee's attorney on file with the council. (3) Prior to a show compliance proceeding under this section, the licensee shall be provided with a brief written statement of the nature of the allegations to be addressed at the show compliance proceeding along with a brief written statement of the provisions of the Physician Assistant Licensing Act which may be grounds for disciplinary action. These statements shall be provided to the licensee by certified mail, return receipt requested, overnight or express mail, or registered mail to the last mailing address of the licensee or the licensee's attorney on file with the council. The licensee shall also be provided with written notice of the time, date, and location of the show compliance proceeding and the rules governing the proceeding by certified mail, return receipt requested, overnight or express mail, or registered mail, to the last mailing address of the licensee or the licensee's attorney on file with the council. (4) A licensee shall be afforded an opportunity to show compliance with the law as provided for under this section; however, a licensee's refusal or failure to take such an opportunity when offered, or when scheduled with proper notice to the licensee, shall not require that an additional show compliance opportunity be made available. In the discretion of the council's representatives an additional show compliance opportunity may be afforded to a licensee who refused a previous opportunity or failed to attend a scheduled show compliance proceeding. (5) Three members of the council, consisting of a physician assistant, a physician, and a public member shall conduct the show compliance proceeding as the council's representatives. The representative who has seniority on the council shall chair the proceeding. (6) The show compliance proceeding shall allow: (A) the council staff to present a synopsis of the allegations and the facts which the staff reasonably believes could be proven by competent evidence at a hearing; (B) the licensee to reply to the staff's presentation and present facts the licensee reasonably believes could be proven by competent evidence at a hearing; (C) presentation of evidence by the staff and the licensee which may include medical and office records, x-rays, pictures, film recordings of all kinds, audio and video recordings, diagrams, charts, drawings, and any other illustrative or explanatory materials which in the discretion of the council's representatives are relevant to the proceeding; (D) representation of the licensee by counsel; (E) presentation of oral or written statements by the licensee or the licensee's counsel; (F) presentation of oral or written statements or testimony by witnesses; and (G) questioning of witnesses. (7) The council's representatives shall exclude from the show compliance proceeding all persons except witnesses during their testimony or presentation of statements, the licensee, the licensee's attorney or representative, council members, and council staff. (8) During the show compliance proceeding, the council's legal counsel or a representative of the Office of the Attorney General shall be present to advise the council's representatives and the council's staff. (9) Except with the agreement of the licensee, during the deliberations of the council's representatives at a show compliance proceeding, the council representatives shall exclude the council staff who presented the allegations and facts related to the complaint against the licensee, the licensee, the licensee's attorney or representative, the complainant, any witnesses, and the general public. The council's legal counsel or a representative of the Office of the Attorney General shall be available to assist the representatives in deliberations. (10) After a show compliance proceeding has been held, the council staff and the council's representatives shall be subject to the ex parte provisions of the Administrative Procedure Act with regard to contacts with council members and administrative law judges concerning the case. (11) To the extent possible, council members are required to serve as representatives at show compliance proceedings an equal number of times during a calendar year. In the event a council member has a complaint regarding the frequency or infrequency of service as a representative, the complaint may be routed in writing to the Director of Hearings for the medical board who shall then bring the complaint to the attention of the presiding officer of the council for submission to the council for a resolution by a majority vote. (12) The show compliance proceeding may be held in conjunction with, and simultaneously with, an informal settlement conference held pursuant to subsection (h) of this section. (13) The council's representatives may call upon council staff at any time for assistance in conducting the show compliance proceeding. (14) The council's representatives shall prohibit or limit access to the council's investigative file by the licensee, the licensee's attorney or representative, the complainant, witnesses, and the public consistent with the Medical Practice Act, sec.4.05(c) and sec.185.23 of this title (relating to Investigations). (15) At the conclusion of the show compliance proceeding, the council's representatives shall make recommendations for disposition of the complaint or allegations which may include recommendations of dismissal and closure of the related investigation. In the event a dismissal and closure of the investigation is not recommended, the representatives shall attempt to mediate the disputed matters and make a recommendation regarding the disposition of the case in the absence of a hearing under the provisions of applicable law concerning contested cases. (16) The licensee may have the show compliance proceeding recorded and reduced to writing at the licensee's expense after providing written notice to the Director of Hearings for the medical board at least one day in advance of the show compliance proceeding. Recording and transcribing equipment shall be provided by the licensee. Efforts to mediate the disputed matters or discussions concerning possible settlement options shall not be recorded. (d) Prehearing Conferences. (1) Appearance. In any contested case the hearings examiner or administrative law judge on his or her own motion or on the motion of a party, may direct the parties, their attorneys, or representatives to appear before him or her at a specified time and place for a conference prior to the hearing for the purpose of: (A) formulating issues; (B) simplifying issues; (C) discussing matters to be officially noticed; (D) discussing the possibility of making admissions of certain averments of fact or stipulations concerning the use by either or both parties of matters of public record, such as official records of the council or medical board, to the end of avoiding the unnecessary introduction of proof; (E) ruling on any previously filed motions; (F) discussing the procedure at a hearing; (G) discussing the limitation, where possible, of the number of witnesses; and (H) discussing such other matters as may aid in the simplification of the proceedings. (2) Order. Action taken at the conference shall be recorded in an appropriate Order by the hearings examiner or administrative law judge. (e) Motions. (1) Any motion filed in a pending proceeding shall, unless made during a hearing: (A) be in writing; (B) set forth the specific grounds and reasons therefore, and the relief sought; (C) be distributed to all parties of record over a certificate of service as outlined in sec.185. 24(g) and (k) of this title (relating to Procedure- General); (D) be filed with the hearings examiner not less than five days prior to the hearing date; (E) if based on facts or matters which are not of record, be supported by an affidavit; and (F) be ruled on by the hearings examiner at the prehearing conference or at the hearing. (2) Motions for continuance or for dismissal of a complaint shall: (A) comply with subsection (a)(1)-(6) of this section; (B) make reference to all prior motions of the same nature filed in the same proceeding. (3) When a complaint has proceeded to its hearing date, pursuant to the notice issued therein, no continuance or dismissal shall be granted by the hearings examiner or administrative law judge without the consent of all parties involved. (f) Consolidated Hearings. A motion for consolidation of two or more complaints, applications, petitions, or other proceedings shall comply with subsection (e) of this section. Proceedings shall not be consolidated unless the council shall find that: (1) the proceedings involve common questions of law and fact; and (2) separate hearings would result in unwarranted expense, delay, or substantial injustice. (g) Place and Nature of Hearings. All hearings conducted in any proceedings shall be open to the public. All hearings shall be held in Austin, Texas, unless for good and sufficient cause the council shall designate another place of hearing in the interest of the public. (h) Informal Disposition. Pursuant to the Administrative Procedure Act, sec.2001.056, the following rules shall apply to informal dispositions of any complaint or matter relating to the Physician Assistant Licensing Act or of any contested case. (1) The council may make an informal disposition of any complaint or matter relating to the Act or of any contested case by stipulation, agreed order, agreed settlement, consent order, or default. (2) In the event the council makes such a disposition of a complaint, contested case, or other matter, the disposition shall be in writing and, if appropriate, the writing shall be signed by the licensee. (3) To facilitate the expeditious disposition of complaints or contested cases, the council may provide a licensee with an opportunity to attend an informal settlement conference. The informal settlement conference may be held in conjunction with, and simultaneously with, a show compliance proceeding held pursuant to subsection (c) of this section. (4) If the opportunity for an informal settlement conference is provided to a licensee, the licensee shall be provided with a brief statement of the nature of the allegations to be addressed at the conference along with a brief statement of the provisions of the Act which may be grounds for disciplinary action. These statements shall be provided to the licensee by certified mail, return receipt requested, overnight or express mail, or registered mail, to the last mailing address of the licensee or the licensee's attorney on file with the council. The licensee shall also be provided with written notice of the time, date, and location of the conference and the rules governing the proceeding by certified mail, return receipt requested, overnight or express mail, or registered mail, to the last mailing address of the licensee or the licensee's attorney on file with the council. (5) Three members of the council, a physician assistant, a physician, and a public member, shall conduct the informal settlement conference as the council's representatives. The representative who has seniority on the council shall chair the conference. (6) The informal settlement conference shall allow: (A) council staff to present a synopsis of the allegations and the facts which staff reasonably believes could be proven by competent evidence at a hearing; (B) the licensee to reply to the council staff's presentation and present facts the licensee reasonably believes could be proven by competent evidence at a hearing; (C) presentation of evidence by the staff and the licensee which may include medical and office records, x-rays, pictures, film recordings of all kinds, audio and video recordings, diagrams, charts, drawings, and any other illustrative or explanatory materials which in the discretion of the council's representatives are relevant to the proceeding; (D) representation of the licensee by counsel; (E) presentation of oral or written statements by the licensee or the licensee's counsel; (F) presentation of oral or written statements or testimony by witnesses; and (G) questioning of witnesses. (7) The council's representatives shall exclude from the informal settlement conference all persons except witnesses during their testimony or presentation of statements, the licensee, the licensee's attorney or representative, council members, and council staff. (8) During the informal settlement conference, the council's legal counsel or a representative of the Office of the Attorney General shall be present to advise the council's representatives or the council's staff. (9) Except with the agreement of the licensee, during the deliberations of an appropriate settlement, the council's representatives at an informal settlement conference shall exclude the council staff which presented the allegations and facts related to the complaint against the licensee, the licensee, the licensee's attorney or representative, the complainant, witnesses, and the general public. Legal counsel for the council or a representative of the Office of the Attorney General shall be available to assist the representatives in their deliberations. (10) After an informal settlement conference has been held, the staff of the council and the council's representatives shall be subject to the ex parte provisions of the Administrative Procedure Act with regard to contacts with council members and administrative law judges concerning the case. (11) To the extent possible, council members are required to serve as representatives at informal settlement conferences an equal number of times during a calendar year. In the event a council member has a complaint regarding the frequency or infrequency of service as a representative, the complaint may be routed in writing to the Director of Hearings for the medical board who shall then bring the complaint to the attention of the presiding officer of the council for submission to the council for a resolution by a majority vote. (12) At the informal settlement conference, the council's representatives will attempt to mediate disputed matters, and the council's representatives may call upon the staff at any time for assistance in conducting the informal settlement conference. (13) The council's representatives shall prohibit or limit access to the council's investigative file by the licensee, the licensee's attorney or representative, the complainant, witnesses, and the public consistent with the Medical Practice Act, sec.4.05(c). (14) Although notes may be made by the participants, mechanical or electronic recordings shall not be made of settlement discussions, mediation efforts, or the informal settlement conference. (15) The settlement conference shall be informal and shall not follow the procedures established under this title for contested cases. (16) At the conclusion of the informal settlement conference, the council's representatives shall make recommendations for disposition of the complaint or allegations which may include recommendations of dismissal and closure of the related investigation. In the event a dismissal and closure of the investigation is not recommended, the representatives shall make a recommendation regarding the disposition of the case in the absence of a hearing under the provisions of applicable law concerning contested cases. The council's representatives may make recommendations to the licensee for resolution of the issues. Such recommendations may include any disciplinary actions authorized by the Physician Assistant Licensing Act and such other reasonable restrictions or remedial actions that are in the public interest. These recommendations may be subsequently modified by the council's representatives or staff based on new information, a change of circumstance, or to expedite a resolution in the interest of protecting the public. The council's representatives may also conclude that the council lacks jurisdiction or that a violation of the Physician Assistant Licensing Act or the council's rules has not been established, and may recommend that the investigation be closed or referred for further investigation. These recommendations may be adopted, modified, or rejected by the duly convened council or through the duly authorized actions of the council's Disciplinary and Ethics Committee. (17) The licensee may either accept or reject the settlement recommendations proposed by the council's representatives. If the licensee accepts the recommendations, the licensee shall execute the settlement agreement in the form of an Agreed Order or affidavit as soon thereafter as is practicable. If the licensee rejects the proposed agreement, the matter shall be referred to the council's staff for appropriate disposition as directed by the council's representatives or the Disciplinary and Ethics Committee. The council through staff may also schedule the matter for a hearing as described in sec.185.26 of this title (relating to Procedure-Hearing). (18) Following acceptance and execution by the licensee of the settlement agreement, the agreement shall be submitted to the council for approval. (19) The following relate to consideration of an agreed disposition by the council: (A) Upon an affirmative majority vote, the council shall enter an Order approving the proposed settlement agreement. The Order shall bear the signature of the presiding officer of the council at such meeting and shall be referenced in the minutes of the council. (B) If the council does not approve a proposed settlement agreement, the licensee shall be so informed and the matter shall be referred to the staff for appropriate action to include dismissal, closure, further negotiation, further investigation, an additional informal settlement conference, or a hearing. (C) To promote the expeditious resolution of any complaint or matter relating to the Physician Assistant Licensing Act or of any contested case, with the approval of the executive director of the medical board, or the Disciplinary and Ethics Committee of the council, council staff may present a proposed settlement agreement to the council for consideration and acceptance without conducting an informal settlement conference. If the council does not approve such a proposed settlement agreement, the licensee shall be so informed and the matter shall be referred to council staff for appropriate action to include dismissal, closure, further negotiation, further investigation, an informal settlement conference, or a hearing. sec.185.26. Procedure-Hearing. (a) Presiding Officer. When the council en banc, or a committee or panel of the council, conducts a hearing pursuant to the Physician Assistant Licensing Act or the Medical Practice Act, the following apply. (1) The hearing will be presided over by the presiding officer of the council. (2) The presiding officer shall have the authority to: (A) administer oaths; (B) examine witnesses; (C) rule on the admissibility of evidence; (D) rule on motions; (E) rule on amendments to pleadings; (F) recess the hearing from day to day; and (G) refer the hearing to an administrative law judge at the State Office of Administrative Hearings. (b) Administrative Law Judges/Hearings Examiners. (1) Authority. When the council utilizes an administrative law judge or hearings examiner such hearings shall be conducted in accordance with the Administrative Procedure Act, the Physician Assistant Licensing Act, the Medical Practice Act, the rules of this council, and all other applicable law. (2) Duties. Except for accepting or rejecting proposed findings of fact or conclusions of law, issuing final orders on the merits, dismissing complaints, and making recommendations as to a licensee's discipline, the administrative law judge or hearings examiner shall have all the authority which the council has regarding the conduct of hearings including, without limitation, the following: (A) to hold hearings and issue notices; (B) to administer oaths and affirmations; (C) to direct all parties to enter their appearance on the record; (D) to subpoena and examine witnesses; (E) to subpoena documents and other physical evidence; (F) to hold conferences before, during, or after the hearing, to consider the matters specified in sec.185.25(d) of this title (relating to Procedure- Prehearing); (G) to regulate the course and conduct of the hearing including, without limitation, setting the time and place of the hearing and/or continued hearings; fixing the time for filing of briefs and other documents; receiving relevant evidence; excluding evidence which is irrelevant, immaterial, repetitious, or cumulative; ruling upon offers of proof; regulating the manner of examination to prevent needless and unreasonable harassment, intimidation, expense, inconvenience, or embarrassment of any witness or party at a hearing; removing disruptive individuals; and ruling on motions; (H) to submit in writing to the parties, a proposal for decision containing the elements specified in sec.185.27(a) of this title (relating to Procedure- Posthearing); (I) to present and explain in person his or her proposal for decision to the council for its consideration and final action; and (J) to dispose of any other matter that arises in the course of a hearing and to take any action authorized by the rules of the council, the Physician Assistant Licensing Act, the Medical Practice Act, the Administrative Procedure Act, and all other applicable law. (c) Order of Proceeding. (1) Hearings. In all proceedings, the petitioner, applicant, or complainant, respectively, shall be entitled to open and close. Where several proceedings are heard on a consolidated record, the hearings examiner or administrative law judge shall designate who shall open and close. The hearings examiner or the Administrative Law Judge in all cases shall determine whether and at what stage intervenors shall be permitted to offer evidence. After all parties have completed the presentation of their evidence, the hearings examiner or the Administrative Law Judge may call upon any party or the council staff for further material or relevant evidence upon any issue, to be presented at further public hearing after notice to all parties of record. (2) Before the council. During proceedings before the council, en banc, the order of proceeding shall be the following. (A) The hearings examiner or administrative law judge shall present his or her proposal for decision and recommended order, explaining the items as specified in subsection (b) of this section. (B) The party adversely affected shall briefly state their reasons for being so affected, supported by the evidence of record. (C) The other party or parties shall be given the opportunity to respond. (D) The council as complainant shall have the right to close. (E) The presiding officer or a member of the council may question any party as to any matter relevant to the proceeding. (F) At the end of any argument by the parties, the council may deliberate the matter in executive session, but shall vote and announce its final decision in open meeting. (3) Limitation. A party shall not inquire into the mental processes used by the council in arriving at its decision, nor be disruptive of the orderly procedure of the council's routine. (d) Reporter and Transcripts. (1) Option. A party has the option of furnishing his or her own stenographic reporter at his or her own expense or using the reporter by the council. If a party elects to provide his or her own reporter, the party shall notify the council prior to the commencement of the hearing. (2) Original. The original transcript shall be delivered to the council as soon as practicable. A stenographic reporter may sell copies of a transcript. If the respondent in the proceedings requests the original record (statement of fact) of the testimony and evidence of a disciplinary hearing, the costs for the original record (transcript) shall be borne by the respondent (appellant) physician assistant. Any subsequent copies of the record (transcript) shall be borne by any person requesting same. (3) Corrections. Suggested corrections to the transcript of the record may be offered within ten days after the transcript is filed in the proceeding, unless the council shall permit suggested corrections to be offered thereafter. Suggested corrections shall be served in writing upon each party of record, the official reporter, and the council. If suggested corrections are not objected to, the council will direct the corrections to be made and the manner of making them. In case the parties disagree on suggested corrections, they may be heard by the council which shall then determine the manner in which the record shall be changed, if at all. (e) Dismissal Without Hearing. (1) The council may entertain motions for dismissal for the following reasons: (A) failure to prosecute; (B) unnecessary duplication of proceedings or res judicata; (C) withdrawal; (D) moot questions or stale petitions; or (E) lack of jurisdiction. (2) Such motions must meet the criteria of sec.185.25(e) of this title (relating to Procedure-Prehearing). (3) These motions may be argued prior to the council ruling thereon. (f) Evidence. (1) Rules. The rules of evidence as applied in nonjury civil cases in the district courts of this state shall be followed. In all cases, irrelevant, immaterial, or unduly repetitious evidence shall be excluded. When necessary to ascertain facts not reasonably susceptible of proof under those rules, evidence not admissible thereunder may be admitted, except where precluded by statute, if it is of a type commonly relied upon by reasonably prudent men in the conduct of their affairs. The council shall give effect to the rules of privilege recognized by law. Opportunity must be afforded all parties to respond and present evidence and argument of all issues involved. (2) Objections. Objections to evidentiary offers shall be made and shall be noted in the record. Formal exceptions to rulings of the hearings examiner or administrative law judge during a hearing shall be unnecessary. It shall be sufficient that the party at the time any ruling is made or sought shall have made known to the hearings examiner or administrative law judge the action which he or she desires. (3) Offer of proof. If evidence is excluded from the record by an exclusionary ruling of the hearings examiner or administrative law judge, the evidence may be included in the record by an offer of proof by the sponsoring party by dictating into the record or submitting in writing the substance of the evidence. An offer of proof shall be sufficient to preserve the evidence for review. (4) Office records. When subpoenaed by the council, the office records of each patient shall have stapled thereto an affidavit in the form approved and furnished by the council which contains the requisite elements to comply with the Texas Rules of Civil Evidence, 902(10)b, relating to the form of affidavits. (5) Documents. Subject to these requirements, if a hearing will be expedited and the interests of the parties will not be substantially prejudiced, any part of the evidence may be received in written form. (A) Copies. Documentary evidence may be received in the form of copies or excerpts if the original is not readily available. On request, parties shall be given an opportunity to compare the copy with the original. When numerous documents are offered, the hearings examiner or administrative law judge may limit those admitted to a number which are typical and representative and may, in his or her discretion, require the abstracting of the relevant data from the documents and the presentation of the abstracts in the form of an exhibit; provided, however, that before making such requirement the hearings examiner or the Administrative Law Judge shall require that all parties of record or their representatives be given the right to examine the documents from which such abstracts were made. (B) Prepared testimony. In all contested proceedings and after service of copies upon all parties of record at such time as may be designated by the hearings examiner or administrative law judge, the prepared testimony of any witness upon direct examination, either in narrative or question and answer form, may be incorporated in the record as if read or received as an exhibit, upon the witness' being sworn and identifying the same. Such witness shall be subject to cross-examination and the prepared testimony shall be subject to a motion to strike in whole or in part. (6) Official notice. Official notice may be taken of all facts judicially cognizable and of records of the council or medical board. In addition, notice may be taken of generally recognized facts within the area of the agency's specialized knowledge. Parties shall be notified either before or during the hearing or by reference in preliminary reports or otherwise, of the material officially noticed, including any staff memoranda or data, and the parties shall be afforded an opportunity to contest the material so noticed. The special skills or knowledge of the council and its staff may be utilized in evaluating the evidence. (7) Limitations on number of witnesses. The hearings examiner or administrative law judge shall have the right in any proceeding to limit the number of witnesses whose testimony is merely cumulative. (8) Exhibits. (A) Form. Documentary exhibits shall be 8 inches by 11 inches in length, so as to not unduly encumber the files and records of the council. There shall be a brief statement on the first sheet of the exhibit of what the exhibit purports to show. Exhibits shall be limited to fact material and relevant to the issues involved in a particular proceeding. (B) Marking and service. The original of each exhibit offered shall be marked sequentially for identification and tendered for inclusion in the evidentiary record. One copy shall be furnished to the hearings examiner or administrative law judge and one copy to each party of record or his or her attorney or representative. (9) After hearing. No exhibit will be permitted to be filed in any proceeding after the conclusion of the hearing unless specifically directed by the hearings examiner, administrative law judge, presiding officer, or by the council with copies of the late-filed exhibit served on all parties of record. sec.185.27. Procedure-Posthearing. (a) Proposals for Decision. (1) Elements. In addition to any other requirement of the Physician Assistant Licensing Act or the Administrative Procedure Act, the administrative law judge shall serve on the parties a proposal for decision which shall contain: (A) a summary of the evidence adduced by each party; (B) a statement of the hearings examiner's or administrative law judge's reasons for the proposed decision; (C) findings of fact expressed in clear, concise factual terms, neither summarizing nor reciting the evidence. Findings of fact must be based explicitly on the evidence and on matters officially noticed; (D) conclusions of law necessary to the proposed decision; (E) a listing and explanation of all mitigating and aggravating circumstances necessary to a complete understanding of the case by the council; and (F) recommended disposition or discipline. (2) Service. When a proposal for decision is prepared, a copy of the proposal shall be served forthwith by the hearings examiner or the administrative law judge on each party, his or her attorney of record or representative, and the council. Service of the proposal for decision shall be in accordance with sec.185.24(f) and (k) of this title (relating to Procedure-General). (3) Statutory statement. If findings of fact are stated in statutory language, each finding must be accompanied by a concise and explicit statement of the facts supporting the finding. (4) Proposed findings. Only when the hearings examiner or administrative law judge requests a party or parties to submit findings of fact will it be necessary for the administrative law judge to rule on each proposed finding in the recommended order. (b) Exceptions and Replies. (1) Entitlement. Any party of record who is aggrieved by the hearings examiner's or the administrative law judge's proposal for decision shall have the opportunity to file exceptions to the proposal for decision within 20 days from the date of service of the proposal for decision. Replies to the exceptions may be filed by other parties within ten days of the filing of the exceptions. Exceptions and replies shall be filed with the hearings examiner or the administrative law judge. Any extensions of time shall be as provided by sec.185.24(c) of this title (relating to Procedure-General). (2) Form. The form of exceptions and replies are as specified in sec.185.24(f) of this title (relating to Procedure-General). (3) Content. Each exception or reply to a finding of fact shall be stated concisely and shall summarize the evidence in support thereof. Arguments shall be logical and citations to authorities shall be complete. (4) Briefs. Briefs shall be filed only when requested or permitted by the council, presiding officer, hearings examiner, or administrative law judge. (5) Service. Exceptions and replies shall be served upon every party of record by the filing party pursuant to sec.185.24(k) of this title (relating to Procedure-General). (c) Oral Argument. Any party may request oral argument prior to the final determination of any proceeding, but oral argument shall be allowed only in the sound discretion of the council. A request for oral argument may be incorporated in exceptions, briefs, replies to exceptions, motions for rehearing, or in separate pleadings. (d) Final Decisions and Orders. (1) Council action. The proposal for decision may be acted on by the council upon the expiration of ten days after the filing of replies to exceptions to the proposal for decision. Parties shall be notified either personally or by mail of any decision or order. On written request, a copy of the decision or order shall be delivered or mailed to any party and to his or her attorney of record. (2) Recorded. All final decisions and orders of the council shall be in writing or stated in the record and shall be signed by the presiding officer of the council. A final order shall include findings of fact and conclusions of law, separately stated. (3) Imminent peril. If the council finds that an imminent peril to the public health, safety, or welfare requires immediate effect of a final decision or order in a contested case, it shall recite that finding in the decision or order as well as the fact that the decision or order is final and effective on the date rendered, in which event the decision or order is final and appealable on the date rendered and no motion for rehearing is required as a prerequisite for appeal. (4) Changes to Recommendation. To protect the public interest and ensure that sound principles govern the decisions of the council, it shall hereafter be the policy of the council to change a finding of fact or conclusion of law or to vacate or modify the proposed order of a hearings examiner or an administrative law judge when the proposed order is: (A) erroneous; (B) against the weight of the evidence; (C) based on unsound medical principles; (D) based on an insufficient review of the evidence; (E) not sufficient to protect the public interest; or (F) not sufficient to adequately allow rehabilitation of the physician assistant. (5) Amended order. If the council modifies, amends, or changes the hearing examiner's or the administrative law judge's recommended order, an order shall be prepared reflecting the council's changes as stated in the record. (6) Administrative finality. A final order or council decision is administratively final: (A) upon a finding of imminent peril to the public health, safety, or welfare as outlined in paragraph (3) of this subsection; (B) when absent the filing of a timely motion for rehearing upon the expiration of 20 days from the date the final order or council decision is entered; or (C) when a timely motion for rehearing is filed and the motion for rehearing is overruled by council order or operation of law as outlined in subsection (e) of this section. (7) Rendering of final decision or order. The final decision or order must be rendered within 60 days after the date the hearing is finally closed. In a contested case heard by an administrative law judge, an extension of time for the issuing of a proposal for decision may be announced at the conclusion of the hearing. (e) Motions for Rehearing. (1) Filing Times. A motion for rehearing must be filed within 20 days after a party has been notified, either in person or by mail, of the final decision or order of the council. (2) Council Action. Action by the council on the motion must be taken within 45 days after the date of rendition of the final decision or order. If council action is not taken within the 45-day period, the motion for rehearing is overruled by operation of law 45 days after the date of rendition of the final decision or order. The council may, by written order, extend the period of time for filing the motions and replies and taking council action, except that an extension may not extend the period for council action beyond 90 days after the date of rendition of the final decision or order. In the event of an extension, the motion for rehearing is overruled by operation of law on the date fixed by the order, or in the absence of a fixed date, 90 days after the date of the final decision or order. The parties may, by agreement, with the approval of the council, provide for a modification of the times provided in this section. (f) The Record. The record in a contested case shall include: (1) all pleadings, motions, and intermediate rulings; (2) evidence received or considered; (3) a statement of matters officially noticed; (4) questions and offers of proof, objections, and rulings on them; (5) proposed findings of fact, conclusions of law, exceptions, and replies; (6) any decision, opinion, or report by the officer presiding at the hearing; and (7) all staff memoranda, correspondence from parties, or other data submitted to or considered by the hearings examiner or the administrative law judge or members of the agency who are involved in making the decision. (g) Costs of Appeal. A party appealing a final decision of the council in a contested case may be ordered by the council to pay all or a part of the cost of preparation of the original or a certified copy of the record of the proceeding that is required to be transmitted to the reviewing court. sec.185.28. Medical Board Review and Approval. Medical board approval of council rules under this section shall be memorialized in the minutes of the medical board, the minutes of a committee of the medical board, or in a writing signed by the medical board's presiding officer, secretary-treasurer, or authorized committee chair after consideration of the rules recommended by the council. sec.185.29. Construction. The provisions of this chapter shall be construed and interpreted so as to be consistent with the statutory provisions of the Physician Assistant Licensing Act and the Medical Practice Act. In the event of a conflict between this chapter and the provisions of the Act(s), the provisions of the Act(s) shall control; however, this chapter shall be construed so that all other provisions of this chapter which are not in conflict with the Act(s) shall remain in effect. Issued in Austin, Texas, on June 28, 1994. TRD-9443263 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: June 30, 1994 Expiration date: October 28, 1994 For further information, please call: (512) 834-7728, Ext. 422