Part 5.
STATE BOARD OF DENTAL EXAMINERS
Chapter 101.
DENTAL LICENSURE
22 TAC §101.7
The State Board of Dental Examiners proposes amendments to §101.7,
Licensure by Credentials, Dentists.
Jeffry R. Hill, Executive Director, State Board of Dental Examiners, has
determined that for the first five-year period the rule is in effect there
will be no fiscal implications for state or local government as a result of
enforcing the rule.
Mr. Hill has determined that for each year of the first five years the
rule is in effect the public benefit anticipated as a result of enforcing
the rule will be that the public will know that all dentists licensed in Texas,
whether by examination or credentials, will have completed continuing education
and will have demonstrated clinical competency.
It is unknown if there will be any fiscal implications for small businesses.
Should such costs be incurred, they will not be of such magnitude to impact
the economic viability of a small business. Therefore the SBDE has determined
that compliance with the proposed amended rule will not have an adverse economic
impact on small businesses when compared to large businesses as the cost of
compliance, if any, will be minimal.
Comments on the proposal may be submitted to Mei Ling Clendennen, Assistant
Executive Director, State Board of Dental Examiners, 333 Guadalupe, Tower
3, Suite 800, Austin, Texas, 78701, (512) 463-6400. To be considered all comments
must be received by the State Board of Dental Examiners on or before March
25, 2000.
The amended rule is proposed under Texas Government Code §2001.021
et. seq.; Texas Civil Statutes, the Occupations Code §254.001 which provides
the State Board of Dental Examiners with the authority to adopt and promulgate
rules consistent with the Dental Practice Act, and §256.101 which provides
the Board with the authority to issue a license after a review of credentials.
The proposed amended rule does not affect other statutes, articles, or
codes.
§101.7.Licensure by Credentials--Dentists.
The State Board of Dental Examiners will license applicants by credentials
upon payment of a fee, in an amount set by the Board, who meet all SBDE and
State of Texas minimum applicant requirements and general licensure qualifications
and all of the following criteria:
(1)-(7)
(No change.)
(8)
Has successfully passed a state or
regional general dentistry clinical examination.
(9)
[
(10)
[
(11)
[
(12)
[
(13)
Effective September 1, 2000, all
applicants must submit proof of completion of 12 hours of continuing education
taken within the twelve months preceding the date the licensure application
is received by the SBDE. All hours shall be taken in accordance with the provisions
as cited in §104.1(5)(6) and (7) (of this title relating to Requirements)
and §104.2 (of this title relating to Providers).
(14)
[
(15)
[
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on February 8, 2000.
TRD-200000975
Jeffry R. Hill
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 463-6400
Chapter 163.
LICENSURE
22 TAC §163.4
The Texas State Board of Medical Examiners proposes an amendment
to §163.4, concerning licensure. The section amends language relating
to procedural rules regarding licensure examinations.
John S. Teer, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendment is in effect
there will be no fiscal implications to state or local government as a result
of enforcing or administering the amendment as proposed.
Mr. Teer also has determined that for each year of the first five years
the amendment as proposed is in effect the public benefit anticipated as a
result of enforcing the amendment will be clarification on procedural rules
regarding licensure examinations. There will be no effect on small businesses.
There is no anticipated economic costs to persons who are required to comply
with the amendment as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the authority of the Occupations
Code, §153.001, which provides the Texas State Board of Medical Examiners
to adopt rules and bylaws as necessary to: govern its own proceedings; perform
its duties; regulate the practice of medicine in this state; and enforce this
subtitle.
The Occupations Code, §155.101 is affected by the proposed amendment.
§163.4.Procedural Rules for Licensure Applicants.
(a)
Applicants for licensure:
(1)
whose documentation indicates any name other than the name
under which the Applicant has applied must furnish proof of the name change;
(2)
whose application for licensure which has been filed
with the board office and which is in excess of one years old from the date
of receipt, shall be considered inactive. Any fee previously submitted with
that application shall be forfeited. Any further application procedure for
licensure will require submission of a new application and inclusion of the
current licensure fee;
(3)
will be allowed to sit for the Texas medical jurisprudence
examination only three times. After the third failure of the Texas medical
jurisprudence examination, and after each subsequent failure, an applicant
for licensure shall be required to appear before a committee of the board
to address the applicant's inability to pass the Texas medical jurisprudence
examination and to re-evaluate the applicant's eligibility for licensure;
(4)
who in any way falsify the application may be required
to appear before the board. It will be at the discretion of the board whether
or not the applicant will be issued a Texas license;
(5)
on whom adverse information is received by the board
may be required to appear before the board. It will be at the discretion of
the board whether or not the applicant will be issued a Texas license;
(6)
shall be required to comply with the board's rules
and regulations which are in effect at the time the completed application
form and fee are filed with the board;
(7)
may be required to sit for additional oral or written
examinations that, in the opinion of the board, are necessary to determine
competency of the applicant;
(8)
must have the application for licensure complete in
every detail 20 days prior to the board meeting in which they are considered
for licensure. Applicants may qualify for a Temporary License prior to being
considered by the board for licensure, as required by §163.7 of this
title (relating to Temporary Licensure - Regular);
(9)
must pass, within seven years all parts of all examinations
required for licensure. The board may consider for licensure graduates of
simultaneous MD-PhD or DO-PhD programs who have passed all parts of their
required examinations no later than two years after their MD or DO degree
was awarded.
(b)
Applicants for licensure who wish to request reasonable
accommodations for the Texas jurisprudence examination, due to a disability,
must submit the request upon filing the Application.
(c)
Applicants for licensure:
(1)
are required to complete an oath swearing that:
(A)
the license certificate under which the applicant has most
recently practiced medicine in the state or Canadian province from which the
applicant is transferring to this state or in the uniformed service in which
the applicant served is in full force and not restricted, canceled, suspended
or revoked;
(B)
the applicant is the identical person to whom the certificate
or diploma was issued;
(C)
no proceedings have been instituted against the applicant
for the restriction, cancellation, suspension, or revocation of the certificate,
license, or authority to practice medicine in the state, Canadian province,
or uniformed service of the United States in which it was issued; and
(D)
no prosecution is pending against the applicant in any
state, federal, or Canadian court for any offense that under the laws of this
state is a felony.
(2)
who have not been examined for licensure in a
ten-year period prior to the filing date of the application must [
(A)
pass
[
(B)
obtain
[
(C)
pass SPEX within the preceding ten years.
This agency hereby certifies that the proposal
has been reviewed by legal counsel and found to be within the agency's legal
authority to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001162
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
The Texas State Board of Medical Examiners proposes the repeal to §164.1
and new §§164.1-164.5, concerning physician advertising. The repeal
and new sections are necessary to provide clarity and definition to the terms
false and deceptive advertising. The title to this chapter is also being amended
from Advertising to Physician Advertising.
John S. Teer, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the repealed section is
in effect there will be no fiscal implications to state or local government
as a result of enforcing or administering the repealed section as proposed.
Mr. Teer also has determined that for each year of the first five years
the repealed section as proposed is in effect the public benefit anticipated
as a result of enforcing the repealed section will be clarity and definition
to the terms false and deceptive advertising. There will be no effect on small
businesses. There are no anticipated economic costs to persons who are required
to comply with the repealed section as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
22 TAC §164.1
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas State Board of Medical Examiners or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeal is proposed under the Medical Practice
Act, Texas Civil Statutes, Article 4495b, §2.09(a), which provides 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.
The Occupations Code, §101.201 is affected by the repeal.
§164.1.Misleading or Deceptive Advertising.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001165
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
22 TAC §§164.1 - 164.5
The new sections are proposed under the Medical Practice Act,
Texas Civil Statutes, Article 4495b, §2.09(a), which provides 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.
The Occupations Code, §101.201 is affected by these new sections.
§164.1.Purpose.
These rules are promulgated under the authority of the Medical Practice
Act, Texas Occupations Code Ann. §153.001 and the Health Professions
Council, Texas Occupations Code Ann. §101.201, to set forth the grounds
under which a physician's license may be disciplined for false and deceptive
advertising. Reasonable regulation designed to foster compliance with appropriate
standards serves the public interest without impeding the flow of useful,
meaningful, and relevant information to the public. The Board permits the
dissemination to the public of legitimate information, in accordance with
the Board's rules, regarding the practice of medicine and where and from whom
medical services may be obtained, so long as such information is in no way
false, deceptive, or misleading. It is the responsibility of each physician
to carefully scrutinize his advertisements and adhere to the highest ethical
standards of truth in advertising.
§164.2.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the contents clearly indicate otherwise.
(1)
Advertising and advertisement - Informational communication
to the public in any manner designed to attract public attention to the practice
of a physician. Advertising may include oral, written, broadcast, and other
types of communications disseminated by or at the behest of a physician. The
communications covered include, but are not limited to, those made to patients,
prospective patients, professionals or other persons who might refer patients,
and to the public at large. The communications covered include signs, nameplates,
professional cards, announcements, letterheads, listings in telephone directories
and other directories, brochures, radio and television appearances, and information
disseminated on the Internet or Web.
(2)
A testimonial - An attestation or implied attestation
to the competence of a physician's service or treatment. Testimonials also
include expressions of appreciation or esteem, a character reference, or a
statement of benefits received. Testimonials are not limited to patient comments
but may also include comments from colleagues, friends, family, actors, models,
fictional characters, or other persons or entities.
§164.3.Misleading or Deceptive Advertising.
No physician shall disseminate or cause the dissemination of any advertisement
that is in any way false, deceptive, or misleading. Any advertisement shall
be deemed by the Board to be false, deceptive, or misleading if it:
(1)
contains material false claims or misrepresentations of
material facts which cannot be substantiated; or
(2)
contains material implied false claims or implied
misrepresentations of material fact; or
(3)
omits material facts; or
(4)
makes a representation likely to create an unjustified
expectation about the results of a health care service or procedure; or
(5)
advertises or assures a permanent cure for an incurable
disease; or
(6)
compares a health care professional's services with
another health care professional's services unless the comparison can be factually
substantiated; or
(7)
advertises professional superiority or the performance
of professional service in a superior manner if the advertising is not subject
to verification; or
(8)
contains a testimonial; or
(9)
includes photographs or other representations of models
or actors without explicitly identifying them as models and not actual patients;
or
(10)
causes confusion or misunderstanding as to the credentials,
education, or licensure of a health care professional; or
(11)
represents that health care insurance deductibles
or copayments may be waived or are not applicable to health care services
to be provided if the deductibles or copayments are required; or
(12)
represents that the benefits of a health benefit
plan will be accepted as full payment when deductibles or copayments are required;
or
(13)
states that a service is free when it is not, or
contains untruthful or deceptive claims regarding costs and fees. If other
costs are frequently incurred when the advertised service is obtained then
this should be disclosed. Offers of free service must indeed be free. To state
that a service is free but a third party is billed is deceptive and subject
to disciplinary action; or
(14)
makes a representation that is designed to take advantage
of the fears or emotions of a particularly susceptible type of patient; or
(15)
advertises or represents in the use of a professional
name, a title, or professional identification that is expressly or commonly
reserved to or used by another profession or professional; or
(16)
claims that a physician has a unique or exclusive
skill without substantiation of such claim; or
(17)
involves uninvited solicitation such as door to door
solicitation of a given population or other such tactics for "drumming" patients;
or
(18)
fails to disclose the fact of giving compensation
or anything of value to representatives of the press, radio, television or
other communicative medium in anticipation of or in return for any advertisement,
article, or infomercial, unless the nature, format or medium of such advertisement
make the fact of compensation apparent.
§164.4.Board Certification.
(a)
A physician's authorization of or use in any advertising
for his or her practice of the term "board certified," or any similar words
or phrase calculated to convey the same meaning shall constitute misleading
or deceptive advertising unless the physician discloses the complete name
of the specialty board which conferred the aforementioned certification. Furthermore,
the certifying organization must be a board as defined by Texas Revised Civil
Statutes, Article 4495b, §5.12(3).
(b)
A physician may not use the term "board certified" or any
similar words or phrase calculated to convey the same meaning if the claimed
board certification has expired and has not been renewed at the time the advertising
in question was published or broadcast.
(c)
The terms "board eligible," "board qualified," or any similar
words or phrase calculated to convey the same meaning shall not be used in
physician advertising.
§164.5.Advertising Records and Responsibility.
(a)
Any and all advertisements are presumed to have been approved
by the licensee named therein.
(b)
Each licensee who is a principal partner, or officer of
a firm or entity identified in any advertisement, is jointly and severally
responsible for the form and content of any advertisement. This provision
shall also include any employees acting as an agent of such firm or entity.
(c)
If photographs or other representations of actual patients
are used in advertising, there must not be communication of facts, data, or
information which may identify the patient without first obtaining patient
consent.
(d)
A recording of every advertisement communicated by electronic
media, and a copy of every advertisement communicated by print media and a
copy of any other form of advertisement shall be retained by the licensee
for a period of two years from the last date of broadcast or publication and
be made available for review upon request by the board or its designee.
(e)
At the time any type of advertisement is placed, the licensee
must possess and rely upon information which, when produced, would substantiate
the truthfulness of any assertion, omission or representation of material
fact set forth in the advertisement or public communication.
(f)
It is hereby declared that the sections, clauses, sentences
and parts of these rules are severable, are not matters of mutual essential
inducement, and any of them shall be exscinded if these rules would otherwise
be unconstitutional or ineffective. If any one or more sections, clauses,
sentences or parts shall for any reasons be questioned in any court, and shall
be adjudged unconstitutional or invalid, such judgment shall not affect, impair
or invalidate the remaining provisions thereof, but shall be confined in its
operation to the specific provision or provisions so held unconstitutional
or invalid, and the inapplicability or invalidity of any section, clause,
sentence or part in any one or more instances shall not be taken to affect
or prejudice in any way its applicability or validity in any other instance.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed
with the Office of the Secretary of State on February 14, 2000.
TRD-200001166
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
22 TAC §165.2, §165.4
The Texas State Board of Medical Examiners proposes an amendment
to §165.2 and new §165.4, concerning medical records. The amendment
will clarify charges for affidavits that may accompany copies of medical records
certifying that the copy is a true and correct copy of the original. New §165.4
includes statutory changes regarding the time limit for release of copies
of records and the procedure for appointing a custodian of medical records.
John S. Teer, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the sections are in effect
there will be no fiscal implications to state or local government as a result
of enforcing or administering the sections as proposed.
Mr. Teer also has determined that for each year of the first five years
the sections as proposed are in effect the public benefit anticipated as a
result of enforcing the sections will be clarification on charges for affidavits
that may accompany copies of medical records certifying that the copy is a
true and correct copy of the original and a procedure for appointing a custodian
of medical records. There will be no effect on small businesses. The anticipated
economic costs to persons who are required to comply with the sections as
proposed would be a fee of up to $10 if requesting an affidavit.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment and new section are proposed under the authority
of the Occupations Code, §153.001, which provides the Texas State Board
of Medical Examiners to adopt rules and bylaws as necessary to: govern its
own proceedings; perform its duties; regulate the practice of medicine in
this state; and enforce this subtitle.
The Occupations Code, §159.006 is affected by the proposed amendment
and new section.
§165.2.Medical Record Release and Charges.
(a)
As required by the Medical Practice Act, §5.08(k),
a physician shall furnish copies of medical records requested or a summary
or narrative of the records pursuant to a written release of the information
as provided by the Medical Practice Act, §5.08(j), except if the physician
determines that access to the information would be harmful to the physical,
mental, or emotional health of the patient, and the physician may delete confidential
information about another patient or family member of the patient who has
not consented to the release.
(b)
The requested copies of medical records or a summary or
narrative of the records shall be furnished by the physician within
15
[
(c)
If the physician denies the request for copies of medical
records or a summary or narrative of the records, either in whole or in part,
the physician shall furnish the patient a written statement, signed and dated,
stating the reason for the denial, and a copy of the statement denying the
request shall be placed in the patient's medical records.
(d)
For purposes of this section, "medical records" shall include
those records as defined in §165.1(a) of this title (relating to Medical
Records) and shall include copies of medical records of other health care
practitioners contained in the records of the physician to whom a request
for release of records has been made.
(e)
The physician responding to a request for such information
shall be entitled to receive a reasonable fee for providing the requested
information. A reasonable fee shall be a charge of no more than $25 for the
first twenty pages and $.15 per page for every copy thereafter. In addition,
a reasonable fee may include actual costs for mailing, shipping, or delivery.
If an affidavit is requested, certifying that the information is a true and
correct copy of the records, a reasonable fee of up to $15 may be charged
for executing the affidavit
.
(f)
The physician providing copies of requested medical records
or a summary or a narrative of such records shall be entitled to payment of
a reasonable fee prior to release of the information unless the information
is requested by a licensed Texas health care provider or a physician licensed
by any state, territory, or insular possession of the United States or any
State or province of Canada if requested for purposes of emergency or acute
medical care. In the event the physician receives a proper request for copies
of medical records or a summary or narrative of the medical records for purposes
other than for emergency or acute medical care, the physician may retain the
requested information until payment is received. In the event payment is not
routed with such a request, within ten calendar days from receiving a request
for the release of such records for reasons other than emergency or acute
medical care, the physician shall notify the requesting party in writing of
the need for payment and may withhold the information until payment of a reasonable
fee is received. A copy of the letter regarding the need for payment shall
be made part of the patient's medical record. Medical records requested pursuant
to a proper request for release may not be withheld from the patient, the
patient's authorized agent, or the patient's designated recipient for such
records based on a past due account for medical care or treatment previously
rendered to the patient.
(g)
A subpoena shall not be required for the release of medical
records requested pursuant to a proper release for records under this section
and the Medical Practice Act, §5.08, made by a patient or by the patient's
guardian or other representative duly authorized to obtain such records.
(h)
In response to a proper request for release of medical
records, a physician shall not be required to provide copies of billing records
pertaining to medical treatment of a patient unless specifically requested
pursuant to the request for release of medical records.
(i)
The allowable charges as set forth in this chapter shall
be maximum amounts, and this chapter shall be construed and applied so as
to be consistent with lower fees or the prohibition or absence of such fees
as required by state statute or prevailing federal law.
§165.4.Appointment of Record Custodian of a Physician's Records.
(a)
The Board may appoint a temporary or permanent custodian
for medical records abandoned by a physician.
(b)
The records will be considered abandoned if they are without
custodial care for a minimum of two weeks without alternative arrangements
being made by the physician, the physician's legal guardian, or by the executor
of the physician's estate.
(c)
The record custodian appointed by the Board shall take
custody of and maintain the confidentiality of the physician's records, to
include available medical records and billing records, according to the provisions
of Board rules and state statutes.
(d)
The appointed record custodian shall provide the records,
or copies of the records, to the patient or to the patient's designee according
to Board rules and state statutes. In addition to the reasonable copying fee
defined in Board rules, the appointed record custodian may charge an additional
fee of $25.00 per patient record.
(e)
The appointed record custodian shall retain care of the
records for no less than 90 days and shall publish appropriate notice of pending
destruction of the records for no less than 30 days prior to destruction of
the records.
(f)
Destruction of medical records shall be done in a manner
which ensures continued confidentiality.
(g)
The Board may publish a Request for Bids for one entity
to function as the appointed record custodian for all areas of the state.
If a sole statewide contractor is not selected, the Board may publish a Request
for Bids for entities to function as regional appointed record custodian or
a custodian may be appointed on a case by case basis.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001168
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
22 TAC §166.2
The Texas State Board of Medical Examiners proposes an amendment
to §166.2, concerning physician registration. The amendment will streamline
the process for gathering information to determine a physician's compliance
with continuing medical education requirements.
John S. Teer, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendment is in effect
there will be no fiscal implications to state or local government as a result
of enforcing or administering the amendment as proposed.
Mr. Teer also has determined that for each year of the first five years
the amendment as proposed is in effect the public benefit anticipated as a
result of enforcing the amendment will be a streamlined process for gathering
information to determine a physician's compliance with continuing medical
education requirements. There will be no effect on small businesses. There
is no anticipated economic costs to persons who are required to comply with
the amendment as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the authority of the Occupations
Code, §153.001, which provides the Texas State Board of Medical Examiners
to adopt rules and bylaws as necessary to: govern its own proceedings; perform
its duties; regulate the practice of medicine in this state; and enforce this
subtitle.
The Occupations Code, §156.051 is affected by the proposed amendment.
§166.2.Continuing Medical Education.
(a)
As a prerequisite to the annual registration of a physician's
license, 24 hours of continuing medical education (CME) are required to be
completed in the following categories:
(1)
At least one-half of the hours are to be from formal courses
that are:
(A)
designated for AMA/PRA Category 1 credit by a CME sponsor
accredited by the Accreditation Council for Continuing Medical Education or
a state medical society recognized by the Committee for Review and Recognition
of the Accreditation Council for Continuing Medical Education;
(B)
approved for prescribed credit by the American Academy
of Family Physicians;
(C)
designated for AOA Category 1-A credit required for osteopathic
physicians by an accredited CME sponsor approved by the American Osteopathic
Association; or
(D)
approved by the Texas Medical Association based on standards
established by the AMA for its Physician's Recognition Award.
(2)
Beginning with annual registrations in 1999,
at least one of the formal hours of CME which are required by
paragraph(1)
of this subsection
[
(3)
The remaining hours may be composed of informal self-study,
attendance at hospital lectures or grand rounds not approved for formal CME,
or case conferences and shall be recorded in a manner that can be easily transmitted
to the board upon request.
(b)
A physician must report on the annual registration form
if she or he has completed the required
[
(c)
A licensee shall be presumed to have complied with this
section if in the preceding 36 months the licensee becomes board certified
or recertified in a medical specialty and the medical specialty program meets
the standards of the American Board of Medical Specialties, the American Medical
Association, the Advisory Board for Osteopathic Specialists and Boards of
Certification, or the American Osteopathic Association. This provision exempts
the physician from all CME requirements, including the requirement for one
hour involving the study of medical ethics and/or professional responsibility,
as outlined in subsection (a)(2) of this section, and this exemption is valid
for one annual renewal period only.
(d)
A physician may request in writing an exemption for the
following reasons:
(1)
catastrophic illness;
(2)
military service of longer than one year's duration
outside the state;
(3)
medical practice and residence of longer than one
year's duration outside the United States; or
(4)
good cause shown on written application of the licensee
that gives satisfactory evidence to the board that the licensee is unable
to comply with the requirement for continuing medical education.
(e)
Exemptions are subject to the approval of the executive
director/medical director and must be requested in writing at least 30 days
prior to the expiration date of the license.
(f)
A temporary exemption under subsection (d) of this section
may not exceed one year but may be renewed annually, subject to the approval
of the board.
(g)
Subsection (a) of this section does not apply to a licensee
who is retired and has been exempted from paying the annual registration fee
under §166.3 of this title (relating to Retired Physician Exception).
(h)
This section does not prevent the board from taking disciplinary
action with respect to a licensee or an applicant for a license by requiring
additional hours of continuing medical education or of specific course subjects.
(i)
The board may require written verification of both formal
and informal credits from any licensee within 30 days of request. Failure
to provide such verification may result in disciplinary action by the board.
(j)
Physicians in residency/fellowship training or who have
completed such training within six months prior to their renewal application
will satisfy the requirements of subsections (a)(1) and (2) of this section
by their residency or fellowship program.
(k)
Unless exempted under the terms of this section, a physician
licensee's apparent failure to obtain and timely report the 24 hours of CME
as required and provided for in this section shall result in nonrenewal of
the license until such time as the physician obtains and reports the required
CME hours; however, the executive director of the board may issue to such
a physician a temporary license numbered so as to correspond to the nonrenewed
license. Such a temporary license shall be issued at the direction of the
executive director for a period of no longer than 90 days. A temporary license
issued pursuant to this subsection may be issued to allow the board to verify
the accuracy of information related to the physician's CME hours and to allow
the physician who has not obtained or timely reported the required number
of hours an opportunity to correct any deficiency so as not to require termination
of ongoing patient care.
(l)
The fee for issuance of a temporary license pursuant to
the provisions of this section shall be in the amount specified for temporary
licenses under §175.1 of this title (relating to Fees); however, the
fee need not be paid prior to the issuance of the temporary license, but shall
be paid prior to the renewal of a permanent license.
(m)
CME hours which are obtained to comply with the CME requirements
for the preceding year as a prerequisite for licensure renewal, shall first
be credited to meet the CME requirements for the previous year. Once the previous
year's CME requirement is satisfied, any additional hours obtained shall be
credited to meet the CME requirements for the current year.
(n)
An intentionally false report or intentionally false statement
to the board by a licensee regarding CME hours reportedly obtained shall be
a basis for disciplinary action by the board pursuant to the Act, §§3.08(1),
(4), (5), 4.01, and 4.12. A licensee who is disciplined by the board for such
a violation may be subject to the full range of actions authorized by the
Act including suspension or revocation of the physician's medical license,
but in no event shall such action be less than an administrative penalty of
$100 and a public reprimand.
(o)
Administrative penalties for failure to timely obtain and
report required CME hours may be determined by the Disciplinary Process Review
Committee of the board as provided for in §187.39 of this title (relating
to Administrative Penalties).
(p)
Failure to obtain and timely report the CME hours for renewal
of a license shall subject the licensee to a monetary penalty for late registration
in the amount set forth in §175.2 of this title (relating to Penalties).
Any temporary licensure fee and any administrative penalty imposed for failure
to obtain and timely report the 24 hours of CME required for renewal of a
license shall be in addition to the applicable penalties for late registration
or renewal as set forth in §175.2 of this title (relating to Penalties).
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001169
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
22 TAC §§167.4 -167.6
The Texas State Board of Medical Examiners proposes new §§167.4,
167.5 and 167.6, concerning Best Interests of Physician, Best Interests of
the Public and Collateral Attack Prohibited. The new sections will outline
the criteria to be considered when making a determination of what is in the
best interest of the physician and the public.
Bruce A. Levy, M.D., J.D., Executive Director, Texas State Board of Medical
Examiners, has determined that for the first five-year period the new sections
are in effect there will be no fiscal implications to state or local government
as a result of enforcing or administering the sections as proposed.
Dr. Levy also has determined that for each year of the first five years
the sections as proposed are in effect the public benefit anticipated as a
result of enforcing the sections will be careful consideration of the public
and physician's best interest. There will be no effect on small businesses.
There are no anticipated economic costs to persons who are required to comply
with the rules as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new sections are proposed under the Medical Practice Act,
Texas Civil Statutes, Article 4495b, §2.09(a), which provides 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.
The Occupations Code, §164.151 is affected by the proposed rules.
§167.4.Best Interests of Physician.
Pursuant to §4.10 of Article 4495b, Texas Revised Civil Statutes,
a physician may be reinstated to the practice of medicine only if the physician
demonstrates that the reinstatement is in the physician's best interests.
Best interests of the physician may include, but not be limited to, an assessment
by the Board as to whether the physician:
(1)
understands all issues of competency, technical, educational,
training or ethical limitations as found in the Order which led to the revocation,
cancellation or suspension of a license; and
(2)
demonstrates that risk of further disciplinary proceedings
for the revocation, cancellation or suspension of the license of the physician
will be minimal or minimized if the physician is returned to the practice
of medicine.
§167.5.Best Interests of the Public.
Pursuant to §4.10 of Article 4495b, Texas Revised Civil Statutes,
a physician may be reinstated to the practice of medicine only if the physician
demonstrates that the reinstatement is in the best interests of the public.
Bests interests of the public may include, but not be limited to, an assessment
by the Board as to whether the physician demonstrates:
(1)
remediation of any competency, technical, educational,
training or ethical limitations as found in the Order leading to revocation,
cancellation or suspension of a license or any competency, technical, educational,
training or ethical limitations found since the entry of the order;
(2)
that risk of further disciplinary proceedings for
the revocation, cancellation or suspension of the license will be minimal
or minimized if the physician is returned to the practice of medicine and
the public will adequately be protected, whether by probationary Order or
other terms and conditions as agreed to by the physician or authorized by §4.11
and §4.12 of Article 4495b, Texas Revised Civil Statutes;
(3)
that an adequate practice plan will be in place to
reduce or eliminate the risk of further disciplinary proceedings by the Board;
and
(4)
continued medical competency such that the physician
is able to provide the same standard of medical care as any applicant for
a license under Chapter 163 of this title (relating to Licensure). Further,
the Board shall require an applicant for reinstatement to meet the qualifications
and requirements set forth in Chapter 163 of this title, including, but not
limited to documentation of completion of the process of a current application
for licensure.
§167.6.Final Action.
In any contested case proceeding regarding a reinstatement application,
the Order revoking, canceling or suspending a license is a final action and
shall not be subject to further litigation as to its findings of fact or conclusions
of law, provided, however, that the Order may be admissible and relevant for
purposes of establishing the basis for the original action and subsequent
efforts after the Order by the physician to demonstrate reinstatement of the
license is in the best interests of the public and the applicant physician.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001170
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
22 TAC §171.7
The Texas State Board of Medical Examiners proposes new §171.7,
concerning institutional permits. The new section will outline terms and conditions
for a post graduate research permit.
Bruce A. Levy, M.D., J.D., Executive Director, Texas State Board of Medical
Examiners, has determined that for the first five-year period the new section
is in effect there will be no fiscal implications to state or local government
as a result of enforcing or administering the section as proposed.
Dr. Levy also has determined that for each year of the first five years
the section as proposed is in effect the public benefit anticipated as a result
of enforcing the section will be a new regulation regarding terms and conditions
for a post graduate research permit. There will be no effect on small businesses.
There are no anticipated economic costs to persons who are required to comply
with the rule as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new section is proposed under the Medical Practice Act, Texas
Civil Statutes, Article 4495b, §2.09(a), which provides 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.
The Occupations Code, §155.105 is affected by the proposed rule.
§171.7.Post Graduate Research Permit.
The board may issue a permit to practice medicine to a medical school
graduate, who holds a research appointment at a Texas medical school, in a
program approved by the board, under the following terms and conditions listed
in paragraphs (1)-(5) of this section.
(1)
The research must be in clinical medicine and/or the basic
sciences of medicine.
(2)
The research must be conducted in the Texas medical
school or its affiliated institutions.
(2)
The research appointment must be approved by the Dean
of Medicine or by the President of the Health Science Center.
(3)
The research appointment must be supervised by a faculty
member of the Texas medical school who has an active unrestricted Texas medical
license.
(4)
The research appointment must be of good professional
character as elaborated in the Medical Practice Act.
(5)
The Post Graduate Research Permit may be issued for
a maximum of one year and is not renewable.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001171
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
22 TAC §174.3
The Texas State Board of Medical Examiners proposes an amendment
to §174.3, concerning telemedicine. The amendment will allow the board
to consider licensing a physician whose license from another state has been
cancelled, suspended, or restricted for reasons other than disciplinary.
Bruce A. Levy, M.D., J.D., Executive Director, Texas State Board of Medical
Examiners, has determined that for the first five-year period the amendment
is in effect there will be no fiscal implications to state or local government
as a result of enforcing or administering the section as proposed.
Dr. Levy also has determined that for each year of the first five years
the section as proposed is in effect the public benefit anticipated as a result
of enforcing the section will be the allowance of the board to consider licensing
a physician whose license from another state has been cancelled, suspended,
or restricted for reasons other than disciplinary. There will be no effect
on small businesses. There are no anticipated economic costs to persons who
are required to comply with the rule as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the Medical Practice Act, Texas
Civil Statutes, Article 4495b, §2.09(a), which provides 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.
The Occupations Code, §151.056 is affected by the proposed rule.
§174.3.Qualifications for Special Purpose License for Practice of Medicine Across State Lines.
For a person to engage in the practice of medicine in Texas as defined
under the Medical Practice Act, §3.06(i), and §174.2 of this title
(relating to Definitions), the person must:
(1)
be 21 years of age or older;
(2)
be actively licensed to practice medicine in another
state which is recognized by the Texas State Board of Medical Examiners for
purposes of licensure [
(3)
be certified in a medical specialty pursuant to the
standards of and approved by the American Board of Medical Specialties or
the Bureau of Osteopathic Specialists and Boards of Certification;
(4)
have passed the Texas Medical Jurisprudence Examination;
(5)
be in possession of a special purpose license issued
pursuant to the terms of this chapter after submission of a completed board-approved
application for a special purpose license for the practice of medicine across
state lines and any requisite initial fee and subsequent annual renewal fees;
and
(6)
not be ineligible for licensure under §174.5
of this title (relating to Denial of Application for Special Purpose License
to Practice Medicine Across State Lines).
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001172
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
22 TAC §§192.1 - 192.6
The Texas State Board of Medical Examiners proposes new Chapter
192, §§192.1-192.6, concerning responsibilities of physicians providing,
or overseeing by proper delegation, anesthesia services in outpatient settings
and to provide the minimum acceptable standards for the provision of anesthesia
services in outpatient settings, as mandated by Senate Bill 1340, 76th Legislature.
These rules will protect the public by assuring that physicians adhere to
acceptable standards in the provision of anesthesia services in office-based
settings.
John S. Teer, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the new sections are in
effect there will be an effect on state and local government as a result of
enforcing or administering the new sections as proposed. The following will
be the cost: Fiscal Year 2000 probable revenue gain - $72,750; probable cost
to implement - $33,750; Fiscal Year 2001 probable revenue gain - $98,000;
probable cost to implement - $45,000; Fiscal Year 2002 probable revenue gain
- $98,000; probable cost to implement - $45,000; Fiscal Year 2003 probable
revenue gain - $98,000; probable cost to implement - $45,000; Fiscal Year
2004 probable revenue gain - $98,000; probable cost to implement - $45,000.
Mr. Teer also has determined that for each year of the first five years
the new sections as proposed are in effect the public benefit anticipated
as a result of enforcing the new sections will be protection to the public
by assuring that physicians adhere to acceptable standards in the provision
of anesthesia services in office-based settings. There will be no effect on
small businesses. There are no anticipated economic costs to persons who are
required to comply with the new sections as proposed.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new sections are proposed under the authority of the Occupations
Code, §153.001, which provides the Texas State Board of Medical Examiners
to adopt rules and bylaws as necessary to: govern its own proceedings; perform
its duties; regulate the practice of medicine in this state; and enforce this
subtitle.
The Occupations Code, §153.001 is affected by the proposed new sections.
§192.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the contents indicate otherwise.
(1)
Anesthesiologist's assistant - A graduate of an approved
anesthesiologist's assistant training program.
(2)
Anesthesiology resident - A physician who is presently
in an approved Texas anesthesiology residency program who is either licensed
as a physician in Texas or holds a postgraduate resident permit issued by
the Texas State Board of Medical Examiners.
(3)
Certified registered nurse anesthetist - A person
licensed by the Board of Nurse Examiners for the State of Texas (BNE) as a
registered professional nurse, authorized by the BNE as an advanced practice
nurse in the role of nurse anesthetist, and certified by a national certifying
body recognized by the BNE.
(4)
Monitored anesthesia care - Situations where a patient
undergoing a diagnostic or therapeutic procedure receives doses of medication
that create a risk of loss of normal protective reflexes or loss of consciousness
and the patient remains able to protect the airway for the majority of the
procedure. If, for an extended period of time, the patient is rendered unconscious
and/or loses normal protective reflexes, then anesthesia care shall be considered
a general anesthetic.
(5)
Outpatient setting - Any facility, clinic, center,
office, or other setting that is not a part of a licensed hospital or a licensed
ambulatory surgical center with the exception of all of the following listed
in subparagraphs (A)-(D) of this paragraph:
(A)
a clinic located on land recognized as tribal land by the
federal government and maintained or operated by a federally recognized Indian
tribe or tribal organization as listed by the United States secretary of the
interior under 25 U.S.C. §479-1 or as listed under a successor federal
statute or regulation;
(B)
a facility maintained or operated by a state or governmental
entity;
(C)
a clinic directly maintained or operated by the United
States or by any of its departments, officers, or agencies; and
(D)
an outpatient setting accredited by either the Joint Commission
on Accreditation of Healthcare Organizations relating to ambulatory surgical
centers, the American Association for the Accreditation of Ambulatory Surgery
Facilities, or the Accreditation Association for Ambulatory Health Care.
(6)
Board - The Texas State Board of Medical Examiners.
(7)
Physician - A person licensed by the Texas State Board
of Medical Examiners as a medical doctor or doctor of osteopathic medicine
who diagnoses, treats, or offers to treat any disease or disorder, mental
or physical, or any physical deformity or injury by any system or method or
effects cures thereof and charges therefor, directly or indirectly, money
or other compensation. "Physician" and "surgeon" shall be construed as synonymous.
§192.2.Provision of Anesthesia in Outpatient Settings.
(a)
The purpose of these rules is to identify the roles and
responsibilities of physicians providing, or overseeing by proper delegation,
anesthesia services in outpatient settings and to provide the minimum acceptable
standards for the provision of anesthesia services in outpatient settings.
(b)
Beginning September 1, 2000, physicians shall comply with
the rules promulgated under this title in order to be authorized to provide
general anesthesia, regional anesthesia, or monitored anesthesia care in outpatient
settings.
(c)
The rules promulgated under this title do not apply to
physicians who practice in the following settings listed in paragraphs (1)-(8)
of this subsection:
(1)
an outpatient setting in which only local anesthesia, peripheral
nerve blocks, or both are used;
(2)
an outpatient setting in which only anxiolytics and
analgesics are used and only in doses that do not have the significant probability
of placing the patient at risk for loss of the patient's life-preserving protective
reflexes;
(3)
a licensed hospital, including an outpatient facility
of the hospital that is separately located apart from the hospital;
(4)
a licensed ambulatory surgical center;
(5)
a clinic located on land recognized as tribal land
by the federal government and maintained or operated by a federally recognized
Indian tribe or tribal organization as listed by the United States secretary
of the interior under 25 U.S.C. §479-1 or as listed under a successor
federal statute or regulation;
(6)
a facility maintained or operated by a state or governmental
entity;
(7)
a clinic directly maintained or operated by the United
States or by any of its departments, officers, or agencies; and
(8)
an outpatient setting accredited by:
(A)
the Joint Commission on Accreditation of Healthcare Organizations
relating to ambulatory surgical centers;
(B)
the American Association for the Accreditation of Ambulatory
Surgery Facilities; or
(C)
the Accreditation Association for Ambulatory Health Care.
(d)
Physicians who practice medicine in this state and who
administer anesthesia or perform a surgical procedure for which anesthesia
services are provided in an outpatient settings shall follow current, applicable
standards and guidelines as put forth by the American Society of Anesthesiologists
(ASA) including, but not limited to, the following listed in paragraphs (1)-(8)
of this subsection:
(1)
Basic Standards for Preanesthesia Care;
(2)
Standards for Basic Anesthetic Monitoring;
(3)
Standards for Postanesthesia Care;
(4)
Position on Monitored Anesthesia Care;
(5)
The ASA Physical Status Classification System;
(6)
Guidelines for Nonoperating Room Anesthetizing Locations;
(7)
Guidelines for Ambulatory Anesthesia and Surgery;
and
(8)
Guidelines for Office-Based Anesthesia.
(e)
A physician delegating the provision of anesthesia or anesthesia-related
services to a certified registered nurse anesthetist shall be in compliance
with ASA standards and guidelines when the certified registered nurse anesthetist
provides a service specified in the ASA standards and guidelines to be provided
by an anesthesiologist.
(f)
In an outpatient setting, where a physician has delegated
to a certified registered nurse anesthetist the ordering of drugs and devices
necessary for the nurse anesthetist to administer an anesthetic or an anesthesia-related
service ordered by a physician, a certified registered nurse anesthetist may
select, obtain and administer drugs, including determination of appropriate
dosages, techniques and medical devices for their administration and in maintaining
the patient in sound physiologic status. This order need not be drug-specific,
dosage specific, or administration-technique specific. Pursuant to a physician's
order for anesthesia or an anesthesia-related service, the certified registered
nurse anesthetist may order anesthesia-related medications during perianesthesia
periods in the preparation for or recovery from anesthesia. In providing anesthesia
or an anesthesia-related service, the certified registered nurse anesthetist
shall select, order, obtain and administer drugs which fall within categories
of drugs generally utilized for anesthesia or anesthesia-related services
and provide the concomitant care required to maintain the patient in sound
physiologic status during those experiences.
(g)
The anesthesiologist or physician providing anesthesia
or anesthesia-related services in an outpatient setting shall perform a pre-anesthetic
evaluation, counsel the patient, and prepare the patient for anesthesia per
current ASA standards. If the physician has delegated the provision of anesthesia
or anesthesia-related services to a CRNA, the CRNA may perform those services
within the scope of practice of the CRNA. Informed consent for the planned
anesthetic intervention shall be obtained from the patient/legal guardian
and maintained as part of the medical record. The consent must include explanation
of the technique, expected results, and potential risks/complications. Appropriate
pre-anesthesia diagnostic testing and consults shall be obtained per indications
and assessment findings. Pre-anesthetic diagnostic testing and specialist
consultation should be obtained as indicated by the pre-anesthetic evaluation
by the anesthesiologist or suggested by the nurse anesthetist's pre-anesthetic
assessment as reviewed by the surgeon. If responsibility for a patient's care
is to be shared with other physicians or non-physician anesthesia providers,
this arrangement should be explained to the patient.
(h)
Physiologic monitoring of the patient shall be determined
by the type of anesthesia and individual patient needs. Minimum monitoring
shall include continuous monitoring of ventilation, oxygenation, and cardiovascular
status. Monitors shall include, but not be limited to, pulse oximetry and
EKG continuously and non-invasive blood pressure to be measured at least every
five minutes. If general anesthesia is utilized, then an O2 analyzer and end-tidal
CO2 analyzer must also be used. A means to measure temperature shall be readily
available and utilized for continuous monitoring when indicated per current
ASA standards. An audible signal alarm device capable of detecting disconnection
of any component of the breathing system shall be utilized. The patient shall
be monitored continuously throughout the duration of the procedure. Postoperatively,
the patient shall be evaluated by continuous monitoring and clinical observation
until stable by a licensed health care provider. Monitoring and observations
shall be documented per current ASA standards. In the event of an electrical
outage which disrupts the capability to continuously monitor all specified
patient parameters, at a minimum, heart rate and breath sounds will be monitored
on a continuous basis using a precordial stethoscope or similar device, and
blood pressure measurements will be reestablished using a non-electrical blood
pressure measuring device until electricity is restored. There should be in
each location, sufficient electrical outlets to satisfy anesthesia machine
and monitoring equipment requirements, including clearly labeled outlets connected
to an emergency power supply. A two-way communication source not dependent
on electrical current shall be available. Sites shall also have a secondary
power source as appropriate for equipment in use in case of power failure.
(i)
All anesthesia-related equipment and monitors shall be
maintained to current operating room standards. All devices shall have regular
service/maintenance checks at least annually or per manufacturer recommendations.
Service/maintenance checks shall be performed by appropriately qualified biomedical
personnel. Prior to the administration of anesthesia, all equipment/monitors
shall be checked using the current FDA recommendations as a guideline. Records
of equipment checks shall be maintained in a separate, dedicated log which
must be made available upon request. Documentation of any criteria deemed
to be substandard shall include a clear description of the problem and the
intervention. If equipment is utilized despite the problem, documentation
must clearly indicate that patient safety is not in jeopardy. All documentation
relating to equipment shall be maintained for seven years or for a period
of time as determined by the board.
(j)
Each location must have emergency supplies immediately
available. Supplies should include emergency drugs and equipment appropriate
for the purpose of cardiopulmonary resuscitation. This must include a defibrillator,
difficult airway equipment, and drugs and equipment necessary for the treatment
of malignant hyperthermia if "triggering agents" associated with malignant
hyperthermia are used or if the patient is at risk for malignant hyperthermia.
Equipment shall be appropriately sized for the patient population being served.
Resources for determining appropriate drug dosages shall be readily available.
The emergency supplies shall be maintained and inspected by qualified personnel
for presence and function of all appropriate equipment and drugs at intervals
established by protocol to ensure that equipment is functional and present,
drugs are not expired, and office personnel are familiar with equipment and
supplies. Records of emergency supply checks shall be maintained in a separate,
dedicated log and made available upon request. Records of emergency supply
checks shall be maintained for seven years or for a period of time as determined
by the board.
(k)
The operating surgeon shall verify that the appropriate
policies or procedures are in place. Policies, procedure, or protocols shall
be evaluated and reviewed at least annually. Agreements with local emergency
medical service (EMS) shall be in place for purposes of transfer of patients
to the hospital in case of an emergency. EMS agreements shall be evaluated
and re-signed at least annually. Policies, procedure, and transfer agreements
shall be kept on file in the setting where procedures are performed and shall
be made available upon request. Policies or procedures must include, but are
not limited to the following listed in paragraphs (1)-(2) of this subsection:
(1)
Management of outpatient anesthesia. At a minimum, these
must address:
(A)
patient selection criteria;
(B)
patients/providers with latex allergy;
(C)
pediatric drug dosage calculations, where applicable;
(D)
ACLS (advanced cardiac life support) or PALS (pediatric
advanced life support) algorithms;
(E)
infection control;
(F)
documentation and tracking use of pharmaceuticals, including
controlled substances, expired drugs and wasting of drugs; and
(G)
discharge criteria.
(2)
Management of emergencies. At a minimum, these
must include, but not be limited to:
(A)
cardiopulmonary emergencies;
(B)
fire;
(C)
bomb threat;
(D)
chemical spill; and
(E)
natural disasters.
(l)
Operating surgeons or anesthesiologists shall maintain
current competency in ACLS, PALS, or a course approved by the board. In all
settings under these rules, at a minimum, at least two persons, including
the surgeon or anesthesiologist, shall maintain current competency in basic
life support.
(m)
Physicians or surgeons must notify the board in writing
within 15 days if a procedure performed in any of the settings under these
rules resulted in an unanticipated and unplanned transport of the patient
to a hospital for observation or treatment for a period in excess of 24 hours,
or a patient's death intraoperatively or within the immediate postoperative
period. Immediate postoperative period is defined as 72 hours.
§192.3.Compliance with Office-Based Anesthesia Rules.
(a)
On or after August 31, 2000, a physician who practices
medicine in this state and who administers anesthesia or performs a surgical
procedure for which anesthesia services are provided in an outpatient setting
shall comply with the rules adopted under this title.
(b)
The board may require a physician to submit and comply
with a corrective action plan to remedy or address any current or potential
deficiencies with the physician's provision of anesthesia in a outpatient
setting in accordance with the Medical Practice Act, Article 4495b, Texas
Revised Civil Statutes, or rules of the board.
(c)
Any physician who violates these rules shall be subject
to disciplinary action and/or termination of the registration issued by the
board as authorized by the Medical Practice Act, Article 4495b, Texas Revised
Civil Statutes.
§192.4.Annual Registration.
(a)
Beginning September 1, 2000, the board shall require each
physician who administers anesthesia or performs a surgical procedure for
which anesthesia services are provided in an outpatient setting to annually
register with the board on a form prescribed by the board and to pay a fee
to the board in an amount established by the board.
(b)
The board shall coordinate the registration required under
this section with the registration required under the Medical Practice Act,
Article 4495b, Texas Revised Civil Statutes, §3.01, so that the times
of registration, payment, notice, and imposition of penalties for late payment
are similar and provide a minimum of administrative burden to the board and
to physicians.
§192.5.Inspections.
(a)
The board may conduct inspections to enforce these rules,
including inspections of an office site and of documents of a physician's
practice that relate to the provision of anesthesia in an outpatient setting.
The board may contract with another state agency or qualified person to conduct
these inspections.
(b)
Unless it would jeopardize an ongoing investigation, the
board shall provide at least five business days' notice before conducting
an on-site inspection under this section. (c) This section does not require
the board to make an on-site inspection of a physician's office.
§192.6.Requests for Inspection and Advisory Opinion.
(a)
The board may consider a request by a physician for an
on-site inspection. The board may, in its discretion and on payment of a fee
in an amount established by the board, conduct the inspection and issue an
advisory opinion.
(b)
An advisory opinion issued by the board under this section
is no binding on the board, and the board, except as provided by subsection
(c) of this section, may take any action under the Medical Practice Act, Article
4495b, Texas Revised Civil Statutes, in relation to the situation addressed
by the advisory opinion that the board considers appropriate.
(c)
A physician who requests and relies on an advisory opinion
of the board may use the opinion as mitigating evidence in an action or proceeding
to impose an administrative or civil penalty under the Medical Practice Act,
Article 4495b, Texas Revised Civil Statutes. The board or court, as appropriate,
shall take proof of reliance on an advisory opinion into consideration and
mitigate the imposition of administrative or civil penalties accordingly.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 14, 2000.
TRD-200001180
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-7016
Chapter 321.
DEFINITIONS
22 TAC §321.1
The Texas Board of Physical Therapy Examiners proposes an
amendment to §321.1, Definitions. The amendment will add definitions
for two terms which are used in the rules, but which are not defined.
John P. Maline, Executive Director of the Executive Council of Physical
Therapy and Occupational Therapy Examiners, has determined that for the first
five-year period the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
rule.
Mr. Maline also has determined that for each year of the first five years
the rule is in effect the public benefit anticipated as a result of enforcing
the rule will be clarification of terms used in the PT rules. There will be
no effect on small businesses. There are no anticipated economic costs to
persons who are required to comply with the rule as proposed.
Comments on the proposed amendment may be submitted to Nina Hurter, PT
Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite
2-510, Austin, Texas, 78701; email: nhurter@mail.capnet.state.tx.us.
The amendment is proposed under the Physical Therapy Practice
Act, Title 3, Subtitle H, Chapter 453, Occupations Code, which provides the
Texas Board of Physical Therapy Examiners with the authority to adopt rules
consistent with this Act to carry out its duties in administering this Act.
Title 3, Subtitle H, Chapter 453, Occupations Code is affected by this
amended section.
§321.1.Definitions.
The following words, terms, and phrases, when used in the rules of
the Texas Board of Physical Therapy Examiners, shall have the following meanings,
unless the context clearly indicates otherwise.
(1)-(3)
(No change.)
(4)
Board-approved--A term denoting an
organization or entity to which the board has formally delegated a role in
the licensure, regulation or enforcement functions of the Physical Therapy
Practice Act and board rules, or the product of those organizations or entities.
(5)
[
(6)
[
(7)
[
(8)
[
(9)
[
(10)
Jurisprudence exam--An open-book
examination made up of multiple-choice or true/false questions covering information
contained in the Texas Physical Therapy Practice Act and Board rules.
(11)
[
(12)
[
(13)
[
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on February 8, 2000.
TRD-200000982
John P. Maline
Executive Director
Texas Board of Physical Therapy Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-6900
22 TAC §322.3
The Texas Board of Physical Therapy Examiners proposes an
amendment to §322.3, concerning Supervision. The amendment will clarify
that it is the professional responsibility of the licensee to determine the
number of extenders he or she can safely supervise.
John P. Maline, Executive Director of the Executive Council of Physical
Therapy and Occupational Therapy Examiners, has determined that for the first
five-year period the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
rule.
Mr. Maline also has determined that for each year of the first five years
the rule is in effect the public benefit anticipated as a result of enforcing
the rule will be added assurance that physical therapy personnel receive adequate
supervision. There will be no effect on small businesses. There are no anticipated
economic costs to persons who are required to comply with the rule as proposed.
Comments on the proposed amendment may be submitted to Nina Hurter, PT
Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite
2-510, Austin, Texas, 78701; email: nhurter@mail.capnet.state.tx.us.
The amendment is proposed under the Physical Therapy Practice
Act, Title 3, Subtitle H, Chapter 453, Occupations Code, which provides the
Texas Board of Physical Therapy Examiners with the authority to adopt rules
consistent with this Act to carry out its duties in administering this Act.
Title 3, Subtitle H, Chapter 453, Occupations Code is affected by this
amended section.
§322.3.Supervision.
(a)
It is the responsibility of each PT and/or
PTA to determine the number of PTAs and/or aides he or she can supervise safely.
(b)
[
(1)
A supervising PT is responsible for and will participate
in the patient's care.
(2)
A supervising PT must be on call and readily available
when physical therapy services are being provided.
(3)
A PT may assign responsibilities to a PTA to provide
physical therapy services, based on the PTA's training, that are within the
scope of activities listed in §322.1, Provision of Services.
(c)
[
(1)
A supervising PT or PTA is responsible for the supervision
of, and the physical therapy services provided by, the PT aide.
(2)
A PT or PTA must provide onsite supervision of a physical
therapy aide, and remain within reasonable proximity during the aide's interaction
with the patient.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on February 8, 2000.
TRD-200000981
John P. Maline
Executive Director
Texas Board of Physical Therapy Examiners
Earliest possible date of adoption: March 26, 2000
For further information, please call: (512) 305-6900
Chapter 535.
PROVISIONS OF THE REAL ESTATE LICENSE ACT
Subchapter G. MANDATORY CONTINUING EDUCATION
(8)
] Has successfully passed
background checks for criminal or fraudulent activities to include information
from the National Practitioner Data Bank, the Healthcare Integrity and Protection
Data Bank and/or the AADE Clearinghouse for Disciplinary Action;
(9)
] Practice experience described
in paragraph (3) of this section must be subsequent to applicant having graduated
from a dental school accredited by the Commission on Dental Accreditation
of the American Dental Association.
(10)
] Each candidate for licensure
by credentials must submit to the Credentials Review Committee of the Board
the required documents and information prescribed in this rule and other documents
or information that may be requested to enable the Committee to evaluate appropriately
an application and to make a recommendation to the Board for action on the
application.
(11)
] Each applicant must
show proof of current CPR certification as required by the Texas Dental Practice
Act
Chapter 256, §256.101
.
(12)
] Applications must be
delivered to the office of the State Board of Dental Examiners.
(13)
] An application for licensure
is filed with the State Board of Dental Examiners when it is actually received,
date-stamped, and logged-in by the State Board of Dental Examiners along with
all required documentation and fees. An incomplete application for licensure
and fee will be returned to applicant within three working days with an explanation
of additional documentation or information needed.
Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
pass
Day III or Component II of the FLEX prior to June 1988, or SPEX, with a grade
of 75 or higher, unless the applicant has
]:
passed
] a specialty certification
examination or formal evaluation, recertification examination or formal evaluation,
or an examination of continued demonstration of qualifications by a board
that is a member of the American Board of Medical Specialties or the
Advisory Board for
[
Bureau of
] Osteopathic Specialists within
the preceding ten years; [
or
]
obtained
] through extraordinary
circumstances, unique training equal to the training required for specialty
certification as determined by a committee of the board and approved by the
board
; or
Chapter 164.
ADVERTISING
Chapter 165.
MEDICAL RECORDS
30
] days after the date of the request and reasonable
fees for furnishing the information shall be paid by the patient or someone
on behalf of the patient.
Chapter 166.
PHYSICIAN REGISTRATION
subsection (a)(1) of this section
] must
involve the study of medical ethics and/or professional responsibility. Whether
a particular hour of CME involves the study of medical ethics and/or professional
responsibility shall be determined by the organizations which are enumerated
in
paragraph(1) of this subsection
[
subsection (a)(1) of this
section
] as part of their course planning.
the number of hours and
type of
] continuing medical education [
completed
] during
the previous year. A licensee may carry forward CME credit hours earned prior
to an annual registration report which are in excess of the 24-hour annual
requirement and such excess hours may be applied to the following years' requirements.
A maximum of 48 total excess credit hours may be carried forward and shall
be reported according to the categories set out in subsection (a) of this
section. Excess CME credit hours of any type may not be carried forward or
applied to an annual report of CME more than two years beyond the date of
the annual registration following the period during which the hours were earned.
Chapter 167.
REINSTATEMENT
Chapter 171.
INSTITUTIONAL PERMITS
Chapter 174.
TELEMEDICINE
by endorsement
], and the license [
for purposes of such endorsement
], as well as any other license currently
held to practice medicine, must be without ongoing restrictions
for cause
or probation,
for cause
and without previous disciplinary
actions or limitations of any kind
for cause
imposed by the state
where the license was issued, and any other medical licenses previously held
must not have been subject to such restrictions
for cause
, probation
for cause
, disciplinary actions or limitations of any kind
for
cause
imposed by the state where the license was issued;
Chapter 192.
OFFICE-BASED ANESTHESIA
Part 16.
TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
(4)
] Emergency circumstances--Instances
where emergency medical care is called for, including first aid.
(5)
] Emergency medical care--Bona
fide emergency services provided after the sudden onset of a medical condition
manifesting itself by acute symptoms of sufficient severity, including severe
pain, such that the absence of immediate medical attention could reasonably
be expected to result in placing the patient's health in serious jeopardy,
serious impairment to bodily functions, or serious dysfunction of any bodily
organ or part.
(6)
] Evidence satisfactory
to the board--Should all official school records be destroyed, sworn affidavits
satisfactory to the board must be received from three persons having personal
knowledge of the applicant's physical therapy education. These affidavits
will not be used when official school records are available.
(7)
] Foreign-trained applicant--Any
applicant whose education is from a country outside the United States, the
District of Columbia, or Territories of the United States.
(8)
] Hearing--An adjudicative
proceeding concerning the issuance, denial, suspension, reprimand, revocation
of license, after which the legal rights of an applicant or licensee are to
be determined by the board.
(9)
] On-site supervision--The
physical therapist or physical therapist assistant is on the premises and
readily available to respond.
(10)
] Physical therapy--The
evaluation, examination, and utilization of exercises, rehabilitative procedures,
massage, manipulations, and physical agents including, but not limited to,
mechanical devices, heat, cold, air, light, water, electricity, and sound
in the aid of diagnosis or treatment. Physical therapists may perform evaluations
without referrals. Physical therapy practice includes the use of modalities,
procedures, and tests to make evaluations. Physical therapy practice includes,
but is not limited to the use of: Electromyographic (EMG) Tests, Nerve Conduction
Velocity (NCV) Tests, Thermography, Transcutaneous Electrical Nerve Stimulation
(TENS), bed traction, application of topical medication to open wounds, sharp
debridement, provision of soft goods, inhibitive casting and splinting, Phonophoresis,
Iontophoresis, and biofeedback services.
(11)
] Supervision--The delegation
and continuing direction by a person or persons responsible for the practice
of physical therapist, physical therapist assistant, or physical therapy aide
as specified in the Physical Therapy Practice Act.
Chapter 322.
PRACTICE
(a)
] Supervision of PTAs
(b)
] Supervision of physical therapy
aides
Part 23.
TEXAS REAL ESTATE COMMISSION