Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
Chapter 163.
LICENSURE
22 TAC §163.1, §163.5
The Texas State Board of Medical Examiners adopts on an emergency
basis amendments to §163.1 and §163.5, concerning licensure examinations
and official translations of documents.
The rules will protect the public by licensing only those physicians who
pass licensure examinations that meet national standards. The rules will also
clarify the information required by the board relating to certified translation
of documents.
These sections are being adopted on an emergency basis due to the legislature
mandating a January 7, 2000, deadline for these amendments to be effective.
The amendments are adopted on an emergency basis 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, §155.051 is affected by the adopted amendments.
§163.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the contents clearly indicate otherwise.
(1)-(6)
(No change.)
(7)
Examinations accepted by the board for licensure.
(A)-(F)
(No change.)
(G)
State board examination,
before January 1, 1977,
(with the exception of Florida, Virgin Islands, Guam, Tennessee Osteopathic
Board or Puerto Rico after June 30, 1963); or
(H)-(J)
(No change.)
(8)-(15)
(No change.)
§163.5.Licensure Documentation.
(a)
(No change.)
(b)
Documentation required of all applicants for licensure.
(1)-(12)
(No change.)
(13)
Graduate Training Verification. Each applicant must
submit a certificate showing successful completion of required training. The
certificate must show the beginning and ending dates of the program and state
that the program was successfully completed. An applicant
must
[
(14)-(18)
(No change.)
(c)
(No change.)
(d)
Applicants may be required to submit other documentation,
which may include the following.
(1)
Translations. Any document that is in a language other
than the English language will need to have a certified translation prepared
and a copy of the translation will have to be submitted along with the translated
document.
(A)
An official translation from the medical
school (or appropriate agency) attached to the foreign language transcript
or other document is acceptable.
(B)
If a foreign document is received without
a translation, the board will send the applicant a copy of the document to
be translated and returned to the board.
(C)
Documents must be translated by a translation
agency who is a member of the American Translations Association or a United
States college or university official.
(D)
The translation must be on the translator's
letterhead, and the translator must verify that it is a "true word for word
translation" to the best of his/her knowledge, and that he/she is fluent in
the language translated, and is qualified to translate the document.
(E)
The translation must be signed in the presence
of a notary public and then notarized. The translator's name must be printed
below his/her signature. The notary public must use this phrase: "Subscribed
and Sworn to this ___ day of _________, 20___ ." The notary must then sign
and date the translation, and affix his/her Notary Seal to the document.
(2)-(7)
(No change.)
(e)
(No change.)
Filed with the Office of the Secretary of State,
on December 22, 1999.
TRD-9909003
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1999
Expiration date: April 20, 2000
For further information, please call: (512) 305-7016
22 TAC §165.2
The Texas State Board of Medical Examiners adopts on an emergency
basis an amendment to §165.2, 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.
The section is being adopted on an emergency basis due to the legislature
mandating a January 7, 2000, deadline for the amendment to be effective.
The amendment is adopted on an emergency basis 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 adopted amendment.
§165.2.Medical Record Release and Charges.
(a)-(d)
(No change.)
(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 20 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 $10 may be charged
for executing the affidavit.
(f)-(i)
(No change.)
Filed with the Office of the Secretary of State,
on December 22, 1999.
TRD-9909004
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1999
Expiration date: April 20, 2000
For further information, please call: (512) 305-7016
22 TAC §171.1
The Texas State Board of Medical Examiners adopts on an emergency
basis an amendment to §171.1, concerning permits issued to physicians
in postgraduate training programs.
The amendment will clarify the provisions of the Medical Practice Act under
which physicians holding training permits may be disciplined.
The section is being adopted on an emergency basis due to the legislature
mandating a January 7, 2000, deadline for the amendment to be effective.
The amendment is adopted on an emergency basis 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, §155.105 is affected by the adopted amendment.
§171.1.Construction.
(a)-(g)
(No change.)
(h)
A violation of §3.08 or any other
provision of the Medical Practice Act is grounds for denial, non-renewal or
cancellation of a permit.
Filed with the Office of the Secretary of State,
on December 22, 1999.
TRD-9909005
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1999
Expiration date: April 20, 2000
For further information, please call: (512) 305-7016
22 TAC §§173.1-173.7
The Texas State Board of Medical Examiners adopts on an emergency
basis new §§173.1-173.7, concerning information to be collected
by the board as mandated by House Bill 110, 76th Legislature.
The rules will outline the information to be collected and made available
to the public. This will enable the public to access information via the Internet
or in paper format that will be helpful in making informed decisions regarding
the choice of a physician.
These sections are being adopted on an emergency basis due to the legislature
mandating a January 7, 2000, deadline for the new sections to be effective.
The new sections are adopted on an emergency basis 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, §160.002 is affected by the adopted new sections.
§173.1.Profile Contents.
(a)
The Texas State Board of Medical Examiners (the "board")
shall develop and make available to the public a comprehensive profile of
each licensed physician electronically via the Internet or in paper format
upon request.
(b)
The profile of each licensed physician shall contain the
following information listed in paragraphs (1)-(28) of this subsection:
(1)
full name;
(2)
date and place of birth;
(3)
gender;
(4)
ethnic origin;
(5)
name of each medical school attended and the dates
of:
(A)
graduation; or
(B)
Fifth Pathway designation and completion of the Fifth Pathway
Program;
(6)
a description of all graduate medical education
in the United States or Canada, including:
(A)
beginning and ending dates;
(B)
program name;
(C)
city and state of program;
(D)
type of training (internship, residency or fellowship);
and,
(E)
specialty of program;
(7)
any specialty certification held by the physician
and issued by a board that is a member of the American Board of Medical Specialties
or the Bureau of Osteopathic Specialists;
(8)
primary and secondary specialties practiced, as designated
by the physician;
(9)
the number of years the physician has actively practiced
medicine in:
(A)
the United States or Canada; and
(B)
Texas;
(10)
the original date of issuance of the physician's
Texas medical license;
(11)
the expiration date of the physician's annual registration
permit;
(12)
the physician's current registration, disciplinary
and licensure statuses and dates of such statuses;
(13)
the physician's Continuing Medical Education status;
(14)
the expiration date of the physician's permit to
conduct outpatient anesthesia services, if applicable;
(15)
the method of licensure of the physician's original
Texas medical license, and, if by reciprocal endorsement, the state and/or
province of reciprocal endorsement;
(16)
the name and city of each hospital in Texas in which
the physician has privileges;
(17)
the physician's primary practice location (street
address, city, state and zip code);
(18)
the physician's mailing address (street address or
post office box, city, state and zip code);
(19)
the type of language translating services, including
translating services for a person with impairment of hearing, that the physician
provides at the physician's primary practice location;
(20)
whether the physician participates in the Medicaid
program;
(21)
whether the physician's patient service areas are
accessible to disabled persons, as defined by federal law;
(22)
a description of any conviction for an offense constituting
a felony, a Class A or Class B misdemeanor, or a Class C misdemeanor involving
moral turpitude during the ten-year period preceding the date of the profile;
(23)
a description of any charges reported to the board
during the ten-year period preceding the date of the profile to which the
physician has pleaded no contest, for which the physician is the subject of
deferred adjudication or pretrial diversion, or in which sufficient facts
of guilt were found and the matter was continued by a court of competent jurisdiction;
(24)
a description of any disciplinary action against
the physician by the board;
(25)
a description of any disciplinary action against
the physician by a medical licensing board of another state during the ten-year
period preceding the date of the profile;
(26)
a description of the final resolution taken by the
board on medical malpractice claims or complaints required to be opened by
the board under §5.05(f) of the Medical Practice Act (Article 4495b,
Vernon's Texas Civil Statutes);
(27)
a description of any formal complaint issued by the
Board's staff against the physician and initiated and filed with the State
Office of Administrative Hearings under §4.03 of the Medical Practice
Act (Article 4495b, Vernon's Texas Civil Statutes) and the status of the complaint;
and,
(28)
a description of a maximum of 5 awards, honors, publications
or academic appointments submitted by the physician, each no longer than 120
characters.
§173.2.Profile Update and Correction Form.
(a)
The board shall develop a Profile Update and Correction
Form (the "Form") which allows for corrections and/or updates to the profile
information to be made by the physician. The physician must submit all changes
to profile information upon this Form, or indicate on the Form that no changes
are necessary. The Form shall contain the date the information will be made
available to the public and will allow the physician to request a copy of
the physician's profile. Upon such request, and when the profile information
has been updated, the board shall provide a copy to the physician. The Form
will be made available in hard copy and on the Internet.
(b)
Compliance with the request for information from the board
is mandatory. Failure to return the completed Form to the board shall be considered
non-compliance. Non-compliance shall result in nonrenewal of the physician's
license until such time as the physician provides the requested information.
(c)
Submission of false or misleading information by the physician
shall be considered grounds for disciplinary action.
(d)
All data contained in the profile shall indicate the source
of the data and the last update date.
§173.3.Initial Collection of Profile Data and Physician-Initiated Updates During the Renewal Process.
(a)
The board shall send a copy of the Form to the physician
with the physician's annual renewal form.
(b)
The physician shall comply with the request for information
by returning the Form to the board prior to the expiration date of the physician's
annual registration permit.
§173.4.Updates to the Physician's Profile Due to Board Action.
When the board takes disciplinary action against a physician, such
action shall be noted on the physician's profile and shall be made available
to the public.
§173.5.Updates to the Physician's Profile Due to Information Received by a Third Party.
When the board is notified by a third party of a change in profile
information for a physician, the board shall send a copy of the Form to the
physician with the changes noted. The physician shall have one month in which
to correct factual errors or dispute the information.
§173.6.Physician-Initiated Updates Outside of the Renewal Process.
If the profile needs correction outside of the regular renewal process,
the physician shall request that the Form be mailed to the physician for corrections.
The physician must then use the Form to submit corrections to the profile
information to the board.
§173.7.Corrections and the Dispute Process.
(a)
If the physician wishes to make corrections or dispute
the proposed profile information, the procedures in this section shall apply.
(b)
If the board receives the Form from the physician without
corrections to the profile information, the profile shall be made available
to the public as is.
(c)
If the board receives the Form from the physician and the
physician has indicated corrections to the information on the Form, the board
shall review the proposed corrections.
(d)
If the board determines that the physician's corrections
are satisfactory, the board shall update the profile information and make
the profile available to the public.
(e)
If the board determines that the physician's corrections
are unsatisfactory, the board shall so notify the physician, along with a
presentation of the information in a format satisfactory to the board, and
instructions of the process that the physician must follow to dispute the
information.
(f)
If the physician wishes to dispute the profile information
which is in the format satisfactory to the board, the physician must submit
a formal letter of dispute to the board within two weeks of the date of the
notification in subsection (e) of this section. The physician must then submit
proof of factual error to the board within one month of the date of the notification
in subsection (e) of this section.
(g)
Upon receipt of the formal letter of dispute from the physician,
a notation that the information under dispute is "Not available" shall be
attached to the appropriate category of the physician's profile and such notation
shall be made available to the public on the profile.
(h)
After review of the proof provided by the physician during
the dispute process as described in subsection (f) of this section, the board
shall make a determination as to the profile information to be provided to
the public.
(i)
Upon determination by the board of the dispute, the board
shall notify the physician of the determination, shall update the physician's
profile with the information, shall remove the "Not available" notation and
shall make the profile available to the public.
Filed with the Office of the Secretary of State,
on December 22, 1999.
TRD-9909006
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1999
Expiration date: April 20, 2000
For further information, please call: (512) 305-7016
22 TAC §175.1, §175.5
The Texas State Board of Medical Examiners adopts on an emergency
basis amendments to §175.1 and §175.5, concerning the fee and application
for office-based anesthesia registration.
The fees collected will implement the program of registering physicians
using office-based anesthesia, as mandated by Senate Bill 1340, 76th Legislature.
These sections are being adopted on an emergency basis due to the legislature
mandating a January 7, 2000, deadline for these amendments to be effective.
The amendments are adopted on an emergency basis 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, §153.051 is affected by the adopted amendments.
§175.1.Fees.
The board shall charge the following fees.
(1)-(6)
(No change.)
(7)
Miscellaneous Fees:
(A)-(B)
(No change.)
(C)
reinstatement after cancellation for cause - $350
;
[
(D)
office-based anesthesia registration -
$300.
§175.5.Applications.
(a)
All information required on applications used by this board
will conform to the Medical Practice Act and rules promulgated by this board.
The board hereby adopts by reference the following forms:
(1)-(6)
(No change.)
(7)
Miscellaneous Applications:
(A)-(B)
(No change.)
(C)
physician designation of prescriptive delegation
;
[
(D)
application for office-based anesthesia
registration.
(b)
(No change.)
Filed with the Office of the Secretary of State,
on December 22, 1999.
TRD-9909007
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1999
Expiration date: April 20, 2000
For further information, please call: (512) 305-7016
22 TAC §183.4
The Texas State Board of Medical Examiners adopts on an emergency
basis an amendment to §183.4, concerning the computer based score for
passage of the Test of English as a Foreign Language.
The amendment will clarify the minimum score required for passage of the
computer based Test of English as a Foreign Language.
The section is being adopted on an emergency basis due to the legislature
mandating a January 7, 2000, deadline for the amendment to be effective.
The amendment is adopted on an emergency basis 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, §§205.101, 205.202, and 205.203 is affected
by the adopted amendment.
§183.4.Licensure.
(a)
Qualifications. An applicant must present satisfactory
proof to the acupuncture board that the applicant:
(1)-(6)
(No change.)
(7)
is able to communicate in English as demonstrated
by one of the following:
(A)
(No change.)
(B)
passage of the TOEFL (Test of English as a Foreign Language)
with a score of 550 or higher
on the paper based test or with a score
of 213 or higher on the computer based test
; or
(C)-(F)
(No change.)
(b)-(g)
(No change.)
Filed with the Office of the Secretary of State,
on December 22, 1999.
TRD-9909008
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1999
Expiration date: April 20, 2000
For further information, please call: (512) 305-7016
22 TAC §§192.1-192.6
The Texas State Board of Medical Examiners adopts on an emergency
basis 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.
These sections are being adopted on an emergency basis due to the legislature
mandating a January 7, 2000, deadline for the new sections to be effective.
The new sections are adopted on an emergency basis 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 adopted 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)
Anesthesiologists in 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 when the certified registered nurse anesthetist provides
a service specified in the ASA standards to be provided by an anesthesiolgist.
(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
assessment, 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 these services.
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 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.
Filed with the Office of the Secretary of State,
on December 22, 1999.
TRD-9909009
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1999
Expiration date: April 20, 2000
For further information, please call: (512) 305-7016
may
] have the
current
Program Director of the program
in which the applicant trained submit a letter, addressed to this board, submitted
directly to this board stating the beginning and ending dates of the program
and attesting to successful completion.
Chapter 165.
MEDICAL RECORDS
Chapter 171.
INSTITUTIONAL PERMITS
Chapter 173.
PHYSICIAN PROFILES
Chapter 175.
FEES, PENALTIES AND APPLICATIONS
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]
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]
Chapter 183.
ACUPUNCTURE
Chapter 192.
OFFICE-BASED ANESTHESIA
Chapter 193.
STANDING DELEGATION ORDERS