Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
Chapter 163.
LICENSURE
22 TAC §163.1, §163.10
The Texas State Board of Medical Examiners proposes amendments
to §163.1 and §163.10, concerning Licensure. The amendments are
made to definitions and relicensure requirements.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendments are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the amendments as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be updated rules. There will be
no effect on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments: Texas Occupations
Code Annotated, §§155.001-.008; 155.051.
§163.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicate otherwise.
(1)
Acceptable approved medical school -- A medical school
or college located in the United States or Canada that
has been accredited
by the Liaison Committee on Medical Education or the American Osteopathic
Association Bureau of Professional Education.
[
[(2)
Acceptable unapproved medical school
-- A school or college located outside the United States or Canada that is
not approved by the board but is substantially equivalent to a Texas medical
school.]
(2)
[
(3)
[
(4)
[
(A)
forms furnished by the board, completed by the applicant:
(i)
all forms and addenda requiring a written response must
be printed in ink;
(ii)
photographs must meet United States Government passport
standards;
(B)
all documents required under §163.5 of this title
(relating to Licensure Documentation); and
(C)
the required fee, payable by check through a United States
bank.
(5)
Continuous -- 12 month periods of uninterrupted
post graduate training with no absences greater than 21 days, unless such
absences have been approved by the training program.
(6)
Eligible for licensure in country of graduation -- An applicant
must be eligible for licensure in the country in which the medical school
is located except for any citizenship requirements.
(7)
Examinations accepted by the board for licensure.
(A)
United States Medical Licensing Examination (USMLE), with
a score of 75 or better on each step, all steps must be passed within seven
years;
(B)
Federation Licensing Examination (FLEX), after July 1,
1985, passage of both components within seven years with a score of 75 or
better on each component;
(C)
Federation Licensing Examination (FLEX), prior to June
30, 1985, with a FLEX weighted average of 75 or better in one sitting;
(D)
National Board of Medical Examiners Examination (NBME)
or its successor all steps must be passed within seven years;
(E)
National Board of Osteopathic Medical Examiners Examination
(NBOME) or its successor all steps must be passed within seven years;
(F)
Medical Council of Canada Examination (LMCC) or its successor,
all steps must be passed within seven years;
(G)
State board examination, before January 1, 1977, (with
the exception of Virgin Islands, Guam, Tennessee Osteopathic Board or Puerto
Rico after June 30, 1963); or
(H)
One of the following examination combinations with a score
of 75 or better on each part, level, component, or step, all parts, levels,
components, or steps must be passed within seven years:
(i)
FLEX I plus USMLE 3;
(ii)
USMLE 1 and USMLE 2, plus FLEX II;
(iii)
NBME I or USMLE 1, plus NBME II or USMLE 2, plus NBME
III or USMLE 3;
(iv)
NBME I or USMLE 1, plus NBME II or USMLE 2, plus FLEX
II;
(v)
NBOME I, plus NBOME II, plus FLEX II;
(vi)
the NBOME Part I or COMLEX Level I and NBOME Part II or
COMLEX Level II and NBOME Part III or COMLEX Level III.
(I)
An applicant must pass each part of an examination within
three attempts, except that an applicant who has passed all but one part of
an examination within three attempts may take the remaining part of the examination
one additional time.
(J)
Notwithstanding subparagraph (I) of this paragraph, an
applicant is considered to have satisfied the requirements of this section
if the applicant:
(i)
passed all but one part of an examination approved by the
board within three attempts and passed the remaining part of the examination
within five attempts;
(ii)
is specialty board certified by a specialty board that:
(I)
is a member of the American Board of Medical Specialties;
or
(II)
is approved by the American Osteopathic Association; and
(iii)
completed in this state an additional two years of postgraduate
medical training approved by the board.
(K)
An applicant who has not passed an examination for licensure
in a ten-year period prior to the filing date of the application must:
(i)
pass 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 Bureau of Osteopathic Specialists within
the preceding ten years;
(ii)
obtain 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, including but not limited
to participation for at least six months in a training program approved by
the board within twelve months prior to the application for licensure; or
(iii)
pass the Special Purpose Examination (SPEX) within the
preceding ten years.
(8)
Examinations administered by the board for licensure --
To be eligible for licensure an applicant must sit for and pass the Texas
medical jurisprudence examination administered by the board. A passing score
is 75 or better on the Texas medical jurisprudence examinations. The board
shall administer the Texas medical jurisprudence examination in writing at
times and places designated by the board.
(9)
Good professional character -- An applicant for licensure
must not be in violation of or committed any act described in the Medical
Practice Act, TEX. OCC. CODE ANN. §§164.051-.053.
(10)
Graduate of an acceptable unapproved
foreign medical school -- An applicant who is a graduate of a school or college
located outside the United States or Canada whose school or college:
(A)
is not currently undergoing the approval process of the
Medical Board of California; and,
(B)
is either;
(i)
substantially equivalent to a Texas medical school; or
(ii)
has not been disapproved by the Medical Board of California.
(11)
[
(A)
accepted for certification by an American Specialty board
that is a member of the American Board of Medical Specialties or the Bureau
of Osteopathic Specialists; or
(B)
accredited by one of the following:
(i)
the Accreditation Council for Graduate Medical Education,
or its predecessor;
(ii)
the American Osteopathic Association;
(iii)
the Committee on Accreditation of Preregistration Physician
Training Programs, Federation of Provincial Medical Licensing Authorities
of Canada;
(iv)
the Royal College of Physicians and Surgeons of Canada;
or
(v)
the College of Family Physicians of Canada; or
(C)
a postresidency program, usually called a fellowship, for
additional training in a medical specialty or subspecialty in a program approved
by the Texas State Board of Medical Examiners.
(12)
[
(13)
Studied medicine in an acceptable unapproved
foreign medical school -- An applicant who has studied at a school or college
located outside the United States or Canada whose school or college:
(A)
is not currently undergoing the approval process of the
Medical Board of California; and,
(B)
is either;
(i)
substantially equivalent to a Texas medical school; or
(ii)
has not been disapproved by the Medical Board of California.
(14)
[
(A)
The facilities for basic sciences and clinical training
(i.e., laboratories, hospitals, library, etc.) shall be adequate to ensure
opportunity for proper education.
(B)
The admissions standards shall be substantially equivalent
to a Texas medical school.
(C)
The basic sciences curriculum shall include the contemporary
content of those expanded disciplines that have been traditionally titled
gross anatomy, biochemistry, biology
,
[
(D)
The fundamental clinical subjects, which shall be offered
in the form of required patient-related clerkships, are internal medicine,
obstetrics and gynecology, pediatrics, psychiatry, neurology, family practice,
introduction to patient/physical examination, and surgery, as defined by the
Texas Higher Education Coordinating Board.
(E)
The curriculum shall be of at least 130 weeks in duration.
(F)
The school shall provide advancement of knowledge through
research.
(G)
The school shall develop programs of graduate medical education
to produce practitioners, teachers, and researchers.
(H)
The school shall provide opportunity for postgraduate and
continuing medical education.
(I)
Medical education courses must be centrally organized,
integrated and controlled into a continuous program which was conducted, monitored
and approved by the medical school which issues the degree.
(J)
All medical or osteopathic medical education received by
the applicant in the United States must be accredited by an accrediting body
officially recognized by the United States Department of Education as the
accrediting body for medical education leading to the doctor of medicine degree
or the doctor of osteopathy degree in the United States. In addition, all
medical or osteopathic medical education received in Texas must also comply
with Chapter 162 of this title (relating to Supervision of Medical School
Students) that requires physicians to register with the board prior to supervising
medical students who are not enrolled at a medical school that has been accredited
by the Liaison Committee on Medical Education or the American Osteopathic
Association. This subsection does not apply to postgraduate medical education
or training.
(K)
An applicant who is unable to comply with the requirements
of subparagraph (J) of this paragraph is eligible for an unrestricted license
if the applicant:
(i)
received such medical education in a hospital or teaching
institution Sponsoring or participating in a program of graduate medical education
accredited by the Accrediting Council for Graduate Medical Education, the
American Osteopathic Association, or the Texas State Board of Medical Examiners
in the same subject as the medical or osteopathic medical education if the
hospital or teaching institution has an agreement with the applicant's school;
or
(ii)
is specialty board certified by a board approved by the
Bureau of Osteopathic Specialists or the American Board of Medical Specialties.
(15)
[
(A)
accredited by one of the following:
(i)
the Accreditation Council for Graduate Medical Education;
(ii)
the American Osteopathic Association;
(iii)
the Committee on Accreditation of Preregistration Physician
Training Programs, Federation of Provincial Medical Licensing Authorities
of Canada;
(iv)
the Royal College of Physicians and Surgeons of Canada;
(v)
the College of Family Physicians of Canada; and
(vi)
all programs approved by the board after August 25, 1984;
or
(B)
a board-approved program for which a Faculty Temporary
Permit was issued; or
(C)
a postresidency program, usually called a fellowship, for
additional training in a medical specialty or subspecialty, approved by the
Texas State Board of Medical Examiners.
§163.10.Relicensure.
(a)
Application for Relicensure.
If a physician's
annual registration permit has been expired for one year due to failure to
submit an application for registration and annual registration fee, it is
considered to have been canceled, unless an investigation is pending, and
the physician may not obtain a new annual registration permit. The physician
must apply for relicensure and may obtain a new license by submitting to reexamination
and complying with the requirements and procedures for obtaining an original
license.
(b)
Exemption from Jurisprudence Examination.
A
person may qualify for a new license without having to take the Texas jurisprudence
examination if that person's license is considered canceled for less than
two years.
(c)
Existing Board Orders at Time of Cancellation.
(1)
A physician who allows his or her license to be canceled
following nonpayment while under an order of the board may apply for relicensure.
Unless otherwise provided, the terms of the order shall be tolled for the
period following cancellation.
(2)
The licensee shall be required to comply with the terms
of the order for either the period of time remaining on the order when the
licensee had his or her license cancelled for nonpayment of licensure fees
or for an extended period of time as established by the board at the time
relicensure.
(3)
A physician who allows his or her license to be cancelled
following nonpayment while under a suspension order of the board must also
demonstrate that his or her return to the practice of medicine is in the physician's
and the public's best interest as defined under Chapter 167 of this title
(relating to Reinstatement and Reissuance.
(4)
The board retains the discretion to add or delete terms
and conditions of the tolled order upon the granting of relicensure.
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, 2003.
TRD-200301117
Donald W. Patrick MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
22 TAC §§167.1, 167.2, 167.4 - 167.6
The Texas State Board of Medical Examiners proposes amendments
to §§167.1, 167.2, 167.4-167.6, concerning procedures for reinstatement
and reissuance of a license.
Elsewhere in this issue of the
Texas Register
, the Texas State Board of Medical Examiners proposes the rule review
for Chapter 167.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendments are in effect
there is possible impact to physicians applying for reinstatement or reissuance
of a license because they are required to prove eligibility for licensure
at the time of reapplication. This may impact some physicians who would be
required to take an examination or become specialty board certified or recertified
in order to qualify for licensure. The dollar amount will vary with each case.
There will be no effect to state or local government.
Ms. Shackelford also has determined that for each year of the first five
years the amendments as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be updated procedures for reinstatement
and reissuance of a license. There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments: Texas Occupations
Code Annotated, §§155.001-155.008; 156.005; 164.001; 164.004-.009;
164.051; 164.101-.103; 164.151-.154.
§167.1.Reinstatement or Reissuance of Medical License Following Suspension or Revocation.
(a)
Reinstatement of Medical License Following Suspension.
(1)
An
[
(2)
A person may not apply for reinstatement of a license that
was suspended before the first anniversary of the date on which the suspension
became effective.
(3)
A request
[
(4)
An applicant's request for reinstatement
must include evidence that all stipulations for the probation of the suspension
have been completed.
(5)
A physician who allows his or her license
to be cancelled for nonpayment while under a suspension order may apply for
relicensure in accordance with §163.10 of this title (relating to Relicensure).
(b)
Reissuance of License Following Revocation.
(1)
An applicant whose license has been revoked must complete
in every detail the application for reissuance of license, including payment
of the required application fee.
(2)
The applicant whose license has been revoked must
submit a written request to the board's licensure division and
appear
before
a committee of
the board to request reissuance of license.
(3)
A person may not apply for reissuance of a license that
was revoked before the first anniversary of the date on which the revocation
became effective.
(4)
An application
[
(5)
In addition to any other requirement set
out in this chapter for reissuance of a license following revocation, an applicant
must also demonstrate compliance with current licensure eligibility requirements.
§167.2. Procedure for [
Pursuant to the Medical Practice Act, §§154.006, 164.003
and 164.151-.154, and the Administrative Procedure Act, Government Code, §2001.056,
the following rules shall apply to [
(1)
The board may make
a
[
(2)
In the event the board makes such a disposition of a request
for reinstatement of a medical license following suspension, the disposition
shall be in writing and, if appropriate, the writing shall be signed by the
applicant.
(3)
To facilitate the expeditious disposition of requests for
reinstatement following suspension, the board may provide an applicant with
an opportunity to attend
a probationer show compliance proceeding in
accordance with §187.44 of this title (relating to Probationer Show Compliance
Proceedings)
[
(4)
[
[(5)
One or more members of the board or a
district review committee shall conduct the informal settlement conference
as the board's representative(s). When a board member and a district review
committee member conduct such a conference, the board member shall serve as
chairman of the conference. In the event that the representatives consist
of two board members or two district review committee members, the representative
who has seniority on the board or committee shall serve as the chairman of
the conference. In the event a public member of the board or a district review
committee member serves as the only board representative in such a conference,
a board consultant or the board's executive director, if the executive director
is a physician, may serve as a medical advisor to the representative.]
(5)
[
(A)
the board staff to address whether it is in the best interest
of the public and the physician to return to the practice of medicine by presenting
a synopsis of the allegations and the basis of the suspension of the applicant's
medical license, the facts which the board staff reasonably believes could
be proven by competent evidence at a hearing, and whether the applicant has
complied with the terms and conditions of the
order
[
(B)
the applicant to reply to the board staff's presentation
and present facts the applicant reasonably believes could be proven by competent
evidence at a hearing;
(C)
presentation of evidence by the staff and the applicant
which may include medical and office records, x-rays, pictures, film recordings
of all kinds, audio and video recordings, diagrams, charts, drawings, and
any other illustrative or explanatory materials which in the discretion of
the board's representative(s) are relevant to the proceeding;
(D)
representation of the applicant by counsel;
(E)
presentation of oral or written statements by the applicant
or the applicant's counsel;
(F)
presentation of oral or written statements or testimony
by witnesses; and,
(G)
questioning of witnesses.
(6)
[
(7)
[
(8)
[
[(10)
After an informal settlement conference
has been held, the staff of the board and the board's representative(s) shall
be subject to the ex parte provisions of the Administrative Procedure Act
with regard to contacts with board members and administrative law judges concerning
the case.]
(9)
[
(10)
[
[(13)
Although notes may be made by the participants,
mechanical or electronic recordings shall not be made of settlement discussions,
mediation efforts, and the informal settlement conference.]
[(14)
The settlement conference shall be informal
and shall not follow the procedures established under Chapter 187 of this
title (relating to Procedure) for contested cases.]
(11)
[
(12)
[
(13)
[
(14)
[
(A)
Upon an affirmative majority vote, the board shall enter
an order approving the proposed settlement agreement. The order shall bear
the signature of the president of the board or of the officer presiding at
such meeting and shall be referenced in the minutes of the board.
(B)
If the board does not approve a proposed settlement agreement,
the applicant shall be so informed and the matter shall be referred to the
board staff for appropriate action to include further negotiation, further
investigation, an additional
probationer show compliance proceeding
[
(C)
To promote the expeditious resolution of any request for
reinstatement, with the approval of the executive director, a member of the
Executive Committee, or the Disciplinary Process Review Committee, board staff
may present a proposed settlement agreement to the board for consideration
and acceptance without conducting
a probationer show compliance proceeding
[
§167.4.Best Interests of Physician.
Pursuant to §164.151 of the Act, a physician may be reissued a
medical license or reinstated to the practice of medicine only if the physician
demonstrates that the reissuance or 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
[
(2)
demonstrates that risk of further disciplinary proceedings
for the revocation 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 §164.151 of the Act, a physician may be reissued a
medical license or reinstated to the practice of medicine only if the physician
demonstrates that the reissuance or reinstatement is in the best interests
of the public. Best 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
[
(2)
that risk of further disciplinary proceedings for the revocation
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
[
(3)
that an adequate practice plan will be in place to reduce
or eliminate the risk of further disciplinary proceedings by the
board
[
(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
[
§167.6.Final Action.
In any contested case proceeding regarding a reinstatement
or
reissuance
request, the
order
[
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, 2003.
TRD-200301118
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
22 TAC §§169.1 - 169.5, 169.7
The Texas State Board of Medical Examiners proposes amendments
to §§169.1-169.5, 169.7, concerning authority of physicians to supply
drugs. The amendments are necessary for general clean up of the chapter.
Elsewhere in this issue of the
Texas Register
, the Texas State Board of Medical Examiners proposes the rule review
for Chapter 169.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendments are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the amendments as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be updated rules. There will be
no effect on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments: Texas Occupations
Code Annotated, §§157.002; 158.001-.003.
§169.1.Purpose.
The purpose of this chapter is to provide physicians with guidelines
for supplying drugs to their patients as authorized by
the Medical Practice
Act§§157.002, 158.001-.003 ("the Act") Title 3 Subtitle B Tex. Occ.
Code Ann.
[
§169.2.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
Act--The Medical Practice Act of Texas,
Title 3 Subtitle
B Tex. Occ. Code Ann.
[
(2)
Administer--The direct application of a drug by injection,
inhalation, ingestion, or any other means to the body of a physician's patient.
(3)
Board--The Texas State Board of Medical Examiners.
(4)
Dispense--Preparing, packing, compounding, or labeling
for delivery a prescription drug or device in the course of professional practice
to an ultimate user or his or her agent by or pursuant to the lawful order
of a physician.
(5)
Distribute--The delivery of a prescription drug or device
other than by administering or dispensing.
(6)
Immediate needs--The amount of a prescription drug needed
for the proper treatment of a patient until access to a pharmacy is possible.
"Immediate needs" shall be considered the amount of medication deemed necessary
for a 72-hour period.
(7)
Physician--A licensee of the Texas State Board of Medical
Examiners.
(8)
Provision--To supply one or more unit doses of a [
(9)
Reimbursed for cost--An additional charge separate from
that made for the physician's professional services which includes the cost
of the drug product and all other actual costs to the physician incidental
to providing the dispensing service, but not including a separate fee for
the act of dispensing the drug product itself.
(10)
Rural area--An area in which there is no pharmacy within
a 15-mile radius of the physician's office and which is within either a county
with a total population of 5,000 or less according to the most recent federal
census; or a city or town, incorporated or unincorporated, with a population
of less than 2,500 according to the most recent federal census, but not including
a city or town, incorporated or unincorporated, whose boundaries are adjacent
to an incorporated city or town with an equal or greater population.
(11)
Sample--A prescription drug which is prepackaged by the
original manufacturer, provided to the physician at no cost by the manufacturer,
and is either marked as a sample on the original container or is included
in the physician's records as a sample.
(12)
Standing delegation order--Written instructions, orders,
rules, regulations, or procedures prepared by a physician and designed for
a patient population with specific diseases, disorders, health problems, or
sets of symptoms. Such written instructions, orders, rules, regulations, or
procedures shall delineate under what set of conditions and circumstances
action should be instituted. These instructions, orders, rules, regulations,
or procedures are to provide authority of and a plan for use with patients
presenting themselves prior to being examined or evaluated by a physician
to assure that such acts are carried out correctly and are distinct from specific
orders written for a particular patient.
(13)
Standing medical orders--Orders, rules, regulations, or
procedures prepared by a physician or approved by a physician or the medical
staff of an institution for patients
who
[
§169.3.Administration of Drugs.
A physician may personally administer those drugs to his or her patients,
which are, in the physician's medical judgment, therapeutically beneficial
or necessary for the patient's treatment. A physician may delegate [
§169.4.Providing, Dispensing, or Distributing Drugs.
Except as
otherwise
provided in
§169.5 of
this
chapter, a physician may provide, dispense, or distribute drugs for use or
consumption by the patient away from the physician's office or after the conclusion
of the physician-patient encounter only in quantities as are necessary to
meet the patient's immediate needs. A physician shall comply personally with
all appropriate labeling and record keeping requirements under state or federal
law or shall oversee compliance by persons acting under his or her direction
and supervision. A physician who provides, dispenses, or distributes drugs
to a patient to meet his or her immediate needs may not charge a fee separate
from that charged for medical services provided to the patient.
§169.5.Exceptions.
Under the following circumstances, a physician may dispense or distribute
drugs in quantities greater than those necessary to meet a patient's immediate
needs.
(1)
A licensed physician who practices medicine in a rural
area [
(2)
If a physician believes that a patient's prescribed treatment
regimen should include certain drugs, the physician may supply them to the
patient by means of pharmaceutical samples. No charge may be made by a physician
for such samples. A patient's immediate needs as defined in this chapter shall
not affect or limit the quantity of pharmaceutical samples a physician may
provide to the patient.
§169.7.Record Keeping.
(a)
The following provisions relate to dangerous drugs.
(1)
A licensee shall be presumed to have complied with record
keeping requirements for dangerous drugs (the Texas Health and Safety Code,
Chapter 483) received as pharmaceutical samples if:
(A)
the licensee maintains a copy of each signed request form
for samples required by the Prescription Drug Marketing Act of 1987, Public
Law Number 100-293, 102 Statute 95 (21 United States Code 503(D) for a period
of two years from the date of acquisition; and
(B)
the licensee makes appropriate entries in patients' medical
records when a pharmaceutical sample is supplied to a patient.
(2)
A licensee shall be presumed to have complied with record
keeping requirements for dangerous drugs (the Texas Health and Safety Code,
Chapter 483) received or acquired other than as a pharmaceutical sample if:
(A)
the licensee maintains all invoices for purchases, receiving
orders, or other documentation of receipt or acquisition for a period of two
years from the date of receipt or acquisition; and
(B)
the licensee makes appropriate entries in patients' medical
records when a dangerous drug is provided, administered, or supplied to a
patient.
(b)
The following provisions relate to controlled substances.
(1)
A licensee shall be presumed to have complied with record
keeping requirements for controlled substances (the Texas Health and Safety
Code, Chapter 481) received as pharmaceutical samples if:
(A)
the licensee maintains a copy of each signed request form
for samples required by the Prescription Drug Marketing Act of 1987, Public
Law Number 100-293, 102 Statute 95 (21 United States Code 503(D) for a period
of two years from the date of acquisition; and
(B)
the licensee maintains records of pharmaceutical samples
as required by
the Texas Department of Public Safety under
37 TAC
§13.202-.207,
[
(2)
A licensee shall be presumed to have complied with the
record keeping requirements for controlled substances (the Texas Health and
Safety Code, Chapter 481) received or acquired other than as a pharmaceutical
sample if the licensee maintains records of such controlled substances as
required by 37 TAC, section 13.28, Texas Department of Public Safety, controlled
substance regulations.
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, 2003.
TRD-200301119
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
22 TAC §171.1
The Texas State Board of Medical Examiners proposes an amendment
to §171.1, concerning reporting requirements relating to postgraduate
training permits. The amendment is necessary to update the reporting requirements.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendment is in effect
there may be fiscal implications. The fiscal impact to those persons required
to report information to the board will be minimal. With the additional reporting
requirements, it may result in complaints being opened and investigations
pursued. The cost of the investigations is difficult to calculate at this
time.
Ms. Shackelford 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 section will be updated reporting requirements.
There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendment: Texas Occupations
Code Annotated, §§155.105; 160.002-.004; 164.051-.053.
§171.1.Construction.
(a)
Permit holders under this chapter shall be subject to the
duties, limitations, disciplinary actions, rehabilitation order provisions,
and procedures applicable to licensees in the Medical Practice Act and board
rules. Permit holders under this chapter shall also be subject to the limitations
and restrictions elaborated in this chapter.
(b)
Permit holders under this chapter shall cooperate with
the board and board staff involved in
the
investigation, review,
or monitoring associated with the permit holder's practice of medicine. Such
cooperation shall include, but not be limited to, permit holder's written
response to the board or board staff written inquiry within 14 days of receipt
of such inquiry.
(c)
In accordance with §155.105 of the Medical Practice
Act, the board shall retain jurisdiction to discipline a permit holder whose
permit has been terminated, canceled, and/or expired if the permit holder
violated the Medical Practice Act or board rules during the time the permit
was valid.
[
(d)
The issuance of a permit to a physician shall not be construed
to obligate the board to issue the physician subsequent permits or licenses.
The board reserves the right to investigate, deny a permit or full licensure,
and/or discipline a physician regardless of when the information was received
by the board.
(e)
The director of each approved postgraduate training program
shall report in writing to the executive director of the board the following
events within seven days of their occurrence:
(1)
if an applicant did not begin the training program due
to failure to graduate from medical school as scheduled or for any other reason(s);
(2)
if a permit holder has been terminated or has resigned
from the program and the reasons(s) why;
(3)
if a permit holder has been or will be absent from the
program for more than
21 consecutive
[
(4)
if the program has information that a permit holder has
been arrested after the permit holder begins training in the program; and/or
(5)
if the program has information that a permit holder,
while in postgraduate training:
[
(A)
engaged in alcohol or chemical substance
abuse, dependency or addiction;
(B)
engaged in sexual contact with a patient,
or sexually inappropriate behavior or comments directed towards a patient;
(C)
behaved in a disruptive manner toward
physicians, hospital personnel, other medical personnel, patients, patient's
family members or others that interferes with patient care or could be reasonably
expected to adversely impact the quality of care rendered to a patient;
(D)
is known or suspected to have a medical
disorder and has exhibited behavior that is likely to have resulted from the
disorder and that could reasonable be expected to adversely affect the quality
of care rendered to patients;
(E)
is known or suspected to have a sexual
disorder, including but not limited to pedophilia, exhibitionism, voyeurism,
frotteurism, or sexual sadism;
(F)
was named in a professional liability
claim or suit in which the permit holder was named that involved death or
serious bodily injury and in which funds were paid on behalf of the permit
holder; or
(G)
failed to practice medicine in an acceptable
professional manner consistent with public health and welfare where such failure
indicates the permit holder in unable to practice medicine in a competent
manner and the permit holder has been unable to correct his or her deficiencies
through the remedial measures, if any, offered by the program.
(6)
if the program has determined that a permit
holder has committed unprofessional or dishonorable conduct within the meaning
of the Act or as defined under §190.1(c)(2) of this title relating to
and the reason(s) why.
(7)
if the program has, in relation to academic
or non-academic reasons, made a final determination and taken disciplinary
or adverse action to include:
(A)
limited, reduced, suspended, revoked or denied privileges;
(B)
formally warned, censured, reprimanded, or admonished in
writing;
(C)
monitored admissions and/or treatment plans in a manner
that exceeds standard educational practices;
(D)
placed the permit holder on academic or disciplinary probation;
(E)
requested termination or terminated the permit holder from
the program, requested or accepted withdrawal of the permit holder from the
program, or requested or accepted resignation of the permit holder from the
program; or
(F)
any such similar action and the reason(s) why.
(f)
Failure of any
physician
, hospital or medical
institution to comply with the provisions of this chapter or the Medical Practice
Act §§160.002-.003 may be grounds for the denial of permits to persons
seeking permits to practice at that institution.
(g)
Board staff shall establish a mechanism by which a medical
institution and/or training program may receive information regarding the
application status of any physician who has applied with the Board for a permit
to practice at that medical institution and/or training program.
(h)
A violation of
§
§164.051
-.053
or any other provision of the Medical Practice Act is grounds for denial
or cancellation of a permit.
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, 2003.
TRD-200301120
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
22 TAC §§174.1 - 174.6, 174.10, 174.12 - 174.14, 174.17
The Texas State Board of Medical Examiners proposes amendments
to §§174.1-174.6, 174.10, 174.12-174.14 and new §174.17, concerning
Telemedicine. The amendments are necessary to clarify definitions and informed
consent and for general cleanup of the chapter. New §174.17 concerns
the use of the Internet in medical practice.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendments are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the amendments as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be clarification and clean up of
existing rules as well as a new rule regarding the internet in medical practice.
There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments and new rule are proposed under the authority
of the Occupations Code Annotated, §153.001, which provides the Texas
State Board of Medical Examiners to adopt rules and bylaws as necessary to:
govern its own proceedings; perform its duties; regulate the practice of medicine
in this state; and enforce this subtitle.
The following are affected by the proposed amendments and new rule: Texas
Occupations Code Annotated, §§151.056; 164.001-.004; 164.051; 164.059.
§174.1.Purpose.
This chapter is promulgated to promote the efficient administration
of the provisions of the Medical Practice Act,
§151.056 (relating
to Application of Telemedicine
[
§174.2.Definitions.
The following words and terms, when used in this chapter shall have
the following meanings unless the context indicates otherwise.
(1)
Act that is part of patient care service--Any diagnosis,
assessment, or treatment including the taking of diagnostic imaging studies
as well as the preparation of pathological material for examination.
(2)
Episodic consultation--Consultation on an irregular or
infrequent basis involving no more than 24 patients of a physician's diagnostic
or therapeutic practice per calendar year. Multiple consultations may be performed
for one or more patients up to 24 patients per calendar year.
(3)
Informal consultation--Consultation performed outside the
context of a contractual relationship and on an irregular or infrequent basis
without the expectation of or exchange of direct or indirect compensation.
(4)
Medical practice site--a patient-specific
Internet site, access to which is limited to licensed physicians, associated
medical personnel and patients. It is an interactive site and thus qualifies
as a practice location. It requires a defined physician-patient relationship.
(5)
[
(6)
[
(7)
[
(8)
Physician-patient e-mail--a computer-based
communication between physician (or their medical personnel) and patients
within a professional relationship in which the physician has taken on an
explicit measure of responsibility for the patient's care.
(9)
[
(A)
the person publicly professes to be a physician or surgeon
and diagnoses, treats, or offers to treat any mental or physical disease or
disorder, or any physical deformity or injury by any system or method or to
effect cures thereof; or,
(B)
the person diagnoses, treats or offers to treat any mental
or physical disease or disorder, or any physical deformity or injury by any
system or method and to effect cures thereof and charges therefor, directly
or indirectly, money or other compensation; or,
(C)
the person exercises medical judgment,
renders an opinion, or gives advice concerning the diagnosis or treatment
of a patient, or makes any determination regarding the appropriate or necessary
medical response to a particular patient's medical condition; or
(D)
[
(10)
[
§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,
§151.056
[
(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, and the license, 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;
(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).
§174.4.Limits on Special Purpose License to Practice Medicine Across State Lines.
A special purpose license to practice medicine across state lines
shall be limited exclusively to the practice of medicine as defined by §174.2
of this chapter (relating to Definitions) and limited to the specialty or
specialization upon which the license was granted under §174.3(a)(3)
of this title (relating to Qualifications for Special Purpose License for
Practice of Medicine Across State Lines), and the license holder shall practice
medicine in a manner so as to comply with all other statutes and laws governing
the practice of medicine in the state of Texas. Unless a person holds a current
full license to practice medicine in this state pursuant to Chapter 163 of
this title (relating to Licensure) and the provisions of the Medical Practice
Act,
Chapter 155 (relating to License to Practice Medicine)
[
§174.5.Denial of Application for Special Purpose License to Practice Medicine Across State Lines.
An application for a special purpose license to practice medicine across
state lines may be denied based on failure to demonstrate the requisite qualifications
for issuance of a special purpose license, any grounds for denial of an application
for a full license, failure to submit the required fee, and any grounds for
disciplinary action of a licensee under the Medical Practice Act,
§164.051
(relating to Grounds for Denial or Disciplinary Action)
[
§174.6.Revocation and Limitation of Special Purpose License.
Upon a majority vote of the board, a person holding a special purpose
license may be subject to the revocation or limitation of the license based
on any grounds set forth in the Medical Practice Act,
§164.051 (relating
to grounds for denial or disciplinary action)
[
§174.10.Informed Consent.
(a)
Written informed consent shall be obtained
from any patient
for the use of physician-patient e-mail or other
[
(b)
The written informed consent shall include
language that describes:
(1)
types of transmissions that will be permitted
(prescription refills, appointment scheduling, patient education, etc.);
(2)
under what circumstances alternate forms
of communication or office visits should be utilized;
(3)
what security measures the physician has
adopted as well as potential risks to privacy;
(4)
the requirement for express patient consent
to forward patient-identifiable information to a third party; and
(5)
an acknowledgment by the patient that confidentiality
of medical information may be compromised by electronic transmission for purposes
of consultation.
(c)
Failure to obtain written informed consent
for
communications
[
§174.12.Delegation and Supervision.
Tasks and activities related to consultation across state lines may
be delegated by consulting physicians and consultant physicians to those persons
qualified by licensing, training, or experience so long as the exercise of
independent medical judgment is not required to be exercised by the individual
to whom the task or activity is delegated. A physician delegating such tasks
or activities shall ensure that the individual to whom delegation is made
is qualified by licensure, training, or experience. A physician delegating
such tasks or activities shall ensure that the person to whom delegation is
made is adequately supervised. Improper delegation and failure to adequately
supervise shall be grounds for revocation or limitation of a special purpose
license pursuant to the provisions of §174.6 of this title (relating
to Revocation and Limitation of Special Purpose License) and grounds for disciplinary
action against licensees pursuant to the provisions of the Medical Practice
Act,
§164.051
[
§174.13.Exemptions.
The following activities shall be exempt from the requirements of a
special purpose license and this chapter:
(1)
episodic consultation by a medical specialist located in
another jurisdiction who provides such consultation services on request to
a person licensed in this state [
(2)
consultation services provided by a physician located in
another jurisdiction to a medical school as defined in the Education Code,
section 61.501;
(3)
consultation services provided by a physician located in
another jurisdiction to an institution defined in either the Education Code,
Subchapter C, Chapter 73, or Subchapter K, Chapter 74;
(4)
informal consultation performed outside the context of
a contractual relationship and on an irregular or infrequent basis without
the expectation or exchange of direct or indirect compensation;
(5)
furnishing of medical assistance in case of an emergency
or disaster if no charge is made for the medical assistance; and,
(6)
the acts of a physician located in another jurisdiction
of a state of the United States whose borders are contiguous with the State
of Texas who is the treating physician of a patient and orders home health
or hospice services for a resident of this state to be delivered by a home
and community support services agency licensed in this state.
§174.14.Temporary Suspension of Special Purpose License.
A special purpose license may be temporarily suspended pursuant to
the provisions of the Medical Practice Act,
§164.059
[
§174.17.Use of the Internet in Medical Practice.
(a)
Evaluation of the Patient. Physicians who utilize the Internet
must ensure a proper physician-patient relationship is established that at
a minimum includes:
(1)
establishing that the person requesting the treatment is
in fact who the person claims to be;
(2)
establishing a diagnosis through the use of acceptable
medical practices such as patient history, mental status examination, physical
examination, and appropriate diagnostic and laboratory testing to establish
diagnoses and identify underlying conditions and/or contra-indications to
treatment recommended/provided;
(3)
discussing with the patient the diagnosis and the evidence
for it, the risks and benefits of various treatment options; and
(4)
ensuring the availability of the physician or coverage
of the patient for appropriate follow-up care.
(b)
Treatment. Treatment and consultation recommendations made
in an online setting including issuing a prescription via electronic means,
will be held to the same standards of appropriate practice as those in traditional
(face-to-face) settings. An online or telephonic evaluation by questionnaire
does not constitute an acceptable standard of care.
(c)
Electronic Communications.
(1)
Written policies and procedures must be maintained when
using electronic mail for physician-patient communications. Policies must
be evaluated periodically for currency. Such policies and procedures must
address:
(A)
privacy to assure confidentiality and integrity of patient-identifiable
information;
(B)
health care personnel, in addition to the physician, who
will process messages;
(C)
hours of operation and availability;
(D)
types of transactions that will be permitted electronically;
(E)
required patient information to be included in the communication,
such as patient name, identification number and type of transaction;
(F)
archival and retrieval; and
(G)
quality oversight mechanisms.
(2)
All patient-physician e-mail, as well as other patient-related
electronic communications, must be stored and filed in the patient's medical
record.
(3)
Patients must be informed of alternative forms of communication
for urgent matters.
(d)
Medical Records.
(1)
Medical records must include copies of all patient-related
electronic communications, including patient-physician e-mail, prescriptions,
laboratory and test results, evaluations and consultations, records of past
care and instructions.
(2)
Informed consent agreements related to the use of e-mail
must be filed in the medical record.
(e)
State Licensure. Physicians who treat and prescribe through
the Internet are practicing medicine and must possess appropriate licensure
in all jurisdictions where patients reside.
(f)
Disclosure. Physician medical practice sites must clearly
disclose:
(1)
ownership of the website;
(2)
specific services provided;
(3)
office address and contact information;
(4)
licensure and qualifications of physician(s) and associated
health care providers;
(5)
fees for online consultation and services and how payment
is to be made;
(6)
financial interest in any information, products, or services;
(7)
appropriate uses and limitations of the site, including
providing health advice and emergency health situations;
(8)
uses and response times for e-mails, electronic messages,
and other communications transmitted via the site;
(9)
to whom patient health information may be disclosed and
for what purpose;
(10)
rights of patients with respect to patient health information;
and
(11)
information collected and any passive tracking mechanisms
utilized.
(g)
Accountability. Medical practice sites must provide patients
with a clear mechanism to:
(1)
access, supplement, and amend patient-provided personal
health information;
(2)
provide feedback regarding the site and the quality of
information and services; and
(3)
register complaints, including information regarding filing
a complaint with the Texas State Board of Medical Examiners as provided for
in Chapter 188 of this title (relating to Complaint Procedure Notification).
(h)
Advertising/Promotion of Goods or Products. Advertising
or promotion of goods or products from which the physician receives direct
remuneration or incentives is prohibited.
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, 2003.
TRD-200301121
Donald W. Patrick MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
22 TAC §184.25
The Texas State Board of Medical Examiners proposes new §184.25,
concerning surgical assistants. The amendments concern continuing education
for surgical assistants.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rule is in effect there
will be an impact to those required to comply with continuing education requirements.
The cost will vary depending on the courses taken by the licensee. There will
be no effect to state or local government.
Ms. Shackelford also has determined that for each year of the first five
years the rule as proposed is in effect the public benefit anticipated as
a result of enforcing the section will be an active rule regarding continuing
education for surgical assistants. There will be no effect on small or micro
businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new rule is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed new rule: Texas Occupations
Code Annotated, §§206.201 and .210.
§184.25.Continuing Education.
(a)
As a prerequisite to the annual registration of a surgical
assistant's license, 18 hours of continuing education (CE) in surgical assisting
or in courses that enhance the practice of surgical assisting 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 I credit by a CE sponsor
accredited by the Accreditation Council for Continuing Medical Education;
(B)
approved for prescribed credit by the Association of Surgical
Technologists/Association of Surgical Assistants, the American Board of Surgical
Assistants, or the National Surgical Assistants Association;
(C)
approved by the Texas Medical Association based on standards
established by the AMA; or
(D)
designated for AOA Category 1-A credit approved by the
American Osteopathic Association.
(2)
At least one of the formal hours of CE which are required
by paragraph (1) of this subsection must involve the study of medical ethics
and/or professional responsibility. Whether a particular hour of CE involves
the study of medical ethics and/or professional responsibility shall be determined
by the organizations which are enumerated in paragraph (1) of this subsection
as part of their course planning.
(3)
The remaining hours may be composed of informal self-study,
attendance at hospital lectures or grand rounds not approved for formal CE,
or case conferences and shall be recorded in a manner that can be easily transmitted
to the board upon request.
(b)
A licensed surgical assistant must report on the license
renewal application if he or she has completed the required continuing education
during the previous year. A licensee may carry forward CE credit hours earned
prior to an annual registration report which are in excess of the 18-hour
annual requirement and such excess hours may be applied to the following years'
requirements. A maximum of 36 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 CE credit hours of any type may not be carried forward
or applied to an annual report of CE more than two years beyond the date of
the annual registration following the period during which the hours were earned.
(c)
A licensed surgical assistant 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)
residence of longer than one year's duration outside the
United States; or
(4)
good cause shown submitted in writing by the licensee that
gives satisfactory evidence to the board that the licensee is unable to comply
with the requirement for continuing education.
(d)
Exemptions are subject to the approval of the executive
director of the board and must be requested in writing at least 30 days prior
to the expiration date of the license.
(e)
A exception under subsection (c) of this section may not
exceed one year but may be requested annually, subject to the approval of
the executive director or the board.
(f)
This section does not prevent the board from taking board
action with respect to a licensee or an applicant for a license by requiring
additional hours of continuing education or of specific course subjects.
(g)
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.
(h)
Unless exempted under the terms of this section, a licensee's
apparent failure to obtain and timely report the 18 hours of CE as required
and provided for in this section shall result in the denial of licensure renewal
until such time as the licensee obtains and reports the required CE hours;
however, the executive director of the board may issue to such a surgical
assistant 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 surgical assistant
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.
(i)
CE hours that are obtained to comply with the CE requirements
for the preceding year as a prerequisite for obtaining licensure renewal,
shall first be credited to meet the CE requirements for the previous year.
Once the previous year's CE requirement is satisfied, any additional hours
obtained shall be credited to meet the CE requirements for the current year.
(j)
A false report or statement to the board by a licensee
regarding CE hours reportedly obtained shall be a basis for disciplinary action
by the board pursuant to §206.302-.304 of the Act and §164.051-.053
of the Medical Practice Act, Tex. Occ. Code Ann. 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 surgical assistant's
license, but in no event shall such action be less than an administrative
penalty of $500.
(k)
Administrative penalties for failure to timely obtain and
report required CE hours may be determined by the Disciplinary Process Review
Committee of the board as provided for in §184.19 of this chapter (relating
to Administrative Penalties).
(l)
Unless otherwise exempted under the terms of this section,
failure to obtain and timely report CE hours for the renewal of a license
shall subject the licensee to a monetary penalty for late registration in
the amount set forth in §184.10 of this chapter (relating to Fees Related
to the Renewal of Expired Licenses). Any temporary CE licensure fee and any
administrative penalty imposed for failure to obtain and timely report the
18 hours of CE required for renewal of a license shall be in additional to
the applicable penalties for late registration or as set forth in §184.11
of this chapter (relating to Fees).
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, 2003.
TRD-200301122
Donald W. Patrick MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
Subchapter B. INFORMAL BOARD PROCEEDINGS
22 TAC §§187.10, 187.12, 187.13
The Texas State Board of Medical Examiners proposes amendments
to §§187.10, 187.12 and 187.13, concerning Procedural Rules. The
amendments are necessary to formalize the procedure whereby the Executive
Director has the authority to offer restricted licenses and permits.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendments are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the amendments as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be formalized procedures regarding
restricted license and permits. There will be no effect on small or micro
businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments: §§155.001-.008;
155.051-.058; 155.1025-.107; 155.151-.152; 164.001; 164.051.
§187.10.Purpose.
The purpose of informal board proceedings is to provide notice to an
applicant or licensee of
alleged violations of board rules or the Act,
or
the basis of denial of
or ineligibility for
licensure
[
§187.12.Notice.
The applicant or licensee shall be given notice of the opportunity
to attend and participate at an informal board proceeding by hand delivery,
regular mail, certified mail - return receipt requested, overnight or express
mail, or registered mail to the address of record. The notice shall include
the basis for denial
or ineligibility
or the alleged violations
and a description of the process for informal board proceedings. Within the
written notice, the
applicant or
licensee shall be adequately informed
that failure to respond to the allegations either in writing or by personal
appearance may result in default judgment.
§187.13.Informal Board Proceedings Relating to Licensure Eligibility.
(a)
Recommendations by the Executive Director.
[
(1)
The executive director shall review applications
for licensure.
If an applicant is determined to be ineligible for a
license by the executive director pursuant to §§155.001-155.152
of the Act
,
[
(2)
To promote the expeditious resolution
of any licensure matter, the executive director with the approval of the board,
may recommend that an applicant be eligible for a license only under certain
terms and conditions and present a proposed agreed order to the applicant.
(A)
If the proposed agreed order is acceptable to the applicant,
the applicant shall sign the order and the order shall be presented to the
board for consideration and acceptance without conducting an informal board
proceeding relating to licensure eligibility.
(B)
If the proposed agreed order is not acceptable to the applicant,
the applicant may request review of the executive director's recommendation
by a committee of the board. The applicant must request review not later than
the 20th day after the date the applicant receives notice of the executive
director's recommendation.
(b)
Determination by
a Committee of the Board
[
[
(1)
Licensure with Restrictions.
(A)
[
(B)
Upon an affirmative majority vote of members
present, the board may approve the agreed order with or without modifications,
and direct staff to present the order to the applicant. The order shall bear
the signature of the president of the board. If the applicant agrees to the
terms of the proposed agreed order, the effective date of the order shall
be upon the signing of the order by the applicant and passage of the medical
jurisprudence examination, if applicable.
(C)
If the board does not approve the proposed
agreed order, the applicant shall be so informed and the matter shall referred
to board staff for appropriate action that may include further investigation
or negotiation, or an additional appearance by the applicant before a committee
of the board. The board must specify their rationale for the rejection of
the proposed agreed order that shall be referenced in the minutes of the board.
(2)
[
(c)
Notice. An applicant determined to be ineligible for licensure
by the board shall be notified of the board's determination and given the
option of appealing the board's decision to SOAH. An applicant has 20 days
from the date the applicant receives notice of the board's determination to
make the request. If an applicant requests a SOAH hearing, the matter shall
be referred to board staff. If the applicant does not timely request a SOAH
hearing, the board's decision shall become administratively final.
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, 2003.
TRD-200301123
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
22 TAC §§196.1 - 196.5
The Texas State Board of Medical Examiners proposes amendments
to §§196.1-196.5, concerning Voluntary Surrender of a Medical License.
The amendments are necessary for general clean up of the chapter.
Elsewhere in this issue of the
Texas Register
, the Texas State Board of Medical Examiners proposes the rule review
for Chapter 196.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendments are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the amendments as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be clear and updated rules. There
will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments: Texas Occupations
Code Annotated, Chapter 155, Subchapters A-C; §§164.051; 164.061.
§196.1.Surrender of License.
(a)
Surrender by licensee.
(1)
A licensee may at any time voluntarily surrender his or
her license to practice medicine in Texas for any reason, without compulsion.
(2)
Tender of the license may be by delivery by any means to
the offices of the board, return receipt requested.
(b)
Acceptance by the board.
[
[(2)
The board shall safeguard and keep secure
any and all Texas medical licenses tendered to the board for purposes of a
voluntary surrender until such time as the board determines an appropriate
disposition of the license.]
§196.2.Surrender Associated with Disciplinary Action.
(a)
When a licensee has surrendered his or her Texas medical
license in lieu of a hearing or further investigation of alleged violations
of the Medical Practice Act
("the Act"), Title 3 Subtitle B Tex. Occ.Code
[
(b)
[
[
(c)
If a licensee agrees to permanently surrender
his or her license in lieu of disciplinary action, the licensee forfeits all
rights to apply for any type of licensure with the board.
§196.3.Surrender Associated with Impairment.
(a)
When a licensee who, by reason of impairment from illness,
drunkenness, excessive use of drugs, narcotics, chemicals, or any other type
of substance
[
(b)
A Texas medical license surrendered in accordance with
this section shall not be returned to a licensee until after the board has
determined that the licensee is competent to resume practice based on adequate
medical and treatment information provided to the board.
§196.4. Reapplication for Licensure After Surrender of License. [
In addition to other requirements established under this chapter,
whenever
[
§196.5.Competence to Resume Practice.
(a)
Unless otherwise specified in an [
(b)
Competence to resume practice may be shown by the licensee
providing probative credible evidence to indicate that he or she is fit to
resume the practice of medicine. Likewise, any controverting evidence may
be introduced to show the licensee's lack of competence or fitness.
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, 2003.
TRD-200301124
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
22 TAC §§200.1 - 200.3
The Texas State Board of Medical Examiners proposes amendments
to §200.2 and §200.3, concerning Integrative and Complementary Medicine.
The amendments are necessary for general cleanup of the chapter, including
detailed requirements regarding informed consent, treatment plan, adequate
medical records, therapeutic validity, and clinical investigations. The chapter
title will be changed to Standards for Physicians Practicing Complementary
and Alternative Medicine.
Elsewhere in this issue of the
Texas Register
, the Texas State Board of Medical Examiners proposes the rule review
for Chapter 200.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the amendments are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the amendments as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be updated regulations. There will
be no effect on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments: Texas Occupations
Code Annotated, §§164.051-.053.
§200.1.Purpose.
The purpose of this chapter is to recognize that physicians should
be allowed a reasonable and responsible degree of latitude in the kinds of
therapies they offer their patients. The Board also recognizes that patients
have a right to seek [
§200.2.Definitions.
The following words and terms, when used in this section, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
[
(2)
Conventional Medicine--Those health care methods of diagnosis,
treatment, or interventions that are offered by most licensed physicians as
generally accepted methods of routine practice, based upon medical training,
experience and review of the peer reviewed scientific literature.
(3)
Reasonable Potential for Therapeutic Gain--An
expected beneficial outcome resulting from the application of a health care
method containing medicinal or healing properties that is supported by scientific
evidence and does not solely rely on placebo effect.
§200.3.Practice Guidelines for the Provision of [
A licensed physician shall not be found guilty of unprofessional conduct
or be found to have committed professional failure to practice medicine in
an acceptable manner solely on the basis of employing a health care method
of [
(1)
Patient Assessment.
Prior to offering advice
about complementary
and alternative
health care therapies, the
physician shall undertake an assessment of the patient. This assessment should
include but not be limited to, conventional methods of diagnosis and may include
non-conventional methods of diagnosis [
(A)
an appropriate medical history and physician
examination of the patient;
[(A)
adequate medical records as defined in §165.1
of this title (relating to Medical Records);]
(B)
[
(C)
[
[(D)
if a treatment is offered which is not
considered to be conventional, documentation of at least a verbal informed
consent for each treatment plan must be included (including documentation
that the risks and benefits of the use of the treatment were discussed with
the patient or guardian);]
(D)
[
(2)
Required Informed Consent. Prior to rendering
any complementary or alternative treatment, the physician shall obtain written
informed consent from the patient that includes the following:
(A)
the objectives, expected outcomes, or goals of the proposed
treatment, such as functional improvement, pain relief, or expected psychosocial
benefit;
(B)
the risks and benefits of the proposed treatment;
(C)
the extent the proposed treatment could interfere with
any ongoing or recommended medical care;
(D)
a description of the underlying therapeutic basis or mechanism
of action of the proposed treatment purporting to have a reasonable potential
for therapeutic gain that is written in a manner understandable to the patient;
and
(E)
if applicable, whether a drug, supplement, or remedy employed
in the treatment is:
(i)
approved for human use by the U.S. Food and Drug Administration
(FDA);
(ii)
exempt from FDA preapproval under the Dietary Supplement
and Health Education Act (DSHEA); or
(iii)
a pharmaceutical compound not commercially available
and, therefore, is also an investigation article subject to clinical investigation
standards as discussed in paragraph (7) of this subsection.
(3)
Treatment Plan.
(A)
[
(B)
The treatment offered should:
(i)
have a favorable risk/benefit ratio compared to other treatments
for the same condition;
(ii)
be based upon a reasonable expectation that it will result
in a favorable patient outcome, including preventive practices; and
(iii)
be based upon the expectation that a greater benefit
for the same condition will be achieved than what can be expected with no
treatment.
(4)
[
(4)
Complete and accurate records of the care
provided including the elements addressed in paragraph 1 (A)-(E) of this section
should be kept.
(5)
Adequate Medical Records. In addition
to those elements addressed in paragraph (1)(A)-(D) of this section, a physician
implementing complementary and alternative therapies shall keep accurate and
complete medical records to include:
(A)
any diagnostic, therapeutic and laboratory results;
(B)
the results of evaluations, consultations and referrals;
(C)
treatments employed and their progress toward the stated
objectives, expected outcomes, and goals of the treatment;
(D)
the date, type, dosage, and quantity prescribed of any
drug, supplement, or remedy used in the treatment plan;
(E)
all patient instructions and agreements;
(F)
periodic reviews;
(G)
documentation of any communications with the patient's
concurrent healthcare providers informing them of treatment plans.
(6)
Therapeutic Validity All physicians must
be able to demonstrate the medical, scientific, or other theoretical principles
connected with any healthcare method offered and provided to patients.
(7)
Clinical Investigations. Physicians using
conventional medical practices or providing complementary and alternative
medicine treatment while engaged in the clinical investigation of new drugs
and procedures (a.k.a. medical research, research studies) are obligated to
maintain their ethical and professional responsibilities. Physicians shall
be expected to conform to the following ethical standards:
(A)
Clinical investigations, medical research,
or clinical studies should be part of a systematic program competently designed,
under accepted standards of scientific research, to produce data that are
scientifically valid and significant;
(B)
A clinical investigator should demonstrate
the same concern and caution for the welfare, safety and comfort of the patient
involved as is required of a physician who is furnishing medical care to a
patient independent of any clinical investigation; and
(C)
A clinical investigator must have patients
sign informed consent forms that are compliant with federal regulations, if
applicable, and that indicate that the patients understand that they are participating
in a clinical trial or investigational research.
(8)
[
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, 2003.
TRD-200301158
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7016
Chapter 395.
CODE OF OPERATING PROCEDURE OF POLYGRAPH EXAMINERS
22 TAC §395.17
(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 Polygraph Examiners Board or in the Texas Register office, Room 245, James
Earl Rudder Building, 1019 Brazos Street, Austin.)
The Polygraph Examiners Board proposes the repeal
to §395.17, concerning Code of Operating Procedure of Polygraph Examiners.
The Texas Polygraph Board Examiners voted at its last board meeting, February
10, 2003 to publish for public comment the repeal of §395.17. This repeal
is in response to an April 2000 Attorney General Opinion JC-0204, which stated
that the board did not have the authority to inspect polygraph records unless
a formal complaint was filed. Therefore, §395.17 is no longer enforceable.
Frank DiTucci, Executive Officer, Polygraph Examiners Board, has determined
that the repeal will not result in any fiscal implications to the state or
to units of local government for the first five year period.
Mr. DiTucci also has determined that for each year of the first five years
the repeal is in effect the public benefit anticipated as a result of enforcing
the repeal will be board compliance with Attorney General Opinion JC-0204.
There will be no effect on small businesses. There are no anticipated economic
costs to persons who are required to comply with the repeal as proposed.
Comments on the repeal may be submitted to: Frank DiTucci, Executive Officer,
Polygraph Examiners Board, P.O. Box 4087, Austin, Texas 78773-0001. Written
comments will be accepted up to May 8, 2003 or can be presented in person
at the next scheduled board meeting, May 20, 2003.
The repeal is proposed under the Polygraph Examiners Act, Article
4413 (29cc), §6, which provides the board with the authority to prescribe,
adopt, and enforce rules relating to the administration and enforcement of
the provisions of the Polygraph Examiners Act, Article 4413 (29cc).
The repeal implements the Polygraph Examiners Act, Article 4413 (29cc).
§395.17.Written Authorization To Inspect Polygraph Records.
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 13, 2003.
TRD-200301099
Frank DiTucci
Executive Director
Polygraph Examiners Board
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 424-2058
Chapter 461.
GENERAL RULINGS
22 TAC §461.3
The Texas State Board of Examiners of Psychologists proposes
amendments to §461.3, concerning Former Board Members. These amendments
are being proposed in order to clarify that former Board members may be utilized
as oral examiners or professional reviewers in furtherance of the Board's
licensing and enforcement strategies.
Sherry L. Lee, Executive Director, 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.
Ms. Lee 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 to make the rules easier for the licensees and public to
follow and understand. There will be no effect on small businesses. There
is no anticipated economic cost to persons who are required to comply with
the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State
Board of Examiners of Psychologists, 333 Guadalupe, Suite 2- 450, Austin,
TX 78701, (512) 305-7700.
The amendments are proposed under Texas Occupations Code, Title
3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners
of Psychologists with the authority to make all rules, not inconsistent with
the Constitution and Laws of this State, which are reasonably necessary for
the proper performance of its duties and regulations of proceedings before
it.
The proposed amendment does not affect other statutes, articles, or codes.
§461.3.Former Board Members.
A Board member whose term has expired and who has ceased to serve as
a Board member will not be employed or utilized to represent the Board in
any official capacity
except to serve as an oral examiner or as a professional
reviewer
. A former Board member may not hold himself or herself out
as an official or unofficial representative of the Board. Any such representations
are not binding upon the Board in any way. Disclosure of confidential or privileged
information obtained by a former Board member in his or her capacity as a
Board member is unprofessional conduct and grounds for disciplinary action
by the Board.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 13, 2003.
TRD-200301100
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7700
22 TAC §461.7
The Texas State Board of Examiners of Psychologists proposes
amendments to §461.7, concerning License Statuses. These amendments are
being proposed in order to (1) explicitly state that a person with a pending
complaint cannot go on inactive status, (2) clarify the meaning of "restricted
status", and (3) eliminate the "resigned in lieu of delinquency" status due
to its not being used.
Sherry L. Lee, Executive Director, 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.
Ms. Lee 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 to make the rules easier for the licensees and public to
follow and understand. There will be no effect on small businesses. There
is no anticipated economic cost to persons who are required to comply with
the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State
Board of Examiners of Psychologists, 333 Guadalupe, Suite 2- 450, Austin,
TX 78701, (512) 305-7700.
The amendments are proposed under Texas Occupations Code, Title
3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners
of Psychologists with the authority to make all rules, not inconsistent with
the Constitution and Laws of this State, which are reasonably necessary for
the proper performance of its duties and regulations of proceedings before
it.
The proposed amendment does not affect other statutes, articles, or codes.
§461.7.License Statuses.
(a)
(No change.)
(b)
Inactive Status.
(1)
(No change.)
(2)
A person may place his/her active license on inactive status
for a period of two years. Reactivation of this license may occur at any time
during this two-year period without the person having to take an exam provided
that the person has notified the Board and has paid the required fees. At
the end of the two-year period, if the
license
[
(3)
(No change.)
(4)
A person with a pending complaint may
not
place
a license on inactive status. [
(c)
(No change.)
(d)
Restricted status. Any licensee that is currently
suspended, on probated suspension, or is currently required to fulfill some
requirement in a Board order
[
(e)
(No change.)
(f)
Resignation Status. A person may resign only upon express
agreement by the Board. A person who resigns shall be reported as:
(1)-(2)
(No change.)
[
(g)-(h)
(No change)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 13, 2003.
TRD-200301101
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7700
22 TAC §461.11
The Texas State Board of Examiners of Psychologists proposes
amendments to §461.11, concerning Continuing Education. These amendments
are being proposed in order to (1) add a requirement that three hours of continuing
education per year be taken in the area of ethics or professional responsibility,
a requirement that is contained in the Rules of other mental health licensing
agencies; (2) make clear that online courses are accepted so long as they
have a certificate of completion; and (3) clarify that certain licensees may
declare Continuing Education on online license renewal forms.
Sherry L. Lee, Executive Director, 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.
Ms. Lee 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 to make the rules easier for the licensees and public to
follow and understand. There will be no effect on small businesses. There
is no anticipated economic cost to persons who are required to comply with
the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State
Board of Examiners of Psychologists, 333 Guadalupe, Suite 2- 450, Austin,
TX 78701, (512) 305-7700.
The amendments are proposed under Texas Occupations Code, Title
3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners
of Psychologists with the authority to make all rules, not inconsistent with
the Constitution and Laws of this State, which are reasonably necessary for
the proper performance of its duties and regulations of proceedings before
it.
The proposed amendment does not affect other statutes, articles, or codes.
§461.11.Continuing Education.
(a)
Requirements. All licensees of the Board are obligated
to continue their professional education by completing a minimum of 12 hours
of continuing education during each year that they hold a license from the
Board regardless of the number of separate licensees held by the licensee.
Of these 12 hours, all licensees must complete a minimum of three hours of
continuing education per year in the areas of ethics, the Board's Rules of
Conduct, or professional responsibility.
(b)
Relevancy. All continuing education hours must be directly
related to the practice of psychology. The Board shall make the determination
as to whether the activity or publication claimed by the licensee is directly
related to the practice of psychology. [
(c)
(No change.)
(d)
Documentation. It is the responsibility of each licensee
to maintain documentation of all continuing education hours claimed under
this rule and to provide this documentation upon request by the Board. Licensees
shall maintain documentation of all continuing education hours claimed for
at least five years. The Board will accept as documentation of continuing
education:
(1)-(3)
(No change.)
(4)
for presenters of continuing education workshops or programs,
copies of the official program announcement naming the licensee as a presenter
and an outline or syllabus of the contents of the program or workshop; [
(5)
for authors or editors of publications, a copy of the article
or table of contents or title page bearing the name of licensee as the author
or editor
; and
(6)
for online or self-study courses, a copy
of the certificate of completion generated by the completion of the course
.
(e)
Declaration Form. All licensees must sign and submit a
completed Continuing Education Declaration Form for each year in which they
are licensed by the Board specifying the continuing education received for
the preceding renewal period. Licensees wishing to renew their license must
submit the declaration form with the annual renewal form and fee no later
than the renewal date. Licensees who do not wish to renew their license must
submit the declaration form along with a written request to retire the license
on or before the renewal date. Licensees shall not submit documentation of
continuing education credits obtained unless requested to do so by the Board.
Licensees who are not audited pursuant to subsection (f) of this section and
who are otherwise eligible may declare their continuing education on the online
license renewal form.
(f)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 13, 2003.
TRD-200301102
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7700
22 TAC §461.15
The Texas State Board of Examiners of Psychologists proposes
amendments to §461.15, concerning Compliance with Act, Rules, Board Directives
and Orders. These amendments are being proposed in order to clarify the responsibility
of a licensee to comply with Board requests for information pursuant to an
investigation.
Sherry L. Lee, Executive Director, 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.
Ms. Lee 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 to make the rules easier for the licensees and public to
follow and understand. There will be no effect on small businesses. There
is no anticipated economic cost to persons who are required to comply with
the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State
Board of Examiners of Psychologists, 333 Guadalupe, Suite 2- 450, Austin,
TX 78701, (512) 305-7700.
The amendments are proposed under Texas Occupations Code, Title
3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners
of Psychologists with the authority to make all rules, not inconsistent with
the Constitution and Laws of this State, which are reasonably necessary for
the proper performance of its duties and regulations of proceedings before
it.
The proposed amendment does not affect other statutes, articles, or codes.
§461.15.Compliance with Act, Rules, Board Directives and Orders.
Licensees must comply with the Act, Rules, Board Directives and Board
Orders and must cooperate with Board investigations
as prescribed in §465.35
of this title. Failure to comply may subject the licensee to a Board-initiated
complaint and disciplinary action.
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 13, 2003.
TRD-200301103
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7700
22 TAC §461.17
The Texas State Board of Examiners of Psychologists proposes
amendments to §461.17, concerning Profile Information. These amendments
are being proposed to clarify that providing profile information is a requirement
for annual license renewal (online or otherwise) for licensed psychologists.
Sherry L. Lee, Executive Director, 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.
Ms. Lee 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 to make the rules easier for the licensees and public to
follow and understand. There will be no effect on small businesses. There
is no anticipated economic cost to persons who are required to comply with
the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State
Board of Examiners of Psychologists, 333 Guadalupe, Suite 2-450, Austin, TX
78701, (512) 305-7700.
The amendments are proposed under Texas Occupations Code, Title
3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners
of Psychologists with the authority to make all rules, not inconsistent with
the Constitution and Laws of this State, which are reasonably necessary for
the proper performance of its duties and regulations of proceedings before
it.
The proposed amendment does not affect other statutes, articles, or codes.
§461.17.Profile Information.
The Board is required to establish a system whereby licensed psychologists
will have public profile information maintained by the Board. The Board must
collect a fee to be set by the Texas Online Authority beginning in 2002 for
this system.
Licensed psychologists must supply this information as a
condition of annual renewal. This information may be supplied as a part of
the online renewal process.
The Board collects the following information
as part of its profile information on licensed psychologists:
(1)-(8)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on February 13, 2003.
TRD-200301104
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7700
22 TAC §463.2
The Texas State Board of Examiners of Psychologists proposes
amendments to §463.2, concerning Application Process. These amendments
are being proposed in order that a applicant may have two simultaneous applications
with the Board, so long as the second application is to become an LSSP.
Sherry L. Lee, Executive Director, 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.
Ms. Lee 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 to make the rules easier for the licensees and public to
follow and understand. There will be no effect on small businesses. There
is no anticipated economic cost to persons who are required to comply with
the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State
Board of Examiners of Psychologists, 333 Guadalupe, Suite 2- 450, Austin,
TX 78701, (512) 305-7700.
The amendments are proposed under Texas Occupations Code, Title
3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners
of Psychologists with the authority to make all rules, not inconsistent with
the Constitution and Laws of this State, which are reasonably necessary for
the proper performance of its duties and regulations of proceedings before
it.
The proposed amendment does not affect other statutes, articles, or codes.
§463.2.Application Process.
Applications for licensure are processed in the following manner:
(1)
An individual requests the application packet for the type
of licensure desired and includes the fee for the Board to send the application
packet. No applicant can have more than one application pending before the
Board at one time,
unless the second application is to become a
[
(2)-(5)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on February 13, 2003.
TRD-200301105
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7700
22 TAC §463.9
The Texas State Board of Examiners of Psychologists proposes
amendments to §463.9, concerning Licensed Specialist in School Psychology.
These amendments are being proposed in order to clarify that all applicants
for a license as a licensed specialist in school psychology must have a formal
internship through a regionally accredited institution of higher education.
Sherry L. Lee, Executive Director, 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.
Ms. Lee 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 to make the rules easier for the licensees and public to
follow and understand. There will be no effect on small businesses. There
is no anticipated economic cost to persons who are required to comply with
the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State
Board of Examiners of Psychologists, 333 Guadalupe, Suite 2- 450, Austin,
TX 78701, (512) 305-7700.
The amendments are proposed under Texas Occupations Code, Title
3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners
of Psychologists with the authority to make all rules, not inconsistent with
the Constitution and Laws of this State, which are reasonably necessary for
the proper performance of its duties and regulations of proceedings before
it.
The proposed amendment does not affect other statutes, articles, or codes.
§463.9.Licensed Specialist in School Psychology.
(a)-(b)
(No change.)
(c)
Completion of internship. Applicants must have completed
a minimum of 1200 hours, of which 600 must be in a public school.
A
[
(d)-(f)
(No change.)
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 13, 2003.
TRD-200301106
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: March 30, 2003
For further information, please call: (512) 305-7700
is approved by the
board.
]
(3)
] Affiliated hospital -- Affiliation
status of a hospital with a medical school as defined by the Liaison Committee
on Medical Education and documented by the medical school in its application
for accreditation.
(4)
] Applicant -- One who files
an application as defined in this section.
(5)
] Application -- An application
is all documents and information necessary to complete an applicant's request
for licensure including the following:
(10)
] One-year training program
-- Applicants who are graduates of acceptable approved medical schools must
successfully complete one
continuous
year of postgraduate training
approved by the board that is:
(11)
] Sixty (60) semester hours
of college courses -- 60 semester hours of college courses other than in medical
school that are acceptable to The University of Texas at Austin for credit
on a bachelor of arts degree or a bachelor of science degree; the entire primary,
secondary, and premedical education required in the country of medical school
graduation, if the medical school is located outside the United States or
Canada; or substantially equivalent courses as determined by the board.
(12)
] Substantially equivalent
to a Texas medical school -- A medical school or college that is an institution
of higher learning designed to select and educate medical students; provide
students with the opportunity to acquire a sound basic medical education through
training in basic sciences and clinical sciences; provide advancement of knowledge
through research; develop programs of graduate medical education to produce
practitioners, teachers, and researchers; and afford opportunity for postgraduate
and continuing medical education. The school must provide resources, including
faculty and facilities, sufficient to support a curriculum offered in an intellectual
environment that enables the program to meet these standards. The faculty
of the school shall actively contribute to the development and transmission
of new knowledge. The medical school shall contribute to the advancement of
knowledge and to the intellectual growth of its students and faculty through
scholarly activity, including research. The medical school shall include,
but not be limited to, the following characteristics:
and
] histology,
physiology, microbiology
,
[
and
] immunology, pathology,
pharmacology and neuroscience, as defined by the Texas Higher Education Coordinating
Board.
(13)
] Three-year training program
-- Applicants who are graduates of,
or have studied at an acceptable
unapproved
foreign
medical schools must successfully complete
three
continuous
years of postgraduate training in the United States
or Canada
, progressive in nature and acceptable for specialty board certification
in one specialty area
that is:
Chapter 167.
REINSTATEMENT AND REISSUANCE
The
] applicant whose license has
been suspended
by order of the board
must
submit a written
request to the board's compliance division and
appear [
before the
board
]
at a probationer show compliance proceeding as described
in §187.44 of this title (relating to Probationer Show Compliance Proceedings)
and in paragraph (2) of this subsection
to request reinstatement of
licensure
[
license
].
Request
] for reinstatement
following suspension cannot be considered more often than annually unless
otherwise specified by
order
[
Order
] of the
board
[
Board
].
Application
] for
reissuance
of a license
following revocation cannot be considered
more often than annually.
Informal Disposition of ] Requests for Reinstatement.
informal
] dispositions of any
requests for reinstatement of a medical license following suspension.
an informal
]
disposition of any request for reinstatement of a medical license following
suspension by stipulation, agreed order, agreed settlement, consent order,
or default.
an informal settlement conference
].
If the opportunity for an informal settlement conference
is provided to an applicant, the
]
In accordance with §187.44
of this title (relating to Probationer Show Compliance Proceedings) an
applicant
for reinstatement
shall be provided with written notice of the time,
date, and location of the [
conference
]
probationer show compliance
proceeding
and the rules governing the proceeding by certified mail
- return receipt requested, overnight or express mail, or registered mail,
to the last mailing address of the applicant or the applicant's attorney on
file with the board.
(6)
] The
probationer show
compliance proceeding
[
informal settlement conference
] shall
allow:
Order
] suspending his license if applicable;
(7)
] The board's representative(s)
shall exclude from the
probationer show compliance proceeding
[
informal settlement conference
] all persons except witnesses during
their testimony or presentation of statements, the applicant, the applicant's
attorney or representative, board members, district review committee members,
and board staff.
(8)
] During the
probationer
show compliance proceeding
[
informal settlement conference
],
the board's legal counsel [
or a representative of the Office of the Attorney
General
] shall be present to advise the board's representative(s) or
the board's employees.
(9)
] [
Except with the agreement
of the applicant, during
]
During
the deliberations of an
appropriate settlement, the board's representative(s) at
a probationer
show compliance proceeding
[
an informal settlement conference
]
shall exclude [
the board staff which presented the allegations and facts
related to the request for reinstatement following suspension,
] the
applicant, the applicant's attorney or representative, any witnesses, and
the general public. A board legal counsel
and board staff
[
or representative of the Office of the Attorney General
] shall be available
to assist the representative(s) in their deliberations.
(11)
] At the
probationer show
compliance proceeding
[
informal settlement conference,
] the
board's representative(s) will attempt to mediate disputed matters, and the
board's representative(s) may call upon the board staff at any time for assistance
in conducting the
proceeding
[
informal settlement conference
].
(12)
] The board's representative(s)
shall prohibit or limit access to the board's investigative file by the applicant,
the applicant's attorney or representative, any witnesses, and the public
consistent with the Medical Practice Act, §164.007.
(15)
] At the conclusion of the
probationer show compliance proceeding
[
informal settlement conference
], the board's representative(s) shall make recommendations for disposition
of the request for reinstatement which may include deferral pending receipt
of additional information, denial of the request, or in accordance with
board rule §187.43
[
Board Rule §187.38
] of this
title (relating to
Proceedings for the
Modification/Termination
of Agreed Orders and Disciplinary Orders), a modification or termination of
the agreed or disciplinary order under which the suspension was originally
granted. The board's representative(s) may make recommendations to the applicant
for resolution of the issues. Such recommendations may include any reasonable
restrictions authorized by the Act and any other remedial actions in the public
interest. These recommendations may be subsequently modified by the board's
representative(s) or staff based on new information, a change of circumstance,
or to expedite a resolution in the interest of protecting the public. These
recommendations may be adopted, modified, or rejected by the duly convened
board or through the duly authorized actions of the board's Disciplinary Process
Review Committee.
(16)
] The applicant may either
accept or reject the settlement recommendations proposed by the board's representative(s).
If the applicant accepts the recommendations, the applicant shall execute
the settlement agreement in the form of an agreed order or affidavit as soon
thereafter as is practicable. If the applicant rejects the proposed agreement,
the applicant shall be given the option of requesting a formal hearing. If
the applicant requests a formal hearing, the matter shall be referred to the
board's staff for hearing, as described in Chapter 187, Subchapter C of this
title (relating to
Formal Proceedings at SOAH
[
Hearing
]).
(17)
] Following acceptance and
execution by the applicant of the settlement agreement, the agreement shall
be submitted to the board for approval.
(18)
] The following as stated
in subparagraphs (A)-(C) of this paragraph relate to consideration of an agreed
disposition by the board.
informal settlement conference
] or a
formal
hearing.
an informal settlement conference
]. If the board does not
approve such a proposed settlement agreement, the applicant shall be so informed
and the matter shall be referred to the board staff for appropriate action
to include further negotiation, further investigation,
a probationer
show compliance proceeding
[
an informal settlement conference
]
or a hearing.
Order
] which led to the revocation or suspension of a license; and
Order
] leading to revocation or suspension of a license or any competency,
technical, educational, training or ethical limitations found since the entry
of the order;
Order
] or
other terms and conditions as agreed to by the physician or authorized by §§164.101-.102
of the Act;
Board
]; and
Board
] shall require an applicant for reissuance 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.
Order
] revoking
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
[
Order
] may be admissible and relevant
for purposes of establishing the basis for the original action and subsequent
efforts after the
order
[
Order
] by the physician to
demonstrate reinstatement of the license is in the best interests of the public
and the applicant physician.
Chapter 169.
AUTHORITY OF PHYSICIANS TO SUPPLY DRUGS
Texas Civil Statutes, Article 4495b, section
3.06(d)(2)
and 5.09,
] and by the Texas Pharmacy Act
Title 3 Subtitle
J Tex. Occ.Code Ann.
Texas Civil Statutes, Article 4495b
].
drug, medicine, or
] dangerous drug
or controlled substance
.
which
] have
been examined or evaluated by a physician and which are used as a guide in
preparation for and carrying out medical and/or surgical procedures. These
orders, rules, regulations, or procedures are authority and direction for
the performance for certain prescribed acts for patients by authorized persons
as distinguished from specific orders written for a particular patient.
authority for administration of drugs to patients in his or her office
]
to any qualified and properly trained person
the authority to administer
drugs
. A physician shall comply with all appropriate record keeping
requirements applicable to the drugs administered, or shall assure compliance
with said record keeping requirements by persons acting under the physician's
direction and supervision. A physician may charge a fee for
the
administration
of drugs to a patient that is separate from fees charged for other medical
services. The separate fee shall allow the physician to recover the cost of
administration, including the cost of the drug itself.
in which there is no pharmacy
] may maintain a supply of dangerous
drugs in his or her office to be dispensed in treating his or her patients
and may be reimbursed for the cost of supplying those drugs without violating
the Texas Pharmacy Act,
Title 3 Subtitle J Tex. Occ. Code Ann.
[
Texas Civil Statutes, Article 4542a-1
]. A physician desiring to dispense
dangerous drugs in compliance with this subsection and
§§158.001-.003
of the Act
[
Texas Civil Statutes, Article 4495b, 5.09(c)
],
shall notify the board and the Texas State Board of Pharmacy that he or she
practices in a rural area.
section 13.28, Texas Department of Public Safety,
controlled substance regulations
]
(Receipt or Distribution of Controlled
Substances)
.
Chapter 171.
POSTGRADUATE TRAINING PERMITS
The board may, in its discretion, retain jurisdiction
over a permit and the permit holder if the permit is terminated, canceled
and/or expires while the permit holder is under investigation
].
30
] days
(excluding vacation, family, or military leave)
and the reason(s) why;
any relevant information relating
to the acts of any permit holder if in the opinion of the director of the
program the permit holder poses a threat to the public welfare through the
practice of medicine
].
Chapter 174.
TELEMEDICINE
§3.06(i) (concerning practice
in another jurisdiction involving care initiated in this state)
].
(4)
] Medium--Any mechanism of information
transfer including electronic means.
(5)
] Patient care service initiated
in this state--Any act constituting the practice of medicine as defined in
this chapter in which the patient is physically located in Texas at the time
of diagnosis, treatment, or testing.
(6)
] Person--An individual unless
otherwise expressly made applicable to a partnership, association, or corporation.
(7)
] Practice of medicine--A person
shall be considered to be practicing medicine under any of the following circumstances:
(C)
] the person is physically located
in another jurisdiction, other than the state of Texas, and through any medium
performs an act that is part of patient care service initiated in this state
that would affect the diagnosis or treatment of the patient.
(8)
] State--Any state, territory,
or insular possession of the United States and the District of Columbia.
§3.06(i)
], and §174.2 of this title (relating to Definitions), the person
must:
Subchapter C (concerning Licensure)
], a person holding a special purpose
license shall not be authorized to physically practice medicine in the state
of Texas.
§3.08
(concerning application denials and grounds for disciplinary action)
].
§3.08 (concerning
application denials and grounds for disciplinary action)
] or failure
to maintain the qualifications set forth in §174.3 of this title (relating
to Qualifications for a Special Purpose License
to
[
for
]
Practice Medicine Across State Lines) or pursuant to §§174.7, 174.8,
174.9 and 174.10 of this title (relating to Cooperation, Appearances, Patient
Medical Records and Informed Consent, Notification of Address, and Delegation
and Supervision). A person holding a special purpose license shall be subject
to the jurisdiction of the board for purposes of revocation or limitation
of the special purpose license. Limitations which may be imposed on a special
purpose license may include any action authorized under the Medical Practice
Act,
§164.001
[
§4.12
] (concerning Methods
of Discipline).
who is the subject of out-of-state consultation by
] electronic means
other than telephone or telefacsimile. [
Such informed consent shall include
an explanation by the consulting physician or, in the absence of a consulting
physician, by the physician consulted.
]
consultation
] by electronic means
other than telephone or telefacsimile shall be grounds for revocation or limitation
of a special purpose license pursuant to §174.6 of this title (relating
to Revocation and Limitation of Special Purpose License) and, if the person
is licensed by the board, grounds for disciplinary action pursuant to the
Medical Practice Act,
§§164.001, 164.051, and 165.001-.004
[
§§3.08, 4.12, and 4.125
] (concerning Grounds
for Disciplinary Action, Authorized Disciplinary Action, and Administrative
Penalties).
§3.08
] (concerning Grounds
for
Denial or
Disciplinary Action).
who practices in the same medical specialty
];
§4.13
] and board rule
§§187.55-187.62
[
§187.40
] of this title (relating to Temporary Suspensions of Licenses).
Chapter 184.
SURGICAL ASSISTANTS
Chapter 187.
PROCEDURAL RULES
or of alleged violations
], an opportunity for an applicant or
licensee to show compliance, and an opportunity for informal disposition of
the matter.
Request for Review.
]
and
] Chapter 163 of this title (relating
to Licensure)
or Chapter 171 of this title (relating to Postgraduate
Training Permits)
, the applicant may request review of that determination
by
a committee of the board
[
the Licensure Committee
].
The applicant must request the review not later than the 20th day after the
date the applicant receives notice of the determination.
Licensure Committee
].
(1)
]
Upon review of an application for licensure,
a committee of the board
[
the Licensure Committee
] may determine
that the applicant is ineligible for licensure or is eligible for licensure
with or without restrictions.
(2)
] If the [
Licensure Committee
]
committee
determines that the applicant should be granted
a license with restrictions based on the applicant's commission of a prohibited
act
or failure to demonstrate compliance with provisions
under
the Act or board rules, the
committee,
[
Committee
] as
the board's representatives, shall propose an agreed order [
as set out
in §187.19 of this title (relating to Resolution by Agreed Order). Following
the acceptance and execution by the application of the settlement agreement,
the agreement.
]
The terms and conditions of the proposed agreed
order
shall be submitted to the board for approval [
as provided
under §187.20 of this title (relating to Board Action)
].
(3)
]
Ineligibility Determination.
If
a committee of the board
[
the Licensure Committee
] determines that an applicant is ineligible for a license, the
committee
[
Committee
] shall submit its determination along
with the reasons for the determination to the full board for consideration.
Chapter 196.
VOLUNTARY SURRENDER OF A MEDICAL LICENSE
(1)
]
The board, based on a petition or request
presented to the full board by a licensee or based on the recommendation of
a committee, a panel, or representative(s) of the board, may consider whether
to formally accept the voluntary surrender of the Texas medical license; however,
surrender of a Texas medical license without acceptance thereof by the board,
or a licensee's failure to pay his or her annual registration fee after initiation
of
an investigation
[
disciplinary action,
] but prior
to imposition of a disciplinary order by the board, shall not result in cancellation
of the license and shall not deprive the board of jurisdiction in regard to
disciplinary action against the licensee.
Article 4495b
], and its subsequent amendments, such a surrender
shall be considered a surrender associated with a disciplinary action.
A Texas medical license surrendered in accordance
with this section shall not be returned to a licensee until after a board
determination that the licensee is competent to resume practice.
]
(c)
]
If the surrender of a Texas medical license
was associated with disciplinary action based on findings of fact substantiating
misconduct, the Texas medical license shall not be returned to the licensee
if the board's order on the merits of the disciplinary action is inconsistent
with the return of that license.
material
] or as a result of any mental or physical
condition, is unable to treat patients with reasonable skill and safety and
surrenders his or her Texas medical license, that surrender shall be deemed
a surrender associated with impairment.
Return of License to Licensee. ]
Whenever
] a licensee [
voluntarily
] surrenders
his or her Texas medical license
and reapplies for licensure,
[
under circumstances not associated with disciplinary or impairment action,
the licensee may have his or her license returned after a determination by
the board that
] the licensee
must establish competence
[
is competent
] to resume practice, [
following
] payment of
applicable fees
, compliance with current licensure eligibility provisions
as provided under Chapter 163 of this title (relating to licensure)
and
[
after
] completion of training, courses, examinations, or seminars
as directed by the board.
agreed
] order[
, consent order, or stipulation
] of the board [
and a licensee,
] the board shall determine whether or not a licensee is competent to
resume practice based on evidence of the licensee's competence or lack thereof
as adduced through the procedures provided for in Chapter 187 of this title
(relating to
Procedural Rules
[
Procedure
]).
Chapter 200.
STANDARDS FOR PHYSICIANS PRACTICING COMPLEMENTARY AND ALTERNATIVE MEDICINE
integrative or
] complementary
and alternative
therapies.
Integrative and
] Complementary
and Alternative
Medicine--Those health care methods of diagnosis, treatment, or interventions
that are not acknowledged to be conventional but that may be offered by some
licensed physicians in addition to, or as an alternative to, conventional
medicine, and that provide a reasonable potential for therapeutic gain in
a patient's medical condition and that are not reasonably outweighed by the
risk of such methods.
Integrative and ] Complementary and Alternative Medicine.
integrative or
] complementary
or alternative
medicine,
unless it can be demonstrated that such method has a safety risk for the patient
that is unreasonably greater than the conventional treatment for the patient's
medical condition. The Texas State Board of Medical Examiners will use the
following guidelines to determine whether a physician's conduct violates the
Medical Practice Act,
§§164.051-.053
[
§§3.08(4),
3.08(4)(E), and 3.08(18)
] in regard to providing complementary and
alternative
[
integrative
] medical treatment.
and shall be documented in the
patient's chart
]. Such assessment shall
be documented in the patient's
medical record and be based on performance and review of
[
include
] the following listed in subparagraphs (A)-
(D)
[
(E)
] of this paragraph:
documentation as to whether
]
the
conventional
medical treatment options [
have been
]
to be
discussed
with the patient and referral input, if necessary;
documentation as to whether
]
any prior
conventional medical
treatments attempted and the outcomes obtained
or
[
options have been tried, and if so, to what effect or a statement
as to
] whether conventional options have been refused by the patient;
(E) documentation as to
] whether
the complementary health care therapy could interfere with any other
recommended or
ongoing [
conventional
] treatment.
(2)
] The physician may offer the
patient complementary
or alternative
[
and integrative
]
treatment pursuant to a documented treatment plan tailored for the individual
needs of the patient by which treatment progress or success can be evaluated
with stated objectives such as pain relief and/or improved physical and/or
psychosocial function. Such a documented treatment plan shall consider pertinent
medical history, previous medical records and physical examination, as well
as the need for further testing, consultations, referrals, or the use of other
treatment modalities.
(3)
]
Periodic Review of Treatment.
The physician may use the treatment subject to documented periodic
review of the patient's care by the physician at reasonable intervals
. The physician shall evaluate the patient's progress under the treatment
prescribed, ordered or administered, as well as any new information about
etiology of the complaint in determining whether treatment objectives are
being adequately met.
[
in view of the individual circumstances
of the patient in regard to progress toward reaching treatment objectives
which takes into consideration the treatment prescribed, ordered or administered,
as well as any new information about the etiology of the complaint.
]
(5)
] If the provisions set out in
paragraphs (1)-
(5)
[
(4)
] of this section are met, and
if all treatment is properly documented, the board will presume such practices
are in conformity with the Medical Practice Act,
§§164.051-.053
[
§§3.08(4), 3.08(4)(E), and 3.08(18)
].
Part 19.
POLYGRAPH EXAMINERS BOARD
Part 21.
TEXAS STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS
person
]
has not been reactivated, the license automatically becomes void. The inactive
status may be extended for additional increments of two years if, prior to
the end of each two-year period, the person notifies the Board in writing
that an extension is requested and submits proof to the Board of continuous
licensure by a psychology licensing board in this or another jurisdiction
for the past two-year period and payment of all required fees. A person may
indefinitely remain on inactive status if he/she is licensed in this or another
jurisdiction and complies with the extension requirements set forth in this
paragraph. Any person wishing to reactivate his/her license that has been
on inactive status for four years or more must take and pass the Jurisprudence
Exam with the minimum acceptable score as set forth in §463.14 of this
title (relating to Cutoff Scores) unless the person holds another license
on active status with this Board.
only with express permission from the
Board.
] If disciplinary action is taken against a person's inactive
license, the person must reactivate the license until the action has been
terminated.
subject to disciplinary action and/or
sanction
] is considered to be on restricted status. A person practicing
under a restricted license must comply with any restrictions placed thereon
by the Board.
(3)
Resigned in lieu of delinquency
status if permitted to resign prior to voiding of the license due to failure
to renew.]
It is the responsibility of the
licensee to engage in activities which provide demonstrated relevance to the
practice of psychology.
] In order to establish relevancy to the practice
of psychology, the Board may require a licensee to produce, in addition to
the documentation required by subsection (d) of this section, course descriptions,
conference catalogs and syllabi, or other material as warranted by the circumstances.
The Board does not pre-approve continuing education credit. The Board shall
not allow continuing education credit for personal psychotherapy, workshops
for personal growth, the provision of services to professional associations
by a licensee, foreign language courses, or computer training classes.
and
]
Chapter 463.
APPLICATIONS AND EXAMINATIONS
with the exception of the
] licensed specialist in school psychology
[
application
].
For applicants whose internships begin on or after July 1, 2001, a
]
formal internship or other site-based training must be provided through a
formal course of supervised study from a regionally accredited institution
of higher education in which the applicant was enrolled or be obtained in
accordance with §463.11(c)(1) and (c)(2)(C) of this title (relating to
Licensed Psychologist). [
For applicants whose internships begin before
this date, either a formal internship or experience may be obtained to comply
with this internship rule.
] The internship in the public school must
be supervised by an individual qualified in accordance with §465.38 of
this title (relating to Psychological Services in the Schools). Internship
which is not obtained in a public school must be supervised by a licensed
psychologist. No experience with a supervisor who is related within the second
degree of affinity or within the second degree by consanguinity to the person,
or is under Board disciplinary order, may be considered for specialist in
school psychology licensure. Internships may not involve more than two sites
(a school district is considered one site) and may be obtained in not less
than one or more than two academic years. These individuals must be designated
as interns. Direct, systematic supervision must involve a minimum of one face-to-face
contact hour per week or two consecutive face-to-face contact hours once every
two weeks with the intern. The internship must include direct intern application
of assessment, intervention, behavior management, and consultation, for children
representing a range of ages, populations and needs.
Chapter 469.
COMPLAINTS AND ENFORCEMENT