Part 5.
STATE BOARD OF DENTAL EXAMINERS
Chapter 107.
DENTAL BOARD PROCEDURES
Subchapter A. PROCEDURES GOVERNING GRIEVANCES, HEARINGS, AND APPEALS
22 TAC §107.63
The Texas State Board of Dental Examiners (Board) proposes
amendments to 22 TAC Chapter 107, §107.63, concerning the Board's use
of informal and alternative dispute resolution processes. The amendments are
proposed to enact certain requirements imposed by Senate Bill 263, §10
and §19, 78th Legislature. The section as amended also contains revisions
to clarify and standardize language, and to improve organization.
Section 107.63(c)(2) has been added to detail the procedures for staff
settlement conferences, pursuant to Senate Bill 263, §19, 78th Legislature.
These proposed amendments allow cases to be resolved via an informal settlement
conference presided over by board staff, with the allowance for participation
by a board member on cases involving standard of care issues.
Section 107.63(d) has been added to specifically allow contested disciplinary
matters to be referred to an alternative dispute resolution process, pursuant
to Senate Bill 263, §10, 78th Legislature.
Section 107.63(f) has been added to specifically allow the board to award
restitution in certain disciplinary matters, pursuant to Senate Bill 263, §19,
78th Legislature.
There are no other substantive changes to the section.
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined that for each year of the first five-year period the section
is in effect, there will be no fiscal implications for local or state government
as a result of enforcing or administering the section.
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined that for each year of the first five-year period the section
is in effect, the public benefit anticipated as a result of enforcing or administering
the section will be significant. The use of staff settlement conferences will
expedite the resolution of many cases, allowing for quicker and more appropriate
response to complaints. The use of informal processes to resolve contested
matters will expand the Board's ability to encourage cooperation, rather than
conflict, in the Board's relationship with licensees. Finally, the ability
to order restitution in some matters will not only help restore complainants
to their original status in some measure, but will likely de-escalate some
conflicts between complainants and licensees.
The impact on large, small or micro-businesses will be negligible, except
that the more expeditious resolution of contested cases will undoubtedly save
licensees from incurring legal and other associated expenses.
The anticipated economic cost to persons as a result of enforcing or administering
the section is negligible, and would only arise from the imposition of orders
for restitution.
Comments on the proposal may be submitted to Bobby D. Schmidt, M.Ed. Executive
Director, Texas State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite
800, Austin, Texas 78701, (512) 475-1660. To be considered, all written comments
must be received by the Texas State Board of Dental Examiners no later than
30 days from the date that this amended section is published in the
The section is proposed under Texas Government Code §2001.021
et seq., Texas Civil Statutes; the Occupations Code §254.001, which provides
the Board with the authority to adopt and enforce rules necessary for it to
perform its duties; the Government Code, Chapter 2009, which allows for and
promotes the use of alternative dispute resolution processes; and Senate Bill
263, §10 and §19, 78th Legislature, 2003, as previously discussed.
The proposed section affects Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§107.63.Informal Disposition and Alternative Dispute Resolution .
(a)
Policy. It is the Board's policy to encourage,
where appropriate, the resolution and early settlement of contested disciplinary
matters and internal disputes through informal and alternative dispute resolution
procedures.
[
(b)
[
[
(c)
Informal Disposition. Pursuant to the Government
Code, Chapter 2001
et. seq.
, ultimate disposition
of any complaint or matter pending before the Board may be made by stipulation,
agreed settlement, or consent order. Under the Occupations Code, §263.007
and §263.0075, such a disposition may be reached through review at an
informal settlement conference, which may take the form of a staff settlement
conference or a Board settlement conference.
(1)
Board Settlement Conference
(A)
The Board Secretary or executive director
may approve a matter for review at a Board settlement conference.
(B)
[
(C)
[
(D)
[
(E)
[
(F)
[
(G)
[
(H)
[
(I)
[
(J)
[
(K)
[
(L)
[
(2)
Staff Settlement Conference.
(A)
The Board Secretary or executive director may
approve a matter for review at a staff settlement conference.
(B)
Staff settlement conferences shall be held by
a panel of board employees consisting, at a minimum, of an attorney of the
Board, and either the investigator responsible for the case or the Director
of Enforcement. A Board member who is able to advise on standard of care issues
must participate in any case involving such issues.
(C)
At the conclusion of the staff settlement conference,
the panel shall make recommendations for resolution or correction of any alleged
violations of the Dental Practice Act or of the Board rules. Such recommendations
may include any disciplinary actions authorized by the Occupations Code, §263.002.
The panel may, on the basis that a violation of the Dental Practice Act or
the Board's rules has not been established, either close the case, or refer
the case to Board staff for further investigation. Closure of a case by a
staff settlement conference shall be given effect immediately without the
necessity of presentation to the full Board.
(D)
Board staff shall draft a proposed settlement
agreement reflecting the settlement recommendations, which the licensee shall
either accept or reject. To accept the settlement recommendations, the licensee
must sign a proposed settlement agreement and return it to the Board within
30 days from receipt. Inaction by the licensee shall constitute rejection.
If the licensee rejects the proposed agreed settlement order, the matter shall
be referred to the Board Secretary and executive director for other appropriate
disposition.
(E)
Following acceptance and execution of the proposed
agreed settlement order by the licensee, said proposed order shall be submitted
to the Board's legal counsel, and/or executive director for review.
(F)
A recommendation to close a case requires no
further action by the Respondent.
(G)
A complainant may appeal the decision to close
a case by the staff in accordance with Rule 107.102(h).
(d)
Alternative Dispute Resolution
(ADR).
(1)
Any ADR procedure used to resolve an internal
or external dispute before the Board shall comply with the requirements of
Chapter 2009, Government Code, and shall, to the extent possible, comply with
any model guidelines issued by the State Office of Administrative Hearings
for the use of ADR by state agencies.
(2)
Use of ADR In Contested Disciplinary Matters.
(A)
The Board Secretary or the executive director
may refer a contested disciplinary matter to an ADR process to seek resolution
or correction of any alleged violations of the Dental Practice Act or of the
Board rules. Such ADR processes may include:
(i)
any procedure described by Chapter 154, Civil
Practice and Remedies Code; or,
(ii)
a combination of the procedures described by
Chapter 154, Civil Practice and Remedies Code.
(B)
Any agreement or recommendation resulting from
the application of an ADR process to a contested disciplinary matter shall
be documented in written form and signed by the licensee, and legal counsel
for the Board and/or the executive director or Board Secretary. Such an agreement
or recommendation may include any disciplinary actions authorized by the Occupations
Code, §263.002.
(C)
If the ADR process results in no agreement or
recommendation, the matter shall be referred to the Board Secretary and executive
director for other appropriate disposition.
(e)
[
(1)
All proposed agreed settlement
orders, agreements or other recommendations shall be reviewed by the full
Board for approval.
(2)
[
(3)
[
(4)
[
(f)
Restitution.
(1)
Pursuant to the Occupations Code, §263.0075,
the board may order a licensee to pay restitution to a patient as provided
in a proposed agreed settlement order or other agreement or recommendation,
instead of or in addition to any administrative penalty.
(2)
The amount of restitution ordered may not exceed
the amount the patient paid to the licensee for the service or services from
which the complaint arose. The board shall not require payment of other damages
or make an estimation of harm in any order for restitution.
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, 2004.
TRD-200401006
Bobby D. Schmidt, M.Ed.
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
22 TAC §107.202
The Texas State Board of Dental Examiners (Board) proposes
an amendment to Rule 107.202, concerning the Board's disciplinary guidelines
and administrative penalty schedule. Specifically, the amendment is proposed
to remove the words "and address" from §107.202(d)(6)(B), as required
by Senate Bill 1571, §4, 78th Legislature.
There are no other changes to the section.
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined that for each year of the first five year period the section
is in effect, there will be no fiscal implications for local or state government
as a result of enforcing or administering the section. The public benefit
anticipated as a result of enforcing or administering the section will be
negligible. There will be no effect on large, small or micro-businesses. There
is no anticipated economic cost to persons as a result of enforcing or administering
the section, and there is no impact on local employment.
Comments on the proposal may be submitted to Bobby D. Schmidt, M.Ed. Executive
Director, Texas State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite
800, Austin, Texas 78701, (512) 475-1660. To be considered, all written comments
must be received by the Texas State Board of Dental Examiners no later than
30 days from the date that this amended section is published in the
The section has been reviewed by legal counsel, who found that
it is proposed under Texas Government Code §2001.021 et seq., Texas Civil
Statutes; the Occupations Code §254.001, which provides the Board with
the authority to adopt and enforce rules necessary for it to perform its duties;
and Senate Bill 1571, §4, 78th Legislature, 2003, as previously discussed.
The proposed section affects Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§107.202.Disciplinary Guidelines and Administrative Penalty Schedule.
(a) - (c)
(No change.)
(d)
Administrative penalties may be imposed for the following
violation categories as set forth in Rule 107.101 of this title (relating
to Guidelines for the Conduct of Investigations) and the amount of penalty
imposed shall be in accordance with this schedule as set forth:
(1) - (5)
(No change.)
(6)
Dental Laboratory violations may include, but are not limited
to:
(A)
Failure to comply with the requirements for registration
of a commercial dental laboratory;
(B)
Failure to obtain written work order(s) or prescription(s)
from a licensed dentist, containing signature and dental license number, date
of signature, name [
(C) - (E)
(No change.)
(7)
(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, 2004.
TRD-200401005
Bobby D. Schmidt, M.Ed.
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
Subchapter A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.7
The Texas State Board of Dental Examiners (Board) proposes
amendments to 22 TAC, Chapter 108, §108.7, concerning the minimum standard
of care in dentistry. The amendments clarify that blood pressure and heart
rate measurements must be taken as part of the required initial medical examination
of any patient, except that such measurements are not required for patients
12 years of age or younger, unless the patient's medical condition or history
indicate such a need.
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined for the first five year period the section as proposed is in
effect there will be no fiscal implications for local or state government
as a result of enforcing or administering the section.
There is no anticipated economic cost to persons who are required to comply
with the section, and there is no anticipated local employment impact as a
result of enforcing the section.
Mr. Schmidt has determined that for each year of the first five years the
section is in effect, the public benefit anticipated as a result of enforcing
the section will be an increase in the prevention of complications from treatment
due to medical conditions that may manifest themselves in vital sign measurements.
The fiscal implications for small or large businesses will be minimal or
none at all. Therefore, the Board has determined that compliance with the
section will not have an adverse economic impact on small business when compared
to large businesses.
Comments on the proposal may be submitted to Bobby D. Schmidt, M.Ed. Executive
Director, Texas State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite
800, Austin, Texas 78701, (512) 475-1660. To be considered, all written comments
must be received by the Texas State Board of Dental Examiners no later than
30 days from the date that this section is published in the
Texas Register
.
The section is proposed under Texas Government Code §2001.021
et seq; Texas Civil Statutes, the Occupations Code §254.001, which provides
the Board with the authority to adopt and enforce rules necessary for it to
perform its duties.
The proposed section affects Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§108.7.Minimum Standard of Care, General.
Each dentist licensed by the State Board of Dental Examiners and practicing
in Texas shall conduct his/her practice in a manner consistent with that of
a reasonable and prudent dentist under the same or similar circumstance. Further,
each dentist:
(1)
Shall maintain patient records that meet the requirements
set forth in §108.8 of this title (relating to Records of the Dentist).
(2)
Shall maintain and review an initial medical history and
perform limited physical evaluation for all dental patients to wit:
(A)
The initial medical history shall include, but shall not
necessarily be limited to, known allergies to drugs, serious illness, current
medications, previous hospitalizations and significant surgery, and a review
of the physiologic systems obtained by patient history. A "check list", for
consistency, may be utilized in obtaining initial information. The dentist
shall review the medical history with the patient at any time a reasonable
and prudent dentist in the same or similar circumstances would so do.
(B)
The initial limited physical examination
shall
[
(3) - (6)
(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, 2004.
TRD-200401004
Bobby D. Schmidt, M.Ed.
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
22 TAC §108.33
The Texas State Board of Dental Examiners (Board) proposes
amendments to 22 TAC, Chapter 108, §108.33, concerning sedation and anesthesia
permits. The proposed amendment adds §108.33(c), which creates a process
and requirements for a provisional permit that would allow a licensed dentist
with appropriate qualifications to administer parenteral conscious sedation
and/or deep sedation and general anesthesia. Currently, permits require the
approval of the Board, which only meets four times per year.
Language has also been added to §108.33(h)(1)(A)(i) to impose a five-year
limit on the amount of time certain training will be considered current for
the purpose of acquiring a nitrous oxide/oxygen inhalation conscious sedation
permit.
All other proposed amendments are for grammatical or organizational purposes.
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined for the first five year period the section as proposed is in
effect there will be limited fiscal implications for local or state government
as a result of enforcing or administering the section.
There is no anticipated economic cost to persons who are required to comply
with the section, and there is no anticipated local employment impact as a
result of enforcing the section.
Mr. Schmidt has determined that for each year of the first five years the
section is in effect, the public benefit anticipated as a result of enforcing
the section will be to allow qualified dentists to begin administration of
certain anesthetic agents in their practice without having to wait for the
formal approval process by the Board. Furthermore, the public will benefit
from the assurance that certain required training will be current.
The fiscal implications for small or large businesses will be minimal or
none at all. Therefore, the Board has determined that compliance with the
section will not have an adverse economic impact on small business when compared
to large businesses.
Comments on the proposal may be submitted to Bobby D. Schmidt, M.Ed. Executive
Director, Texas State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite
800, Austin, Texas 78701, (512) 475-1660. To be considered, all written comments
must be received by the Texas State Board of Dental Examiners no later than
30 days from the date that this section is published in the
Texas Register
.
The section is proposed under Texas Government Code §2001.021
et seq; Texas Civil Statutes, the Occupations Code §254.001, which provides
the Board with the authority to adopt and enforce rules necessary for it to
perform its duties.
The proposed section affects Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§108.33.Sedation/Anesthesia Permit.
(a)
The State Board of Dental Examiners shall appoint advisory
consultants for advice and recommendations to the Board on permit requirements,
applicant and facility approval.
(b)
A dentist licensed by the State Board of Dental Examiners
and practicing in Texas, who desires to
administer
[
(1) - (4)
(No change.)
(c)
Provisional Permit. A dentist licensed
by the State Board of Dental Examiners, who is enrolled and approaching graduation
in a specialty program as detailed in Rule 108.33(g)(2)(A)(ii) and/or 108.33(g)(3)(A)(ii),
may, upon approval of the Board or its designees, obtain a provisional permit
from the State Board of Dental Examiners to administer parenteral conscious
sedation and/or deep sedation and general anesthesia.
(1)
The applicant must meet all requirements under §108.33(b).
(2)
A letter shall be submitted on behalf of the applicant:
(A)
on the letterhead of the school administering the program;
(B)
signed by the director of the program;
(C)
specifying the specific training completed; and,
(D)
confirming imminent graduation as a result of successful
completion of all requirements in the program.
(3)
For the purposes of Rules 108.30 through 108.34, "completion"
means the successful conclusion of all requirements of the program in question,
but not including the formal graduation process.
(4)
Any provisional permit issued under this subsection shall
remain in effect until the next-scheduled regular board meeting, at which
time the Board will consider ratifying the provisional permit.
(5)
On ratification of a provisional permit, the status of
the permit will be changed to that of a regular permit under this section.
(d)
[
(e)
[
(f)
[
(g)
[
(1)
A sedation/anesthesia permit is valid for the dentist's
facility, if any, as well as any satellite facility.
(2)
Portability of a sedation/anesthesia permit will be granted
to a dentist who, after September 1, 2000, applies for portability if the
dentist is granted:
(A)
a deep sedation/general anesthesia permit; or
(B)
an intravenous parenteral conscious sedation permit if
training for the permit was obtained on the basis of completion of
(i)
a specialty program approved by the Commission on Dental
Accreditation of the American Dental Association, or
(ii)
a general practice residency, approved by the Commission
on Dental Accreditation of the American Dental Association, or
(iii)
an advanced education in general dentistry program, approved
by the Commission on Dental Accreditation of the American Dental Association,
or
(iv)
a Continuing Education (CE) program specifically approved
by the SBDE. The board may approve a graduate of a CE program under this subsection
only if the applicant can demonstrate administration of intravenous parenteral
conscious sedation in at least 30 cases that are documented showing provision
of anesthesia services in keeping with the standard of care as determined
by one or more of the SBDE's anesthesia consultants; and the applicant establishes
that the program consisted of
:
(I)
sixty hours of didactic courses;
and,
(II)
administration of intravenous parenteral conscious sedation
in at least 20 cases where the applicant was the anesthesia provider.
(3)
When anesthesia services are provided by a dentist at a
location other than a facility or a satellite facility, the dentist shall
strictly adhere to all rules of the State Board of Dental Examiners which
may apply. The dentist shall ascertain that the location is supplied, equipped,
staffed and maintained in a condition to support provision of anesthesia services
that meet the standard of care.
(4)
A dentist holding a permit to administer parenteral conscious
sedation on the effective date of this rule who is qualified by training or
experience to administer intravenous parenteral conscious sedation anesthesia
on a portable basis, and who desires to do so must file with the State Board
of Dental Examiners proof of completion of:
(A)
a specialty program approved by the Commission on Dental
Accreditation of the American Dental Association, or
(B)
a general practice residency approved by the Commission
on Dental Accreditation of the American Dental Association, or
(C)
an advanced education in a general dentistry program approved
by the Commission on Dental Accreditation of the American Dental Association,
or
(D)
a Continuing Education program and administration of intravenous
parenteral conscious sedation in at least 30 cases that are documented showing
provision of anesthesia services in keeping with the standard of care as determined
by one or more of the SBDE's anesthesia consultants.
(E)
The records of all dentists permitted to administer parenteral
conscious sedation will be annotated showing whether portability status is
granted.
(F)
Any applicant whose request for portability is not granted
on the basis of the application will be provided an opportunity for hearing
pursuant to Texas Government Code, Section 2001 et.seq.
(5)
A dentist holding a permit to administer deep sedation/general
anesthesia on the effective date of this rule who desires to provide anesthesia
on a portable basis must file with the State Board of Dental Examiners a request
for a portability designation.
(A)
The records of all dentists permitted to administer deep
sedation/general anesthesia will be annotated showing whether portability
status is granted.
(B)
Any applicant whose request for portability status is not
granted on the basis of the application will be provided an opportunity for
hearing pursuant to Texas Government Code, Section 2001 et.seq.
(6)
The Board may elect to issue a temporary sedation/anesthesia
permit which will expire on a date certain. A full sedation/anesthesia permit
may be issued after the dentist has complied with requests of the Board which
may include, but shall not be limited to, review of the dentist's anesthetic
technique, facility inspection and/or review of patient records to ascertain
that the minimum standard of care is being met. If a full permit is not issued,
the temporary permit will expire on the stated date, and no further action
by the State Board of Dental Examiners will be required, and no hearing will
be conducted.
(h)
[
(1)
Nitrous Oxide/Oxygen Inhalation Conscious Sedation
(A)
To administer nitrous oxide/oxygen inhalation conscious
sedation, the dentist must satisfy one of the following criteria:
(i)
must have completed
, within the last five (5) years,
training consistent with that described in Part I or Part III of the
American Dental Association (ADA) Guidelines for Teaching the Comprehensive
Control of Pain and Anxiety in Dentistry; or
(ii)
must have completed an ADA accredited post-doctoral training
program which affords comprehensive and appropriate training necessary to
administer and manage nitrous oxide/oxygen inhalation conscious sedation.
(B)
The following shall apply to the administration of nitrous
oxide/oxygen inhalation conscious sedation in the dental office:
(i)
provision of nitrous oxide/oxygen inhalation conscious
sedation by another duly qualified dentist or physician anesthesiologist requires
the operating dentist and his/her clinical staff to maintain current expertise
in Basic Life Support (BLS);
(ii)
when a Certified Registered Nurse Anesthetist (CRNA) is
permitted to function under the supervision of a dentist, in the dental office,
provision of nitrous oxide/oxygen inhalation conscious sedation by a CRNA
shall require the operating dentist to have completed training in nitrous
oxide/oxygen inhalation conscious sedation, and to be permitted for its utilization.
(2)
Parenteral Conscious Sedation
(A)
To administer parenteral conscious sedation, the dentist
must satisfy one of the following criteria:
(i)
completion of a comprehensive training program for the
parenteral conscious sedation technique requested that satisfies the requirement
described in Part III of the American Dental Association (ADA) Guidelines
for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry at
the time training was commenced; or
(ii)
completion of an ADA accredited post-doctoral training
program which affords comprehensive and appropriate training necessary to
administer and manage the parenteral conscious sedation technique requested.
(B)
The following shall apply to the administration of parenteral
conscious sedation in the dental office:
(i)
provision of parenteral conscious sedation by another duly
qualified dentist or physician anesthesiologist requires the operating dentist
and his/her clinical staff to maintain current expertise in Basic Life Support
(BLS);
(ii)
when a Certified Registered Nurse Anesthetist (CRNA) is
permitted to function under the supervision of a dentist, in the dental office,
provision of parenteral conscious sedation by a CRNA shall require the operating
dentist to have completed training in parenteral conscious sedation, and to
be permitted for its utilization;
(iii)
a dentist administering parenteral conscious sedation
must document current, successful completion every three years of an advanced
emergency procedures course approved by the State Board of Dental Examiners
or an Advanced Cardiac Life Support (ACLS) course, or a Pediatric Advanced
Life Support (PALS) or age appropriate equivalent course.
(3)
Deep Sedation/General Anesthesia
(A)
To administer deep sedation/general anesthesia, the dentist
must satisfy one of the following criteria:
(i)
completion of an advanced training program in anesthesia
and related subjects beyond the undergraduate dental curriculum that satisfies
the requirements described in Part II of the American Dental Association (ADA)
Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry
at the time training was commenced; or,
(ii)
completion of an ADA accredited post-doctoral training
program which affords comprehensive and appropriate training necessary to
administer and manage deep sedation/general anesthesia.
(B)
The following shall apply to the administration of deep
sedation/general anesthesia in the dental office:
(i)
provision of deep sedation/general anesthesia by another
duly qualified dentist or physician anesthesiologist requires the operating
dentist and his/her clinical staff to maintain current expertise in Basic
Life Support (BLS);
(ii)
when a Certified Registered Nurse Anesthetist (CRNA) is
permitted to function under the supervision of a dentist, in the dental office,
provision of deep sedation/general anesthesia by a CRNA shall require the
operating dentist to have completed training in deep sedation/general anesthesia,
and to be permitted for its utilization;
(iii)
a dentist administering deep sedation/general anesthesia
must document current, successful completion every three years of an advanced
emergency procedures course approved by the State Board of Dental Examiners
or an Advanced Cardiac Life Support (ACLS) course, or a Pediatric Advanced
Life Support (PALS) or age appropriate equivalent course.
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, 2004.
TRD-200401053
Bobby D. Schmidt, M.Ed.
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
22 TAC §108.34
The Texas State Board of Dental Examiners (Board) proposes
amendments to 22 TAC, Chapter 108, §108.34, concerning permit requirements
and clinical provisions for the administration of sedation and anesthesia.
The amendments proposed are made necessary by proposed amendments to §108.33,
and only change three citations to subsections of §108.33 that would
changed should the proposed amendments be approved.
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined for the first five year period the section as proposed is in
effect there will be no fiscal implications for local or state government
as a result of enforcing or administering the section.
There is no anticipated economic cost to persons who are required to comply
with the section, and there is no anticipated local employment impact as a
result of enforcing the section.
Mr. Schmidt has determined that for each year of the first five years the
section is in effect, no public benefit is anticipated.
The fiscal implications for small or large businesses will be minimal or
none at all. Therefore, the Board has determined that compliance with the
section will not have an adverse economic impact on small business when compared
to large businesses.
Comments on the proposal may be submitted to Bobby D. Schmidt, M.Ed. Executive
Director, Texas State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite
800, Austin, Texas 78701, (512) 475-1660. To be considered, all written comments
must be received by the Texas State Board of Dental Examiners no later than
30 days from the date that this section is published in the
Texas Register
.
The section is proposed under Texas Government Code §2001.021
et seq; Texas Civil Statutes, the Occupations Code §254.001, which provides
the Board with the authority to adopt and enforce rules necessary for it to
perform its duties.
The proposed section affects Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§108.34.Permit Requirements and Clinical Provisions.
(a)
Nitrous Oxide/oxygen inhalation conscious sedation. To
induce and maintain this type of conscious sedation on patients having dental/oral
and maxillofacial surgical procedures in the State of Texas, the following
requirements must be met:
(1)
Professional requirements.
(A)
Each dentist wishing to utilize this technique must be
permitted by the State Board of Dental Examiners (SBDE) to deliver nitrous
oxide/oxygen conscious sedation after having met the Education Requirements
as detailed in rule 108.33
(h)(1)
[
(B)
(No change.)
(2) - (3)
(No change.)
(b)
Parenteral conscious sedation intravenous (IV), intramuscular
(IM), subcutaneous (SC), submucosal (SM), intranasal (IN). To induce and maintain
this type of conscious sedation on patients having dental/oral and maxillofacial
surgical procedures in the State of Texas, the following requirements must
be met:
(1)
Professional Requirements:
(A)
each dentist wishing to utilize these techniques must be
permitted by the State Board of Dental Examiners (SBDE) to deliver parenteral
conscious sedation after having met the educational requirements as detailed
in Rule 108.33
(h)(2)
[
(B)
(No change.)
(2) - (3)
(No change.)
(c)
Deep sedation and/or general anesthesia. To induce and
maintain deep sedation/general anesthesia on patients having dental/oral and
maxillofacial surgical procedures in the State of Texas, the following requirements
must be met:
(1)
Professional Requirements:
(A)
Each dentist wishing to utilize either of these techniques
must be permitted by the State Board of Dental Examiners (SBDE) to deliver
deep sedation and/or general anesthesia after having met the education requirements
as detailed in rule 108.33 (g)(3) of this title (relating to Sedation/Anesthesia
Permit).
(B)
(No change.)
(2) - (3)
(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, 2004.
TRD-200401056
Bobby D. Schmidt, M.Ed.
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
The Texas State Board of Dental Examiners (Board) proposes amendments
to 22 TAC, Chapter 114, §114.1 and §114.3, the repeal of §114.2,
and new §114.2 and §114.10, all of which concern dental assistants.
These sections contain extensive revisions to clarify and standardize language,
as well as new language to enact the provisions of Senate Bill 263, §25,
78th Legislature, requiring that dental assistants that make x-rays be registered
to do so.
Proposed amendments to §114.1 incorporate the definition of a "reversible"
procedure, and specific examples of "irreversible" procedures that were previously
contained in §114.2.
§114.2, which contains definitions, is proposed for repeal, with those
definitions reduced and redistributed to the proposed amendments in other
sections.
A new §114.2 is proposed to detail the requirements and process for
the registration of dental assistants who perform x-ray procedures.
Proposed amendments to §114.3 incorporate some of the definitions
previously found in §114.2, and clarify and organize the remainder of
its language.
§114.10 is proposed for addition as a new section, relocating language
from §115.10, which details the currently existing x-ray certification
process for dental assistants. That language currently resides in Chapter
115, which relates to dental hygienists. Accordingly, §115.10 is concurrently
being proposed for repeal. Language clarifying the dates for transition between
the two registration schemes, pursuant to Senate Bill 263, §34, 78th
Legislature has also been added, as §114.10(a).
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined for the first five year period the sections are in effect there
will be limited fiscal implications for local or state government as a result
of enforcing or administering those sections.
There is an anticipated economic cost to persons who are required to comply
with the sections as proposed. Those dental assistants required to comply
with the sections will have to take and complete a one-time examination process
in three parts, all of which may be taken in one sitting, as well as complete
a minimum of six hours of continuing education in each one-year license period.
There is no anticipated local employment impact as a result of enforcing the
sections as proposed.
Mr. Schmidt has determined that for each year of the first five years the
sections are in effect, the public benefit anticipated as a result of enforcing
them will be the increase in education and regulation of dental assistants
who perform radiographic procedures on patients in the State of Texas.
The fiscal implications for small or large businesses will be minimal or
none at all. Therefore, the Board has determined that compliance with the
proposed sections will not have an adverse economic impact on small business
when compared to large businesses. The requirements of Chapter 114 will impact
individuals who make application for registration, and would only impact small
businesses who choose to pay examination and registration fees for their dental
assistant employees. Sites for the examination will be sufficiently numerous
and well-distributed to minimize loss of employee time.
Comments on the proposal may be submitted to Bobby D. Schmidt, M.Ed. Executive
Director, Texas State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite
800, Austin, Texas 78701, (512) 475-1660. To be considered, all written comments
must be received by the Texas State Board of Dental Examiners no later than
30 days from the date that these sections are published in the
Texas Register
.
22 TAC §§114.1 - 114.3, 114.10
The sections are proposed under Texas Government Code §2001.021
et seq; Texas Civil Statutes, the Occupations Code §254.001, which provides
the Board with the authority to adopt and enforce rules necessary for it to
perform its duties, and Senate Bill 263, §25, 78th Legislature, 2003,
which requires the Board to establish rules for the registration of dental
assistants who make x-rays.
The proposed sections affect Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§114.1.Permitted Duties.
(a)
A dentist may delegate to a dental assistant
the authority to perform only acts or procedures that are reversible. The
employing dentist or dentist in charge must be physically present in the dental
office when the delegated act is performed, and the dentist shall remain responsible
for any delegated act.
(b)
An act or procedure that is
reversible is capable of being reversed or corrected. Acts or procedures that
are irreversible include, but are not limited to, the result of intra-oral
use of any laser for any purpose, including all or part of a whitening process.
§114.2.Registration of Dental Assistants.
(a)
Beginning September 1, 2004, a dental assistant may not
position or expose dental x-rays unless the dental assistant holds a certificate
of registration issued by the State Board of Dental Examiners under this section,
except that any dental assistant certified under former Rule 115.10 (now recodified
as Rule 114.10) prior to September 1, 2004 shall not be required to register
for certification under Rule 114.2 until September 1, 2006, and shall continue
to be governed by Rule 114.10 until September 1, 2006.
(b)
To be eligible for a certificate of registration as a dental
assistant under this section, an applicant must present on or accompanying
an application form approved by the State Board of Dental Examiners proof
satisfactory to the Board that the applicant has:
(1)
Paid all application, examination and licensing fees required
by law and Board rules and regulations;
(2)
Successfully completed a current course in basic life support;
and,
(3)
Either:
(A)
taken and passed an examination administered by the State
Board of Dental Examiners or its designated agent, that covers:
(i)
procedures for positioning and examining dental x-rays;
(ii)
jurisprudence; and,
(iii)
infection control; or,
(B)
if the applicant is certified as a dental assistant by
the Dental Assisting National Board, taken and passed a jurisprudence examination
administered by the State Board of Dental Examiners or its designated agent.
(c)
The State Board of Dental Examiners has established a staggered
license registration system comprised of initial dental license registration
periods followed by annual registrations (i.e., renewals). The initial, staggered
dental assistant registration periods will range from 6 months to 17 months.
Each dental assistant for whom an initial certificate of registration is issued
will be assigned a computer-generated check digit. The length of the initial
registration period will be according to the assigned check digit as follows:
(1)
a dental assistant assigned to check digit 1 will be registered
for 6 months;
(2)
a dental assistant assigned to check digit 2 will be registered
for 7 months;
(3)
a dental assistant assigned to check digit 3 will be registered
for 8 months;
(4)
a dental assistant assigned to check digit 4 will be registered
for 9 months;
(5)
a dental assistant assigned to check digit 5 will be registered
for 11 months;
(6)
a dental assistant assigned to check digit 6 will be registered
for 12 months;
(7)
a dental assistant assigned to check digit 7 will be registered
for 13 months;
(8)
a dental assistant assigned to check digit 8 will be registered
for 14 months;
(9)
a dental assistant assigned to check digit 9 will be registered
for 15 months; and
(10)
a dental assistant assigned to check digit 10 will be
registered for 17 months.
(11)
Initial dental assistant registration fees will be prorated
according to the number of months in the initial registration period.
(d)
Subsequent to the initial registration period, a registered
dental assistant's annual renewal will occur on the first day of the month
that follows the last month of the dental assistant initial registration period.
(1)
Approximately 60 days prior to the expiration date of the
initial dental assistant registration period, renewal notices will be mailed
to all registered dental assistants who have that expiration date.
(2)
A dental assistant registered under this section who wishes
to renew his or her registration must:
(A)
Pay a renewal fee set by Board rule;
(B)
Submit proof that applicant has successfully completed
a current course in basic life support; and,
(C)
Provide proof of completion of at least six (6) hours of
continuing education in the previous registration year.
(i)
The continuing education curriculum must cover standards
of care, infection control, and the applicable requirements of the Dental
Practices Act and Board Rules.
(ii)
Dental assistants shall select and participate in continuing
education courses offered by or endorsed by continuing education providers
listed in 22 TAC §104.2.
(iii)
No more than three hours of the required continuing education
coursework may be in self-study.
(3)
A registration expired for one year or more may not be
renewed.
(e)
Applications for registration or for renewal of registration
must be submitted to the office of the State Board of Dental Examiners.
(f)
An application for registration is filed with the State
Board of Dental Examiners when it is actually received, date-stamped, and
logged-in by the State Board of Dental Examiners along with all required documentation
and fees. An incomplete application for registration and fee will be returned
to applicant within three working days with an explanation of additional documentation
or information needed.
(g)
A dental assistant shall display a current registration
certificate in each office where the dental assistant provides services for
which registration is required by this chapter. When a dental assistant provides
such services at more than one location, a duplicate registration certificate
issued by the Board may be displayed. Photocopies are not acceptable. The
duplicate may be obtained from the State Board of Dental Examiners for a fee
set by the Board.
§114.3.Application of Pit and Fissure Sealants.
(a)
The following words and terms,
when used in this section, shall have the following meanings, unless the context
clearly indicates otherwise:
(1)
"Didactic education" requires the presentation and instruction
of theory and scientific principles.
(2)
"Clinical education" requires providing care to patient(s)
under the direct supervision of a dentist or dental hygienist instructor.
(3)
"Direct Supervision" requires that the instructor responsible
for the procedure shall be physically present during patient care and shall
be aware of the patient's physical status and well-being.
(b)
[
(1)
is employed by and works under the direct supervision of
the licensed dentist; and
(2)
is certified pursuant to subsection
(e)
[
(c)
[
(d)
[
(e)
[
(1)
Pay
[
(2)
And
[
(A)
[
(B)
Successfully completed a current
course in basic life support; and,
(C)
[
(i)
[
(ii)
[
(iii)
[
(iv)
[
(v)
[
(vi)
[
(vii)
[
(viii)
[
(ix)
[
[
(f)
[
(1)
Pay a renewal fee set by Board
rule;
(2)
Submit proof that the applicant
has successfully completed a current course in basic life support; and,
(3)
[
(A)
The terms "technical" and "scientific",
as applied to continuing education, shall mean that courses have significant
intellectual or practical content and are designed to directly enhance the
practitioner's knowledge and skill in providing clinical care to the individual
patient.
(B)
[
(i)
dental schools, dental hygiene
schools, or dental assisting schools that have been accredited by the Commission
on Dental Accreditation of the American Dental Association; or,
(ii)
[
(C)
No more than three
(3)
hours
of the required
continuing education coursework
may be in self-study
.
[
[
§114.10.Radiologic Procedures.
(a)
Pursuant to S.B. 263, 78th Regular Session, former Rule
115.10, relating to the issuance of a certificate of registration has been
superseded by Rule 114.2, relating to Registration of Dental Assistants. Accordingly:
(1)
Beginning September 1, 2004, a dental assistant may not
position or expose dental x-rays unless the dental assistant holds a certificate
of registration issued pursuant to Rule 114.2;
(2)
Notwithstanding the requirement of subsection (a)(1) of
this section, any dental assistant certified under this section (formerly
codified as Rule 115.10) prior to September 1, 2004 shall not be required
to register for certification under Rule 114.2 until September 1, 2006, and
shall continue to be governed by this Rule 114.10, until September 1, 2006;
and,
(3)
This section shall expire in its entirety on September
1, 2006. Dental assistants may not continue to position or expose dental x-rays
pursuant to subsection (g) of this section after August 31, 2006.
(b)
Any person performing radiologic procedures under the supervision
of a Texas licensed dentist must register with the Texas State Board of Dental
Examiners (TSBDE). A registrant may perform, by the direct oral or written
order(s) of the supervising dentist, any radiologic procedures required for
the diagnosis of the maxillofacial complex.
(c)
This section does not apply to registered nurses or persons
certified under the Medical Radiologic Technologist Certification Act.
(d)
A dental hygienist who is licensed and currently registered
in this state, shall be deemed to be registered for the purpose of performing
radiologic procedures.
(e)
A dental assistant is qualified to perform radiographic
procedures if any one of the following criteria is met:
(1)
current certification as a certified dental assistant by
the Dental Assisting National Board, Inc.;
(2)
successful completion of the dental radiation health and
safety examination administered by the Dental Assisting National Board, Inc.;
or
(3)
successful completion of an examination specified by the
TSBDE.
(f)
Dental assistants who are not qualified under the provisions
of this section, may be allowed to perform necessary diagnostic radiographs
under the direct supervision of the dentist for a period of six months as
a part of their training and as a part of their examination, provided the
dental assistant is personally supervised by a person authorized to perform
radiologic procedures.
(g)
All dental radiologic procedures can be performed by any
person qualified and certified under this section.
(h)
Registration may be revoked, for the following reasons:
(1)
violation of the rules of the Texas State Board of Dental
Examiners;
(2)
violation of the Texas Dental Practice Act; and
(3)
violation of all other applicable rules and statutes affecting
radiologic procedures in Texas.
(i)
All registrants must comply with the rules and regulations
of the Texas Department of Health for control of radiation.
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, 2004.
TRD-200401002
Bobby D. Schmidt, M.Ed
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
22 TAC §114.2
(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 State Board of Dental Examiners or in the Texas Register office, Room
245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeal is proposed under Texas Government Code §2001.021
et seq; Texas Civil Statutes, the Occupations Code §254.001, which provides
the Board with the authority to adopt and enforce rules necessary for it to
perform its duties, and Senate Bill 263, §25, 78th Legislature, 2003,
which requires the Board to establish rules for the registration of dental
assistants who make x-rays.
The proposed repeal affects Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§114.2.Definitions.
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, 2004.
TRD-200401003
Bobby D. Schmidt, M.Ed
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
22 TAC §115.10
(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 State Board of Dental Examiners or in the Texas Register office, Room
245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas State Board of Dental Examiners (Board)
proposes the repeal of 22 TAC Chapter 115, §115.10, concerning the registration
of dental assistants performing radiological procedures.
The repeal is necessary because the language in this section is being relocated
to new §114.10, which is published contemporaneously as a proposed rule
in this issue of the
Texas Register
. Although
Chapter 115 pertains to dental hygienists, the provisions of §115.10
were only relevant to dental assistants.
Mr. Bobby D. Schmidt, Executive Director, Texas State Board of Dental Examiners
has determined that for each year of the first five year period after the
repeal of the section, the public benefit anticipated as a result of repealing
the rule will be negligible. There will be no effect on large, small or micro-businesses.
There is no anticipated economic cost to persons as a result of the repeal
and there is no impact on local employment.
Comments on the proposal may be submitted to Bobby D. Schmidt, M.Ed. Executive
Director, Texas State Board of Dental Examiners, 333 Guadalupe, Tower 3, Suite
800, Austin, Texas 78701, (512) 475-1660. To be considered, all written comments
must be received by the Texas State Board of Dental Examiners no later than
30 days from the date that this amended rule is published in the
Texas Register
.
The repeal is proposed under Texas Government Code §2001.021
et seq; Texas Civil Statutes, the Occupations Code §254.001 which provides
the Board with the authority to adopt and enforce rules necessary for it to
perform its duties.
The proposed repeal affects Title 3, Subtitle D of the Occupations Code
and Title 22, Texas Administrative Code, Chapter 101-125.
§115.10.Radiological Procedures.
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, 2004.
TRD-200401001
Bobby D. Schmidt, M.Ed.
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 475-0972
Chapter 163.
LICENSURE
22 TAC §§163.1 - 163.7, 163.11, 163.12
The Texas State Board of Medical Examiners proposes amendments
to §§163.1-163.7, 163.11 and 163.12, concerning Licensure. The proposal
concerns eligibility for licensure and general clean up of the rules.
Elsewhere in this issue of the
Texas Register
, the Texas State Board of Medical Examiners proposes the rule review
of Chapter 163.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the proposed rules are
in effect physician applicants will be responsible for paying for the cost
of the medical jurisprudence examination. Although applicants will be required
to pay to take the examination online, it is anticipated that this cost will
be offset because they will not be required to travel to Austin for the examination.
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 rules 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 rules: Texas Occupations Code
Annotated, §§155.001, 155.002, 155.003, 155.0031, 155.004, 155.005,
155.007, 155.008, 155.051, 155.0511, 155.052, 155.053, 155.054, 155.055, 155.056,
155.057, 155.058, 155.104.
§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:
(A)
is substantially equivalent to a Texas medical
school; and
(B)
has not been disapproved by another state physician
licensing agency unless the applicant can provide evidence that the disapproval
was unfounded.
(3)
[
(4)
[
(5)
[
(A)
forms furnished by the board, completed by the applicant:
(i)
all forms and addenda requiring a written response must
be
typed or
printed in ink;
(ii)
photographs must meet United States Government passport
standards;
(B)
all documents required under section 163.5 of this title
(relating to Licensure Documentation); and
(C)
the required fee, payable by check through a United States
bank.
(6)
Board - Texas State Board of
Medical Examiners
(7)
[
(8)
[
(9)
[
(A)
United States Medical Licensing Examination (USMLE), with
a score of 75 or better
, or a passing grade if applicable,
on each
step,
with
all steps [
(B)
Federation Licensing Examination (FLEX),
on or
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),
before July
1,
[
(D)
National Board of Medical Examiners Examination (NBME)
or its successor
with
all steps [
(E)
National Board of Osteopathic Medical Examiners Examination
(NBOME) or its successor
with
all steps [
(F)
Medical Council of Canada Examination (LMCC) or its successor,
with
all steps [
(G)
State board
licensing
examination,
passed
before January 1, 1977, (with the exception of Virgin Islands, Guam,
Tennessee Osteopathic Board or Puerto Rico
then the exams must be passed
before July 1, 1963
[
(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
(including passage of the clinical
skills component if applicable)
, plus FLEX II;
(iii)
NBME I or USMLE 1, plus NBME II or USMLE 2
(including
passage of the clinical skills component if applicable)
, plus NBME III
or USMLE 3;
(iv)
NBME I or USMLE 1, plus NBME II or USMLE 2
(including
passage of the clinical skills component if applicable)
, 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 a member of the Bureau of Osteopathic Specialists;
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
monitored
specialty certification examination
or formal evaluation,
a monitored
recertification examination or
formal evaluation, or
a monitored
[
(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.
[
(10)
[
[
[
[
[
[
(11)
One-year training program - [
(A)
accepted for certification by
a specialty
[
(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,
performed in the U.S. or Canada and approved by the board
for additional
training in a medical specialty or subspecialty [
(12)
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.
[
[
[
[
[
(13)
[
(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, histology, physiology, microbiology,
immunology, pathology, pharmacology and neuroscience, as defined by the Texas
Higher Education Coordinating Board.
(D)
The fundamental clinical subjects, which shall be offered
in the form of required patient-related clerkships, are internal medicine,
obstetrics and gynecology, pediatrics, psychiatry, neurology, family 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.
[
[
[
[
(14)
Texas Medical Jurisprudence
Examination (JP exam): the ethics examination administered by the board for
licensure that must be passed by an applicant for licensure within three attempts
with a score 75 or better.
(15)
Three-year training program - [
(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;
or
[
(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.
§163.2.Licensure for United States/Canadian Medical School Graduates.
To be eligible for licensure, an applicant who is a graduate from
a school in the United States or Canada must
[
(1)
be 21 years of age;
(2)
be of good professional character
as defined under §163.1(10)
of this title
;
(3)
have completed 60 semester hours of college courses
as defined under §163.1(12) of this title
[
(4)
be a graduate of an acceptable approved medical school
as defined under §163.1(2) of this title
;
(5)
have successfully completed a one-year training program
of graduate medical training
in the United States or Canada as defined
under §163.1(11) of this title
[
(6)
submit evidence of passing [
(7)
pass the Texas Medical Jurisprudence Examination with a
score of 75 or better.
§163.3.Licensure for Graduates of Acceptable Unapproved [
To be eligible for licensure, an applicant who is a graduate from
a school outside the United States or Canada must
[
(1)
be 21 years of age;
(2)
be of good professional character
as defined under §163.1(10)
of this title
;
(3)
have completed 60 semester hours of college courses
as defined under §163.1(12) of this title
[
(4)
be a graduate of an acceptable unapproved [
(5)
have successfully completed a three-year training program
of graduate medical training in the United States or Canada
as defined
under §163.1(15) of this title
[
(6)
submit evidence of passing [
(7)
pass the Texas Medical Jurisprudence Examination with a
score of 75 or better;
(8)
be eligible for licensure in country of graduation
as defined under §163.1(8) of this title
;
(9)
possess a valid certificate issued by the Educational Commission
for Foreign Medical Graduates (ECFMG);
(10)
have the ability to communicate in the English language;
and
(11)
have supplied all additional information that the board
may require concerning the applicant's medical school.
§163.4.Procedural Rules for Licensure Applicants.
(a)
All applicants
[
(1)
if appropriate, are
encouraged
[
(2)
whose
applications have
[
[
(3)
[
(4)
[
(5)
[
[
[
[
[
(6)
[
(7)
[
(8)
that receive any medical or
osteopathic medical education in the United States must have obtained such
education while enrolled as a full-time or visiting student at a medical school
that is 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. This subsection does not apply to postgraduate medical
education or training. An applicant who is unable to comply with this requirement
must demonstrate that the applicant either:
(A)
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
(B)
is specialty board certified by a board approved
by the Bureau of Osteopathic Specialists or the American Board of Medical
Specialties.
[
[
(b)
[
(c)
[
(1)
the applicant holds a medical license that is currently
restricted for cause, canceled for cause, suspended for cause, or revoked
by a state of the United States, a province of Canada, or a uniformed service
of the United States;
(2)
an investigation or a proceeding is instituted against
the applicant for the restriction, cancellation, suspension, or revocation
of the applicant's medical license in a state of the United States, a province
of Canada, or a uniformed service of the United States; or
(3)
a prosecution is pending against the applicant in any state,
federal, or Canadian court for any offense that under the laws of this state
is a felony or a misdemeanor that involves moral turpitude.
§163.5.Licensure Documentation.
(a)
An applicant must appear for a personal interview at the
board offices and present original documents to a representative of the board
for inspection. Original documents may include, but are not limited to, those
listed in subsections (b)-(e) of this section.
(b)
Documentation required of all applicants for licensure.
(1)
Birth Certificate/Proof of Age. Each applicant for licensure
must provide a copy of a [
(2)
Name Change. Any applicant who submits documentation showing
a name other than the name under which the applicant has applied must present
copies of marriage licenses, divorce decrees, or court orders stating the
name change. In cases where the applicant's name has been changed by naturalization,
the applicant should send the original naturalization certificate by certified
mail to the board office for inspection.
(3)
Examination Scores. Each applicant for licensure must have
a certified transcript of grades submitted directly from the appropriate testing
service to
the
[
(4)
Dean's Certification. Each applicant for licensure must
have a certificate of graduation submitted directly from the medical school
on a form provided
to the applicant
by the board. The applicant
shall attach a recent photograph, meeting United States Government passport
standards, to the form before submitting to the medical school. The school
shall have the Dean of the medical school or designated appointee sign the
form attesting to the information on the form and placing the school seal
over the photograph.
(5)
Evaluations. All applicants must provide evaluations
completed by an appropriate supervisor
, on a form provided by the board,
of their professional affiliations for the past ten years or since graduation
from medical school, whichever is the shorter period.
(6)
Medical School Transcript. Each applicant must have his
or her medical school submit a transcript of courses taken and grades obtained.
(7)
National Practitioner Data Bank [
(8)
Graduate Training Verification. Each applicant must
have
[
(9)
Specialty Board Certification. Each applicant who has obtained
certification by a board that is a member of the American Board of Medical
Specialties or the Bureau of Osteopathic Specialists must submit a copy of
the certificate issued by the member showing board certification.
(10)
Medical License Verifications. Each applicant
must
[
(c)
Applicants for licensure who are graduates of [
(1)
Educational Commission for Foreign Medical Graduates (ECFMG)
Status Report. Each applicant must submit an ECFMG status report.
(2)
Unique Documentation. The board may request documentation
unique to an individual unapproved medical school and additional documentation
as needed to verify completion of medical education that is substantially
equivalent to a Texas medical school education. This may include but is not
limited to:
(A)
a copy of the applicant's ECFMG file;
(B)
a copy of other states' licensing files;
(C)
copies of the applicant's clinical clerkship evaluations;
and
(D)
a copy of the applicant's medical school file.
(3)
Certificate of Registration. Each applicant must provide
a copy of his or her certificate to practice in the country in which his or
her medical school is located. If a certificate is unavailable, a letter submitted
directly to this board from the body governing licensure of physicians in
the country in which the school is located, will be accepted. The letter must
state that the applicant has met all the requirements for licensure in the
country in which the school is located. If an applicant is not licensed in
the country of graduation due to a citizenship requirement, a letter attesting
to this, submitted directly to this board, will be required.
(4)
Clinical Clerkship Affidavit. A form, supplied by the board,
to be completed by the applicant, is required listing each clinical clerkship
that was completed as part of an applicant's medical education. The form will
require the name of the clerkship, where the clerkship was located (name [
(5)
"
Substantially equivalent
"
documentation.
An applicant who is a graduate of a medical school that is located outside
the United States and Canada must present satisfactory proof to the board
that each medical school attended was substantially equivalent to a Texas
medical school at the time of attendance
as defined under §163.1(13)
of this title
. This may include but is not limited to:
(A)
a Foreign Educational Credentials Evaluation from the Office
of International Education Services of the American Association of Collegiate
Registrars and Admissions Officers (AACRAO);
(B)
a board questionnaire, to be completed by the medical school
and returned directly to board;
(C)
a copy of the medical school's catalog;
(D)
verification from the
country's
educational
agency confirming the validity of school and licensure of applicant;
(E)
proof of written agreements between the medical school
and all hospitals that are not located in the same country as the medical
school, where medical education was obtained
[
[
(F)
[
(G)
[
(H)
[
(I)
[
(6)
Medical Diploma. Each applicant must submit a copy of
his or her
[
(d)
Applicants may be required to submit other documentation,
which may include the following
:
[
(1)
Translations. Any document that is in a language other
than the English language will need to have a certified translation prepared
and a copy of the translation will have to be submitted along with the translated
document.
(A)
An official translation from the medical school (or appropriate
agency) attached to the foreign language transcript or other document is acceptable.
(B)
If a foreign document is received without a translation,
the board will send the applicant a copy of the document to be translated
and returned to the board.
(C)
Documents must be translated by a translation agency
that
[
(D)
The translation must be on the translator's letterhead,
and the translator must verify that it is a "true word for word translation"
to the best of his/her knowledge, and that he/she is fluent in the language
translated, and is qualified to translate the document.
(E)
The translation must be signed in the presence of a notary
public and then notarized. The translator's name must be printed below his/her
signature. The notary public must use this phrase: "Subscribed and Sworn to
this ________ day of ________, 20___." The notary must then sign and date
the translation, and affix his/her Notary Seal to the document.
(2)
Arrest Records. If an Applicant has ever been arrested
,
a copy of the arrest and arrest disposition need to be requested from
the arresting authority and said authority must submit copies directly to
this board.
(3)
Malpractice. If an applicant has ever been named in a malpractice
claim filed with any medical liability carrier or if an applicant has ever
been named in a malpractice suit, the applicant must
do the following
[
(A)
have each medical liability carrier complete a form furnished
by this board regarding each claim filed against the applicant's insurance;
(B)
for each claim that becomes a malpractice suit
,
have
the attorney representing the applicant in each suit submit a letter directly
to this board explaining the allegation, dates of the allegation, and current
status of the suit. If the suit has been closed, the attorney must state the
disposition of the suit, and if any money was paid, the amount of the settlement.
The letter should include supporting court records.
If such letter is
not available, the Applicant will be required to furnish a notarized affidavit
explaining why this letter cannot be provided; and
(C)
provide
a statement, composed by the applicant,
explaining the circumstances pertaining to patient care in defense of the
allegations.
(4)
Inpatient Treatment for Alcohol/Substance Abuse or Mental
Illness. Each applicant that has been admitted to an inpatient facility within
the last five years for the treatment of alcohol/substance abuse or mental
illness
shall submit documentation to include, but not limited to
[
(A)
an applicant's statement explaining the circumstances of
the hospitalization;
(B)
all records, submitted directly from the inpatient facility;
(C)
a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up treatment
recommended;
and
(D)
a copy of any contracts signed with any licensing authority
or medical society or impaired physician's committee.
(5)
Outpatient Treatment for Alcohol/Substance Abuse or Mental
Illness. Each applicant that has been treated on an outpatient basis within
the last five years for alcohol/substance abuse or mental illness
shall
submit documentation to include, but not limited to
[
(A)
an applicant's statement explaining the circumstances of
the outpatient treatment;
(B)
a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up treatment
recommended; and
(C)
a copy of any contracts signed with any licensing authority
or medical society or impaired physician's committee.
[
(6)
[
(7)
[
(8)
[
(9)
Additional Documentation. Additional
documentation as is deemed necessary to facilitate the investigation of any
application for medical licensure.
(e)
The board may, in unusual circumstances, allow substitute
documents where proof of exhaustive efforts on the applicant's part to secure
the required documents is presented. These exceptions are reviewed by the
board's executive director on a case-by-case basis.
§163.6. Examinations Accepted for Licensure [
(a)
Licensing Examinations Accepted
by the Board for Licensure. The following examinations are acceptable for
licensure:
(1)
United States Medical Licensing Examination
(USMLE), with a score of 75 or better, or a passing grade if applicable, on
each step, with all steps passed within seven years;
(2)
Federation Licensing Examination (FLEX), on
or after July 1, 1985, passage of both components within seven years with
a score of 75 or better on each component;
(3)
Federation Licensing Examination (FLEX), before
July 1, 1985, with a FLEX weighted average of 75 or better in one sitting;
(4)
National Board of Medical Examiners Examination
(NBME) or its successor all steps passed within seven years;
(5)
National Board of Osteopathic Medical Examiners
Examination (NBOME) or its successor with all steps passed within seven years;
(6)
Medical Council of Canada Examination (LMCC)
or its successor, with all steps passed within seven years;
(7)
State board licensing examination, passed before
January 1, 1977, (with the exception of Virgin Islands, Guam, Tennessee Osteopathic
Board or Puerto Rico then the exams must be passed before July 1, 1963); or
(8)
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:
(A)
FLEX I plus USMLE 3;
(B)
USMLE 1 and USMLE 2 (including passage of the
clinical skills component if applicable), plus FLEX II;
(C)
NBME I or USMLE 1, plus NBME II or USMLE 2 (including
passage of the clinical skills component if applicable), plus NBME III or
USMLE 3;
(D)
NBME I or USMLE 1, plus NBME II or USMLE 2 (including
passage of the clinical skills component if applicable), plus FLEX II;
(E)
NBOME I, plus NBOME II, plus FLEX II;
(F)
the NBOME Part I or COMLEX Level I and NBOME
Part II or COMLEX Level II and NBOME Part III or COMLEX Level III.
(b)
An applicant must pass each
part of an examination listed in subsection (a) of this section 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.
(c)
Notwithstanding subsection
(c) of this section, an applicant is considered to have satisfied the requirements
of this section if the applicant:
(1)
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;
(2)
is specialty board certified by a specialty
board that:
(A)
is a member of the American Board of Medical
Specialties; or
(B)
is a member of the Bureau of Osteopathic Specialists;
and
(C)
completed in this state an additional two years
of postgraduate medical training approved by the board.
(d)
An applicant who has not passed
an examination listed in subsection (a) for licensure in a ten-year period
prior to the filing date of the application must:
(1)
pass a monitored specialty certification examination
or formal evaluation, a monitored recertification examination or formal evaluation,
or a monitored 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;
(2)
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
(3)
pass the Special Purpose Examination (SPEX)
within the preceding ten years.
(4)
For those applicants who do no pass all parts
of all examinations required for licensure within a seven-year period, the
board may consider for licensure graduates of simultaneous MD-PhD or DO-PhD
programs who have passed all parts of their required examinations no later
than two years after their MD or DO degree was awarded.
(e)
JP Exam.
(1)
In addition to the licensing examinations
required for licensure under subsection (a) of this section, applicants must
pass the JP exam with a score of 75 or better.
(2)
[
(3)
[
(4)
[
(5)
An applicant who is unable
to pass the JP exam within three attempts must appear before a committee of
the board to address the applicant's inability to pass the examination and
to re-evaluate the applicant's eligibility for licensure. It is at the discretion
of the committee to allow an applicant additional attempts to take the JP
exam.
(6)
Applicants for licensure who
wish to request reasonable accommodations for the JP exam due to a disability
must submit the request upon filing the Application.
§163.7.Temporary Licensure - Regular.
(a)
The executive director of the board may issue a temporary
license to an applicant:
(1)
who has passed the Texas medical jurisprudence examination;
(2)
whose completed application has been filed, processed,
and found to be in order; and
(3)
who has met all other requirements for licensure.
(b)
Each applicant shall receive only one temporary license
prior to the issuance of a permanent license. The
board
[
§163.11.Active Practice of Medicine.
(a)
All applicants for licensure shall provide sufficient documentation
to the board that the applicant has, on a full-time basis, actively diagnosed
or treated persons or has been on the active teaching faculty of an acceptable
approved medical school, within
either
[
(b)
The term "full-time basis," for purposes of this section,
shall mean at least 20 hours per week for 40 weeks duration during a given
year.
(c)
Applicants who do not meet the requirements of subsections
(a) and (b) of this section may, in the discretion of the executive director
or board, be eligible for an unrestricted license or a restricted license
subject to one or more of the following conditions or restrictions:
(1)
current certification or recertification by the American
Board of Medical Specialties or Bureau of Osteopathic Specialists
obtained
by passing a monitored specialty certification or recertification examination
or forma evaluation
;
(2)
passage of the SPEX examination;
[
(3)
[
(4)
[
(5)
[
§163.12.Licensure for the Fifth Pathway.
An applicant who has completed a Fifth Pathway Program to be eligible
for licensure must:
(1)
be at least 21 years of age;
(2)
be of good professional character
as defined under §163.1(10)
of this title
;
(3)
have completed 60 semester hours of college courses
as defined under §163.1(12) of this title
[
(4)
have completed all of the didactic work of the foreign
medical school, whose curriculum meets the requirements for an acceptable
unapproved medical school as determined by a committee of experts selected
by the Texas Higher Education Coordinating Board, but has not graduated from
an
acceptable unapproved
[
(5)
have completed all of the didactic work of the foreign
medical school, that is substantially equivalent to a Texas medical school
as defined under §163.1(13) of this title
, but has not graduated
from an acceptable unapproved medical school;
(6)
have successfully completed a three-year training program
of graduate medical education in the United States or Canada that was approved
by the board on the date the training was completed;
(7)
submit evidence of passing an examination, , that is acceptable
to the board
for
[
(8)
pass the Texas Medical Jurisprudence Examination with a
score of 75 or better;
(9)
submit a sworn affidavit that no proceedings, past or current,
have been instituted against the applicant before any state medical board,
provincial medical board, in any military jurisdiction or federal facility;
(10)
have attained a passing score on the ECFMG examination;
(11)
have the ability to communicate in the English language;
(12)
have attained a satisfactory score on a qualifying examination
and have completed one academic year of supervised clinical training for foreign
medical students as defined by the American Medical Association Council on
Medical Education (Fifth Pathway Program) in a United States medical school;
and
(13)
have supplied all additional information that the board
may require, concerning the applicant's medical school, before approving the
applicant.
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, 2004.
TRD-200401011
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 305-7016
22 TAC §164.4
The Texas State Board of Medical Examiners proposes an amendment
to §164.4, concerning advertising board certification. The amendment
will provide a method for informing the public of the physician's interest
and expertise, as well as identify those physicians possessing board certification.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the proposed rule is in
effect there will be no effect to individuals required to comply with the
rule as proposed. There will be no fiscal implications to state or local government
as a result of enforcing the rule as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rule as proposed is in effect the public benefit anticipated as
a result of enforcing the section will be an updated method for informing
the public of the physician's interest and expertise, as well as identify
those physicians possessing board certification. 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 rule: Texas Occupations Code
Annotated, §§153.002, 101.201.
§164.4.Board Certification.
(a)
A
physician is authorized to use
[
(1)
The certifying organization is a member board of the American
Board of Medical Specialties, or the Bureau of Osteopathic Specialists, or
is the American Board of Oral and Maxillofacial Surgery; or
(2)
The certifying organization requires that its applicants
be certified by a separate certifying organization that is a member board
of the American Board of Medical Specialties or the Bureau of Osteopathic
Specialists, or appropriate Royal College of Physicians and Surgeons, and
the certifying organization meets the criteria set forth in subsection (b)
of this section.
(b)
Each certifying organization that is not a member board
of the American Board of Medical Specialties or the Bureau of Osteopathic
Specialists must meet each of the requirements set forth in paragraphs (1)-(5)
of this subsection:
(1)
the certifying organization requires all physicians who
are seeking certification to successfully pass a written or an oral examination
or both, which tests the applicant's knowledge and skills in the specialty
or subspecialty area of medicine. All or part of the examination may be delegated
to a testing organization. All examinations require a psychometric evaluation
for validation;
(2)
the certifying organization has written proof of a determination
by the Internal Revenue Service that the certifying board is tax exempt under
the Internal Revenue Code pursuant to Section 501(c);
(3)
the certifying board has a permanent headquarters and staff;
(4)
the certifying board has at least 100 duly licensed certificants
from at least one-third of the states; and
(5)
the certifying organization requires all physicians who
are seeking certification to have satisfactorily completed identifiable and
substantial training in the specialty or subspecialty area of medicine in
which the physician is seeking certification, and the certifying organization
utilizes appropriate peer review. This identifiable training shall be deemed
acceptable unless determined by the Board of Medical Examiners to be inadequate
in scope, content, and duration in that specialty or subspecialty area of
medicine in order to protect the public health and safety.
(c)
A physician may not
authorize the use of or
use
the term "board certified" or any similar words or phrase calculated to convey
the same meaning if the claimed board certification has expired and has not
been renewed at the time the advertising in question was published or broadcast.
(d)
The terms "board eligible," "board qualified," or any similar
words or phrase calculated to convey the same meaning shall not be used in
physician advertising.
(e)
A physician's authorization
of or use of the term "board certified", or any similar words or phrase calculated
to convey the same meaning in any advertising for his or her practice shall
constitute misleading or deceptive advertising unless the specialty board
which conferred the certification and the certifying organization meet the
requirements in subsections (a) and (b) of this section.
(f)
A physician who is board certified
by an organization that does not meet the requirements set out in subsections
(a) and (b) of this section, or otherwise has a special interest in a particular
field of medicine, may include in advertisements the physician's field of
interest. For each area of interest advertised the physician must clearly
state in the advertising "Not certified by an organization recognized by the
Texas State Board of Medical Examiners." This statement must be separate and
apart from other statements and shall be displayed conspicuously with no abbreviations,
changes, or additions in the quoted language so as to be easily seen or understood
by an ordinary consumer.
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, 2004.
TRD-200401010
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 305-7016
22 TAC §175.1, §175.4
The Texas State Board of Medical Examiners proposes amendments
to §175.1 and §175.4, concerning Fees, Penalties and Applications.
The proposal concerns increases in application and registration fees for licenses
and permits issued by the Board and mandated by Texas Online Authority.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the proposed rules are
in effect, the following fiscal implications will apply:
Increase revenue for state government:
FY04 (partial year - effective date of rule anticipated May 2004)
$2 increase for postgraduate training permits X 1,713 permits = $3,425
$2 increase for non-certified radiologic technicians X 355 permits = $711
$30 increase for non-profit health organization biennial certification
X 33 permits = $1,000
$5 increase for acupuncturist registration X 182 permits = $911
FY05 - FY08 (calculated for each year)
$2 increase for postgraduate training permits X 5,138 permits = $10,276
$2 increase for non-certified radiologic technicians X 1,066 permits =
$2,132
$30 increase for non-profit health organization biennial certification
X 100 permits = $3,000
$5 increase for acupuncturist registration X 547 permits = $2,735
The impact to those required to comply with the rule change is negligible
as indicated by the small fee increase and is offset by the convenience of
online applications and the ability to pay with a credit card.
There will be some setup cost for implementing the online renewal, but
should be offset by reduced paperwork.
Ms. Shackelford also has determined that for each year of the first five
years the rules as proposed are in effect the public benefit anticipated as
a result of enforcing the sections will be compliance with the Texas Online
Authority. 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 rules: Texas Occupations Code
Annotated, §153.051, Texas Government Code, §2054.252(g).
§175.1.Fees.
The board shall charge the following fees.
(1)
Physicians:
(A)
processing an application for licensure examination (includes
surcharges of $200
[
[
(B)
[
(C)
[
(i)
regular - $50;
(ii)
distinguished professor - $50;
(iii)
state health agency - $50;
(iv)
rural/underserved areas - $50;
(v)
continuing medical education - $55;
(D)
[
(i)
permits issued to license holders with an expiration date
before December 30, 2003;
(I)
initial permit (includes
surcharges of $209
[
(II)
subsequent permit (includes
surcharges of $205
[
(ii)
permits issued to license holders with an expiration date
between January 1, 2004 and December 31, 2004;
(I)
initial permit (includes
surcharges of $289
[
(II)
subsequent permit (includes
surcharges of $285
[
(iii)
permits issued to license holders with an expiration
date on or after January 1, 2005;
(I)
initial permit (includes
surcharges of $494
[
(II)
subsequent permit (includes
surcharges of $490
[
[
(E)
[
(F)
[
(2)
Physicians in Training:
(A)
institutional permit (began training program prior to 6-1-2000)
- $45;
(B)
postgraduate resident permit
(includes surcharges
of $2) - $62
[
(C)
temporary postgraduate resident permit - $50;
(D)
faculty temporary permit - $110;
(E)
visiting professor permit - $110;
(F)
evaluation or re-evaluation of postgraduate training program
-$250.
(3)
Physician Assistants:
(A)
processing application for licensure as a physician assistant
- $200;
(B)
temporary license - $50;
(C)
annual renewal:
(i)
initial permit (includes
surcharges of $10
[
(ii)
subsequent permit (includes
surcharges of $1
[
(D)
processing application for reissuance of license following
revocation - $200.
(4)
Acupuncturists/Acudetox Specialists:
(A)
processing an application for licensure as an acupuncturist
- $300;
(B)
temporary license for an acupuncturist - $50;
(C)
annual renewal for an acupuncturist:
(i)
initial permit (includes
surcharges of $10
[
(ii)
subsequent permit (includes
surcharges of $6
[
(D)
acupuncturist distinguished professor - $50;
(E)
processing an application for acudetox specialist - $50;
(F)
annual renewal for acudetox specialist - $25;
(G)
review of continuing acupuncture education courses - $50;
(H)
review of application for continuing acupuncture education
provider - $50;
(I)
review of continuing acudetox acupuncture education courses
- $50.
(5)
Non-Certified Radiologic Technicians:
(A)
processing an application - $50;
(B)
annual renewal
(includes surcharges of $2) - $52
[
(6)
Certification as a Non-Profit Health Organization:
(A)
processing an application for new or initial certification
- $2,500;
(B)
processing an application for biennial recertification
(includes surcharges of $30) - $1,030
[
(C)
fee for a late application for biennial recertification
- $1,000.
(7)
Surgical Assistants:
(A)
processing licensure application fee - $300;
(B)
temporary license - $50;
(C)
biennial registration fee:
(i)
initial permit (includes
surcharges of $6
[
(ii)
subsequent permit (includes
surcharges of $2
[
[
§175.4.Applications.
(a)
All information required on applications used by this board
will conform to the Medical Practice Act and rules promulgated by this board.
The board hereby adopts by reference the following forms:
(1)
Physicians:
(A)
application for licensure;
(B)
application for a special purpose license for practice
of medicine across state lines;
(C)
application for registration of physician's permit;
(D)
application for a duplicate wall certificate;
(E)
application for reissuance of license following revocation;
(F)
physician designation of prescriptive delegation;
(G)
application for office-based anesthesia registration.
(2)
Physicians in Training:
(A)
application for institutional permit (physician began program
prior to 5-31-2000);
(B)
application for basic postgraduate resident permit;
(C)
application for advanced postgraduate resident permit;
(D)
application for renewal of basic postgraduate resident
permit;
(E)
application for renewal of advanced postgraduate resident
permit;
(F)
application for faculty temporary permit;
(G)
application for visiting professor permit;
(H)
application for National Health Service Corps Permit.
(3)
Physician Assistants:
(A)
licensure application;
(B)
application for temporary license;
(C)
notice of intent to supervise a physician assistant;
(D)
notice of intent to practice as a physician assistant;
(E)
application for annual renewal of license;
(F)
application for reissuance of license following revocation.
(4)
Acupuncturists/Acudetox Specialists:
(A)
licensure application for acupuncturist;
(B)
application for acupuncture distinguished professor temporary
license;
(C)
application for annual renewal of acupuncturist license;
(D)
application for acudetox specialist certification;
(E)
application for annual renewal of acudetox specialist certification;
(F)
application for approval of continuing acupuncture education
courses;
(G)
application for approval of continuing acupuncture education
provider;
(H)
application for approval of continuing acudetox acupuncture
education courses.
(5)
Non-Certified Radiologic Technicians:
(A)
application for initial non-certified radiologic technician
permit;
(B)
application for annual renewal of non-certified radiologic
technician permit;
(C)
application for supervision of a non-certified radiologic
technician.
(6)
Certification as a Non-Profit Health Organization:
(A)
application for initial certification;
(B)
application for biennial recertification
;
[
(7)
Surgical Assistants:
(A)
licensure application;
(B)
application for temporary license;
(C)
application for biennial renewal of license;
(D)
application for reissuance of license following
revocation.
(b)
These forms may be examined and copies may be obtained
at the offices of the Texas State Board of Medical Examiners, 333 Guadalupe,
Tower 3, Suite 610, Austin, Texas.
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, 2004.
TRD-200401009
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: March 28, 2004
For further information, please call: (512) 305-7016
Pursuant to the Government Code, Chapter 2001 et seq.,
ultimate disposition of any complaint or matter pending before the Board may
be made by stipulation, agreed settlement, or consent order. Such informal
dispositions will facilitate the expeditious change or correction of dental
practice patterns which constitute violations of the Dental Practice Act or
the rules of the Board.
]
(1)
] Approval. The
Board Secretary
[
secretary
] or executive director shall determine if the
public interest would be served by offering to resolve a complaint or other
matter pending before the Board by
either informal disposition as described
in Chapter 2001
et. seq.
, of the Government
Code, or by a method of alternative dispute resolution under Chapter 2009
of the Government Code,
[
stipulation, settlement agreement, or
consent order
] in lieu of a formal disciplinary proceeding described
in
the
[
Texas Civil Statutes,
] Occupations Code, [
Chapter 263,
] §263.003. [
If the secretary or executive director
approves the matter for possible resolution by stipulation, agreed settlement,
or consent order, the licensee and other persons shall be notified as provided
in this section.
]
(2)
Procedure. Upon referral by
the secretary or executive director of a complaint or other matter for possible
resolution by stipulation, agreed settlement, or consent order, the following
procedure shall be followed.]
(A)
] One or more members of the
Board
[
board
] shall represent the full
Board
[
board
] at the
Board
settlement conference.
(B)
] The
Board
[
board
] will provide the licensee notice in writing of the time, date,
and place of the settlement conference. Such notification shall inform the
licensee
:
of the nature of the alleged violation
;
[
,
] that he or she may be represented by legal counsel
;
[
,
] that the licensee may offer the testimony of such witnesses as he
or she may desire
;
[
,
] that the
Board
[
board
] will be represented by one or more of its members and by legal
counsel
;
[
,
] and that he or she may request that the
matter be considered by the
Board
[
board
] according
to procedures described in [
Texas Civil Statutes,
] Occupations
Code, [
Chapter 263,
] §263.007. A copy of the
Board's
[
board's
] rules relating to the informal disposition of
cases shall be enclosed with the notice of the settlement conference. Notice
of the settlement conference, with enclosures, shall be sent by certified
mail, return receipt requested, to the current address of the licensee on
file with the Board.
(C)
] The settlement conference shall
be informal and will not follow the procedure established in State Office
of Administrative Hearing (SOAH) rules for contested cases. The licensee,
his or her attorney, and representative(s) of the
Board
[
board
] and
Board
[
board
] staff may question witnesses,
make relevant statements, present affidavits or statements of persons not
in attendance, and may present such other evidence as may be appropriate.
Any documentary evidence received by the
Board
[
board
]
less than 10 days before the scheduled dates of the settlement conference
will not be considered by the panel.
(D)
] The settlement conference will
be conducted by a representative(s) of the
Board
[
board
].
The
Board's
[
board's
] representative may call upon the
Board's
[
board's
] attorney at any time for assistance in
conducting the settlement conference. The
Board's
[
board's
] representative(s) may question any witness, and shall afford each
participant in the settlement conference the opportunity to make such statements
as are material and relevant.
(E)
] The
Board's
[
board's
] representative(s) may prohibit or limit access to the Board's
investigative file by the licensee, his or her attorney, and the complainant
and his or her representative.
(F)
] The
Board's
[
board's
] representative(s) shall exclude from the settlement conference
all persons except witnesses during their testimony, the licensee, his or
her attorney, the complainant,
Board
[
board
] members,
and board staff.
(G)
] At the conclusion of the settlement
conference, the
Board's
[
board's
] representative(s)
shall make recommendations to the licensee and consultant for resolution or
correction of any alleged violations of the Dental Practice Act or of the
Board rules. Such recommendations may include any disciplinary actions authorized
by the Occupations Code, [
Chapter 263,
] §263.002 [
, Texas
Civil Statutes
]. The
Board's
[
board's
] representative(s)
may, on the basis that a violation of the Dental Practice Act or the Board's
rules has not been established
, either close the case
[
recommend
that the case be closed
], or
refer the case to Board staff
[
the case may be referred to the Board Secretary
] for further investigation.
Closure of a case by the Board's representative(s) shall be given effect immediately
without the necessity of presentation to the full Board.
(H)
] [
The
]
Board
staff shall draft a proposed settlement agreement reflecting the settlement
recommendations, which the
licensee shall either accept or reject [
the settlement recommendations proposed by the board representative(s)
].
To accept the settlement
recommendations
[
recommendation
],
the licensee must sign the proposed
agreed
settlement
order
[
agreement
] and return it to the Board within 30 days from
receipt. Inaction by the licensee shall constitute rejection. If the licensee
rejects the proposed
agreed settlement order
[
agreement
],
the matter shall be referred to the
Board Secretary
[
secretary
] and executive director for other appropriate disposition.
(I)
] Following acceptance and execution
of the
proposed agreed settlement order
[
agreement
] by
the licensee, said
proposed order
[
agreement
] shall
be submitted to the
Board's
[
board's
] legal counsel,
and /or executive director for review.
(J)
] The settlement proposal will
then be submitted to the entire
Board
[
board
] for approval.
(K)
] A recommendation to close a
case requires no
further
action by the Respondent [
prior to
its presentation to the Board
].
(3)
] Consideration by the Board.
(A)
] The name and license number
of the licensee will not be made available to the board until after the board
has reviewed and made a decision on the
proposed agreed
settlement
order,
agreement
or recommendation
.
(B)
] Upon an affirmative majority
vote, the Board shall [
either
] enter an order approving the proposed
agreed
settlement
order, agreement, or recommendation
[
agreements, or without entry of an order, approve the recommendation to close.
] Said order shall bear the signature of the
presiding officer
and Board Secretary
[
president and secretary of the Board
],
or of the officer presiding at such meeting and shall be included in the minutes
of the Board.
(C)
] If the board does not approve
a proposed settlement
order,
agreement,
or recommendation,
the licensee shall be so informed. The matter shall be referred by
the
Board
[
board
] to the
Board Secretary
[
secretary
] and executive director for consideration of appropriate action.
Subchapter C. ADMINISTRATIVE PENALTIES
and address
] of patient, and description of
kind and type of act, service or material ordered;
Chapter 108.
PROFESSIONAL CONDUCT
should
] include, but shall not necessarily be limited to,
measurement
of
blood pressure and pulse/heart rate [
as may be indicated for
each patient
].
Blood pressure and pulse/heart rate measurements
are not required to be taken on any patient twelve (12) years of age or younger,
unless the patient's medical condition or history indicate such a need.
Subchapter C. ANESTHESIA AND ANESTHETIC AGENTS
utilize
] nitrous oxide/oxygen inhalation conscious sedation, parenteral conscious
sedation, and/or deep sedation and general anesthesia, must obtain a permit
from the State Board of Dental Examiners for the requested procedure.
(c)
] Any dentist approved by the
State Board of Dental Examiners under previous rules prior to the effective
date of this section for the utilization of nitrous oxide/oxygen inhalation
conscious sedation, parenteral conscious sedation, or deep sedation/general
anesthesia, except as described in subsection
(e)
[
(d)
]
of this section, shall remain permitted provided that the appropriate fees
have been paid and that the dentist has a current license.
(d)
] Once a permit is issued, the
State Board of Dental Examiners upon payment of required fees shall automatically
renew the permit annually unless after notice and opportunity for hearing
the Board finds the permit holder has, or is likely to provide anesthesia
services in a manner that does not meet the minimum standard of care. At such
hearing the Board shall consider factors including patient complaints, morbidity,
mortality, and anesthesia consultant recommendations.
(e)
] Annual dental license renewal
certificates shall include the annual permit renewal, except as provided for
in subsection
(e)
[
(d)
] of this section and shall be
assessed an annual renewal fee of $5.00 payable with the license renewal.
New permit fees are $28.75 payable with the application for permit.
(f)
] Permit Restrictions:
(g)
] Educational/Professional requirements
for sedation/anesthesia permits:
(g)(1)
] of this title
(relating to Sedation/Anesthesia Permit).
(g)(2)
] of this title (relating
to Sedation/Anesthesia Permit).
Chapter 114.
EXTENSION OF DUTIES OF AUXILIARY PERSONNEL--DENTAL ASSISTANTS
(a)
] A Texas
-
licensed
dentist who is enrolled as a Medicaid Provider with appropriate state agencies
, or who practices in an area determined to be underserved by the Texas Department
of Health,
may delegate the application of a pit and fissure sealant
to a dental assistant, if the dental assistant:
(d)
] of this section.
(b)
] In addition to application
of pit and fissure sealants a dental assistant certified in this section may
use a rubber prophylaxis cup and appropriate polishing materials to cleanse
the occlusal and smooth surfaces of teeth that will be sealed or to prepare
teeth for application of orthodontic bonding resins Cleansing is intended
only to prepare the teeth for the application of sealants or bonding resins
and should not exceed the amount needed to do so.
(c)
] The dentist may not bill for
a cleansing provided hereunder as a prophylaxis.
(d)
] A dental assistant wishing
to obtain certification
under this subsection
must
:
pay
] an application
fee set by Board rule
;
and
] on a form prescribed
by the Board [
must
] provide proof
that the applicant has
[
of the following
]:
(1)
]
At
[
at
]
least two years of experience as a dental assistant;
(2)
]
Completed
[
completion of
] a minimum of 16 hours of clinical and didactic education
in pit and fissure sealants taken through a CODA accredited dental hygiene
program approved by the Board whose course of instruction includes:
(A)
] infection control;
(B)
] cardiopulmonary resuscitation;
(C)
] treatment of medical emergencies;
(D)
] microbiology;
(E)
] chemistry;
(F)
] dental anatomy;
(G)
] ethics related to pit and
fissure sealants;
(H)
] jurisprudence related to
pit and fissure sealants; and
(I)
] the correct application of
sealants, including the actual clinical application of sealants; and
(3)
Submit proof that applicant
has successfully completed a current course in basic life support given by
the American Heart Association or the American Red Cross.]
(e)
] Before January 1 of each year,
a
dental
assistant registered under this section who wishes to
renew that registration must
[
assistants certified hereunder who
wish to renew their certifications must pay a renewal fee set by Board rule
and must provide proof of the following
]:
(1)
]
Provide proof of
completion
of at least six
(6)
hours of continuing education in technical
and scientific coursework
in the previous calendar year.
[
annually. The terms technical and scientific as applied to continuing education
shall mean that courses have significant intellectual or practical content
and are designed to directly enhance the practitioner's knowledge and skill
in providing clinical care to the individual patient.
]
(A)
] Dental assistants shall select
and participate in continuing education courses offered by or endorsed by
:
[
dental schools, dental hygiene schools, or dental assisting
schools that have been accredited by the Commission on Dental Accreditation
of the American Dental Association; or
]
(B) by
] nationally recognized dental,
dental hygiene or dental assisting organizations.
; and
]
(2)
Submit proof that applicant
has successfully completed a current course in basic life support given by
the American Heart Association or the American Red Cross.]
Chapter 115.
EXTENSION OF DUTIES OF AUXILIARY PERSONNEL--DENTAL HYGIENE
Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
(2)
] 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.
(3)
] Applicant - One who files an
application as defined in this section.
(4)
] Application - An application
is all documents and information necessary to complete an applicant's request
for licensure including the following:
(5)
] Continuous - 12 month periods
of uninterrupted postgraduate 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.
must be
] passed within seven years;
prior to June 30,
] 1985, with a FLEX weighted average
of 75 or better in one sitting;
must be
] passed within
seven years;
must be
] passed
within seven years;
must be
] passed within seven years;
after June 30, 1963
]); 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;
(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.]
Applicants who are graduates
of acceptable approved medical schools must successfully complete
]
a program that is
one continuous year of postgraduate training approved
by the board that is:
an American Specialty
] board that is a member of the American Board
of Medical Specialties or the Bureau of Osteopathic Specialists; or
in a program approved
by the Texas State Board of Medical Examiners
].
(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)
] 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:
(J)
All medical or osteopathic
medical education received by the applicant in the United States must be obtained
while enrolled as a visiting student at a medical school that is 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. 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.]
Applicants who are
graduates of, or have studied at an acceptable unapproved foreign medical
school 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:
and
]
An applicant, to
be eligible for licensure must
]:
other than in medical
school
];
approved by the board
];
,
] an examination
[
,
]
accepted
[
acceptable
] by the board for
licensure
as defined under §163.1(9) of this title
; and,
Foreign ] Medical Schools.
An applicant,
to be eligible for licensure must
]:
other than in medical
school or have completed 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
];
foreign
] medical school
as defined under §163.1(2) of this title
[
that is substantially equivalent to a Texas medical school
];
that was approved by the board
on the date the training was completed
];
,
] an examination
[
,
]
accepted
[
acceptable
] by the board for
licensure
as defined under §163.1(9) of this title
;
Applicants
] for licensure:
recommended
] to use the Federation Credentials Verification Service (FCVS) offered
by the Federation of State Medical Boards of the United States (FSMB) to verify
medical education, postgraduate training, licensure examination history, board
action history and identity;
application has
] been filed with the board [
office
] in excess of one year
will be considered expired. Any fee previously submitted with that application
shall be forfeited. Any further
request
[
application procedure
] for licensure will require submission of a new application and inclusion
of the current licensure fee;
(3)
will be allowed to sit for
the Texas medical jurisprudence examination only three times. After the third
failure of the Texas medical jurisprudence examination, and after each subsequent
failure, an applicant for licensure shall be required to appear before a committee
of the board to address the applicant's inability to pass the Texas medical
jurisprudence examination and to re-evaluate the applicant's eligibility for
licensure;]
(4)
] who in any way
submit
a false or misleading statement, document, or certificate in an
[
falsify the
] application may be required to appear before the board.
It will be at the discretion of the board whether or not the applicant will
be issued a Texas license;
(5)
] on whom adverse information
is received by the board may be required to appear before the board. It will
be at the discretion of the board whether or not the applicant will be issued
a Texas license;
(6)
] shall be required to comply
with the board's rules and regulations which are in effect at the time the
[
completed
] application form and fee are filed with the board;
(7)
who have not passed an examination
for licensure in a ten-year period prior to the filing date of the application
must:]
(A)
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;]
(B)
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]
(C)
pass SPEX within the preceding ten years;]
(8)
] may be required to sit for
additional oral, written, mental or physical examinations that, in the opinion
of the board, are necessary to determine competency and ability of the applicant;
(9)
] must have the application for
licensure complete in every detail 20 days prior to the board meeting in which
they are considered for licensure. Applicants with complete applications may
qualify for a Temporary License prior to being considered by the board for
licensure, as required by section §163.7 of this title (relating to Temporary
Licensure - Regular);
and
(10)
must pass, within seven years
all parts of all examinations required for licensure. The board may consider
for licensure graduates of simultaneous MD-PhD or DO-PhD programs who have
passed all parts of their required examinations no later than two years after
their MD or DO degree was awarded.]
(b)
Applicants for licensure who
wish to request reasonable accommodations for the Texas jurisprudence examination,
due to a disability, must submit the request upon filing the Application.]
(c)
] Applicants for a license must
subscribe to an oath in writing [
before an officer authorized by law
to administer oaths
]. The written oath is part of the application.
(d)
] An applicant is not eligible
for a license if:
current state driver's license, current state
identification card,
] valid passport or birth certificate and translation
if necessary to prove that the applicant is at least 21 years of age. In instances
where
such documentation
[
a birth certificate
] is not
available the applicant must provide copies of [
a passport or
]
other suitable alternate documentation.
this
] board for all examinations
accepted by the board
[
used in Texas or another state
] for
licensure.
(NPDB)
]
/Health Integrity and Protection Data Bank (NPDB-HIPDB)
. Each applicant
must contact the NPDB
-HIPDB
and have a report of action submitted
directly to the board on the applicant's behalf.
submit an evaluation from
] each of the training programs
in which
they have participated in
submit verification
on
a form provided by the board. The evaluation must show the beginning and ending
dates of the program and state that the program was successfully completed.
will
] have every state [
,
] in which he or she
has ever been licensed, regardless of the current status of the license, submit
[
on his or her behalf,
] directly to this board a letter verifying
the status of the license and a description of any sanctions or pending disciplinary
matters.
unapproved
] medical schools
outside the United States or Canada
must
furnish all appropriate documentation listed in this subsection, as well as
that listed in subsections (a) and (b) of this section.
of hospital
] and location of hospital) and dates of the clerkship.
proof of affiliation
agreements between the medical school and the hospitals where clinical clerkships
were taught
];
(F)
proof that the institutions
had written contracts with the medical school if the institutions were not
located in a country where the medical school was located;]
(G)
] proof that the faculty members
of the medical school had written contracts with the school if they taught
a course outside the country where the medical school was located;
(H)
] proof that the medical education
courses taught in the United States complied with the higher education laws
of the state in which the courses were taught;
(I)
] proof that the faculty members
of the medical school
who taught courses in the United States
were
on the faculty of the program of graduate medical education when the
courses were
[
course was
] taught [
in the United States
]; and
(J)
] proof that all education completed
in the United States or Canada was while the applicant was enrolled as a visiting
student as evidenced by a letter of verification from the U.S. or Canadian
medical school.
their
] medical diploma, and translation if necessary.
.
]
who
] is a member of the American Translations Association
or a United States college or university official.
have the following submitted
]:
must submit the following
]:
must submit
the following
]:
(6)
Additional Documentation.
Additional documentation as is deemed necessary to facilitate the investigation
of any application for medical licensure.]
(7)
] DD214. A copy of the DD214,
indicating separation from any branch of the United States military.
(8)
] Premedical School Transcript.
Applicants
, upon request,
may be required to submit a copy of
the record of their undergraduate education. Transcripts must show courses
taken and grades obtained. If determined that the documentation submitted
by the applicant is not sufficient to show proof of the completion of 60 semester
hours of college courses other than in medical school or education required
for country of graduation, the applicant may be requested to contact the Office
of Admissions at The University of Texas at Austin for course work verification.
(9)
] Fingerprint Card. Upon request,
applicants must complete a fingerprint card and return to the board as part
of the application.
Administration of Examinations ] .
(a)
] The board shall
provide
for the administration of the JP exam.
[
administer the Texas medical
jurisprudence examination in writing or by electronic means, at times and
places as designated by the board
].
(b)
] An examinee shall not be permitted
to bring medical books, compends, notes, medical journals, calculators or
other help into the examination room, nor be allowed to communicate by word
or sign with another examinee while the examination is in progress without
permission of the presiding examiner, nor be allowed to leave the examination
room except when so permitted by the presiding examiner.
(c)
] Irregularities during an examination
such as giving or obtaining unauthorized information or aid as evidenced by
observation or subsequent statistical analysis of answer sheets, shall be
sufficient cause to terminate an applicant's participation in an examination
,
[
or to
] invalidate the applicant's examination results
,
or [
to
] take other appropriate action.
Board
], in unusual circumstances, may allow the issuance of one additional
temporary license if it finds it is in the best interest of the public [
and that the
] health and welfare [
of the public would not be endangered,
but would be served
]. These exceptions are reviewed by the executive
director on a case-by-case basis.
each
] of the
last two years preceding receipt of an Application for licensure.
(3)
completion of specified continuing
medical education hours approved for Category I credits by the American Medical
Association or the American Osteopathic Association;]
(4)
] limitation of the practice
of the applicant to specified activities of medicine and/or exclusion of specified
activities of medicine;
(5)
] remedial education, including
but not limited to a mini-residency, fellowship or other structured program;
(6)
] such other remedial or restrictive
conditions or requirements
that
[
which
], in the discretion
of the board are necessary to ensure protection of the public and minimal
competency of the applicant to safely practice medicine.
other than in medical
school, which courses would be acceptable, at the time of completion, to The
University of Texas at Austin for credit on a bachelor of arts or a bachelor
of science degree
];
unapproved acceptable
] medical
school;
of
] licensure;
Chapter 164.
PHYSICIAN ADVERTISING
physician's
authorization of or use of
] the term "board certified," or any similar
words or phrase calculated to convey the same meaning in any advertising for
his or her practice [
shall constitute misleading or deceptive advertising
unless the physician discloses the complete name of
]
if
the
specialty board which conferred the certification and the certifying organization
meets the requirements in paragraphs (1)-(2) of this subsection:
Chapter 175.
FEES, PENALTIES, AND APPLICATIONS
a $200 surcharge and one jurisprudence examination
sitting
]) -$800;
(B)
Jurisprudence examination
fees (required and payable each time applicant is scheduled for a repeat of
examination) - $50;]
(C)
] processing an application for
a special purpose license for practice of medicine across state lines (includes
surcharges of $200
[
a $200 surcharge and one jurisprudence examination
sitting
]) - $800;
(D)
] temporary license:
(E)
] Registration permits:
a $209 surcharge
]) - $339;
a $205 surcharge
]) - $335;
a $289 surcharge
]) - $419;
a $285 surcharge
]) - $415;
a $494 surcharge
]) -
$754
[
$753
];
a $490 surcharge
]) - $750;
(F)
duplicate wall certificate
- $45;]
(G)
] processing an application for
reissuance of license following revocation (includes
surcharges of $200
[
a surcharge of $200 and one jurisprudence examination sitting
]) - $800;
(H)
] office-based anesthesia site
registration - $600.
$60
];
a $5 surcharge
]) - $160;
a $1 surcharge
]) - $156;
a $5 surcharge
]) -
$260
[
$255
];
a $1 surcharge
]) -
$256
[
$251
];
$50
].
$1,000
];
a $5 surcharge
]) -
$406
[
$405
];
a $1 surcharge
]) -
$402.
[
$401;
]
(D)
duplicate license - $45.]
.
]
Chapter 183.
ACUPUNCTURE