Part 9.
TEXAS MEDICAL BOARD
Chapter 163.
LICENSURE
The Texas Medical Board proposes amendments to §§163.1,
163.2, 163.4, 163.6 and the repeal of 163.12, concerning Licensure.
The amendment to §163.1 allows payment of fees on-line and makes minor
clean-up changes. The amendment to §163.2 creates an alternative opportunity
for licensure for applicants who have graduated from a foreign medical school
that has not been approved as substantially equivalent to a U.S. or Canadian
medical school or that has been disapproved by another state licensing board
and reorganizes provisions for fifth pathway to licensure. The amendment to §163.4
authorizes the Executive Director to issue licenses to applicants who clearly
qualify for licensure as authorized by provisions of SB 419. The amendment
to §163.6 is necessary for minor clean-up of language. Section 163.12
is repealed in order to reorganize the chapter and include all provisions
for licensure of foreign medical school graduates in the same section.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the amendments and repeal are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the sections as proposed. There will be no effect to individuals
required to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be updating rule to allow for on-line
payment of fees, allowing for licensure of more qualified graduates of foreign
medical schools to increase the number of physicians in Texas, expediting
licensure of physicians who clearly meet all licensure requirement and makes
the process more efficient and making the rules more understandable. There
will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
22 TAC §§163.1, 163.2, 163.4, 163.6
The amendments are proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
The following statutes, articles or codes are affected by this proposal: §155.004, §155.002(b),
Texas Occupations Code.
§163.1.Definitions.
The following words and terms, (concerning General Definitions) when
used in this chapter, shall have the following meanings, unless the context
clearly indicates otherwise.
(1) - (4)
(No change.)
(5)
Application--An application is all documents and information
necessary to complete an applicant's request for licensure including the following:
(A)
forms furnished by the board, completed by the applicant:
(i)
all forms and addenda requiring a written response must
be typed
,
[
(ii)
(No change.)
(B)
(No change.)
(C)
the required fee[
(6) - (8)
(No change.)
(9)
Good professional character--An applicant for licensure
must not be in violation of or
have
committed any act described
in the Medical Practice Act, TEX. OCC. CODE ANN. §§164.051-.053.
(10) - (12)
(No change.)
(13)
Texas Medical Jurisprudence Examination (JP exam): the
ethics examination developed by the board [
(14)
(No change.)
§163.2.Full Texas Medical License.
(a)
[
(1) - (6)
(No change.)
(7)
pass the Texas Medical Jurisprudence Examination [
(b)
Graduates of
medical schools outside the United States
or Canada
[
(1) - (3)
(No change.)
(4)
be a graduate of
:
(A)
an acceptable unapproved medical school as
defined under §163.1(2) of this title;
or
(B)
any medical school and:
(i)
have passed the basic sciences portion of an
acceptable examination listed in §163.6(a) of this title within two attempts;
(ii)
have not been the subject of disciplinary action
by any other state, the uniformed services of the United States, or the applicant's
peers in a local, regional, state, or national professional medical association
or staff of a hospital;
(iii)
have, on a full-time basis, actively diagnosed
or treated persons or have been on the active teaching faculty of an acceptable
approved medical school for three of the last four years preceding receipt
of an Application for licensure, which may include post-graduate training
(The term "full-time basis" shall have the same meaning provided in §163.11(b)
of this title); and
(iv)
hold a certificate from a specialty board that
is a member of the American Board of Medical Specialties or the Bureau of
Osteopathic Specialists or have passed a monitored examination leading to
such certification by the specialty board.
(5) - (6)
(No change.)
(7)
pass the Texas Medical Jurisprudence Examination [
(8) - (11)
(No change.)
(c)
Fifth Pathway Program. To be
eligible for licensure, an applicant who has completed a Fifth Pathway Program
must:
(1)
be at least 21 years of age;
(2)
be of good professional character as defined
under §163.1(9) 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, but
not graduated from a foreign medical school and meet the requirements subparagraph
A or B of this subsection.
(A)
The medical school's 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; or
(B)
Either:
(i)
the medical school's curriculum is substantially
equivalent to a Texas medical school as defined under §163.1(13) of this
title and has not been disapproved by another state physician licensing agency
unless the applicant can provide evidence that the disapproval was unfounded,
or:
(ii)
the applicant must:
(I)
have passed the basic sciences portion of an
acceptable examination listed in §163.6(a) of this title within two attempts;
(II)
have not been the subject of disciplinary action
by any other state, the uniformed services of the United States, or the applicant's
peers in a local, regional, state, or national professional medical association
or staff of a hospital;
(III)
have, on a full-time basis, actively diagnosed
or treated persons or have been on the active teaching faculty of an acceptable
approved medical school for three of the last fours years preceding receipt
of an Application for licensure, which may include post-graduate training
(The term "full-time basis" shall have the same meaning provided in §163.11(b)
of this title); and
(IV)
hold a certificate from a specialty board that is a member
of the American Board of Medical Specialties or the Bureau of Osteopathic
Specialists or have passed a monitored examination leading to such certification
by the specialty board.
(5)
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;
(6)
submit evidence of passing an examination, that
is acceptable to the board for licensure;
(7)
pass the Texas Medical Jurisprudence Examination;
(8)
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;
(9)
have attained a passing score on the ECFMG examination;
(10)
have the ability to communicate in the English
language;
(11)
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
(12)
have supplied all additional information that
the board may require, concerning the applicant's medical school, before approving
the applicant.
§163.4.Procedural Rules for Licensure Applicants.
(a) - (c)
(No change.)
(d)
If the Executive Director determines
that the applicant clearly meets all licensing requirements, the Executive
Director or a person designated by the Executive Director, may issue a license
to the applicant, to be effective on the date issued without formal board
approval, as authorized by §155.002(b) of the Act.
(e)
If the Executive Director determines
that the applicant does not clearly meet all licensing requirements, a license
may be issued only upon action by the board following a recommendation by
the Licensure Committee, in accordance with §155.007 of the Act and §187.13
of this title.
§163.6.Examinations Accepted for Licensure.
(a) - (e)
(No change.)
(f)
Texas Medical Jurisprudence Examination (JP Exam)
[
(1)
In this chapter, when applicants are required to pass
the JP exam,
[
(2)
An examinee shall not be permitted to bring medical books,
compendia
[
(3) - (4)
(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 April 17, 2006.
TRD-200602197
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §163.12
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Medical Board or in the Texas Register office, Room 245, James Earl
Rudder Building, 1019 Brazos Street, Austin.)
The repeal is proposed under the authority of the
Texas Occupations Code Annotated, §153.001, which provides the Texas
Medical Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§163.12.Licensure for the Fifth Pathway.
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 April 17, 2006.
TRD-200602198
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §165.1, §165.6
The Texas Medical Board proposes an amendment to §165.1
and new §165.6 concerning Medical Records.
The amendment to §165.1 adds requirements that written consents for
treatment or surgery be included in a patient's medical records. New §165.6
provides a form for parental consent for an abortion to be performed on an
unemancipated minor, as required by SB 419.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the amendment and new section are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the sections as proposed. There will be no effect to individuals
required to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be to assure the public that their
consent to medical treatment and surgery will be included in their medical
records and to provide a standard form for parental consent for an abortion.
There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment and new section are proposed under the authority
of the Texas Occupations Code Annotated, §153.001, which provides the
Texas Medical Board to adopt rules and bylaws as necessary to: govern its
own proceedings; perform its duties; regulate the practice of medicine in
this state; enforce this subtitle; and establish rules related to licensure.
The following statutes, articles or codes are affected by this proposal: §164.052(c),
Texas Occupations Code.
§165.1.Medical Records.
(a)
Contents of Medical Record. Each licensed physician of
the board shall maintain an adequate medical record for each patient that
is complete, contemporaneous and legible. For purposes of this section, an
"adequate medical record" should meet the following standards:
(1) - (6)
(No change.)
(7)
any written consents for treatment
or surgery requested from the patient/family by the physician.
(8)
[
(9)
[
(10)
[
(11)
[
(b)
(No change.)
§165.6.Medical Records Regarding an Abortion on an Unemancipated Minor.
(a)
As used in this section:
(1)
"Abortion" means the use of any means to terminate the
pregnancy of a female known by the attending physician to be pregnant with
the intention that the termination of the pregnancy by those means will, with
reasonable likelihood, cause the death of the fetus (as defined at §33.001,
Texas Family Code).
(2)
"Unemancipated minor" means a minor who is not 18 years,
unmarried and has not had the disabilities of minority removed under Chapter
31, Texas Family Code (as defined at §33.001, Texas Family Code).
(b)
In the case of an unemancipated minor patient on whom a
physician plans to perform an abortion, the physician shall obtain and maintain
in the medical records one of the following:
(1)
the written consent of one of the patient's parents, managing
conservator, or legal guardian, in accordance with §164.052(a)(19), Medical
Practice Act;
(2)
a court order authorizing the minor to consent to the abortion,
in accordance with §33.003 or §33.004, Texas Family Code;
(3)
an affidavit of the physician authorizing the physician
to perform the abortion as if the court had issued an order granting the application
or appeal, in accordance with §33.005, Texas Family Code; or
(4)
indications supporting the physician's judgment, if the
physician concludes, on the basis of good faith clinical judgment, that a
condition exists that complicates the medical condition of the pregnant minor
and necessitates the immediate abortion of her pregnancy to avert her death
or to avoid a serious risk of substantial impairment of a major bodily function
and that there is insufficient time to obtain the consent of the patient's
parent, managing conservator, or legal guardian, in accordance with §164.052(a)(19),
Medical Practice Act. The physician shall also maintain in the medical records
a copy of the certification to the Department of State Health Services, as
required by §33.002, Texas Family Code.
(c)
Except in the case of a medical emergency, the physician
shall obtain and maintain in the medical records a written consent signed
by the patient that includes the requirements set forth in §171.011 and §171.012,
Texas Health and Safety Code.
(d)
The physician must use due diligence in determining that
any person signing a written consent for an abortion on an unemancipated minor
is, in fact, who the person purports to be. In any disciplinary action before
the board, based on allegations that a consent was not signed by the person
purporting to sign it, the physician must show that the written consent is
either
(1)
witnessed in the office or clinic of the physician; or
(2)
is notarized.
(e)
The physician shall maintain the medical records required
by this section until the later of the fifth anniversary of the date of the
patient's majority or the seventh anniversary of the date the physician received
or created the documentation for the record.
(f)
Pursuant to §164.052(c), Medical Practice Act, the
board adopts the following form for physicians to obtain the consent required
for an abortion to be performed on an unemancipated minor:
Figure: 22 TAC §165.6(f) (.pdf)
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 April 17, 2006.
TRD-200602199
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §§166.1, 166.2, 166.6
The Texas Medical Board proposes an amendment to §§166.1,
166.2 and 166.6, concerning Physician Registration.
The amendment to §166.1 eliminates reference to "written" application
in order to allow for on-line registration and removes obsolete provisions
that were adopted to transition from annual to biennial registration of physicians.
The amendment to §166.2 adds a provision allowing emergency room physician
to receive Continuing Medical Education in forensic evidence, as required
by the Legislature in 2005. The amendment to §166.6 expands the rule
regarding voluntary charity care by retired physicians to include care to
medically underserved areas and for a disaster relief organization, as required
by the Legislature in 2005.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the amendments are in effect there will
be no fiscal implications to state or local government as a result of enforcing
the sections as proposed. There will be no effect to individuals required
to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be making the Board more efficient
by allowing for on-line registration of physicians, to encourage continuing
medical education in forensic evidence to assist in prosecution of sexual
assault cases and allows the experience and expertise of retired physicians
to be applied to a broader range of voluntary charity care. There will be
no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§166.1.Physician Registration.
(a)
Each physician licensed to practice medicine in Texas shall
register with the board, submit a current physician profile, and pay a fee.
A physician may obtain a registration permit ("permit") by submitting the
required form and by paying the required registration fee to the board on
or before the expiration date of the permit. The fee shall accompany
an
[
(b) - (d)
(No change.)
(e)
[
§166.2.Continuing Medical Education.
(a)
As a prerequisite to the registration of a physician's
permit a physician must complete 24 hours of continuing medical education
(CME) every 12 months. CME hours must be completed in the following categories:
(1) - (3)
(No change.)
(4)
A physician whose practice
includes treating patients in an emergency room setting may complete two hours
of formal continuing medical education, as required by paragraph (1) of this
subsection, relating to forensic evidence. To obtain credit for such courses,
a course must include information regarding indicators of sexual assault and
interviewing a person who may have been the victim of a sexual assault.
(b) - (p)
(No change.)
§166.6.Exemption From Registration Fee for Retired Physician Providing Voluntary Charity Care.
(a)
A retired physician licensed by the board whose only practice
is the provision of voluntary charity care [
(b)
As used in this section:
(1)
"voluntary charity care" means medical care
provided for no compensation to indigent populations, in medically underserved
areas, or for a disaster relief organization.
(2)
"compensation" means direct or indirect payment
of anything of monetary value, except payment or reimbursement of reasonable,
necessary, and actual travel and related expenses.
(c)
To qualify for and obtain such an exemption,
a physician must truthfully certify under oath, on a form approved by the
board, and received by the board at least 30 days prior to the expiration
date of the permit, that the following information is correct:
(1)
the physician's practice of medicine does not include the
provision of medical services for either direct or indirect compensation which
has monetary value of any kind;
(2)
the physician's practice of medicine is limited to voluntary
charity care for which the physician receives no direct or indirect compensation
of any kind for medical services rendered;
(3)
the physician's practice of medicine does not include the
provision of medical services to members of the physician's family; and
(4)
the physician's practice of medicine does not include the
self-prescribing of controlled substances or dangerous drugs.
(d)
[
(e)
[
(f)
[
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 April 17, 2006.
TRD-200602200
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
The Texas Medical Board proposes the repeal and replacement of §§170.1
- 170.3. The current Chapter is titled "Authority of Physician to Prescribe
for the Treatment of Pain". The new title will be "Pain Management".
The repeal and replacement revises rules regarding guidelines for physicians
in the treatment of pain.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the repeal and replacement are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the sections as proposed. There will be no effect to individuals
required to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be to provide better guidelines
for physicians regarding the treatment of pain to address issues of adequate
pain management as well as concern for the possible addiction to and diversion
of pain medications. There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
22 TAC §§170.1 - 170.3
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Medical Board or in the Texas Register office, Room 245, James
Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the authority of the
Texas Occupations Code Annotated, §153.001, which provides the Texas
Medical Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§170.1.Purpose.
§170.2.Definitions.
§170.3.Guidelines.
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 April 17, 2006.
TRD-200602201
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §§170.1 - 170.3
The new sections are proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§170.1.Purpose.
The treatment of pain is a vital part of the practice of medicine.
Optimal pain management, however, is difficult. The physician must temper
the desire to relieve pain with concern for the addictive potential and possible
abuse and diversion of drugs. This Rule sets forth the board's policy for
the proper treatment of pain. The board's intent is to protect the public
and give guidance to physicians. The principles underlying this policy include:
(1)
Pain is a medical condition that every physician sees regularly.
It is an integral part of the practice of medicine.
(2)
The goal of pain management is to treat the patient's pain
in relation to overall health. Physical function, psychological, social, and
work-related factors affect the patient's need for pain treatment.
(3)
Drugs may be essential for the treatment of pain.
(4)
A license to practice medicine gives a physician legal
authority to prescribe drugs for pain. The physician has a duty to use that
authority to help, and not to harm patients and the public.
(5)
Improper pain treatment may involve over-treatment, under-treatment,
or no treatment. It may also involve prescribing drugs for purposes other
than the treatment of a medical condition.
(6)
Over-treatment of pain is a threat to patients and the
public, because it may lead to abuse, addiction, and diversion of drugs. Thus,
physicians must minimize this potential.
(7)
Physicians should not fear board action if they provide
proper pain treatment. Sound clinical judgment is the most important consideration.
(8)
Sound clinical judgment results from evidence-based medicine
or the use of generally accepted standards. The board will not look solely
at the quantity or duration of drug therapy.
(9)
Adequate medical records are crucial when a physician uses
dangerous or scheduled drugs. The physician must keep current, legible, complete,
and accurate records for each patient. The physician must record the rationale
for the treatment plan in a way that shows that these guidelines have been
followed.
(10)
The extent of medical records must be reasonable for the
case. For example, a treatment plan for acute, episodic pain may note only
the dosage and frequency of drugs prescribed and that no further treatment
is planned. Treatment of chronic pain, on the other hand, would require a
more extensive plan, to assure that the success of the treatment is monitored.
An explanation of the thought process is important when the physician continues
scheduled drug therapy or escalates the prescription of scheduled drugs. A
thorough explanation is especially required for cases in which treatment with
scheduled drugs is difficult to relate to the patients objective physical,
radiographic, or laboratory findings.
(11)
The board does not require a physician to comply strictly
with these guidelines, provided medical records show a sound basis for the
treatment plan. A physician cannot always relieve all of a patient's pain.
Proper pain treatment may require the escalation of drug use. The board will
consider all factors, including:
(A)
how a diagnosis supports the drug therapy;
(B)
the efforts to monitor the efficacy of drug therapy; and
(C)
whether the medical records show a rationale and plan to
improve function.
§170.2.Definitions.
In this Chapter:
(1)
"Abuse" or "substance abuse"--a patient's use of a drug
for purposes other than the treatment of a medical condition, including pain,
as prescribed by a physician.
(2)
"Acute pain"--the normal, predicted, physiological response
to a stimulus such as trauma and disease. Acute pain is time limited.
(3)
"Addiction"--a primary, chronic, neurobiological disease
characterized by craving and compulsive use of drugs. Addiction is often characterized
by impaired control over drug use, including taking more drugs more often
than prescribed by a physician. It may also be characterized by continued
use despite harm to oneself or others. Genetic, psychosocial, and environmental
factors may influence the development and manifestations of addiction. Physical
dependence and tolerance are normal physiological consequences of extended
drug therapy for pain and, alone, do not indicate addiction.
(4)
"Chronic pain"-- a state in which pain persists beyond
the usual course of an acute disease or healing of an injury. Chronic pain
may be associated with a chronic pathologic process that causes continuous
or intermittent pain over months or years.
(5)
"Proper treatment of pain"--treatment of pain by a physician
using sound clinical judgment documented by adequate medical records.
(6)
"Scheduled drugs" (sometimes referred to as "Controlled
Substances")--medications defined by the Texas Controlled Substances Act,
Chapter 481, Texas Health and Safety Code. This Act establishes five categories,
or schedules of drugs, based on risk of abuse and addiction. (Schedule I includes
drugs that carry an extremely high risk of abuse and addiction and have no
legitimate medical use. Schedule V includes drugs that have the lowest abuse/addiction
risk).
(7)
"Dangerous drugs"--medications defined by the Texas Dangerous
Drug Act, Chapter 483, Texas Health and Safety Code. Dangerous drugs require
a prescription, but are not included in the list of scheduled drugs. A dangerous
drug bears the legend "Caution: federal law prohibits dispensing without a
prescription" or "Prescription Only."
(8)
"Diversion"--the use of drugs by anyone other than the
person for whom the drug was prescribed by a physician.
(9)
"Escalation"--increasing the dosage or frequency of the
use of drugs.
(10)
"Improper pain treatment"--includes over treatment, under
treatment, no treatment, and the prescription of drugs for purposes other
than the proper treatment of pain. Improper pain treatment results from the
failure to follow the guidelines set forth in this Chapter.
(11)
"Non-therapeutic"--has the same definition as improper
pain treatment.
(12)
"Pain"--An unpleasant sensory and emotional experience
associated with actual or potential tissue damage or described in terms of
tissue damage.
(13)
"Physical dependence"--A state of adaptation that is a
normal physiological consequence of extended drug therapy for pain. Symptoms
of dependence can be produced by abruptly discontinuing drug therapy, rapidly
reducing dosage, decreasing blood level of the drug, and administering an
antagonist. Physical dependence, alone, does not indicate addiction.
(14)
"Tolerance" (tachyphylaxis)--the progressive decrease
in the relief of pain following extended drug therapy. Tolerance does not
necessarily occur during drug treatment and does not, alone, indicate addiction.
(15)
"Withdrawal"--the physiological and mental readjustment
that accompanies discontinuation of a drug for which a person has established
a physical dependence.
§170.3.Guidelines.
(a)
The Texas Medical Board will use these guidelines to assess
a physician's treatment of pain. Failure to follow these guidelines will be
grounds for disciplinary action under the Medical Practice Act. The board
interprets the word "Nontherapeutic," as used in §164.053(a)(5), Texas
Occupations Code, to include improper pain treatment. "Must," as used in these
guidelines means that failure to follow the guideline violates the Medical
Practice Act, unless a sound basis for deviation is noted in the medical records.
"Should" means that the guideline must be followed unless there is a sound
basis for deviation.
(1)
Evaluation of the patient.
(A)
A physician must obtain a medical history either orally
or in writing from the patient.
(B)
The physician must perform a proper physical examination.
(C)
The medical record should document the medical history
and physical examination, including:
(i)
the nature and intensity of the pain,
(ii)
current and past treatments for pain,
(iii)
underlying or coexisting diseases and conditions,
(iv)
the effect of the pain on physical and psychological function,
(v)
any history and potential for substance abuse, and
(vi)
the presence of one or more recognized medical indications
for the use of a dangerous or scheduled drug.
(2)
Treatment plan. A written treatment plan must be included
in the medical records. In preparing the treatment plan, the physician shall
consider and the treatment plan should mention:
(A)
dosage and frequency of any drugs prescribed,
(B)
further testing and diagnostic evaluations to be ordered,
(C)
other treatments that are planned or considered,
(D)
periodic reviews planned, and
(E)
objectives that will be used to determine treatment success,
such as pain relief and improved physical and psychosocial function.
(3)
Informed consent. The physician should discuss the risks
and benefits of the use of dangerous and scheduled drugs with the patient.
If the patient does not have medical decision-making capacity, the discussion
should be with another appropriate person. Discussion of risks and benefits
should include an explanation of the:
(A)
diagnosis;
(B)
treatment plan;
(C)
anticipated therapeutic results, including the realistic
expectations for sustained pain relief and improved functioning and it should
be mentioned that it might not be possible to relieve all of the patient's
pain;
(D)
alternatives or complementary therapies to drug therapy,
including physical therapy or psychological techniques;
(E)
potential side effects and how to manage them, including
the potential for dependence, addiction, escalation, tolerance, and withdrawal;
and
(F)
potential for impairment of judgment and motor skills.
(4)
Agreement for treatment. The patient should agree to obtain
prescriptions from only one physician and only one pharmacy. If the treatment
plan includes extended drug therapy, the physician should consider the use
of a written pain management agreement between the physician and the patient
outlining patient responsibilities, including the following provisions:
(A)
the physician may require laboratory tests for drug levels
upon request;
(B)
the physician may limit the number and frequency of prescription
refills;
(C)
only one physician will prescribe dangerous and scheduled
drugs;
(D)
only one pharmacy will be used for prescriptions, and
(E)
reasons for which drug therapy may be discontinued (e.g.
violation of agreement).
(5)
Periodic review.
(A)
The physician should see the patient for periodic review
at reasonable intervals in view of the individual circumstances of the patient.
(B)
Periodic review should assess progress toward reaching
treatment objectives, taking into consideration the course of medications,
as well as any new information about the etiology of the pain.
(C)
Each periodic visit should be documented in the medical
records.
(D)
Contemporaneous to the periodic reviews, the physician
should note in the medical records any adjustment in the treatment plan based
on the individual medical needs of the patient.
(E)
A physician should continue or modify the use of dangerous
and scheduled drugs for pain management based on an evaluation of progress
toward treatment objectives.
(i)
Progress or the lack of progress in relieving pain must
be documented in the patient's record.
(ii)
Satisfactory response to treatment may be indicated by
the patient's decreased pain, increased level of function, or improved quality
of life.
(iii)
Objective evidence of improved or diminished function
should be monitored. Information from family members or other caregivers should
be considered in determining the patient's response to treatment. If the patient's
progress is unsatisfactory, the physician should assess the appropriateness
of continued use of the current treatment plan and consider the use of other
therapeutic modalities.
(6)
Consultation and Referral. The physician should refer a
patient for further evaluation and treatment as necessary. Patients who are
at-risk for abuse, addiction, or diversion require special attention. Patients
with a history of substance abuse or with a co-morbid psychiatric disorder
require even more care. A consult with or referral to a pain management specialist
should be considered in the treatment of such patients.
(7)
Medical records. The medical records must document the
physician's rationale for the treatment plan and the prescription of drugs
and show that the physician has followed these guidelines. Specifically the
records should include:
(A)
the medical history and the physical examination;
(B)
diagnostic, therapeutic and laboratory results;
(C)
evaluations and consultations;
(D)
treatment objectives;
(E)
discussion of risks and benefits;
(F)
informed consent;
(G)
treatments;
(H)
medications (including date, type, dosage and quantity
prescribed);
(I)
instructions and agreements; and
(J)
periodic reviews.
(b)
It is not the board's policy to take disciplinary action
against a physician solely for not adhering strictly to these guidelines if
the reason for deviation is documented in the medical records. Each case of
prescribing for pain will be evaluated on an individual basis. The physician's
conduct will be evaluated by considering:
(1)
the treatment outcome, including any improvement in functioning;
(2)
whether the drugs and amounts used are medically and pharmacologically
recognized to be appropriate for the diagnosis;
(3)
the patient's individual needs; and
(4)
that some types of pain cannot be completely relieved.
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 April 17, 2006.
TRD-200602202
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §§171.2 - 171.4, 171.6, 171.7
The Texas Medical Board proposes amendments to §§171.2-171.4,
171.6 and 171.7, concerning Postgraduate Training Permits.
The amendment to §171.2 reinforces the Board's authority to discipline
a licensee who supervises a training program. The amendment to §171.3
requires that training programs for which physician in training permits are
issued be supervised by a physician over which the Board has jurisdiction;
makes more specific the requirements for certification of training program
by supervisors; deletes obsolete provisions; and reorganizes the chapter to
put annual reporting with other similar provisions. The amendment to §171.4
substantially revises the rule regarding postgraduate fellowship training
programs that seek Board approval and assures that the program has been reviewed
and approved by the graduate medical education committee of the institution.
The amendment to §171.6 specifies a disciplinary action against the supervisor
of a training program as an administrative violation and moves provisions
for annual reporting from another section to include in the duties of a supervisor.
The amendment to §171.7 changes the provision regarding a return to active
status of a physician in training permit from mandatory to permissive upon
a training program lifting a suspension.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the amendments are in effect there will
be no fiscal implications to state or local government as a result of enforcing
the sections as proposed. There will be no effect to individuals required
to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be to assure that the Board can
discipline a physician regarding the physician's duties in supervising a medical
training program, assures that the Board has jurisdiction to oversee postgraduate
training and reorganizes the chapter, assures that physician in training permits
are issued on for fellowship programs that are based on needed training and
quality education, assures that postgraduate training programs are properly
supervised and gives the Board discretion to refuse to re-activate a physician
in training permit after a training program has suspended a student and then
lifted the suspension. There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
The following statutes, articles or codes are affected by this proposal: §155.105,
Texas Occupations Code.
§171.2.Construction.
(a)
Unless otherwise indicated, permit holders under this chapter
shall be subject to the duties, limitations, disciplinary actions, rehabilitation
order provisions, and procedures applicable to licensees in the Medical Practice
Act and board rules. Permit holders under this chapter shall also be subject
to the limitations and restrictions elaborated in this chapter.
(b)
Permit holders under this chapter shall cooperate with
the board and board staff involved in investigation, review, or monitoring
associated with the permit holder's practice of medicine. Such cooperation
shall include, but not be limited to, permit holder's written response to
the board or board staff written inquiry within 14 days of receipt of such
inquiry.
(c)
A physician-in-training permit
holder's failure to comply with required annual reporting is grounds for disciplinary
action by the Board.
(d)
[
(e)
[
§171.3.Physician-in-Training Permits.
(a)
Definitions.
(1)
Approved Postgraduate Training Program: a clearly defined
and delineated postgraduate medical education training program, including
postgraduate subspecialty training programs, approved by the Accreditation
Council for Graduate Medical Education (ACGME), the American Osteopathic Association
(AOA), the Committee on Accreditation of Preregistration Physician Training
Programs, the Federation of Provincial Medical Licensing Authorities of Canada
(internships prior to 1994), the Royal College of Physicians and Surgeons
of Canada, or the College of Family Physicians of Canada.
(2)
Board-approved [
(3)
Designated Institutional Official
(DIO): The individual in a sponsoring graduate medical education institution
who has the authority and responsibility for the graduate medical education
programs.
(4)
Fellowship: A subspecialty
training program of graduate medical education for postgraduate residents
who have completed the requirements for eligibility for first board certification
in the specialty and that is approved by the Accreditation Council for Graduate
Medical Education (ACGME), the American Osteopathic Association (AOA), a member
board of the American Board of Medical Specialties (ABMS), or a member board
of the Bureau of Osteopathic Specialists (BOS).
(5)
[
(6)
[
(A)
A physician-in-training permit is a permit issued by the
board in its discretion to a physician who does not hold a license to practice
medicine in Texas and is enrolled in a training program as defined in paragraphs
(1) and (2) of this subsection in Texas, regardless of his/her postgraduate
year (PGY) status within the program.
(B)
The permit shall be effective for the length of the postgraduate
training program as reported by the training program.
(C)
A physician-in-training permit is valid only for the practice
of medicine within the training program for which it was approved. If a permit
holder enters into a new program that is not covered by the issued permit,
the permit shall be terminated and the permit holder must apply for a new
permit for the new program.
(D)
A physician-in-training permit holder is restricted to
the supervised practice of medicine that is part of and approved by the training
program. The permit does not allow for the practice of medicine that is outside
of the approved program.
(b)
Qualifications of Physician-in-Training Permit Holders.
(1)
To be eligible for a physician-in-training permit, an applicant
must present satisfactory proof to the board that the applicant:
(A)
is at least 18 years of age;
(B)
is of good professional character and has not violated §§164.051-164.053
of the Medical Practice Act;
(C)
is a graduate of a medical school or has completed a Fifth
Pathway Program;
(D)
has been accepted into an approved postgraduate training
program or board-approved postgraduate fellowship training program; and
(E)
has been credentialed by the postgraduate training program
to include verification by the program of:
(i)
the applicant's identity; and
(ii)
the applicant's character and academic qualifications
including verification of medical school graduation.
(2)
To be eligible for a physician-in-training permit, an applicant
must not have:
(A)
a medical license, permit, or other authority to practice
medicine that is currently restricted for cause, canceled for cause, suspended
for cause, revoked or subject to another form of discipline in a state or
territory of the United States, a province of Canada, or a uniformed service
of the United States;
(B)
an investigation or proceeding pending against the applicant
for the restriction, cancellation, suspension, revocation, or other discipline
of the applicant's medical license, permit, or authority to practice medicine
in a state or territory of the United States, a province of Canada, or a uniformed
service of the United States;
(C)
a prosecution pending against the applicant in any state,
federal, or Canadian court for any offense that under the laws of this state
is a felony, a misdemeanor that involves the practice of medicine, or a misdemeanor
that involves a crime of moral turpitude.
(c)
Application for Physician-in-Training Permit.
(1)
Application Procedures.
(A)
Applications for a physician-in-training permit shall be
submitted to the board no earlier than the ninetieth (90th) day prior to the
date the applicant intends to begin postgraduate training in Texas to ensure
the application information is not outdated. To assist in the expedited processing
of the application, the application should be submitted as early as possible
within the sixty-day window prior to the date the applicant intends to begin
postgraduate training in Texas.
(B)
The board may, in unusual circumstances, allow substitute
documents where exhaustive efforts on the applicant's part to secure the required
documents is presented. These exceptions shall be reviewed by the board's
executive director on a case-by-case basis.
(C)
For each document presented to the board, which is in a
foreign language, an official word-for-word translation must be furnished.
The board's definition of an official translation is one prepared by a government
official, official translation agency, or a college or university official,
on official letterhead. The translator must certify that it is a "true translation
to the best of his/her knowledge, that he/she is fluent in the language, and
is qualified to translate." He/she must sign the translation with his/her
signature notarized by a Notary Public. The translator's name and title must
be typed/printed under the signature.
(D)
The board's executive director shall review each application
for training permit and shall approve the issuance of physician-in-training
permits for all applicants eligible to receive a permit. The executive director
shall also report to the board the names of all applicants determined to be
ineligible to receive a permit, together with the reasons for each recommendation.
The executive director may refer any application to a committee or panel of
the board for review of the application for a determination of eligibility.
(E)
An applicant deemed ineligible to receive a permit by the
executive director may request review of such recommendation by a committee
or panel of the board within 20 days of written receipt of such notice from
the executive director.
(F)
If the committee or panel finds the applicant ineligible
to receive a permit, such recommendation together with the reasons for the
recommendation, shall be submitted to the board unless the applicant makes
a written request for a hearing within 20 days of receipt of notice of the
committee's or panel's determination. The hearing shall be before an administrative
law judge of the State Office of Administrative Hearings and shall comply
with the Administrative Procedure Act, the rules of the State Office of Administrative
Hearings and the board. The board shall, after receiving the administrative
law judge's proposed findings of fact and conclusions of law, determine the
eligibility of the applicant to receive a permit. A physician whose application
to receive a permit is denied by the board shall receive a written statement
containing the reasons for the board's action.
(G)
All reports and investigative information received or gathered
by the board on each applicant are confidential and are not subject to disclosure
under the Public Information Act, Gov't Code Chapter 552 and the Medical Practice
Act, Tex. Occ. Code §§155.007(g), 155.058, and 164.007(c). The board
may disclose such reports and investigative information to appropriate licensing
authorities in other states.
(2)
Physician-in-Training Permit Application. An application
for a physician-in-training permit must be on forms furnished by the board
and include the following:
(A)
the required fee as mandated in the Medical Practice Act, §153.051
and as construed in board rules[
(B)
certification
by the postgraduate training program:
(i)
for a Texas postgraduate training program,
a certification must be completed
by the director of medical education,
the chair of graduate medical education, the program director, or, if none
of the previously named positions is held by a
Texas licensed
physician,
the
Texas Licensed physician
supervising [
(I)
[
(II)
[
(III)
[
(ii)
[
(I)
a certification must be completed
by the director of medical education, the chair of graduate medical education,
the program director, or, if none of the previously named positions is held
by a physician licensed in any state, the supervising physician, licensed
in any state, of the postgraduate training program on a form provided by the
board that certifies that:
(-a-)
the program meets the definition of an approved
postgraduate training program in subsection (a)(2) and (3) of this section;
(-b-)
the applicant has met all educational and
character requirements established by the program and has been accepted into
the program;
(-c-)
the program has received a letter from the
dean of the applicant's medical school which states that the applicant is
scheduled to graduate from medical school before the date the applicant plans
to begin postgraduate training, if the applicant has not yet graduated from
medical school; and
(II)
a certification by the Texas Licensed
physician supervising the Texas rotations of the postgraduate training program
on a form provided by the board that certifies:
[
(-a-)
the facility at which the
rotations are being completed,
(-b-)
the dates the rotations will
be completed in Texas, and
(-c-)
that the Texas postgraduate
training program will supervise and be responsible for the applicant during
the rotation in Texas;
(C)
arrest records. If an applicant has ever been arrested,
a copy of the arrest and arrest disposition must be requested from the arresting
authority by the applicant and said authority must submit copies directly
to the board;
(D)
medical records for inpatient treatment for alcohol/substance
abuse, mental illness, and physical illness. Each applicant who has been admitted
to an inpatient facility within the last five years for the treatment of alcohol/substance
abuse, mental illness (recurrent or severe major depressive disorder, bipolar
disorder, schizophrenia, schizoaffective disorder, or any severe personality
disorder), or physical illness shall submit documentation to include, but
not limited to:
(i)
an applicant's statement explaining the circumstances of
the hospitalization;
(ii)
all records, submitted directly from the inpatient facility;
(iii)
a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up treatment
recommended; and
(iv)
a copy of any contracts signed with any licensing authority
or medical society or impaired physician's committee;
(E)
medical records for outpatient treatment for alcohol/substance
abuse, mental illness, or physical illness. Each applicant that has been treated
on an outpatient basis within the last five years for alcohol/substance abuse,
mental illness (recurrent or severe major depressive disorder, bipolar disorder,
schizophrenia, schizoaffective disorder, or any severe personality disorder),
or physical illness shall submit documentation to include, but not limited
to:
(i)
an applicant's statement explaining the circumstances of
the outpatient treatment;
(ii)
a statement from the applicant's treating physician/psychotherapist
as to diagnosis, prognosis, medications prescribed, and follow-up treatment
recommended; and
(iii)
a copy of any contracts signed with any licensing authority
or medical society or impaired physician's committee;
(F)
an oath on a form provided by the board attesting to the
truthfulness of statements provided by the applicant;
(G)
such other information or documentation the board and/or
the executive director deem necessary to ensure compliance with this chapter,
the Medical Practice Act and board rules.
(d)
Expiration of Physician-in-Training Permit.
(1)
Physician-in-Training permits shall be issued with effective
dates corresponding with the beginning and ending dates of the postgraduate
resident's training program as reported to the board by the program director.
(2)
Physician-in-training permits shall expire on any of the
following, whichever occurs first:
(A)
on the reported ending date of the postgraduate training
program;
(B)
on the date a postgraduate training program terminates
or otherwise releases a permit holder from its training program; or
(C)
on the date the permit holder obtains full licensure or
temporary licensure pending full licensure pursuant to §155.002 of the
Act.
(3)
Physician-in-training permit holders who are issued permits
on or after April 1, 2005, and who require extensions to remain in a training
program after a program's reported ending date must submit a written request
to the board and fee, if required, along with a statement by the program director
authorizing the request for the extension. Such extensions shall be granted
at the discretion of the board's executive director and may not be for longer
than 90 days unless good cause is shown.
[
[
[
[
[
(e)
[
§171.4.Board-Approved Fellowships [
(a)
The executive director may in his/her discretion, upon
written request, approve
fellowships
[
(b)
The initial request for approval should be submitted
to the executive director, on a form prescribed by the board, 90 days prior
to the beginning date of the program to assist in the expedited processing
of an application. The request must include the length of the fellowship;
the length of time for which the institution is requesting approval of the
fellowship itself, not to exceed five years; and other information as required
by the board.
[
(c)
Approval of fellowships requires certification
by the DIO and the chair of the GMEC of the institution in which the fellowship
will be conducted that the fellowship program has been evaluated and approved
by the institution's graduate medical education committee. The evaluation
shall include but not be limited to satisfactory demonstration to the committee
of the fellowship's:
(1)
[
(2)
[
(3)
prerequisite requirements of the postgraduate residents,
including
whether prior residency training in a related specialty is
required [
(4)
delineated
[
(5)
number of subspecialty postgraduate residents to be
enrolled each year
[
(6)
[
(7)
[
[
(8)
[
[
(9)
[
[
(10)
[
(d)
Institutions with board-approved
fellowships must determine whether to conduct internal reviews of the program
at the mid-point of the program's most recent approval period.
(e)
Institutions with board-approved
fellowships that are eligible for accreditation as described in §171.3(a)(4)
of this chapter must determine whether the fellowship should seek such accreditation
rather than board approval of the fellowship.
(f)
[
(g)
[
(h)
All fellowships that have been
approved before September 1, 2006 shall terminate no later than August 31,
2007, but shall expire on such earlier date provided in the approval. A new
application for approval must be submitted at least three months prior to
the expiration date or on June 1, 2007, whichever date is earlier. All requests
for board approval of fellowships submitted on or after September 1, 2006
must comply with the requirements of this chapter.
§171.6.Duties of Program Directors to Report [
(a)
Failure of any postgraduate training program director to
comply with the provisions of this chapter or the Medical Practice Act §160.002
and §160.003 may be grounds for disciplinary action
as an administrative
violation
against the program director.
(b)
The director of each approved postgraduate training program
shall report in writing to the executive director of the board the following
circumstances within seven days of the director's knowledge for any physician-in-training
permit holder completing postgraduate training:
(1)
if a physician did not begin the training program due to
failure to graduate from medical school as scheduled or for any other reason(s);
(2)
if a physician has been or will be absent from the program
for more than 21 consecutive days (excluding vacation, family, or military
leave) and the reason(s) why;
(3)
if a physician has been arrested after the permit holder
begins training in the program;
(4)
if a physician poses a continuing threat to the public
welfare as defined under Tex. Occ. Code §151.002(a)(2), as amended;
(5)
if the program has taken final action that adversely affects
the physician's status or privileges in a program for a period longer than
30 days;
(6)
if the program has suspended the physician from the program;
(7)
if the program has requested termination or terminated
the physician from the program, requested or accepted withdrawal of the physician
from the program, or requested or accepted resignation of the permit holder
from the program and the action is final.
(c)
Annual reports. Program directors
for postgraduate training programs must ensure that the board receives certain
information annually in order to keep the board informed on a permit holder's
progress while in the approved training program. The required information
shall be sent to the board on forms provided by the board and shall include:
(1)
information regarding the permit holder's criminal
and disciplinary history, professional character, mailing address, and place
where engaged in training since the program director's last report;
(2)
certification by the permit holder's program
director, on a form provided by the board, regarding the permit holder's training;
and
(3)
such other information or documentation the
board and/or the executive director deem necessary to ensure compliance with
this chapter, the Medical Practice Act and board rules.
(d)
[
§171.7.Inactive Status.
(a)
A physician-in-training permit holder who is placed on
suspension, dismissed, or terminated by a training program shall have his
permit placed on inactive status.
(b)
The board retains jurisdiction to investigate any physician-in-training
permit holder placed on inactive status for possible violation(s) of the Medical
Practice Act and/or board rules.
(c)
If a postgraduate training program lifts the suspension
of a physician-in-training permit holder, the program must notify the board
of the lifted suspension and board
may
[
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 April 17, 2006.
TRD-200602203
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
Subchapter C. LIMITED LICENSES
22 TAC §172.13
The Texas Medical Board proposes new §172.13, concerning
Conceded Eminence.
New §172.13 creates a new limited license for physicians with conceded
eminence in their specialty, as required by SB 419.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the new section is in effect there will
be no fiscal implications to state or local government as a result of enforcing
the section as proposed. There will be no effect to individuals required to
comply with the section as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the section as proposed is in effect the public benefit anticipated
as a result of enforcing the section will be to increase the effectiveness
of recruiting professors for Texas medical schools. There will be no effect
on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new section is proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
The following statutes, articles or codes are affected by this proposal: §155.006,
Texas Occupations Code.
§172.13.Conceded Eminence.
(a)
The board may issue a license to an applicant pursuant
to the authority of §155.006, Tex. Occ. Code, by virtue of the applicant's
conceded eminence and authority in the applicant's specialty.
(b)
"Conceded eminence and authority in the applicant's specialty,"
as used in this section, shall mean that the physician has achieved a high
level of academic or professional recognition for excellence in research,
teaching, or the practice of medicine, as evidenced by objective factors,
including academic appointments, length of time in a profession, scholarly
publications and presentations, professional accomplishments, and awards.
(c)
An applicant for a license based on conceded eminence must
complete an application showing that the applicant:
(1)
is recommended to the board by the dean, president, or
chief academic officer of:
(A)
a school of medicine in this state;
(B)
The University of Texas Health Center at Tyler;
(C)
The University of Texas M.D. Anderson Cancer Center, or
(D)
a program of graduate medical education, accredited by
the Accreditation Council for Graduate Medical Education, that exceeds the
requirements for eligibility for first board certification in the discipline;
(2)
is expected to receive an appointment at the institution
or program making the recommendation under paragraph (1) of this subsection;
(3)
has not failed a licensing examination within the three-attempt
limit provided by §163.6(b) and §163.6(f)(1) of this title;
(4)
has passed the Texas Medical Jurisprudence Examination;
(5)
has successfully completed at least one year of approved
subspecialty training accredited by the Accreditation Council for Graduate
Medical Education or the American Osteopathic Association;
(6)
is of good professional character, as defined by §163.1(a)(9)
of this title;
(7)
has conceded eminence and authority in a medical specialty
identified in the application;
(8)
has not been the subject of disciplinary action by any
other state, the uniformed services of the United States, or the applicant's
peers in a local, regional, state, or national professional medical association
or staff of a hospital;
(9)
has not been convicted of, or placed on deferred adjudication,
community supervision, or deferred disposition for a felony, a misdemeanor
connected with the practice of medicine, or a misdemeanor involving moral
turpitude. And
(10)
has read and will abide by board rules and the Medical
Practice Act.
(d)
Applicants with complete applications may qualify for a
Temporary License prior to being considered by the board for licensure, as
required by §172.11 of this title (relating to Temporary Licensure--Regular).
(e)
The holder of a conceded eminence license shall be limited
to the practice of only a specialty of medicine for which the license holder
has conceded eminence and authority, as identified in the application. The
license holder may only practice medicine within the setting of the institution
or program that recommended the license holder under subsection (c)(1) of
this section, including a setting that is part of the institution or program
by contractual arrangement.
(f)
If the holder of a conceded eminence license terminates
the relationship with the institution or program that recommended the license
holder under subsection (c)(1) of this section, the conceded eminence license
shall be considered automatically canceled. To practice medicine in Texas,
the license holder must:
(1)
file a new application with the recommendation of a new
institution or program, as required by subsection (c)(1) of this section,
or
(2)
file an application for another Texas medical license or
permit.
(g)
The holder of a conceded eminence license shall be required
to pay the same fees and meet all other procedural requirements for issuance
and renewal of the license as a person holding a full Texas medical license.
(h)
The holder of a conceded eminence license shall be subject
to disciplinary action under the Medical Practice Act and board rules.
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 April 17, 2006.
TRD-200602204
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §174.2, §174.6
The Texas Medical Board proposes an amendment to §174.2
and new §174.6, concerning Telemedicine.
The amendment to §174.2 adds the definition for "telepresenter." New §174.6
creates standards for delegation by a physician to a non-physician in the
practice of telemedicine.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the sections are in effect there will
be no fiscal implications to state or local government as a result of enforcing
the sections as proposed. There will be no effect to individuals required
to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be to define the use of non-physicians
in the practice of telemedicine and to assures that physicians delegate duties
only to properly trained and qualified personnel in the practice of telemedicine.
There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment and new section are proposed under the authority
of the Texas Occupations Code Annotated, §153.001, which provides the
Texas Medical Board to adopt rules and bylaws as necessary to: govern its
own proceedings; perform its duties; regulate the practice of medicine in
this state; enforce this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§174.2.Definitions.
The following words and terms, when used in this chapter shall have
the following meanings unless the context indicates otherwise.
(1)
Medical practice site--A patient-specific Internet site,
access to which is limited to licensed physicians, associated medical personnel
and patients. It is an interactive site and thus qualifies as a practice location.
It requires a defined physician-patient relationship.
(2)
Medium--Any mechanism of information transfer including
electronic means.
(3)
Person--An individual unless otherwise expressly made applicable
to a partnership, association, or corporation.
(4)
Physician-patient e-mail--A computer-based communication
between physician (or their medical personnel) and patients within a professional
relationship in which the physician has taken on an explicit measure of responsibility
for the patient's care.
(5)
Telemedicine medical service--A health care service initiated
by a physician or provided by a health professional acting under physician
delegation and supervision, for purposes of assessment by a health professional,
diagnosis or consultation by a physician, treatment, or the transfer of medical
data, that requires the use of advanced telecommunications other than by telephone
or facsimile as described in §57.042 of the Utilities Code.
(6)
Telepresenter--a remote site
provider, as defined in 1 TAC §354.1430, who is not a physician, registered
nurse, advanced practice nurse or physician assistant, unless such physician,
registered nurse, advanced practice nurse or physician assistant is a qualified
mental health professional as defined in §531.02175(a) of the Government
Code.
§174.6.Delegation to and Supervision of Telepresenters.
(a)
A physician may delegate tasks and activities to a telepresenter
who is qualified by licensing, training or experience for the performance
of the task or activity as long as the task or activity does not require the
exercise of independent medical judgment for its performance;
(b)
A physician delegating tasks or activities to a telepresenter
shall ensure that the telepresenter to whom delegation is made is qualified
by licensure, training, or experience to perform the task or activity delegated;
(c)
A physician delegating tasks or activities to a telepresenter
shall ensure that the telepresenter to whom delegation is made is adequately
supervised.
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 April 17, 2006.
TRD-200602205
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §175.5
The Texas Medical Board proposes new §175.5, concerning
Payment of Fees or Penalties.
New §175.5 specifies the procedure for payment of fees and penalties,
including payment on-line.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the section is in effect there will be
no fiscal implications to state or local government as a result of enforcing
the section as proposed. There will be no effect to individuals required to
comply with the section as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the section as proposed is in effect the public benefit anticipated
as a result of enforcing the section will be to provide guidance in the procedures
for payment of fees and penalties to the Board. There will be no effect on
small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new section is proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§175.5.Payment of Fees or Penalties.
Fees paid online must be submitted by credit card, electronic check,
or debit card, as required by the online application. All other licensure
fees or penalties must be submitted in the form of a money order, personal
check, or cashier's check payable on or through a United States bank. Fees
and penalties cannot be refunded. If a single payment is made for more than
one individual permit, it must be made for the same class of permit and a
detailed listing, on a form prescribed by the board, must be included with
each payment.
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 April 17, 2006.
TRD-200602206
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §178.8
The Texas Medical Board proposes an amendment to §178.8,
concerning Appeals.
The amendment to §178.8 deletes the time limit for a complainant to
appeal the dismissal of a complaint.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the section is in effect there will be
no fiscal implications to state or local government as a result of enforcing
the section as proposed. There will be no effect to individuals required to
comply with the section as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the section as proposed is in effect the public benefit anticipated
as a result of enforcing the section will be removing time limits for a member
of the public who has complained against a physician to appeal a Board decision
to dismiss the complaint. There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the authority of the Texas Occupations
Code Annotated, §153.001, which provides the Texas Medical Board to adopt
rules and bylaws as necessary to: govern its own proceedings; perform its
duties; regulate the practice of medicine in this state; enforce this subtitle;
and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§178.8.Appeals.
(a)
Initiation. Following the receipt of the notice of dismissal
of a complaint, the complainant may appeal the dismissal to the board. To
be considered by the board, the appeal must:
(1)
be in writing;
and
[
(2)
[
(b) - (e)
(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 April 17, 2006.
TRD-200602207
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §§185.1 - 185.4, 185.6 - 185.8, 185.13, 185.15 - 185.19, 185.22, 185.23, 185.26
The Texas Medical Board proposes amendments to §§185.1
- 185.4, 185.6 - 185.8, 185.13, 185.15 - 185.19, 185.22, 185.23 and new §185.26,
concerning Physician Assistants.
The amendment to §185.1 expands the expressed purpose of the Physician
Assistant Board to more fully state the functions of the Board. The amendment
to §185.2 conforms the name of the Physician Assistant Board and the
Medical Board as required by SB 419 and adds definitions for clarity. The
amendment to §185.3 conforms the rule to SB 419 changes regarding the
appointment of the presiding officer of the Physician Assistant Board; changes
the name of the Long Range Planning Committee to the Executive Committee;
and revises duties of the committees. The amendment to §185.4 updates
the name of the Accreditation Review Commission for the Education of Physician
Assistants and adds the Jurisprudence Exam as a required exam for Physician
Assistant licensure. The amendment to §185.6 sets out procedure and fees
for reinstatement of Physician Assistant license after expiration. The amendment
to §185.7 updates the name of the Accreditation Review Commission for
the Education of Physician Assistants and allows a temporary license to be
issued to a Physician Assistant who cannot demonstrate the required active
practice. The amendment to §185.8 places additional limits of Physician
Assistants to place their license on inactive status. The amendment to §185.13
adds requirements for a Physician Assistant to notify the Board of the termination
of a supervising physician. The amendment to §185.15 eliminates unnecessary
words. The amendment to §185.16 updates the name of the Medical Board
to conform to changes made by SB 419. The amendment to §185.17 eliminates
unnecessary words and adds to grounds for discipline the writing of a false
prescription for a controlled substance. The amendment to §185.18 corrects
a reference to another section and adds criminal convictions to the list of
subjects in the Medical Boards rules that are adopted by reference. The amendment
to §185.19 abbreviates Administrative Procedure Act, as defined. The
amendment to §185.22 changes "this" to "the" in reference to the Physician
Assistant Act. The amendment to §185.23 conforms the name of the Physician
Assistant Board with changes made by SB 419. New §185.26 authorizes the
Physician Assistant Board to accept the voluntary surrender of a license and
adopts Medical Board procedures for voluntary surrender.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the sections are in effect there will
be no fiscal implications to state or local government as a result of enforcing
the sections as proposed. There will be no effect to individuals required
to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be to provide a better description
of the functions of the Physician Assistant Board, update the rules and provide
additional definitions, update the rule to conform to the statute and provides
more effective committee structure for the Physician Assistant Board, assures
that licensed Physician Assistants have knowledge of the legal requirement
for practice as a Physician Assistant, makes clear the procedures and fees
required for a Physician Assistant after expiration of a license, allows Physician
Assistants to be temporarily licensed, pending the demonstration of clinical
competency through the active practice as a Physician Assistant, assures that
a Physician Assistant who returns to practice after being on inactive status
is clinically competent to practice, assures that the Board is notified upon
the termination of a supervising physician, economizes on the language used
to describe the Physician Assistant Act, makes the rule clear regarding the
name of the Medical Board, economizes on language and conforms the rule to
the statutory provision making it a violation of the Physician Assistant Act
to write a false prescription for a controlled substance, corrects references
in the rule and conforms the rule to disciplinary guidelines used by the Medical
Board, economizes on language used in the rule, corrects language of the rule,
updates name of the Physician Assistant Board and provides a more efficient
way to resolve some disciplinary cases. There will be no effect on small or
micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments and new section are proposed under the authority
of the Texas Occupations Code Annotated, §153.001, which provides the
Texas Medical Board to adopt rules and bylaws as necessary to: govern its
own proceedings; perform its duties; regulate the practice of medicine in
this state; enforce this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§185.1.Purpose.
(a)
These rules are promulgated under the authority
of the Medical Practice Act, Title 3, Subtitle B, Texas Occupations Code and
the Physician Assistant Licensing Act, Chapter 204, Texas Occupations Code,
to establish procedures and standards for the training, education, licensing,
and discipline of persons performing as a physician assistant in this State
so as to establish an orderly system of regulating the practice of a physician
assistant in a manner that protects the health, safety, and welfare of the
public.
[
(b)
The functions of the physician
assistant board include but are not limited to the following:
(1)
Establish standards for the practice of a physician
assistant.
(2)
Regulate the practice of a physician assistant
through the licensure and discipline of physician assistants.
(3)
Interpret the Physician Assistant Licensing
Act and the physician assistant board Rules to ensure that physician assistants,
other allied health professionals, and consumers are properly informed.
(4)
Receive complaints and investigate possible
violations of the Physician Assistant Licensing Act and the physician assistant
board Rules.
(5)
Discipline violators through appropriate legal
action to enforce the Physician Assistant Licensing Act and the physician
assistant board Rules.
(6)
Provide a mechanism for public comment with
regard to the Physician Assistant Licensing Act and the physician assistant
board Rules.
(7)
Review and modify the physician assistant board
Rules when necessary and appropriate.
(8)
Examine and license qualified applicants to
practice as a physician assistant in Texas in a manner that ensures that applicable
standards are maintained.
(9)
Provide recommendations to the legislature concerning
appropriate changes to the Physician Assistant Licensing Act to ensure that
the acts are current and applicable to changing needs and practices.
(10)
Provide public information on licensees.
(11)
Maintain data concerning the practice of a
physician assistant.
§185.2.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
(No change.)
(2)
Agency--The divisions, departments, and employees of the
Texas [
(3) - (4)
(No change.)
(5)
Applicant--A party seeking a license from the Texas [
(6)
Board or the "physician assistant board"--The Texas [
(7)
Executive Director--the Executive
Director of the Agency or the authorized designee of the Executive Director.
(8)
Good professional character--an
applicant for licensure must not be in violation of or committed any act described
in the Physician Assistant Licensing Act, §§204.302-204.304, Texas
Occupations Code Annotated.
(9)
[
(10)
[
(11)
[
(12)
[
(13)
[
(14)
Presiding Officer--The person
appointed by the Governor to serve as the presiding officer of the board.
(15)
[
(16)
[
(17)
[
(18)
[
§185.3.Meetings and Committees .
(a) - (d)
(No change.)
(e)
The governor shall designate a member of the physician
assistant board as the presiding officer of the board to serve in that capacity
at the will of the governor.
The board, at a regular meeting or special
meeting,
shall
[
(f)
The board, at a regular meeting or special meeting, upon
majority vote of the members present, may remove the [
(g)
The following are standing and permanent committees of
the board.
Each committee, with the exception of the Executive Committee,
shall consist of at least one board member who is a licensed physician, one
board member who is a licensed physician assistant, and one public board member.
In the event that a committee does not have a representative of one or more
of these groups, the presiding officer shall appoint additional members as
necessary to maintain this composition. The Executive Committee shall include
the presiding officer, secretary, and other members as named by the presiding
officer. The presiding officer shall name the chair and assign the members
of the other committees.
The responsibilities and authority of these
committees shall include those duties and powers as defined in paragraphs
(1) - (3) of this subsection and such other responsibilities and authority
which the board may from time to time delegate to these committees.
(1)
Licensure Committee.
(A) - (E)
(No change.)
(F)
Oversee and make recommendations
to the physician assistant board regarding any aspect of the examination process
including the approval of an appropriate licensure examination and the administration
of such an examination and documentation and verification of records from
all applicants for licensure;
(2)
Disciplinary [
(A)
Draft and review proposed rules regarding the discipline
of physician assistants and enforcement of the [
(B)
Oversee the disciplinary process and give guidance to the
board and staff regarding methods to improve the disciplinary process and
more effectively enforce the [
(C) - (D)
(No change.)
[
(E)
[
(F)
[
(3)
Executive
[
(A)
Ensure records are maintained of all committee actions;
[
(B)
Review requests from the public to appear before the
board and provide opportunities for the public to speak regarding issues related
to the regulations of practice of Physician Assistants;
[
(C)
Review inquiries regarding policy or administrative
procedure;
[
(D)
Delegate tasks to other committees;
[
(E)
Take action on matter of urgency that may arise between
board meetings; such matters shall be presented to the board at the next board
meeting;
[
(F)
Assist the Medical Board in the organization, preparation,
and delivery of information and testimony to the Legislators and committees
of the Legislature;
[
(G)
Formulate and make recommendations
to the board regarding future board goals and objectives and the establishment
of priorities and methods for their accomplishment;
(H)
Study and make recommendations
to the board regarding the role and responsibility of the board officers and
committees;
(I)
Review staff reports regarding
finances and the budget; and
(J)
Make recommendations to the
board regarding matters brought to the attention of the Executive Committee.
(h)
Meetings of the board and of its committees are open to
the public unless such meetings are conducted in executive session pursuant
to the Open Meetings Act, the [
(i)
Journalists have the same right of access as other members
of the public to board meetings conducted in open session, and are also subject
to the
same
rules [
(j)
(No change.)
(k)
In the event of the absence or temporary incapacity of
the presiding officer, and the secretary, the members of the board may elect
another member to act as the presiding officer of a board meeting or may elect
an interim acting presiding officer for the duration of the absences or incapacity
or until another presiding officer is appointed by the governor
.
(l)
Upon the death, resignation, removal or permanent incapacity
of the presiding officer or the secretary, the board shall elect
a secretary
from its membership an officer to fill the vacant position.
The
board may elect an interim acting presiding officer until another presiding
officer is appointed by the governor.
Such an election shall be conducted
as soon as practicable at a regular or special meeting of the board.
§185.4.Procedural Rules for Licensure Applicants.
(a)
Except as otherwise provided in this section, an individual
shall be licensed by the board before the individual may function as a physician
assistant. A license shall be granted to an applicant who:
(1) - (2)
(No change.)
(3)
has successfully completed an educational program for physician
assistants or surgeon assistants accredited by the
Accreditation Review
Commission for the Education of Physician Assistants (ARC-PA)
[
(4) - (6)
(No change.)
(7)
is of good professional character
as defined under §185.1(7) of this title.
(8)
[
(9)
[
(10)
for applicants who apply for
a license on or after January 1, 2007, passes the national licensing examination
required for NCCPA certification within no more than three attempts.
(11)
for applicants who apply for
a license on or after September 1, 2007, passes a jurisprudence examination
("JP exam"), which shall be conducted on the licensing requirements and other
laws, rules, or regulations applicable to the physician assistant profession
in this state. The jurisprudence examination shall be developed and administered
as follows:
(A)
The staff of the Medical Board shall prepare
questions for the JP exam and provide a facility by which applicants can take
the examination.
(B)
Applicants must pass the JP exam with a score
of 75 or better within three attempts.
(C)
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.
(D)
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, invalidate the
applicant's examination results, or take other appropriate action.
(E)
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.
(b)
The following documentation shall be submitted as a part
of the licensure process:
(1) - (2)
(No change.)
(3)
Examination Scores. Each applicant
for licensure must have a certified transcript of grades submitted directly
from the appropriate testing service to the board for all examinations accepted
by the board for licensure.
(4)
[
(5)
[
(6)
[
(7)
[
(A)
have each 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 the 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 shall be accompanied by supporting documentation including court
records if applicable. If such letter is not available, the applicant will
be required to furnish a notarized affidavit explaining why this letter cannot
be provided; and
(C)
provide a statement, composed by the applicant, explaining
the circumstances pertaining to patient care in defense of the allegations.
(8)
[
(c) - (d)
(No change.)
(e)
Applicants for licensure:
(1)
whose application for licensure which has been filed with
the board office and which is in excess of
one year
[
(2) - (6)
(No change.)
(7)
who previously held a Texas health care provider license
, certificate, permit, or registration
may be required to complete additional
forms as required.
§185.6.Annual Renewal of License.
(a) - (b)
(No change.)
(c)
Falsification of an affidavit or submission of false information
to obtain renewal of a license shall subject a physician assistant to denial
of the renewal and/or to discipline pursuant to the [
(d) - (f)
(No change.)
(g)
Practicing as a physician assistant as defined in the [
(h)
(No change.)
(i)
Expired Annual Registration
Permits.
(1)
If a physician assistant's registration permit
has expired, the physician assistant may register for a new permit without
monetary penalty during the first 30 days following expiration. If a physician
assistant's permit has been expired for longer than 30 days, but less than
91, the physician may obtain a new permit by submitting to the board a completed
permit application, the registration fee, and the penalty fee, as defined
in §175.3(2) of this title.
(2)
If a physician assistant's registration permit
has been expired for longer than 90 days but less than one year, the physician
assistant may obtain a new permit by submitting a completed permit application,
the registration fee, and a penalty fee as defined in §175.3(2) of this
title.
(3)
If a physician assistant's registration permit
has been expired for one year or longer, the physician assistant's license
is automatically canceled, unless an investigation is pending, and the physician
assistant may not obtain a new permit.
(4)
Practicing as a physician assistant after the
expiration of the 30-day grace period under subsection (a) of this section
without obtaining a new registration permit for the current registration period
has the same effect as, and is subject to all penalties of, practicing as
a physician assistant without a license.
§185.7.Temporary License.
(a)
The board, or its designee may issue a temporary license
to an applicant who:
(1)
meets all the qualifications for a license under the [
(2)
seeks to temporarily substitute for a licensed physician
assistant during the licensee's absence, if the applicant:
(A) - (B)
(No change.)
(C)
pays the appropriate fee prescribed by the board; [
(3)
has graduated from an educational program for physician
assistants or surgeon assistants accredited by the
Accreditation Review
Commission for the Education of Physician Assistants (ARC-PA)
[
(4)
has not, on a full-time basis,
actively practiced as a physician assistant , as defined under §185.4(d)
of this title, but meets guidelines set by the physician assistant board including,
but not limited to, length of time out of active practice as a physician assistant
and duration of temporary licenses.
(b)
(No change.)
§185.8.Inactive License.
(a) - (b)
(No change.)
(c)
A license holder who practices as a physician assistant
in Texas
while on inactive status is considered to be practicing without
a license.
(d)
A physician assistant may return to active status by applying
to the board, paying
an application fee equal to an application fee for
a physician assistant license,
[
(e)
A physician assistant applicant applying to return to active
status shall provide sufficient documentation to the board that the applicant
has, on a full-time basis as defined in §185.4(d) of this
title
(relating to Procedural Rules for Licensure Applicants)
[
(1) - (3)
(No change.)
(4)
remedial education; and
/or
(5)
(No change.)
(f)
After five years on inactive
status, the license shall be canceled as if by request. The physician assistant
may obtain a new license by complying with the requirements and procedures
for obtaining an original license.
§185.13.Notification of Intent to Practice and Supervise.
(a)
A physician assistant licensed under the [
(1) - (2)
(No change.)
(b)
(No change.)
(c)
For the purposes of this section, a single form prescribed
by the board shall be used to provide notification of the license holder's
intent to begin practice or
termination of, and
any changes in,
or additions to, the person acting as a supervising physician.
(d)
(No change.)
§185.15.Supervising Physician.
(a)
(No change.)
(b)
A physician assistant may be supervised by an alternate
supervising physician in the absence of the supervising physician consistent
with this chapter, the Texas Medical Practice Act, the [
§185.16.Employment Guidelines.
(a) - (c)
(No change.)
(d)
A physician who provides medical services in preventive
medicine, disease management, health and wellness education, or similar services
in an accredited academic/teaching institution listed in paragraphs (1) -
(10) of this subsection, or its affiliates, may be denoted as the supervising
physician for more than five physician assistants in that institution or its
affiliates, provided the supervising physician determines that the physician
assistants are properly trained to deliver the services, that the services
are of such a nature that they may be safely and competently delivered by
the supervised physician assistants, and the proper paperwork has been filed
with the [
(1) - (10)
(No change.)
(e)
A physician who holds the position of Medical Director,
Chief of Staff, or Emergency Room Department Chair at a licensed hospital
may be denoted as the supervising physician for more than five physician assistants
for the purpose of staffing a hospital emergency room. This physician may
then delegate the direct supervision of the physician assistant to staff physicians
providing medical services within the emergency room, provided that the supervising
physician determines that the physician assistants are properly trained to
deliver services, that the services are of such a nature that they may be
safely and competently delivered by the supervised physician assistants, and
that the proper paperwork has been filed with the [
(f)
(No change.)
§185.17.Grounds for Denial of Licensure and for Disciplinary Action.
The board may refuse to issue a license to any person and may, following
notice of hearing and a hearing as provided for in the
APA
[
(1) - (2)
(No change.)
(3)
violates the [
(4) - (13)
(No change.)
(14)
writes a false or fictitious prescription
for a scheduled
or a dangerous drug as defined by
Chapters 481 and
[
(15) - (22)
(No change.)
§185.18.Discipline of Physician Assistants.
(a)
The board, upon finding a physician assistant has committed
any of the acts set forth in
§185.17
[
(b)
Disciplinary Guidelines.
(1)
Chapter 190 of this title (relating to Disciplinary Guidelines)
shall apply to physician assistants regulated under this chapter to be used
as guidelines for the following areas as they relate to the denial of licensure
or disciplinary action of a licensee:
(A) - (C)
(No change.)
(D)
repeated and recurring meritorious health care liability
claims; [
(E)
aggravating and mitigating factors
; and
[
(F)
criminal convictions.
(2)
If the provisions of Chapter 190
of this title
conflict
with the Act or rules under this chapter, the Act and provisions of this chapter
shall control.
§185.19.Administrative Penalties.
(a)
The board by order may impose an administrative penalty,
subject to the provisions of the
APA
[
(b) - (c)
(No change.)
§185.22.Impaired Physician Assistants.
(a)
(No change.)
(b)
Rehabilitation Orders.
(1) - (2)
(No change.)
(3)
Violation of a rehabilitation order entered pursuant to
this section may result in disciplinary action under the provisions of
the
[
(4)
(No change.)
§185.23.Third Party Reports to the Board.
(a) - (c)
(No change.)
(d)
Reporting Professional Liability Claims.
(1) - (4)
(No change.)
(5)
Penalty. Failure by a licensed insurer to report under
this section shall be referred to the
Texas Department
[
(6) - (8) (No change.)
(9) Reporting Form. The reporting form shall be as follows:
(10) (No change.)
(e) (No change.)
§185.26.Voluntary Surrender of Physician Assistant License.
Pursuant to §204.315 of the Act, the Board may accept the voluntary
surrender of a physician assistant license. Chapter 196 of this title (relating
to Voluntary Surrender of a Medical License) shall govern the voluntary surrender
of a physician assistant license in a similar manner as that chapter applies
to a medical license. Section 185.4 of this title (relating to Procedural
Rules for Licensure Applicants) shall govern reapplication after a voluntary
surrender.
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 April 17, 2006.
TRD-200602208
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §§192.1 - 192.5
The Texas Medical Board proposes amendments to §§192.1
- 192.5, concerning Office Based Anesthesia Services.
The amendment to §192.1 adds definitions necessary to provide regulation
for the administration of analgesics and anxiolytics, as required by SB 419.
The amendment to §192.2 expands the rule to include regulation of the
use of analgesics and anxiolytics, as required by SB 419. The amendment to §192.3
broadens the reference to anesthesia services to include use of analgesics
and anxiolytics. The amendment to §192.4 expands the reference to anesthesia
and conforms payment of fees for registration of office based anesthesia services
so that fees are paid by each physician and not by the site location. The
amendment to §192.5 broadens the reference to anesthesia services to
include use of analgesics and anxiolytics.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the amendments are in effect there will
be no fiscal implications to state or local government as a result of enforcing
the sections as proposed. There will be no effect to individuals required
to comply with the sections as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the sections as proposed are in effect the public benefit anticipated
as a result of enforcing the sections will be to provide assurance that properly
trained personnel and equipment will be present for any medical procedure
in which analgesics and anxiolytics are administered and to assure that each
physician that provides office based anesthesia services registers with the
Board. There will be no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§192.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the contents indicate otherwise.
(1)
ACLS--Advanced Cardiac Life Support, as
defined by the AHA.
(2)
AED--Automatic External Defibrillator.
(3)
AHA--American Heart Association.
(4)
Analgesics--Dangerous or scheduled drugs
that alleviate pain.
(5)
Anesthesia--The loss of feeling or sensation
resulting from the use of dangerous or scheduled drugs to depress nerve function.
Anesthetics are scheduled or dangerous drugs used to induce anesthesia.
(6)
Anesthesia Services--The use of dangerous
and scheduled drugs, including anesthetics, analgesics, and anxiolytics, to
permit the performance of surgery or other painful medical procedures.
(7)
Anxiolytics--Dangerous or scheduled drugs
used to treat episodes of anxiety.
(8)
[
(9)
[
(10)
BCLS--Basic Cardiac Life Support, as defined
by the AHA.
(11)
[
(12)
Dangerous drugs--medications defined by
the Texas Dangerous Drug Act, Chapter 483, Texas Health and Safety Code. Dangerous
drugs require a prescription, but are not included in the list of scheduled
drugs. A dangerous drug bears the legend "Caution: federal law prohibits dispensing
without a prescription" or "Prescription Only."
(13)
Level I services--delivery of analgesics
or anxiolytics by mouth, as prescribed for the patient on order of a physician,
at a dose level low enough to allow the patient to remain ambulatory.
(14)
Level II services--delivery of analgesics
or anxiolytics by mouth in dosages greater than allowed at Level I and tunescent
anesthesia, as prescribed for the patient on order of a physician.
(15)
Level III services--delivery of analgesics
or anxiolytics other than by mouth, including intravenously, intramuscularly,
or rectally.
(16)
Level IV services--delivery of general
anesthetics, including regional anesthetics and monitored anesthesia care.
(17)
[
(18)
[
(A)
a clinic located on land recognized as tribal land by the
federal government and maintained or operated by a federally recognized Indian
tribe or tribal organization as listed by the United States secretary of the
interior under 25 U.S.C. (479-1 or as listed under a successor federal statute
or regulation;
(B)
a facility maintained or operated by a state or governmental
entity;
(C)
a clinic directly maintained or operated by the United
States or by any of its departments, officers, or agencies; and
(D)
an outpatient setting accredited by either the Joint Commission
on Accreditation of Healthcare Organizations relating to ambulatory surgical
centers, the American Association for the Accreditation of Ambulatory Surgery
Facilities, or the Accreditation Association for Ambulatory Health Care.
(19)
[
(20)
PALS--Pediatric Advanced Life Support,
as defined by the AHA.
(21)
[
(22)
Scheduled Drugs--medications defined by
the Texas Controlled Substances Act, Chapter 481, Texas Health and Safety
Code. This Act establishes five categories, or schedules of drugs, based on
risk of abuse and addiction. (Schedule I includes drugs that carry an extremely
high risk of abuse and addiction and have no legitimate medical use. Schedule
V includes drugs that have the lowest abuse/addiction risk).
§192.2.Provision of Anesthesia Services in Outpatient Settings.
(a)
The purpose of these rules is to identify the roles and
responsibilities of physicians providing, or overseeing by proper delegation,
anesthesia services in outpatient settings and to provide the minimum acceptable
standards for the provision of anesthesia services in outpatient settings.
(b)
The rules promulgated under this title do not apply to
physicians who practice in the following settings listed in paragraphs (1)
- (8) of this subsection:
(1)
an outpatient setting in which only local anesthesia, peripheral
nerve blocks, or both are used;
(2)
any setting physically located outside the State of
Texas
[
(3)
a licensed hospital, including an outpatient facility of
the hospital that is separately located apart from the hospital;
(4)
a licensed ambulatory surgical center;
(5)
a clinic located on land recognized as tribal land by the
federal government and maintained or operated by a federally recognized Indian
tribe or tribal organization as listed by the United States secretary of the
interior under 25 U.S.C. (479-1 or as listed under a successor federal statute
or regulation;
(6)
a facility maintained or operated by a state or governmental
entity;
(7)
a clinic directly maintained or operated by the United
States or by any of its departments, officers, or agencies; and
(8)
an outpatient setting accredited by:
(A)
the Joint Commission on Accreditation of Healthcare Organizations
relating to ambulatory surgical centers;
(B)
the American Association for the Accreditation of Ambulatory
Surgery Facilities; or
(C)
the Accreditation Association for Ambulatory Health Care.
(c)
Standards for Anesthesia Services. The
following standards are required for outpatient settings providing anesthesia
services that are administered within two hours before an out patient procedure.
If personnel and equipment meet the requirements of a higher level, lower
level anesthesia services may also be provided.
(1)
Level I services:
(A)
at least two personnel must be present,
including the physician who must be currently certified at least in AHA approved
BCLS; and
(B)
the following age-appropriate equipment
must be present:
(i)
bag mask valve;
(ii)
oxygen;
(iii)
AED or other defibrillator; and
(iv)
pre-measured doses of epinephrine, atropine,
adreno-corticoids, and antihistamines.
(2)
Level II services:
(A)
at least two personnel must be present,
including the physician who must be currently certified at least in AHA approved
ACLS or PALS, as appropriate;
(i)
another person must be currently certified
at least in AHA approved BCLS; and
(ii)
a licensed health care provider, who may
be one of the two required personnel, must attend the patient, until the patient
is ready for discharge; and
(B)
a crash cart must be present containing
drugs and equipment necessary to carry out ACLS protocols, including, but
not limited to, the following age-appropriate equipment:
(i)
bag mask valve and appropriate airway maintenance
devices;
(ii)
oxygen;
(iii)
AED or other defibrillator;
(iv)
pre-measured doses of first line cardiac
medications, including epinephrine, atropine, adreno-corticoids, and antihistamines;
(v)
IV equipment;
(vi)
pulse oximeter; and
(vii)
EKG Monitor.
(3)
Level III services:
(A)
at least two personnel must be present,
including the physician who must be currently certified at least in AHA approved
ACLS or PALS, as appropriate;
(i)
another person must be currently certified
at least in AHA approved BCLS;
(ii)
a licensed health care provider, which
may be either of the two required personnel, must attend the patient, until
the patient is ready for discharge; and
(iii)
a person, who may be either of the two
required personnel, must be responsible for monitoring the patient during
the procedure; and
(B)
the same equipment required for Level II;
(4)
[
(A)
[
(B)
[
(C)
[
(D)
[
(E)
[
(F)
[
(G)
[
(H)
[
(d)
A physician delegating the provision of anesthesia or anesthesia-related
services to a certified registered nurse anesthetist shall be in compliance
with ASA standards and guidelines when the certified registered nurse anesthetist
provides a service specified in the ASA standards and guidelines to be provided
by an anesthesiologist.
(e)
In an outpatient setting, where a physician has delegated
to a certified registered nurse anesthetist the ordering of drugs and devices
necessary for the nurse anesthetist to administer an anesthetic or an anesthesia-related
service ordered by a physician, a certified registered nurse anesthetist may
select, obtain and administer drugs, including determination of appropriate
dosages, techniques and medical devices for their administration and in maintaining
the patient in sound physiologic status. This order need not be drug-specific,
dosage specific, or administration-technique specific. Pursuant to a physician's
order for anesthesia or an anesthesia-related service, the certified registered
nurse anesthetist may order anesthesia-related medications during perianesthesia
periods in the preparation for or recovery from anesthesia. In providing anesthesia
or an anesthesia-related service, the certified registered nurse anesthetist
shall select, order, obtain and administer drugs which fall within categories
of drugs generally utilized for anesthesia or anesthesia-related services
and provide the concomitant care required to maintain the patient in sound
physiologic status during those experiences.
(f)
The anesthesiologist or physician providing anesthesia
or anesthesia-related services in an outpatient setting shall perform a pre-anesthetic
evaluation, counsel the patient, and prepare the patient for anesthesia per
current ASA standards. If the physician has delegated the provision of anesthesia
or anesthesia-related services to a CRNA, the CRNA may perform those services
within the scope of practice of the CRNA. Informed consent for the planned
anesthetic intervention shall be obtained from the patient/legal guardian
and maintained as part of the medical record. The consent must include explanation
of the technique, expected results, and potential risks/complications. Appropriate
pre-anesthesia diagnostic testing and consults shall be obtained per indications
and assessment findings. Pre-anesthetic diagnostic testing and specialist
consultation should be obtained as indicated by the pre-anesthetic evaluation
by the anesthesiologist or suggested by the nurse anesthetist's pre-anesthetic
assessment as reviewed by the surgeon. If responsibility for a patient's care
is to be shared with other physicians or non-physician anesthesia providers,
this arrangement should be explained to the patient.
(g)
Physiologic monitoring of the patient shall be determined
by the type of anesthesia and individual patient needs. Minimum monitoring
shall include continuous monitoring of ventilation, oxygenation, and cardiovascular
status. Monitors shall include, but not be limited to, pulse oximetry and
EKG continuously and non-invasive blood pressure to be measured at least every
five minutes. If general anesthesia is utilized, then an O2 analyzer and end-tidal
CO2 analyzer must also be used. A means to measure temperature shall be readily
available and utilized for continuous monitoring when indicated per current
ASA standards. An audible signal alarm device capable of detecting disconnection
of any component of the breathing system shall be utilized. The patient shall
be monitored continuously throughout the duration of the procedure. Postoperatively,
the patient shall be evaluated by continuous monitoring and clinical observation
until stable by a licensed health care provider. Monitoring and observations
shall be documented per current ASA standards. In the event of an electrical
outage which disrupts the capability to continuously monitor all specified
patient parameters, at a minimum, heart rate and breath sounds will be monitored
on a continuous basis using a precordial stethoscope or similar device, and
blood pressure measurements will be reestablished using a non-electrical blood
pressure measuring device until electricity is restored. There should be in
each location, sufficient electrical outlets to satisfy anesthesia machine
and monitoring equipment requirements, including clearly labeled outlets connected
to an emergency power supply. A two-way communication source not dependent
on electrical current shall be available. Sites shall also have a secondary
power source as appropriate for equipment in use in case of power failure.
(h)
All anesthesia-related equipment and monitors shall be
maintained to current operating room standards. All devices shall have regular
service/maintenance checks at least annually or per manufacturer recommendations.
Service/maintenance checks shall be performed by appropriately qualified biomedical
personnel. Prior to the administration of anesthesia, all equipment/monitors
shall be checked using the current FDA recommendations as a guideline. Records
of equipment checks shall be maintained in a separate, dedicated log which
must be made available upon request. Documentation of any criteria deemed
to be substandard shall include a clear description of the problem and the
intervention. If equipment is utilized despite the problem, documentation
must clearly indicate that patient safety is not in jeopardy. All documentation
relating to equipment shall be maintained for seven years or for a period
of time as determined by the board.
(i)
Each location must have emergency supplies immediately
available. Supplies should include emergency drugs and equipment appropriate
for the purpose of cardiopulmonary resuscitation. This must include a defibrillator,
difficult airway equipment, and drugs and equipment necessary for the treatment
of malignant hyperthermia if "triggering agents" associated with malignant
hyperthermia are used or if the patient is at risk for malignant hyperthermia.
Equipment shall be appropriately sized for the patient population being served.
Resources for determining appropriate drug dosages shall be readily available.
The emergency supplies shall be maintained and inspected by qualified personnel
for presence and function of all appropriate equipment and drugs at intervals
established by protocol to ensure that equipment is functional and present,
drugs are not expired, and office personnel are familiar with equipment and
supplies. Records of emergency supply checks shall be maintained in a separate,
dedicated log and made available upon request. Records of emergency supply
checks shall be maintained for seven years or for a period of time as determined
by the board.
(j)
The operating surgeon shall verify that the appropriate
policies or procedures are in place. Policies, procedure, or protocols shall
be evaluated and reviewed at least annually. Agreements with local emergency
medical service (EMS) shall be in place for purposes of transfer of patients
to the hospital in case of an emergency. EMS agreements shall be evaluated
and re-signed at least annually. Policies, procedure, and transfer agreements
shall be kept on file in the setting where procedures are performed and shall
be made available upon request. Policies or procedures must include, but are
not limited to the following listed in paragraphs (1) - (2) of this subsection:
(1)
Management of outpatient anesthesia. At a minimum, these
must address:
(A)
patient selection criteria;
(B)
patients/providers with latex allergy;
(C)
pediatric drug dosage calculations, where applicable;
(D)
ACLS (advanced cardiac life support) or PALS (pediatric
advanced life support) algorithms;
(E)
infection control;
(F)
documentation and tracking use of pharmaceuticals, including
controlled substances, expired drugs and wasting of drugs; and
(G)
discharge criteria.
(2)
Management of emergencies. At a minimum, these must include,
but not be limited to:
(A)
cardiopulmonary emergencies;
(B)
fire;
(C)
bomb threat;
(D)
chemical spill; and
(E)
natural disasters.
(k)
Physicians, certified registered nurse anesthetists,
and
[
(l)
Physicians or surgeons must notify the board in writing
within 15 days if a procedure performed in any of the settings under these
rules resulted in an unanticipated and unplanned transport of the patient
to a hospital for observation or treatment for a period in excess of 24 hours,
or a patient's death intraoperatively or within the immediate postoperative
period. Immediate postoperative period is defined as 72 hours.
§192.3.Compliance with Office-Based Anesthesia Rules.
(a)
A physician who
provides anesthesia services
[
(b)
The board may require a physician to submit and comply
with a corrective action plan to remedy or address any current or potential
deficiencies with the physician's provision of anesthesia
services
in
an outpatient setting in accordance with the Medical Practice Act, Title 3
Subtitle C §§162.101-.107 of the Texas Occupations Code, or rules
of the board.
(c)
Any physician who violates these rules shall be subject
to disciplinary action and/or termination of the registration issued by the
board as authorized by the Medical Practice Act or rules of the board.
§192.4.Registration.
(a)
Each physician who
provides
[
[
(b)
[
§192.5.Inspections.
(a)
The board may conduct inspections to enforce these rules,
including inspections of an office site and of documents of a physician's
practice that relate to the provision of anesthesia
services
in
an outpatient setting. The board may contract with another state agency or
qualified person to conduct these inspections.
(b)
Unless it would jeopardize an ongoing investigation, the
board shall provide at least five business days' notice before conducting
an on-site inspection under this section.
(c)
This section does not require the board to make an on-site
inspection of a physician's office.
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 April 17, 2006.
TRD-200602209
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
22 TAC §199.5
The Texas Medical Board proposes new §199.5, concerning
Notice of Ownership Interest in a Niche Hospital.
New §199.5 requires physicians to notify the Department of State Health
Services of an ownership interest in niche hospitals and provides a form for
such notification as required by the Legislature in 2005.
Michele Shackelford, General Counsel, Texas Medical Board, has determined
that for the first five-year period the new section is in effect there will
be no fiscal implications to state or local government as a result of enforcing
the section as proposed. There will be no effect to individuals required to
comply with the section as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the section as proposed is in effect the public benefit anticipated
as a result of enforcing the section will be to provide public information
regarding physician's ownership interests in niche hospitals. There will be
no effect on small or micro businesses.
Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new section is proposed under the authority of the Texas
Occupations Code Annotated, §153.001, which provides the Texas Medical
Board to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; enforce
this subtitle; and establish rules related to licensure.
No other statutes, articles or codes are affected by this proposal.
§199.5.Notice of Ownership Interest in a Niche Hospital.
(a)
A physician shall notify the Department of State Health
Services of an ownership interest held by the physician in a niche hospital
as required by §162.052 of the Act.
(b)
In this section, "niche hospital," as defined by §105.002,
Tex. Occ. Code, means a hospital that:
(1)
classifies at least two-thirds of the hospital's Medicare
patients or, if data is available, all patients:
(A)
in not more than two major diagnosis-related groups; or
(B)
in surgical diagnosis-related groups;
(2)
specializes in one or more of the following areas:
(A)
cardiac;
(B)
orthopedics;
(C)
surgery; or
(D)
women's health; and
(3)
is not:
(A)
a public hospital;
(B)
a hospital for which the majority of inpatient claims are
for major diagnosis-related groups relating to rehabilitation, psychiatry,
alcohol and drug treatment, or children or newborns; or
(C)
a hospital with fewer than 10 claims per bed per year.
(c)
The board hereby adopts by reference the Disclosure and
Consent Form, which shall be published on the board's web site and may be
examined and copies obtained at the offices of the board.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on April 17, 2006.
TRD-200602210
Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: May 28, 2006
For further information, please call: (512) 305-7016
Chapter 365.
LICENSING AND REGISTRATION
or
] printed in ink
, or completed online
;
, payable by check through a United
States bank
].
for licensure that must be
passed by an applicant for licensure within three attempts with a score 75
or better
].
United States/Canadian Medical School
] Graduates
of medical schools in the United States or Canada
. To be eligible for
full licensure, an applicant who is a graduate from a school in the United
States or Canada must:
with a score of 75 or better within three attempts
].
Acceptable Unapproved Medical Schools
]. To be
eligible for full licensure, an applicant who is a graduate from a school
outside the United States or Canada must:
with a score of 75 or better within three attempts
];
JP Exam
].
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 within three attempts.
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.
Chapter 165.
MEDICAL RECORDS
(7)
] Billing codes, including CPT
and ICD-9-CM codes, reported on health insurance claim forms or billing statements
should be supported by the documentation in the medical record.
(8)
] Any amendment, supplementation,
change, or correction in a medical record not made contemporaneously with
the act or observation shall be noted by indicating the time and date of the
amendment, supplementation, change, or correction, and clearly indicating
that there has been an amendment, supplementation, change, or correction.
(9)
] Records received from another
physician or health care provider involved in the care or treatment of the
patient shall be maintained as part of the patient's medical records.
(10)
] The board acknowledges that
the nature and amount of physician work and documentation varies by type of
services, place of service and the patient's status. Paragraphs (1) -
(11)
[
(10)
] of this subsection may be modified to account
for these variable circumstances in providing medical care.
Chapter 166.
PHYSICIAN REGISTRATION
a written
] application
prescribed by the board
which
sets forth the licensee's name, mailing address, primary practice site, and
address for receipt of electronic mail if available.
Approximately half of all permits issued to license
holders that expire between January 1, 2005 and December 31, 2005 shall remain
in effect for a one-year period; the other half shall remain in effect for
a two-year period.
] All permits issued to license holders that expire
on or after January 1, 2006 shall remain in effect for two-year periods.
to indigent populations
]
shall be exempt from the registration fee.
(b)
] A physician who qualifies
for and obtains an exemption from the registration fee authorized under this
section shall obtain and report continuing medical education as required under
the Act, §§156.051-.055 and §166.2 of this title (relating
to Continuing Medical Education)
, except that the number of hours of
informal CME, as required by §166.2(a)(3) shall be reduced from 12 hours
to 10 hours
.
(c)
] A retired physician who has
obtained an exemption from the registration fee as provided for under this
section, may be subject to disciplinary action under the Act, §§164.051-.053,
based on unprofessional or dishonorable conduct likely to deceive, defraud,
or injure the public if the physician engages in the compensated practice
of medicine, the provision of medical services to members of the physician's
family, or the self-prescribing of controlled substances or dangerous drugs.
(d)
] A physician who attempts to
obtain an exemption from the registration fee under this section by submitting
false or misleading statements to the board shall be subject to disciplinary
action pursuant to the Act, §164.052(a)(1), in addition to any civil
or criminal actions provided for by state or federal law.
Chapter 170.
AUTHORITY OF PHYSICIAN TO PRESCRIBE FOR THE TREATMENT OF PAIN
Chapter 170.
PAIN MANAGEMENT
Chapter 171.
POSTGRADUATE TRAINING PERMITS
(c)
] In accordance with §155.105
of the Medical Practice Act, the board shall retain jurisdiction to discipline
a permit holder whose permit has been terminated, canceled, and/or expired
if the permit holder violated the Medical Practice Act or board rules during
the time the permit was valid.
(d)
] The issuance of a permit to
a physician shall not be construed to obligate the board to issue the physician
subsequent permits or licenses. The board reserves the right to investigate,
deny a permit or full licensure, and/or discipline a physician regardless
of when the information was received by the board.
Postgraduate
] Fellowship [
Training Program
]: a clearly defined and delineated postgraduate subspecialty-training
program approved by the Texas [
State Board of
] Medical
Board
[
Examiners
]
under §171.4 of this title
.
(3)
] Postgraduate Resident: a physician
who is in postgraduate training as an intern, resident, or fellow in an approved
postgraduate training program or a board-approved [
postgraduate
]
fellowship [
training program
].
(4)
] Physician-in-Training Permit:
, payable by personal check, money order
or cashier's check through a United States bank
];
physician, of
]
the postgraduate training program on a form provided by the board that certifies
that:
(i)
] the program meets the definition
of an approved postgraduate training program in subsection (a)(2) and (3)
of this section;
(ii)
] the applicant has met all
educational and character requirements established by the program and has
been accepted into the program;
and
(iii)
] the program has received
a letter from the dean of the applicant's medical school
that
[
which
] states that the applicant is scheduled to graduate from medical
school before the date the applicant plans to begin postgraduate training,
if the applicant has not yet graduated from medical school
.
[
; and
]
(iv)
] if the applicant is completing
rotations in Texas as part of the applicant's residency out-of-state training
program or with the military
:
[
, the facility at which the
rotations are being completed, and the dates the rotations will be completed
in Texas;
]
,
]
(4)
If a postgraduate resident
was issued a permit for a program with an initial start date prior to April
1, 2005, and the permit is set to expire before the ending date of the permit
holder's training program, and the expiration date is on or after July 2,
2005, the program director and/or permit holder must submit an application
and fee requesting that the permit be extended to the ending date of the training
program. The fee shall be in accordance with §175.1(2)(B) of this title
(relating to Fees, Penalties, and Applications).]
(e)
Annual reports. Program directors
for postgraduate training programs must ensure that the board receives certain
information annually in order to keep the board informed on a permit holder's
progress while in the approved training program. The required information
shall be sent to the board on forms provided by the board and shall include:]
(1)
information regarding the permit holder's criminal
and disciplinary history, professional character, mailing address, and place
where engaged in training since the program director's last report;]
(2)
certification by the permit holder's program
director, on a form provided by the board, regarding the permit holder's training;
and]
(3)
such other information or documentation the
board and/or the executive director deem necessary to ensure compliance with
this chapter, the Medical Practice Act and board rules.]
(f)
] The executive director of the
board may, in his/her discretion, issue a temporary physician-in-in-training
permit to an applicant if the applicant and the postgraduate training program
have submitted written requests. The executive director, in his/her discretion,
will determine the length of the permit and may issue additional temporary
physician-in-training permits to an applicant.
Postgraduate Fellowship Training Programs ].
training programs
]
as referenced in §171.3(a)
(2)
[
(3)
] of this chapter
[
for up to three years
].
Fellowships meeting the criteria
set forth in §171.3(a)(4) of this chapter do not require board approval
for physician-in-training permits to be issued to subspecialty postgraduate
residents in the fellowship.
[
The initial request should be submitted
to the executive director 180 days prior to the beginning date of the program
to assist in the expedited processing of an application. Said training programs
shall be limited to postgraduate subspecialty programs.
] If the executive
director does not recommend approval, the
institution's designated institutional
official (DIO) and chair of the Graduate Medical Education Committee (GMEC)
[
program's director
] may appeal to the board for its discretionary
consideration of the request.
Approval of training programs shall include but
not be limited to the following considerations:
]
the
] goals and objectives [
of the program
];
documented curriculum; and, qualifications of the program director
and program faculty, including, but not limited to, certification by the appropriate
specialty board and/or appropriate educational qualifications;
the
] process by which [
the program selects
] subspecialty postgraduate residents
are selected
;
of subspecialty postgraduate residents in the program
];
the
] duties and responsibilities
required of subspecialty postgraduate residents in the program [
including
the number of subspecialty postgraduate residents to be enrolled each year
and when subspecialty postgraduate residents are required to be permanently
licensed
];
the formal educational experiences required
of subspecialty postgraduate residents in the program, including grand rounds,
seminars and journal club
];
the
] scholarly
activity to be
[
research
] required of subspecialty postgraduate residents [
in the
program, including participation in peer reviewed and funded research which
may result in publications or presentations at regional and national scientific
meetings
];
the
] type of supervision
to be
provided
for subspecialty postgraduate residents [
by the program
];
(8)
the curriculum vitae, including
academic appointments, of all supervising staff;]
(9)
]
requirements for
[
that
] the program director or supervising physician
to hold
[
holds
] a Texas license or faculty temporary license issued by the board;
(10)
the academic affiliation
of the program;]
(11)
] [
the
] methods
for evaluation of subspecialty postgraduate residents by the program; and
(12)
whether a specialty board
that is a member of the American Board of Medical Specialties or the Bureau
of Osteopathic Specialists gives credit for the program; and]
(13)
] [
the
] progressive
nature
, including, but not limited to, the progressively greater responsibility
of the subspecialty postgraduate residents throughout the course
of
the fellowship if the fellowship [
training program
] is over one
year in length.
(c)
]
The DIO and the chair
of the GMEC of the institution for which a
[
All program directors
for
] fellowship
program has
[
training programs that
have
] been
previously
approved by the board must apply to
have the program
[
be re-evaluated
]
approved again, if
the program is to continue after the expiration date
[
to assure
compliance with the above considerations and consideration of continuation
of the fellowship training program
].
Applications for subsequent
approval must comply with all requirements in this section for initial approval
and must be submitted
[
The program director must apply for re-evaluation
] at least
three
[
six
] months prior to the expiration
of the approved program in order to prevent a lapse in time of the fellowship
[
training program
]. Permit holders shall be allowed to complete
their
fellowship
[
training program
] regardless of continuing
program
approval
[
re-evaluation
].
(d)
] All board-approved fellowships
that subsequently become approved by the ACGME
, AOA, a member board of
the ABMS, or a member board of the BOS,
[
or AOA
] must notify
the board within 30 days of their approval. Fellowships may not be dually
approved by the board and ACGME
, AOA, a member board of the ABMS, or
a member board of the BOS
[
or AOA
]. A board-approved fellowship
that becomes
approved by the
ACGME
, AOA, a member board of
the ABMS, or a member board of the BOS
[
or AOA approved
]
immediately loses its board-approved status when its new approval becomes
effective through the ACGME
, AOA, a member board of the ABMS, or a member
board of the BOS
[
or AOA
].
Certain Types of Conduct ].
(c)
] A violation of §§164.051-164.053
or any other provision of the Medical Practice Act is grounds for disciplinary
action by the Board.
shall
] return
the physician's permit to active status effective the date the board is notified
that the suspension is lifted.
Chapter 172.
TEMPORARY AND LIMITED LICENSES
Chapter 174.
TELEMEDICINE
Chapter 175.
FEES, PENALTIES AND FORMS
Chapter 178.
COMPLAINTS
(2)
be received within 60 days
of the mailing of the notice of dismissal of the complaint; and]
(3)
] list the reason(s) for the
appeal. The appeal should provide sufficient information to indicate that
additional review is warranted.
Chapter 185.
PHYSICIAN ASSISTANTS
The purpose of these rules is to create a system of licensing
and regulating physician assistants as a means to ensure the competency of
physician assistants without a financial burden to the people of Texas. Furthermore,
the purpose of these rules and regulations is to also encourage the more effective
utilization of the skills of physicians by enabling them to delegate health
care tasks to qualified physician assistants. These sections are not intended
to, and shall not be construed to, restrict the physician from delegating
technical and clinical tasks to technicians, other assistants, or employees
who perform delegated tasks in the office of a physician and who are not rendering
services as a physician assistant or identifying themselves as a physician
assistant. Nothing in these rules and regulations shall be construed to relieve
the supervising physician of the professional or legal responsibility for
the care and treatment of his or her patients.
]
State Board of
] Medical
Board
[
Examiners
], the Texas [
State Board of
] Physician Assistant
Board
[
Examiners
], and the Texas State Board of Acupuncture Examiners.
State Board of
] Physician Assistant
Board
[
Examiners
].
State Board of
] Physician Assistant
Board
[
Examiners
].
(7)
] Medical Board--The Texas [
State Board of
] Medical
Board
[
Examiners
].
(8)
] Medical Practice Act--Texas
Occupations Code Annotated, Title 3, Subtitle B, as amended.
(9)
] Open Meetings Act--Texas
Government Code Annotated, Chapter 551 as amended.
(10)
] Party--The physician assistant
board and each person named or admitted as a party in a [
SOAH
]
hearing
before the State Office of Administrative Hearings
or contested
case before the physician assistant board.
(11)
] Physician assistant--A person
licensed as a physician assistant by the Texas [
State Board of
]
Physician Assistant
Board
[
Examiners
].
(12)
] State--Any state, territory,
or insular possession of the United States and the District of Columbia.
(13)
] Submit--The term used to
indicate that a completed item has been actually received and date-stamped
by the board along with all required documentation and fees, if any.
(14)
] Supervising physician--A
physician licensed by the medical board [
either as a doctor of medicine
or doctor of osteopathic medicine
] who assumes responsibility and legal
liability for the services rendered by the physician assistant, and who has
notified the Medical Board of the intent
[
received approval from
the medical board
] to supervise a specific physician assistant
and of the termination of such supervision
.
(15)
] Supervision--Overseeing
the activities of, and accepting responsibility for, the medical services
rendered by a physician assistant. Supervision does not require the constant
physical presence of the supervising physician but includes a situation where
a supervising physician and the person being supervised are, or can easily
be, in contact with one another by radio, telephone, or another telecommunication
device.
may
] elect from its membership a [
presiding officer and a
] secretary for one year.
presiding officer
or
] the secretary from office.
and Ethics
] Committee.
Physician Assistant Licensing
] Act.
Physician Assistant Licensing
] Act.
(E)
Draft and review proposed
ethics guidelines and rules for the practice of physician assistants, and
make recommendations to the board regarding the adoption of such ethics guidelines
and rules.]
(F)
] Make recommendations to the
board and staff regarding policies, priorities, budget, and any other matters
related to the disciplinary process and enforcement of the [
Physician
Assistant Licensing
] Act.
(G)
] Make recommendations to the
board regarding matters brought to the attention of the Disciplinary [
and Ethics
] Committee.
Long Range Planning
] Committee.
Formulate and make recommendations to the board concerning future
board goals and objectives and the establishment of priorities and methods
for their accomplishment.
]
Study
and make recommendations to the board regarding the role and responsibility
of the board officers and committees.
]
Study and make recommendations to the board regarding
ways to improve the efficiency and effectiveness of the administration of
the board.
]
Study
and make recommendations to the board regarding board rules or any area of
a board function that, in the judgment of the committee needs consideration.
]
Study and make recommendations to the board regarding
legislative changes pertinent to the practice of Physician Assistants.
]
Study and make recommendations to the board
regarding financial issues.
]
Physician Assistant Licensing
] Act,
or the Medical Practice Act. In order that board meetings may be conducted
safely, efficiently, and with decorum,
attendees
[
members
of the public shall refrain at all times from smoking or using tobacco products,
eating, or reading newspapers and magazines. Members of the public
]
may not engage in disruptive activity that interferes with board proceedings[
, including excessive movement within the meeting room, noise or loud talking,
and resting of feet on tables and chairs
]. The public shall remain within
those areas
of the board offices and board meeting room
designated
as open to the public. Members of the public shall not address or question
board members during meetings unless recognized by the board's presiding officer
pursuant to a published agenda item.
of conduct described in subsection (h)
of this section
]. Observers of any board meeting
may not disrupt
the meeting or disturb participants. Observers
may make audio or visual
recordings of such proceedings conducted in open session
as long as these
activities do not disrupt the meeting and
subject to the following limitations:
the board's presiding officer may request periodically that camera operators
extinguish their artificial lights to allow excessive heat to dissipate; camera
operators may not assemble or disassemble their equipment while the board
is in session and conducting business; persons seeking to position microphones
for recording board proceedings may not disrupt the meeting or disturb participants
. Journalists
[
; journalists
] may conduct interviews in the
reception area of the
agency's
[
medical board's
] offices
or, at the discretion of the board's presiding officer, in the meeting room
after recess or adjournment; no interview may be conducted in the hallways
of the
agency's
[
medical board's
] offices; and the board's
presiding officer may exclude from a meeting any person who, after being duly
warned, persists in conduct described in this subsection and subsection (h)
of this section.
Commission on Accreditation of Allied Health Education Programs
], or
by that committee's predecessor or successor entities, and holds a valid and
current certificate issued by the National Commission on Certification of
Physician Assistants ("NCCPA");
(7)
] submits to the board any other
information the board considers necessary to evaluate the applicant's qualifications;
[
and
]
(8)
] meets any other requirement
established by rules adopted by the board
; and
[
.
]
(3)
] Verification from other states.
Each applicant for licensure who is licensed, registered, or certified in
another state must have that state submit directly to the board, on a form
provided by the board, that the physician assistant's license, registration,
or certification is current and in full force and that the license, registration,
or certification has not been restricted, canceled, suspended, or revoked.
The other state shall also include a description of any sanctions imposed
by or disciplinary matters pending in the state.
(4)
] State License Registration.
Each applicant, if licensed, registered, or certified in another state as
a physician assistant, must submit a copy of the license registration certificate
to the board. The license, registration, or certificate number and the date
of expiration must be visible on the copy.
(5)
] Arrest Records. If an applicant
has ever been arrested, a copy of the arrest and arrest disposition needs
to be requested from the arresting authority and that authority must submit
copies directly to the board.
(6)
] Malpractice. If an applicant
has ever been named in a malpractice claim filed with any liability carrier
or if an applicant has ever been named in a malpractice suit, the applicant
must:
(7)
] Additional Documentation.
Additional documentation as is deemed necessary to facilitate the investigation
of any application for licensure must be submitted.
two years
] old from the date of receipt, shall be considered inactive. Any fee
previously submitted with the application shall be forfeited. Any further
application procedure for licensure will require submission of a new application
and inclusion of the current licensure fee;
Physician Assistant
Licensing
] Act, §§204.301-.303.
Physician Assistant Licensing
] Act without an annual registration permit
for the current year as provided for in the board rules has the same force
and effect as and is subject to all penalties of practicing as a physician
assistant without a license.
Physician Assistant Licensing
] Act but is waiting for the next scheduled
meeting of the board for the license to be issued;
or
]
Commission on Accreditation of Allied Health Education Programs
] or
by the committee's predecessor or successor entities no later than six months
previous to the application for temporary licensure and is waiting for examination
results from the National Commission on Certification of Physician Assistants
; or
[
.
]
the license renewal fee,
]
complying with the requirements for license renewal under the [
Physician
Assistant Licensing
] Act
, providing current verifications from
each state in which the physician assistant holds a license, demonstrating
current certification by NCCPA, and submitting professional evaluations from
each employment held after the license was placed on inactive status,
and
complying with subsection (e) of this section.
chapter
], actively practiced as a physician assistant or has been on the active
teaching faculty of an acceptable approved physician assistant program, within
either of the two years preceding receipt of an application for reactivation.
Applicants who do not meet this requirement may, in the discretion of the
board, be eligible for the reactivation of a license subject to one or more
of the following conditions or restrictions as set forth in paragraphs (1)
- (5) of this subsection:
Physician
Assistant Licensing
] Act must, before beginning practice or upon changing
practice, submit notification of the license holder's intent to begin practice.
Notification under this section must include:
Physician Assistant
Licensing
] Act, board rules, medical board rules, and any standing orders
or protocols established in accordance with these statutes and rules.
Texas State Board of
] Medical
Board
[
Examiners
]. The supervision of physician assistants must comply with
all institutional rules and there must be accurate and timely internal institutional
records, which are available upon request within 24 hours to the [
Texas
State Board of
] Medical
Board
[
Examiners
], which
list the name and license number of the physician who is specifically assigned
to actively supervise each physician assistant at one of the following institutions:
Texas State Board
of
] Medical
Board
[
Examiners
]. The supervision
of physician assistants must comply with all institutional rules and there
must be accurate and timely internal institutional records, which are available
upon request within 24 hours to the Texas [
State Board of
] Medical
Board
[
Examiners
], which list the name and license number
of the physician who is specifically assigned to actively supervise each physician
assistant.
Administrative Procedure Act
], take disciplinary action against any
physician assistant who:
Physician Assistant Licensing
]
Act, or any rules relating to the practice of a physician assistant;
Chapter
] 483, Health and Safety Code;
§185.18
]
of this title (relating to Grounds for Denial of Licensure and for Disciplinary
Action), shall enter an order imposing one or more of the allowable actions
set forth under §204.301 of the Act.
and
]
.
]
Administrative Procedure
Act
], against a person licensed or regulated under the [
Physician
Assistant Licensing
] Act who violates the Act or a rule or order adopted
under the Act.
this
] Act for contested matters or pursuant to the terms
of the agreed order. A violation of a rehabilitation order may be grounds
for disciplinary action based on unprofessional or dishonorable conduct or
on any of the provisions of this Act which may apply to the misconduct which
resulted in violation of the rehabilitation order.
State
Board
] of Insurance.
Chapter 192.
OFFICE-BASED ANESTHESIA SERVICES
(1)
]
Anesthesiologist
[
Anesthesiologist's
] assistant--A graduate of an approved
anesthesiologist
[
anesthesiologist's
] assistant training program.
(2)
] Anesthesiology resident--A
physician who is presently in an approved Texas anesthesiology residency program
who is either licensed as a physician in Texas or holds a postgraduate resident
permit issued by the Texas [
State Board of
] Medical
Board
[
Examiners
].
(3)
] Certified registered nurse
anesthetist--A person licensed by the Board of Nurse Examiners for the State
of Texas (BNE) as a registered professional nurse, authorized by the BNE as
an advanced practice nurse in the role of nurse anesthetist, and certified
by a national certifying body recognized by the BNE.
(4)
] Monitored anesthesia care--Situations
where a patient undergoing a diagnostic or therapeutic procedure receives
doses of medication that create a risk of loss of normal protective reflexes
or loss of consciousness and the patient remains able to protect the airway
during
[
for the majority of
] the procedure. If[
, for
an extended period of time,
] the patient is rendered unconscious
and
[
and/or
] loses normal protective reflexes, then anesthesia
care shall be considered a general anesthetic.
(5)
] Outpatient setting--Any facility,
clinic, center, office, or other setting that is not a part of a licensed
hospital or a licensed ambulatory surgical center with the exception of all
of the following listed in subparagraphs (A) - (D) of this paragraph:
(6)
] Board--The Texas [
State
Board of
] Medical
Board
[
Examiners
].
(7)
] Physician--A person licensed
by the Texas [
State Board of
] Medical
Board
[
Examiners
] as a medical doctor or doctor of osteopathic medicine who diagnoses,
treats, or offers to treat any disease or disorder, mental or physical, or
any physical deformity or injury by any system or method or effects cures
thereof and charges therefor, directly or indirectly, money or other compensation.
"Physician" and "surgeon" shall be construed as synonymous.
an outpatient setting in which only anxiolytics and analgesics
are used and only in doses that do not have the significant probability of
placing the patient at risk for loss of the patient's life-preserving protective
reflexes
];
(c)
] Physicians who practice medicine
in this state and who administer anesthesia or perform a [
surgical
]
procedure for which anesthesia services are provided in [
an
] outpatient
settings
at Level IV
shall follow current, applicable standards
and guidelines as put forth by the American Society of Anesthesiologists (ASA)
including, but not limited to, the following listed in paragraphs (1) - (8)
of this subsection:
(1)
] Basic Standards for Preanesthesia
Care;
(2)
] Standards for Basic Anesthetic
Monitoring;
(3)
] Standards for Postanesthesia
Care;
(4)
] Position on Monitored Anesthesia
Care;
(5)
] The ASA Physical Status Classification
System;
(6)
] Guidelines for Nonoperating
Room Anesthetizing Locations;
(7)
] Guidelines for Ambulatory
Anesthesia and Surgery; and
(8)
] Guidelines for Office-Based
Anesthesia.
Operating surgeons or
] anesthesiologists shall maintain
current competency in ACLS, PALS, or a course approved by the board. In all
settings under these rules, at a minimum, at least two persons, including
the surgeon or anesthesiologist, shall maintain current competency in basic
life support.
practices medicine in this state and who administers anesthesia
] or
performs a [
surgical
] procedure for which anesthesia services are
provided in an outpatient setting shall comply with the rules adopted under
this title.
Nothing in this chapter shall be construed to relieve a physician
who delegates anesthesia services to a non-physician, including a Certified
Registered Nurse Anesthetist, of professional or legal responsibility for
such delegation.
administers
] anesthesia
services
or performs a [
surgical
]
procedure for which anesthesia services are provided in an outpatient setting
shall register with the board on a form prescribed by the board and pay a
fee to the board in an amount established by the board.
(b)
The physician who owns, maintains, controls,
or is otherwise deemed to be responsible for the office-based anesthesia site
shall pay a biennial office-based anesthesia site registration fee to the
board in an amount established by the board. In the event that a non-physician
or any other entity owns, maintains, controls, or is otherwise deemed to be
responsible for the office-based anesthesia site, that non-physician or entity
shall designate a duly licensed Texas physician to be responsible for that
office-based anesthesia site. The designated physician shall be responsible
for the registration of the office-based anesthesia site.
]
(c)
] The board shall coordinate
the registration required under this section with the registration required
under the Medical Practice Act, Texas Occupations Code Chapter 156, so that
the times of registration, payment, notice, and imposition of penalties for
late payment are similar and provide a minimum of administrative burden to
the board and to physicians.
Chapter 199.
PUBLIC INFORMATION
Part 17.
TEXAS STATE BOARD OF PLUMBING EXAMINERS