The Texas Medical Board (Board) adopts an amendment to §163.5, concerning Licensure Documentation, without changes to the proposed text as published in the October 31, 2008, issue of the Texas Register (33 TexReg 8867) and will not be republished.
The amendment adds additional credentialing organizations that are recognized for the purpose of an international medical school graduate to prove that the medical school was substantially equivalent to a Texas medical school at the time of attendance.
Prior to publishing the proposed amendment, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rule at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rule.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806738
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: October 31, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §165.1, concerning Medical Records, and §165.5, concerning Transfer and Disposal of Medical Records, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7955) and will not be republished.
The amendment to §165.1 clarifies that a physician must destroy medical records after the required time for maintenance in a manner that ensures continued confidentiality.
The amendment to §165.5 clarifies when a physician must notify the board of termination, retirement, or relocation of practice and clarifies that the notice to patients must offer the patient the opportunity to obtain a copy of the patient's medical records or have those medical records transferred to another physician.
Elsewhere in this issue of the Texas Register, the Texas Medical Board contemporaneously adopts the rule review of Chapter 165, Medical Records.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rules at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rules.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806739
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §166.2, concerning Continuing Medical Education, and §166.6, concerning Exemption From Registration Fee for Retired Physician Providing Voluntary Charity Care, without changes to the proposed text as published in the October 31, 2008, issue of the Texas Register (33 TexReg 8868) and will not be republished.
The amendments update the word "hours" to "credits" to comport with modern language usage.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rules at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rules.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806740
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: October 31, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §169.7, concerning Record Keeping, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7956) and will not be republished.
The amendments provide clarifying references to rules of the Texas Department of Public Safety.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rule at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rule.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806741
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts an amendment to §173.1, concerning Profile Contents, without changes to the proposed text as published in the October 31, 2008, issue of the Texas Register (33 TexReg 8870) and will not be republished.
The amendment adds required information to the physician profile, including year of birth, name as the physician requests it to be published, and mailing address.
Prior to publishing the proposed amendment, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rule at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rule.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806742
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: October 31, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts an amendment to §178.1, concerning Purpose and Scope, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7957) and will not be republished.
The amendment specifies statutory authority for the board to adopt rules regarding complaints.
Elsewhere in this issue of the Texas Register, the Texas Medical Board contemporaneously adopts the rule review of Chapter 178, Complaints.
Prior to publishing the proposed amendment, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rule at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rule.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806743
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §179.1, concerning Purpose and Scope, §179.4, concerning Request for Information and Records from Physicians and §179.6, concerning Time Limits, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7957) and will not be republished.
The amendment to §179.1 specifies statutory authority for the board to adopt rules regarding investigations.
The amendment to §179.4 adds a provision specifying that probable cause to obtain a licensee's medical records may be shown by actions or statements by a licensee at a hearing conducted by the Board that gives the Board reason to believe that the licensee has an impairment.
The amendment to §179.6 provides that a decision by the Quality Assurance Committee or the Disciplinary Process Review Committee that there is a necessity for additional investigation of a complaint constitutes good cause for an investigation to extend beyond 180 days.
Elsewhere in this issue of the Texas Register , the Texas Medical Board contemporaneously adopts the rule review of Chapter 179, Investigations.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rules at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rules.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806744
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts an amendment to §180.1, concerning Rehabilitation Orders, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7958) and will not be republished.
The amendment corrects a reference to this "section" instead of this "chapter."
Elsewhere in this issue of the Texas Register, the Texas Medical Board contemporaneously adopts the rule review of Chapter 180, Rehabilitation Orders.
Prior to publishing the proposed amendment, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rule at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rule.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806745
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §182.1, concerning Purpose, §182.5, concerning Expert Panel and §182.8, concerning Expert Physician Reviewers, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7959) and will not be republished.
The amendment to §182.1 specifies statutory authority for the board to adopt rules regarding experts.
The amendment to §182.5 specifies that members of the Expert Physician Panel may only be appointed by the board.
The amendment to §182.8 clarifies that, in determining the same or similar specialty of a physician, the practice area or specialty declared by the subject physician as his area of practice may be the specialty of the expert reviewers.
Elsewhere in this issue of the Texas Register, the Texas Medical Board contemporaneously adopts the rule review of Chapter 182, Use of Experts.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rules at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rules.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806746
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §187.3, concerning Computation of Time, §187.4, concerning Agreement to be in Writing, §187.13, concerning Informal Board Proceedings Relating to Licensure Eligibility, §187.14, concerning Informal Resolution of Disciplinary Issues Against a Licensee, §187.24, concerning Pleadings, §187.29, concerning Mediated Settlement Conferences, §187.59, concerning Evidence, §187.70, concerning Purposes and Construction, §187.71, concerning Hearing before a Panel of Board Representatives, §187.72, concerning Decision of the Panel and §187.73, concerning Termination of Suspension, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7959) and will not be republished.
The amendment to §187.3 clarifies that requirements regarding the computation of time may be made by statute or rule.
The amendment to §187.4 modernizes language used in the rule.
The amendment to 187.13 adds reference to Chapter 172, and updates term "Licensure with Restrictions" to "Licensure with "terms and conditions".
The amendment to §187.14 deletes "Administrative" as a modifier regarding informal resolution of violations.
The amendment to §187.24 updates the name of the agency to Texas Medical Board.
The amendment to §187.29 clarifies abbreviation used in the rule.
The amendment to §187.59 adds additional language used in §2001.081 Government Code.
The amendment to §187.70 adds, as a purpose of the rule regarding suspension by operation of law, the initial conviction of certain offenses.
The amendment to §187.71 and §187.72 adds conviction of certain offenses as a basis for a panel of the board ordering suspension by operation of law.
The amendment to §187.73 requires a person who has been suspended by operation of law to show competence and safety to practice medicine as a requirement for terminating suspension.
Elsewhere in this issue of the Texas Register, the Texas Medical Board contemporaneously adopts the rule review of Chapter 187, Procedural Rules.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rules at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rules.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
SUBCHAPTER A. GENERAL PROVISIONS AND DEFINITIONS
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806747
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806748
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806749
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806750
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The amendments are adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806751
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §187.18, concerning Informal Show Compliance Proceeding and Settlement Conference Based on Personal Appearance, without changes to the proposed text as published in the October 31, 2008, issue of the Texas Register (33 TexReg 8872) and will not be republished.
The amendment revises procedures for requesting and granting a postponement of an ISC; recognizes right of a complainant to make a statement in an informal show compliance and settlement conference and clarifies alternatives that an ISC Panel may consider, adding recommendation of imposition of administrative penalty.
Elsewhere in this issue of the Texas Register, the Texas Medical Board contemporaneously adopts the rule review of Chapter 187, Procedural Rules.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rules at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rules.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on January 2, 2009.
TRD-200900001
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 22, 2009
Proposal publication date: October 31, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts amendments to §190.1, concerning Purpose and §190.14, concerning Disciplinary Sanction Guidelines, without changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7963) and will not be republished.
The amendment to §190.1 adds reference to statutory authority for the board to adopt rules regarding disciplinary guidelines.
The amendment to §190.14 updates sanction guidelines to follow sanctions approved for the imposition of administrative penalties.
Elsewhere in this issue of the Texas Register , the Texas Medical Board contemporaneously adopts the rule review of Chapter 190, Disciplinary Guidelines.
Prior to publishing the proposed amendments, the Board sought stakeholder input through Stakeholder Groups, which made comments on the suggested changes to the rules at a meeting held on October 29, 2008. The comments were incorporated into the published proposed rules.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
SUBCHAPTER A. GENERAL PROVISIONS
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806752
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001 and §154.006, which provide authority for 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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806753
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016
The Texas Medical Board (Board) adopts an amendment to §192.2, concerning Provision of Anesthesia Services in Outpatient Settings, with non-substantive changes to the proposed text as published in the September 19, 2008, issue of the Texas Register (33 TexReg 7965). The text of the rule will be republished.
The amendment provides that it is not necessary to have premeasured doses of certain drugs in the delivery of Level I anesthesia services.
Elsewhere in this issue of the Texas Register, the Texas Medical Board contemporaneously adopts the rule review of Chapter 192, Office Based Anesthesia Services.
The Board received no public written comments and no one appeared to testify at the public hearing held on December 12, 2008.
The amendment is adopted under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for 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.
§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; and
(iii) AED or other defibrillator; and
(iv) 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) Level IV services: Physicians who practice medicine in this state and who administer anesthesia or perform a procedure for which anesthesia services are provided in 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 subparagraphs (A) - (H) of this paragraph:
(A) Basic Standards for Preanesthesia Care;
(B) Standards for Basic Anesthetic Monitoring;
(C) Standards for Postanesthesia Care;
(D) Position on Monitored Anesthesia Care;
(E) The ASA Physical Status Classification System;
(F) Guidelines for Nonoperating Room Anesthetizing Locations;
(G) Guidelines for Ambulatory Anesthesia and Surgery; and
(H) Guidelines for Office-Based Anesthesia.
(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, and 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.
(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.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on December 31, 2008.
TRD-200806754
Mari Robinson, J.D.
Interim Executive Director
Texas Medical Board
Effective date: January 20, 2009
Proposal publication date: September 19, 2008
For further information, please call: (512) 305-7016