“... , M.D., of Houston, is the President of the Texas Medical Board. He is a Board Certified Anesthesiologist and is the Vice-Chair of the Clinical Governance Board for US Anesthesia Partners for the Gulf Coast region as well as a member of the Clinical Governance Board for US Anesthesia Partners Texas. ... ”
“... States must submit proof of their eligibility to practice in the country in which they are granted. All documentation that is not in English must be translated into English before it is submitted to the TSBAE.
Eligibility to Practice in Country of Graduation. Submit a copy of your licen ... ”
“... IDGE UNIVERSITY, HONOLULU, HI
0523
ORIENTAL MEDICAL INST OF HAWAII, HONOLULU, HI
0524
UNIV. OF HEALTH SCIENCE, HONOLULU, HI
0525
UNIVERSITY OF SCIENCES, BATON ROUGE, LA
0526
NEW ENGLAND SCHOOL OF ACUP, WATERTOWN, MA
0527
MINSHEW ACUP SCH, COLUMBIA FALLS, MT
0528
I ... ”
“... quo; answers to questions on the Professionalism, Medical Liability section of the application.
Once all items have been received, and have been reviewed and approved by the appropriate members of Board staff, your application will be considered complete and your name will be added to ... ”
“... at the verification be sent directly to the Texas Medical Board.
Verification of CCAOM Clean Needle Technique course contact the entity where you took this course and examination and request that they furnish you a verification in a sealed envelope with the providers signature across the outside of ... ”
“... hich:
o is approved by the Medical Board
o is 70 hours in length
o includes a clean needle technique course or equivalent universal infection control precaution procedures course approved by the Medical Board
· &n ... ”
“
Full Texas Medical License
Physician in Training Permit
Faculty Temporary License
Out-of-State Telemedicine License
Administrative Medicine License
Provisional License
Medical License Limited to Underserved Areas
Visiting Physician Temporary Permit
Visiting Professor Temporary License
Physician Pub ... ”
“... r chemical dependency, which:
is approved by the Medical Board
is 70 hours in length
includes a clean needle technique course or equivalent universal infection control precaution procedures course approved by the Medical Board
Hold an unrestricted and current license, registration, or certificatio ... ”
“... rements for permanent licensure, to enable you to practice until issuance of your permanent license at the next Acupuncture Board meeting. The fee is $107.
Registration Fees ”
“... There is no increase in the number of continuing medical education credits required prior to renewal as part of the biennial renewal system.
Physician assistants need to complete at least 40 credits of continuing medical education every 24 months. (24 month timeline is in relation to th ... ”
“... IN THESE SECTIONS HAVE BEEN VERIFIED BY THE TEXAS MEDICAL BOARD
Verified Information
Current Board Action
Medical Malpractice Investigations
THE INFORMATION IN THESE SECTIONS WAS REPORTED BY THE LICENSEE AND MAY HAVE NOT BEEN VERIFIED BY THE TEXAS MEDICAL BOARD
Self-Reported Informat ... ”
“... ysician, physician assistant, acupuncturist, medical radiologic technologist, non-certified radiological technician, respiratory care practitioner, medical physicist, or perfusionist.
Please note that this evaluation is not a guarantee of eligibility for licensure. Applicants must m ... ”
“... s State Board of Acupuncture Examiners (TSBAE) to practice acupuncture, which is defined as the insertion of an acupuncture needle and the application of moxibustion to specific areas of the human body as a primary mode of therapy to treat and mitigate a human condition, including the evaluation and ... ”
“
Texas Statutes regarding acupuncture practice are at http://www.statutes.legis.state.tx.us/?link=OC.
Acupuncture Board Rules ”
“... mation is seen, processed, or stored by the Texas Medical Board.
The payment portion of the online registration system is handled by Texas.gov, the official website of Texas. The price of this service includes funds that support the ongoing operations and enhancements of Texas.gov, w ... ”
“... ly and safely performed by the person to whom the medical act is delegated; 2) the act is performed in its customary manner; and 3) the performance of the act by the delegate is not in violation of any other statute.It is clear that AAs can be delegated certain tasks under Chapter 157. The question ... ”
What are the general rules related to AAs/CRNAs?
The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:
1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.
It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”
Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.
One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.
As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.
Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.
While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.
Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient.
“... approved a hardship exemption, prior to starting practice. ”
Do I need to register my supervising physician?
Registering a supervising physician for an NCT will no longer be required. However, an NCT will still need to obtain and maintain placement on the MRT Board’s general registry, or have an approved a hardship exemption, prior to starting practice.
“... cally underserved population or in facility based practice. ”
How many physician assistants can a physician supervise?
There is no limitation to the number of PAs or APNs a physician may supervise. However, a physician may only delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent. The only exception relates to supervision and prescriptive delegation to a medically underserved population or in facility based practice.
“... cally underserved population or in facility based practice. Refer to Board rule 193. ”
How many PAs can a physician delegate prescriptive authority to?
A physician may delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent. There are some statutory exceptions for prescriptive delegation to a medically underserved population or in facility based practice. Refer to Board rule 193.
“... it is considering practicing without a license to practice as a PA, which may be prosecuted by the local district attorney. The policy of the Board, however, is that the only administrative penalty is the payment of penalty fees required by statute. ”
Is there a grace period if I do not pay my PA registration on time?
There is no grace period if you do not register your license on time. Once a license becomes delinquent, it is considering practicing without a license to practice as a PA, which may be prosecuted by the local district attorney. The policy of the Board, however, is that the only administrative penalty is the payment of penalty fees required by statute.
“... d Rule 185.10 covers Physician Assistant Scope of Practice. ”
What are the laws or rules concerning a PA's scope of practice?
Board Rule 185.10 covers Physician Assistant Scope of Practice.
“... tten request by mail, fax or email to: Texas Medical BoardAttn: Registration DepartmentP.O. Box 2029 MC 240Austin, TX 78768 fax - (888) 512-2581 ”
How do I verify what level of OBA services an individual is registered for?
Verifications of OBA registration are available on request. Please submit a written request by mail, fax or email to:
Texas Medical Board
Attn: Registration Department
P.O. Box 2029 MC 240
Austin, TX 78768
fax - (888) 512-2581
“... need to complete at least 24 hours of continuing medical education each year, at least half of which must be in formal courses. One hour of formal CME must be in medical ethics and/or professional responsibility. A physician must report on the registration form if she or he has completed the requir ... ”
Is a physician required to complete CME to register a license?
Yes. Physicians need to complete at least 24 hours of continuing medical education each year, at least half of which must be in formal courses. One hour of formal CME must be in medical ethics and/or professional responsibility. A physician must report on the registration form if she or he has completed the required CME. However, newly licensed physicians are exempt from the CME requirements the first time they register.
“... status must not engage in clinical activities or practice in any state, must not prescribe or administer drugs to anyone, nor may the physician possess a DEA or Texas controlled substance number. Additionally, the physician's license may not be endorsed to any state. A physician whose license has b ... ”
Is there a retired status for physicians in Texas?
Yes. A physician on an official retired status is exempt from the registration fee. To be eligible for retired status, a physician's license cannot be under investigation, under a Board order, or be otherwise restricted. Physicians on a retired status must not engage in clinical activities or practice in any state, must not prescribe or administer drugs to anyone, nor may the physician possess a DEA or Texas controlled substance number. Additionally, the physician's license may not be endorsed to any state. A physician whose license has been placed on official retired status must obtain the approval of the board before returning to active status. The physician should contact the board for information on the approval procedure.
“Yes. You can search all license types, or select the individual license/permit type of your choosing by using the “License Type” drop down menu, and then entering in the name or TMB License/Permit #.Disciplinary actions for these licenses and permits available at: http://www.tmb.state.tx ... ”
Will the “Look up a License” system verify a MRT, RCP, Medical Physicist or Perfusionist?
Yes. You can search all license types, or select the individual license/permit type of your choosing by using the “License Type” drop down menu, and then entering in the name or TMB License/Permit #.
Disciplinary actions for these licenses and permits available at: http://www.tmb.state.tx.us/page/DSHS-Transferred-Licenses
“... sciplinary/Enforcement Actions tab labeled “Medical Radiologic Technologist”. ”
How do I verify disciplinary action on a MRT or LMRT?
Disciplinary actions for MRTs and LMRTs are available at: http://www.tmb.state.tx.us/page/DSHS-Transferred-Licenses under the Disciplinary/Enforcement Actions tab labeled “Medical Radiologic Technologist”.
“Yes. A retired physician whose only clinical practice is the provision of voluntary charity care to indigent populations shall be exempt from the registration fee but must register the license as well as report CME. The physician's practice of medicine must not include the provision of medical servi ... ”
Is there an exemption for retired physicians providing voluntary charity care?
Yes. A retired physician whose only clinical practice is the provision of voluntary charity care to indigent populations shall be exempt from the registration fee but must register the license as well as report CME. The physician's practice of medicine must not include the provision of medical services for either direct or indirect compensation which has monetary value of any kind and the physician's practice is limited to voluntary charity care to indigent populations and receives no direct or indirect compensation of any kind for medical services rendered. Also, the physician's practice cannot include the provision of medical services to family members or the self-prescribing of controlled substances or dangerous drugs. A physician who violates the provisions of this exemption may be subject to disciplinary action. Action may be based on unprofessional or dishonorable conduct likely to deceive, defraud, or injure the public if the physician engages in the compensated practice of medicine, provides medical services to members of the physician's family, or self-prescribes controlled substances or dangerous drugs. Additionally, a physician who attempts to obtain this exemption by submitting false or misleading statements shall be subject to disciplinary action pursuant to the Medical Practice Act, in addition to any civil or criminal actions provided for by the state or federal law.
“... clinics do not apply to the following settings: a medical or dental school or an outpatient clinics associated with a medical or dental school; a hospital, including any outpatient facility or clinic of a hospital; a hospice established under 40 TAC §97.403 (relating to Standards Specific to Ag ... ”
Who does not need to register a pain management clinic?
Regulations regarding the registration and operation of pain management clinics do not apply to the following settings:
Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your clinic meets one of the exemptions listed above. However, the Board does have inspection authority, and owners of clinics that have not been properly registered can be investigated.
“... exas unless the clinic is owned and operated by a medical director who: • is a physician who practices in Texas • has an unrestricted medical license • holds a certificate of registration for that pain management clinic In addition, the owner/operator of a pain management clini ... ”
Who can own or operate a pain management clinic?
A pain management clinic may not operate in Texas unless the clinic is owned and operated by a medical director who: • is a physician who practices in Texas • has an unrestricted medical license • holds a certificate of registration for that pain management clinic In addition, the owner/operator of a pain management clinic, an employee of the clinic, or a person with whom a clinic contracts for services may not: • have been denied, by any jurisdiction, a license issued by the Drug Enforcement Agency or a state public safety agency under which the person may prescribe, dispense, administer, supply, or sell a controlled substance; • have held a license issued by the Drug Enforcement Agency or a state public safety agency in any jurisdiction, under which the person may prescribe, dispense, administer, supply, or sell a controlled substance, that has been restricted; or • have been subject to disciplinary action by any licensing entity for conduct that was a result of inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance A pain management clinic may not be owned wholly or partly by a person who has been convicted of, pled nolo contendere to, or received deferred adjudication for: • an offense that constitutes a felony; or • an offense that constitutes a misdemeanor, the facts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined by Texas Occupations Code Annotated §551.003(11) The medical director of a pain management clinic must operate the clinic in compliance with Drug Prevention and Control Act, 21 U.S.C.A. 801 et.seq. and the Texas Controlled Substances Act, Chapter 481 of the Texas Health and Safety Code, relating to the prescribing and dispensing of controlled substances. The medical director of a pain management clinic must, on an annual basis, ensure that all personnel: • are properly licensed, if applicable, • are trained including 10 hours of continuing medical education related to pain management, and • are qualified for employment.
“Per Board Rule 195.4(e), the medical director or owner/operator of the pain management clinic, must on annual basis, ensure all personnel are properly licensed and, if applicable, have the requisite training to include 10 hours of continuing medical education (CME) annually in the area of pain manag ... ”
What are the continuing education requirements for pain management clinics?
Per Board Rule 195.4(e), the medical director or owner/operator of the pain management clinic, must on annual basis, ensure all personnel are properly licensed and, if applicable, have the requisite training to include 10 hours of continuing medical education (CME) annually in the area of pain management. This CME requirement applies to all personnel providing medical services to the patients (including, but not limited to: PAs, x-ray techs, phlebotomists, RNs, MAs, etc.). Office staff, such as managers, janitors, etc. who do not provide medical services, would not be required to meet the CME requirement, but would need to be listed in response to a pain clinic audit which requires listing all clinic personnel for that clinic. Documentation of the completed CME course shall be required to be made available upon request by Board Staff, including, but not limited to, during an on-site audit of the clinic, or during the certificate renewal process. The Board does have the authority to conduct audits and inspections at clinics to ensure compliance with all requirements and regulations pertaining to registered pain clinics, including audits of CME training as required.