- My TMB |
- Contact Us |
-
-
“Anyone may register a complaint against a practitioner licensed by the Board. Complaints must be submitted in writing. The identity of complainants is protected and kept confidential by law, with the exception of complaints filed by insurance and pharmaceutical companies. The Board cannot accept com ... ”
“... to practice or operate in Texas for each type of practitioner or non-profit entity can be found by using the navigation links at the top of this page.
Due to the high volume of applications being processed by the agency, staff members are unable to meet personally with applicants about ... ”
“... tion Monitoring Program (PMP) is used to verify a practitioner’s own records and prescribing history as well as inquiring about patients. In addition, the program may be used to generate and disseminate information regarding prescription trends.
House Bill 3284 (2019) requires prescribers ... ”
“... nd all physician owners must contact the National Practitioner Data Bank (NPDB)/Healthcare Integrity and Protection Databank (HIPDB) at https://www.npdb.hrsa.gov/ and perform a self-query.
List of current employees and their license numbers - A complete list of current clinic employees, incl ... ”
“... ORMATION
As mandated, TMB reports to the National Practitioner Data Bank all required disciplinary actions, including but not limited to any suspension, revocation, or public reprimand.
TMB disciplinary actions are also made public. Names and summaries of any type of order approved by the board (agr ... ”
“... se to see me?
Is a physician required to have a nurse or someone else present when performing gynecological exams on a patient?
”
“... is a licensed acupuncturist, herbalist and family nurse practitioner in the State of Texas. She graduated from the American College of Acupuncture and Oriental Medicine in Houston, Texas with a Master’s Degree in Oriental Medicine, and received a Doctor of Acupuncture and Oriental Me ... ”
“... the Inactive status for a Texas Respiratory Care Practitioner certificate, complete and return the inactive request form (link below) to the Board for approval before the expiration date of the current certificate. Refunds of registration/renewal fees already paid cannot be made.
Because this ... ”
“... aff at Houston Physicians' Hospital and is a solo practitioner in general orthopedics.
”
“... ange, or some other official document.
National Practitioner Data Bank/Health Integrity Data Bank Self-Query Response - Contact the National Practitioner Data Bank (NPDB)/Healthcare Integrity and Protection Databank (HIPDB) at http://www.npdb.hrsa.gov/ and perform a self-query. Send ei ... ”
“... iate
o licensed vocational nurse
o licensed registered nurse
o licensed physician assistant
· Provide that such practice of acudetox is not prohibited by the regulatory ag ... ”
“... chemical dependency counselor
licensed vocational nurse
licensed registered nurse
provided that such practice of acudetox is not prohibited by the regulatory agency authorizing such practice
Work under protocol and have access to a licensed Texas physician or a licensed Texas acupuncturist read ... ”
“... must be completed.
See HHSC's Health Care Practitioner Human Trafficking Training page to access the approved courses and for more information about this requirement.
The remaining 20 credit hours may be from Category II, composed of:
informal self-study,
attendance at hospital lect ... ”
“... Physician Assistant Supervision
Advanced Practice Nurse Delegation
”
“... rtified radiological technician, respiratory care practitioner, medical physicist, or perfusionist.
Please note that this evaluation is not a guarantee of eligibility for licensure. Applicants must meet all licensure requirements that are in place at the time of their licensure applicati ... ”
Description: TMB Bulletin Fall 2006
Document: ... Texas Academy of Family Physicians, and advanced nurse practitioners. My participation in this group was unique in that, in addition to representing TMB, I am a practicing board certified pain medicine physician dealing with these issues and rules on a daily basis in my private practice. During an ...
Description: TMB Bulletin Fall 2004
Document: ... tal to deliver a stillborn infant and directing a nurse to deliver the stillborn infant. Lewis, Harold Ray, M.D., Dallas, TX, Lic. #D8323
On August 13, 2004, the Board and Dr. Lewis entered into an Agreed Order prohibiting Dr. Lewis from performing any cardiac procedures, whether for diagnostic or ...
Description: TMB Bulletin Fall 2010
Document: ... LINARY
INFORMATION
TMB reports to the National Practitioner Data Bank all ac-
tions that place
restrictions on a physician’s practice
, as well as
any suspension, revocation, or public reprimand. TMB
to the NPDB actions that only place
, such as participation in a chart monitoring program,
...
Description: TMB Bulletin Fall 2008
Document: ... nsure, clarifies what is an acceptable registered nurse first assisting program and a surgical physician assistant program, deletes surgical assistant programs that are not CAAHEP accredited from being acceptable for purposes of licensure, and updates name of LCC-ST; 184.5, Procedural Rules for Lice ...
Description: TMB Bulletin Fall 1997
Document: ... primary care physicians, physician assistants and nurse practitioners. The Texas Department of Health has prepared an Official Clearinghouse Application Form (CH-1296) for applicants to register for the Clearinghouse. Physicians may seek PA's or NP's to join their practices, and PA's and NP's may se ...
Description: TMB Bulletin Fall 1998
Document: ... established jointly with the Texas State Board of Nurse Examiners. To view these bills, go to the Legislature's web site at www.capitol.state.tx.us. To receive a copy of a bill, contact the Legislative document distribution divisions at the following addresses: House Document Distribution John H. Re ...
Description: TMB Bulletin Fall 1999
Document: ... established jointly with the Texas State Board of Nurse Examiners. To view these bills, go to the Legislature's web site at www.capitol.state.tx.us. To receive a copy of a bill, contact the Legislative document distribution divisions at the following addresses: House Document Distribution John H. Re ...
Description: TMB Bulletin Fall 2005
Document: ... e from UCLA in 1991. Dr. Counts has been a family practitioner in Austin since 1975, with medical interests in primary preventive care and pain modulation.
Registration Updates Please check the Graduate Medical Education section of your online Physician Profile. A contractor's computer error may ha ...
Description: TMB Bulletin March 2013
Document: ... haved in a disrup ve man- IMPAIRMENT ner toward a nurse. Moran, Cynthia Hartmann, M.D., Lic. No. H3251, Houston VIOLATION OF PRIOR ORDER On February 8, 2013, the Board and Cynthia Hartmann MoDo, Phu M., M.D., Lic. No. L2224, Houston ran, M.D., entered into an Agreed Order li ing Dr. Moran's On Febru ...
Description: TMB Bulletin Spring 2005
Document: ... BS, whether as a specimen collector, physician or nurse following up on abnormal screens, a physician doing confirmatory testing and/or treating these infants, or someone involved in locating families and explaining the screening that is done and the importance of followup. Rule Changes To see the f ...
Description: TMB Bulletin Spring 2006
Document: ... ve authority to a physician assistant or advanced nurse practitioner during the one-year term of the order. The action was based on allegations that Dr. Martin failed to adequately manage and document treatment for a patient for whom she was prescribing Cylert, including a failure to obtain baseline ...
Description: TMB Bulletin Spring 2007
Document: ... from supervising physician assistants or advanced nurse practitioners, and assessing an administrative penalty of $250. The action was based on allegations stemming from the action of the Michigan Board of Medicine suspending Dr. Samuel's license in 2004 based on complaints alleging violations of th ...
Description: TMB Bulletin Spring 2004
Document: ... plaints And Investigations
Created Central Nurse Investigator positions, requiring both legal and nursing expertise to review complaints and assure quality of investigations. Developed the required expert physician panel composed of 400 well-qualified physicians in 75 medical specialties and ...
Description: TMB Bulletin Spring 2010
Document: ... ately
after his name on a fax sent to the school nurse of a
patient, and held himself out as a physician or surgeon
44
where they can contact him to obtain copies of their
medical records. The action was based on Dr. Crain’s
being placed on deferred adjudication due to a Class
A misdemeanor as ...
Description: TMB Bulletin Spring 1997
Document: ... ported to various agencies including the National Practitioner Data Bank.
Physician Laurels Vicente Tavarez,Jr., M.D. The Board would like to offer its condolences to the family and friends of Vicente Tavarez, Jr., M.D., who died on October 5, 1996. Dr. Tavarez was a McAllen surgeon who served as a ...
“It is recommended, but not required, that a physician have a third party such as a staff or family member serve as a chaperone during such an exam. If a chaperone is unavailable, the patient may decline the exam and may wish to consider finding another physician. ... ”
It is recommended, but not required, that a physician have a third party such as a staff or family member serve as a chaperone during such an exam. If a chaperone is unavailable, the patient may decline the exam and may wish to consider finding another physician.
“... inst any licensee for impersonation of a licensed practitioner or permitting another to use his license to practice medicine. Section 164.052(a)(17) authorizes disciplinary action against a practitioner for aiding or abetting, directly or indirectly, the practice of medicine by non-licensed individu ... ”
What is the "corporate practice of medicine"?
The corporate practice of medicine is a legal doctrine, which generally prohibits corporations, entities or individuals (i.e. non-physicians) from practicing medicine.
A general summary of the corporate practice of medicine doctrine is that it prohibits physicians from entering into partnerships, employee relationships, fee splitting, or other situations with non-physicians where the physician's practice of medicine is in any way controlled or directed by, or fees shared with a non-physician. Generally, physicians may enter into independent contractor arrangements with non-physicians. However, whether an independent contractor situation exists is a question of law and attendant facts.
Section 165.156 of the Medical Practice Act makes it unlawful for any individual, partnership, trust, association or corporation by use of any letters, words, or terms, as an affix on stationery or advertisements or in any other manner, to indicate the individual, partnership, trust, association or corporation is entitled to practice medicine if the individual or entity is not licensed to do so.
Section 164.052(a)(13) of the Medical Practice Act authorizes disciplinary action against any licensee for impersonation of a licensed practitioner or permitting another to use his license to practice medicine. Section 164.052(a)(17) authorizes disciplinary action against a practitioner for aiding or abetting, directly or indirectly, the practice of medicine by non-licensed individuals or entities.
Beginning in 2011, the Texas Legislature enacted laws authorizing certain types of hospitals and specific hospital districts to directly hire physicians.
Because of the highly technical aspects of this doctrine, a physician should consult with private counsel regarding any actual or contemplated arrangement. Please be advised that the Board staff is not authorized to provide private legal advice.
The following case law/legal authority may be helpful in the analysis and are available from any local law library or private counsel:
a. Garcia v. Texas State Board of Medical Examiners, 384 F.Supp. 434 (W.D. Texas 1974);
b. F.W.B. Rockett v. Texas State Board of Medical Examiners, 287 S.W.2d 190 (Tex. Civ.App.- San Antonio 1956, writ ref'd n.r.e.);
c. Watt v. Texas State Board of Medical Examiners, 303 S.W.2d 884 (Tex. Civ. App.- Dallas 1957, writ ref'd n.r.e.);
d. Flynn Brothers, Inc. v. First Medical Associates, 715 S.W.2d 782 (Tex. Civ. App.- Dallas 1986, writ ref'd n.r.e.)
e. Woodson v. Scott & White Hospital, 186 S.W.2d 720 (Tex. App. 1945, writ ref'd w.o.m.)
f. Tex. Atty. Gen. Op. JM-1042 (1989)
g. Tex. Atty. Gen. Op. WW-278 (1957).
h. Tex. Atty. Gen. Op. JM 369 (1985)
i. Tex. Atty. Gen. Op. DM-138 (1992)
j. Tex. Atty. Gen. Op. M-551 (1970)
k. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
l. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
m. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, 151.055.
n. Occupations Code, section 102.001.
“... ysician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the pr ... ”
Is the Prescription Monitoring Program (PMP) check mandated each and every time a physician or authorized delegate prescribes one of the four scheduled drug types?
Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/.
“... exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however. ”
Do I need to have a protocol in addition to a prescriptive authority agreement?
APRNs and PAs are required to have delegated authority from a licensed physician in order to provide medical aspects of patient care. Historically, this delegation has occurred through a protocol or other written authorization. Rather than requiring multiple documents, delegation protocols can now be included in one document the prescriptive authority agreement. The prescriptive authority agreement need not describe the exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however.
“A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement. ... ”
What constitutes a license that is in good standing for purposes of entering a prescriptive authority agreement?
A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement.
Note that if a licensee’s authority to supervise, delegate, or prescribe devices is limited under a board order, the licensee may enter into a prescriptive authority agreement and practice under the agreement only to the extent permitted by the board order.
“... nesthesia-related tasks to a certified registered nurse anesthetist (“CRNA”) to supervise the performance of those acts.” (Page 5)However, KP-0353 also found “…the language of chapter 157 is not the only relevant authority to consider in addressing the question of phys ... ”
When is Physician supervision of a CRNA required?
Regardless of the circumstances when supervision is or is not required, it is important to remember that the delegating physician must abide by all required federal and state statutes and regulations regarding delegation. The physician retains responsibility of the medical management of the patient. Therefore, the delegating physician must consider the delegatee’s education, training, and experience prior to delegating. Additionally, delegation may be revoked by the delegating physician at any time.
The Texas Attorney General has issued three opinions on CRNA supervision. The latest opinion found that although physician supervision of a CRNA is not required in Texas Occupations Code Sec. 157.058, other federal and state statutes and regulations may require physician supervision of a CRNA, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician, and the Legislature did not expressly limit the liability of the delegating physician.
Specifically, Texas Attorney General Opinion KP-0353 found “Section 157.058 of the Occupations Code does not, by itself, require a physician who properly delegates anesthesia-related tasks to a certified registered nurse anesthetist (“CRNA”) to supervise the performance of those acts.” (Page 5)
However, KP-0353 also found “…the language of chapter 157 is not the only relevant authority to consider in addressing the question of physician supervision over acts delegated to a CRNA. Federal regulations limiting Medicare coverage and conditioning hospital participation in Medicare and Medicaid programs require physician supervision of a CRNA when administering anesthesia in certain circumstances. See, e.g., 42 C.F.R. §§ 416.42(b)(2), 482.52(a)(4), 485.639(c)(1)(v), (2) (requiring a CRNA to operate under a physician’s supervision when administering anesthesia in certain circumstances). Furthermore, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician. See TEX. HEALTH & SAFETY CODE §§ 481.002(1)(A) (defining “administer” to require agent to apply controlled substance in presence of physician), .071(a) (prohibiting physician from causing controlled substance to be administered under physician’s “direction and supervision” except for valid medical purpose and in course of medical practice). And a CRNA may not obtain an anesthetic that is a dangerous drug unless a physician has listed that CRNA as the physician’s designated agent. See id. §§ 483.001(4) (defining “designated agent”), .022(a) (requiring physician to name each designated agent in writing). (Page 3 with emphasis added.)
Finally, KP-0353 found “Whether and the extent to which physician supervision is required for an act delegated to a CRNA will depend on the specific act delegated, the type of facility in which the CRNA performs the act, and any relevant regulations of that facility. And while section 157.058 authorizes a physician to delegate to a CRNA, a physician is never required to do so. If a physician is concerned about a CRNA’s ability to perform a delegated act or desires to limit the delegation, the physician retains the authority to refrain from delegating, to limit the delegation, or to supervise the delegation to whatever extent the physician determines necessary. In sum, the authority to delegate provided by section 157.058 of the Occupations Code does not eliminate the need to comply with all other applicable statutes, regulations, bylaws, ethical standards, and a physician’s own professional judgment. See TEX. OCC. CODE § 157.007 (“An act delegated by a physician under [chapter 157] must comply with other applicable laws.”). (Page 4 with emphasis added.)
“... ement Actions tab labeled “Respiratory Care Practitioner”. ”
How do I verify disciplinary action on a RCP?
Disciplinary actions for RCPs are available at: http://www.tmb.state.tx.us/page/DSHS-Transferred-Licenses under the Disciplinary/Enforcement Actions tab labeled “Respiratory Care Practitioner”.
“... o;s birth month). Moving forward respiratory care practitioner licensees will expire twice a year, on May 31st or November 30th. As part of the transition from DSHS to TMB, existing RCP licenses will have their first registration with TMB per the existing permit expiration date. The renewal fee ... ”
Will I continue to renew my license in my birth month?
Registration/renewal through TMB will be completed on a different schedule than DSHS, with all permits expiring during specific set times of year (as opposed to expiring in the permit holder’s birth month). Moving forward respiratory care practitioner licensees will expire twice a year, on May 31st or November 30th.
As part of the transition from DSHS to TMB, existing RCP licenses will have their first registration with TMB per the existing permit expiration date. The renewal fee charged at the time of the first renewal with TMB will be pro-rated to bring the permits in line with the new expiration dates.
“... iod for the expiration date of a Respiratory Care Practitioner permit. Once the expiration date has occurred, a penalty fee equal to one half of the registration fee will be added. After 90 days, the penalty fee will increase to equal a full registration fee. If a license has been expired for one ye ... ”
What is the penalty for renewing past the expiration date?
There is no grace period for the expiration date of a Respiratory Care Practitioner permit. Once the expiration date has occurred, a penalty fee equal to one half of the registration fee will be added. After 90 days, the penalty fee will increase to equal a full registration fee. If a license has been expired for one year or longer it is automatically cancelled.
“... n No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without delegation by a physician.” (Page 5). Since the selection and administration of anesthesia is a medical act, CRNAs must be properly delegated this ac ... ”
Are CRNA’s authorized to practice independent of physician supervision and delegation?
No, neither the Medical Practice Act nor the Nursing Practice Act authorize independent practice by a CRNA. Additionally, Texas Attorney General Opinion No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without delegation by a physician.” (Page 5). Since the selection and administration of anesthesia is a medical act, CRNAs must be properly delegated this act by a physician. A CRNA who administers anesthesia without proper delegation from a physician would be liable for the unlicensed practice of medicine.
“... rofile page will list the waiver status. For nurse practitioners: APRN waivers are determined by the Texas Board of Nursing. Information on the waiver process for the APRNs is available on the Texas Board of Nursing Website. ”
Do delegates who have prescribing authority have to apply for their own waiver or are they covered by the supervising physician’s waiver?
If the supervising physician has a waiver, then the prescribing delegate is also covered under that waiver. So long as the prescribing delegate is prescribing under the authority of a physician who has been granted a waiver, then the prescribing delegate may use non-electronic prescribing means. If a prescribing delegate is issuing a prescription under the authority of a physician who does not have a waiver, then the prescribing delegate must issue the prescription via e-prescribing.
If an individual wants to look up whether a prescribing delegate has a waver they can do so as listed below:
For physician assistants: A PA’s waiver status will not be viewable on their TMB public profile. Each PA’s public profile has a link to their supervising physician’s profile page. The physician’s profile page will list the waiver status.
For nurse practitioners: APRN waivers are determined by the Texas Board of Nursing. Information on the waiver process for the APRNs is available on the Texas Board of Nursing Website.
“... o; If you want to verify that a PA or nurse practitioner has a waiver, you will have to look at the delegating physician’s public profile. You can look up a prescriber’s public profile here: Look up a LicenseNOTE: Per the Texas State Board of Pharmacy, a “pharmaci ... ”
How can someone determine if a practitioner has a waiver?
If a physician has a waiver from e-prescribing, it is viewable on their public profile page, under the section entitled “Verified Information.” If you want to verify that a PA or nurse practitioner has a waiver, you will have to look at the delegating physician’s public profile. You can look up a prescriber’s public profile here: Look up a License
NOTE: Per the Texas State Board of Pharmacy, a “pharmacist is not responsible for ensuring there is a waiver. In addition, there is no requirement of the pharmacist to ensure an appropriate waiver is granted.”