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“... Services Commission.
See HHSC's Health Care Practitioner Human Trafficking Training page to access the approved courses and for more information about this requirement.
Other course requirements:
No more tha 4 hours in courses that primarily relate to ... ”
“... impacted by HB 2059.
See HHSC's Health Care Practitioner Human Trafficking Training page to access the approved courses and for more information about this requirement.
Documentation of CE courses shall be made available to the Board upon request, but should not be submitted with ... ”
“... istry of Radiologic Technologists; or
a radiology practitioner assistant by the Certification Board for Radiology Practitioner Assistants.
RA licenses expire twice a year, February 28th or August 31st
Information on continuing education is available at CE for Radiologist ... ”
“... ending Physician Assistant (PA), Respiratory Care Practitioner (RCP), Perfusionist (PF), and Medical Physicist (MP) Applicants
Licensing for Out-of-State Providers
Licensing for Foreign Medical Graduates
Retired Physicians Returning to Active Status
Retired Physician Assistants (PAs) Returni ... ”
“... impacted by HB 2059.
See HHSC's Health Care Practitioner Human Trafficking Training page to access the course and for more information about this requirement.
Senate Bill 415 (2023) requires physicians to complete at least 1 hour of CME in the identification and ass ... ”
“... tronic failure, as prescribed by board rule;
by a practitioner to be dispensed by a pharmacy located outside this state, as prescribed by board rule;
when the prescriber and dispenser are in the same location or under the same license;
in circumstances in which necessary elements are not supported b ... ”
Description: Medical Board - 2015- January - Emergency Board Meeting *Minutes adopted at February 2015 Full Board Meeting
Document: ... in
-
person evaluation makes it
impossible for a practitioner to insure proper and accurate diagnosis and treatment; to insure
proper prescribing practices are followed; to insure the drug
s prescribed are therapeutic, i.e., the
medications prescribed are actually needed and/or proper for the con ...
Description: TMB Adopts Rules Expanding Telemedicine Opportunities
Document: ... ch as
an emergency medical technician
(EMT)
, nurse,
physician assistant,
pharmacist
, etc.
See
§174.2(7)
.
###
Description: Medical Board 2015 - April - Licensure Committee Minutes
Document: ... linical sciences coursework;
(ii) a registered nurse first assistant program that is approved or
recognized by an organization recognized by the Texas Board of Nursing
for purposes of lic
ensure as a registered nurse first assistant; or
(iii) a post graduate clinical physician assistant prog ...
Description: TMB restricts Dallas physician
Document: ... y to a
physician assistant or
advanced practice nurse, or supervise
a surgical assistant.
The Board panel found that Dr. Packard has engaged in a pattern of delegating prescriptive
authorit
y to nurse practitioners
and
physician assistants
that have
non
-
therapeutically
prescribed contr ...
Description: TMB restricts Arlington physician
Document: ... ty to a physician assistant or
advanced practice nurse or supervise a surgical assistant that is engaged in the practice of
clinical medicine.
The Board panel found that there wer
e unresolved issues relating to Methamphetamine use. Dr.
Ferguson failed to clear these allegations with the Boar ...
Description: TMB restricts Houston physician
Document: ... ty to a physician assistant or advanced practice
nurse, nor is he permitted to supervise any midlevel provider, including physician assistants and
advanced practice nurses, except in the practice
settings per
missible under the Order of
Temporary Restriction.
The Board panel found that Dr.
Ch ...
Description: TMB disciplines 40 physicians at June meeting, adopts rule changes
Document: ... ty to a physician
assistant or advanced practice nurse or supervise a surgical assistant. The Board found Dr. Stasikowski surrendered his
privileges at Baylor All Saints Hospital while a peer review investigation w
as pending regarding changes in his behavior
and patient care.
OTHER STATE ...
Description: TMB restricts Webster physician
Document: ... ysician assistant or advanced practice registered nurse
or supervising any midlevel provider.
The Board panel found that Dr.
Patel
failed to adequately treat at least four chronic pain patients
and was operating
a
pain management clinic
without proper certification.
The temporary
r ...
Description: Legislative Update 84th Legislature (2015)
Document: ... st or designee to communicate to the prescribing
practitioner the specific product provided to the patient, including the name and the
manufacturer or natio
nal drug code number.
This requirement expires Sept. 1, 2019.
http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill ...
Description: TMB Bulletin August 2015
Document: ... (tA) or ad-
vanced pracce registered nurse (Atwb) prescribe a
Schedule II Controlled Substance?
troperly authorized Atwbs and tAs may issue prescrip-
ons for Schedule II controlled substances to paents
who are admied to a hospital for an intende ...
Description: Medical Board 2015 - August - Licensure Committee Minutes
Document: ... ) The board shall
provide written notice to each practitioner at the practitioner's address of
record at least 30 days prior to the expiration date of the license.
(d) Within 30 days of a surgical assistant's change of mailing, residence or office address from
the address
on file with the boa ...
Description: TMB disciplines 61 physicians at August meeting, adopts rule changes
Document: ... iled to adequately supervise an advanced practice nurse who was engaged in nontherapeutic
prescribing of controlled substance
pain medications and who was operating a clinic as a pain management clinic
without a valid certification. Dr. Nasser failed to exercise due diligence when he learned tha ...
Description: MRT, LMRT and RCP applicants should have a form L completed for each MRT, LMRT or RCP position you have held within the past 5 years.
Document: ... __________Name of Evaluating Hospital/Institution/Practitioners Office
I hereby authorize all hospitals, institutions or organizations, my references, personal physicians, employers (past, presentand future), business or professional associates (past, present and future) and all governmental a ...
Description: PA Board 2015 November - Licensure Committee Minutes
Document: ... on;
(vi) submitting a report from the National Practitioner Data Bank/Health Integrity and Protection Data Bank
(NPDB
-
HIPDB) by contacting the NPDB
-
HIPDB and having a report of action submitted dire
ctly to the board on
the applicant's behalf;
and
(vii)
submitting professional evaluat ...
Description: TMB Bulletin December 2015
Document: ... a
licensed acupuncturist, herbalist and
family nurse praconer in the State
of Texas. She graduated from the
American College of Acupuncture and
hriental aedicine in Iouston, Texas
with a aaster’s 5egree in hriental
aedicine. She also trained at
Zhejiang College of ...
“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.”