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“... riting. Provide full name and practice address of practitioner. Also, provide dates and details of any incident, being as specific as possible. If your complaint is within the Board's jurisdiction, it will be assigned for proper study. Complainants are advised of an investigation status approximatel ... ”
“... alth Education Programs (CAAHEP),
2) a registered Nurse First Assisting program,
3) a Surgical Physician Assistant program or a
4) a full medical school (and receipt of a physician's degree).
Worked 2000 hours within the last 3 years as a Surgical Assistant.
Taken and passed one of the thre ... ”
“... 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 submitte ... ”
“... y for any physician.
See HHSC's Health Care Practitioner Human Trafficking Training page to access the free course that satisfies these requirements, and for more information about this requirement.
This requirement applies to the renewal of a license on or after September 1, 2020.
Senate ... ”
“... 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.
If you have any questions regarding continuing education requirements, please email us at registrations@tmb.stat ... ”
“... p; Respiratory Care Practitioner
Non-Certified Radiological Technician
Medical Physicist
Perfusionist
&nb ... ”
“Physicians are required to register with the TMB if the physician delegates prescriptive authority to Advanced Practice Registered Nurses (APRNs). Current registered delegations to APRNs are displayed in this section of the physician profile. ”
“... ification of Physician Assistants
NPDB - National Practitioner Data Bank
USMLE - USMLE Secretariat
Physician and Other Professional Databases
The links provided below will take you to external practitioner database/verification services. Basic physician information is available on these sites, howe ... ”
“... ted on page 3 of the Form L Evaluation.
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-hipdb.hrsa.gov and perform a self-query. Send eith ... ”
“... tended use of the substance prescribed unless the practitioner determines the furnishing of this information is not in the best interest of the patient
printed or stamped name, address, Federal Drug Enforcement Administrations (DEA) registration number, and telephone number of the practitioner&rsquo ... ”
“... Medical Physicist, Perfusionist, Respiratory Care Practitioner)
Other Registrations
Contact Information
If the registration information provided on our web site did not answer your questions, please contact the TMB by e-mail at Registrations@tmb.state.tx.us. Please include your name ... ”
“... ogic Technician Registry (NCRs),
Respiratory Care Practitioner (RCP) AND Temporary Respiratory Care Practitioner (TRCP),
Medical Physicist (MP) AND Temporary Medical Physicist (TMP),
Perfusionist (PF) AND Provisional Perfusionist (PROV-PF)
In accordance with law passed by the 84th Legis ... ”
“... g Program (PMP) fee, $11.00 for the National Practitioner Data Bank (NPDB), $5.25 for the Physician Health Program (PHP), and a $2 Office of Patient Protection fee. These fees are required by statute. The remaining $370 is the fee required by the TMB.
These fees are explained in mor ... ”
“... d Radiologic Technician Registry
Respiratory Care Practitioner
Medical Physicist
Perfusionist
”
“... non-refundable surcharges related to the National Practitioner Data Bank/Health Integrity Data Bank ($11.00) and the Texas Physician Health Program ($5.25) will be assessed with the application fee. The entire fee must be submitted before your application can be assigned and processed.
A ... ”
Description: TMB Bulletin Spring 1999
Document: ... an Assistant Info Disabled Person License Plates
Practitioner, heal thyself: Coping with stress in clinical practice By W. Walter Menninger, M.D. Permission for web publication of this article was not granted. T o receive a printed copy of the newsletter, write to the board at MC 251, P.O. Box 2018 ...
Description: TMB Bulletin January 2011
Document: ... l or clinic, a site could be a facility such as a nurse's station in a public or private school, a volunteer fire department, an EMS station, a residential or institutional care facility, or even a pharmacy. The key criteria are the availability and presence of: · a patient site presenter who is a l ...
Description: TMB Bulletin Spring 2009
Document: Medical Board Bulletin Spring 2009
Medical Board Bulletin Spring 09 (1.5Mb pdf)
Texas Medical Board Bulletin The newsletter of the Texas Medical Board Spring 2009 Volume 6, No. 2
Governor Appoints, Reappoints Board Members
Governor Rick Perry has made the following appointments and reappointment ...
Description: TMB Bulletin January 2012
Document: ... and, as such, are not reportable to the National Practitioner Data Bank. Remedial Plans typically are offered for administrative violations after a complaint is received or in other situations after an investigation is completed. In some instances, a case is reviewed by the Quality Assurance Panel ...
Description: TMB Bulletin December 2012
Document: ... and the physician assistant or advanced practice nurse. · The requestor's type of primary practice and the type of practice conducted at the site for which a waiver is requested, including the populations served by the practices and duties assigned to mid-level practitioners. · Whether the proposed ...
Description: Rule Changes November 30, 2009
Document: ... and facility-based practice sites; the number of nurse midwives and physician assistants to whom delegation in relation to obstetrical services is appropriate; registration requirements related to prescriptive delegation; and grounds for obtaining waivers regarding supervision and prescription dele ...
Description: Rule Changes October 03, 2010
Document: ... t physicians who delegate to certified registered nurse anesthetists (CRNAs) who only sign or carry out prescription drug orders are not required to register with the Board. The Board has determined that the clarification is necessary, based on the interpretation of Texas Occupations Code §157.0711( ...
Description: Rule Changes August 10, 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 Lic ...
Description: Rule Changes January 09, 2005
Document: ... drug orders to Physician Assistants and Advanced Nurse Practitioners.
Description: Press Release February 06, 2006 (PDF File)
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: Press Release February 10, 2009 A (PDF File)
Document: ... sistant, physician assistant or advanced practice nurse. The action was based on his compliance with a previous order and his need to change practice setting. Coleman, Brent J., D.O., Lic, #G3241, Laguna Vista TX On January 21, 2009, after notice and hearing, the board entered an Automatic Suspensio ...
Description: Press Release February 15, 2008 A (PDF File)
Document: ... rity to a physician assistant or advance practice nurse or supervising a surgical assistant. KODALI, SAYOJIRAO, M.D., LIC. #G1691, LONGVIEW, TX On February 8, 2008, the Board and Dr. Kodali entered into an Agreed Order requiring that Dr. Kodali submit proof of current ACLS certification and complete ...
Description: Press Release February 17, 2010 (PDF File)
Document: ... ain. The patient was seen almost exclusively by a nurse practitioner between June 2004 and August 2007 when the patient was diagnosed with an inoperable tumor. Hughes, Larry Charles, D.O., Lic. #J1692, Groesbeck TX On February 5, 2010, the Board and Dr. Hughes entered into an agreed order requiring ...
Description: Press Release April 07, 2004 (PDF File)
Document: ... tive behavior with hospital personnel (striking a nurse while on duty). SKRIPKA, CHARLES FRANK JR., M.D., TOMBALL, TX, Lic. #D4308 On 4-2-04 the Board and Dr. Skripka entered into an Agreed Order converting a prior confidential order to a public order, and extending restrictions on Dr. Skripka's lic ...
Description: Press Release April 07, 2005 (PDF File)
Document: ... , 2003, action was taken against a Luling general practitioner based on allegations relating to improper nontherapeutic prescribing, prescribing with an expired DPS registration, and failure to provide medical records as required to support the long term prescribing of narcotics, controlled substanc ...
“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.”