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“... an assistant (PA) or advanced practice registered nurse (APRN) prescribe a Schedule II Controlled Substance?
Properly authorized APRNs and PAs may issue prescriptions for Schedule II controlled substances to patients who are admitted to a hospital for an intended length of stay of at least 24 hours, ... ”
“... h Legislature (SB 202), all Respiratory Care Practitioner, Medical Radiologic Technologist, Limited Medical Radiologic Technologist, and Non-Certified Radiologic Technician applicants who apply after August 31, 2019, will also now be required to successfully pass the Jurisprudence (JP) exam.
Th ... ”
“... w.tmb.state.tx.us/page/licensing-jp-exam
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 either of ... ”
“... w.tmb.state.tx.us/page/licensing-jp-exam
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 either of ... ”
“... amp; Study Guide
Please know all Respiratory Care Practitioner, Medical Radiologic Technologist, Limited Medical Radiologic Technologist, and Non-Certified Radiologic Technician applicants who apply after August 31, 2019, will also now be required to successfully pass the Jurisprudence (JP) exam.
Th ... ”
“... Fee: The current base fee for a Respiratory Care Practitioner application in Texas is $125.00. The entire fee must be submitted before your application can be assigned and processed.
The application fee includes a $5 Office of Patient Protection fee. An additional non-refundable surcharg ... ”
“... h Legislature (SB 202), all Respiratory Care Practitioner, Medical Radiologic Technologist, Limited Medical Radiologic Technologist, and Non-Certified Radiologic Technician applicants who apply after August 31, 2019, will also now be required to successfully pass the Jurisprudence (JP) exam.
Th ... ”
“... -Certified Radiologic Technician
Respiratory Care Practitioner
Medical Physicist
Perfusionist
What does this mean for licensees renewing their licenses on or after September 1, 2019?
Once your registration/renewal is complete, please allow 2 business days for processing. After that tim ... ”
“... t
Medical Physicist
Perfusionist
Respiratory Care Practitioner
”
“... h Legislature (SB 202), all Respiratory Care Practitioner, Medical Radiologic Technologist, Limited Medical Radiologic Technologist, and Non-Certified Radiologic Technician applicants who apply after August 31, 2019, will also now be required to successfully pass the Jurisprudence (JP) exam.
Th ... ”
“... -Certified Radiologic Technician
Respiratory Care Practitioner
Medical Physicist
Perfusionist
What does this mean for licensees issued on or after September 1, 2019?
Once your license is issued, please allow 2 business days for processing. After that time you will be able to log into your My ... ”
“... click here
PLEASE NOTE:
Respiratory care practitioner licensees expire twice a year, on May 31st or November 30th .
Information on continuing education is available at CE for RCPs .
”
“... 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 ... ”
“A respiratory care practitioner with a currently active certificate may decide to obtain an “inactive” registration status. Current regulations state that a RCP certificate may remain on an inactive status for no longer than 5 years.
If you have not already completed the cri ... ”
“... mance of a radiological procedure prescribed by a practitioner. This would include diagnostic radiological physics, therapeutic radiological physics, medical nuclear health and medical health physics.
Some responsibilities of a Medical Physicist may include:
Developing equipment specifications
Deve ... ”
Description: Press Release April 10, 2009 (PDF File)
Document: ... one Cease and Desist order against an unlicensed practitioner. Correction: The February 10, 2009, TMB release included a summary of an order for Rick Allen Boyles, M.D., Lic. #J6345, of Jasper TX, in the wrong category. The summary should have been listed as a modification of a previous order.
Rul ...
Description: Press Release April 13, 2006 (PDF File)
Document: ... action was based on allegations that Dr. Luecke's nurse practitioner failed to document vital signs and physical examination for one patient, that Dr. Luecke failed to document home visitations for one patient, and that his medication log did not reflect the administration of all medications. SCHRAP ...
Description: Press Release April 14, 2003 (PDF File)
Document: ... welfare. The action against Dr. Trimble, a family practitioner, was taken based on allegations relating to nontherapeutic prescribing to numerous patients, failure to practice medicine consistent with public health and safety, prescribing to persons known to be habitual users of alcohol and/or drugs ...
Description: Press Release April 16, 2008 A (PDF File)
Document: ... sure , 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 Li ...
Description: Press Release April 18, 2007 A (PDF File)
Document: ... from supervising physician assistants or advanced nurse practitioners; and assessing an administrative penalty of $1,000. The action was based on allegations that Dr. Arafiles failed to adequately supervise a physician assistant and failed to make an independent medical professional decision about t ...
Description: Press Release April 20, 2011 (PDF File)
Document: ... not supervise any physician assistant or advanced nurse practitioner; shall not obtain a controlled substance certificate; and shall limit his duties to worker compensation patients, private insurance cases, and making recommendations for treatment and therapy. The action was based on the Board's fi ...
Description: Press Release April 21, 2010 (PDF File)
Document: ... lure to adequately supervise an advanced practice nurse in the care of a patient with a ruptured appendix.
Watson, Stephen Wayne, M.D., Lic. #G6115, Plano TX On April 9, 2010, the Board and Stephen Wayne Watson, M.D., entered into an Agreed Order requiring Dr. Watson to complete within one year ei ...
Description: Press Release April 30, 2008 A (PDF File)
Document: ... of drugs; that physician assistants and advanced nurse practitioners who were dispensing the drugs were not adequately supervised; that drugs were being improperly dispensed at the clinics; and that Dr. Zayas was billing for treating patients whom he never saw or treated. The length of a temporary ...
Description: Press Release June 08, 2006 (PDF File)
Document: ... ity to a physician assistant or advanced practice nurse; and assessing an administrative penalty of $20,000. The action was based on allegations that Dr. Arredondo failed to meet the standard of care in treating 10 patients for the following reasons: failure to review past records; inadequate assess ...
Description: Press Release June 09, 2005 (PDF File)
Document: ... ity to a physician assistant or advanced practice nurse; he may not prescribe controlled substances and must surrender his controlled substances certificates; he must enroll in the "CPEP" program (now the Center for Personalized Education for Physicians) and implement recommendations of that program ...
Description: Press Release June 10, 2004 (PDF File)
Document: ... tal to deliver a stillborn infant and directing a nurse to deliver the stillborn infant. McMINN, MONTY RUEY, M.D., SAN ANTONIO, TX, Lic. #E2422 On 6-4-04 the Board and Dr. McMinn entered into an Agreed Order in which Dr. McMinn retired from the practice of medicine and voluntarily and permanently su ...
Description: Press Release June 10, 2010 (PDF File)
Document: ... shall not be reported by the TMB to the National Practitioner Data Bank Chapter 190, Disciplinary Guidelines: §190.8 Violation Guidelines, amendments allow physicians to prescribe to family members of a patient without first establishing a physicianpatient relationship in pandemic cases; establish ...
Description: Press Release June 16, 2011 (PDF File)
Document: ... ot supervise any physician assistants or advanced nurse practitioners. The Order was based on Dr. Caddell's violation of Board Rules regarding pain management treatment, inability to practice medicine with reasonable skill and safety to patients because of excessive use of drugs, inappropriate presc ...
Description: Press Release June 20, 2008 A (PDF File)
Document: ... dent medical evaluation, at his own expense, by a practitioner approved by the board; 2. within 90 days, Dr. Louis must take and pass with a score of 75 or more the Special Purpose Examination within three attempts; 3. within 180 days, Dr. Lewis must complete specific continuing medical education re ...
Description: Press Release July 07, 2008 B (PDF File)
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 ...
“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.”