- My TMB |
- Contact Us |
-
-
“... t to a standing order, approved protocol for drug therapy, collaborative drug management, or comprehensive medication management, in response to a public health emergency or in other circumstances in which the practitioner may issue a non-patient-specific prescription;
for a drug under a research pr ... ”
“... ain coaching, acupuncture, chiropractic, physical therapy, massage, and exercise/movement; or
collaborative care or other behavioral health integration services such as evidenced-based cognitive behavioral therapy interventions for mental health and pain reduction, medication management and opioid w ... ”
Description: Medical Board 2014 - May - DPRC - Agenda Item 02 - TX PHP Report
Document: ... id she could
not get in
I forgot I had PHyaical Therapy scheduled 7 am today
the alarms went off and i had f
orgotten i had breakfast at school
with my son. I called PT and rescheduled and my wife told me we
were late to the breakfast. I rushed to bkft and then had a 830
new patient apt I stay ...
Description: Physician Statistics 2014 May - Physicians by Specialty
Document: ...
1
7
GYNECOLOGY
254
4
258
HAIR TRANSPLANT
10
3
13
HAND SURGERY
67
3
70
HAND SURGERY-ORTHOPEDIC SURGERY
45
3
48
HAND SURGERY - PLASTIC SURGERY
10
10
HAND SURGERY - SURGERY
11
1
12
HEAD AND NECK SURGERY
14
14
HEMATOLOGY (PATHOLOGY)
25
2
27
HEMATOLOGY - INTERNAL MEDICINE
112
1
113
HEMATOLOGY/ONCOLOGY
3 ...
Description: Physician Statistics 2014 May - Physicians by County W-Z
Document: ... DICINE
1
1
GENERAL SURGERY
24
24
GYNECOLOGY
2
2
HAND SURGERY - ORTHOPEDIC SURGERY
2
2
HEMATOLOGY/ONCOLOGY
7
7
HOSPITALIST
8
1
9
INTERNAL MED - PEDS
4
4
INTERNAL MEDICINE
82
5
87
INTERVENTIONAL CARDIOLOGY
5
5
MOHS MICROGRAPHIC SURGERY
1
1
NEONATAL-PERINATAL MEDICINE
1
1
NEPHROLOGY
1
1
NEUROLOGICAL ...
Description: Physician Statistics 2014 May - Physicians by County T-V
Document: ... 5
5
GYNECOLOGIC ONCOLOGY
5
1
6
GYNECOLOGY
19
1
20
HAND SURGERY
5
5
HAND SURGERY - ORTHOPEDIC SURGERY
3
1
4
HAND SURGERY - SURGERY
1
1
HEAD AND NECK SURGERY
1
1
HEMATOLOGY (PATHOLOGY)
1
1
HEMATOLOGY - INTERNAL MEDICINE
3
3
HEMATOLOGY/ONCOLOGY
10
1
11
HEPATOLOGY
3
3
HOSPITALIST
35
8
43
INFECTIOUS DI ...
Description: Physician Statistics 2014 May - Physicians by County Q-S
Document: ... MEDICINE
1
1
GENERAL SURGERY
21
21
GYNECOLOGY
6
6
HAND SURGERY - ORTHOPEDIC SURGERY
1
1
HAND SURGERY - PLASTIC SURGERY
1
1
HEMATOLOGY - INTERNAL MEDICINE
4
4
HEMATOLOGY/ONCOLOGY
1
1
HOSPITALIST
9
9
INFECTIOUS DISEASES
6
6
INTERNAL MEDICINE
89
3
92
INTERVENTIONAL CARDIOLOGY
3
3
MOVEMENT DISORDERS
1
1 ...
Description: Physician Statistics 2014 May - Physicians by County M-N
Document: ... ERY
17
17
GERIATRIC PSYCHIATRY
1
1
GYNECOLOGY
3
3
HAND SURGERY
1
1
HAND SURGERY - ORTHOPEDIC SURGERY
1
1
HEMATOLOGY/ONCOLOGY
2
2
HOSPITALIST
4
4
INFECTIOUS DISEASES
2
2
INTERNAL MEDICINE
39
2
41
INTERVENTIONAL CARDIOLOGY
2
2
NEONATAL-PERINATAL MEDICINE
2
2
NEPHROLOGY
9
9
NEUROLOGICAL SURGERY
6
6
NEU ...
Description: Physician Statistics 2014 May - Physicians by County I-L
Document: ... TRICS
1
1
GYNECOLOGY
5
5
HAND SURGERY
2
2
HAND SURGERY - SURGERY
1
1
HEMATOLOGY - INTERNAL MEDICINE
2
2
HEMATOLOGY/ONCOLOGY
3
3
HOSPITALIST
5
1
6
INFECTIOUS DISEASES
4
4
INTERNAL MED - PEDS
2
2
INTERNAL MEDICINE ...
Description: Physician Statistics 2014 May - Physicians by County H
Document: ...
46
46
HAIR TRANSPLANT
4
1
5
HAND SURGERY
9
1
10
HAND SURGERY - ORTHOPEDIC SURGERY
8
8
HAND SURGERY - PLASTIC SURGERY
2
2
HAND SURGERY - SURGERY
1
1
HEAD AND NECK SURGERY
8
8
HEMATOLOGY (PATHOLOGY)
5
5
HEMATOLOGY - INTERNAL MEDICINE ...
Description: Physician Statistics 2014 May - Physicians by County D-F
Document: ... E
1
1
GYNECOLOGIC ONCOLOGY
11
11
GYNECOLOGY
40
40
HAND SURGERY
12
12
HAND SURGERY - ORTHOPEDIC SURGERY
4
4
HAND SURGERY - PLASTIC SURGERY
5
5
HAND SURGERY - SURGERY
1
1
HEAD AND NECK SURGERY
1
1
HEMATOLOGY (PATHOLOGY)
1
1
HEMATOLOGY - INTERNAL MEDICINE
19
1
20
HEMATOLOGY/ONCOLOGY
33
33
HEPATOLOGY
15 ...
Description: Physician Statistics 2014 May - Physicians by County C
Document: ... TRICS
1
1
GYNECOLOGIC ONCOLOGY
1
1
GYNECOLOGY
6
6
HAND SURGERY
1
1
HAND SURGERY - SURGERY
2
2
HEMATOLOGY/ONCOLOGY
5
5
HOSPITALIST
10
1
11
INFECTIOUS DISEASES
4
4
INTERNAL MED - EMERGENCY MED
1
1
INTERNAL MED - PEDS
2
2
INTERNAL MED/REHABILITATION
1
1
INTERNAL MEDICINE
197
11
208
INTERVENTIONAL CARDI ...
Description: Physician Statistics 2014 May - Physicians by County B
Document: ... INE
1
1
GYNECOLOGIC ONCOLOGY
1
1
2
GYNECOLOGY
1
1
HAND SURGERY
1
1
HAND SURGERY - ORTHOPEDIC SURGERY
1
1
HEAD AND NECK SURGERY
1
1
HEMATOLOGY - INTERNAL MEDICINE
4
4
HEMATOLOGY/ONCOLOGY
5
2
7
HOSPITALIST
11
11
INFECTIOUS DISEASES
9
1
10
INTERNAL MEDICINE
165
19
184
INTERVENTIONAL CARDIOLOGY
1
1
2
...
Description: Medical Board 2014 - June - DPRC - Agenda Item 02 - TX PHP Report
Document: ... to surrender my license if need be. On the other hand, txphp has saved my life and I view it as my higher power
.
Since r
eporting myself 2 years ago, I have had a wonderful life. I got remarried, bought a new house, got custody of my sons,
reconnected with family and friends, and sold my busines ...
Description: Medical Board 2014 - May 2 - Full Board Minutes
Document: ... o address
the
concerns surrounding testosterone therapy for anti
-
aging
on all TMB media and seek a
joint publication with other physician groups.
Agenda item #10, Discussion,
recommendation, and possible action relating to policy
that clarifies rule 189.11.
After discussion,
the B ...
Description: Acupuncture 2014 - February - Full Board Minutes
Document: ... hysical therapists to the Texas Board of Physical Therapy Examiners.
Agenda item #9,
Discussion, recommendation, and possible action re
garding
as
sessment options for acupuncturists in relation to diagnosis and CPT coding.
Ms.
Robinson summarized the board’s policy for CP ...
Description: Medical Board 2014 - June - Full Board Minutes
Document: ... t’s license. A
fter discussion on the motion, a hand vote was
taken
and the motion failed.
Dr. Snoots moved, Mr. Webb seconded to accept the order as written.
After
discussion, Mr. Gallardo made a friendly amendment to add a public reprimand, 8 hours
T
EXAS
M
EDICAL
B
OARD
J
UNE ...
“... a-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.While the Nursing Act places responsibility for patient hand-off o ... ”
What are the general rules related to AAs/CRNAs?
The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:
1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.
It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”
Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.
One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.
As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.
Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.
While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.
Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient.
“... the “My TMB” link in the upper right hand corner of our website (near the “search” box), and create an account if you do not have one already. ”
How do I change my address with the Texas Medical Board?
As part of the “My TMB” system, we are now able to offer the ability to update mailing and practice addresses online for the majority of our licensees.
To update your mailing or practice address online click the “My TMB” link in the upper right hand corner of our website (near the “search” box), and create an account if you do not have one already.
“... ves and receiving treatment such as counseling or therapy does not alone disqualify a licensee. However, the Board is obligated to determine whether a licensee is physically and mentally fit to practice and, therefore, must inquire to the extent necessary to make this determination. Whil ... ”
Why does the application ask about my mental and physical health status?
The Board understands that medical or mental health treatment is a normal part of many people's lives and receiving treatment such as counseling or therapy does not alone disqualify a licensee. However, the Board is obligated to determine whether a licensee is physically and mentally fit to practice and, therefore, must inquire to the extent necessary to make this determination. While the application does include a question pertaining to impairment, the question has been thoughtfully written to limit overly broad probing language that might dissuade health professionals from seeking treatment and reporting their conditions.
“... ves and receiving treatment such as counseling or therapy does not alone disqualify a licensee. However, the Board is obligated to determine whether a licensee is physically and mentally fit to practice and, therefore, must inquire to the extent necessary to make this determination. Whil ... ”
Why am I asked about my mental and physical health status during renewal?
The Board understands that medical or mental health treatment is a normal part of many people's lives and receiving treatment such as counseling or therapy does not alone disqualify a licensee. However, the Board is obligated to determine whether a licensee is physically and mentally fit to practice and, therefore, must inquire to the extent necessary to make this determination. While the renewal process does include a question pertaining to impairment, the question has been thoughtfully written to limit overly broad probing language that might dissuade health professionals from seeking treatment and reporting their conditions.