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“... 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: Acupuncture 2014 - July - Full Board Minutes
Document: ... ysical therapists to the Texas Board of Physical
Therapy Examiners.
There were no items for Agenda item
s
#9
-
19.
Agenda item #20,
Discussion, recommendation, and possible action regarding
remedial plans.
After discus
sion,
Dr. Ximene
s
moved,
Ms. Webb
seconded
,
and ...
Description: Medical Board 2014 - August - Full Board Minutes
Document: ... l Order filed by Board staff for revocation.
A
hand vote was taken
, and the motion failed
. Dr. Simonson, Mr
. Ellis, Dr.
Snoots, Ms. Attebury, Dr. Guajardo, Dr. Willeford, Dr. Holliday, and Mr.
Denton voted against the motion.
Dr. Willeford moved, Dr. Snoots seconded a motion to
adopt ...
Description: District Review Committee Member Biographies
Document: ... e and family therapist associate at HiveZenFamily Therapy. He is a member of the Texas Association for Marriage and Family Therapy, National Alliance for Children’s Grief, Texas Funeral Directors Association, and Association for Death Education and Counseling. Putnam received a Bachelor of Arts ...
Description: PA Board 2016 April - Licensure Committee Minutes
Document: ...
Ms. Jones provided
the
new board members a hand
-
out that explained the referrals by the Executive Director to the
Licensure Committee.
Agenda Item 8
–
Discussion, recommendation, and possible action regarding staff issuance
of Physician Assistant Licenses.
Ms. Robinson exp ...
Description: Acupuncture 2014 - October - Full Board Minutes
Document: ... on the dry
needling letter sent to the Physical Therapy & Occupational Therapy Examiners.
There were no items for Agenda items #8
-
9.
Agenda item #10, Consideration and Approval of Agreed Board Orders.
After
discussion,
M
s. Webb moved, Ms. Drain seconded, and the motion passed to app ...
Description: Acupuncture 2015 - January - Licensure Committee Minutes
Document: ... ubmit the original naturalization certificate by
hand delivery or by certified mail to the board office for inspection.
(C) Examination scores. Each applicant for licensure must have a
certified transcript of grades
submitted directly from the appropriate testing service to the acupuncture ...
Description: Physician Statistics 2015 Jan - Physicians by Specialty
Document: ...
243
5
248
HAIR TRANSPLANT
9
3
12
HAND SURGERY
66
3
69
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)
27
2
29
HEMATOLOGY - INTERNAL MEDICINE
10 ...
Description: TMB disciplines 27 physicians at March meeting
Document: ... ound Dr. Havins’ choice to utilize Pelvic Floor Therapy was not adequately supported by the
patient’s diagnos
is or medical records and therefore its use was inconsistent with the standard of care for a patient
diagnosed with orthostatic tachycardia.
Williams, Balmore Willoughby, M.D., Lic ...
Description: Acupuncture 2015 - January - Full Board Minutes
Document: ... n the meeting
with the
Texas Board of Physical Therapy
Examiners to discuss dry needling.
After discussion, the board d
irected staff to prepare a letter
to request an Attorney General opinion
on the interpretation of the statue surrounding physical
therapy and dry needling.
Agenda ite ...
Description: Medical Board 2015 - February - Full Board Minutes
Document: ... with the same terms and conditions presented
. A hand vote
was taken
and the motion failed.
After consideration,
Mr. Webb
moved
, Ms. Southard
seconded, and the motion
passed to approve
the following Remedial Plans en masse for:
Jeffrey A. Astbury, M.D.;
Abimbola M. Banjo, M.D.; R ...
Description: TMB disciplines 29 physicians at April meeting, adopts rule changes
Document: ... inadequate given the length of ongoing medication therapy and that Dr. Dharma’s
delegate’s prescr
ibing of phentermine for intermittent periods in excess of the maximum FDA approved labeling use of
the drug was inappropriate because the medical records and protocols were inadequate to support ...
Description: Physician Statistics 2015 May - Physicians by Specialty
Document: ...
247
5
0
252
HAIR TRANSPLANT
9
3
0
12
HAND SURGERY
65
3
0
68
HAND SURGERY - ORTHOPEDIC SURGERY
50
3
0
53
HAND SURGERY - PLASTIC SURGERY
11
0
0
11
HAND SURGERY - SURGERY
11
1
0
12
HEAD AND NECK SURGERY
14
0
0
14
HEMATOLOGY (PATHOLOGY)
27
2
0
29
HEMATOLOGY - INTE ...
Description: Acupuncture Board's CPT Code Billing Position Statement
Document: ... r actions connected to the acupuncture procedure: hand
washing, patient positions, locating and cleaning the points, insertingand stimulating the needles, checking on the patient, removing the needles. This does not include needle retention time without direct patient monitoring or communication.
P ...
Description: Medical Board 2015 - April - Full Board Minutes
Document: ... , Assessment, and Research
(KSTAR) program.
A hand vote was taken and the motion pass
ed.
Agreed Order #22 was pulled from consideration
; licensee withdrew.
After discussion,
Dr. McNeese moved, Ms. Southard seconded, and the motion
passed to approve
Agreed Order #25 with new suggeste ...
Description: Medical Board 2013 - April - Full Board Minutes
Document: ... e
n by the respondent, Dr. Gallardo secon
ded. A hand
vote was taken and the motion passed as amended.
Mr. Webb made a counter motion to
undo the previous motion and made the
motion to
schedule
the case for an
other
ISC
and reject the proposed order
, Dr.
Shulkin
seconded
.
Aft ...
“... 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.