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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: 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 ...
Description: Medical Board 2015 - June - Full Board Minutes
Document: ...
add
ition of
12
cycles of chart monitoring. A hand vote was taken and the
motion passed. Mr. Denton and
Mr. Webb opposed.
The remaining Agreed Board Orders were deferred to later in the meeting
.
Agenda item #4, Consideration and possible action regarding pending litigation.
Dr. Wi ...
Description: TMB disciplines 61 physicians at August meeting, adopts rule changes
Document: ... ded as follows: four hours in anti
-
coagulation
therapy and four hours in
medical recordkeeping; and within 90 days pay an administrative penalty of $3,000. The Board
found Dr͘ Armstrong failed to document his reason for discontinuing a patient’s anticoagulant therapy who later
suffered a s ...
Description: Acupuncture 2015 - May - Full Board Minutes
Document: ...
s
to
become approved providers including the
Korean Acupunctures Association in Texas
that was
approved by staff
as an approved provider
.
After discussion,
Dr. Ximenes
moved,
Ms. Webb
seconded, and the motion passed to approve
Applied Clinical Nutrition Seminars, Inc.;
and
...
Description: Acupuncture 2016 - October - Full Board Minutes
Document: ... that dry needling is within the scope of physical therapy.There were no items for Agenda item #4Agenda item #5, Consideration and possible action regarding pending litigation.Mr. Freshour gave a report on thestatus oflitigationof Acupuncture Association vs Chiropractic Board lawsuit regarding the pr ...
Description: Physician Statistics 2015 Sept - Physicians by Specialty
Document: ...
239
4
0
243
HAIR TRANSPLANT
8
3
0
11
HAND SURGERY
65
3
0
68
HAND SURGERY - ORTHOPEDIC SURGERY
53
3
0
56
HAND SURGERY - PLASTIC SURGERY
10
0
0
10
HAND SURGERY - SURGERY
11
1
0
12
HEAD AND NECK SURGERY
15
0
0
15
HEMATOLOGY (PATHOLOGY)
28
2
0
30
HEMATOLOGY - INTE ...
Description: TMB disciplines 26 physicians at June meeting
Document: ... e for three patients with complications following hand
or wrist surgeries, exhibited unprofessional conduct that was disruptive to surgi
cal staff during a procedure, and self
-
prescribed medications, including controlled substances to himself beyond immediate need.
UNPROFESSIONAL CONDUCT
...
Description:
Document: ... IN TX 78757 31/10/2015
Hardship Exemption 213200 HAND, MICHAEL SHANE D C 3005 CHURCH ST. SUITE D AMARILLO TX 79109 31/07/2016
Hardship Exemption 213158 HAUN, E. STAN MD 400 ENTERPRISE BLVD. STE 4 ROCKPORT TX 78382 31/03/2016
Hardship Exemption 213174 HOWARD, JOHN, MD P.O. DRAWER K CLARENDON TX ...
Description: TMB disciplines 38 physicians at August meeting
Document: ...
for
several patients
receiving chronic opioid therapy, failed to adequately document his care and comply with Board rules relating to the
treatment of chronic pain, and should have been more diligent in
performing adequate physical exams and monitoring.
Binur, Nir Shamai, M.D., Lic. No. J1 ...
Description: Acupuncture 2016 - February - Licensure Committee Minutes
Document: ... submit 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 bo ...
Description: Medical Board 2015 - December- Full Board Minutes
Document: ... , Dr. Holliday seconded, and the motion passed by hand vote to approve Remedial PlanDr. Arambula thanked the board for their service.Agendaitem #34, Adjourn. There being no further agenda items, Ms. Attebury moved, Mr. Gallardo seconded, and the motion passed to adjourn the meeting at 1:08 p.m.
...
Description: TMB disciplines 62 physicians at March meeting
Document: ... in risk management,
four hours in diagnosis and therapy of cervical spine diseases and four hours in p
hysician
-
patient communications. The
Board found Dr. Whisenant failed to maintain adequate medical records, failed to meet the standard of care by failing to
utilize fluoroscopy or other acce ...
Description: Physician Statistics 2016 Jan - Physicians by Specialty
Document: ...
237
4
0
241
HAIR TRANSPLANT
7
3
0
10
HAND SURGERY
66
3
0
69
HAND SURGERY - ORTHOPEDIC SURGERY
54
3
0
57
HAND SURGERY - PLASTIC SURGERY
9
0
0
9
HAND SURGERY - SURGERY
11
1
0
12
HEAD AND NECK SURGERY
16
0
0
16
HEMATOLOGY (PATHOLOGY)
32
2
0
34
HEMATOLOGY - INTERN ...
Description: Medical Physicists Licensure Professional Evaluation
Document: ... leted, signed, and dated by a person having first-hand knowledge of the applicant’s practice of medical
physics and must be mailed directly to the Board.
·
A medical physicist making a professional reference must be practicing in a specialty area for which the applicant is
applying. A physici ...
“... 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.