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“What is this? A request for evaluation of your criminal history and potential eligibility for licensure prior to application for licensure as a physician, physician assistant, acupuncturist, medical radiologic technologist, non-certified radiological technician, respiratory care practitio ... ”
“... s State Board of Acupuncture Examiners (TSBAE) to practice acupuncture, which is defined as the insertion of an acupuncture needle and the application of moxibustion to specific areas of the human body as a primary mode of therapy to treat and mitigate a human condition, including the evaluation and ... ”
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Texas Statutes regarding acupuncture practice are at http://www.statutes.legis.state.tx.us/?link=OC.
Acupuncture Board Rules ”
“... s: TMB does not have the authority to investigate a nurse for care provided within the scope of nursing. If your complaint involves a licensed nurse, you should review the Texas Board of Nursing’s website here: Welcome to the Texas Board of Nursing Website.
Pharmacists: TMB does no ... ”
“... icensee but not verified by the TMB (e.g. primary practice address, hospital privileges, delegation information, etc.) All verifications also include a description of any action taken by the Board against a licensee.
Data is updated daily and may be considered the most current information available. ... ”
“What is a surgical assistant?
A Surgical Assistant assists physicians in surgery by performing certain tasks like opening and closing surgical sites, harvesting grafts, dissecting and removing tissue, and implanting devices to name a few. Under the Occupations Code, the practice of a surgical assist ... ”
“Once a license is cancelled, the acupuncturist will no longer be able to practice in the state of Texas as an acupuncturist. In order to practice again in Texas following cancellation, a acupuncturist must file an application for relicensure and meet all requirements for licensure in effect at ... ”
“An Administrative Medicine license is a limited license that allows physicians to use the medical and clinical knowledge, skill, and judgment of a fully licensed physician in ways which may affect the health and safety of the public or any person.
It does not include the authority to
&n ... ”
“... the Capitol Complex.
We employ over 200 people in a wide variety of professional, administrative, and technical positions to fulfill the mission of the agency: “to protect and enhance the public’s health, safety and welfare by establishing and maintaining standards of excellence use ... ”
“... ard-certified” is widely understood to mean a doctor who possesses exceptional expertise in a particular area.
To protect the public, the Texas Medical Board (TMB) has taken steps to standardize what “board certified” means under TMB advertising rules. In October 2010 the TMB amend ... ”
“... w 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 link below, and create a “My TMB” account if you do not have one already. (Note - if you already have an ... ”
“As a prerequisite for physician registration, practitioners are required to complete continuing medical education. Current requirements for physicians are summarized below. If you would like to review the current rule, these requirements are currently listed Board rule 166.2 available on our w ... ”
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A physician may request in writing an exemption* for the following reasons:
catastrophic illness;
military service of longer than one year's duration outside the state;
medical practice and residence of longer than one year's duration outside the United States; or
good cause shown on written ... ”
“... be included on the prescription?
Is there still a ratio for the number of APRNs or PAs to whom a physician may delegate prescriptive authority?
Is there a waiver if a physician wants to delegate prescriptive authority to more than seven full time equivalent APRNs and PAs?
How many delegating p ... ”
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What constitutes a license that is in good standing for purposes of entering a prescriptive authority agreement?
Do I have to disclose information regarding investigations and discipline? If so, to whom must this information be disclosed
What must be included in a prescriptive authority a ... ”
Description: Rule Changes January 25, 2006
Document: 2006 Board Rules Changes
The following is a summary of the changes that were effective on January 25, 2006. Click here for the complete board rules. Chapter 161, General Provisions. Amendments change "Texas State Board of Medical Examiners" to "Texas Medical Board" and "Texas State Board of Physicia ...
Description: Rule Changes January 22, 2009
Document: 2009 Board Rules Changes
The following is a summary of the changes effective on January 22, 2009. Click here for the complete board rules. Chapter 163 Licensure, amending 163.5,Licensure Documentation, adds additional credentialing organizations that are recognized for the purpose of an internationa ...
Description: Rule Changes January 06, 2002
Document: 2002 Board Rules Changes
The following is a summary of the changes that were effective 1-6-02. Please replace the table of contents and these chapters in your rule book. Click here for the complete board rules. Chapter 163, Licensure. Proposed new 163.13, regarding expedited licensure process. Chapt ...
Description: Rule Changes January 04, 2007
Document: 2007 Board Rules Changes
The following is a summary of the changes that became effective on January 4, 2007. Click here for the complete board rules. Chapter 163, Licensure - (60) days extension of emergency rule currently in effect, adding 163.14 Interpretation of Section 1.51(d), S.B. 419, relatin ...
Description: Rule Changes January 02, 2013
Document: ... ds the rule to provide remedies for out of active practice issues and to allow for granting a license under a remedial plan. Chapter 171, POSTGRADUATE TRAINING PERMITS 22 TAC §171.3, §171.6 The amendment to §171.3 amends the rule to exempt applicants for PIT rotator permits from having to submit med ...
Description: Rule Changes December 22 and 25, 2011
Document: ... anges - December 22 and 25, 2011
The following is a summary of the changes effective December 22, 2011 and December 25, 2011. Click here for the complete board rules: The following is a summary of the changes effective December 22, 2011 and December 25, 2011. Click here for the complete board rules: ...
Description: Press Release January 6, 2011
Document: ... 2002 to 2010 as president, vice-president and as a member of the Licensure Committee and the Board's Malpractice Committee. "We're very pleased to have someone of this caliber join the agency," said TMB Executive Director Mari Robinson, J.D. "Dr. Gage- White's extensive, relevant experience and her ...
Description: Press Release January 18, 2011 (PDF File)
Document: ... gal operation of pain clinic
On January 14, 2011, a disciplinary panel of the Texas Medical Board temporarily suspended the medical license of Julia Renee Ward, M.D., Lic. No. M5571, of Houston, after determining that Dr. Ward's continuation in the practice of medicine presents a continuing threat t ...
Description: Press Release January 12, 2010 B (Pdf File)
Document: ... mothy N. Marks, M.D., due to his incarceration in a federal correctional facility following his conviction for failure to file a tax return for three years. Dr. Marks will not practice in Texas until authorized to do so by the Board. This order will remain in effect until superseded by a subsequent ...
Description: Press Release January 11, 2007 (PDF File)
Document: ... ense of Michael Lee Williams, M.D., of Palestine
A panel of the Texas Medical Board temporarily suspended the license of Michael Lee Williams, M.D., license #H5995, of Palestine, after determining that Dr. Williams continuation in the practice of medicine presents a continuing threat to the public ...
Description: Press Release January 16, 2011 (PDF File)
Document: ... 2002 to 2010 as president, vice-president and as a member of the Licensure Committee and the Board's Malpractice Committee. "We're very pleased to have someone of this caliber join the agency," said TMB Executive Director Mari Robinson, J.D. "Dr. Gage- White's extensive, relevant experience and her ...
Description: Press Release January 22, 2009 A (PDF File)
Document: ... icense of Brent J. Coleman, D.O., of Laguna Vista
A panel of the Texas Medical Board suspended the license of Brent J. Coleman, D.O., license number G3241, after determining that Dr. Coleman's continuation in the practice of medicine presents a continuing threat to the public welfare. The action was ...
Description: Press Release January 24, 2005 (PDF File)
Document: ... icense of James Everett Elder Jr., M.D., of Plano
A panel of the Texas State Board of Medical Examiners suspended the license of James Everett Elder Jr., M.D., license number K5289, after determining that Dr. Elder's continuation in the practice of medicine presents a continuing threat to the public ...
Description: Press Release January 25, 2003 (PDF File)
Document: ... 2003
27 Texas Physicians Have Been Removed from Practice for Standard of Care Issues
Contrary to reports that continue to appear in the Texas media, the Texas State Board of Medical Examiners has revoked, obtained surrenders or indefinitely suspended the licenses of at least 27 physicians in the p ...
Description: Press Release January 27, 2011 (PDF File)
Document: ... ychiatrist Rajen Desai, M.D.
On January 26, 2011, a Disciplinary Panel of the Texas Medical Board entered an Order of Temporary Suspension (With Notice of Hearing) against Rajen Desai, M.D., of Beaumont, suspending his medical license after determining that Dr. Desai's continuation in the practice o ...
“... authority. The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the distance ... ”
How many miles from my delegating physician can my practice site be?
SB 406 eliminated site based prescriptive authority. The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the distance between a physician’s primary practice and the practice site at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision.
“... n requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all ti ... ”
What are the Texas Medical Board’s requirements for a physician who delegates to an APRN or PA?
All prescriptive delegation requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have adequate supervision.
“... 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 ... ”
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.
“... t to seek the advice of private legal counsel.For a prescriptive authority agreement executed on or after September 1, 2019, the agreement must, at a minimum:(1) be in writing and reviewed, signed and dated by the parties to the agreement on an annual basis;(2) state the name, address, a ... ”
What must be included in a prescriptive authority agreement?
It depends upon when the agreement was executed. Note that there have been several changes to the law affecting this area in recent legislative sessions. To understand how the law might apply to your situation, you may want to seek the advice of private legal counsel.
For a prescriptive authority agreement executed on or after September 1, 2019, the agreement must, at a minimum:
(1) be in writing and reviewed, signed and dated by the parties to the agreement on an annual basis;
(2) state the name, address, and all professional license numbers of the parties to the agreement;
(3) state the nature of the practice, practice locations, or practice settings;
(4) identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;
(5) provide a general plan for addressing consultation and referral;
(6) provide a plan for addressing patient emergencies;
(7) state the general process for communication and the sharing of information related to the care and treatment of patients;
(8) if alternate physician supervision is to be utilized, designate one or more alternate physicians; and
(9) describe a prescriptive authority quality assurance and improvement plan and how it will be implemented. The plan must require chart reviews and periodic meetings.
“The law does not provide a specific number or percentage of charts that must be reviewed. Rather, the law provides that the number of charts to be reviewed is determined by the parties to the prescriptive authority agreement. The number may vary from one practice setting to another. ... ”
How many charts must be reviewed?
The law does not provide a specific number or percentage of charts that must be reviewed. Rather, the law provides that the number of charts to be reviewed is determined by the parties to the prescriptive authority agreement. The number may vary from one practice setting to another. Factors such as the length of time the APRN or PA has been in practice, the length of time the physician and APRN or PA have practiced together, whether the parties to the prescriptive authority agreement practice together in the same practice setting, and the complexity of patient care needs should be given consideration when making this determination. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the number or percentage of charts reviewed may be an important factor in determining the quality of the physician’s supervision.
“... locations at which the physician and delegate(s) practice. ”
Can we skip conducting periodic meetings if the physician and APRN or PA practice together at the same location?
No. Periodic meetings are required, regardless of the distance between or locations at which the physician and delegate(s) practice.
“... that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings. ... ”
If I work in a clinic owned by the hospital, is this considered a facility-based practice?
No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings.
“Although it is possible to use a prescriptive authority agreement in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation ... ”
Is a prescriptive authority agreement required in a hospital or long term care facility-based practice?
Although it is possible to use a prescriptive authority agreement in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms.
“In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate. &n ... ”
Who may delegate prescriptive authority in a hospital facility-based practice?
In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate.
“In a long term care facility based practice, delegation is by the medical director. ”
Who may delegate prescriptive authority in a long term care facility based practice?
In a long term care facility based practice, delegation is by the medical director.
“... nion 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 o ... ”
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.)
“... II drugs in the following situations: (1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a pa ... ”
Who can prescribe Schedule II drugs under physician delegation?
APRNs or PAs may prescribe schedule II drugs in the following situations:
(1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
(A) has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department of the hospital; or
(2) as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
“... security number of an applicant for or holder of a license, certificate of registration, or other legal authorization issued by a licensing agency to practice in a specific occupation or profession that is provided to the licensing agency is confidential and is not subject to disclosure under the o ... ”
Is my social security number subject to open records through TMB?
The 76th Legislature passed HB 692, which states in part: "The social security number of an applicant for or holder of a license, certificate of registration, or other legal authorization issued by a licensing agency to practice in a specific occupation or profession that is provided to the licensing agency is confidential and is not subject to disclosure under the open records law."
The law was passed in the House on March 18 and in the Senate on May 17 and went into effect after being signed by Governor George W. Bush on May 29, 1999.
“OBA registration does not apply to physicians who practice in the following settings: An outpatient setting in which only local anesthesia, peripheral nerve blocks, or both are used. Any setting physically located outside the State of Texas. A licensed hospital, including an outpatient facility of t ... ”
Who does not need to register for office-based anesthesia?
OBA registration does not apply to physicians who practice in the following settings:
Note: physicians that provide only level I services, must still meet all other requirements under Chapter 173.