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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 3 years.
Please read the relevant board rule, Tex. Admin. ... ”
“... 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 September 02, 2010 (PDF File)
Document: ... th care services must be reported to the National Practitioner Data Bank. Chapter 190. Disciplinary Guidelines, Subchapter B: Amendment to §190.8, Violation Guidelines, provides that (1) a physician-patient relationship is not necessary when a physician prescribes medications to a patient's family m ...
Description: Press Release September 08, 2011 (PDF File)
Document: ... a supervisor for physician assistants or advanced nurse practitioners. The Board found Dr. Campbell, who treats patients with histories of exposure to molds and chemicals, failed to meet the standard of care, prescribed drugs or treatment in a nontherapeutic manner and relied on antibody testing at ...
Description: Press Release September 10, 2008 A (PDF File)
Document: ... onte failed to adequately document supervision of nurse practitioners and physician assistants in clinical settings.
FOGEL, GUY RUTLEDGE, M.D., Lic. #J5322, San Antonio, TX On August 29, 2008, the Board and Dr. Fogel entered into a Mediated Agreed Order requiring Dr. Fogel to attend 10 hours CME in ...
Description: Press Release September 18, 2003 (PDF File)
Document: ... une 10. The action against Dr. Bennett, a general practitioner, was taken based on allegations relating to improper nontherapeutic prescribing, prescribing with an expired DPS registration, and failure to provide medical records as required to support the long-term prescribing of narcotics, controll ...
Description: Press Release October 12, 2005 (PDF File)
Document: ... rom supervising a physician assistant or advanced nurse practitioner. The action was based on allegations that Dr. Smith relapsed by ingesting a controlled substance without a legitimate prescription after having previously entered into a rehabilitation agreement with the Board. SOWKA, LAWRENCE ROBE ...
Description: Press Release October 16, 2008 A (PDF File)
Document: ... sed on Dr. Reddy's allowing a Women's Health Care Nurse Practitioner, whose license limited her treatment to women, to treat a male patient.
ACTIONS BASED ON CRIMINAL CONVICTIONS
Kim, Michael D., M.D., Lic, #F0544, Houston, TX On October 10, 2008, the Board and Dr. Kim entered into an Agreed Order ...
Description: Press Release November 17, 2011 (PDF File)
Document: ... iled to adequately supervise an Advancee Practice Nurse acting under his supervision and prescribing controlled substances under his authority; and , failed to keep complete and accurate records of purchases and disposals of drugs. Benavides, German, M.D., Lic. No. F0877, San Antonio On November 4, ...
Description: Press Release December 03, 2003 (PDF File)
Document: ... d resources to the agency, allowing the hiring of nurse/investigators and attorneys to further increase the agency's rate of disciplinary actions and its ability to remove from practice physicians who do not meet the standard of care. With these additional resources, the agency, under the leadership ...
Description: Press Release December 06, 2007 A
Document: ... in the supervision of physician assistants and/or nurse practitioners; and pay an administrative penalty of $10,000. The action was based on Dr. Juarez's failure to personally assess a patient who had been admitted to the hospital by his physician assistant, who was not qualified to treat the patien ...
Description: Press Release December 18, 2012 (PDF File)
Document: ... that she failed to adequately supervise advanced nurse practitioners and/or physician assistants at two pain clinics. The temporary restriction remains in effect until it is superseded by a subsequent order of the Board. Simmons, Clyde W., Jr., M.D., Lic. No. D7303, Houston On December 10, 2012, a ...
Description: Press Release December 13, 2006 A (PDF File)
Document: ... from supervising physician assistants or advanced nurse practitioners, and assessing an administrative penalty of $250. The action was based on allegations stemming from the action of the Michigan Board of Medicine suspending Dr. Samuel's license in 2004 based on complaints alleging violations of th ...
Description: Press Release December 15, 2005 (PDF File)
Document: ... ity to a physician assistant or advanced practice nurse. The action is based on allegations that Dr. Basped prescribed narcotics without conducting a proper history or physical examination to support the need for narcotics. The allegations arose after an undercover officer from the narcotics task fo ...
Description: Press Release December 16, 2004 (PDF File)
Document: ... drug orders to Physician Assistants and Advanced Nurse Practitioners. Proposed Rule Changes The Board proposed the following rule changes for publication in the Texas Register and comment:
Chapter 170, Authority of Physician to Prescribe for the Treatment of Pain. Proposed repeal of existing chap ...
Description: TEXAS PHYSICIAN ASSISTANT BOARD BOARD MEETING December 14, 2012
Document: ... ction regarding reporting actions to the National Practitioner Databank. Ms. Robinson reviewed the current National Practitioner Databank reporting requirements. After discussion, Ms. Chapman moved, Ms. Jones seconded, and the motion passed that the following are not considered related to the delive ...
Description: TEXAS STATE BOARD OF PHYSICIAN ASSISTANT EXAMINERS LICENSURE COMMITTEE MEETING MINUTES FEBRUARY 27, 2004
Document: ... rnia for the last four months and had worked as a nurse for the last three years. The committee asked Applicant #PA-41 what his employment plans were in Texas. Applicant #PA-41 indicated that he plans to work neurology group with preoperative and post-operative patients. Mr. Deter moved, Ms. Clark s ...
“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.)
“... 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.”