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“As a prerequisite for acudetox registration, practitioners are required to complete continuing auricular acupuncture education (CAAE).
Documentation of continuing educaiton courses shall be made available to the Board upon request but should not be submitted with the registration. Random audi ... ”
“... ation coursework.
All PHYSICIAN, RESPIRATORY CARE PRACTITIONERS, ACUPUNCTURE, MEDICAL RADIOLOGIC TECHNOLOGISTS, ACUDETOX SPECIALISTS, MEDICAL PHYSICISTS AND SURGICAL ASSISTANTS licensees have access to establish a free, basic account with CE Broker. Beginning June 2, 2025, licensed physici ... ”
Description: TMB restricts Arlington physician
Document: ... ty to a physician assistant or
advanced practice nurse or supervise a surgical assistant that is engaged in the practice of
clinical medicine.
The Board panel found that there wer
e unresolved issues relating to Methamphetamine use. Dr.
Ferguson failed to clear these allegations with the Boar ...
Description: TMB restricts Houston physician
Document: ... ment of chronic pain
,
and supervising midlevel practitioners
in the treatment of chronic p
ain
,
poses a continuing th
reat to public welfare.
The
restriction
was
effective immediately.
The restriction
prohibits
Dr.
Charles
from engaging in the treatment of any chronic pain as
de ...
Description: TMB disciplines 40 physicians at June meeting, adopts rule changes
Document: ... ty to a physician
assistant or advanced practice nurse or supervise a surgical assistant. The Board found Dr. Stasikowski surrendered his
privileges at Baylor All Saints Hospital while a peer review investigation w
as pending regarding changes in his behavior
and patient care.
OTHER STATE ...
Description: TMB restricts Webster physician
Document: ... ysician assistant or advanced practice registered nurse
or supervising any midlevel provider.
The Board panel found that Dr.
Patel
failed to adequately treat at least four chronic pain patients
and was operating
a
pain management clinic
without proper certification.
The temporary
r ...
Description: Legislative Update 84th Legislature (2015)
Document: ... cal Radiologic Technicians, and
Respiratory Care Practitioners.
http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=84R&Bill=SB202
...
Description: Medical Board 2015 - August - Licensure Committee Minutes
Document: ... sing authority, professional society or impaired
practitioners committee.
(5) Malpractice. If an applicant has ever been named in a malpractice claim filed with any
liability carrier or if an applicant has ever been named in a malpractice suit, t
he applicant must:
TEXAS MEDICAL BOARD RULES ...
Description: TMB disciplines 61 physicians at August meeting, adopts rule changes
Document: ... iled to adequately supervise an advanced practice nurse who was engaged in nontherapeutic
prescribing of controlled substance
pain medications and who was operating a clinic as a pain management clinic
without a valid certification. Dr. Nasser failed to exercise due diligence when he learned tha ...
Description: Medical Board 2016 - March - Licensure Committee Minutes
Document: ... sing authority, professional
society or impaired practitioners commi
ttee.
(5) Malpractice. If an applicant has ever been named in a malpractice claim filed with any
liability carrier or if an applicant has ever been named in a malpractice suit, the applicant
must:
(A) have each liability c ...
Description: TMB disciplines 26 physicians at June meeting
Document: ... ity to a physician assistant or advanced practice nurse or supervise a surgical
assistant. The Board found Dr. Doan has engaged in unprofessional misconduct with multiple female patients and
employees by improperly touching their breasts and makin
g inappropriate comments and pleaded guilty to one ...
Description: TMB disciplines 38 physicians at August meeting
Document: ...
for colonic irrigation performed by a registered nurse, failed to maintain any
medical records for the patients and failed to adequately supervise the delegate.
VIOLATION OF PRIOR
BOARD
ORDER
Durairaj, Vikram, M.D., Lic. No. Q4391, San Antonio
On August 25, 2017, the Board and Vikram D ...
Description: CAE Approved Courses
Document: ... ese Herbs Provider Ethical Relationship Between Practitioners Ethical Basis for Charging Medical Fees Date Approved 9 Safety Tips for Acupuncturists Office Administration for Acupuncturists Requested
Type Requested
CAE Hours Practice Enhancement/
Business Administration CPR for Acupuncturi ...
Description: TMB restricts Houston physician (Marquis)
Document: ... ty
to a physician assistant or advanced practice nurse or supervise a surgical assistant.
The Board panel found
that Dr.
Marquis nontherapeutically
prescribed high volumes of
controlled substances to 15 chronic pain patients
.
The temporary restriction remains in place until the Board ...
Description: Medical Board 2016 - March - Full Board Minutes
Document: ... Dr. Bredt also gave information on matching rural practitioners with rural expertsand will provide more information in the following monthsAgenda item #5, Public Information Update.JarrettSchneidergave an update onagencyacepage. The mFebruary bulletin listed the Physician ssistant Board members and ...
Description: TMB disciplines 62 physicians at March meeting
Document: ... y to a physician assis
tant or advanced
practice nurse or supervise a surgical assistant; and pay an administrative penalty of $3,000 within 90 days. The Board
found Dr. Elhage failed to destroy, or document the destruction of, his prescription pad, and failed to turn his
prescr
iption pads over ...
Description: TMB disciplines 78 physicians at June meeting, adopts rule changes
Document: ... ty to a
physician assistant or advanced practice nurse or supervise a surgical
assistant. The Board found Dr. Gregory inappropriately prescribed controlled substances to family members and close
friends and pleaded guilty to a Class A misdemeanor offense of Fraudu
lent Possession of a Controlled ...
“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.
“... 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.)
“... 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.”