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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 ... ”
Description: Respiratory Care Board Full Board Minutes (November 9, 2017)
Document: ... ules to 22 T.A.C. Chapter 186.
Resp
iratory Care Practitioners
.
§186.2 Definitions
§186.4 Procedural Rules and Qualifications for Certificate Applicants
§186.6 Biennial Renewal of Certificate
§186.7 Temporary Permit
§186.8 Inactive Certificate
§186.10 Continuing Education Requireme ...
Description: TMB disciplines 52 physicians at March meeting, adopts rules changes
Document: ... technicians
, perfusionists, and respiratory care practitioners.
The amendments to
§175.2
, concerning
Registration and Renewal Fees
, adds language outlining renewal fees for
continuing licenses, permits, and certificates for medical physicists, medical radiologic tec
hnologists, non
-
certi ...
Description: Rule Changes Effective March 27, 2018
Document: ... echnicians
, perfusionists, and respiratory care
practitioners.
The amendments to
§175.2
, concerning
Registration and Renewal Fees
, adds language outlining renewal
fees for continuing licenses, permits, and certificates for medical physicists, medical radiologic
tec
hnologists, non
-
cert ...
Description: Rule Changes Effective April 15, 2018
Document: ... permit to hold themselves out as temporary care
practitioners or TRCPs.
The amendments to
§186.17
, concerning
Grounds for Denial of Certification and for Disciplinary Action
,
adds language in paragraph (4) to make clear tha
t disciplinary action or denial of certification based on
cr ...
Description: RFP Jurisprudence Exam 6-6-18
Document: ... ist (all types)
45
58
*
Respiratory Care
Practitioners
1,020
1,216
*
Total
11,460
11,093
6,552
Profession
Licenses Issued
FY17
09/01/2
01
6
-
08/31/2017
FY16
09/01/2015
–
08/31/2016
F
Y
15
09/01/2014
–
08/31/2015
Physician
(all types)
4,939
...
Description: TMB Strategic Plan FY 19-23 (2018)
Document: ... NSURE
Protect the public by licensing qualified practitioners, andprofit entities, by determining eligibility for licensure through credential verification or renewal, and by collecting information on professionals regulated by the Texas Medical Board and its associated boards and advisory committ ...
Description: TMB disciplines 80 physicians at June meeting, adopts rules changes
Document: ... ve authority to a physician or advanced
practice nurse or supervise a surgical assistant. Dr. Hooper’s license had been temporarily suspended for impairment
related to drug a
nd/or alcohol abuse, which resulted in her being intoxicated while on duty at a hospital. The order shall
remain in effe ...
Description: TMB restricts Deer Park physician (Brown)
Document: ... or delegating prescriptive authority to midlevel
practitioners outside his current practice setting at Occucare International.
The Board panel found
,
based on the evidence
provided
,
that Dr.
Brown
improperly
supervised
the acts of his delegates, two advanced practice nurses whose p ...
Description: TMB Legislative Appropriations Request FY 20-21
Document: ... Protect the Public through Licensure of Qualified Practitioners
Ensure Compliance with Board Rules by Applicants 2,811,653TOTAL, GOAL$2,811,653
2Protect the Public with Investigations, Discipline and Education
Ensure Timely Due Process on Enforcement Cases and Complaints1 ENFORCEMENT 2 PHYSICIAN ...
Description: TMB disciplines 35 physicians at August meeting, adopts rules changes
Document: ... ity to a physician assistant or advanced practice nurse or superv
ise a surgical assistant in the
treatment of chronic pain patients. The Board found Dr. Jakubowski violated the standard of care in his attempted
management of a patient’s chronic pain, depression, and anxiety, and engaged in an i ...
Description: Medical Board 2018 - August - Licensure Committee Minutes
Document: ... me MD Nonprofit, Inc.
62.
National House Call Practitioners
63.
Nuestra Clinica Del Valle, Inc.
64.
OPGT, Inc.
65.
Peterson Medical Associates
66.
Peterson Regional Physician Hospital Org. Prime
67.
Premier Family Care I
68.
Project Vida Healthcare
69.
Shannon Primary ...
Description: TMB FY 17 Internal Audit Plan
Document: ... Technologists
- Perfusionists
- Respiratory Care Practitioners
Although TMB implemented all aspects of the transfers for these license types as required by the provisions of SB 202, they were not considered in the
fiscal year 2017 risk assessment since internal efforts; such as, aligning informtion ...
Description: TMB FY 18 Internal Audit Plan
Document: ... Assistants
Licensing
–
Respiratory Care
Practitioners
Mail & Cash Receipts Processing
Licensing
–
Other Types
Litigation (includes related
Enforcement Support)
Information Resources
Travel
Fixed Asset Management
Purchasing/Procurement/Cash
Disb ...
Description: TMB FY 18 Annual Internal Audit Report
Document: ... Assistants
Licensing
–
Respiratory Care
Practitioners
Mail & Cash Receipts Processing
Licensing
–
Other Types
Litigation (includes related
Enforcement Support)
Information Resources
Travel
Fixed Asset Management
Purchasing/Procurement/Cash
Disb ...
Description: Medical Board 2018 - August - Full Board Minutes
Document: ... ice of medicine. (Sec. 160.003, Report by Certain Practitioners).
”
Dr. Za
afra
n
acknowledged that there was an increase in nu
mber of complaints
received in
rega
rds to improper supervision.
Agenda item #3,
Consideration and Approval of
Mediated Settlement
Agreed
Orders
.
Afte ...
“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.”