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“... echnologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupation’s respective board/advisory committee.
Online JP Exam & Study Guide
Please know in accordance with law passed by the 84th Legislature (SB 202), all Respiratory Care Pr ... ”
“... echnologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupation’s respective board/advisory committee.
The TMB began processing the registration/renewal of existing Medical Radiologic Technologist licenses on January 4, 2016.
... ”
“... echnologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupation’s respective board/advisory committee.
Please note that the Non-Certified Radiologic Technician Registry is part of this transition.
Online JP Exam & Study Guide
Please know&nbs ... ”
“... e of the expiration date.
Respiratory Care Practitioners Online Registration/Renewal - 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 .
&nb ... ”
“... 674 (2017) amended the statutory requirements for practitioners seeking a hardship exemption. Applicants seeking an exemption under Section 601.203(b)(1) of the Texas Occupations Code, claiming the inability to attract or retain an MRT, LMRT or NCT, must now be located in a Texas county with a popul ... ”
“... a prerequisite for registration, respiratory care practitioners are required to complete continuing education. Current requirements for respiratory care practitioners are summarized below. If you would like to review the current rule, these requirements are currently listed in Board rule 187.16 ... ”
“... echnologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupation’s respective board/advisory committee.
The TMB began processing the registration/renewal of existing Respiratory Care Practitioner licenses on January 4, 2016.
&n ... ”
“... enate as follows:
(1) four respiratory care practitioners who each have at least five years of experience as a respiratory care practitioner;
(2) two physicians licensed in this state who supervise respiratory care practitioners; and
(3) three members who represent the public.
The ... ”
“... following restrictions apply to respiratory care practitioners whose certificates are on retired status:
the certificate holder must not engage in clinical activities or practice respiratory care in Texas;
the certificate holder may not administer drugs to anyone; and
to be eligible for retired st ... ”
“... made by SB 674 affect other agencies that license practitioners who also employ NCTs, such as chiropractors, podiatrists, and dentists. For information on what actions those agencies are taking with respect to laws regulating those practice areas, please contact those agencies directly. ... ”
“... umber.
Reactivate Online – Respiratory Care Practitioners - click here
Once your online application for re-activation has been received, you will be contacted by our licensure department regarding any additional documentation required.
As part of the re-activation process, you wi ... ”
“... try of Radiologic Technologists
Respiratory Care Practitioners (RCPs)
Texas Society for Respiratory Care
American Association for Respiratory Care
National Board for Respiratory Care
Medical Physicists
American Association of Physicists in Medicine
The American Board of Radiology
The American Co ... ”
“... stant that is now applying for a Respiratory Care Practitioners license), you will be required to take the exam relevant to the license type of that new application.
I am reapplying for licensure and previously passed the JP. Do I have to take it again?
If you took the JP exam as part of your prio ... ”
“... rning to Active Status
Retired Respiratory Care Practitioners (RCPs) Returning to Active Status
Retired Medical Radiologic Technologists (MRTs) Returning to Active Status
How Can You Volunteer?
TMB is not placing providers. Physicians and other health professionals wishing to volunteer may ... ”
“... ertified radiologic technicians, respiratory care practitioners, medical physicists, perfusionists, surgical assistants, and pain management clinics. This search will also include cease and desist orders issued to non-licensed individuals.
Click Here to Search TMB Board Actions
&nb ... ”
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 28, 1997 (PDF File)
Document: ... de copies of medical records of other health care practitioners contained in the records of the physician to whom a request for release of records has been made. The Board proposed to amend Chapter 174, Telemedicine, to require physicians licensed under this Chapter to comply with registration requi ...
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 October 28, 2005 B (PDF File)
Document: ... nsumers can also file complaints against licensed practitioners. The agency investigates complaints and administers disciplinary actions when warranted. Actions can range from public reprimands and administrative penalties, restrictions on licenses, up to suspension or revocation of licenses. Health ...
Description: Press Release November 13, 2002 (PDF File)
Document: ... ld be better served if we could actively identify practitioners at risk of poor performance. Physicians who have passed a monit ored exam like a board-certification exam have demonstrated current knowledge and cognitive ability," said Donald W. Patrick, M.D., J.D., TMB executive director. Out-of-sta ...
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 February 23, 2012 (PDF File)
Document: ... -keeping and eight hours in supervising mid-level practitioners. The Board found Dr. Marrow failed to meet the standard of care, violated guidelines for standing delegation orders, improper billing, failure to adequately supervise and aiding or abetting unlicensed practice of medicine. Marsden, John ...
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 June 15, 2012 (PDF File)
Document: ... logbook of all prescriptions written by midlevel practitioners, maintain at all practice sites a logbook of all charts reviewed by Dr. Dailey for patients treated by mid-level practitioners working under his supervision and complete within one year eight hours of CME in the topic of supervising mid ...
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 ...
“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.”