Complaints and investigational information received and maintained are not public information, by state law. Any resulting disciplinary orders are public and can be viewed on the physician’s profile. Formal complaints filed by the Board at the State Office of Administrative Hearings are public documents.

Board rules define a reasonable fee for providing paper copies of medical records as no more than $25 for the first twenty pages and $.50 per page for every copy thereafter.  A reasonable fee for providing copies of medical records in electronic format is a charge of no more than: $25 for 500 pages or less and $50 for more than 500 pages.  Also, a reasonable fee of up to $15 may be charged for executing an affidavit, if requested. 

A physician may not charge a fee for a medical or mental health record if the request is related to a benefits or assistance claim based on the patient's disability. 

A reasonable fee for copies of imaging studies shall be no more than $8 per copy of an imaging study.

Put your request in writing and send it to the physician’s address listed on the physician’s Profile on the TMB website. You can also contact the TMB to determine if a custodian of records has been reported. If another physician has taken over the practice, the records may also be available there.

The TMB does not provide a referral service or make recommendations to patient consumers regarding specific health care providers. Here are some tips on locating a new physician:

• Contact your health insurance provider – check with your group or individual health plan or employer’s benefits office. Plans will have a listing of providers who accept your insurance and can offer further guidance.

For physicians who accept Medicare payments, visit the Centers for Medicare and Medicaid Services' Physician Compare: https://www.medicare.gov/physiciancompare/.

For Medicaid and the Children's Health Insurance Program (CHIP), visit https://hhs.texas.gov/services/health/medicaid-chip.

• Check the Texas Medical Board’s website – licensees of the Medical Board are searchable several ways including by city, zip code and specialty. Visit the following link: http://www.tmb.state.tx.us/page/look-up-a-license.

• Texas Health Compare – an online guide from the Texas Department of Insurance for choosing health plans and providers, available at the following link: http://www.texashealthoptions.com/compare/index.html.

• Other provider directories – another helpful resource is the National Institutes of Health’s MedlinePlus, available at the following link: https://medlineplus.gov/directories.html.

For information concerning practice opportunities in rural Texas please contact the State Office of Rural Health or the Southern Rural Access Program

The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:

1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.

It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”

Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.

The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.

One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.

As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.

While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.

Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.

While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.

Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient. 

There is no limitation to the number of PAs or APNs a physician may supervise. However, a physician may only delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent.  The only exception relates to supervision and prescriptive delegation to a medically underserved population or in facility based practice.

A physician may delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent. There are some statutory exceptions for prescriptive delegation to a medically underserved population or in facility based practice. Refer to Board rule 193.

Yes, both the anesthesiologist and the physician performing the procedure should be registered for OBA. Statute states that each physician who administers anesthesia or performs a procedure for which anesthesia services are performed in an outpatient setting shall register for OBA and comply with current OBA regulations. Please note, an anesthesiologist who contracts out their services to multiple physicians is not required to register each location where they perform OBA, but only the highest level of OBA services that they provide.

The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.

For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee.  Please note that payments for the incorrect OBA pro-rated fee will be voided, causing a delay in the registration process.  You may email us to request a pro-rated registration form at registrations@tmb.state.tx.us.

Yes. A retired physician whose only clinical practice is the provision of voluntary charity care to indigent populations shall be exempt from the registration fee but must register the license as well as report CME. The physician's practice of medicine must not include the provision of medical services for either direct or indirect compensation which has monetary value of any kind and the physician's practice is limited to voluntary charity care to indigent populations and receives no direct or indirect compensation of any kind for medical services rendered. Also, the physician's practice cannot include the provision of medical services to family members or the self-prescribing of controlled substances or dangerous drugs. A physician who violates the provisions of this exemption may be subject to disciplinary action. Action may be based on unprofessional or dishonorable conduct likely to deceive, defraud, or injure the public if the physician engages in the compensated practice of medicine, provides medical services to members of the physician's family, or self-prescribes controlled substances or dangerous drugs. Additionally, a physician who attempts to obtain this exemption by submitting false or misleading statements shall be subject to disciplinary action pursuant to the Medical Practice Act, in addition to any civil or criminal actions provided for by the state or federal law.

Per Board Rule 195.4(e), the medical director or owner/operator of the pain management clinic, must on annual basis, ensure all personnel are properly licensed and, if applicable, have the requisite training to include 10 hours of continuing medical education (CME) annually in the area of pain management. This CME requirement applies to all personnel providing medical services to the patients (including, but not limited to: PAs, x-ray techs, phlebotomists, RNs, MAs, etc.). Office staff, such as managers, janitors, etc. who do not provide medical services, would not be required to meet the CME requirement, but would need to be listed in response to a pain clinic audit which requires listing all clinic personnel for that clinic. Documentation of the completed CME course shall be required to be made available upon request by Board Staff, including, but not limited to, during an on-site audit of the clinic, or during the certificate renewal process. The Board does have the authority to conduct audits and inspections at clinics to ensure compliance with all requirements and regulations pertaining to registered pain clinics, including audits of CME training as required.

The answer to the question depends on the practice setting.  In facility-based hospital practices and in practices that serve medically underserved populations, there are no limitations.  In all other practice settings, one physician may delegate to no more than seven full time equivalent APRNs and PAs (1:7 FTEs).  

No, the waiver process no longer exists.  A physician may only delegate prescriptive authority to more than seven full time equivalent APRNs and PAs in facility based hospital practices and in practices that serve medically underserved populations.  In all other settings and practice scenarios, the 1:7 FTE ratios applies.  

No.  The old site-based prescriptive authority system is no longer in effect.