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“... gibility for licensure; conducting investigations based on complaints filed against acupuncturists to determine if a licensee is in violation the Texas Occupations Code (Chapter 205) and/or the Board's rules; and exercising the authority to cancel, revoke, restrict, suspend or otherwi ... ”
“... not reached, the complaint proceeds to the State Office of Administrative Hearings as a contested case for mediation or trial.
More information on the enforcement process is available online via this link: http://www.tmb.state.tx.us/page/enforcement
Licensure The Licensure Division licenses physici ... ”
“... ice-Chair of the Clinical Governance Board for US Anesthesia Partners for the Gulf Coast region as well as a member of the Clinical Governance Board for US Anesthesia Partners Texas. He serves on the Board of Directors of Lucid Lane and is a member of the FDA Analgesia and Anesthesia Drug Product Ad ... ”
“... ards. Sometimes more items will be required based on information obtained from the new documentation.The length of time it will take to complete your application will depend on the acceptability of submitted items and the complexity of the application. Some factors that can increase complexity ... ”
“...
Individual application processing time will vary based on the complexity of the application. Factors that increase the processing time are answering “yes” to any of the Professionalism questions on the application.
Communication with the Board
Applications are submitted online, bu ... ”
“...
The initial registration fee includes a $5 Office of Patient Protection fee for the first year, with an additional $1 charged for any subsequent year. This fees are required by statute and cannot be pro-rated. The remaining amount is required by the Acupuncture Board and prorated for each per ... ”
“... -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 ... ”
“... the general public;
receive notice if we ask the Office of the Attorney General for a ruling on whether the information can be withheld under one of the accepted exceptions;
lodge a complaint about charges for public records and a complaint related to other possible violations with the county attor ... ”
“... public by two Pre-Determination letters from the Office of the Attorney General, available at the links below:
OAG Predetermination Letter_March 2007
OAG Predetermination Ltr_Jan 2006
”
“... able time for doing so;
ask for a ruling from the Office of the Attorney General regarding any information to be withheld, and inform the requestor of this request for ruling;
segregate public information from information that might be withheld and provide that public information promptly;
inform th ... ”
“... o release public information, you may contact the Office of the Attorney General, Open Records Division Hotline, at (512) 478-6736 or toll-free at (877) 673-6839. Additional information is available at: https://www.texasattorneygeneral.gov/og/complaints-enforcement.
If you need special accommo ... ”
“... tate funds may be reported to the State Auditor's Office by the following means:
Phone: 1-800-TX-AUDIT
Web site: http://sao.fraud.state.tx.us ”
“... individual application processing time will vary based on the complexity of the application. The processing time clock begins when the applicant has submitted all initial documents and has moved to the second step. Factors that increase the processing time are answering “yes” to a ... ”
“... page. TMB is housed in the George H.W. Bush State Office Building at 1801 Congress Avenue, Suite 9.200, just north of the Texas State Capitol in the Capitol Complex.
We employ over 200 people in a wide variety of professional, administrative, and technical positions to fulfill the mission of the age ... ”
“... 1, 2010, or
the TMB determines that the physician-based certifying organization that conferred the certification has certification requirements that are substantially equivalent to the requirements of the ABMS or the BOS existing at the time of application to the medical board.
To qualify under Opt ... ”
Description: TMB Bulletin Spring 2000
Document: ... d complementary medicine, resident permitting and office-based anesthesia and will soon implement physician profiles. In 1998, Dr. Levy requested an outside audit by consultants KPMG, which resulted in a reorganization of the agency that has enhance d efficiency and made it possible for the agency t ...
Description: TMB Bulletin Spring 2005
Document: ... on to step down after five years as president was based on his desire to turn the reins over to someone else after a period of tremendous growth and change for the Board and the agency. He will continue to serve on the Board. The board also elected officers at its June 2-3 board meeting. They are Vi ...
Description: TMB Bulletin Spring 2006
Document: ... Formal Complaints have been filed with the State Office of Administrative Hearings regarding the licensees listed below. The cases were unresolved at the time of publication.
Name License No. Date filed Allegations
Paul K. Blissard, M.D.............. F6453........... 5/3/06...... Failure to meet ...
Description: TMB Bulletin Spring 2007
Document: ... tnesses who may testify in cases before the State Office of Administrative Hearings. For all the Board rules, go to http://www.tmb.state.tx.us/rules/rules/bdrules_toc.php
Formal Complaints The following Formal Complaints have been filed with the State Office of Administrative Hearings regarding the ...
Description: TMB Bulletin Spring 2004
Document: ... Settlement Conferences and hearings at the State Office of Administrative Hearings. Integrated all legal services under a single manager.
Compliance
Centralized drug testing oversight to assure greater consistency. Contracted for new and expanded drug testing of probationers. Doubled complian ...
Description: TMB Bulletin Spring 2010
Document: ... e to safely practice acupuncture.
The action was based on the Board’s
nding that Ms.
and safety due to illness.
RULES VIOLATION
Schell, Michael Todd, M.D., PIT Permit No.
On June 4, 2010, the Board and Michael Todd Schell,
M.D., entered into an Agreed Order requiring Dr.
Schell to pass within ...
Description: TMB Bulletin Spring 2002
Document: ... te of the physicians permit to conduct outpatient anesthesia services, if any; and
Method of licensure of the physician s original Texas license. The physician mailing address was eliminated from the report, leaving only the practice address. This was done at the request of physicians who use the ...
Description: TMB Bulletin Spring 1997
Document: ... ysician's primary practice site; and (3)facility -based practice. Q: What is considered a physician's primary practice site? A: (1) The practice location where the physician spends the majority of his or her time; (2) a licensed hospital, a licensed long-term care facility and a licensed adult care ...
Description: TMB Bulletin Spring 2008
Document: ... grees to the action or it is filed with the State Office of Administrative Hearings, at which time it becomes public. The medical board received 6,700 complaints last year and took action on nearly 400, all of which became public. How many final malpractice litigation actions went public last year? ...
Description: TMB Bulletin Spring 1999
Document: ... owing formal Complaints were filed with the State Office of Administrative Hearings since the last publication of The Medical Board Report regarding the licensees listed below: Physicians Date filed Alleged statutory violations Herbert R. Melt, M.D. 2-17-99 3.08(4)(E) and 3.08(18)
Mary Francis Sla ...
Description: TMB Bulletin Spring 1998
Document: ... perative patient evaluations;
Administer anesthesia under direct supervision of a qualified anesthesiologist; Perform initial CPR/ACLS in life-threatening situations until supervising anesthesiologist arrives; Initiate multi-parameter monitoring prior to anesthesia or in acute-care settings ...
Description: TMB Bulletin January 2011
Document: ... at appear unrelated to the pre-existing condition based on the following criteria and clarifications: · Distant site providers may treat patients at home for up to 72 hours as long as the patient is advised to see a physician in a face-to-face visit within 72 hours if the symptoms do not resolve. Di ...
Description: TMB Bulletin May 2011
Document: ... ce agreed to a suspension of his medical license, based on his criminal indictment. According to the DEA, Dr. Ratinov was the No. 1 prescriber of Hydrocodone in the state. What does it take to shut down a pill mill? A TMB investigator recently gave a glimpse of the nuts and bolts involved a pain cli ...
Description: TMB Bulletin Spring 2009
Document: ... f of all DWI and controlled substance arrests are based on recreational use of prescription medications, according to the Jefferson County sheriff s office. The National Association of Drug Diversion Investigators identifies 57 prescription drugs that are commonly diverted. Some of the most frequent ...
Description: TMB Bulletin July 2012
Document: ... s has existed for some time, but is are evidenced-based, and allow paper-based and not functional physicians who follow them to for real-time decisions. Current balance the welfare of individual projections are that the electronic patients with the management of the inherent patient safety risk. dat ...
“... gh SB 406 did not specifically note that facility-based protocols must also be submitted within this time frame, each licensing board has the authority to request this information. Failure to provide the requested information could result in disciplinary action against the professional license ... ”
Do I have to produce my prescriptive authority agreement or facility-based protocol if a licensing board asks to see it?
Yes. You are required to provide a copy of the prescriptive authority agreement to the board that requested it within three business days. Although SB 406 did not specifically note that facility-based protocols must also be submitted within this time frame, each licensing board has the authority to request this information. Failure to provide the requested information could result in disciplinary action against the professional license.
“SB 406 eliminated site based prescriptive authority. The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of d ... ”
How many miles from my delegating physician can my practice site be?
SB 406 eliminated site based prescriptive authority. The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the distance between a physician’s primary practice and the practice site at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision.
“... ng term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings. ”
If I work in a clinic owned by the hospital, is this considered a facility-based practice?
No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings.
“... greement in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms. ... ”
Is a prescriptive authority agreement required in a hospital or long term care facility-based practice?
Although it is possible to use a prescriptive authority agreement in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms.
“... may delegate prescriptive authority via facility based protocol at no more than one licensed hospital or no more than two long term care facilities. ”
At how many facilities can one physician delegate prescriptive authority through protocols?
A physician may delegate prescriptive authority via facility based protocol at no more than one licensed hospital or no more than two long term care facilities.
“In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate. &n ... ”
Who may delegate prescriptive authority in a hospital facility-based practice?
In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate.
“In a long term care facility based practice, delegation is by the medical director. ”
Who may delegate prescriptive authority in a long term care facility based practice?
In a long term care facility based practice, delegation is by the medical director.
“... ervise a CRNA during the performance of a task in anesthesia services is left to the “physician’s professional judgment in light of other relevant federal and state laws, facility policies, medical staff bylaws, and ethical standards.” (Texas Attorney General Opinion No. JC-0117).& ... ”
Are physicians potentially subject to discipline for violations of the standard of care by CRNAs to whom they have delegated the selection or administration of anesthesia or the care of an anesthetized patient?
Yes, potentially. Although physicians are not required to supervise CRNA’s for delegated tasks, they nonetheless remain subject to potential liability for violations of the standard of care by CRNAs, depending on federal and state statutes and regulations. The degree to which a physician is required to supervise a CRNA during the performance of a task in anesthesia services is left to the “physician’s professional judgment in light of other relevant federal and state laws, facility policies, medical staff bylaws, and ethical standards.” (Texas Attorney General Opinion No. JC-0117). However, physician supervision during the medical management of a patient while undergoing an anesthetic may require supervision dependent on federal and state statutes and regulations.
Additionally, Texas Attorney General Opinion No. KP-0353 found “In authorizing physicians to delegate the administration of anesthesia to CRNAs, the Legislature did not expressly limit the liability of the delegating physician. See TEX. OCC. CODE § 157.058; cf. id. § 157.004(c) (providing that in specified circumstances a physician who issues a standing delegation under chapter 203 generally “is not liable in connection with an act performed under that standing delegation order”). Thus, we cannot conclude that the liability of a physician delegating the administration of anesthesia to a CRNA is limited solely to the determination of competency. Questions of physician liability in any specific context are highly factual and not an appropriate determination for the opinion process. See Tex. Att’y Gen. Op. No. GA-0446 (2006) at 18 (“Questions of fact are not appropriate to the opinion process.”) (Page 4 with emphasis added.)
“... tself, 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 autho ... ”
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.)
“... owing situations: (1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who: (A) ... ”
Who can prescribe Schedule II drugs under physician delegation?
APRNs or PAs may prescribe schedule II drugs in the following situations:
(1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
(A) has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department of the hospital; or
(2) as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
“Yes. Nothing changed for delegation of prescriptive authority for controlled substances in schedules III through V. ”
Can APRNs and PAs in hospital-based clinics continue to prescribe drugs in schedules III through V?
Yes. Nothing changed for delegation of prescriptive authority for controlled substances in schedules III through V.
“... ges greater than allowed at Level I and tumescent anesthesia, as prescribed for the patient on order of a physician.Level III Services: Delivery of analgesics or anxiolytics other than by mouth, including intravenously, intramuscularly, or rectally.Level IV Services: Delivery of general anesthetics, ... ”
What are the different levels of anesthesia services relating to OBA?
Level I Services: Delivery of analgesics or anxiolytics by mouth, as prescribed for the patient on order of a physician, at a dose level low enough to allow the patient to remain ambulatory.
Level II Services: Delivery of analgesics or anxiolytics by mouth in dosages greater than allowed at Level I and tumescent anesthesia, as prescribed for the patient on order of a physician.
Level III Services: Delivery of analgesics or anxiolytics other than by mouth, including intravenously, intramuscularly, or rectally.
Level IV Services: Delivery of general anesthetics, including regional anesthetics and monitored anesthesia care.
“ A physician who provides level II-IV anesthesia services in an outpatient setting (including analgesics and anxiolytics). A physician who performs a procedure for which level II-IV anesthesia services are provided in an outpatient setting (including analgesics and anxiolytics). ... ”
Who has to register for office-based anesthesia?
“Physicians and anesthesiologists shall maintain current competency in ACLS, PALS, or a course approved by the board. In all settings under Chapter 192, at a minimum, at least two persons, including the surgeon or anesthesiologist, shall maintain current competency in basic life support. ... ”
What are the standards for anesthesia services relating to OBA?
Physicians and anesthesiologists shall maintain current competency in ACLS, PALS, or a course approved by the board. In all settings under Chapter 192, at a minimum, at least two persons, including the surgeon or anesthesiologist, shall maintain current competency in basic life support.
“... ttings: An outpatient setting in which only local anesthesia, peripheral nerve blocks, or both are used. Any setting physically located outside the State of Texas. A licensed hospital, including an outpatient facility of the hospital that is located apart from the hospital. A licensed ambulatory sur ... ”
Who does not need to register for office-based anesthesia?
OBA registration does not apply to physicians who practice in the following settings:
Note: physicians that provide only level I services, must still meet all other requirements under Chapter 192.