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“... technicians; and certifies acudetox specialists, pain management clinics, and non-profit health organizations.
The Licensure Department processes the applications of practitioners and non-profit entities to determine whether they meet all the criteria to practice or operate in Texas. In gener ... ”
“... pes of permits, including Surgical Assistants and Pain Management Clinics.
Click on the links below to view information on these license holders:
Surgical Assistant Licensees – information now available as part of the new TMB Healthcare provider search
Pain Manage ... ”
“The physician owner of a pain management clinic must register with the TMB. Only the primary physician owner is required to register with the board if there is more than one physician owner of the clinic. Each clinic requires a separate certificate.
When applying for PMC registration&nb ... ”
“If you do not find the answer to your question below, please contact us at.....
”
“... cal Practice Affiliate of The American Academy of Pain Management. Additionally, he is a member of Texas Association of Acupuncture and Oriental Medicine. Weidler received a Bachelor of Science in mechanical engineering from Michigan Technological University and a Master of Acupuncture and Oriental ... ”
“... ease and desist, etc.), including those issued to pain management clinics.
After clicking the link below and accepting the usage terms, click on the "License Type" dropdown, select "Pain Management Clinic (Board Action Only)" and click "Search" to view all clinics with a Board action.
Look up ... ”
“... the U.S. Department of Health and Human Services Pain Management Taskforce. He is also a delegate for the Texas Medical Association (TMA), Texas Society of Anesthesiologists, delegate and Fellow for the American Society of Anesthesiologists, and a member of the TMA delegation to the American Medica ... ”
“... ysicists, perfusionists, surgical assistants, and pain management clinics.
Senate Bill 202 (effective 9/1/2015) transferred four occupational regulatory programs from the Department of State Health Services (DSHS) to the Texas Medical Board (TMB). Medical Physicists, Medical Radiologic Technolo ... ”
“... d), 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 ... ”
“... on the TMB web site only for statistical and site management purposes. The site (http://www.tmb.state.tx.us) does not use cookies (small files residing on a user's hard drive, used by a web site to track specific information). All information collected, including server log information and e-mails s ... ”
“... efficient and effective manner.
Regarding energy management, the TMB’s original Resource Efficiency Plan (REP), submitted October 2002, in accordance with 34 TAC § 19.14, established the agency’s commitment to support the State in agency-owned and leased facilities with infrastruct ... ”
“... r
Organs
Oscellation
Osteoporosis
Pain
Pathogenic
Pathophysiological
Patients
Pearls
Pediatrics
Pharmacology
Phlegm
Physical
Physiology
Plegm
PMS
Points
Postpartum
Potency
Practice Management
Pre and Post Op Care
Pre ... ”
“... uncture, Biomedicine, Ethics, Herbal and Practice Management/Business Administration. For information on the courses available, please contact the providers directly.
List of Current Approved Providers: CAE Approved Provider Numbers ”
“... he spreadsheet below to confirm registration of a pain management clinic. The pain management clinic registration information below is updated regularly.
Pain Management Clinics - Spreadsheet of Current Certificate status
”
“... ; Pain Management Clinic - Change of Address Form
If you have any questions regarding the "My TMB" system or the online change of address, please email us at registrations@tmb.state.tx.us .
... ”
Description: TMB Bulletin Fall 2000
Document: ... t to clarify issues such as Internet prescribing, pain management and integrative and complementary medicine, as well as new delivery paradigms such as co-management with non-physician clinicians.
Like all my fellow Board members, I give these matters great importance, which requires patience on e ...
Description: TMB Bulletin Fall 2006
Document: ... everal examples of ongoing collaborative efforts. Pain Medicine Resource Group There is no better example of success in working together than the recent work done in updating and essentially rewriting Board Rule 170: Authority of Physician to Prescribe for the Treatment of Pain. A resource group was ...
Description: TMB Bulletin Fall 2002
Document: ... low Board guidelines for treatment of intractable pain. Respondent filed a motion for rehearing on 9-4-02. Effective 9-23-02, motion for rehearing denied by Board. Order was final effective 9-23-02. Caderao, Jess B., M.D., Arlington, TX, Lic. #F6363 An Agreed Order was entered on 8-16-02 restricting ...
Description: TMB Bulletin Fall 2001
Document: ... ist may treat a patient for alcoholism or chronic pain without a referral from a physician, dentist, or chiropractor. SB 1166: PA Prescriptive Authority Allows physician to delegate prescriptive authority to up to three PAs or APNs at an alternate site, and does not require that the alternate site m ...
Description: TMB Bulletin Fall 2004
Document: ... and intervening in a timely fashion Setting up a pain medicine practice without suitable residency training and experience Delegating tasks to employees or preceptees that they are not competent to perform Inadequate informed consent for diagnostic procedures, invasive procedures, and various treat ...
Description: TMB Bulletin Fall 2009
Document: ... M.D., of Austin, is owner, medical
director and pain manage
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ment specialist of the Pain
and Stress Management
Center. He is a member of
the Texas Medical Asso
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ciation, Texas Society of
Anesthesiologists and Texas
State Naturopathic Associa
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tion. He is also a volunteer
race doctor for t ...
Description: TMB Bulletin Fall 2007
Document: ... sional conduct; violation of board rule regarding pain treatment; violation of a state or federal law; prescribing to known abuser of drugs. Daniel H. Kinzie IV, M.D.. G8562 ..........8/20/07......Failure to practice consistent with public health and welfare; failure to meet the standard of care; no ...
Description: TMB Bulletin Fall 2010
Document: ... Associates, L.L.C., a busi-
ness development and management consulting firm in Hous-
Additionally, Mr. Turner served as Chairman of the Texas
Statewide Health Coordinating Council’s Health Information
Technology Advisory Committee (HITAC).
HITAC produced a strategic roadmap for the
creatio ...
Description: TMB Bulletin Fall 2008
Document: ... , cleanup language; 193.7, Delegated Drug Therapy Management, updates reference to the Texas Pharmacy Act; 193.8, Delegated Administration of Immunizations or Vaccinations by a Pharmacist Under Written Protocol, updates reference to the Texas Medical Practice Act; 193.9, Pronouncement of Death, upda ...
Description: TMB Bulletin Fall 1997
Document: ... ysicians: HB120 adds a new definition of chronic pain that allows physicians to administer controlled substances to persons who are current drug users, who have a history of drug abuse, or live in an environment that poses a risk. The bill includes specific documentation requirements. HB196 require ...
Description: TMB Bulletin Fall 1998
Document: ... iger Ms. Seliger received a BBA in petroleum land management from t he University of Texas at Austin. She works in recruiting and business development for the Underwood law firm in Amarillo. She serves on the M.D. Anderson Board of Visitors and the board of the Amarillo Museum of Art and also volunt ...
Description: TMB Bulletin Fall 1999
Document: ... iger Ms. Seliger received a BBA in petroleum land management from t he University of Texas at Austin. She works in recruiting and business development for the Underwood law firm in Amarillo. She serves on the M.D. Anderson Board of Visitors and the board of the Amarillo Museum of Art and also volunt ...
Description: TMB Bulletin Fall 2005
Document: ... ctive September 1, physicians responsible for the management of an office that provides ongoing medical care to elderly persons are required by TMB to offer, to the extent possible as determined by the physician, the opportunity to receive the pneumococcal and influenza vaccines to each elderly pers ...
Description: TMB Bulletin June-July 2003
Document: ... ing. Ms. Seliger received a BBA in petroleum land management from the University of Texas at Austin. She works in recruiting and business development for the Underwood law firm in Amarillo. She serves on the M.D. Anderson Board of Visitors and the board of the Amarillo Museum of Art and also volunte ...
Description: TMB Bulletin March 2013
Document: ... : general acupuncture, herbology, ethics, prac ce management/general and biomedicine. Of those 17 hours: · At least eight hours shall be in general acupuncture in order to ensure that a licensee's CAE is comprehensive and that the licensee's overall acupuncture knowledge, skills, and competence are ...
“HB 2098 has no effect on the requirement that pain management clinics be owned by physicians. HB 2098, enacted by the 82nd Legislature, allows entities to be jointly owned by physicians and physician assistants subject to certain limitations, including percent of ownership by physician assistants. T ... ”
How does HB 2098 affect my pain management clinic ownership?
HB 2098 has no effect on the requirement that pain management clinics be owned by physicians. HB 2098, enacted by the 82nd Legislature, allows entities to be jointly owned by physicians and physician assistants subject to certain limitations, including percent of ownership by physician assistants. Tex. Occ. Code, Sec. 167.102(a), requires that a pain management clinic be owned and operated by physicians practicing in Texas under an unrestricted license. An ownership interest by anyone other than a physician is not allowed. Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your entity is required to report. However, the owners of entities that have not been properly reported can be investigated.
“A pain management clinic is defined in statute and rule as a publicly or privately owned facility for which a majority of patients are issued on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone. ... ”
What is a “pain management clinic”?
A pain management clinic is defined in statute and rule as a publicly or privately owned facility for which a majority of patients are issued on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.
“The physician owner/operator of a pain management clinic must register with the TMB. Certificates, once issued, are not transferable or assignable. Only the primary physician owner is required to register with the board if there is more than one physician owner of the clinic. Each clinic requires a ... ”
Who needs to register a pain management clinic?
The physician owner/operator of a pain management clinic must register with the TMB. Certificates, once issued, are not transferable or assignable. Only the primary physician owner is required to register with the board if there is more than one physician owner of the clinic. Each clinic requires a separate certificate.
“... tions regarding the registration and operation of pain management clinics do not apply to the following settings: a medical or dental school or an outpatient clinics associated with a medical or dental school; a hospital, including any outpatient facility or clinic of a hospital; a hospice establish ... ”
Who does not need to register a pain management clinic?
Regulations regarding the registration and operation of pain management clinics do not apply to the following settings:
Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your clinic meets one of the exemptions listed above. However, the Board does have inspection authority, and owners of clinics that have not been properly registered can be investigated.
“A pain management clinic may not operate in Texas unless the clinic is owned and operated by a medical director who: • is a physician who practices in Texas • has an unrestricted medical license • holds a certificate of registration for that pain management clinic In addition, ... ”
Who can own or operate a pain management clinic?
A pain management clinic may not operate in Texas unless the clinic is owned and operated by a medical director who: • is a physician who practices in Texas • has an unrestricted medical license • holds a certificate of registration for that pain management clinic In addition, the owner/operator of a pain management clinic, an employee of the clinic, or a person with whom a clinic contracts for services may not: • have been denied, by any jurisdiction, a license issued by the Drug Enforcement Agency or a state public safety agency under which the person may prescribe, dispense, administer, supply, or sell a controlled substance; • have held a license issued by the Drug Enforcement Agency or a state public safety agency in any jurisdiction, under which the person may prescribe, dispense, administer, supply, or sell a controlled substance, that has been restricted; or • have been subject to disciplinary action by any licensing entity for conduct that was a result of inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance A pain management clinic may not be owned wholly or partly by a person who has been convicted of, pled nolo contendere to, or received deferred adjudication for: • an offense that constitutes a felony; or • an offense that constitutes a misdemeanor, the facts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined by Texas Occupations Code Annotated §551.003(11) The medical director of a pain management clinic must operate the clinic in compliance with Drug Prevention and Control Act, 21 U.S.C.A. 801 et.seq. and the Texas Controlled Substances Act, Chapter 481 of the Texas Health and Safety Code, relating to the prescribing and dispensing of controlled substances. The medical director of a pain management clinic must, on an annual basis, ensure that all personnel: • are properly licensed, if applicable, • are trained including 10 hours of continuing medical education related to pain management, and • are qualified for employment.
“At this time there is no charge to register a pain management clinic. ”
How much does a pain management clinic registration cost?
At this time there is no charge to register a pain management clinic.
“Certificates will be valid for two years. Registration forms will be mailed 60-90 days prior to the expiration date of a certificate. Certificate holders shall have a 180-day grace period from the expiration date to renew the certificate, however, the owner or operator of the clinic may not continue ... ”
How often is registration required for pain management clinics?
Certificates will be valid for two years. Registration forms will be mailed 60-90 days prior to the expiration date of a certificate. Certificate holders shall have a 180-day grace period from the expiration date to renew the certificate, however, the owner or operator of the clinic may not continue to operate the clinic while the permit is expired. Certificates must be timely renewed. If a certificate is not renewed before the expiration of the grace period, the certificate will be automatically cancelled and the owner or operator of the clinic must reapply for original certification.
“... name change or change of address for a registered pain management clinic must be submitted in writing (by mail or fax). Please use the PMC change of address form located here. ”
How do I submit a name change or change of address for my pain management clinic?
A name change or change of address for a registered pain management clinic must be submitted in writing (by mail or fax). Please use the PMC change of address form located here.
“... 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 requi ... ”
What are the continuing education requirements for pain management clinics?
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.
“Documentation of CME courses shall be made available to the Board upon request but should not be mailed with the registration. CME audits will be conducted to assure compliance. ”
Does my continuing education documentation need to be sent in with my pain management registration forms?
Documentation of CME courses shall be made available to the Board upon request but should not be mailed with the registration. CME audits will be conducted to assure compliance.
“... 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 adm ... ”
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.)
“... e 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.Th ... ”
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.)
“... give access to any public actions taken against a Pain Management Clinic (PMC) certificate. However, for additional information on the status of a PMC certificate, please look under the “Other Healthcare Professionals” tab on the “Look up a License” page. ... ”
How can I verify a Pain Management Clinic Certificate?
At this time “Look up a License” can give access to any public actions taken against a Pain Management Clinic (PMC) certificate. However, for additional information on the status of a PMC certificate, please look under the “Other Healthcare Professionals” tab on the “Look up a License” page.
“... responsibility and accountability for the medical management of a patient under anesthesia remains with the delegating physician who may be subject to discipline for improper delegation dependent upon the facts and circumstances of each case, and how state statutes and regulations apply in those sit ... ”
Is a CRNA under a valid delegation order, subject to discipline by the Texas Medical Board under the Medical Practice Act for a violation of the standard of care in the selection and administration of anesthesia or the care of an anesthetized patient?
No, while the selection and administration of anesthesia is a medical act, if such an act was validly delegated to a CNRA by a physician, the act is considered to be within the practice of nursing and governed by the Nursing Practice Act. Any discipline for a violation of the standard of care by a CRNA would be carried out by the Texas Board of Nursing under the authority of the Nursing Practice Act. Ultimate responsibility and accountability for the medical management of a patient under anesthesia remains with the delegating physician who may be subject to discipline for improper delegation dependent upon the facts and circumstances of each case, and how state statutes and regulations apply in those situations.
“... sics--Dangerous or scheduled drugs that alleviate pain, but not including non-opioid based drugs such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).Anxiolytics--Dangerous or scheduled drugs used to provide sedation and/or to treat episodes of anxiety. ... ”
What is the TMB definition of an analgesic and anxiolytics?
Board rule 192 defines analgesic and anxiolytics as shown below:
Analgesics--Dangerous or scheduled drugs that alleviate pain, but not including non-opioid based drugs such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).
Anxiolytics--Dangerous or scheduled drugs used to provide sedation and/or to treat episodes of anxiety.