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“... y includes but is not limited to courses in: Risk management, Domestic Abuse; or Child Abuse. Formal courses must be approved for ethics or professional responsibility credit by the accrediting agency.
Please note that during the October 14, 2016 Full Board meeting, agenda item –&n ... ”
“... ssional responsibility, the two credits involving pain management and the prescription of opioids, or the required course in the prevention of human trafficking, as outlined on the page above. ”
“... an from the requirement for two credits involving pain management and the prescription of opioids, or the required course in the prevention of human trafficking, as outlined on the page above. ”
“... any physician assistants participate in the management of the partnership
a physician assistant or combination of physician assistants can have no more than a minority ownership interest
the ownership interest of an individual physician assistant cannot not equal or exceed the ownership intere ... ”
“... DF | Word
Chapter 168 -
Regulation of Pain Management Clinics: HTML | PDF | Word
Chapter 169 -
Authority to Prescribe Low-THC Cannabis to Certain Patients for Compassionate Use: HTML | PDF | Word
Chapter 170 -
Presc ... ”
“... , of Southlake, is the founder and CEO of Premier Pain Centers, which has locations from Dallas to Waco. He is a double board-certified pain physician, who did his residency in physical medicine and rehabilitation at the Montefiore Medical Center and fellowship in interventi ... ”
“U.S. HHS Pain Management Best Practices Inter-Agency Task Force Report
The Pain Management Best Practices Inter-Agency Task Force (Task Force) was convened by the U.S. Department of Health and Human Services in conjunction with the U.S. Department of Defense and the U.S. Department of Veterans ... ”
“... Bill 1330 (2005), 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 ... ”
“
To apply for an initial pain management clinic certification, please download and fill out the form below. At this time there is no charge for a pain management clinic certification.
Pain Management Clinic Registration Form
To withdraw a pending application or cancel certification, ple ... ”
“Texas requires pain management clinics (PMC) to be registered with Texas Medical Board.
A “pain management clinic” is 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 cariso ... ”
“... processes.
You may view the Board Rules on pain management clinic in detail on our website under Board Rules,Chapter 195. ”
“... n)
5) PAIN MANAGEMENT CLINIC INFORMATION
If you have questions regarding the Pain Management Clinic registration process, click here: (http://www.tmb.state.tx.us/page/renewal-pain-mgt-clinic-pegistration)
If you have questions regarding the ... ”
“... enced in prehospital emergency care and emergency management of ill and injured patients;
actively involved in:
o the training and/or continuing education of EMS personnel, under his o ... ”
“... emergency medicine, and those involved during the management of patients with the Ebola Virus Disease.
Learning Objectives
Recognize the epidemiologic risk factors
Identify the clinical signs and symptoms
Understand the modes of transmission and means of prevention
Understand the proper donning and ... ”
“... ation skills,
public speaking,
technical writing,
management,
administration,
accounting,
ethics,
adult education,
medical sciences,
and health sciences.
Other courses may be accepted for credit provided there is a demonstrated benefit to patient care.
Alternative Continuing Educa ... ”
Description: TMB Bulletin Spring 2000
Document: ... ed guidelines or rules for proper prescribing for pain management, integrative and 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 ...
Description: TMB Bulletin Spring 2005
Document: ... ine and Rehabilitation, and is board-certified in Pain Medicine and Physical Medicine and Rehabilitation. She joined the Board in January, 2002. Dr. Kalafut takes over from Lee S. Anderson, M.D., who has served on the Board since 1997 and as president since 2000. His decision to step down after five ...
Description: TMB Bulletin Spring 2006
Document: ... medical records; failure to adhere to established pain guidelines.
Nondisciplinary Rehab Orders an Option for Impaired Physicians Physicians who have received their Texas licenses fairly recently may not be aware of nondisciplinary rehabilitation orders. Established by the Legislature in 1995, reha ...
Description: TMB Bulletin Spring 2007
Document: ... ty of Physician to Prescribe for the Treatment of Pain. Chapter 172, Temporary and Limited Licenses, new 172.15, Limited License for the Practice of Public Health Medicine. New Chapter 170, Pain Management, to substantially rewrite the current rule. The revised rule sets forth appropriate standards ...
Description: TMB Bulletin Spring 2004
Document: ... t at Harvard University, Ms. Raggette entered the management consulting world, where she assisted clients in developing and protecting their human capital. She entered the private sector in 2001 as a vice president of human resources and is currently the organizational assessment director for E-Team ...
Description: TMB Bulletin Spring 2010
Document: ... Ms. Garza to complete eight
hours of CME in risk management and eight hours
of CME in patient communication within one year.
The board found that Ms. Garza failed to use proper
diligence in her treatment of a patient on Coumadin
therapy.
Mazuca, Maricela Azeneth, P.A., Lic. No. PA03610, San
O ...
Description: TMB Bulletin Spring 2002
Document: ... an acupuncturist to treat alcoholism and chronic pain without referral; licensure documentation; and updates Occupations Code cites. Chapter 184, Surgical Assistants: new 184.1-.3, 184.5-.16 regarding the regulation of surgical assistants as mandated by HB 1183 of the 77th Legislature. Section 184. ...
Description: TMB Bulletin Spring 1997
Document: ... ntribute an additional mechanism of action to the management of NIDDM but resembles those drug regimens which utilize large doses of single agents. NIDDM treatment with oral sulfonylurea combinations may also limit, rather than improve, the effectiveness of oral therapy. Patients who do not respond ...
Description: TMB Bulletin Spring 1999
Document: ... ugs (NSAIDs) designed to reduce inflamma tion and pain by selectively inhibiting cyclooxygenase 2 has been discovered. It has been accepted that aspirin and NSAIDs exert antiinflammatory and analgesic effects by inhibiting the activity of cyclooxygenase, which regulates the conversion of arachadonic ...
Description: TMB Bulletin Spring 1998
Document: ... matory drug specifically indicated for short-term management of acute pain (use for 10 days or less), and is not labeled for long-term use in chronic conditions such as osteoarthritis or rheumatoid arthritis. Serious liver damage has occurred in patients taking Duract for more than 10 days. Serious ...
Description: TMB Bulletin January 2011
Document: ... access, set standards for telemedicine in Texas
Pain Clinic Update
Houston is the "dark heart" of Texas' growing prescription drug abuse problem, according to the Houston Chronicle, accounting for a quarter of complaints about doctors' suspect prescriptions and one-sixth of the state's 1,900 annua ...
Description: TMB Bulletin May 2011
Document: ... Board of Acupuncture Examiners May 2011
Illegal pain clinic crackdown continues:
The Texas Medical Board's initiative to shut down illegal pain pill mills continues. The most recent highprofile crackdown was the arrest of Houston doctor Gerald Ratinov, M.D., and 18 co-conspirators, the Drug Enforc ...
Description: TMB Bulletin Spring 2009
Document: ... ete Garcia of Frisco.
Guidelines for prescribing pain meds, scheduled drugs
In several Texas counties, more than half 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 ...
Description: TMB Bulletin July 2012
Document: ... State Board of Acupuncture Examiners
July 2012
Pain prescribing:
An important and legitimate part of medicine
By Irvin E. Zeitler Jr., D.O. President, Texas Medical Board The United States is experiencing an epidemic of prescription opioid misuse and related deaths, mostly unintentional. The Sta ...
Description: TMB Bulletin March 2012
Document: ... r can any physician assistants participate in the management of the partnership a physician assistant or combination of physician assistants can have no more than a minority ownership interest the ownership interest of an individual physician assistant cannot not equal or exceed the ownership intere ...
“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.