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“... on specific continuing education requirements per license type, please select the proper link above.
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Does the physician's name need to be included on the prescription?
Is there still a ratio for the number of APRNs or PAs to whom a physician may delegate prescriptive authority?
Is there a waiver if a physician wants to delegate prescriptive authority to more than seven full time equivalent AP ... ”
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What constitutes a license that is in good standing for purposes of entering a prescriptive authority agreement?
Do I have to disclose information regarding investigations and discipline? If so, to whom must this information be disclosed
What must be included in a prescriptive authority a ... ”
“If you're a physician and you will EVER be called upon to sign a death certificate, state law requires you to register with the Texas Department of State Health Services (DSHS) to file the certificate electronically.
You cannot wait until a death has occurred in order to register; that’s too l ... ”
“... ed licensing if I do not currently have an active license?
No. The Interstate Medical Licensure Compact (IMLC) is a voluntary, expedited pathway to licensure for physicians who already hold a full, unrestricted medical license in a state that is a member of the Compact, and wish to p ... ”
“The Faculty Temporary License (FTL) is a limited license that allows physicians who do not meet all the requirements for full licensure, but who have the expertise to educate Texas medical students, residents, and fellows, to practice within the confines of the sponsoring institution. The sponsoring ... ”
“Physicians, Physician Assistants, and several other types of licensure applicants are required to submit their fingerprints for state and national criminal history background checks.
Please note that having a criminal history does not automatically disqualify you from obtaining a license throu ... ”
“... 54.006(b)(9) and (10) of the Act requires that: a physician profile display a description of (1) "any conviction for an offense constituting a felony, a Class A or Class B misdemeanor, or a Class C misdemeanor involving moral turpitude" and (2) "any charges reported to the board to which the physici ... ”
“... ection 154.006(b)(12) of the Act requires that: a physician profile display a description of any disciplinary action against the physician by a medical licensing board of another state.
This section of the physician profile displays any applicable descriptions. ... ”
“... ians are required to register with the TMB if the physician supervises or delegates prescriptive authority to Physician Assistants (PAs)s. Current registered supervisions and delegations to PAs are displayed in this section of the physician profile. ... ”
“... ians are required to register with the TMB if the physician delegates prescriptive authority to Advanced Practice Registered Nurses (APRNs). Current registered delegations to APRNs are displayed in this section of the physician profile. ”
“... nt) in Texas are displayed in this section of the physician profile. ”
“When a physician retires, terminates employment, or otherwise leaves a medical practice, he or she is responsible for:
ensuring that patients receive reasonable notification and are given the opportunity to obtain copies of their records or arrange for the transfer of their medical records to anoth ... ”
“Once the Board has issued you an official license number, you will have 90 days to register and activate your license. Failure to register will result in penalty fees, and after one year, license cancellation.
Please note: If you have not registered your license within 90 days of your license ... ”
“... ilable. If an online option is not available (ex: license is delinquent or suspended at the time of registration) the additional processing fee will not be required.
To request a hard copy registration form, please contact the Registration Department at registrations@tmb.state.tx.us or ( ... ”
Description: Rule Changes January 09, 2003
Document: ... suing postgraduate training permits. Chapter 173, Physician Profiles. Amendments to §'173.1 regarding board actions contained in the profile. Chapter 177, Certification of Non-Profit Health Organizations. Amendment to §177.16 regarding the complaint procedure notification. Chapter 184, Surgical Assi ...
Description: Rule Changes January 08, 2004
Document: ... k here for the complete board rules. Chapter 173, Physician Profiles. Rule review only - no changes to the text of the rule. Chapter 176, Health Care Liability Lawsuits and Settlements. New c hapter, §§176.1-176.9, concerning reporting responsibilities for licensees against whom a health care liabil ...
Description: Rule Changes January 07, 2001
Document: ... with Disabilities Act requirements. Chapter 173, Physician Profiles - proposed amendments to §173.1 regarding information to be released on the physician profiles. Chapter 199, Public Information - rule review and proposed amendments to §§ 199.1-.4 to correct the name of the Public Information Comm ...
Description: Rule Changes January 06, 2002
Document: ... garding expedited licensure process. Chapter 166, Physician Registration. Rule review and proposed amendments to 166.1-166.6 regarding general cleanup, CME temporary licenses, SB1300 (30-day grace period to practice with an expired permit) and voluntary charity care provided to indigent populations. ...
Description: Rule Changes January 04, 2007
Document: ... e United State or Canada; 183.5 Annual Renewal of License, to provide for the automatic cancellation of a license that has been expired for more than one year; 183.15, Use of Professional Titles, to delete the requirement to include "Texas" in the title; and 183.20, Continuing Acupuncture Education, ...
Description: Rule Changes January 02, 2013
Document: ... nsure during the licensure application process if physician intends to use board certification as an alternate grounds for eligibility. The amendment to §163.11 amends the rule to provide remedies for out of active practice issues and to allow for granting a license under a remedial plan. Chapter 17 ...
Description: Rule Changes December 22 and 25, 2011
Document: ... m jointly owned entities. New §177.16, concerning Physician Assistants, provides that physicians and physician assistants may form jointly owned entities. New §177.17, concerning Exceptions to Corporate Practice of Medicine Doctrine, sets out exceptions to the corporate practice of medicine doctrine ...
Description: Press Release January 6, 2011
Document: ... that if the agency's executive director is a non-physician, a medical director be hired. -30-
Description: Press Release January 18, 2011 (PDF File)
Document: ... s Medical Board temporarily suspended the medical license of Julia Renee Ward, M.D., Lic. No. M5571, of Houston, after determining that Dr. Ward's continuation in the practice of medicine presents a continuing threat to the public welfare. The suspension is effective immediately. The Order of Tempor ...
Description: Press Release January 12, 2010 B (Pdf File)
Document: ... 5-7030 or (800) 248-4062.
Medical Board Suspends License of Dr. Timothy N. Marks, Lic. # J-3719, of Dallas
On Jan. 8, 2010, the Board entered an automatic Order of Suspension against Timothy N. Marks, M.D., due to his incarceration in a federal correctional facility following his conviction for fai ...
Description: Press Release January 11, 2007 (PDF File)
Document: ... 05-7030 or (800) 248-4062
Medical Board Suspends License of Michael Lee Williams, M.D., of Palestine
A panel of the Texas Medical Board temporarily suspended the license of Michael Lee Williams, M.D., license #H5995, of Palestine, after determining that Dr. Williams continuation in the practice of ...
Description: Press Release January 16, 2011 (PDF File)
Document: ... that if the agency's executive director is a non-physician, a medical director be hired. -30-
Description: Press Release January 20, 2010 (PDF File)
Document: ... 05-7030 or (800) 248-4062.
Medical Board Revokes License of Dr. Scott Shaw McNeill, Lic. # K7058, of San Antonio
On January 15, 2010, the Board entered an Automatic Revocation Order for an indefinite period against Scott Shaw McNeill, M.D., for violations of a 2004 10-year Agreed Order, which requi ...
Description: Press Release January 12, 2010 A (Pdf File)
Document: ... 05-7030 or (800) 248-4062.
Medical Board Revokes License of Dr. Clarence Gordon King, Lic. # E1883, of San Antonio
On January 7, 2010, the Board entered an automatic Order of Revocation against Clarence Gordon King, M.D., due to his having a positive screen for alcohol in violation of a 2003 Agreed ...
Description: Press Release January 22, 2009 A (PDF File)
Document: ... 05-7030 or (800) 248-4062
Medical Board Suspends License of Brent J. Coleman, D.O., of Laguna Vista
A panel of the Texas Medical Board suspended the license of Brent J. Coleman, D.O., license number G3241, after determining that Dr. Coleman's continuation in the practice of medicine presents a cont ...
“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 scena ... ”
Is there a waiver if a physician wants to delegate prescriptive authority to more than seven full time equivalent APRNs and PAs?
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.
“... t 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.
“... 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&rsqu ... ”
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.
“... under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have ad ... ”
What are the Texas Medical Board’s requirements for a physician who delegates to an APRN or PA?
All prescriptive delegation requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have adequate supervision.
“... uired 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 doc ... ”
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.
“... sp; state the name, address, and all professional license numbers of the parties to the agreement;(3) state the nature of the practice, practice locations, or practice settings;(4) identify the types or categories of drugs or devices that may be prescribed or the types or categories of d ... ”
What must be included in a prescriptive authority agreement?
It depends upon when the agreement was executed. Note that there have been several changes to the law affecting this area in recent legislative sessions. To understand how the law might apply to your situation, you may want to seek the advice of private legal counsel.
For a prescriptive authority agreement executed on or after September 1, 2019, the agreement must, at a minimum:
(1) be in writing and reviewed, signed and dated by the parties to the agreement on an annual basis;
(2) state the name, address, and all professional license numbers of the parties to the agreement;
(3) state the nature of the practice, practice locations, or practice settings;
(4) identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;
(5) provide a general plan for addressing consultation and referral;
(6) provide a plan for addressing patient emergencies;
(7) state the general process for communication and the sharing of information related to the care and treatment of patients;
(8) if alternate physician supervision is to be utilized, designate one or more alternate physicians; and
(9) describe a prescriptive authority quality assurance and improvement plan and how it will be implemented. The plan must require chart reviews and periodic meetings.
“... r PA has been in practice, the length of time the physician and APRN or PA have practiced together, whether the parties to the prescriptive authority agreement practice together in the same practice setting, and the complexity of patient care needs should be given consideration when making this dete ... ”
How many charts must be reviewed?
The law does not provide a specific number or percentage of charts that must be reviewed. Rather, the law provides that the number of charts to be reviewed is determined by the parties to the prescriptive authority agreement. The number may vary from one practice setting to another. Factors such as the length of time the APRN or PA has been in practice, the length of time the physician and APRN or PA have practiced together, whether the parties to the prescriptive authority agreement practice together in the same practice setting, and the complexity of patient care needs should be given consideration when making this determination. 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 number or percentage of charts reviewed may be an important factor in determining the quality of the physician’s supervision.
“... d under the delegated prescriptive authority of a physician under a prescriptive authority agreement includes the amount of time practiced under the delegated prescriptive authority of that same physician prior to November 1, 2013. For agreements entered on or after September 1, 2019, the lengt ... ”
Is credit given for time practiced in a supervised prescriptive authority arrangement prior to November 1, 2013?
It depends upon when the agreement was executed. For prescriptive authority agreements entered into prior to September 1, 2019, factors such as the type of delegate licensure and amount of time spent practicing under an agreement determined the required frequency and manner of meetings. For such agreements, the amount of time an APRN or PA practiced under the delegated prescriptive authority of a physician under a prescriptive authority agreement includes the amount of time practiced under the delegated prescriptive authority of that same physician prior to November 1, 2013.
For agreements entered on or after September 1, 2019, the length of time that a delegate has practiced in a supervised prescriptive authority arrangement with a physician is no longer relevant to how often parties to the prescriptive authority agreement must meet. Such participants must meet at least on a monthly basis, no matter the length of time spent practicing together under a prescriptive authority agreement.
“... of the distance between or locations at which the physician and delegate(s) practice. ”
Can we skip conducting periodic meetings if the physician and APRN or PA practice together at the same location?
No. Periodic meetings are required, regardless of the distance between or locations at which the physician and delegate(s) practice.
“... greement designates who may serve as an alternate physician if alternate physician supervision will be utilized. If an alternate physician(s) will participate in the quality assurance and improvement meetings with the APRN or PA, this information must be included in the prescriptive authority ... ”
What if an alternate physician is involved in delegation of prescriptive authority on a temporary basis?
The prescriptive authority agreement designates who may serve as an alternate physician if alternate physician supervision will be utilized. If an alternate physician(s) will participate in the quality assurance and improvement meetings with the APRN or PA, this information must be included in the prescriptive authority agreement.
“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. ”
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.
“... 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. ... ”
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.
“... e 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 ... ”
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.)
“... , 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 del ... ”
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.)