“... drugs to anyone, nor may the physician possess a Drug Enforcement Agency controlled substances registration; and
to be eligible for retired status, a physician's license cannot be under investigation, under a Board order, or be otherwise restricted.
To return to practice from retired status, a phy ... ”
“... provides a confidential program of diagnosis and monitoring for licensees affected by substance use disorders, physical illnesses and impairment, and/or psychiatric conditions is available by clicking here.
”
“... r process is available here.
Register with Prescription Monitoring Program - Mandatory Checks Started March 1, 2020
The Texas Prescription Monitoring Program (PMP) is used to verify a practitioner’s own records and prescribing history as well as inquiring about patients. In addition, th ... ”
“... iring abstention from drugs and alcohol
Requiring drug testing
Requiring participation in AA or similar programs
Prohibiting a licensee from treating certain types of patients
Assessing an administrative penalty (a fine)
Issuing a public reprimand
Approximately 90 percent of all disciplinary ... ”
“... d is a member of the FDA Analgesia and Anesthesia Drug Product Advisory Committee. He has also served as subcommittee chair on 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 ... ”
“... r opioids or controlled substances; or who have a Drug Enforcement Agency (DEA) number for prescribing or ordering opioids or controlled substances: as part of the 20 formal hours required, at least 2 hours must cover topics outlined in the TMB Initial Guidance on New Opioid Continuing Medical Educa ... ”
“... identified in the UAR or PEA, and a strategy for monitoring the status of implementation of the Resource Efficiency Plan.
See response to #2 above.
(4) A finance strategy that describes how the agency or institution plans to obtain funding for the recommended cost effective effici ... ”
“... py
Hari
Headache
Hepatitis
Herbal Drug Interactions
Herbal tea
Herpes
High cholesterol
HIV
Holistic
Hua Tuo Wu
Hyperlipoproteinemia
Hyperplasia
Hypertension
Hyperthyroid
Hypothyroid
I Ching
Imagery
Imaging
Immune
Infecti ... ”
“...
Pain Management and the Prescription of Opioids
At least 2 of the 24 formal hours must involve the study of the following topics:
• best practices, alternative treatment options, and multi-modal approaches to pain management that may include physical ... ”
“... 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. ”
“... 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. ”
“... s 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 APRNs a ... ”
“... 104 (2003) fee per registration, the $13.48 Prescription Monitoring Program (PMP) fee, and a $5 Office of Patient Protection fee for the first year, with an additional $1 charged for any subsequent year. These fees are required by statute and cannot be pro-rated. The remaining amount is requir ... ”
“... ealth and Human Services Commission Medicaid/CHIP Drug Utilization Review
Poison Control Center Information and Services 1-800-222-1222
State Office of Rural Health (Texas Dept. of Agriculture)
Texas Department of State Health Services , (512) 458-7111
Texas Department of State Health ... ”
“... sp;PDF | Word
Chapter 170 -
Prescription of Opioid Antagonists: HTML | PDF | Word
Chapter 171 -
Interstate Medical Licensure Compact: HTML | PDF | Word
Physician Assistants
Chapt ... ”
Description: TMB Bulletin Fall 2000
Document: ... e Board of Physician Assistant Examiners Medicaid Drug Use Review Renewal and CME Information Physicians-in-Training Program Issuing Permits "Baby Moses" Law Will Help Abandoned Infants Physicians Can Take Lead in Improving Immunization Rates for Children, Adults Physicians Have Responsibility to He ...
Description: TMB Bulletin Fall 2006
Document: ... Investigations, amendments to §179.8, Alcohol and Drug Screening During Investigations for Substance Abuse, regarding alcohol and drug screening during an investigation for substance abuse. Chapter 185, Physician Assistants, relating to changes mandated by S.B. 419. Chapter 192, Office Based Anesthe ...
Description: TMB Bulletin Fall 2002
Document: ... 02.pdf, PDF file, 72 KB) Please note: The Medical Drug Review information that formerly appeared in the Medical Board Report is now available at the Texas Department of Health, Drug Utilization Review Board. CONTENTS: Board Shows Regulatory Improvements Physician Profile Project Complete Board Appro ...
Description: TMB Bulletin Fall 2001
Document: ... 1.pdf, PDF file, 100 KB) Please note: The Medical Drug Review information that formerly appeared in the Medical Board Report is now available at the Texas Department of Health, Drug Utilization Review Board. CONTENTS: Governor Appoints New Board Member New Executive Director Named Profiles Mandatory ...
Description: TMB Bulletin Fall 2004
Document: ... types of non-standard-of-care violations:
Drug and alcohol abuse Drug and alcohol diversion Drug and alcohol co-dependency Sexual misconduct Uncontrolled anger Failure to accurately document evaluations, procedures or treatments.
Dr. Roberts Resigns from Board
Joyce A. Roberts, M.D., has ...
Description: TMB Bulletin Fall 2009
Document: ... to meet the standard
of care in his prescribing, monitoring, follow-up care,
treatment plan and management of a pain patient and
failing to heed multiple red ags for nontherapeutic
controlled substance abuse by the patient, who died of
acute Methadone intoxication.
Babcock, Chad, M. ...
Description: TMB Bulletin Fall 2007
Document: ... 181.2 Definitions; 181.3 Release of Contact Lens Prescription; and 181.6 Physician s Prescriptions: Delegation, relating to establishing that the verification of a contact lens prescription may substitute for an original signature to create a valid contact lens prescription. Chapter 182, Use of Ex ...
Description: TMB Bulletin Fall 2010
Document: ... alth professionals
to seek early assistance with drug or alcohol-
related problems or mental or physical
conditions that present a potentially dangerous
limitation or inability to practice medicine with
reasonable skill and safety.
The Texas Physician Health Program, or
TXPHP, recommends ...
Description: TMB Bulletin Fall 2008
Document: ... gation orders, 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 o ...
Description: TMB Bulletin Fall 1997
Document: ... 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 requires a doctor to provide a contact lens prescription to a patient who requests it unless to do ...
Description: TMB Bulletin Fall 1998
Document: ... d of Physician Assistant Examiners Texas Medicaid Drug Use Review Triplicate Prescription Program Modifications Board Adopts New Rules Are You Practicing Medicine Without a License? Continuing Medical Education Reminder Texas State Board of Acupuncture Examiners Frequently Asked Questions TxDot Prov ...
Description: TMB Bulletin Fall 1999
Document: ... d of Physician Assistant Examiners Texas Medicaid Drug Use Review Triplicate Prescription Program Modifications Board Adopts New Rules Are You Practicing Medicine Without a License? Continuing Medical Education Reminder Texas State Board of Acupuncture Examiners Frequently Asked Questions TxDot Prov ...
Description: TMB Bulletin Fall 2005
Document: ... rsuant to a grant from the United States Food and Drug Administration. AVILA, FERNANDO T., M.D., SAN ANTONIO, TX, Lic. #G2899 On August 26, 2005, the Board and Dr. Avila entered into an Agreed Order assessing an administrative penalty of $1,000. The action was based on allegations that Dr. Avila vio ...
Description: TMB Bulletin June-July 2003
Document: ... urs CME in record-keeping and risk management and monitoring of prescriptions. Action due to failure to maintain adequate medical records. Brackett, Fred B., M.D., Corpus Christi, TX, Lic. #E7836 An Agreed Order was entered on 6-6-03 assessing an administrative penalty in the amount of $5,000. Actio ...
Description: TMB Bulletin March 2013
Document: ... ial impact on his ability to safely practice four monitoring cycles, pass within one year and within medicine. In addition, Dr. Fraser must cease treating three attempts the Medical Jurisprudence Exam, com- any chronic pain patients, surrender his DEA and DPS plete within one year 24 hours of in-per ...
“... ian or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/. ”
Is the Prescription Monitoring Program (PMP) check mandated each and every time a physician or authorized delegate prescribes one of the four scheduled drug types?
Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/.
“... sia-related services is not required to specify a drug, dose, or administration technique.As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Orde ... ”
What are the general rules related to AAs/CRNAs?
The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:
1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.
It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”
Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.
One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.
As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.
Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.
While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.
Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient.
“... s are allowed in very limited circumstances). All prescription drugs that are not controlled substances fall into the category of "dangerous drugs." Physician assistants with prescriptive authority must have their own DEA numbers to prescribe controlled substances. In addition, physician assistants ... ”
Can a PA sign a prescription for controlled substances?
Yes, the PAs supervising physician must delegate prescriptive authority allowing a PA to sign prescriptions for controlled substances, also called scheduled drugs, as well as Dangerous Drugs. However, PA's are generally limited to Schedules III – V (Schedule IIs are allowed in very limited circumstances). All prescription drugs that are not controlled substances fall into the category of "dangerous drugs." Physician assistants with prescriptive authority must have their own DEA numbers to prescribe controlled substances. In addition, physician assistants must have the name of their current delegating physician authorizing prescriptive authority on file with DEA.
Please note: Under Senate Bill 195, the requirement for controlled substances registration (CSR) with the Texas Department of Public Safety (DPS) was eliminated as of September 1, 2016.
“Yes, a PA can call in a prescription to a pharmacy. However, the PA can only do so at the direction of a physician. ”
Can a PA call in a prescription to a pharmacy?
Yes, a PA can call in a prescription to a pharmacy. However, the PA can only do so at the direction of a physician.
“... rity 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.
“... atment, including surgery, with the issuance of a prescription for a majority of the patients. 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 inspecti ... ”
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.
“... ied, 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 agen ... ”
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.
“... lephone number are required to be included on the prescription drug order. If the prescription is for a controlled substance, the physician’s DEA number is also required to be included on the prescription. SB 406 did not change the requirements for what needs to be included on a pr ... ”
Does the physician's name need to be included on the prescription?
Yes, the physician’s name, address and telephone number are required to be included on the prescription drug order. If the prescription is for a controlled substance, the physician’s DEA number is also required to be included on the prescription. SB 406 did not change the requirements for what needs to be included on a prescription drug order.
“... ldquo;dangerous drugs.” The Dangerous Drug Act defines a dangerous drug as a device or drug that is unsafe for self-medication and that is not included in Schedules I through V or Penalty Groups 1 through 4 of Chapter 481, Health and Safety Code (Texas Controlled Substances Act). The ter ... ”
What is a dangerous drug? Are these legend drugs?
Texas is one of just a few states that use the term “dangerous drugs.” The Dangerous Drug Act defines a dangerous drug as a device or drug that is unsafe for self-medication and that is not included in Schedules I through V or Penalty Groups 1 through 4 of Chapter 481, Health and Safety Code (Texas Controlled Substances Act). The term includes a device or drug that bears, or is required to bear, the legend: “Caution: federal law prohibits dispensing without prescription” or “Rx only” or another legend that complies with federal law. Many other states use the term “legend drugs.”
“... ication order is an order for administration of a drug or device to a patient in a hospital for administration while the patient is in the hospital or for emergency use on the patient’s release from the hospital, as defined by §551.003, Occupations Code and §481.002, Health and Safet ... ”
What is the difference between medication orders and prescriptions?
A medication order is an order for administration of a drug or device to a patient in a hospital for administration while the patient is in the hospital or for emergency use on the patient’s release from the hospital, as defined by §551.003, Occupations Code and §481.002, Health and Safety Code. A prescription is an order to dispense a drug or device to a patient for self-administration as defined by §551.003, Occupations Code.
“... 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 em ... ”
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.)
“... lt with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in th ... ”
How often is physician consultation required when prescribing controlled substances?
APRNs and PAs must consult with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in the patient’s medical record.
“... that the PMP has been checked prior to issuing a prescription. Certain electronic medical record systems, for example, may provide other ways to document that the review has been completed. ”
May I maintain a copy of the PMP history report in the patient’s medical record?
Yes. The provider may maintain a copy of the PMP history report in the patient’s medical record. There is no specific method required for documenting that the PMP has been checked prior to issuing a prescription. Certain electronic medical record systems, for example, may provide other ways to document that the review has been completed.
“Refills issued to the patient pursuant to a valid prescription and without any reauthorization from the prescriber do not require a PMP check by the prescriber. However, if a prescriber is issuing a prescription for a patient that is unchanged from a previous prescription issued to the patient ... ”
What if a prescriber is just approving a refill?
Refills issued to the patient pursuant to a valid prescription and without any reauthorization from the prescriber do not require a PMP check by the prescriber. However, if a prescriber is issuing a prescription for a patient that is unchanged from a previous prescription issued to the patient (often referred to as a refill), then this would be considered a new prescription and would require a PMP check.
“... count any relevant information prior to issuing a prescription. ”
Is only the prescriber allowed to check the PMP, or can someone else check on behalf of the physician?
A physician, their delegated midlevel provider, or any other qualified and licensed individual delegated authority to check the PMP may do so on behalf of the prescriber. Ultimately though, it is the prescriber’s responsibility to ensure that the PMP has been checked and that they have reviewed and taken into account any relevant information prior to issuing a prescription.