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“... nvestigation status, or the issuance of any Board orders?
No. To receive additional information a new request will need to be submitted for review.
”
“... a non-patient-specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative drug management, or comprehensive medication management, in response to a public health emergency or in other circumstances in which the practitioner may issue a non-patient-specific p ... ”
“... have access to a team of support representatives standing by ready to answer questions by email at support@cebroker.com or by chat via our Help Center, help.cebroker.com.Help CenterCE Broker’s Help Center is accessible anytime, anywhere, providing assistance even outside of reg ... ”
Description: Medical Board 2023 - June - Disciplinary Process Review Committee Minutes
Document: ... tion, peer review information, and rehabilitation orders under the authority of the Medical Practice Act Sections 152.009, 160.006 through 160.008, 164.007(c), Texas Occupations Code. Open session resumed at 12:34pm, and it was announced that no action was taken during executive session. A certifie ...
Description: PA Board 2023 March - Full Board Minutes
Document: ... mendation, and possible action regarding proposed orders offered by the ExecutiveDirector.There were none. Agenda item #1, Report on physician assistant licenses issued by Board staff. Grace Unterborn, Licensure Manager,reported that staff issued 409 licenses between July and November 17, 2022.Agend ...
Description: Acupuncture 2023 - April - Full Board Minutes
Document: ... ration and Approva
l
of Agreed Cease and Desist Orders
.
A
fter consideration,
Dr
.
Ximenes moved,
Ms. Gonzalez
seconded, and the motion passed to
approve the Agreed Cease and Desist Order for Dominique Navarette.
Agenda Item #10,
Consideration and Approval of Remedial Plans.
Aft ...
Description: Medical Board 2023 - June - Full Board Minutes
Document: ... ation and approva
l of Mediated Settlement Agreed Orders.
After
consideration,
Dr. Distefano
moved,
Dr.
Vanderweide
seconded
,
and the motion passed to approve
the Mediated Settlement Agreed Order
s
for
Jerome M. Adams, M.D.; Renato Geralde, D.O.;
Daniel A. Mackay, M.D.;
Frederico Rom ...
Description: Medical Board 2023 - August - Licensure Committee Minutes
Document: ... Ebony Todd, J.D.
Agenda Item 2
a.
Proposed orders offered by the Executive Director.
There are none.
Agenda Item 2b. Physician licensure applicants to be licensed.
Ms. Unterborn reported that there were
267
applicants who met all
the requirements
permanent licensure by the f ...
Description: ... that the individual is currently licensed in good standing in another state and has current orders assigning the servicemember to Texas. The recognition, once approved, is only the ability to practice while in Texas on assignment, but it is not a Texas license. ...
Document: ... valid
for the duration of a servicemember’s
orders in Texas
.
Full
Name
SSN
______________
______________
Print Name
Date of Birth
__________________________
Alternate Name(s) (if applicable)
________________________________
Email Address
...
Description: PA Board 2023 July - Full Board Minutes
Document: ... m #22, Consideration and Approval of Agreed Board Orders. After consideration, Mr. McElhaney moved, Dr. Hughes secondedand the motion passed to approve the Agreed Orders for Derek Brown, PA and Thomas Cook, PA. Agenda item #23, Consideration and Approval of Remedial Plans. After consideration, Dr. H ...
Description: ... that the individual is currently licensed in good standing in another state and has current orders assigning the servicemember to Texas. The recognition, once approved, is only the ability to practice while in Texas on assignment, but it is not a Texas license. ...
Document: ... is valid
for the duration of a servicemember’s orders in Texas
.
Full
Name
SSN
______________
______________
Print Name
Date of Birth
__________________________
Alternate Name(s) (if applicable)
________________________________
Email Address
...
Description: ... that the individual is currently licensed in good standing in another state and has current orders assigning the servicemember to Texas. The recognition, once approved, is only the ability to practice while in Texas on assignment, but it is not a Texas license. ...
Document: ... e Last Date of Verification Current Supervision/Delegation Status Information current as of: Date Approve Cartwright Fugitt Shelbie Medical Radiologic Technologist MS - MRT-7044 AC - Active N/A Weaver Natalie HI - R-4478 Crissman Erin Michelle Physician Assistant Campbell James H ...
Description:
TMB disciplines 27 physicians at August meeting
Document: ...
The disciplinary actions
included
:
three
orders related to unprofessional conduct,
nine
orders related to quality of care,
three
voluntary
surrender
s
/revocation
s
,
one
revocation
,
one restriction,
five
order
s
related to
nontherapeutic
prescribing,
two
order
s
...
Description: Medical Board 2023 - August - Disciplinary Review Committee Minutes
Document: ... Assistant SB202/Other
Waiver Orders (out of state discipline)
5
14
20
24
Physician Physician Assistant Acupuncturist Surgical Assistant SB202/Other
Consent Orders
0
8
4
0
Physician Physician A ...
Description: Respiratory Care Board Full Board Minutes (June 22, 2023)
Document: ... ommendation, and possible action regarding Agreed Orders.After discussion,Mr. Pellizzari moved,Mr. Brown secondedand the motion passed to approve the Agreed Order forNaim Rita, RCP. Agenda Item #19, Discussion, recommendation, and possible action regarding Remedial Plans.After discussion, Mr. Brown ...
Description: Medical Radiologic Technology Board Full Board Minutes (June 23, 2023)
Document: ... mmendation and possible action regarding proposed orders offered by the Executive Director. There were none.There were no items for Agenda Item #Agenda item #10, Report on Program Approvals/Renewals. Ms. Unterborn reported that there wereNCT programs that were renewed and 1 LMRT program that was ren ...
Description: Medical Board 2023 - August - Full Board Minutes
Document: ... roval of Modification Request/Termination Request Orders. After consideration, Dr. Bhatiamoved, Dr. Distefano secondedand the motion passed to approve the Modification Requests/Termination Requests Orders for Brett Cordes, MD; Jeffrey Glass, MD; Rachel KientcTita, MD; Ventatesh Madhav, MD; Darius Pe ...
Description: Medical Board 2023 - October - Licensure Committee Minutes
Document: ... ing at 11:35 a.m.
Agenda Item 2
a.
Proposed orders offered by the Executive Director.
Ms. Unterborn reported on
1
Remedial
Plan offered
by the Executive Director and accepted by the applicant.
After discussion
Dr. Farmer
Remedial Plan
be approved.
Mr. Cokinos
seconded the ...
“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 ... ”
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.
“No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive au ... ”
If I work in a clinic owned by the hospital, is this considered a facility-based practice?
No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings.
“... xercise prescriptive authority under one of these delegation mechanisms. ”
Is a prescriptive authority agreement required in a hospital or long term care facility-based practice?
Although it is possible to use a prescriptive authority agreement in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms.
“In a long term care facility based practice, delegation is by the medical director. ”
Who may delegate prescriptive authority in a long term care facility based practice?
In a long term care facility based practice, delegation is by the medical director.
“... 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 anesthe ... ”
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.)
“... eral 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 ... ”
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.)
“APRNs or PAs may prescribe schedule II drugs in the following situations: (1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety ... ”
Who can prescribe Schedule II drugs under physician delegation?
APRNs or PAs may prescribe schedule II drugs in the following situations:
(1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
(A) has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department of the hospital; or
(2) as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
“No. A free standing emergency department is not located within the hospital anddoes not qualify as an eligible site for delegation of schedule II authority. The physician may only delegate authority to prescribe controlled substances in schedules III through V in this setting. Auth ... ”
Can schedule II authority be delegated in a free standing emergency department that is affiliated with a hospital?
No. A free standing emergency department is not located within the hospital anddoes not qualify as an eligible site for delegation of schedule II authority. The physician may only delegate authority to prescribe controlled substances in schedules III through V in this setting. Authority to prescribe dangerous drugs, nonprescription drugs and devices may be delegated in any setting.
“Yes. Nothing changed for delegation of prescriptive authority for controlled substances in schedules III through V. ”
Can APRNs and PAs in hospital-based clinics continue to prescribe drugs in schedules III through V?
Yes. Nothing changed for delegation of prescriptive authority for controlled substances in schedules III through V.
“... ian 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. ”
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.
“... endent authority to administer anesthesia without delegation by a physician.” (Page 5). Since the selection and administration of anesthesia is a medical act, CRNAs must be properly delegated this act by a physician. A CRNA who administers anesthesia without proper delegation from a ... ”
Are CRNA’s authorized to practice independent of physician supervision and delegation?
No, neither the Medical Practice Act nor the Nursing Practice Act authorize independent practice by a CRNA. Additionally, Texas Attorney General Opinion No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without delegation by a physician.” (Page 5). Since the selection and administration of anesthesia is a medical act, CRNAs must be properly delegated this act by a physician. A CRNA who administers anesthesia without proper delegation from a physician would be liable for the unlicensed practice of medicine.
“... m. If there is a change to the scope of the delegation, physicians must notify the Board within 30 days of this change.PAs are likewise required to register their supervising physicians with the Board prior to beginning to practice under the employment or prescriptive authority agreement. ... ”
Do I have to let the Medical Board know about my delegates/supervising physicians?
Yes, if you are a physician or a physician assistant.
Physicians are required to register all PAs and APRNs that they supervise prior to the delegates beginning to work for them. If there is a change to the scope of the delegation, physicians must notify the Board within 30 days of this change.
PAs are likewise required to register their supervising physicians with the Board prior to beginning to practice under the employment or prescriptive authority agreement. They are also required to notify the Board within 30 days of any change to the scope of the delegation.
APRNs should look to guidance provided by the Texas Board of Nursing for how to register their delegating physicians, as the Medical Board does not have licensing authority for nurses.