reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.9 - Grounds for Temporary Suspension or Automatic Suspension of Probationers

Current through Reg. 49, No. 28; July 12, 2024
(a) Certain
				violations of an order by a probationer are of such a nature that the
				continuation in practice by the probationer shall be considered a continuing
				threat to the public welfare. Such violation is grounds for a temporary
				suspension hearing as provided under Chapter 187, Subchapter F of this title
				(relating to Temporary Suspension and Restriction Proceedings) or for automatic
				suspension pursuant to terms and conditions of the probationer's order. Such
				violations include, but are not limited to:
(1) failure to pass the Special Purpose
				Examination within the required number of attempts;
(2) failure to pass the Medical Jurisprudence
				Examination within the required number of attempts;
(3) testing positive for a prohibited
				substance;
(4) failure to timely
				submit to a drug and/or alcohol screen;
(5) refusal to submit to a drug and/or
				alcohol screen; and
(6) any attempt
				to circumvent or tamper with the accuracy of a drug and/or alcohol
				screen.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.10 - Drug Screens

Current through Reg. 49, No. 28; July 12, 2024
(a) If the terms
				and conditions of an order provide for the screening of a prohibited substance,
				the probationer shall be screened by urine, blood, hair, breath, or other
				scientifically acceptable means to test for prohibited substances within a
				prescribed time period.
(b) Random
				testing is mandated. Agency representatives shall not make appointments or
				schedule times to collect screens.
(c) The probationer must submit to the screen
				within the prescribed time period.
(d) Probationers may not prospectively
				request copies of screens. The agency does not accept a standing request for
				copies of all drug screens. Upon receipt of written request, a copy of a screen
				may be forwarded only to a probationer or a probationer's authorized
				representative.
(e) The selection
				of any drug screening panel or screening method is at the sole discretion of
				the board and may be changed without prior notice to the probationer.
(f) The probationer is responsible for all
				costs related to drug screens.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.11 - Process for Approval of Physicians, Other Professionals, Group Practices and Institutional Settings

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Any approval of a physician or other professional to serve as a proctor,
				monitor, or supervisor or the approval of a group practice or institutional
				setting required by an order shall be given by the executive director or his or
				her designee.
(b) Approval of a
				physician or other professional required by an order must meet all of the
				following criteria:
(1) board certification
				by a board certifying organization that meets the requirements of §
										164.4 of this
				title (relating to Board Certification);
(2) no economic relationship with
				probationer;
(3) no direct personal
				relationship with probationer;
(4)
				no more than three medical malpractice suits filed and/or pending against the
				physician or other professional within a five year period;
(5) no more than three resolved
				investigations by the board against the physician or other professional within
				a five year period; and
(6) no
				disciplinary history, pending investigations, or formal SOAH complaints with
				the board.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.12 - Suspended licenses

Current through Reg. 49, No. 28; July 12, 2024
A probationer whose license has been suspended by the board
				  remains under the jurisdiction of the board and must comply with Chapter 166 of
				  this title (relating to Physician Registration). Failure to do so may lead to
				  cancellation of probationer's license for non-payment.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.13 - Investigative Reports

Current through Reg. 49, No. 28; July 12, 2024
All reports created by agency representatives while
				  investigating a probationer's compliance with an order are investigative
				  reports as defined by the Act.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.14 - Receipt of Probationer's Address of Record and Contact Information

Current through Reg. 49, No. 28; July 12, 2024
(a) A probationer
				must maintain an address of record with the agency.
(b) In addition to the requirements set out
				in subsection (a) of this section, a probationer must provide current up to
				date contact information to the agency. Such contact information shall include,
				all the following information applicable to the probationer:
(1) Mailing address;
(2) Home address;
(3) Work address;
(4) Home telephone number;
(5) Work telephone number;
(6) Mobile pager number;
(7) Cellular telephone number; and
(8) Electronic mail address.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.15 - Determination of Successful Completion of an Order

Current through Reg. 49, No. 28; July 12, 2024
(a) The determination of successful
				completion of an order as defined by §
									189.2(22)
				of this title (relating to Definitions) shall require that all terms and
				conditions of the order have been completed and verified by a board Compliance
				Officer.
(b) Upon determination
				that all the terms and conditions have been satisfied as outlined in subsection
				(a) of this section, and no exception to a determination of Successful
				Completion as listed in subsection (c) or (d) of this section exist, the
				Compliance Officer will issue a written Notice of Termination of the Order. The
				effective date of Successful Completion shall be the date on Notice of
				Termination of the Order.
(c) If
				the Probationer is subject to an investigation, ISC, and/or a SOAH contested
				case arising out of an alleged violation of the order, the occurrence of which
				allegedly happened at any time the order was in effect, there shall be no
				determination of Successful Completion until the investigation, ISC, or pending
				SOAH contested case arising from an alleged violation of the order is resolved
				and approved by the Board through:
(1) a
				dismissal;
(2) agreed
				order;
(3) modification of the
				order; or
(4) a mediated or final
				order, resulting from a proceeding or mediation at SOAH.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 189 - COMPLIANCE PROGRAM › Section 189.16 - Monitoring, Proctoring, or Supervising Physician/Professional's Recommendation for Competency Assessment

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				physician/professional assigned by the Board to monitor a probationer's
				practice ("monitor") may recommend that the probationer complete a competency
				evaluation. A monitor's recommendation for a competency evaluation must be
				reviewed by the Chair of the Disciplinary Process and Review Committee ("DPRC")
				for the purpose of making a determination of whether a competency evaluation is
				warranted. The Chair may approve or deny the monitor's
				recommendation.
(b) Upon the DPRC
				Chair's approval of a recommendation for a competency evaluation, the following
				procedure applies:
(1) Within a required
				timeframe as directed by the compliance officer, after receiving written notice
				of the monitor's recommendation for a competency evaluation, the probationer
				must contact a program approved by the Board and schedule an assessment of at
				least two days in length to determine the probationer's competence and ability
				to practice medicine.
(2) The
				probationer shall authorize the approved program to send a written report
				regarding the probationer's performance and results of the competency
				evaluation directly to the compliance officer.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 190 - DISCIPLINARY GUIDELINES › Subchapter A - GENERAL PROVISIONS › Section 190.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose. This
				  chapter is promulgated to:
(1) promote
				  consistency in the exercise of sound discretion by board members in licensure
				  and disciplinary matters;
(2)
				  provide guidance for board members for the resolution of potentially contested
				  matters; and
(3) provide guidance
				  as to the types of conduct that constitute violations of the Medical Practice
				  Act (the "Act") or board rules.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 190 - DISCIPLINARY GUIDELINES › Subchapter A - GENERAL PROVISIONS › Section 190.2 - Board's Role

Current through Reg. 49, No. 28; July 12, 2024
The board shall render the final decision in a contested
					 case and has the responsibility to assess sanctions against licensees who are
					 found to have violated the Medical Practice Act. A sanction should be
					 consistent with sanctions imposed in other similar cases and should reflect the
					 board's determination of the seriousness of the violation and the sanction
					 required to deter future violations. A determination of the appropriate
					 sanction is reserved to the board. The appropriate sanction is not a proper
					 finding of fact or conclusion of law. This chapter shall be construed and
					 applied so as to preserve board member discretion in the imposition of
					 sanctions and remedial measures pursuant to the Act's provisions related to
					 methods of discipline and administrative penalties. This chapter shall be
					 further construed and applied so as to be consistent with the Act, and shall be
					 limited to the extent as otherwise proscribed by statute and board
					 rule.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 190 - DISCIPLINARY GUIDELINES › Subchapter C - SANCTION GUIDELINES › Section 190.15 - Aggravating and Mitigating Factors

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Aggravation. In any disciplinary action, the following may be considered as
				  aggravating factors that warrant more severe or restrictive action by the
				  board. Board staff shall have the burden to present evidence regarding any
				  aggravating factors that may apply in the particular case. A final order shall
				  include a finding of fact on each applicable aggravating factor.
(1) harm to one or more patients;
(2) the severity of patient harm;
(3) one or more violations that involve more
				  than one patient;
(4) economic harm
				  to any individual or entity and the severity of such harm;
(5) increased potential for harm to the
				  public;
(6) attempted concealment
				  of the act constituting a violation;
(7) intentional, premeditated, knowing, or
				  grossly negligent act constituting a violation;
(8) prior similar violations;
(9) previous disciplinary action by the
				  board, any government agency, peer review organization, or health care
				  entity;
(10) violation of a board
				  order;
(11) other relevant
				  circumstances increasing the seriousness of the misconduct.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 190 - DISCIPLINARY GUIDELINES › Subchapter D - ADMINISTRATIVE PENALTIES › Section 190.16 - Administrative Penalties

Current through Reg. 49, No. 28; July 12, 2024
(a) The amount of
				  an administrative penalty may not exceed $5,000 for each violation. Each day a
				  violation continues or occurs is a separate violation for purposes of imposing
				  a penalty.
(b) The amount of the
				  penalty shall be based on:
(1) the
				  seriousness of the violation, including;
(A)
				  whether it is an administrative violation, an aggravated administrative
				  violation, or a patient care violation;
(B) the nature, circumstances, extent, and
				  gravity of any prohibited act; and
(C) the hazard or potential hazard created to
				  the health, safety, or economic welfare of the public;
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 191 - DISTRICT REVIEW COMMITTEES › Section 191.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this chapter is to establish district review
				  committees as required by the Medical Practice Act, Tex. Occ.Code
				  Ann.163.001-.005.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 191 - DISTRICT REVIEW COMMITTEES › Section 191.2 - Districts

Current through Reg. 49, No. 28; July 12, 2024
The State of Texas shall be divided into four districts for
				  the purpose of establishing district review committees.
(1) District 1 shall consist of the following
				counties: Brazoria, Galveston, and Harris.
(2) District 2 shall consist of the following
				counties: Anderson, Angelina, Austin, Bowie, Brazos, Camp, Cass, Chambers,
				Cherokee, Collin, Cooke, Dallas, Delta, Denton, Ellis, Fannin, Franklin,
				Freestone, Grayson, Gregg, Grimes, Hardin, Harrison, Henderson, Hill, Hopkins,
				Houston, Hunt, Jasper, Jefferson, Kaufman, Lamar, Leon, Liberty, Limestone,
				Madison, Marion, Montgomery, Morris, Nacogdoches, Navarro, Newton, Orange,
				Panola, Polk, Rains, Red River, Robertson, Rockwall, Rusk, Sabine, San
				Augustine, San Jacinto, Shelby, Smith, Titus, Tyler, Trinity, Upshur, Van
				Zandt, Walker, Waller, and Wood.
(3) District 3 shall consist of the following
				counties: Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Brewster,
				Briscoe, Brown, Callahan, Carson, Castro, Childress, Clay, Cochran, Coke,
				Coleman, Collinsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby,
				Culberson, Dallas, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, El
				Paso, Erath, Fisher, Floyd, Foard, Gaines, Garza, Glasscock, Gray, Hale, Hall,
				Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Hood, Howard,
				Hudspeth, Hutchinson, Irion, Jack, Jeff Davis, Johnson, Jones, Kent, Kimble,
				King, Knox, Lamb, Lipscomb, Loving, Lubbock, Lynn, Martin, Mason, Menard,
				McCulloch, Midland, Mills, Mitchell, Montague, Moore, Motley, Nolan, Ochiltree,
				Oldham, Palo Pinto, Parker, Parmer, Pecos, Potter, Presidio, Randall, Reagan,
				Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman,
				Somervell, Stephens, Sterling, Stonewall, Sutton, Swisher, Tarrant, Taylor,
				Terrell, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Wichita,
				Wilbarger, Winkler, Wise, Yoakum, and Young.
(4) District 4 shall consist of the following
				counties: Aransas, Atascosa, Bandera, Bastrop, Basque, Bee, Bell, Bexar,
				Blanco, Brooks, Burleson, Burnet, Caldwell, Calhoun, Cameron, Colorado, Comal,
				Coryell, Dewitt, Dimmit, Duval, Edwards, Falls, Fayette, Fort Bend, Frio,
				Gillespie, Goliad, Gonzales, Guadalupe, Hamilton, Hayes, Hidalgo, Jackson, Jim
				Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kerr, Kinney, Kleburg, Lampasas,
				LaSalle, Lavaca, Lee, Live Oak, Llano, Matagorda, Maverick, McLennan, McMullen,
				Medina, Milam, Nueces, Real, Refugio, San Patricio, Starr, Travis, Uvalde,
				Valverde, Victoria, Washington, Webb, Wharton, Willacy, Williamson, Wilson,
				Zapata, and Zavala.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 191 - DISTRICT REVIEW COMMITTEES › Section 191.3 - Committee Meetings

Current through Reg. 49, No. 28; July 12, 2024
(a) Meetings of the
				committee may be called by the executive director or president of the board.
				When the committee or committee members wish to call a meeting, they shall
				first secure authorization for the meeting from the executive director or the
				president.
(b) Any meeting called
				under any of the above methods shall be promptly brought to the attention of
				the board secretary or executive director in order to comply with all statutory
				requirements of public notice of a committee meeting.
(c) The committee meetings and all committee
				business shall be conducted in accordance with Robert's Rules of Order Newly
				Revised, the Medical Practice Act Tex. Occ. Code Ann. Title 3 Subtitle B, the
				Administrative Procedure Act Tex. Gov't Code Ann. Chapter 2001, and the Texas
				Open Meetings Act Tex. Gov't Code Ann. Chapter 551 as and where each may be
				applicable and consistent with the statutorily confidential nature of the
				board's investigative files and a patient's right to privacy.
(d) The board shall serve as the official
				custodian of records of each district review committee.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 191 - DISTRICT REVIEW COMMITTEES › Section 191.4 - Activities and Scope of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Each district review committee member will endeavor to be reasonably available
				to act as a resource person for board investigators in the event an
				investigator needs assistance from the committee member.
(b) Upon the written request of the board,
				the executive director, or the secretary-treasurer of the board and upon a
				committee member's availability and willingness to do so, committee members may
				on occasion be requested to serve as a public information representative of the
				board. Information delivered at these events by representatives of the board
				shall be factual, consistent with expressed board policy, and shall not be
				personal opinions or viewpoints. No committee or member of a committee,
				including its chairman, shall make or cause to be published any public
				statement representing such to be the official position or policy of the board
				unless such position or policy has been adopted or expressed by the board, nor
				make nor cause to be published any statement or policy statement regarding the
				committee's findings, recommendations, opinions, or conclusions.
(c) After appropriate orientation and
				training by the board and the disciplinary process review committee, district
				review committee members may on occasion be requested by the executive director
				to participate in informal settlement conferences, probationary panels,
				mediation, or perform other duties as may be assigned to committees or
				committee members. Pursuant to Chapter 187 of this title, (relating to
				Procedural Rules), the committee member shall make recommendations for each
				investigative file. A physician committee member who participates in an
				informal settlement conference on a complaint relating to medical competency
				must have the qualifications of an expert panel provided under §
									182.5(2)
				of this title (relating to Expert Panels). A DRC member is not required to meet
				the selection criteria of expert physician reviewers as set out in §
									182.8
				of this title (relating to Expert Physician Reviewers) that requires an expert
				physician reviewer be in the same specialty as a physician who is the subject
				of a complaint.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 191 - DISTRICT REVIEW COMMITTEES › Section 191.5 - Per Diem and Expenses

Current through Reg. 49, No. 28; July 12, 2024
Each district review committee member shall not incur or
				  cause to be incurred any travel expenses, per diem expenses, or other expenses
				  for which the board may be responsible for payment or reimbursement unless such
				  expenses are approved in advance by the executive director or are incurred at
				  the request of the executive director.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 192 - OFFICE-BASED ANESTHESIA SERVICES › Section 192.1 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the contents indicate
				  otherwise.
(1) ACLS--Advanced Cardiac
				Life Support, as defined by the AHA.
(2) AED--Automatic External
				Defibrillator.
(3) AHA--American
				Heart Association.
(4)
				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).
(5) Anesthesia--Use
				of local anesthetics (in amounts that generate the effect of general
				anesthesia, regional anesthesia, or monitored anesthesia care), analgesics,
				anxiolytics, and/or hypnotics to create a loss of feeling or sensation by
				interrupting or depressing nerve function.
(6) Anesthesia Services--The use of
				anesthesia for the performance of Level II - IV services.
(7) Anxiolytics--Dangerous or scheduled drugs
				used to provide sedation and/or to treat episodes of anxiety.
(8) ASHI--American Safety and Health
				Institute.
(9) ASA--American
				Society of Anesthesiologists.
(10)
				BLS--Basic Life Support, as defined by the AHA.
(11) Certified registered nurse anesthetist
				(CRNA)--A person licensed by the Texas Board of Nursing (TBN) as a registered
				professional nurse, authorized by the TBN as an advanced practice nurse in the
				role of nurse anesthetist, and certified by a national certifying body
				recognized by the TBN.
(12)
				Dangerous drugs--Medications defined by the Texas Dangerous Drug Act, Chapter
				483, Texas Health and Safety Code. Dangerous drugs require a prescription, but
				are not included in the list of scheduled drugs. A dangerous drug bears the
				legend "Caution: federal law prohibits dispensing without a prescription" or
				"Prescription Only."
(13)
				Hypnotics--Dangerous or scheduled drugs used to induce unconsciousness. This
				includes inhaled anesthetics and nonvolatile anesthetic agents such as
				Barbiturates, Benzodiazepines, Opioids, Etomidate, Propofol, and
				Ketamine.
(14) Level I
				services--Delivery of analgesics or anxiolytics by mouth, as prescribed for the
				patient on order of a physician, at a dose level low enough to allow the
				patient to remain ambulatory.
(15)
				Level II services--
(A) The administration of
				tumescent anesthesia;
(B) The
				delivery of analgesics or anxiolytics by mouth in dosages greater than allowed
				at Level I, as prescribed for the patient on order of a physician; or
(C) Except as provided by §
										192.2(b)(9)
				of this title (relating to Provision of Anesthesia Services in Outpatient
				Settings), the administration of local anesthesia, peripheral nerve blocks, or
				both in a total dosage amount that exceeds 50 percent of the recommended
				maximum safe dosage per outpatient visit.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 192 - OFFICE-BASED ANESTHESIA SERVICES › Section 192.2 - Provision of Anesthesia Services in Outpatient Settings

Current through Reg. 49, No. 28; July 12, 2024
(a) The purpose of this chapter is to
				identify the roles and responsibilities of physicians providing, or overseeing
				by proper delegation, anesthesia services in outpatient settings and to provide
				the minimum acceptable standards for the provision of anesthesia services in
				outpatient settings.
(b) The rules
				promulgated under this title do not apply to:
(1) an outpatient setting in which only local
				anesthesia, peripheral nerve blocks, or both are used in a total dosage amount
				that does not exceed 50 percent of the recommended maximum safe dosage per
				outpatient visit;
(2) any setting
				physically located outside the State of Texas;
(3) a licensed hospital, including an
				outpatient facility of the hospital that is separately located apart from the
				hospital;
(4) a licensed ambulatory
				surgical center;
(5) a clinic
				located on land recognized as tribal land by the federal government and
				maintained or operated by a federally recognized Indian tribe or tribal
				organization as listed by the United States secretary of the interior under 25
				U.S.C. §479-1 or as listed under a successor federal statute or
				regulation;
(6) a facility
				maintained or operated by a state or governmental entity;
(7) a clinic directly maintained or operated
				by the United States or by any of its departments, officers, or
				agencies;
(8) an outpatient setting
				where the facility itself is accredited as an office-based surgery facility or
				treatment room by:
(A) The Joint Commission
				relating to ambulatory surgical centers;
(B) the American Association for
				Accreditation of Ambulatory Surgery Facilities; or
(C) the Accreditation Association for
				Ambulatory Health Care; and
(9) the performance of Mohs micrographic
				surgery.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 192 - OFFICE-BASED ANESTHESIA SERVICES › Section 192.3 - Compliance with Office-Based Anesthesia Rules

Current through Reg. 49, No. 28; July 12, 2024
(a) A physician who provides anesthesia
				services or performs a procedure for which anesthesia services are provided in
				an outpatient setting shall comply with the rules adopted under this
				title.
(b) The board may require a
				physician to submit and comply with a corrective action plan to remedy or
				address any current or potential deficiencies with the physician's provision of
				anesthesia services in an outpatient setting in accordance with the Medical
				Practice Act, Title 3 Subtitle C §§ 162.101-.107 of the Texas
				Occupations Code, or rules of the board.
(c) Any physician who violates these rules
				shall be subject to disciplinary action and/or termination of the registration
				issued by the board as authorized by the Medical Practice Act or rules of the
				board.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 192 - OFFICE-BASED ANESTHESIA SERVICES › Section 192.4 - Registration

Current through Reg. 49, No. 28; July 12, 2024
(a) Each physician
				who provides anesthesia services or performs a procedure for which anesthesia
				services are provided in an outpatient setting, excluding level I services,
				shall register with the board on a form prescribed by the board and pay a fee
				to the board in an amount established by the board.
(b) The board shall coordinate the
				registration required under this section with the registration required under
				the Medical Practice Act, Texas Occupations Code Chapter 156, so that the times
				of registration, payment, notice, and imposition of penalties for late payment
				are similar and provide a minimum of administrative burden to the board and to
				physicians.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 192 - OFFICE-BASED ANESTHESIA SERVICES › Section 192.5 - Inspections

Current through Reg. 49, No. 28; July 12, 2024
(a) The board may
				conduct inspections to enforce these rules, including inspections of an
				operating surgeon's office site, a mobile anesthesia provider's practice and
				procedures related to storage, transport, and setup of necessary equipment, and
				of documents of such physicians' practices. The board may contract with another
				state agency or qualified person to conduct these inspections.
(b) Unless it would jeopardize an ongoing
				investigation, the board shall provide at least five business days' notice
				before conducting an on-site inspection under this section.
(c) This section does not require the board
				to make an on-site inspection of a physician's office.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 192 - OFFICE-BASED ANESTHESIA SERVICES › Section 192.6 - Requests for Inspection and Advisory Opinion

Current through Reg. 49, No. 28; July 12, 2024
(a) The board may consider a request by a
				physician for an on-site inspection offering office-based anesthesia. The board
				may, in its discretion and on payment of a fee in an amount established by the
				board, conduct the inspection and issue an advisory opinion.
(b) An advisory opinion issued by the board
				under this section is not binding on the board, and the board, except as
				provided by subsection (c) of this section, may take any action under the
				Medical Practice Act, in relation to the situation addressed by the advisory
				opinion that the board considers appropriate.
(c) A physician who requests and relies on an
				advisory opinion of the board may use the opinion as mitigating evidence in an
				action or proceeding to impose an administrative or civil penalty under the
				Medical Practice Act. The board or court, as appropriate, shall take proof of
				reliance on an advisory opinion into consideration and mitigate the imposition
				of administrative or civil penalties accordingly.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) The purpose of
				this chapter is to encourage the more effective utilization of the skills of
				physicians by establishing guidelines for the delegation of health care tasks
				to qualified non-physicians providing services under reasonable physician
				control and supervision where such delegation is consistent with the patient's
				health and welfare; and to provide guidelines for physicians in order that
				existing legal constraints should not be an unnecessary hindrance to the more
				effective provision of health care services. Texas Occupations Code Annotated,
				§§ 164.001, 164.052, and 164.053 empower the Texas Medical Board to
				cancel, revoke or suspend the license of any practitioner of medicine upon
				proof that such practitioner is guilty of failing to supervise adequately the
				activities of persons acting under the physician's supervision, allowing
				another person to use his license for the purpose of practicing medicine, or of
				aiding or abetting, directly or indirectly, the practice of medicine by a
				person or entity not licensed to do so by the board. The board recognizes that
				the delivery of quality health care requires expertise and assistance of many
				dedicated individuals in the allied health profession. The provisions of this
				chapter are not intended to, and shall not be construed to, restrict the
				physician from delegating administrative and technical or clinical tasks not
				involving the exercise of medical judgment, to those specially trained
				individuals instructed and directed by a licensed physician who accepts
				responsibility for the acts of such allied health personnel. The board
				recognizes that statutory law shall prevail over any rules adopted and that the
				practice of medicine is, under Texas Occupations Code Annotated §
				151.002(13), defined as follows: A person shall be considered to be practicing
				medicine within the Medical Practice Act ("the Act"):
(1) who shall publicly profess to be a
				physician or surgeon and shall diagnose, treat, or offer to treat, any disease
				or disorder, mental or physical, or any physical deformity or injury, by any
				system or method, or to effect cures thereof; or
(2) who shall diagnose, treat, or offer to
				treat any disease or disorder, mental or physical or any physical deformity or
				injury by any system or method and to effect cures thereof and charge therefor,
				directly or indirectly, money or other compensation.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.2 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the contents clearly indicate
				  otherwise.
(1) Advanced practice
				registered nurse--A registered nurse approved by the Texas Board of Nursing to
				practice as an advanced practice nurse on the basis of completion of an
				advanced educational program. The term includes an advanced nurse practitioner,
				a nurse midwife, nurse anesthetist, clinical nurse specialist, and advanced
				practice nurse, as defined by Texas Occupations Code Annotated, §
				301.152.
(2) Authorizing
				physician--A physician or physicians licensed by the board who execute a
				standing delegation order or prescriptive authority agreement.
(3) Controlled substance--A substance,
				including a drug, an adulterant, and a dilutant, listed in Schedules I through
				V or Penalty Groups 1, 1-A, or 2 through 4 as described under the Texas Health
				and Safety Code, Chapter 481 (Texas Controlled Substances Act). The term
				includes the aggregate weight of any mixture, solution, or other substance
				containing a controlled substance.
(4) Dangerous drug--A device or a drug that
				is unsafe for self medication and that is not included in the Texas Health and
				Safety Code, Schedules I-V or Penalty Groups I-IV of Chapter 481 (Texas
				Controlled Substances Act). The term includes a device or a drug that bears or
				is required to bear the legend: "Caution: federal law prohibits dispensing
				without prescription".
(5)
				Device--Means an instrument, apparatus, implement, machine, contrivance,
				implant, in vitro reagent, or other similar or related article, including a
				component part or accessory, that is required under federal or state law to be
				ordered or prescribed by a practitioner, as defined by §
									551.003 of the
				Occupations Code.
(6) Facility
				based practice site--A hospital, as defined by § 157.051(6) of the Act and
				this chapter, or a licensed long-term care facility. A facility-based practice
				does not include a freestanding clinic, center or other medical practice
				associated with or owned or operated by, a hospital or licensed long-term care
				facility.
(7) Health professional
				shortage area (HPSA)--
(A) an urban or rural
				area of this state that:
(i) is not required
				to conform to the geographic boundaries of a political subdivision but is a
				rational area for the delivery of health services;
(ii) the secretary of health and human
				services determines has a health professional shortage; and
(iii) is not reasonably accessible to an
				adequately served area;
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.3 - Exclusion from the Provisions of this Chapter

Current through Reg. 49, No. 28; July 12, 2024
The provisions of this chapter shall not restrict physicians
				  from authorizing the provision of patient care by use of pre-established
				  programs under the following circumstances listed in paragraphs (1) - (6) of
				  this section:
(1) where a patient is
				institutionalized and the care is to be delivered in a hospital, nursing home,
				or other institution which has an organized medical staff which has authorized
				or approved standing delegation orders or standing medical orders;
(2) where care is rendered in an emergency.
				Emergency care is that care provided to a person who is unconscious, ill, or
				injured, when the reasonable apparent circumstances require prompt decisions
				and actions in care and when the necessity of immediate care is so reasonably
				apparent that any delay in the rendering of care or treatment would seriously
				worsen the physical condition or endanger the life of the person;
(3) where care is rendered as a part of
				disaster relief and charges for the services are not made;
(4) where limitation from civil liability is
				provided under the Texas Civil Practice and Remedies Code, §
									74.151;
(5) where first aid care is provided at the
				site of an injury or as an interim measure prior to transfer of the patient to
				a medical facility where medical services are available;
(6) where care rendered is provided by
				licensed health professional acting within the scope of the licensed profession
				as defined by Texas Occupations Code Annotated.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.5 - Physician Liability for Delegated Acts and Enforcement

Current through Reg. 49, No. 28; July 12, 2024
(a) A physician shall not be liable for the
				act or acts of a physician assistant or advanced practice registered nurse
				solely on the basis of having signed an order, a standing medical order, a
				standing delegation order, a prescriptive authority agreement, or other order
				or protocol, authorizing a physician assistant or advanced practice registered
				nurse to administer, provide, prescribe or order a drug or device, unless the
				physician has reason to believe the physician assistant or advanced practice
				registered nurse lacked the competency to perform the act or acts.
(b) Notwithstanding subsection (a) of this
				section, delegating physicians remain responsible to the Board and to their
				patients for acts performed under the physician's delegated
				authority.
(c) Any physician
				authorizing standing delegation orders or standing medical orders which
				authorize the exercise of independent medical judgment or treatment shall be
				subject to having his or her license to practice medicine in the State of Texas
				revoked or suspended under §§ 164.001, 164.052, and 164.053 of the
				Act.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.6 - Delegation of Prescribing and Ordering Drugs and Devices

Current through Reg. 49, No. 28; July 12, 2024
(a) Pursuant to § 157.0511 of the Act, a
				physician's authority to delegate the prescribing or ordering of a drug or
				device is limited to:
(1) nonprescription
				drugs;
(2) dangerous drugs;
				and
(3) controlled substances to
				the extent provided in subsections (b) and (c) of this section.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.7 - Prescriptive Authority Agreements Generally

Current through Reg. 49, No. 28; July 12, 2024
(a) A physician may delegate to an advanced
				practice registered nurse or physician assistant, acting under adequate
				physician supervision, the act of prescribing or ordering a drug or device as
				authorized through a prescriptive authority agreement between the physician and
				the advanced practice registered nurse or physician assistant, as
				applicable.
(b) A physician and an
				advanced practice registered nurse or physician assistant are eligible to enter
				into or be parties to a prescriptive authority agreement only if:
(1) if applicable, the Texas Board of Nursing
				has approved the advanced practice registered nurse's authority to prescribe or
				order a drug or device as authorized under this chapter;
(2) the advanced practice registered nurse or
				physician assistant:
(A) holds an active
				license to practice in this state as an advanced practice registered nurse or
				physician assistant, as applicable, and is in good standing in this state;
				and
(B) is not currently prohibited
				by the Texas Board of Nursing or the Texas Physician Assistant Board, as
				applicable, from executing a prescriptive authority agreement.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.10 - Registration of Delegation and Prescriptive Authority Agreements

Current through Reg. 49, No. 28; July 12, 2024
(a) The Board shall
				maintain and exchange information with the Texas Board of Nursing, and the
				Texas Physician Assistant Board, regarding the names locations and license
				numbers, of each physician, advanced practice registered nurse, and physician
				assistant who has entered into a prescriptive authority agreement.
(1) The Board shall immediately notify the
				Texas Physician Assistant Board and the Texas Board of Nursing when a license
				holder of the Board who has registered a prescriptive authority agreement(s)
				becomes the subject of an investigation involving the delegation and
				supervision of prescriptive authority, as well as the final disposition of any
				such investigation. Such notifications shall be made subject to, and without
				waiving any confidentiality provisions related to board investigations provided
				for under the Act and this Title.
(2) The Board shall maintain and share with
				the other boards a list of board license holders who have been subject to
				disciplinary action involving the delegation and supervision of prescriptive
				authority.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.11 - Prescription Forms

Current through Reg. 49, No. 28; July 12, 2024
Prescription forms shall comply with applicable rules adopted
				  by the Texas State Board of Pharmacy. A delegating physician is responsible for
				  devising and enforcing a system to account for and monitor the issuance of
				  prescriptions under the physician's supervision.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.12 - Prescriptive Authority Agreement Inspections

Current through Reg. 49, No. 28; July 12, 2024
If the board receives a notice under § 157.0513(a)(2) of
				  the Act, the board or an authorized board representative may enter, with
				  reasonable notice and at a reasonable time, unless the notice would jeopardize
				  an investigation, a site where a party to a prescriptive authority agreement
				  practices to inspect and audit any records or activities relating to the
				  implementation and operation of the agreement. To the extent reasonably
				  possible, the board and the board's authorized representative shall conduct any
				  inspection or audit under this section in a manner that minimizes disruption to
				  the delivery of patient care. The board may use information obtained during the
				  inspection for any purpose allowed under the law, including licensure and
				  enforcement.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.13 - Delegation to Certified Registered Nurse Anesthetists

Current through Reg. 49, No. 28; July 12, 2024
(a) In a licensed hospital or ambulatory
				surgical center a physician may delegate to a certified registered nurse
				anesthetist the ordering of drugs and devices necessary for a certified
				registered nurse anesthetist to administer an anesthetic or an
				anesthesia-related service ordered by the physician. The physician's order for
				anesthesia or anesthesia-related services does not have to be drug-specific,
				dose-specific, or administration-technique-specific. Pursuant to the order and
				in accordance with facility policies or medical staff bylaws, the nurse
				anesthetist may select, obtain, and administer those drugs and apply the
				appropriate medical devices necessary to accomplish the order and maintain the
				patient within a sound physiological status.
(b) A physician who delegates to a certified
				registered nurse anesthetist the ordering of drugs and devices necessary for
				the certified registered anesthetist to administer an anesthetic or an
				anesthesia-related service is not required to register the name and license
				number of the certified registered nurse anesthetist with the board.
(c) This section shall be liberally construed
				to permit the full use of safe and effective medication orders to utilize the
				skills and services of certified registered nurse anesthetists.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.14 - Delegation Related to Obstetrical Services

Current through Reg. 49, No. 28; July 12, 2024
(a) A physician may delegate to a physician
				assistant offering obstetrical services and certified by the board as
				specializing in obstetrics or an advanced practice registered nurse recognized
				by the Texas Board of Nursing as a nurse midwife the act or acts of
				administering or providing controlled substances to the nurse midwife's or
				physician assistant's clients during intra-partum and immediate post-partum
				care. The physician shall not delegate the use of a prescription sticker or the
				use or issuance of an official prescription form relating to the prescription
				of Schedule II controlled substance as described under §
									481.075
				of the Health and Safety Code.
(b)
				The delegation of authority to administer or provide controlled substances
				under this section must be under a physician's order, medical order, standing
				delegation order, prescriptive authority agreement, or protocol which shall
				require adequate and documented availability for access to medical
				care.
(c) The physician's orders,
				medical orders, standing delegation orders, prescriptive authority agreements,
				or protocols shall provide for reporting or monitoring of client's progress
				including complications of pregnancy and delivery and the administration and
				provision of controlled substances by the nurse midwife or physician assistant
				to the clients of the nurse midwife or physician assistant.
(d) The authority of a physician to delegate
				under this section is limited to:
(1) seven
				nurse midwives or physician assistants or their full-time equivalents;
				and
(2) the designated facility at
				which the nurse midwife or physician assistant provides care.