H.B. No. 756
1-1 AN ACT
1-2 relating to the regulation of the practice of professional nursing.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Article 4525a, Revised Statutes, is amended by
1-5 amending Sections 1, 2, 3, and 4 and adding Sections 1A, 6A, and
1-6 12A to read as follows:
1-7 Sec. 1. Each registered nurse having reasonable cause to
1-8 suspect that a registered nurse has exposed or is likely to expose
1-9 a patient or other person unnecessarily to a risk of harm, has
1-10 engaged in <because of> unprofessional conduct, has failed
1-11 <failure> to care adequately for a patient, or has failed <failure>
1-12 to conform to the minimum standards of acceptable professional
1-13 nursing practice, or that a registered nurse's practice is or is
1-14 likely to be impaired by chemical dependency <impaired status>
1-15 shall report in a signed, written report to the board the identity
1-16 <name> of the nurse <committing the violation or suspected
1-17 violation> and such additional <any other pertinent> information
1-18 <within the nurse's knowledge> as the board may require. <A
1-19 registered nurse without personal knowledge of the nurse's actions
1-20 is not required to report under this section if she or he has
1-21 reasonable cause to believe the nurse has already been reported.>
1-22 Sec. 1A. A professional nursing peer review committee
1-23 operating under Article 4525b, Revised Statutes, that finds a
2-1 registered nurse exposed or is likely to expose a patient or other
2-2 person unnecessarily to a risk of harm, engaged in unprofessional
2-3 conduct, failed to care adequately for a patient, or failed to
2-4 conform to the minimum standards of acceptable professional nursing
2-5 practice, or that a registered nurse's practice is or is likely to
2-6 be impaired by chemical dependency shall report in a signed,
2-7 written report to the board the identity of the nurse and such
2-8 additional information as the board may require. The report shall
2-9 include what corrective action was taken against the nurse and
2-10 whether the committee recommends the board take formal disciplinary
2-11 action against the nurse.
2-12 Sec. 2. (a) Each hospital, health science center, nursing
2-13 home, home health agency, other health-care facility, state agency,
2-14 political subdivision, school of professional nursing, temporary
2-15 nursing service, or person that employs, hires, or contracts for
2-16 the services of registered nurses that terminates, suspends for
2-17 more than 7 days, or takes other substantive disciplinary action as
2-18 defined by the board against a registered nurse because the
2-19 registered nurse has exposed or is likely to expose a patient or
2-20 other person <was exposed or is likely to be exposed> unnecessarily
2-21 to a risk of harm, has engaged in <because of> unprofessional
2-22 conduct, has failed <failure> to care adequately for a patient, or
2-23 has failed <failure> to conform to the minimum standards of
2-24 acceptable professional nursing practice<,> or because the
2-25 registered nurse's practice is or is likely to be impaired by
3-1 chemical dependency <impaired status> shall report in writing to
3-2 the board the identity <name> of the nurse and such additional
3-3 information as the board may require <other pertinent information
3-4 within the knowledge of the facility, agency, school, or person>.
3-5 (b) Each hospital, nursing home, health science center, home
3-6 health agency, other health-care facility, state agency, political
3-7 subdivision, school of professional nursing, temporary nursing
3-8 service, or person that regularly employs, hires, or otherwise
3-9 contracts for the services of 10 or more registered nurses shall
3-10 develop a written plan for identifying and reporting registered
3-11 nurses in its service who expose or are likely to expose patients
3-12 or other persons unnecessarily to a risk of harm, engage in
3-13 <because of> unprofessional conduct, fail <failure> to care
3-14 adequately for a patient, or fail <failure> to conform to the
3-15 minimum standards of acceptable professional nursing practice, or
3-16 whose practice is or is likely to be impaired by chemical
3-17 dependency <impaired status>. The plan must include an appropriate
3-18 process for the review of any incident reportable under this
3-19 section by a professional nursing peer review committee established
3-20 and operated under Article 4525b, Revised Statutes, and for the
3-21 affected nurse to submit rebuttal information to that committee.
3-22 The board shall enter into memoranda of understanding with any
3-23 state agency that licenses, registers, or certifies health-care
3-24 facilities or agencies or surveys such facilities or agencies with
3-25 respect to professional nursing care as to how that state agency
4-1 can promote compliance with this subsection.
4-2 (c) The requirement that a report to the board be reviewed
4-3 by a professional nursing peer review committee applies only to a
4-4 required report, and review by the peer review committee is only
4-5 advisory. The requirement may not be construed as subjecting an
4-6 employer's or other person's administrative decision to discipline
4-7 a registered nurse to the peer review process or as preventing an
4-8 employer or other person from taking disciplinary action before
4-9 review by the peer review committee is conducted. The review by
4-10 the peer review committee established under Subsection (b) of this
4-11 section must include a determination as to whether or not the nurse
4-12 undergoing review <engaged in conduct that> exposed or was likely
4-13 to expose a patient or other person unnecessarily to risk of harm,
4-14 engaged in <because of> unprofessional conduct, failed <failure> to
4-15 care adequately for a patient, or failed <failure> to conform to
4-16 the minimum standards of acceptable professional nursing practice,
4-17 or as to whether the registered nurse's practice is or is likely to
4-18 be impaired by chemical dependency <impaired status>. The peer
4-19 review committee's determination shall be included in the report
4-20 made to the board under Subsection (a) of this section.
4-21 Sec. 3. Each professional association of registered nurses
4-22 or any organization that conducts a certification or accreditation
4-23 program for registered nurses that expels, decertifies, or takes
4-24 any other substantive disciplinary action, as defined by the board,
4-25 against a registered nurse as a result of the registered nurse's
5-1 failure to conform to the minimum standards of acceptable
5-2 professional nursing practice shall report in writing to the board
5-3 the identity of the nurse <nurse's name> and such additional
5-4 information <other pertinent information within the organization's
5-5 knowledge> as the board may require.
5-6 Sec. 4. Each state agency that licenses, registers or
5-7 certifies <surveys> hospitals, nursing homes, health science
5-8 centers, home health agencies, or other health-care facilities or
5-9 agencies or surveys such facilities or agencies with respect to
5-10 quality of professional nursing care provided, unless otherwise
5-11 expressly prohibited by state or federal law, shall report in
5-12 writing to the board any registered nurse that it has reason to
5-13 believe exposed or is likely to expose patients or other persons
5-14 unnecessarily to a risk of harm, engaged in <because of>
5-15 unprofessional conduct, failed <failure> to care adequately for a
5-16 patient, or failed <failure> to conform to the minimum standards of
5-17 acceptable professional nursing practice, or that the registered
5-18 nurse's practice is or is likely to be impaired by chemical
5-19 dependency <impaired status>.
5-20 Sec. 6A. (a) The board by rule shall adopt rules governing
5-21 required reporting under this article to minimize:
5-22 (1) unnecessary duplicative reporting; and
5-23 (2) the reporting of minor incidents.
5-24 (b) In this section, "minor incident" means conduct that
5-25 does not indicate the nurse's continuing to practice professional
6-1 nursing poses a risk of harm to a client or other person.
6-2 Sec. 12A. (a) Except as provided by Subsections (b) and (c)
6-3 of this section, a report under this article shall be handled as a
6-4 complaint under Section (b), Article 4525, Revised Statutes.
6-5 (b) If the board determines that the conduct reported does
6-6 not indicate the reported nurse's continuing to practice
6-7 professional nursing poses a risk of harm to clients or other
6-8 persons, the board may, with the written consent of the reported
6-9 nurse and the person making the report, elect not to proceed with
6-10 an investigation or to file formal charges. In such event, the
6-11 board shall keep a record of the report and shall investigate if it
6-12 receives two or more reports involving separate incidents on a
6-13 nurse in any five-year period.
6-14 (c) The board is not required to investigate a report filed
6-15 by an insurer under Section 5 of this article, but shall maintain a
6-16 record of the report and investigate if it receives two or more
6-17 reports involving separate incidents on a nurse in any five-year
6-18 period.
6-19 SECTION 2. Section 11(c), Article 4525a, Revised Statutes,
6-20 is amended to read as follows:
6-21 (c) A person who sues under this section has the burden of
6-22 proof, but in the event of a determination by either the board or a
6-23 court of competent jurisdiction that the report or abstract made
6-24 the subject of the cause of action was authorized or required under
6-25 Section 1, 1A, 2, 3, 4, 5, 6, 7, or 8 of this article and that it
7-1 was made without malice, it is a rebuttable presumption that a
7-2 person's employment was suspended or terminated for reporting under
7-3 this article if the person is suspended or terminated within 60
7-4 days after making the report.
7-5 SECTION 3. Sections 12(a) and (b), Article 4525a, Revised
7-6 Statutes, are amended to read as follows:
7-7 (a) The board shall notify each registered nurse who is
7-8 reported to the board under Section 1, 1A, 2, 3, 4, or 5 of this
7-9 article of the filing of the report unless doing so would
7-10 jeopardize an active investigation.
7-11 (b) The registered nurse or the nurse's authorized
7-12 representative is entitled on request to review any report
7-13 submitted to the board under Section 1, 1A, 2, 3, 4, or 5 of this
7-14 article unless doing so would jeopardize an active investigation.
7-15 The identity of the individual making or signing the report may not
7-16 be revealed.
7-17 SECTION 4. Section 1(1), Article 4525b, Revised Statutes, is
7-18 amended to read as follows:
7-19 (1) "Professional nursing peer review committee" means
7-20 a committee <composed of at least a majority of registered nurses>
7-21 established under the authority of the governing body of a
7-22 national, state, or local professional nursing association, a
7-23 school of professional nursing, the nursing staff of a hospital,
7-24 health science center, nursing home, home health agency, temporary
7-25 nursing service, or other health-care facility, or state agency or
8-1 political subdivision for the purpose of conducting peer review. A
8-2 professional nursing peer review committee includes the employees
8-3 and agents of the committee, including assistants, investigators,
8-4 intervenors, attorneys, and any other person or organization that
8-5 is employed by or serves the committee in any capacity.
8-6 SECTION 5. Article 4525b, Revised Statutes, is amended by
8-7 adding Sections 1A and 1B to read as follows:
8-8 Sec. 1A. A professional nursing peer review committee must:
8-9 (1) have registered nurses as three-fourths of its
8-10 members;
8-11 (2) have only registered nurses as voting members;
8-12 (3) to the extent feasible, consist of at least one
8-13 registered nurse who has a working familiarity with the area of
8-14 nursing practice in which the nurse being reviewed practices;
8-15 (4) afford the nurse being reviewed minimum due
8-16 process, including notice and opportunity for hearing; and
8-17 (5) afford the nurse the opportunity to file a
8-18 rebuttal statement as provided by Section 3(c) of this article.
8-19 Sec. 1B. A registered nurse who, as a temporary agency
8-20 nurse, faculty member, or similar personnel, practices professional
8-21 nursing for a person, educational institution, or health-care
8-22 facility, agency, or entity other than the one that employs or
8-23 directly compensates the nurse shall be subject to peer review by
8-24 both. For the purposes of exchange of information, the peer review
8-25 committee reviewing the nurse's conduct is considered as
9-1 established under the authority of both. The two entities may
9-2 contract with respect to which entity will conduct peer review of
9-3 the nurse.
9-4 SECTION 6. Sections 3(b) and (d), Article 4525b, Revised
9-5 Statutes, are amended to read as follows:
9-6 (b) A professional nursing peer review committee may
9-7 disclose written or oral communications made to the committee and
9-8 the records and proceedings of the committee to:
9-9 (1) the state board of registration or licensure of
9-10 any state;
9-11 (2) a law enforcement authority investigating a
9-12 criminal matter;
9-13 (3) <(1)> the association, school, agency, facility,
9-14 or other organization under whose authority the committee is
9-15 established;
9-16 (4) <(2)> another professional nursing peer review
9-17 committee;
9-18 (5) <(3)> a peer assistance program approved by the
9-19 board under Chapter 467, Health and Safety Code;
9-20 (6) <(4)> appropriate state or federal agencies or
9-21 accrediting organizations which accredit health-care facilities or
9-22 schools of nursing or which survey facilities for quality of care;
9-23 or
9-24 (7) <(5)> persons engaged in bona fide research, if
9-25 all individual-identifying information is deleted.
10-1 (d) If a committee discloses information <to a nurse> under
10-2 this section, the committee has not by that action waived the
10-3 privilege of nondisclosure of committee information and
10-4 proceedings.
10-5 SECTION 7. Section (c), Article 4523, Revised Statutes, is
10-6 amended to read as follows:
10-7 (c) To allow a nurse to satisfy a requirement imposed by the
10-8 board <under Article 4526, Revised Statutes,> to renew an expired
10-9 <a> license <expired for two years or more or a requirement imposed
10-10 under Article 4526b, Revised Statutes>, to reactivate an inactive
10-11 <a nursing> license <from inactive status>, or to reissue a
10-12 suspended, revoked, or surrendered license, the board may issue a
10-13 temporary permit to practice professional nursing for the limited
10-14 purpose of satisfying the requirement. A permit issued under this
10-15 subsection expires on the earlier of the receipt of a permanent
10-16 license or six months from the date of issuance.
10-17 SECTION 8. Subsections (a), (b), and (c), Article 4525,
10-18 Revised Statutes, are amended to read as follows:
10-19 (a) The board <of nurse examiners> may refuse to admit
10-20 persons to the licensing examination <its examinations>, <may
10-21 refuse> to issue or renew a license, <or certificate of
10-22 registration> or <to issue a certificate of re-registration, may
10-23 refuse> to issue a temporary permit for any of the reasons for
10-24 which the board may take disciplinary action against a registered
10-25 nurse under Subsection (b) of this article. If the board proposes
11-1 to refuse to admit a person to the examination, to issue or renew a
11-2 license, or to issue a temporary permit, the board shall notify the
11-3 person of the basis for its decision. A person who is refused
11-4 admittance to the examination or the renewal or issuance of a
11-5 license or temporary permit is entitled to a hearing before an
11-6 administrative law judge of the State Office of Administrative
11-7 Hearings.
11-8 (b) The board may take disciplinary action against a
11-9 registered nurse<, may issue a warning or reprimand with or without
11-10 stipulations, may suspend for any period not to exceed 5 years, or
11-11 may revoke the license or certificate of any practitioner of
11-12 professional nursing,> for any of the following reasons:
11-13 (1) The violation of any of the provisions of this
11-14 law, any rule, regulation not inconsistent with this law, or order
11-15 issued hereinunder.
11-16 (2) Fraud <Is guilty of fraud> or deceit in procuring
11-17 or attempting to procure a license to practice professional
11-18 nursing.
11-19 (3) Conviction of a crime of the grade of felony, or a
11-20 crime of lesser grade which involves moral turpitude, or any
11-21 conduct resulting in the revocation of probation imposed pursuant
11-22 to such conviction.
11-23 (4) The use of any nursing license, certificate,
11-24 diploma or permit, or transcript of such license, certificate,
11-25 diploma or permit, which has been fraudulently purchased, issued,
12-1 counterfeited, or materially altered.
12-2 (5) The impersonation of, or the acting as a proxy
12-3 for, another in any examination required by law to obtain a license
12-4 to practice professional nursing.
12-5 (6) Aiding or abetting, directly or indirectly, or in
12-6 any manner whatsoever, any unlicensed person in connection with the
12-7 unauthorized practice of professional nursing.
12-8 (7) Revocation, suspension, or denial of or any other
12-9 action relating to the license to practice nursing in another
12-10 jurisdiction. Certified copy of the order of denial, suspension,
12-11 revocation, or any other action shall be conclusive evidence
12-12 thereof.
12-13 (8) Intemperate use of alcohol or drugs that the board
12-14 determines endangers or could endanger patients. Intemperate use
12-15 includes but is not limited to practicing professional nursing or
12-16 being on duty or call while under the influence of alcohol or
12-17 drugs.
12-18 (9) Unprofessional or dishonorable conduct which, in
12-19 the opinion of the board, is likely to deceive, defraud, or injure
12-20 patients or the public.
12-21 (10) Adjudication of mental incompetency.
12-22 (11) Lack of fitness to practice by reason of mental
12-23 or physical health that could result in injury to patients or the
12-24 public.
12-25 (12) Failing to care adequately for patients or to
13-1 conform to the minimum standards of acceptable professional nursing
13-2 practice that, in the opinion of the board, exposes a patient or
13-3 other person unnecessarily to risk of harm.
13-4 <(b) Proceedings under this article shall be begun by filing
13-5 a written complaint with the board of nurse examiners. Such
13-6 complaint may be made by any person or filed by the board on its
13-7 own initiative. Unless it would jeopardize an investigation, the
13-8 board shall notify the registered nurse that a complaint has been
13-9 filed and the nature of the complaint. An information file about
13-10 each complaint filed relating to a licensee shall be maintained by
13-11 the board. If a written complaint is filed with the board relating
13-12 to a licensee, the board at least as frequently as quarterly and
13-13 until final disposition of the complaint, shall notify the party
13-14 that filed the complaint of the status of the file unless notice
13-15 would jeopardize an investigation. The board shall make a timely
13-16 and appropriate preliminary investigation of the complaint and may
13-17 issue a warning or reprimand to the person against whom the
13-18 complaint was filed. If the investigation reveals probable cause
13-19 to take further disciplinary action, the board shall file formal
13-20 charges against the registered nurse stating the provisions of this
13-21 chapter or the board's rules that are alleged to have been violated
13-22 and a brief description of the acts or omissions that constituted
13-23 the violation. If the board proposes to refuse to admit a person
13-24 to its examination, to refuse to issue a temporary permit, license,
13-25 certificate of registration, certificate of re-registration, or to
14-1 suspend or revoke a person's permit, license, or certificate, the
14-2 person is entitled to a hearing before the board. The hearing may
14-3 be before a subcommittee of the board, a majority of which is
14-4 composed of registered nurses. The person shall on request be
14-5 granted a hearing before the entire board. Proceedings for a
14-6 disciplinary action are governed by the Administrative Procedure
14-7 and Texas Register Act (Article 6252-13a, Vernon's Texas Civil
14-8 Statutes). The board may assess a person found to have violated
14-9 any provision of this chapter the administrative costs of
14-10 conducting a hearing to determine that violation. If a licensed
14-11 professional nurse voluntarily surrenders his or her license to the
14-12 board and executes a sworn statement that he or she no longer
14-13 desires to be licensed, the board may revoke his or her license
14-14 without the necessity of formal charges, notice, or opportunity of
14-15 hearing.>
14-16 (c)(1) Any person against whom the board has taken adverse
14-17 action under this chapter <whose license or certificate to practice
14-18 professional nursing has been revoked or suspended by the board or
14-19 who has been otherwise disciplined by the board> may take an appeal
14-20 to any of the district courts in the county of residence or in
14-21 Travis County, but the decision of the board shall not be enjoined
14-22 or stayed except on application to such district courts after
14-23 notice to the board.
14-24 (2) Upon application the board may reissue a license
14-25 or certificate to practice professional nursing to a person whose
15-1 license has been revoked, <or> suspended, or surrendered, but such
15-2 application, in case of revocation, shall not be made prior to one
15-3 year after the revocation was issued and shall be made in such
15-4 manner and form as the board may require. At the time the board
15-5 denies an application for reinstatement, it may set a reasonable
15-6 period that must lapse before the applicant may reapply for
15-7 reinstatement.
15-8 SECTION 9. Chapter 7, Title 71, Revised Statutes, is amended
15-9 by adding Articles 4525.1-4525.6 to read as follows:
15-10 Art. 4525.1. PENALTIES AND SANCTIONS. (a) If the board
15-11 finds a person has committed any act set forth in Subsection (b),
15-12 Article 4525, Revised Statutes, or has violated any provision of
15-13 this chapter or a rule or order of the board, it shall enter an
15-14 order imposing one or more of the following:
15-15 (1) deny the person's application for a license,
15-16 license renewal, or temporary permit;
15-17 (2) issue a written warning;
15-18 (3) administer a public reprimand;
15-19 (4) limit, or restrict the registered nurse's license,
15-20 including limiting the registered nurse's practice to, or excluding
15-21 it from, one or more specified activities of professional nursing
15-22 or stipulating periodic board review;
15-23 (5) suspend the registered nurse's license;
15-24 (6) revoke the registered nurse's license;
15-25 (7) require the registered nurse to submit to care,
16-1 counseling, or treatment of health providers designated by the
16-2 board as a condition for the issuance or renewal of a license;
16-3 (8) require the registered nurse to participate in a
16-4 program of education or counseling prescribed by the board;
16-5 (9) require the registered nurse to practice under the
16-6 direction of a registered nurse designated by the board for a
16-7 specified period of time;
16-8 (10) require the registered nurse to perform public
16-9 service considered appropriate by the board; or
16-10 (11) assess a monetary fine.
16-11 (b) The board may probate any penalty imposed on the
16-12 registered nurse.
16-13 (c) The board in its discretion may accept the voluntary
16-14 surrender of a license. The board may not reinstate a surrendered
16-15 license unless it determines the registered nurse is competent to
16-16 resume practice.
16-17 (d) When the board suspends, revokes, or accepts surrender
16-18 of a license, it may impose conditions for reinstatement that the
16-19 person must satisfy before the board may issue an unrestricted
16-20 license.
16-21 (e) The schedule of sanctions adopted by the board by rule
16-22 shall be used by the State Office of Administrative Hearings for
16-23 any sanction imposed as the result of a hearing conducted by that
16-24 office.
16-25 Art. 4525.2. COMPLAINT AND INVESTIGATION. (a) Any person
17-1 may file a complaint against a registered nurse with the board, or
17-2 the board may file a complaint on its own initiative. The
17-3 complaint shall be in writing and signed by the complainant.
17-4 (b) Except as otherwise provided by this article, all
17-5 investigations shall be conducted by the board or persons
17-6 authorized by the board to conduct them. Each complaint against a
17-7 registered nurse that requires a determination of professional
17-8 nursing competency shall be reviewed by a board member, consultant,
17-9 or employee with professional nursing background considered
17-10 sufficient by the board.
17-11 (c) On the filing of a complaint, the board may conduct a
17-12 preliminary investigation into the identity of the person named or
17-13 described in the complaint. After the preliminary investigation,
17-14 unless it would jeopardize an investigation, the board shall notify
17-15 the registered nurse that a complaint has been filed and the nature
17-16 of the complaint. The board shall make an initial investigation of
17-17 the complaint to determine if formal charges should be filed
17-18 charging the registered nurse with having committed an act or acts
17-19 prohibited by Subsection (b), Article 4525, Revised Statutes, or
17-20 that violate a statute, board rule, or board order. The first
17-21 consideration of the board shall be whether the registered nurse's
17-22 continuing to practice professional nursing poses a risk of harm to
17-23 clients or other persons.
17-24 Art. 4525.3. AGREED DISPOSITION. (a) The board may, unless
17-25 precluded by law or this chapter, make a disposition of any
18-1 complaint by stipulation, agreed settlement, agreed order, or
18-2 dismissal.
18-3 (b) An agreed disposition is considered a disciplinary order
18-4 for purposes of reporting under this chapter and of administrative
18-5 hearings and proceedings by state and federal regulatory agencies
18-6 regarding the practice of professional nursing. An agreed order is
18-7 a public record. In civil or criminal litigation, an agreed
18-8 disposition is a settlement agreement under Rule 408, Texas Rules
18-9 of Civil Evidence, and Rule 408, Texas Rules of Criminal Evidence.
18-10 (c) This article does not apply to a licensee who has
18-11 previously entered into an agreed disposition with the board of a
18-12 different disciplinary matter or whose license the board is seeking
18-13 to revoke.
18-14 Art. 4525.4. RIGHTS OF REGISTERED NURSE. (a) Except in the
18-15 case of a temporary suspension authorized under this chapter or
18-16 action taken in accordance with the terms of an agreement between
18-17 the board and a licensee, a revocation, suspension, or other
18-18 disciplinary action relating to a license is not effective unless,
18-19 before board proceedings are instituted:
18-20 (1) the board has served notice to the registered
18-21 nurse of the facts or conduct alleged to warrant the intended
18-22 action; and
18-23 (2) the registered nurse was given an opportunity to
18-24 show compliance with all requirements of law for the retention of
18-25 the license whether in writing or through informal meeting.
19-1 (b) If an informal meeting is held, any board member, staff
19-2 member, or representative of the board in attendance at the meeting
19-3 shall be considered to have participated in the hearing of the case
19-4 for the purposes of ex parte communications under Section 17 of
19-5 the Administrative Procedure and Texas Register Act (Article
19-6 6252-13a, Vernon's Texas Civil Statutes).
19-7 Art. 4525.5. INITIATION OF FORMAL CHARGES. (a) If the
19-8 board's initial investigation reveals probable cause that the
19-9 registered nurse committed an act or acts prohibited by Subsection
19-10 (b), Article 4525, Revised Statutes, or that violate a statute,
19-11 board rule, or board order, proceedings shall be initiated against
19-12 the registered nurse unless there is an agreed disposition of the
19-13 complaint under Article 4525.3, Revised Statutes. Proceedings
19-14 shall be initiated by the board or its duly authorized
19-15 representative by filing formal charges against the registered
19-16 nurse. A copy of the formal charges shall be served on the
19-17 registered nurse or the nurse's counsel of record.
19-18 (b) Formal charges shall be in writing and shall allege with
19-19 reasonable certainty the specific act or acts relied on by the
19-20 board to constitute a violation of a specific statute, board rule,
19-21 or board order. The formal charges shall be specific enough to
19-22 enable a person of common understanding to know what is meant by
19-23 the formal charges and shall contain a degree of certainty that
19-24 will give the person who is the subject of the formal charges
19-25 notice of the particular act or acts alleged to be a violation of a
20-1 specific statute, board rule, or board order.
20-2 (c) The board shall adopt reasonable rules to promote
20-3 discovery by all parties to contested cases.
20-4 Art. 4525.6. HEARINGS. (a) The board by rule shall adopt
20-5 procedures governing formal disposition of a contested case under
20-6 the Administrative Procedure and Texas Register Act (Article
20-7 6252-13a, Vernon's Texas Civil Statutes). A formal hearing shall
20-8 be conducted by the State Office of Administrative Hearings.
20-9 (b) Not later than the 30th day after receiving a written
20-10 request from a licensee who is the subject of formal charges filed
20-11 under Article 4525.5, Revised Statutes, or from the licensee's
20-12 counsel of record and subject to any other privileges or
20-13 restrictions set forth by rule, statute, or legal precedent, and
20-14 unless good cause is shown for delay, the board shall provide the
20-15 licensee with access to all known exculpatory information in its
20-16 possession and all information in its possession that the board
20-17 intends to offer into evidence in presenting its case in chief at
20-18 the contested hearing on the complaint. However, the board is not
20-19 required to provide board investigative reports or investigative
20-20 memoranda, the identity of nontestifying complainants,
20-21 attorney-client communications, attorney-work product, or other
20-22 materials covered by a privilege as recognized by the Texas Rules
20-23 of Civil Procedure or the Texas Rules of Civil Evidence. The
20-24 furnishing of information does not constitute a waiver of privilege
20-25 or confidentiality under this article, this chapter, or other
21-1 applicable law.
21-2 (c) In all hearings under this article, the registered nurse
21-3 shall have the right to appear either personally or by counsel or
21-4 both.
21-5 SECTION 10. Article 4526b, Revised Statutes, is amended to
21-6 read as follows:
21-7 Art. 4526b. INACTIVE STATUS LIST. Any nurse licensed under
21-8 the provisions of this law, not actively or actually engaged in the
21-9 practice of professional nursing, at the expiration of any such
21-10 license upon written request to the board in such form and manner
21-11 as the board shall determine may be placed on an inactive status
21-12 list which shall be maintained by the board. No professional nurse
21-13 on such inactive status list shall perform any professional nursing
21-14 services or work or violate any of the provisions of this law or
21-15 any rule or regulation of the board so long as on such inactive
21-16 status. At any time such person desires to reenter the active
21-17 practice of professional nursing or again begin performing or
21-18 offering to perform professional nursing services, such person
21-19 shall notify the board and upon payment of appropriate fees and
21-20 meeting requirements as determined by the board shall be removed
21-21 from the inactive status list. The board shall adopt rules
21-22 permitting a nurse on inactive status under this section who is 65
21-23 or older to use the title "Registered Nurse Retired" or "RN
21-24 Retired."
21-25 SECTION 11. Article 4527, Revised Statutes, is amended by
22-1 adding Section 3 to read as follows:
22-2 Sec. 3. The Board may charge a fee in the amount necessary
22-3 to produce and disseminate to its licensees the information
22-4 required under Section 16(a), Article 4525a, Revised Statutes.
22-5 Such fees shall be expended for a periodic newsletter. Any balance
22-6 remaining from this fee at the end of a fiscal year will be carried
22-7 forward for the purposes stated.
22-8 SECTION 12. Section 5, Article 4518, Revised Statutes, is
22-9 amended to read as follows:
22-10 Sec. 5. Insofar as any of the following acts require
22-11 substantial specialized judgment and skill and insofar as the
22-12 proper performance of any of the following acts is based upon
22-13 knowledge and application of the principles of biological,
22-14 physical, and social science as acquired by a completed course in
22-15 an approved school of professional nursing, "Professional Nursing"
22-16 shall be defined as the performance for compensation of any nursing
22-17 act (a) in the observation, assessment, intervention, evaluation,
22-18 rehabilitation, care and counsel and health teachings of persons
22-19 who are ill, injured or infirm or experiencing changes in normal
22-20 health processes; (b) in the maintenance of health or prevention of
22-21 illness; (c) in the administration of medications or treatments as
22-22 ordered by a licensed physician, including a podiatric physician
22-23 licensed by the Texas State Board of Podiatry Examiners, or
22-24 dentist; (d) in the supervision or teaching of nursing; (e) in the
22-25 administration, supervision, and evaluation of nursing practices,
23-1 policies, and procedures; or (f) in the requesting, receiving, and
23-2 signing for professional samples and distributing the samples to
23-3 patients at a site serving underserved populations, as provided by
23-4 Section 3.06(d)(5), Medical Practice Act (Article 4495b, Vernon's
23-5 Texas Civil Statutes), and rules implementing that section. The
23-6 foregoing shall not be deemed to include acts of medical diagnosis
23-7 or prescription of therapeutic or corrective measures. Nothing in
23-8 this section shall be construed as prohibiting a registered nurse
23-9 recognized by the board as having the specialized education and
23-10 training required under Section 7, Article 4514, Revised Statutes,
23-11 and functioning under adequate physician supervision from carrying
23-12 out prescription drug orders or treatments under physician's
23-13 orders, standing medical orders, standing delegation orders, or
23-14 other orders or protocols.
23-15 SECTION 13. This Act takes effect September 1, 1993.
23-16 SECTION 14. The importance of this legislation and the
23-17 crowded condition of the calendars in both houses create an
23-18 emergency and an imperative public necessity that the
23-19 constitutional rule requiring bills to be read on three several
23-20 days in each house be suspended, and this rule is hereby suspended.