73R9642 CAG-D
          By Black                                              H.B. No. 2180
          Substitute the following for H.B. No. 2180:
          By Berlanga                                       C.S.H.B. No. 2180
                                 A BILL TO BE ENTITLED
    1-1                                AN ACT
    1-2  relating to the regulation of the practice of registered nursing
    1-3  and to the continuation of the Board of Nurse Examiners; providing
    1-4  penalties.
    1-6        SECTION 1.  Article 4513, Revised Statutes, is amended to
    1-7  read as follows:
    1-8        Art. 4513.  BOARD OF NURSE EXAMINERS
    1-9        Sec. 1.  Composition of Board; Programs of Study.  The Board
   1-10  of Nurse Examiners is composed of nine members appointed by the
   1-11  governor with the advice and consent of the senate.  Appointments
   1-12  to the board shall be made without regard to the race, color
   1-13  <creed>, disability, sex, religion, age, or national origin of the
   1-14  appointees.  The board <Board of Nurse Examiners> shall prescribe
   1-15  three programs of study to prepare professional nurse
   1-16  practitioners, to wit:  (1) The Baccalaureate Degree Program--A
   1-17  program leading to a baccalaureate degree in nursing conducted by
   1-18  an educational unit in nursing (department, division, school, or
   1-19  college) which is a part of a senior college or university; (2) The
   1-20  Associate Degree Program--A program leading to an associate degree
   1-21  in nursing conducted by an educational unit in nursing within the
   1-22  structure of a college or a university; and (3) The Diploma
   1-23  Program--A program leading to a diploma in nursing conducted by a
   1-24  single purpose school usually under the control of a hospital.  Six
    2-1  of the board members must be Registered Nurses, three of whom shall
    2-2  be engaged in professional nurse education and shall be
    2-3  representative of said three programs in that one shall be a nurse
    2-4  faculty member in a school of nursing pursuing the Baccalaureate
    2-5  Degree Program; one shall be a nurse faculty member in a school of
    2-6  nursing pursuing the Associate Degree Program; and one shall be a
    2-7  nurse faculty member in a school of nursing pursuing the Diploma
    2-8  Program.  Three members must be members of the general public.
    2-9        Sec. 2.  Terms; Requirements of Professional Nurse Members
   2-10  and Public Members.  (a)  The members of the board shall hold
   2-11  office for staggered terms of six years, with the terms of one
   2-12  practicing registered nurse, one professional nurse engaged in
   2-13  nurse education, and one public member expiring on January 31 of
   2-14  odd-numbered years.  The professional nurse members must be
   2-15  actually employed in the nursing profession for at least three
   2-16  years before their appointment.
   2-17        (b)  A person is not eligible for appointment as a public
   2-18  member of the board if the person or the person's spouse:
   2-19              (1)  is registered, certified, or licensed by an
   2-20  occupational regulatory agency in the field of health care;
   2-21              (2)  is employed by or participates in the management
   2-22  of a business entity or other organization regulated by the board
   2-23  or receiving funds from the board;
   2-24              (3)  owns or controls, directly or indirectly, more
   2-25  than a 10 percent interest in a business entity or other
   2-26  organization regulated by the board or receiving funds from the
   2-27  board; or
    3-1              (4)  uses or receives a substantial amount of tangible
    3-2  goods, services, or funds from the board, other than compensation
    3-3  or reimbursement authorized by law for board membership,
    3-4  attendance, or expenses.  <A person is not eligible for appointment
    3-5  as a public member if the person or the person's spouse:>
    3-6              <(1)  is licensed by an occupational regulatory agency
    3-7  in the field of health care;>
    3-8              <(2)  is employed by or participates in the management
    3-9  of a business entity or other organization that provides
   3-10  health-care services or that sells, manufactures, or distributes
   3-11  health-care supplies or equipment; or>
   3-12              <(3)  owns, controls, or has, directly or indirectly,
   3-13  more than a 10 percent interest in a business entity or other
   3-14  organization that provides health-care services or that sells,
   3-15  manufacturers, or distributes health-care supplies or equipment.>
   3-16        Sec. 3.  CONFLICT OF INTEREST RESTRICTIONS.  (a)  An officer,
   3-17  employee, or paid consultant of a Texas trade association in the
   3-18  field of health care may not be a board member.
   3-19        (b)  A person who is the spouse of an officer, manager, or
   3-20  paid consultant of a Texas trade association in the field of health
   3-21  care may not be a board member.
   3-22        (c)  For the purposes of this section, a Texas trade
   3-23  association is a nonprofit, cooperative, and voluntarily joined
   3-24  association of business or professional competitors in this state
   3-25  designed to assist its members and its industry or profession in
   3-26  dealing with mutual business or professional problems and in
   3-27  promoting their common interest.
    4-1        Sec. 4.  EFFECT OF LOBBYING ACTIVITY.  A person may not serve
    4-2  as a board member if the person is required to register as a
    4-3  lobbyist under Chapter 305, Government Code, and its subsequent
    4-4  amendments, because of the person's activities for compensation on
    4-5  behalf of a profession related to the operation of the board.
    4-6        Sec. 5.  GROUNDS FOR REMOVAL FROM BOARD.  (a)  It is a ground
    4-7  for removal from the board if a member:
    4-8              (1)  does not have at the time of appointment the
    4-9  qualifications required by Section 1 of this Act;
   4-10              (2)  does not maintain during service on the board the
   4-11  qualifications required by Section 1 of this Act;
   4-12              (3)  violates a prohibition established by Section 3 or
   4-13  4 of this Act;
   4-14              (4)  cannot discharge the member's term for a
   4-15  substantial part of the term for which the member is appointed
   4-16  because of illness or disability; or
   4-17              (5)  is absent from more than half of the regularly
   4-18  scheduled board meetings that the member is eligible to attend
   4-19  during a calendar year unless the absence is excused by majority
   4-20  vote of the board.
   4-21        (b)  The validity of an action of the board is not affected
   4-22  by the fact that it is taken when a ground for removal of a board
   4-23  member exists.
   4-24        (c)  If the executive director has knowledge that a potential
   4-25  ground for removal exists, the executive director shall notify the
   4-26  presiding officer of the board of the ground.  The presiding
   4-27  officer shall then notify the governor that a potential ground for
    5-1  removal exists.
    5-3  Each board member shall comply with the board member training
    5-4  requirements established by any other state agency that is given
    5-5  authority to establish the requirements for the board.
    5-6        (b)  The board shall provide to its members and employees, as
    5-7  often as necessary, information regarding their qualifications for
    5-8  office or employment under this Act and their responsibilities
    5-9  under applicable laws relating to standards of conduct for state
   5-10  officers or employees.
   5-11        Sec. 7.  STAFF.  The board shall develop and implement
   5-12  policies that clearly define the respective responsibilities of the
   5-13  board and the staff of the board.
   5-14        Sec. 8.  ANNUAL FINANCIAL REPORT.  The board shall file
   5-15  annually with the governor and the presiding officer of each house
   5-16  of the legislature a complete and detailed written report
   5-17  accounting for all funds received and disbursed by the board during
   5-18  the preceding fiscal year.  The annual report must be in the form
   5-19  and reported in the time provided by the General Appropriations
   5-20  Act.
   5-21        Sec. 9.  PERSONNEL POLICIES.  (a)  The executive director or
   5-22  the director's designee shall develop an intra-agency career ladder
   5-23  program.  The program shall require intra-agency posting of all
   5-24  nonentry level positions concurrently with any public posting.
   5-25        (b)  The executive director or the director's designee shall
   5-26  develop a system of annual performance evaluations based on
   5-27  measurable job tasks.  All merit pay for board employees must be
    6-1  based on the system established under this subsection.
    6-2        Sec. 10.  EQUAL EMPLOYMENT OPPORTUNITY POLICIES.  (a)  The
    6-3  executive director or the director's designee shall prepare and
    6-4  maintain a written policy statement to ensure implementation of a
    6-5  program of equal employment opportunity under which all personnel
    6-6  transactions are made without regard to race, color, disability,
    6-7  sex, religion, age, or national origin.  The policy statement must
    6-8  include:
    6-9              (1)  personnel policies, including policies relating to
   6-10  recruitment, evaluation, selection, application, training, and
   6-11  promotion of personnel that are in compliance with the Commission
   6-12  on Human Rights Act (Article 5221k, Vernon's Texas Civil Statutes)
   6-13  and its subsequent amendments;
   6-14              (2)  a comprehensive analysis of the board work force
   6-15  that meets federal and state guidelines;
   6-16              (3)  procedures by which a determination can be made of
   6-17  significant underuse in the board work force of all persons for
   6-18  whom federal or state guidelines encourage a more equitable
   6-19  balance; and
   6-20              (4)  reasonable methods to appropriately address those
   6-21  areas of underuse.
   6-22        (b)  A policy statement prepared under Subsection (a) of this
   6-23  section must cover an annual period, be updated annually, be
   6-24  reviewed by the Commission on Human Rights for compliance with
   6-25  Subsection (a)(1) of this section, and be filed with the governor's
   6-26  office.
   6-27        (c)  The governor's office shall deliver a biennial report to
    7-1  the legislature based on the information received under Subsection
    7-2  (b)  of this section.  The report may be made separately or as part
    7-3  of other biennial reports to the legislature.
    7-4        Sec. 11.  PUBLIC INTEREST INFORMATION.  (a)  The board shall
    7-5  prepare information of public interest describing the functions of
    7-6  the board and the procedures by which complaints are filed with and
    7-7  resolved by the board.  The board shall make the information
    7-8  available to the public and appropriate state agencies.
    7-9        (b)  The board by rule shall establish methods by which
   7-10  consumers and service recipients are notified of the name, mailing
   7-11  address, and telephone number of the board for the purpose of
   7-12  directing complaints to the board.  The board may provide for that
   7-13  notification:
   7-14              (1)  on each registration form, application, or written
   7-15  contract for services of an individual or entity regulated by the
   7-16  board;
   7-17              (2)  on a sign prominently displayed in the place of
   7-18  business of each individual or entity regulated by the board; or
   7-19              (3)  in a bill for service provided by an individual or
   7-20  entity regulated by the board.
   7-21        (c)  The board shall list along with its regular telephone
   7-22  number the toll-free telephone number that may be called to present
   7-23  a complaint about a health professional if the toll-free number is
   7-24  established under other state law.
   7-25        Sec. 12.  PUBLIC PARTICIPATION IN BOARD HEARINGS.  The board
   7-26  shall develop and implement policies that provide the public with a
   7-27  reasonable opportunity to appear before the board and to speak on
    8-1  any issue under the jurisdiction of the board.
    8-2        Sec. 13.  PROGRAM ACCESSIBILITY.  The board shall prepare and
    8-3  maintain a written plan that describes how a person who does not
    8-4  speak English can be provided reasonable access to the board's
    8-5  programs.  The board shall also comply with federal and state laws
    8-6  for program and facility accessibility.
    8-8  board member shall comply with the board member training
    8-9  requirements established by any other state agency that is given
   8-10  authority to establish the requirements for the board.
   8-11        Sec. 15.  INTERAGENCY CONTRACTS.  The board may enter
   8-12  interagency contracts for any purpose authorized by law.
   8-14  or employee of the board may not be an officer, employee, or paid
   8-15  consultant of a national or statewide trade association in the
   8-16  health-care industry.  A member or employee of the board may not be
   8-17  related within the second degree by affinity or within the second
   8-18  degree by consanguinity, as determined under Article 5996h, Revised
   8-19  Statutes, to a person who is an officer, employee, or paid
   8-20  consultant of a national or statewide trade association in the
   8-21  regulated industry.  A person who is required to register as a
   8-22  lobbyist under Chapter 305, Government Code, by virtue of his
   8-23  activities on behalf of a national or statewide trade or
   8-24  professional association in a health-services industry may not
   8-25  serve as a member of the board or act as the general counsel to the
   8-26  board.>
   8-27        <Sec. 4.  GROUNDS FOR REMOVAL.  It is grounds for removal
    9-1  from the board if a member:>
    9-2              <(1)  does not have at the time of appointment the
    9-3  qualifications required for appointment to the board;>
    9-4              <(2)  does not maintain during the service on the board
    9-5  the qualifications for appointment to the board;>
    9-6              <(3)  violates a prohibition imposed on members of the
    9-7  board; or>
    9-8              <(4)  fails to attend at least half of the regularly
    9-9  scheduled board meetings held in a calendar year, excluding
   9-10  meetings held while the person was not a board member.>
   9-11        <Sec. 5.  VALIDITY OF ACTIONS.  The validity of an action of
   9-12  the board is not affected by the fact that it was taken when a
   9-13  ground for removal of a member of the board existed.>
   9-14        SECTION 2.  Article 4513a, Revised Statutes, is amended to
   9-15  read as follows:
   9-16        Art. 4513a.  SUNSET PROVISION
   9-17        The Board of Nurse Examiners is subject to Chapter 325,
   9-18  Government Code (Texas Sunset Act).  Unless continued in existence
   9-19  as provided by that chapter, the board is abolished September 1,
   9-20  2005 <1993>.
   9-21        SECTION 3.  Article 4514, Revised Statutes, is amended to
   9-22  read as follows:
   9-23        Art. 4514.  Organization of board
   9-24        Sec. 1.  President; Special Meetings; Powers.  The members of
   9-25  the board shall elect from their number a president.  Special
   9-26  meetings of said board shall be called by the president acting upon
   9-27  the written request of any two members.  The board shall have the
   10-1  authority and power to make and enforce all rules and regulations
   10-2  necessary for the performance of its duties and conducting of
   10-3  proceedings before it, to establish standards of professional
   10-4  conduct for all persons licensed under the provisions of this law
   10-5  in keeping with its purpose and objectives, to regulate the
   10-6  practice of registered nurses <professional nursing> and to
   10-7  determine whether or not an act constitutes the practice of
   10-8  registered nurses <professional nursing>, not inconsistent with
   10-9  this Act.  Such rules and regulations shall not be inconsistent
  10-10  with the provisions of this law.
  10-11        Sec. 2.  Legislative Disapproval of Rules.  If the
  10-12  appropriate standing committees of both houses of the legislature
  10-13  acting under Subsection (g), Section 5, Administrative Procedure
  10-14  and Texas Register Act, as amended (Article 6252-13a, Vernon's
  10-15  Texas Civil Statutes), transmit to the board statements opposing
  10-16  adoption of a rule under that section, the rule may not take
  10-17  effect, or if the rule has already taken effect, the rule is
  10-18  repealed effective on the date the board receives the committee's
  10-19  statements.
  10-20        Sec. 3.  Rules Restricting Competitive Bidding or Advertising
  10-21  Prohibited.  The board may not promulgate rules restricting
  10-22  competitive bidding or advertising by licensees except to prohibit
  10-23  false, misleading, or deceptive practices by the person.  The board
  10-24  may not include in its rules to prohibit false, misleading, or
  10-25  deceptive practices by a person regulated by the board a rule that:
  10-26                  (1)  restricts the person's use of any medium for
  10-27  advertising;
   11-1              (2)  restricts the person's personal appearance or use
   11-2  of the person's <his or her> voice in an advertisement;
   11-3              (3)  relates to the size or duration of an
   11-4  advertisement by the person; or
   11-5              (4)  restricts the person's advertisement under a trade
   11-6  name.
   11-8  AUTHORITIES.  The executive director <secretary> shall be required
   11-9  to keep a record of each meeting of said board, including a
  11-10  register of the names of all nurses registered under this law,
  11-11  which shall be at all times open to public inspection.  The <board
  11-12  shall prepare information of consumer interest describing the
  11-13  regulatory functions of the board and the board's procedures by
  11-14  which consumer complaints are filed with and resolved by the board.
  11-15  The board shall make the information available to the general
  11-16  public and appropriate state agencies.  Said> board shall assist
  11-17  the proper legal authorities in the prosecution of all persons
  11-18  violating any provision of this law.  Nothing herein shall either
  11-19  expand or contract the board's present powers as they relate to the
  11-20  regulation of nursing education.
  11-21        Sec. 5.  Open Meetings; Administrative Procedure.  The board
  11-22  is subject to the open meetings law, Chapter 271, Acts of the 60th
  11-23  Legislature, Regular Session, 1967, as amended (Article 6252-17,
  11-24  Vernon's Texas Civil Statutes), and the Administrative Procedure
  11-25  and Texas Register Act, as amended (Article 6252-13a, Vernon's
  11-26  Texas Civil Statutes).
  11-27        Sec. 6.  Recommendation of Rules Relating to Delegation of
   12-1  Medical Acts by Physicians.  The board may recommend to the Texas
   12-2  State Board of Medical Examiners the adoption of rules relating to
   12-3  physician's delegating medical acts to registered nurses <persons>
   12-4  licensed by the board.  The recommendations shall be acted on in
   12-5  the same manner as a petition for the adoption of a rule by an
   12-6  interested party under the Administrative Procedure and Texas
   12-7  Register Act, as amended (Article 6252-13a, Vernon's Texas Civil
   12-8  Statutes).  The board in making recommendations may distinguish
   12-9  between nurses on the basis of special training and education.  The
  12-10  board <Board of Nurse Examiners> in recommending rules and the
  12-11  Texas State Board of Medical Examiners in acting on recommended
  12-12  rules shall act, to the extent allowable under state and federal
  12-13  statutes and regulations, so as to permit the state to obtain its
  12-14  fair share of federal funds available for the delivery of health
  12-15  care in this state.
  12-16        Sec. 7.  Rules.  The board shall adopt rules establishing:
  12-17              (1)  any specialized education and training, including
  12-18  pharmacology, a registered nurse must have to carry out a
  12-19  prescription drug order pursuant to Subdivision (5), Subsection
  12-20  (d), Section 3.06, Medical Practice Act (Article 4495b, Vernon's
  12-21  Texas Civil Statutes); and
  12-22              (2)  a system for assigning an identification number to
  12-23  a registered nurse who provides the board with evidence of
  12-24  completing the required specialized education and training.
  12-25        SECTION 4.  Article 4515, Revised Statutes, is amended to
  12-26  read as follows:
  12-27        Art. 4515.  Per diem, salary, travel and other expenses
   13-1        Each member of the board is entitled to a per diem as set by
   13-2  legislative appropriation for each day that the member engages in
   13-3  the business of the board.  A member may not receive any
   13-4  compensation  for travel expenses, including expenses for meals and
   13-5  lodging, other than transportation expenses.  A member is entitled
   13-6  to compensation for transportation expenses as provided by the
   13-7  General Appropriations Act.  The board shall determine the salaries
   13-8  and compensation to be paid to employees and persons retained by
   13-9  the board.
  13-10        SECTION 5.  Article 4517, Revised Statutes, is amended to
  13-11  read as follows:
  13-13  <Sec. 1.>  The board shall employ a qualified executive director
  13-14  <secretary>, who shall not be a member of the board.  Under the
  13-15  direction of the board, the executive director <secretary> shall
  13-16  perform duties required by this Act and duties designated by the
  13-17  board.  Also, the board shall employ all other persons necessary to
  13-18  carry on the work of the board.  The executive director <secretary>
  13-19  shall upon employment execute a bond in the sum of One Thousand
  13-20  Dollars payable to the Governor.  The bond is conditioned that the
  13-21  executive director <secretary> shall faithfully perform the duties
  13-22  of the <his or her> office and shall account for funds coming into
  13-23  the director's <his or her> hands as executive director
  13-24  <secretary>.  The bond shall be signed by two or more sufficient
  13-25  sureties or by a surety company authorized to do business in this
  13-26  state and approved by the president of the board.
  13-27        <Sec. 2.  The executive secretary or his designee shall
   14-1  develop a system of annual performance evaluations based on
   14-2  measurable job tasks.  All merit pay authorized by the executive
   14-3  secretary must be based on the system established under this
   14-4  section.>
   14-5        SECTION 6.  Sections 1, 3, and 4, Article 4518, Revised
   14-6  Statutes, are amended to read as follows:
   14-7        Sec. 1.  It shall be the duty of the Board <of Nurse
   14-8  Examiners> to prescribe and publish the minimum requirements and
   14-9  standards for a course of study in programs which prepare
  14-10  professional nurse practitioners.  All other regulations necessary
  14-11  to conduct accredited schools of nursing and educational programs
  14-12  for the preparation of professional nurses shall be as prescribed
  14-13  by the Board, provided, however, that the minimum period of time
  14-14  that the Board may require shall be at least two (2) academic years
  14-15  and the maximum period of time shall not exceed four (4) calendar
  14-16  years.  The Board shall accredit such schools of nursing and
  14-17  educational programs as meet its requirements and shall deny or
  14-18  withdraw accreditation from schools of nursing and educational
  14-19  programs which fail to meet the prescribed course of study or other
  14-20  standards.
  14-21        The Board shall give those persons and organizations affected
  14-22  by its orders or decisions under this Article reasonable notice
  14-23  thereof, not less than twenty (20) days, and an opportunity to
  14-24  appear and be heard with respect to same.  The Board shall hear all
  14-25  protests or complaints from such persons and organizations affected
  14-26  by such rule, regulation or decision as to the inadequacy or
  14-27  unreasonableness of any rule, regulation or order promulgated or
   15-1  adopted by it, or the injustice of any order or decision by it.  If
   15-2  any person or organization which shall be affected by such order or
   15-3  decision shall be dissatisfied with any regulation, rule or order
   15-4  by such Board, such person or organization shall have the right,
   15-5  within thirty (30) days from the date such order is entered and
   15-6  approved by the board of nursing, to bring an action against said
   15-7  Board in the District Court of Travis County, Texas, to have such
   15-8  regulation, rule or order vacated or modified, and shall set forth
   15-9  in a petition therefor the principal grounds of objection to any or
  15-10  all of such rules, regulations or orders.  Such appeal as herein
  15-11  provided shall be de novo as that term is known and understood in
  15-12  appeals from the Justice Court to the County Court.
  15-13        Sec. 3.  Every applicant for registration as a registered
  15-14  nurse <under this law> shall present to the Board <of Nurse
  15-15  Examiners> evidence of successful completion of an accredited
  15-16  program of professional nursing education and a sworn application
  15-17  and shall upon payment of required fees be entitled to take the
  15-18  examination prescribed by the Board.  Upon <making a> passing the
  15-19  examination <grade>, the applicant shall be entitled to receive
  15-20  from said Board a certificate attested by the seal of said Board,
  15-21  entitling such person to practice as a registered nurse in the
  15-22  State of Texas.  The Board shall determine the criteria <score>,
  15-23  not to exceed the criteria <a score> required by a majority of the
  15-24  states, that constitutes <a> passing <grade on> the examination.
  15-25        Sec. 4.  Any person practicing or offering to practice
  15-26  professional nursing in this state for compensation, shall
  15-27  hereafter be required to submit evidence to the Board <of Nurse
   16-1  Examiners> that the person <he or she> is qualified to practice and
   16-2  shall be registered as provided by this law.
   16-3        SECTION 7.  Sections 7(a), (b), and (c), Article 4518,
   16-4  Revised Statutes, are amended to read as follows:
   16-5        (a)  To renew a license to practice as a registered nurse, a
   16-6  licensee must demonstrate to the satisfaction of the Board
   16-7  completion of the requirement for continuing professional education
   16-8  <The Board may recognize, prepare, or implement continuing
   16-9  education programs for its licensees and may require participation
  16-10  in continuing education programs as a condition of renewal of a
  16-11  registration certificate>.
  16-12        (b)  The Board shall adopt rules relating to the operation of
  16-13  the mandatory continuing education programs.  In establishing the
  16-14  requirement for continuing education, the Board shall consider:
  16-15              (1)  factors that lead to the competent performance of
  16-16  professional duties; and
  16-17              (2)  the continuing education needs of licensees <The
  16-18  Board may not require more than a total of 20 hours of continuing
  16-19  education in a two-year registration period and may not require
  16-20  that more than 10 of those hours consist of classroom instruction
  16-21  in approved programs.  The remaining 10 hours may consist of any
  16-22  combination of classroom instruction, institutional-based
  16-23  instruction, or individualized study>.
  16-24        (c)  The Board shall adopt rules relating to the adoption or
  16-25  approval of mandatory continuing education programs and providers
  16-26  and shall adopt rules to evaluate the effectiveness of the programs
  16-27  and a licensee's participation and performance in the programs <If
   17-1  the Board requires participation in continuing education programs
   17-2  as a condition of renewal of a registration certificate, the Board
   17-3  shall by rule establish a system for the approval of programs and
   17-4  providers of continuing education.  In adopting the rules, the
   17-5  Board shall consider but is not obligated to approve programs or
   17-6  providers approved or accredited through the Board of Accreditation
   17-7  of the American Nurses' Association or the National Federation of
   17-8  Specialty Nursing Organizations and nurse in-service programs
   17-9  offered by hospitals accredited by the Joint Commission on
  17-10  Accreditation of Healthcare Organizations, certified by Medicare,
  17-11  or maintained or operated by the federal government or the State of
  17-12  Texas.  The Board may assess programs and providers a fee in an
  17-13  amount reasonable and necessary to defray the costs incurred in
  17-14  approving providers and programs.  The fee collected under this
  17-15  subsection shall be deposited in the Professional Nurse
  17-16  Registration Fund>.
  17-17        SECTION 8.  Article 4519, Revised Statutes, is amended to
  17-18  read as follows:
  17-19        Art. 4519.  EXAMINATION <AND FEE>.  (a)  An applicant that
  17-20  wishes to take a licensing examination must submit to the board an
  17-21  application demonstrating the applicant's qualifications under this
  17-22  chapter.  If the board determines that the applicant meets the
  17-23  qualifications, the applicant may take the licensing examination
  17-24  <Upon filing application for examination each applicant shall pay
  17-25  an examination fee which shall in no case be returned to the
  17-26  applicant.  If the applicant passes the examination, then no
  17-27  further fee shall be required for registration.  Any applicant for
   18-1  registration who fails to successfully pass the examination herein
   18-2  provided for shall have the right to stand a second examination>.
   18-3  The examination shall be given in various cities throughout the
   18-4  State and shall be of such character as to determine the fitness of
   18-5  the applicant to practice professional nursing.  A written
   18-6  examination prepared, approved, or offered by the board, including
   18-7  a standardized national examination, shall be validated by an
   18-8  independent testing professional.  Not later than the 30th day
   18-9  <Within 30 days> after the date on which a licensing examination is
  18-10  administered under this article, the board shall notify each
  18-11  examinee of the results of the examination.  However, if an
  18-12  examination is graded or reviewed by a national testing service,
  18-13  the board shall notify each examinee of the results of the
  18-14  examination not later than the 14th day <within two weeks> after
  18-15  the date the board receives the results from the testing service.
  18-16  If the notice of the examination results graded or reviewed by a
  18-17  national testing service will be delayed for more than 90 days
  18-18  after the examination date, the board shall notify each examinee of
  18-19  the reason for the delay before the 90th day.  If requested in
  18-20  writing by a person who fails the licensing examination, the board
  18-21  shall furnish the person with an analysis of the person's
  18-22  performance on the examination.  If the result of the examination
  18-23  be satisfactory to the board, a certificate shall be issued to the
  18-24  applicant, signed by the president of the board, and executive
  18-25  director <secretary> and attested by the seal of said board, which
  18-26  certificate shall qualify the person receiving the same to practice
  18-27  professional nursing in this State.
   19-1        (b)  The board by rule shall establish the conditions under
   19-2  which an applicant who fails the licensing examination may retake
   19-3  the examination.  After twice failing the examination, the board
   19-4  may require an applicant to fulfill additional educational
   19-5  requirements and, after twice failing an examination,  may deny an
   19-6  applicant who failed the examination the opportunity to retake the
   19-7  examination.
   19-8        SECTION 9.  Article 4521, Revised Statutes, is amended to
   19-9  read as follows:
  19-11  ANOTHER STATE>.  (a)  To qualify for a temporary license to
  19-12  practice as a registered nurse by endorsement, an applicant for
  19-13  licensing must:
  19-14              (1)  submit to the board an endorsement fee as
  19-15  determined by the board and a completed application given under
  19-16  oath, in the form prescribed by the board;
  19-17              (2)  have possessed at the time of initial licensing as
  19-18  a registered nurse other qualifications necessary to have been
  19-19  eligible for licensing at that time in this state; and
  19-20              (3)  have presented to the board proof of initial
  19-21  licensing by examination and proof that the license and other
  19-22  license or licenses granted to the applicant by any other state
  19-23  have not been suspended, revoked, canceled, surrendered, or
  19-24  otherwise restricted for any reason.
  19-25        (b)  A holder of a temporary license under this section shall
  19-26  receive a permanent license if the applicant:
  19-27              (1)  has verified the academic and professional
   20-1  credentials of the applicant; and
   20-2              (2)  satisfies any other requirement set by statute.
   20-3        (c)  The board shall either grant or deny an application for
   20-4  a permanent license within 180 days after the date of the board's
   20-5  receipt of all required forms or information.  The board may extend
   20-6  the 180-day time limit to allow for the receipt and tabulation of
   20-7  examination results.
   20-8        (d)  Any applicant who holds a registration certificate as a
   20-9  registered nurse from another state, district, territory or
  20-10  possession of the United States, or from a foreign country, may be
  20-11  issued a license to practice as a registered nurse in the State of
  20-12  Texas by endorsement and without examination upon the payment of a
  20-13  fee established by the board, provided in the opinion of the Board
  20-14  of Nurse Examiners such other board issuing such other certificate
  20-15  in its examination required the same general degree of fitness
  20-16  required by this state.
  20-17        SECTION 10.  Chapter 7, Title 71, Revised Statutes, is
  20-18  amended by adding Articles 4524A-4524D to read as follows:
  20-19        Art. 4524A.  RECORDS OF COMPLAINTS.  (a)  The board shall
  20-20  keep an information file about each complaint filed with the board.
  20-21  The board's information file shall be kept current and contain a
  20-22  record for each complaint of:
  20-23              (1)  all persons contacted in relation to the
  20-24  complaint;
  20-25              (2)  a summary of findings made at each step of the
  20-26  complaint process;
  20-27              (3)  an explanation of the legal basis and reason for a
   21-1  complaint that is dismissed; and
   21-2              (4)  other relevant information.
   21-3        (b)  If a written complaint is filed with the board that the
   21-4  board has authority to resolve, the board, at least as frequently
   21-5  as quarterly and until final disposition of the complaint, shall
   21-6  notify the parties to the complaint of the status of the complaint
   21-7  unless the notice would jeopardize an undercover investigation.
   21-8        (c)  The board by rule shall adopt a form to standardize
   21-9  information concerning complaints made to the board.  The board by
  21-10  rule shall prescribe information to be provided to a person when
  21-11  the person files a complaint with the board.
  21-12        (d)  The board shall provide reasonable assistance to a
  21-13  person who wishes to file a complaint with the board.
  21-15  The board shall adopt rules concerning the investigation of a
  21-16  complaint filed with the board.  The rules adopted under this
  21-17  subsection shall:
  21-18              (1)  distinguish between categories of complaints;
  21-19              (2)  ensure that complaints are not dismissed without
  21-20  appropriate consideration;
  21-21              (3)  require that the board be advised of a complaint
  21-22  that is dismissed and that a letter be sent to the person who filed
  21-23  the complaint explaining the action taken on the dismissed
  21-24  complaint;
  21-25              (4)  ensure that the person who filed the complaint has
  21-26  an opportunity to explain the allegations made in the complaint;
  21-27  and
   22-1              (5)  prescribe guidelines concerning the categories of
   22-2  complaints that require the use of a private investigator and the
   22-3  procedures for the board to obtain the services of a private
   22-4  investigator.
   22-5        (b)  The board shall dispose of all complaints in a timely
   22-6  manner.  The board shall establish a timeline for conducting each
   22-7  phase of a complaint that is under the control of the board not
   22-8  later than the 30th day after the date the complaint is received by
   22-9  the board.  The timeline shall be kept in the information file for
  22-10  the complaint and all parties shall be notified of the projected
  22-11  time requirements for pursuing the complaint.  A change in the
  22-12  timeline must be noted in the complaint information file and all
  22-13  parties to the complaint must be notified not later than the
  22-14  seventh day after the date the change is made.
  22-15        (c)  The executive director of the board shall notify the
  22-16  board of a complaint that extends beyond the time prescribed by the
  22-17  board for resolving the complaint so that the board may take
  22-18  necessary action on the complaint.
  22-19        Art. 4524C.  INFORMAL PROCEEDINGS.  (a)  The board by rule
  22-20  shall adopt procedures governing:
  22-21              (1)  informal disposition of a contested case under
  22-22  Section 13(e), Administrative Procedure and Texas Register Act
  22-23  (Article 6252-13a, Vernon's Texas Civil Statutes), and its
  22-24  subsequent amendments; and
  22-25              (2)  informal proceedings held in compliance with
  22-26  Section 18(c), Administrative Procedure and Texas Register Act
  22-27  (Article 6252-13a, Vernon's Texas Civil Statutes), and its
   23-1  subsequent amendments.
   23-2        (b)  Rules adopted under this article must provide the
   23-3  complainant and the licensee an opportunity to be heard and must
   23-4  require the presence of a representative of the board's legal staff
   23-5  or of the office of the attorney general to advise the board or the
   23-6  board's employees.
   23-7        Art. 4524D.  MONITORING OF LICENSEE.  The board by rule shall
   23-8  develop a system for monitoring licensees' compliance with the
   23-9  requirements of this chapter.  Rules adopted under this article
  23-10  shall include procedures for monitoring a licensee who is ordered
  23-11  by the board to perform certain acts to ascertain that the licensee
  23-12  performs the required acts and to identify and monitor licensees
  23-13  who represent a risk to the public.
  23-14        SECTION 11.  Article 4525, Revised Statutes, is amended by
  23-15  amending Subsections (a), (b), and (e) and adding Subsection (k) to
  23-16  read as follows:
  23-17        (a)  The board <of nurse examiners> may refuse to admit
  23-18  persons to its examinations, may refuse to issue a license or
  23-19  certificate of registration or to issue a certificate of renewal
  23-20  <re-registration>, may refuse to issue a temporary permit,
  23-21  endorsement, or license, may issue a warning or reprimand with or
  23-22  without stipulations, may suspend for any period not to exceed 5
  23-23  years, or may revoke the license or certificate of any practitioner
  23-24  of professional nursing, for any of the following reasons:
  23-25              (1)  The violation of any of the provisions of this
  23-26  law, any rule, regulation not inconsistent with this law, or order
  23-27  issued hereinunder.
   24-1              (2)  Is guilty of fraud or deceit in procuring or
   24-2  attempting to procure a license to practice professional nursing.
   24-3              (3)  Conviction of a crime of the grade of felony, or a
   24-4  crime of lesser grade which involves moral turpitude, or any
   24-5  conduct resulting in the revocation of probation imposed pursuant
   24-6  to such conviction.
   24-7              (4)  The use of any nursing license, certificate,
   24-8  diploma or permit, or transcript of such license, certificate,
   24-9  diploma or permit, which has been fraudulently purchased, issued,
  24-10  counterfeited, or materially altered.
  24-11              (5)  The impersonation of, or the acting as a proxy
  24-12  for, another in any examination required by law to obtain a license
  24-13  to practice professional nursing.
  24-14              (6)  Aiding or abetting, directly or indirectly, or in
  24-15  any manner whatsoever, any unlicensed person in connection with the
  24-16  unauthorized practice of professional nursing.
  24-17              (7)  Revocation, suspension, or denial of or any other
  24-18  action relating to the license to practice nursing in another
  24-19  jurisdiction.  Certified copy of the order of denial, suspension,
  24-20  revocation, or any other action shall be conclusive evidence
  24-21  thereof.
  24-22              (8)  Intemperate use of alcohol or drugs that the board
  24-23  determines endangers or could endanger patients.  Intemperate use
  24-24  includes but is not limited to practicing professional nursing or
  24-25  being on duty or call while under the influence of alcohol or
  24-26  drugs.
  24-27              (9)  Unprofessional or dishonorable conduct which, in
   25-1  the opinion of the board, is likely to deceive, defraud, or injure
   25-2  patients or the public.
   25-3              (10)  Adjudication of mental incompetency.
   25-4              (11)  Lack of fitness to practice by reason of mental
   25-5  or physical health that could result in injury to patients or the
   25-6  public.
   25-7              (12)  Failing to care adequately for patients or to
   25-8  conform to the minimum standards of acceptable professional nursing
   25-9  practice that, in the opinion of the board, exposes a patient or
  25-10  other person unnecessarily to risk of harm.
  25-11        (b)  Proceedings under this article shall be begun by filing
  25-12  a written complaint with the board <of nurse examiners>.  Such
  25-13  complaint may be made by any person or filed by the board on its
  25-14  own initiative.  Unless it would jeopardize an investigation, the
  25-15  board shall notify the registered nurse that a complaint has been
  25-16  filed and the nature of the complaint after a determination of the
  25-17  identity of the subject of the complaint.  <An information file
  25-18  about each complaint filed relating to a licensee shall be
  25-19  maintained by the board.  If a written complaint is filed with the
  25-20  board relating to a licensee, the board at least as frequently as
  25-21  quarterly and until final disposition of the complaint, shall
  25-22  notify the party that filed the complaint of the status of the file
  25-23  unless notice would jeopardize an investigation.>  The board shall
  25-24  make a timely and appropriate preliminary investigation of the
  25-25  complaint and may issue a warning or reprimand to the person
  25-26  against whom the complaint was filed.  If the investigation reveals
  25-27  probable cause to take further disciplinary action, the board shall
   26-1  either attempt an informal disposition of the complaint or file
   26-2  formal charges against the registered nurse stating the provisions
   26-3  of this chapter or the board's rules that are alleged to have been
   26-4  violated and a brief description of the acts or omissions that
   26-5  constituted the violation.  If the board proposes to refuse to
   26-6  admit a person to its examination, to refuse to issue a temporary
   26-7  permit, license, certificate of registration, certificate of
   26-8  re-registration, or to suspend or revoke a person's permit,
   26-9  license, or certificate, the person is entitled to a hearing before
  26-10  the State Office of Administrative Hearings <board.  The hearing
  26-11  may be before a subcommittee of the board, a majority of which is
  26-12  composed of registered nurses.  The person shall on request be
  26-13  granted a hearing before the entire board>.  Proceedings for a
  26-14  disciplinary action are governed by the Administrative Procedure
  26-15  and Texas Register Act (Article 6252-13a, Vernon's Texas Civil
  26-16  Statutes).  The board may assess a person found to have violated
  26-17  any provision of this chapter the administrative costs of
  26-18  conducting a hearing to determine that violation.  If a licensed
  26-19  professional nurse voluntarily surrenders his or her license to the
  26-20  board and executes a sworn statement that he or she no longer
  26-21  desires to be licensed, the board may revoke his or her license
  26-22  without the necessity of formal charges, notice, or opportunity of
  26-23  hearing.
  26-24        (e)  The board <of nurse examiners> is charged with the duty
  26-25  of aiding in the enforcement of the provisions of this chapter, and
  26-26  may retain legal counsel to represent the board, but prior to
  26-27  retaining outside legal counsel, the board shall request the
   27-1  attorney general to perform such services and may only retain
   27-2  outside counsel if the attorney general so certifies to the board
   27-3  that the attorney general cannot provide such services.  The board
   27-4  shall have the power to issue subpoenas, compel the attendance of
   27-5  witnesses, administer oaths to persons giving testimony at
   27-6  hearings, and cause the prosecution of all persons violating any
   27-7  provisions of this chapter.  It shall keep a record of all its
   27-8  proceedings and make an annual report to the Governor.  Any member
   27-9  of the board may present to a prosecuting officer complaints
  27-10  relating to violations of any of the provisions of this chapter,
  27-11  and the board through its members, officers, counsel, or agents
  27-12  shall assist in the trial of any cases involving alleged violation
  27-13  of this chapter, subject to the control of the prosecuting
  27-14  officers.  The Attorney General is directed to render such legal
  27-15  assistance as may be necessary in enforcing and making effective
  27-16  the provisions of this chapter; provided that this shall not
  27-17  relieve the local prosecuting officers of any of their duties under
  27-18  the law as such.
  27-19        (k)  The schedule of sanctions adopted by the board by rule
  27-20  shall be used by the State Office of Administrative Hearings for
  27-21  any sanction imposed as the result of a hearing conducted by that
  27-22  office.
  27-23        SECTION 12.  Section 1, Article 4525a, Revised Statutes, is
  27-24  amended to read as follows:
  27-25        Sec. 1.  REPORTING REQUIREMENTS.  The board shall adopt rules
  27-26  governing reporting required under this article to minimize
  27-27  unnecessary duplicative reporting and the reporting of minor
   28-1  incidents.  A "minor incident" means conduct that does not indicate
   28-2  the nurse's continuing to practice professional nursing poses a
   28-3  risk of harm to a client or other person <REGISTERED NURSES; DUTY
   28-4  TO REPORT VIOLATIONS.  Each registered nurse having reasonable
   28-5  cause to suspect that a registered nurse has exposed or is likely
   28-6  to expose a patient or other person unnecessarily to a risk of harm
   28-7  because of unprofessional conduct, failure to care adequately for a
   28-8  patient, failure to conform to the minimum standards of acceptable
   28-9  professional nursing practice, or impaired status shall report in a
  28-10  signed, written report to the board the name of the nurse
  28-11  committing the violation or suspected violation and any other
  28-12  pertinent information within the nurse's knowledge as the board may
  28-13  require.  A registered nurse without personal knowledge of the
  28-14  nurse's actions is not required to report under this section if she
  28-15  or he has reasonable cause to believe the nurse has already been
  28-16  reported>.
  28-17        SECTION 13.  Chapter 7, Title 71, Revised Statutes, is
  28-18  amended by adding Article 4525c to read as follows:
  28-19        Art. 4525c.  MEMORANDUM OF UNDERSTANDING.  The board shall
  28-20  sign a memorandum of understanding with state agencies that
  28-21  license, register, or certify a facility required by law to have a
  28-22  registered nurse peer review committee.  The memorandum of
  28-23  understanding shall:
  28-24              (1)  state the actions the board and agency shall take
  28-25  to encourage compliance with the requirement to have a registered
  28-26  nurse peer review committee; and
  28-27              (2)  be adopted as a rule of the board and the agency.
   29-1        SECTION 14.  Chapter 7, Title 71, Revised Statutes, is
   29-2  amended by adding Article 4525e to read as follows:
   29-3        Art. 4525e.  TEMPORARY SUSPENSION OF LICENSE.  If the
   29-4  majority of the board or a three-member committee of board members
   29-5  designated by the board determines from the evidence or information
   29-6  presented to it that a registered nurse by continuation in practice
   29-7  would constitute a continuing and imminent threat to the public
   29-8  welfare, the board or the three-member committee shall temporarily
   29-9  suspend the license of the registered nurse.  The license may be
  29-10  suspended under this article without notice or hearing on the
  29-11  complaint, provided institution of proceedings for a hearing before
  29-12  the State Office of Administrative Hearings is initiated
  29-13  simultaneously with the temporary suspension and provided that a
  29-14  hearing is held as soon as can be accomplished under this chapter
  29-15  and the Administrative Procedure and Texas Register Act (Article
  29-16  6252-13a, Vernon's Texas Civil Statutes) and its subsequent
  29-17  amendments.  The State Office of Administrative Hearings shall hold
  29-18  a preliminary hearing not later than the 14th day after the date of
  29-19  the temporary suspension to determine if probable cause exists that
  29-20  a continuing and imminent threat to the public welfare still
  29-21  exists.  A final hearing on the matter shall be held not later than
  29-22  the 61st day after the date of temporary suspension.
  29-23        SECTION 15.  Article 4526, Revised Statutes, is amended to
  29-24  read as follows:
  29-25        Art. 4526.  LICENSE RENEWAL <Re-registration>.  The board by
  29-26  rule may <shall> adopt a system under which licenses expire on
  29-27  various dates during the year <issued by the board shall be renewed
   30-1  each biennium>.  <For the year in which the  expiration date is
   30-2  changed, registration fees payable on or before March 31 shall be
   30-3  prorated on a monthly basis so that each registrant shall pay only
   30-4  that portion of the re-registration fee that is allocable to the
   30-5  months in which the registration is valid.  On the new expiration
   30-6  date, the total re-registration fee is payable.  The board shall
   30-7  notify each licensee at least 30 days in advance of the date of
   30-8  expiration of the license.  The application for re-registration
   30-9  shall be mailed by United States mail to the address shown in the
  30-10  board's records.  Any application received after the expiration
  30-11  date shall be charged a late fee.>  If a person's license has been
  30-12  expired for <not more than> 90 days or less, the person may renew
  30-13  the license by paying to the board the required renewal fee and a
  30-14  fee that is one-half the examination fee for the license.  If a
  30-15  license has been expired for <more than> 90 days but less than one
  30-16  year <two years>, the person may renew the license by paying to the
  30-17  board all unpaid renewal fees and a fee that is equal to the
  30-18  examination fee for the license.   The board shall by rule set a
  30-19  length of time beyond which an expired license may not be renewed.
  30-20  The board may establish by rule additional requirements that shall
  30-21  apply to the renewal of a license that has been expired for more
  30-22  than one year but less than the time limit set by the board beyond
  30-23  which a license may not be renewed  <If a license has been expired
  30-24  for two years or more, the person may renew the license on meeting
  30-25  the requirements that the board considers necessary>.  The person
  30-26  may obtain a new license by submitting to reexamination and
  30-27  complying with the requirements and procedures for obtaining an
   31-1  original license.  However, the board may renew without
   31-2  reexamination an expired license of a person who was licensed in
   31-3  this state, moved to another state, and is currently licensed and
   31-4  has been in practice in the other state for the two years preceding
   31-5  application.  The person must pay to the State Board of Nursing a
   31-6  fee that is equal to the examination fee for the license.  At least
   31-7  30 days before the expiration of the person's license, the State
   31-8  Board of Nursing shall send written notice of the impending license
   31-9  expiration to the person at the person's last known address
  31-10  according to the records of the board.  If any registered nurse
  31-11  continues to practice professional nursing beyond the time for
  31-12  which the nurse is registered <or re-registered>, the nurse shall
  31-13  be considered to be an illegal practitioner and the license may be
  31-14  revoked or suspended.
  31-15        SECTION 16.  Article 4527, Revised Statutes, is amended to
  31-16  read as follows:
  31-17        Art. 4527.  Fees.
  31-18        Sec. 1.  The board by rule shall establish reasonable and
  31-19  necessary fees so that the fees, in the aggregate, produce
  31-20  sufficient revenue to cover the cost of administering this chapter.
  31-21  The board may not set a fee for an amount less than the amount of
  31-22  that fee on September 1, 1993.  <The Board of Nurse Examiners shall
  31-23  establish reasonable and necessary fees for the administration of
  31-24  its functions in amounts not to exceed:>
  31-25        <Admission fee to examination ......................... $200>
  31-26        <Duplicate or substitute of current certificate .......   25>
  31-27        <Duplicate or substitute of permanent certificate .....   25>
   32-1        <Duplicate permits ....................................   15>
   32-2        <Endorsement with or without examination ..............  150>
   32-3        <Re-registration ......................................   50>
   32-4        <Issuance of a temporary permit under Art. 4523 .......   25>
   32-5        <Reactivating from inactive status ....................   30>
   32-6        <Accreditation of new schools and programs ............  150>
   32-7        <Filing of affidavits in re-change of name ............   10>
   32-8        <Verification of records ..............................   50>
   32-9        <Bad checks ...........................................   25>
  32-10        <Advanced Nurse Practitioner-initial credentials ......   50>
  32-11        <Advanced Nurse Practitioner-renewal of credentials ...   25>
  32-12        <Issuance    of   declaratory   order   of  eligibility>
  32-13           <for license ........................................   25>
  32-14        Sec. 2.  The board may receive gifts, grants, or other funds
  32-15  or assets  <The Board shall not maintain unnecessary fund balances,
  32-16  and fee amounts shall be set in accordance with this
  32-17  requirement.   The Board shall set and collect a sales charge for
  32-18  copies of any paper or record in the office of the Board and for
  32-19  any printed material published by the Board.  The charges are to be
  32-20  in an amount considered sufficient to reimburse the Board for its
  32-21  actual expenses>.
  32-22        Sec. 3.    All fees received by said Board under this law
  32-23  shall be placed in the State Treasury to the credit of a special
  32-24  fund to be known as the "Professional Nurse Registration Fund" and
  32-25  the Comptroller shall upon requisition of the Board from time to
  32-26  time draw warrants upon the State Treasurer for the amounts
  32-27  specified in such requisition; provided, however, all fees
   33-1  collected by the Board and deposited in the Professional Nurse
   33-2  Registration Fund shall be expended as specified by itemized
   33-3  appropriation in the General Appropriations Act and shall be used
   33-4  by the Board, and under its directions, only for purposes of
   33-5  carrying out this Act.  <The Board may use any of the fees and
   33-6  charges collected by it, as necessary, to retain, hire, or contract
   33-7  for additional prosecutors, hearing examiners, investigators, and
   33-8  support staff as necessary to aid in the investigation of
   33-9  complaints and the prosecution of persons subject to the Board's
  33-10  jurisdiction.  This provision shall apply to all fees of whatsoever
  33-11  nature as permitted by law.  The financial transactions of the
  33-12  Board are subject to audit by the state auditor in accordance with
  33-13  Chapter 321, Government Code.>
  33-14        SECTION 17.  Article 4527b, Revised Statutes, is amended to
  33-15  read as follows:
  33-16        Art. 4527b.  PENALTIES <Penalty>.  (a)  A person who violates
  33-17  any provision of Article 4527a, Revised Statutes, commits an
  33-18  offense.  Except as provided by this section, an offense under that
  33-19  article is a Class A misdemeanor.  If it is shown in the trial of a
  33-20  person allegedly in violation of that article that the person has
  33-21  once before been convicted of a violation of Article 4527a, on
  33-22  conviction the person shall be punished for a third degree felony.
  33-23  Each day of violation constitutes a separate offense.  On final
  33-24  conviction of an offense under that article, a person forfeits all
  33-25  rights and privileges conferred by virtue of licensure under this
  33-26  chapter.
  33-27        (b)  A person who violates Article 4527a, Revised Statutes,
   34-1  is liable to the state for a civil penalty that does not exceed
   34-2  $1,000 a day.  The civil penalty may be collected in a suit
   34-3  initiated by the board.
   34-4        SECTION 18.  Chapter 7, Title 71, Revised Statutes, is
   34-5  amended by adding Article 4527d to read as follows:
   34-6        Art. 4527d.  ADMINISTRATIVE PENALTIES.  (a)  The board may
   34-7  impose an administrative penalty against a person licensed or
   34-8  regulated under this Act who violates this Act or a rule or order
   34-9  adopted under this Act.
  34-10        (b)  The penalty for each violation may be in an amount not
  34-11  to exceed $2,500.  Each day a violation continues or occurs is a
  34-12  separate violation for purposes of imposing a penalty.
  34-13        (c)  The amount of the penalty shall be based on:
  34-14              (1)  the seriousness of the violation, including the
  34-15  nature, circumstances, extent, and gravity of any prohibited acts,
  34-16  and the hazard or potential hazard created to the health, safety,
  34-17  or economic welfare of the public;
  34-18              (2)  the economic harm to property or the environment
  34-19  caused by the violation;
  34-20              (3)  the history of previous violations;
  34-21              (4)  the amount necessary to deter future violations;
  34-22              (5)  efforts to correct the violation; and
  34-23              (6)  any other matter that justice may require.
  34-24        (d)  The executive director who determines that a violation
  34-25  has occurred may issue to the board a report that states the facts
  34-26  on which the determination is based and the director's
  34-27  recommendation on the imposition of a penalty, including a
   35-1  recommendation on the amount of the penalty.
   35-2        (e)  Within 14 days after the date the report is issued, the
   35-3  executive director shall give written notice of the report to the
   35-4  person.  The notice may be given by certified mail.  The notice
   35-5  must include a brief summary of the alleged violation and a
   35-6  statement of the amount of the recommended penalty and must inform
   35-7  the person that the person has a right to a hearing on the
   35-8  occurrence of the violation, the amount of the penalty, or both the
   35-9  occurrence of the violation and the amount of the penalty.
  35-10        (f)  Within 20 days after the date the person receives the
  35-11  notice, the person in writing may accept the determination and
  35-12  recommended penalty of the executive director or may make a written
  35-13  request for a hearing on the occurrence of the violation, the
  35-14  amount of the penalty, or both the occurrence of the violation and
  35-15  the amount of the penalty.
  35-16        (g)  If the person accepts the determination and recommended
  35-17  penalty of the executive director, the board by order shall approve
  35-18  the determination and impose the recommended penalty.
  35-19        (h)  If the person requests a hearing or fails to respond
  35-20  timely to the notice, the executive director shall set a hearing
  35-21  and give notice of the hearing to the person.  The hearing shall be
  35-22  held by an administrative law judge of the State Office of
  35-23  Administrative Hearings.  The administrative law judge shall make
  35-24  findings of fact and conclusions of law.  The administrative law
  35-25  judge shall promptly issue to the board a proposal for a decision
  35-26  about the occurrence of the violation and the amount of a proposed
  35-27  penalty.  Based on the findings of fact, conclusions of law, and
   36-1  proposal for a decision, the board by order may find that a
   36-2  violation has occurred and impose a penalty or may find that no
   36-3  violation occurred.
   36-4        (i)  The notice of the board's order given to the person
   36-5  under the Administrative Procedure and Texas Register Act (Article
   36-6  6252-13a, Vernon's Texas Civil Statutes) and its subsequent
   36-7  amendments must include a statement of the right of the person to
   36-8  judicial review of the order.
   36-9        (j)  Within 30 days after the date the board's order is final
  36-10  as provided by Section 16(c), Administrative Procedure and Texas
  36-11  Register Act (Article 6252-13a, Vernon's Texas Civil Statutes), the
  36-12  person shall:
  36-13              (1)  pay the amount of the penalty;
  36-14              (2)  pay the amount of the penalty and file a petition
  36-15  for judicial review contesting the occurrence of the violation, the
  36-16  amount of the penalty, or both the occurrence of the violation and
  36-17  the amount of the penalty; or
  36-18              (3)  without paying the amount of the penalty, file a
  36-19  petition for judicial review contesting the occurrence of the
  36-20  violation, the amount of the penalty, or both the occurrence of the
  36-21  violation and the amount of the penalty.
  36-22        (k)  Within the 30-day period, a person who acts under
  36-23  Subsection (j)(3) of this section may:
  36-24              (1)  stay enforcement of the penalty by:
  36-25                    (A)  paying the amount of the penalty to the
  36-26  court for placement in an escrow account; or
  36-27                    (B)  giving to the court a supersedeas bond
   37-1  approved by the court for the amount of the penalty and that is
   37-2  effective until all judicial review of the board's order is final;
   37-3  or
   37-4              (2)  request the court to stay enforcement of the
   37-5  penalty by:
   37-6                    (A)  filing with the court a sworn affidavit of
   37-7  the person stating that the person is financially unable to pay the
   37-8  amount of the penalty and is financially unable to give the
   37-9  supersedeas bond; and
  37-10                    (B)  giving a copy of the affidavit to the
  37-11  executive director by certified mail.
  37-12        (l)  The executive director who receives a copy of an
  37-13  affidavit under Subsection (k)(2) of this section may file with the
  37-14  court, within five days after the date the copy is received, a
  37-15  contest to the affidavit.  The court shall hold a hearing on the
  37-16  facts alleged in the affidavit as soon as practicable and shall
  37-17  stay the enforcement of the penalty on finding that the alleged
  37-18  facts are true.  The person who files an affidavit has the burden
  37-19  of proving that the person is financially unable to pay the amount
  37-20  of the penalty and to give a supersedeas bond.
  37-21        (m)  If the person does not pay the amount of the penalty and
  37-22  the enforcement of the penalty is not stayed, the executive
  37-23  director may refer the matter to the attorney general for
  37-24  collection of the amount of the penalty.
  37-25        (n)  Judicial review of the order of the board:
  37-26              (1)  is instituted by filing a petition as provided by
  37-27  Section 19, Administrative Procedure and Texas Register Act
   38-1  (Article 6252-13a, Vernon's Texas Civil Statutes), and its
   38-2  subsequent amendments; and
   38-3              (2)  is under the substantial evidence rule.
   38-4        (o)  If the court sustains the occurrence of the violation,
   38-5  the court may uphold or reduce the amount of the penalty and order
   38-6  the person to pay the full or reduced amount of the penalty.  If
   38-7  the court does not sustain the occurrence of the violation, the
   38-8  court shall order that no penalty is owed.
   38-9        (p)  When the judgment of the court becomes final, the court
  38-10  shall proceed under this subsection.  If the person paid the amount
  38-11  of the penalty and if that amount is reduced or is not upheld by
  38-12  the court, the court shall order that the appropriate amount plus
  38-13  accrued interest be remitted to the person.  The rate of the
  38-14  interest is the rate charged on loans to depository institutions by
  38-15  the New York Federal Reserve Bank, and the interest shall be paid
  38-16  for the period beginning on the date the penalty was paid and
  38-17  ending on the date the penalty is remitted.  If the person gave a
  38-18  supersedeas bond and if the amount of the penalty is not upheld by
  38-19  the court, the court shall order the release of the bond.  If the
  38-20  person gave a supersedeas bond and if the amount of the penalty is
  38-21  reduced, the court shall order the release of the bond after the
  38-22  person pays the amount.
  38-23        (q)  A penalty collected under this section shall be remitted
  38-24  to the comptroller for deposit in the general revenue fund.
  38-25        (r)  All proceedings under this section are subject to the
  38-26  Administrative Procedure and Texas Register Act (Article 6252-13a,
  38-27  Vernon's Texas Civil Statutes) and its subsequent amendments.
   39-1        SECTION 19.  Article 4516, Revised Statutes, is repealed.
   39-2        SECTION 20.  The changes in law made by this Act in the
   39-3  qualifications of members of the Board of Nurse Examiners do not
   39-4  affect the entitlement of a member appointed before September 1,
   39-5  1993, to continue to hold office to the term to which the member
   39-6  was appointed.  The change in qualifications applies only to a
   39-7  member appointed on or after September 1, 1993.
   39-8        SECTION 21.  This Act takes effect September 1, 1993.
   39-9        SECTION 22.  The importance of this legislation and the
  39-10  crowded condition of the calendars in both houses create an
  39-11  emergency and an imperative public necessity that the
  39-12  constitutional rule requiring bills to be read on three several
  39-13  days in each house be suspended, and this rule is hereby suspended.