1-1  By:  Black (Senate Sponsor - Moncrief)                H.B. No. 2180
    1-2        (In the Senate - Received from the House May 14, 1993;
    1-3  May 14, 1993, read first time and referred to Committee on Health
    1-4  and Human Services; May 20, 1993, reported adversely, with
    1-5  favorable Committee Substitute by the following vote:  Yeas 8, Nays
    1-6  0; May 20, 1993, sent to printer.)
    1-7                            COMMITTEE VOTE
    1-8                          Yea     Nay      PNV      Absent 
    1-9        Zaffirini          x                               
   1-10        Ellis              x                               
   1-11        Madla              x                               
   1-12        Moncrief           x                               
   1-13        Nelson             x                               
   1-14        Patterson          x                               
   1-15        Shelley            x                               
   1-16        Truan              x                               
   1-17        Wentworth                                     x    
   1-18  COMMITTEE SUBSTITUTE FOR H.B. No. 2180                By:  Moncrief
   1-19                         A BILL TO BE ENTITLED
   1-20                                AN ACT
   1-21  relating to the regulation of the practice of registered nursing
   1-22  and to the continuation of the Board of Nurse Examiners; providing
   1-23  penalties.
   1-25        SECTION 1.  Article 4513, Revised Statutes, is amended to
   1-26  read as follows:
   1-27        Art. 4513.  BOARD OF NURSE EXAMINERS
   1-28        Sec. 1.  Composition of Board; Programs of Study.  The Board
   1-29  of Nurse Examiners is composed of nine members appointed by the
   1-30  governor with the advice and consent of the senate.  Appointments
   1-31  to the board shall be made without regard to the race, color
   1-32  <creed>, disability, sex, religion, age, or national origin of the
   1-33  appointees.  The board <Board of Nurse Examiners> shall prescribe
   1-34  three programs of study to prepare professional nurse
   1-35  practitioners, to wit:  (1) The Baccalaureate Degree Program--A
   1-36  program leading to a baccalaureate degree in nursing conducted by
   1-37  an educational unit in nursing (department, division, school, or
   1-38  college) which is a part of a senior college or university; (2) The
   1-39  Associate Degree Program--A program leading to an associate degree
   1-40  in nursing conducted by an educational unit in nursing within the
   1-41  structure of a college or a university; and (3) The Diploma
   1-42  Program--A program leading to a diploma in nursing conducted by a
   1-43  single purpose school usually under the control of a hospital.  Six
   1-44  of the board members must be Registered Nurses, three of whom shall
   1-45  be engaged in professional nurse education and shall be
   1-46  representative of said three programs in that one shall be a nurse
   1-47  faculty member in a school of nursing pursuing the Baccalaureate
   1-48  Degree Program; one shall be a nurse faculty member in a school of
   1-49  nursing pursuing the Associate Degree Program; and one shall be a
   1-50  nurse faculty member in a school of nursing pursuing the Diploma
   1-51  Program.  Three members must be members of the general public.
   1-52        Sec. 2.  Terms; Requirements of Professional Nurse Members
   1-53  and Public Members.  (a)  The members of the board shall hold
   1-54  office for staggered terms of six years, with the terms of one
   1-55  practicing registered nurse, one professional nurse engaged in
   1-56  nurse education, and one public member expiring on January 31 of
   1-57  odd-numbered years.  The professional nurse members must be
   1-58  actually employed in the nursing profession for at least three
   1-59  years before their appointment.
   1-60        (b)  A person is not eligible for appointment as a public
   1-61  member if the person or the person's spouse:
   1-62              (1)  is licensed by an occupational regulatory agency
   1-63  in the field of health care;
   1-64              (2)  is employed by or participates in the management
   1-65  of a business entity or other organization that provides
   1-66  health-care services or that sells, manufactures, or distributes
   1-67  health-care supplies or equipment; <or>
   1-68              (3)  owns, controls, or has, directly or indirectly,
    2-1  more than a 10 percent interest in a business entity or other
    2-2  organization that provides health-care services or that sells,
    2-3  manufactures, or distributes health-care supplies or equipment; or
    2-4              (4)  uses or receives a substantial amount of tangible
    2-5  goods, services, or funds from the board, other than compensation
    2-6  or reimbursement authorized by law for board membership,
    2-7  attendance, or expenses.
    2-8        Sec. 3.  CONFLICT OF INTEREST RESTRICTIONS.  (a)  An officer,
    2-9  employee, or paid consultant of a Texas trade association in the
   2-10  field of health care may not be a board member or employee of the
   2-11  board who is exempt from the state's position classification plan
   2-12  or is compensated at or above the amount prescribed by the General
   2-13  Appropriations Act for step 1, salary group 17, of the position
   2-14  classification salary schedule.
   2-15        (b)  A person who is the spouse of an officer, manager, or
   2-16  paid consultant of a Texas trade association in the field of health
   2-17  care may not be a board member or employee of the board who is
   2-18  exempt from the state's position classification plan or is
   2-19  compensated at or above the amount prescribed by the General
   2-20  Appropriations Act for step 1, salary group 17, of the position
   2-21  classification salary schedule.
   2-22        (c)  For the purposes of this section, a Texas trade
   2-23  association is a nonprofit, cooperative, and voluntarily joined
   2-24  association of business or professional competitors in this state
   2-25  designed to assist its members and its industry or profession in
   2-26  dealing with mutual business or professional problems and in
   2-27  promoting their common interest.
   2-28        Sec. 4.  EFFECT OF LOBBYING ACTIVITY.  A person may not serve
   2-29  as a board member or act as general counsel to the board if the
   2-30  person is required to register as a lobbyist under Chapter 305,
   2-31  Government Code, and its subsequent amendments, because of the
   2-32  person's activities for compensation on behalf of a profession
   2-33  related to the operation of the board.
   2-34        Sec. 5.  GROUNDS FOR REMOVAL FROM BOARD.  (a)  It is a ground
   2-35  for removal from the board if a member:
   2-36              (1)  does not have at the time of appointment the
   2-37  qualifications required by Section 1 of this article;
   2-38              (2)  does not maintain during service on the board the
   2-39  qualifications required by Section 1 of this article;
   2-40              (3)  violates a prohibition established by Section 3 or
   2-41  4 of this article;
   2-42              (4)  cannot discharge the member's term for a
   2-43  substantial part of the term for which the member is appointed
   2-44  because of illness or disability; or
   2-45              (5)  is absent from more than half of the regularly
   2-46  scheduled board meetings that the member is eligible to attend
   2-47  during a calendar year unless the absence is excused by majority
   2-48  vote of the board.
   2-49        (b)  The validity of an action of the board is not affected
   2-50  by the fact that it is taken when a ground for removal of a board
   2-51  member exists.
   2-52        (c)  If the executive director has knowledge that a potential
   2-53  ground for removal exists, the executive director shall notify the
   2-54  presiding officer of the board of the ground.  The presiding
   2-55  officer shall then notify the governor that a potential ground for
   2-56  removal exists.
   2-57        Sec. 6.  STANDARDS OF CONDUCT INFORMATION.  The board shall
   2-58  provide to its members and employees, as often as necessary,
   2-59  information regarding their qualifications for office or employment
   2-60  under this article and their responsibilities under applicable laws
   2-61  relating to standards of conduct for state officers or employees.
   2-62        Sec. 7.  STAFF.  The board shall develop and implement
   2-63  policies that clearly define the respective responsibilities of the
   2-64  board and the staff of the board.
   2-65        Sec. 8.  ANNUAL FINANCIAL REPORT.  The board shall file
   2-66  annually with the governor and the presiding officer of each house
   2-67  of the legislature a complete and detailed written report
   2-68  accounting for all funds received and disbursed by the board during
   2-69  the preceding fiscal year.  The annual report must be in the form
   2-70  and reported in the time provided by the General Appropriations
    3-1  Act.
    3-2        Sec. 9.  PERSONNEL POLICIES.  (a)  The executive director or
    3-3  the director's designee shall develop an intra-agency career ladder
    3-4  program.  The program shall require intra-agency posting of all
    3-5  nonentry level positions concurrently with any public posting.
    3-6        (b)  The executive director or the director's designee shall
    3-7  develop a system of annual performance evaluations based on
    3-8  measurable job tasks.  All merit pay for board employees must be
    3-9  based on the system established under this subsection.
   3-10        Sec. 10.  EQUAL EMPLOYMENT OPPORTUNITY POLICIES.  (a)  The
   3-11  executive director or the director's designee shall prepare and
   3-12  maintain a written policy statement to ensure implementation of a
   3-13  program of equal employment opportunity under which all personnel
   3-14  transactions are made without regard to race, color, disability,
   3-15  sex, religion, age, or national origin.  The policy statement must
   3-16  include:
   3-17              (1)  personnel policies, including policies relating to
   3-18  recruitment, evaluation, selection, application, training, and
   3-19  promotion of personnel that are in compliance with the Commission
   3-20  on Human Rights Act (Article 5221k, Vernon's Texas Civil Statutes)
   3-21  and its subsequent amendments;
   3-22              (2)  a comprehensive analysis of the board work force
   3-23  that meets federal and state guidelines;
   3-24              (3)  procedures by which a determination can be made of
   3-25  significant underuse in the board work force of all persons for
   3-26  whom federal or state guidelines encourage a more equitable
   3-27  balance; and
   3-28              (4)  reasonable methods to appropriately address those
   3-29  areas of underuse.
   3-30        (b)  A policy statement prepared under Subsection (a) of this
   3-31  section must cover an annual period, be updated annually, be
   3-32  reviewed by the Commission on Human Rights for compliance with
   3-33  Subsection (a)(1) of this section, and be filed with the governor's
   3-34  office.
   3-35        (c)  The governor's office shall deliver a biennial report to
   3-36  the legislature based on the information received under Subsection
   3-37  (b)  of this section.  The report may be made separately or as part
   3-38  of other biennial reports to the legislature.
   3-39        Sec. 11.  PUBLIC INTEREST INFORMATION.  (a)  The board shall
   3-40  prepare information of public interest describing the functions of
   3-41  the board and the procedures by which complaints are filed with and
   3-42  resolved by the board.  The board shall make the information
   3-43  available to the public and appropriate state agencies.
   3-44        (b)  The board by rule shall establish methods by which
   3-45  consumers and service recipients are notified of the name, mailing
   3-46  address, and telephone number of the board for the purpose of
   3-47  directing complaints to the board.  The board may provide for that
   3-48  notification:
   3-49              (1)  on each registration form, application, or written
   3-50  contract for services of an individual or entity regulated by the
   3-51  board;
   3-52              (2)  on a sign prominently displayed in the place of
   3-53  business of each individual or entity regulated by the board; or
   3-54              (3)  in a bill for service provided by an individual or
   3-55  entity regulated by the board.
   3-56        (c)  The board shall list along with its regular telephone
   3-57  number the toll-free telephone number that may be called to present
   3-58  a complaint about a health professional if the toll-free number is
   3-59  established under other state law.
   3-60        (d)  The board shall enter into memoranda of understanding
   3-61  with each state agency that licenses health-care facilities or
   3-62  agencies for the purpose of coordinating any posting or
   3-63  notification requirements under Subsection (b) of this section with
   3-64  posting or notification requirements that may be imposed on the
   3-65  health-care facility or agency by that state agency.
   3-66        Sec. 12.  PUBLIC PARTICIPATION IN BOARD HEARINGS.  The board
   3-67  shall develop and implement policies that provide the public with a
   3-68  reasonable opportunity to appear before the board and to speak on
   3-69  any issue under the jurisdiction of the board.
   3-70        Sec. 13.  PROGRAM ACCESSIBILITY.  The board shall prepare and
    4-1  maintain a written plan that describes how a person who does not
    4-2  speak English can be provided reasonable access to the board's
    4-3  programs.  The board shall also comply with federal and state laws
    4-4  for program and facility accessibility.
    4-6  (a)  The board shall establish a training program for the members
    4-7  of the board.
    4-8        (b)  Before a member of a board may assume the member's
    4-9  duties and before the member may be confirmed by the senate, the
   4-10  member must complete at least one course of the training program
   4-11  established under this section.
   4-12        (c)  A training program established under this section shall
   4-13  provide information to a participant regarding:
   4-14              (1)  the enabling legislation that created the board;
   4-15              (2)  the programs operated by the board;
   4-16              (3)  the role and functions of the board;
   4-17              (4)  the rules of the board with an emphasis on the
   4-18  rules that relate to disciplinary and investigatory authority;
   4-19              (5)  the current budget for the board;
   4-20              (6)  the results of the most recent formal audit of the
   4-21  board;
   4-22              (7)  the requirements of the:
   4-23                    (A)  open meetings law, Chapter 271, Acts of the
   4-24  60th Legislature, Regular Session, 1967 (Article 6252-17, Vernon's
   4-25  Texas Civil Statutes), and its subsequent amendments;
   4-26                    (B)  open records law, Chapter 424, Acts of the
   4-27  63rd Legislature, Regular Session, 1973 (Article 6252-17a, Vernon's
   4-28  Texas Civil Statutes), and its subsequent amendments; and
   4-29                    (C)  Administrative Procedure and Texas Register
   4-30  Act (Article 6252-13a, Vernon's Texas Civil Statutes) and its
   4-31  subsequent amendments;
   4-32              (8)  the requirements of the conflict of interest laws
   4-33  and other laws relating to public officials; and
   4-34              (9)  any applicable ethics policies adopted by that
   4-35  state agency or the Texas Ethics Commission.
   4-36        (d)  In developing the training requirements provided for in
   4-37  this section, the board shall consult with the governor's office,
   4-38  the attorney general's office, and the ethics commission.
   4-39        (e)  In the event that another state agency or entity is
   4-40  given the authority to establish the training requirements, the
   4-41  board shall allow that training in lieu of developing its own
   4-42  program.
   4-43        Sec. 15.  INTERAGENCY CONTRACTS.  The board may enter
   4-44  interagency contracts for any purpose authorized by law.
   4-46  or employee of the board may not be an officer, employee, or paid
   4-47  consultant of a national or statewide trade association in the
   4-48  health-care industry.  A member or employee of the board may not be
   4-49  related within the second degree by affinity or within the second
   4-50  degree by consanguinity, as determined under Article 5996h, Revised
   4-51  Statutes, to a person who is an officer, employee, or paid
   4-52  consultant of a national or statewide trade association in the
   4-53  regulated industry.  A person who is required to register as a
   4-54  lobbyist under Chapter 305, Government Code, by virtue of his
   4-55  activities on behalf of a national or statewide trade or
   4-56  professional association in a health-services industry may not
   4-57  serve as a member of the board or act as the general counsel to the
   4-58  board.>
   4-59        <Sec. 4.  GROUNDS FOR REMOVAL.  It is grounds for removal
   4-60  from the board if a member:>
   4-61              <(1)  does not have at the time of appointment the
   4-62  qualifications required for appointment to the board;>
   4-63              <(2)  does not maintain during the service on the board
   4-64  the qualifications for appointment to the board;>
   4-65              <(3)  violates a prohibition imposed on members of the
   4-66  board; or>
   4-67              <(4)  fails to attend at least half of the regularly
   4-68  scheduled board meetings held in a calendar year, excluding
   4-69  meetings held while the person was not a board member.>
   4-70        <Sec. 5.  VALIDITY OF ACTIONS.  The validity of an action of
    5-1  the board is not affected by the fact that it was taken when a
    5-2  ground for removal of a member of the board existed.>
    5-3        SECTION 2.  Article 4513a, Revised Statutes, is amended to
    5-4  read as follows:
    5-5        Art. 4513a.  SUNSET PROVISION.  The Board of Nurse Examiners
    5-6  is subject to Chapter 325, Government Code (Texas Sunset Act).
    5-7  Unless continued in existence as provided by that chapter, the
    5-8  board is abolished September 1, 2005 <1993>.
    5-9        SECTION 3.  Article 4514, Revised Statutes, is amended to
   5-10  read as follows:
   5-11        Art. 4514.  Organization of board
   5-12        Sec. 1.  President; Special Meetings; Powers.  The governor
   5-13  shall designate one of the members of the board as presiding
   5-14  officer to serve in that capacity at the pleasure of the governor.
   5-15  The members of the board shall elect other officers from their
   5-16  members <number a president>.  Special meetings of said board shall
   5-17  be called by the presiding officer <president> acting upon the
   5-18  written request of any two members.  The board shall have the
   5-19  authority and power to make and enforce all rules and regulations
   5-20  necessary for the performance of its duties and conducting of
   5-21  proceedings before it, to establish standards of professional
   5-22  conduct for all persons licensed under the provisions of this law
   5-23  in keeping with its purpose and objectives, to regulate the
   5-24  practice of professional nursing and to determine whether or not an
   5-25  act constitutes the practice of professional nursing, not
   5-26  inconsistent with this Act.  Such rules and regulations shall not
   5-27  be inconsistent with the provisions of this law.
   5-28        Sec. 2.  <LEGISLATIVE DISAPPROVAL OF RULES.  If the
   5-29  appropriate standing committees of both houses of the legislature
   5-30  acting under Subsection (g), Section 5, Administrative Procedure
   5-31  and Texas Register Act, as amended (Article 6252-13a, Vernon's
   5-32  Texas Civil Statutes), transmit to the board statements opposing
   5-33  adoption of a rule under that section, the rule may not take
   5-34  effect, or if the rule has already taken effect, the rule is
   5-35  repealed effective on the date the board receives the committee's
   5-36  statements.>
   5-37        <Sec. 3.>  Rules Restricting Competitive Bidding or
   5-38  Advertising Prohibited.  The board may not promulgate rules
   5-39  restricting competitive bidding or advertising by licensees except
   5-40  to prohibit false, misleading, or deceptive practices by the
   5-41  person.  The board may not include in its rules to prohibit false,
   5-42  misleading, or deceptive practices by a person regulated by the
   5-43  board a rule that:
   5-44              (1)  restricts the person's use of any medium for
   5-45  advertising;
   5-46              (2)  restricts the person's personal appearance or use
   5-47  of the person's <his or her> voice in an advertisement;
   5-48              (3)  relates to the size or duration of an
   5-49  advertisement by the person; or
   5-50              (4)  restricts the person's advertisement under a trade
   5-51  name.
   5-53  LEGAL AUTHORITIES.  The executive director <secretary> shall be
   5-54  required to keep a record of each meeting of said board, including
   5-55  a register of the names of all nurses registered under this law,
   5-56  which shall be at all times open to public inspection.  The <board
   5-57  shall prepare information of consumer interest describing the
   5-58  regulatory functions of the board and the board's procedures by
   5-59  which consumer complaints are filed with and resolved by the board.
   5-60  The board shall make the information available to the general
   5-61  public and appropriate state agencies.  Said> board shall assist
   5-62  the proper legal authorities in the prosecution of all persons
   5-63  violating any provision of this law.  Nothing herein shall either
   5-64  expand or contract the board's present powers as they relate to the
   5-65  regulation of nursing education.
   5-66        Sec. 4 <5>.  Open Meetings; Administrative Procedure.  The
   5-67  board is subject to the open meetings law, Chapter 271, Acts of the
   5-68  60th Legislature, Regular Session, 1967, as amended (Article
   5-69  6252-17, Vernon's Texas Civil Statutes), and the Administrative
   5-70  Procedure and Texas Register Act, as amended (Article 6252-13a,
    6-1  Vernon's Texas Civil Statutes).
    6-2        Sec. 5 <6>.  Recommendation of Rules Relating to Delegation
    6-3  of Medical Acts by Physicians.  The board may recommend to the
    6-4  Texas State Board of Medical Examiners the adoption of rules
    6-5  relating to physician's delegating medical acts to registered
    6-6  nurses <persons> licensed by the board.  The recommendations shall
    6-7  be acted on in the same manner as a petition for the adoption of a
    6-8  rule by an interested party under the Administrative Procedure and
    6-9  Texas Register Act, as amended (Article 6252-13a, Vernon's Texas
   6-10  Civil Statutes).  The board in making recommendations may
   6-11  distinguish between nurses on the basis of special training and
   6-12  education.  The board <Board of Nurse Examiners> in recommending
   6-13  rules and the Texas State Board of Medical Examiners in acting on
   6-14  recommended rules shall act, to the extent allowable under state
   6-15  and federal statutes and regulations, so as to permit the state to
   6-16  obtain its fair share of federal funds available for the delivery
   6-17  of health care in this state.
   6-18        Sec. 6 <7>.  Rules.  The board shall adopt rules
   6-19  establishing:
   6-20              (1)  any specialized education and training, including
   6-21  pharmacology, a registered nurse must have to carry out a
   6-22  prescription drug order pursuant to Subdivision (5), Subsection
   6-23  (d), Section 3.06, Medical Practice Act (Article 4495b, Vernon's
   6-24  Texas Civil Statutes); and
   6-25              (2)  a system for assigning an identification number to
   6-26  a registered nurse who provides the board with evidence of
   6-27  completing the required specialized education and training.
   6-28        Sec. 7.  NURSING PRACTICE ACT.  Articles 4513-4528, Revised
   6-29  Statutes, collectively may be referred to as the Nursing Practice
   6-30  Act.
   6-31        SECTION 4.  Article 4517, Revised Statutes, is amended to
   6-32  read as follows:
   6-34        <Sec. 1.>  The board shall employ a qualified executive
   6-35  director <secretary>, who shall not be a member of the board.
   6-36  Under the direction of the board, the executive director
   6-37  <secretary> shall perform duties required by this Act and duties
   6-38  designated by the board.  Also, the board shall employ all other
   6-39  persons necessary to carry on the work of the board.  The executive
   6-40  director <secretary> shall upon employment execute a bond in the
   6-41  sum of One Thousand Dollars payable to the Governor.  The bond is
   6-42  conditioned that the executive director <secretary> shall
   6-43  faithfully perform the duties of the <his or her> office and shall
   6-44  account for funds coming into the director's <his or her> hands as
   6-45  executive director <secretary>.  The bond shall be signed by two or
   6-46  more sufficient sureties or by a surety company authorized to do
   6-47  business in this state and approved by the president of the board.
   6-48        <Sec. 2.  The executive secretary or his designee shall
   6-49  develop a system of annual performance evaluations based on
   6-50  measurable job tasks.  All merit pay authorized by the executive
   6-51  secretary must be based on the system established under this
   6-52  section.>
   6-53        SECTION 5.  Sections 1, 3, and 4, Article 4518, Revised
   6-54  Statutes, are amended to read as follows:
   6-55        Sec. 1.  It shall be the duty of the Board <of Nurse
   6-56  Examiners> to prescribe and publish the minimum requirements and
   6-57  standards for a course of study in programs which prepare
   6-58  professional nurse practitioners.  All other regulations necessary
   6-59  to conduct accredited schools of nursing and educational programs
   6-60  for the preparation of professional nurses shall be as prescribed
   6-61  by the Board, provided, however, that the minimum period of time
   6-62  that the Board may require shall be at least two (2) academic years
   6-63  and the maximum period of time shall not exceed four (4) calendar
   6-64  years.  The Board shall accredit such schools of nursing and
   6-65  educational programs as meet its requirements and shall deny or
   6-66  withdraw accreditation from schools of nursing and educational
   6-67  programs which fail to meet the prescribed course of study or other
   6-68  standards.
   6-69        The Board shall give those persons and organizations affected
   6-70  by its orders or decisions under this Article reasonable notice
    7-1  thereof, not less than twenty (20) days, and an opportunity to
    7-2  appear and be heard with respect to same.  The Board shall hear all
    7-3  protests or complaints from such persons and organizations affected
    7-4  by such rule, regulation or decision as to the inadequacy or
    7-5  unreasonableness of any rule, regulation or order promulgated or
    7-6  adopted by it, or the injustice of any order or decision by it.  If
    7-7  any person or organization which shall be affected by such order or
    7-8  decision shall be dissatisfied with any regulation, rule or order
    7-9  by such Board, such person or organization shall have the right,
   7-10  within thirty (30) days from the date such order is entered and
   7-11  approved by the Board, to bring an action against said Board in the
   7-12  District Court of Travis County, Texas, to have such regulation,
   7-13  rule or order vacated or modified, and shall set forth in a
   7-14  petition therefor the principal grounds of objection to any or all
   7-15  of such rules, regulations or orders.  Such appeal as herein
   7-16  provided shall be de novo as that term is known and understood in
   7-17  appeals from the Justice Court to the County Court.
   7-18        Sec. 3.  Every applicant for registration as a registered
   7-19  nurse <under this law> shall present to the Board <of Nurse
   7-20  Examiners> evidence of successful completion of an accredited
   7-21  program of professional nursing education and a sworn application
   7-22  and shall upon payment of required fees be entitled to take the
   7-23  examination prescribed by the Board.  Upon <making a> passing the
   7-24  examination <grade>, the applicant shall be entitled to receive
   7-25  from said Board a certificate attested by the seal of said Board,
   7-26  entitling such person to practice as a registered nurse in the
   7-27  State of Texas.  The Board shall determine the criteria <score>,
   7-28  not to exceed the criteria <a score> required by a majority of the
   7-29  states, that constitutes <a> passing <grade on> the examination.
   7-30        Sec. 4.  Any person practicing or offering to practice
   7-31  professional nursing in this state for compensation, shall
   7-32  hereafter be required to submit evidence to the Board <of Nurse
   7-33  Examiners> that the person <he or she> is qualified to practice and
   7-34  shall be registered as provided by this law.
   7-35        SECTION 6.  Article 4519, Revised Statutes, is amended to
   7-36  read as follows:
   7-37        Art. 4519.  EXAMINATION <AND FEE>.  (a)  An applicant that
   7-38  wishes to take a licensing examination must submit to the board an
   7-39  application demonstrating the applicant's qualifications under this
   7-40  chapter.  If the board determines that the applicant meets the
   7-41  qualifications, the applicant may take the licensing examination
   7-42  <Upon filing application for examination each applicant shall pay
   7-43  an examination fee which shall in no case be returned to the
   7-44  applicant.  If the applicant passes the examination, then no
   7-45  further fee shall be required for registration.  Any applicant for
   7-46  registration who fails to successfully pass the examination herein
   7-47  provided for shall have the right to stand a second examination>.
   7-48        (b)  The examination shall be given in various cities
   7-49  throughout the State and shall be of such character as to determine
   7-50  the fitness of the applicant to practice professional nursing.  A
   7-51  written examination prepared, approved, or offered by the board,
   7-52  including a standardized national examination, shall be validated
   7-53  by an independent testing professional.  Not later than the 30th
   7-54  day <Within 30 days> after the date on which a licensing
   7-55  examination is administered under this article, the board shall
   7-56  notify each examinee of the results of the examination.  However,
   7-57  if an examination is graded or reviewed by a national testing
   7-58  service, the board shall notify each examinee of the results of the
   7-59  examination not later than the 14th day <within two weeks> after
   7-60  the date the board receives the results from the testing service.
   7-61  If the notice of the examination results graded or reviewed by a
   7-62  national testing service will be delayed for more than 90 days
   7-63  after the examination date, the board shall notify each examinee of
   7-64  the reason for the delay before the 90th day.  If requested in
   7-65  writing by a person who fails the licensing examination, the board
   7-66  shall furnish the person with an analysis of the person's
   7-67  performance on the examination.  If the result of the examination
   7-68  be satisfactory to the board, a certificate shall be issued to the
   7-69  applicant, signed by the president of the board, and executive
   7-70  director <secretary> and attested by the seal of said board, which
    8-1  certificate shall qualify the person receiving the same to practice
    8-2  professional nursing in this State.
    8-3        (c)  The board by rule shall establish the conditions under
    8-4  which an applicant who fails the licensing examination may retake
    8-5  the examination.  After twice failing the examination, the board
    8-6  may require an applicant to fulfill additional educational
    8-7  requirements and, after twice failing an examination,  may deny an
    8-8  applicant who failed the examination the opportunity to retake the
    8-9  examination.
   8-10        SECTION 7.  Article 4521, Revised Statutes, is amended to
   8-11  read as follows:
   8-13  ANOTHER STATE>.  (a)  To qualify for a temporary license to
   8-14  practice as a registered nurse by endorsement, an applicant for
   8-15  licensing must:
   8-16              (1)  submit to the board an endorsement fee as
   8-17  determined by the board and a completed application given under
   8-18  oath, in the form prescribed by the board;
   8-19              (2)  have possessed at the time of initial licensing as
   8-20  a registered nurse other qualifications necessary to have been
   8-21  eligible for licensing at that time in this state; and
   8-22              (3)  have presented to the board proof of initial
   8-23  licensing by examination and proof that the license and other
   8-24  license or licenses granted to the applicant by any other state
   8-25  have not been suspended, revoked, canceled, surrendered, or
   8-26  otherwise restricted for any reason.
   8-27        (b)  A holder of a temporary license under this section shall
   8-28  receive a permanent license if the applicant:
   8-29              (1)  has verified the academic and professional
   8-30  credentials of the applicant; and
   8-31              (2)  satisfies any other requirement set by statute.
   8-32        (c)  The board shall either grant or deny an application for
   8-33  a permanent license within 180 days after the date of the board's
   8-34  receipt of all required forms or information.  The board may extend
   8-35  the 180-day time limit to allow for the receipt and tabulation of
   8-36  examination results.
   8-37        (d)  Any applicant who holds a registration certificate as a
   8-38  registered nurse from a <another state, district,> territory or
   8-39  possession of the United States, or from a foreign country, may be
   8-40  issued a license to practice as a registered nurse in the State of
   8-41  Texas by endorsement and without examination upon the payment of a
   8-42  fee established by the board, provided in the opinion of the Board
   8-43  of Nurse Examiners such other board issuing such other certificate
   8-44  in its examination required the same general degree of fitness
   8-45  required by this state.
   8-46        SECTION 8.  Article 4523, Revised Statutes, is amended to
   8-47  read as follows:
   8-48        Art. 4523.  Temporary permit.  (a)  <Any nurse who has
   8-49  graduated from an accredited school of nursing, who holds a
   8-50  registration certificate as a Registered Nurse from another state
   8-51  or from a possession of the United States, and who is actually
   8-52  engaged in the pursuit of his or her profession, shall be permitted
   8-53  to practice in the state under a permit issued by the board of
   8-54  nurse examiners, upon the payment of a fee established by the
   8-55  board.>
   8-56        <(b)>  The board may issue a permit to practice professional
   8-57  nursing under the direct supervision of a Registered Nurse to
   8-58  graduates of approved educational programs pending the results of
   8-59  the licensing examination.  The permit expires on receipt of a
   8-60  permanent license or on receipt of a notice of failing the
   8-61  examination from the board.  The permit may not be issued to any
   8-62  applicant who has previously failed an examination administered by
   8-63  the board or by another state.
   8-64        (b) <(c)>  To allow a nurse to satisfy a requirement imposed
   8-65  under Article 4526, Revised Statutes, to renew an expired <a>
   8-66  license <expired for two years or more> or a requirement imposed
   8-67  under Article 4526b, Revised Statutes, to reactivate a nursing
   8-68  license from inactive status, the board may issue a temporary
   8-69  permit to practice professional nursing for the limited purpose of
   8-70  satisfying the requirement.  A permit issued under this subsection
    9-1  expires on the earlier of the receipt of a permanent license or six
    9-2  months from the date of issuance.
    9-3        (c) <(d)>  A person who holds a temporary permit under this
    9-4  article is a licensed professional registered nurse for all
    9-5  purposes except to the extent of any stipulations or limitations on
    9-6  practice imposed by the board as a condition of issuing the permit.
    9-7        SECTION 9.  Chapter 7, Title 71, Revised Statutes, is amended
    9-8  by adding Articles 4524A-4524D to read as follows:
    9-9        Art. 4524A.  RECORDS OF COMPLAINTS.  (a)  The board shall
   9-10  keep an information file about each complaint filed with the board.
   9-11  The board's information file shall be kept current and contain a
   9-12  record for each complaint of:
   9-13              (1)  all persons contacted in relation to the
   9-14  complaint;
   9-15              (2)  a summary of findings made at each step of the
   9-16  complaint process;
   9-17              (3)  an explanation of the legal basis and reason for a
   9-18  complaint that is dismissed; and
   9-19              (4)  other relevant information.
   9-20        (b)  If a written complaint is filed with the board that the
   9-21  board has authority to resolve, the board, at least as frequently
   9-22  as quarterly and until final disposition of the complaint, shall
   9-23  notify the parties to the complaint of the status of the complaint
   9-24  unless the notice would jeopardize an undercover investigation.
   9-25        (c)  The board by rule shall adopt a form to standardize
   9-26  information concerning complaints made to the board.  The board by
   9-27  rule shall prescribe information to be provided to a person when
   9-28  the person files a complaint with the board.
   9-29        (d)  The board shall provide reasonable assistance to a
   9-30  person who wishes to file a complaint with the board.
   9-32  (a)  The board shall adopt rules concerning the investigation of a
   9-33  complaint filed with the board.  The rules adopted under this
   9-34  subsection shall:
   9-35              (1)  distinguish between categories of complaints;
   9-36              (2)  ensure that complaints are not dismissed without
   9-37  appropriate consideration;
   9-38              (3)  require that the board be advised of a complaint
   9-39  that is dismissed and that a letter be sent to the person who filed
   9-40  the complaint explaining the action taken on the dismissed
   9-41  complaint;
   9-42              (4)  ensure that the person who filed the complaint has
   9-43  an opportunity to explain the allegations made in the complaint;
   9-44  and
   9-45              (5)  prescribe guidelines concerning the categories of
   9-46  complaints that require the use of a private investigator and the
   9-47  procedures for the board to obtain the services of a private
   9-48  investigator.
   9-49        (b)  The board shall dispose of all complaints in a timely
   9-50  manner.  The board shall establish a timeline for conducting each
   9-51  phase of a complaint that is under the control of the board not
   9-52  later than the 30th day after the date the complaint is received by
   9-53  the board.  The timeline shall be kept in the information file for
   9-54  the complaint and all parties shall be notified of the projected
   9-55  time requirements for pursuing the complaint.  A change in the
   9-56  timeline must be noted in the complaint information file and all
   9-57  parties to the complaint must be notified not later than the
   9-58  seventh day after the date the change is made.
   9-59        (c)  The executive director of the board shall notify the
   9-60  board of a complaint that extends beyond the time prescribed by the
   9-61  board for resolving the complaint so that the board may take
   9-62  necessary action on the complaint.
   9-63        Art. 4524C.  INFORMAL PROCEEDINGS.  (a)  The board by rule
   9-64  shall adopt procedures governing:
   9-65              (1)  informal disposition of a contested case under
   9-66  Section 13(e), Administrative Procedure and Texas Register Act
   9-67  (Article 6252-13a, Vernon's Texas Civil Statutes), and its
   9-68  subsequent amendments; and
   9-69              (2)  informal proceedings held in compliance with
   9-70  Section 18(c), Administrative Procedure and Texas Register Act
   10-1  (Article 6252-13a, Vernon's Texas Civil Statutes), and its
   10-2  subsequent amendments.
   10-3        (b)  Rules adopted under this article must provide the
   10-4  complainant and the licensee an opportunity to be heard and must
   10-5  require the presence of a representative of the board's legal staff
   10-6  or of the office of the attorney general to advise the board or the
   10-7  board's employees.
   10-8        Art. 4524D.  MONITORING OF LICENSEE.  The board by rule shall
   10-9  develop a system for monitoring licensees' compliance with the
  10-10  requirements of this chapter.  Rules adopted under this article
  10-11  shall include procedures for monitoring a licensee who is ordered
  10-12  by the board to perform certain acts to ascertain that the licensee
  10-13  performs the required acts and to identify and monitor licensees
  10-14  who represent a risk to the public.
  10-15        SECTION 10.  Article 4525, Revised Statutes, is amended by
  10-16  amending Subsections (a), (b), and (e) and adding Subsection (k) to
  10-17  read as follows:
  10-18        (a)  The board <of nurse examiners> may refuse to admit
  10-19  persons to its examinations, may refuse to issue a license or
  10-20  certificate of registration or to issue a certificate of renewal
  10-21  <re-registration>, may refuse to issue a temporary permit, license
  10-22  by endorsement, or license, may issue a warning or reprimand with
  10-23  or without stipulations, may suspend for any period not to exceed 5
  10-24  years, or may revoke the license or certificate of any practitioner
  10-25  of professional nursing, for any of the following reasons:
  10-26              (1)  The violation of any of the provisions of this
  10-27  law, any rule, regulation not inconsistent with this law, or order
  10-28  issued hereinunder.
  10-29              (2)  Is guilty of fraud or deceit in procuring or
  10-30  attempting to procure a license to practice professional nursing.
  10-31              (3)  Conviction of a crime of the grade of felony, or a
  10-32  crime of lesser grade which involves moral turpitude, or any
  10-33  conduct resulting in the revocation of probation imposed pursuant
  10-34  to such conviction.
  10-35              (4)  The use of any nursing license, certificate,
  10-36  diploma or permit, or transcript of such license, certificate,
  10-37  diploma or permit, which has been fraudulently purchased, issued,
  10-38  counterfeited, or materially altered.
  10-39              (5)  The impersonation of, or the acting as a proxy
  10-40  for, another in any examination required by law to obtain a license
  10-41  to practice professional nursing.
  10-42              (6)  Aiding or abetting, directly or indirectly, or in
  10-43  any manner whatsoever, any unlicensed person in connection with the
  10-44  unauthorized practice of professional nursing.
  10-45              (7)  Revocation, suspension, or denial of or any other
  10-46  action relating to the license to practice nursing in another
  10-47  jurisdiction.  Certified copy of the order of denial, suspension,
  10-48  revocation, or any other action shall be conclusive evidence
  10-49  thereof.
  10-50              (8)  Intemperate use of alcohol or drugs that the board
  10-51  determines endangers or could endanger patients.  Intemperate use
  10-52  includes but is not limited to practicing professional nursing or
  10-53  being on duty or call while under the influence of alcohol or
  10-54  drugs.
  10-55              (9)  Unprofessional or dishonorable conduct which, in
  10-56  the opinion of the board, is likely to deceive, defraud, or injure
  10-57  patients or the public.
  10-58              (10)  Adjudication of mental incompetency.
  10-59              (11)  Lack of fitness to practice by reason of mental
  10-60  or physical health that could result in injury to patients or the
  10-61  public.
  10-62              (12)  Failing to care adequately for patients or to
  10-63  conform to the minimum standards of acceptable professional nursing
  10-64  practice that, in the opinion of the board, exposes a patient or
  10-65  other person unnecessarily to risk of harm.
  10-66        (b)  Proceedings under this article shall be begun by filing
  10-67  a written complaint with the board <of nurse examiners>.  Such
  10-68  complaint may be made by any person or filed by the board on its
  10-69  own initiative.  Unless it would jeopardize an investigation, the
  10-70  board shall notify the registered nurse that a complaint has been
   11-1  filed and the nature of the complaint after a determination of the
   11-2  identity of the subject of the complaint.  <An information file
   11-3  about each complaint filed relating to a licensee shall be
   11-4  maintained by the board.  If a written complaint is filed with the
   11-5  board relating to a licensee, the board at least as frequently as
   11-6  quarterly and until final disposition of the complaint, shall
   11-7  notify the party that filed the complaint of the status of the file
   11-8  unless notice would jeopardize an investigation.>  The board shall
   11-9  make a timely and appropriate preliminary investigation of the
  11-10  complaint and may issue a warning or reprimand to the person
  11-11  against whom the complaint was filed.  If the investigation reveals
  11-12  probable cause to take further disciplinary action, the board shall
  11-13  either attempt an informal disposition of the complaint or file
  11-14  formal charges against the registered nurse stating the provisions
  11-15  of this chapter or the board's rules that are alleged to have been
  11-16  violated and a brief description of the acts or omissions that
  11-17  constituted the violation.  If the board proposes to refuse to
  11-18  admit a person to its examination, to refuse to issue a temporary
  11-19  permit, license, certificate of registration, certificate of
  11-20  re-registration, or to suspend or revoke a person's permit,
  11-21  license, or certificate, the person is entitled to a hearing before
  11-22  the State Office of Administrative Hearings <board.  The hearing
  11-23  may be before a subcommittee of the board, a majority of which is
  11-24  composed of registered nurses.  The person shall on request be
  11-25  granted a hearing before the entire board>.  Proceedings for a
  11-26  disciplinary action are governed by the Administrative Procedure
  11-27  and Texas Register Act (Article 6252-13a, Vernon's Texas Civil
  11-28  Statutes).  The board may assess a person found to have violated
  11-29  any provision of this chapter the administrative costs of
  11-30  conducting a hearing to determine that violation.  If a licensed
  11-31  professional nurse voluntarily surrenders his or her license to the
  11-32  board and executes a sworn statement that he or she no longer
  11-33  desires to be licensed, the board may revoke his or her license
  11-34  without the necessity of formal charges, notice, or opportunity of
  11-35  hearing.
  11-36        (e)  The board <of nurse examiners> is charged with the duty
  11-37  of aiding in the enforcement of the provisions of this chapter, and
  11-38  may retain legal counsel to represent the board, but prior to
  11-39  retaining outside legal counsel, the board shall request the
  11-40  attorney general to perform such services and may only retain
  11-41  outside counsel if the attorney general so certifies to the board
  11-42  that the attorney general cannot provide such services.  The board
  11-43  shall have the power to issue subpoenas, compel the attendance of
  11-44  witnesses, administer oaths to persons giving testimony at
  11-45  hearings, and cause the prosecution of all persons violating any
  11-46  provisions of this chapter.  It shall keep a record of all its
  11-47  proceedings and make an annual report to the Governor.  Any member
  11-48  of the board may present to a prosecuting officer complaints
  11-49  relating to violations of any of the provisions of this chapter,
  11-50  and the board through its members, officers, counsel, or agents
  11-51  shall assist in the trial of any cases involving alleged violation
  11-52  of this chapter, subject to the control of the prosecuting
  11-53  officers.  The Attorney General is directed to render such legal
  11-54  assistance as may be necessary in enforcing and making effective
  11-55  the provisions of this chapter; provided that this shall not
  11-56  relieve the local prosecuting officers of any of their duties under
  11-57  the law as such.
  11-58        (k)  The schedule of sanctions adopted by the board by rule
  11-59  shall be used by the State Office of Administrative Hearings for
  11-60  any sanction imposed as the result of a hearing conducted by that
  11-61  office.
  11-62        SECTION 11.  Section 1, Article 4525a, Revised Statutes, is
  11-63  amended to read as follows:
  11-65  (a)  Each registered nurse having reasonable cause to suspect that
  11-66  a registered nurse has exposed or is likely to expose a patient or
  11-67  other person unnecessarily to a risk of harm because of
  11-68  unprofessional conduct, failure to care adequately for a patient,
  11-69  failure to conform to the minimum standards of acceptable
  11-70  professional nursing practice, or impaired status shall report in a
   12-1  signed, written report to the board the name of the nurse
   12-2  committing the violation or suspected violation and any other
   12-3  pertinent information within the nurse's knowledge as the board may
   12-4  require.  A registered nurse without personal knowledge of the
   12-5  nurse's actions is not required to report under this section if she
   12-6  or he has reasonable cause to believe the nurse has already been
   12-7  reported.
   12-8        (b)  The board shall adopt rules governing reporting required
   12-9  under this article to minimize unnecessary duplicative reporting
  12-10  and the reporting of minor incidents.  A "minor incident" means
  12-11  conduct that does not indicate the nurse's continuing to practice
  12-12  professional nursing poses a risk of harm to a client or other
  12-13  person.
  12-14        SECTION 12.  Chapter 7, Title 71, Revised Statutes, is
  12-15  amended by adding Article 4525c to read as follows:
  12-16        Art. 4525c.  MEMORANDUM OF UNDERSTANDING.  The board shall
  12-17  sign a memorandum of understanding with state agencies that
  12-18  license, register, or certify a facility required by law to have a
  12-19  registered nurse peer review committee.  The memorandum of
  12-20  understanding shall:
  12-21              (1)  state the actions the board and agency shall take
  12-22  to encourage compliance with the requirement to have a registered
  12-23  nurse peer review committee; and
  12-24              (2)  be adopted as a rule of the board and the agency.
  12-25        SECTION 13.  Chapter 7, Title 71, Revised Statutes, is
  12-26  amended by adding Article 4525e to read as follows:
  12-27        Art. 4525e.  TEMPORARY SUSPENSION OF LICENSE.  If the
  12-28  majority of the board or a three-member committee of board members
  12-29  designated by the board determines from the evidence or information
  12-30  presented to it that a registered nurse by continuation in practice
  12-31  would constitute a continuing and imminent threat to the public
  12-32  welfare, the board or the three-member committee shall temporarily
  12-33  suspend the license of the registered nurse.  The license may be
  12-34  suspended under this article without notice or hearing on the
  12-35  complaint, provided institution of proceedings for a hearing before
  12-36  the State Office of Administrative Hearings is initiated
  12-37  simultaneously with the temporary suspension and provided that a
  12-38  hearing is held as soon as can be accomplished under this chapter
  12-39  and the Administrative Procedure and Texas Register Act (Article
  12-40  6252-13a, Vernon's Texas Civil Statutes) and its subsequent
  12-41  amendments.  The State Office of Administrative Hearings shall hold
  12-42  a preliminary hearing not later than the 14th day after the date of
  12-43  the temporary suspension to determine if probable cause exists that
  12-44  a continuing and imminent threat to the public welfare still
  12-45  exists.  A final hearing on the matter shall be held not later than
  12-46  the 61st day after the date of temporary suspension.
  12-47        SECTION 14.  Article 4526, Revised Statutes, is amended to
  12-48  read as follows:
  12-49        Art. 4526.  LICENSE RENEWAL <Re-registration>.  The board by
  12-50  rule may <shall> adopt a system under which licenses expire on
  12-51  various dates during the year <issued by the board shall be renewed
  12-52  each biennium>.  <For the year in which the  expiration date is
  12-53  changed, registration fees payable on or before March 31 shall be
  12-54  prorated on a monthly basis so that each registrant shall pay only
  12-55  that portion of the re-registration fee that is allocable to the
  12-56  months in which the registration is valid.  On the new expiration
  12-57  date, the total re-registration fee is payable.  The board shall
  12-58  notify each licensee at least 30 days in advance of the date of
  12-59  expiration of the license.  The application for re-registration
  12-60  shall be mailed by United States mail to the address shown in the
  12-61  board's records.  Any application received after the expiration
  12-62  date shall be charged a late fee.>  If a person's license has been
  12-63  expired for <not more than> 90 days or less, the person may renew
  12-64  the license by paying to the board the required renewal fee and a
  12-65  fee that is one-half the amount charged by the board or a designee
  12-66  for examination <fee> for the license.  If a license has been
  12-67  expired for <more than> 90 days but less than one year <two years>,
  12-68  the person may renew the license by paying to the board all unpaid
  12-69  renewal fees and a fee that is equal to the amount charged by the
  12-70  board or a designee for examination <fee> for the license.   The
   13-1  board shall by rule set a length of time beyond which an expired
   13-2  license may not be renewed.  The board may establish by rule
   13-3  additional requirements that shall apply to the renewal of a
   13-4  license that has been expired for more than one year but less than
   13-5  the time limit set by the board beyond which a license may not be
   13-6  renewed  <If a license has been expired for two years or more, the
   13-7  person may renew the license on meeting the requirements that the
   13-8  board considers necessary>.  The person may obtain a new license by
   13-9  submitting to reexamination and complying with the requirements and
  13-10  procedures for obtaining an original license.  However, the board
  13-11  may renew without reexamination an expired license of a person who
  13-12  was licensed in this state, moved to another state, and is
  13-13  currently licensed and has been in practice in the other state for
  13-14  the two years preceding application.  The person must pay to the
  13-15  board a fee that is equal to the initial fee for the license and
  13-16  the renewal fee.  At least 30 days before the expiration of the
  13-17  person's license, the board shall send written notice of the
  13-18  impending license expiration to the person at the person's last
  13-19  known address according to the records of the board.  If any
  13-20  registered nurse continues to practice professional nursing beyond
  13-21  the time for which the nurse is registered <or re-registered>, the
  13-22  nurse shall be considered to be an illegal practitioner and the
  13-23  license may be revoked or suspended.
  13-24        SECTION 15.  Article 4527, Revised Statutes, is amended to
  13-25  read as follows:
  13-26        Art. 4527.  Fees
  13-27        Sec. 1.  The board by rule shall establish reasonable and
  13-28  necessary fees so that the fees, in the aggregate, produce
  13-29  sufficient revenue to cover the cost of administering this chapter.
  13-30  The board may not set a fee for an amount less than the amount of
  13-31  that fee on September 1, 1993.  <The Board of Nurse Examiners shall
  13-32  establish reasonable and necessary fees for the administration of
  13-33  its functions in amounts not to exceed:>
  13-34        <Admission fee to examination ......................... $200>
  13-35        <Duplicate or substitute of current certificate .......   25>
  13-36        <Duplicate or substitute of permanent certificate .....   25>
  13-37        <Duplicate permits ....................................   15>
  13-38        <Endorsement with or without examination ..............  150>
  13-39        <Re-registration ......................................   50>
  13-40        <Issuance of a temporary permit under Art. 4523 .......   25>
  13-41        <Reactivating from inactive status ....................   30>
  13-42        <Accreditation of new schools and programs ............  150>
  13-43        <Filing of affidavits in re-change of name ............   10>
  13-44        <Verification of records ..............................   50>
  13-45        <Bad checks ...........................................   25>
  13-46        <Advanced Nurse Practitioner-initial credentials ......   50>
  13-47        <Advanced Nurse Practitioner-renewal of credentials ...   25>
  13-48        <Issuance    of   declaratory   order   of  eligibility>
  13-49           <for license ........................................   25>
  13-50        Sec. 2.  The board may receive gifts, grants, or other funds
  13-51  or assets  <The Board shall not maintain unnecessary fund balances,
  13-52  and fee amounts shall be set in accordance with this
  13-53  requirement.   The Board shall set and collect a sales charge for
  13-54  copies of any paper or record in the office of the Board and for
  13-55  any printed material published by the Board.  The charges are to be
  13-56  in an amount considered sufficient to reimburse the Board for its
  13-57  actual expenses>.
  13-58        Sec. 3.    All fees received by said Board under this law
  13-59  shall be placed in the State Treasury to the credit of a special
  13-60  fund to be known as the "Professional Nurse Registration Fund" and
  13-61  the Comptroller shall upon requisition of the Board from time to
  13-62  time draw warrants upon the State Treasurer for the amounts
  13-63  specified in such requisition; provided, however, all fees
  13-64  collected by the Board and deposited in the Professional Nurse
  13-65  Registration Fund shall be expended as specified by itemized
  13-66  appropriation in the General Appropriations Act and shall be used
  13-67  by the Board, and under its directions, only for purposes of
  13-68  carrying out this Act.  <The Board may use any of the fees and
  13-69  charges collected by it, as necessary, to retain, hire, or contract
  13-70  for additional prosecutors, hearing examiners, investigators, and
   14-1  support staff as necessary to aid in the investigation of
   14-2  complaints and the prosecution of persons subject to the Board's
   14-3  jurisdiction.  This provision shall apply to all fees of whatsoever
   14-4  nature as permitted by law.  The financial transactions of the
   14-5  Board are subject to audit by the state auditor in accordance with
   14-6  Chapter 321, Government Code.>
   14-7        SECTION 16.  Article 4527b, Revised Statutes, is amended to
   14-8  read as follows:
   14-9        Art. 4527b.  PENALTIES <Penalty>.  (a)  A person who violates
  14-10  any provision of Article 4527a, Revised Statutes, commits an
  14-11  offense.  Except as provided by this section, an offense under that
  14-12  article is a Class A misdemeanor.  If it is shown in the trial of a
  14-13  person allegedly in violation of that article that the person has
  14-14  once before been convicted of a violation of Article 4527a, on
  14-15  conviction the person shall be punished for a third degree felony.
  14-16  Each day of violation constitutes a separate offense.  On final
  14-17  conviction of an offense under that article, a person forfeits all
  14-18  rights and privileges conferred by virtue of licensure under this
  14-19  chapter.
  14-20        (b)  A person who violates Article 4527a, Revised Statutes,
  14-21  is liable to the state for a civil penalty that does not exceed
  14-22  $1,000 a day.  The civil penalty may be collected in a suit
  14-23  initiated by the board.
  14-24        SECTION 17.  Chapter 7, Title 71, Revised Statutes, is
  14-25  amended by adding Article 4527d to read as follows:
  14-26        Art. 4527d.  ADMINISTRATIVE PENALTIES.  (a)  The board may
  14-27  impose an administrative penalty against a person licensed or
  14-28  regulated under this article who violates this article or a rule or
  14-29  order adopted under this article.
  14-30        (b)  The penalty for each violation may be in an amount not
  14-31  to exceed $2,500.  Each day a violation continues or occurs is a
  14-32  separate violation for purposes of imposing a penalty.
  14-33        (c)  The amount of the penalty shall be based on:
  14-34              (1)  the seriousness of the violation, including the
  14-35  nature, circumstances, extent, and gravity of any prohibited acts,
  14-36  and the hazard or potential hazard created to the health, safety,
  14-37  or economic welfare of the public;
  14-38              (2)  the economic harm to property or the environment
  14-39  caused by the violation;
  14-40              (3)  the history of previous violations;
  14-41              (4)  the amount necessary to deter future violations;
  14-42              (5)  efforts to correct the violation; and
  14-43              (6)  any other matter that justice may require.
  14-44        (d)  The executive director who determines that a violation
  14-45  has occurred may issue to the board a report that states the facts
  14-46  on which the determination is based and the director's
  14-47  recommendation on the imposition of a penalty, including a
  14-48  recommendation on the amount of the penalty.
  14-49        (e)  Within 14 days after the date the report is issued, the
  14-50  executive director shall give written notice of the report to the
  14-51  person.  The notice may be given by certified mail.  The notice
  14-52  must include a brief summary of the alleged violation and a
  14-53  statement of the amount of the recommended penalty and must inform
  14-54  the person that the person has a right to a hearing on the
  14-55  occurrence of the violation, the amount of the penalty, or both the
  14-56  occurrence of the violation and the amount of the penalty.
  14-57        (f)  Within 20 days after the date the person receives the
  14-58  notice, the person in writing may accept the determination and
  14-59  recommended penalty of the executive director or may make a written
  14-60  request for a hearing on the occurrence of the violation, the
  14-61  amount of the penalty, or both the occurrence of the violation and
  14-62  the amount of the penalty.
  14-63        (g)  If the person accepts the determination and recommended
  14-64  penalty of the executive director, the board by order shall approve
  14-65  the determination and impose the recommended penalty.
  14-66        (h)  If the person requests a hearing or fails to respond
  14-67  timely to the notice, the executive director shall set a hearing
  14-68  and give notice of the hearing to the person.  The hearing shall be
  14-69  held by an administrative law judge of the State Office of
  14-70  Administrative Hearings.  The administrative law judge shall make
   15-1  findings of fact and conclusions of law.  The administrative law
   15-2  judge shall promptly issue to the board a proposal for a decision
   15-3  about the occurrence of the violation and the amount of a proposed
   15-4  penalty.  Based on the findings of fact, conclusions of law, and
   15-5  proposal for a decision, the board by order may find that a
   15-6  violation has occurred and impose a penalty or may find that no
   15-7  violation occurred.
   15-8        (i)  The notice of the board's order given to the person
   15-9  under the Administrative Procedure and Texas Register Act (Article
  15-10  6252-13a, Vernon's Texas Civil Statutes) and its subsequent
  15-11  amendments must include a statement of the right of the person to
  15-12  judicial review of the order.
  15-13        (j)  Within 30 days after the date the board's order is final
  15-14  as provided by Section 16(c), Administrative Procedure and Texas
  15-15  Register Act (Article 6252-13a, Vernon's Texas Civil Statutes), the
  15-16  person shall:
  15-17              (1)  pay the amount of the penalty;
  15-18              (2)  pay the amount of the penalty and file a petition
  15-19  for judicial review contesting the occurrence of the violation, the
  15-20  amount of the penalty, or both the occurrence of the violation and
  15-21  the amount of the penalty; or
  15-22              (3)  without paying the amount of the penalty, file a
  15-23  petition for judicial review contesting the occurrence of the
  15-24  violation, the amount of the penalty, or both the occurrence of the
  15-25  violation and the amount of the penalty.
  15-26        (k)  Within the 30-day period, a person who acts under
  15-27  Subsection (j)(3) of this section may:
  15-28              (1)  stay enforcement of the penalty by:
  15-29                    (A)  paying the amount of the penalty to the
  15-30  court for placement in an escrow account; or
  15-31                    (B)  giving to the court a supersedeas bond
  15-32  approved by the court for the amount of the penalty and that is
  15-33  effective until all judicial review of the board's order is final;
  15-34  or
  15-35              (2)  request the court to stay enforcement of the
  15-36  penalty by:
  15-37                    (A)  filing with the court a sworn affidavit of
  15-38  the person stating that the person is financially unable to pay the
  15-39  amount of the penalty and is financially unable to give the
  15-40  supersedeas bond; and
  15-41                    (B)  giving a copy of the affidavit to the
  15-42  executive director by certified mail.
  15-43        (l)  The executive director who receives a copy of an
  15-44  affidavit under Subsection (k)(2) of this section may file with the
  15-45  court, within five days after the date the copy is received, a
  15-46  contest to the affidavit.  The court shall hold a hearing on the
  15-47  facts alleged in the affidavit as soon as practicable and shall
  15-48  stay the enforcement of the penalty on finding that the alleged
  15-49  facts are true.  The person who files an affidavit has the burden
  15-50  of proving that the person is financially unable to pay the amount
  15-51  of the penalty and to give a supersedeas bond.
  15-52        (m)  If the person does not pay the amount of the penalty and
  15-53  the enforcement of the penalty is not stayed, the executive
  15-54  director may refer the matter to the attorney general for
  15-55  collection of the amount of the penalty.
  15-56        (n)  Judicial review of the order of the board:
  15-57              (1)  is instituted by filing a petition as provided by
  15-58  Section 19, Administrative Procedure and Texas Register Act
  15-59  (Article 6252-13a, Vernon's Texas Civil Statutes), and its
  15-60  subsequent amendments; and
  15-61              (2)  is under the substantial evidence rule.
  15-62        (o)  If the court sustains the occurrence of the violation,
  15-63  the court may uphold or reduce the amount of the penalty and order
  15-64  the person to pay the full or reduced amount of the penalty.  If
  15-65  the court does not sustain the occurrence of the violation, the
  15-66  court shall order that no penalty is owed.
  15-67        (p)  When the judgment of the court becomes final, the court
  15-68  shall proceed under this subsection.  If the person paid the amount
  15-69  of the penalty and if that amount is reduced or is not upheld by
  15-70  the court, the court shall order that the appropriate amount plus
   16-1  accrued interest be remitted to the person.  The rate of the
   16-2  interest is the rate charged on loans to depository institutions by
   16-3  the New York Federal Reserve Bank, and the interest shall be paid
   16-4  for the period beginning on the date the penalty was paid and
   16-5  ending on the date the penalty is remitted.  If the person gave a
   16-6  supersedeas bond and if the amount of the penalty is not upheld by
   16-7  the court, the court shall order the release of the bond.  If the
   16-8  person gave a supersedeas bond and if the amount of the penalty is
   16-9  reduced, the court shall order the release of the bond after the
  16-10  person pays the amount.
  16-11        (q)  A penalty collected under this section shall be remitted
  16-12  to the comptroller for deposit in the general revenue fund.
  16-13        (r)  All proceedings under this section are subject to the
  16-14  Administrative Procedure and Texas Register Act (Article 6252-13a,
  16-15  Vernon's Texas Civil Statutes) and its subsequent amendments.
  16-16        SECTION 18.  Article 4516, Revised Statutes, is repealed.
  16-17        SECTION 19.  The changes in law made by this Act in the
  16-18  qualifications of members of the Board of Nurse Examiners do not
  16-19  affect the entitlement of a member appointed before September 1,
  16-20  1993, to continue to hold office to the term to which the member
  16-21  was appointed.  The change in qualifications applies only to a
  16-22  member appointed on or after September 1, 1993.
  16-23        SECTION 20.  This Act takes effect September 1, 1993.
  16-24        SECTION 21.  The importance of this legislation and the
  16-25  crowded condition of the calendars in both houses create an
  16-26  emergency and an imperative public necessity that the
  16-27  constitutional rule requiring bills to be read on three several
  16-28  days in each house be suspended, and this rule is hereby suspended.
  16-29                               * * * * *
  16-30                                                         Austin,
  16-31  Texas
  16-32                                                         May 20, 1993
  16-33  Hon. Bob Bullock
  16-34  President of the Senate
  16-35  Sir:
  16-36  We, your Committee on Health and Human Services to which was
  16-37  referred H.B. No. 2180, have had the same under consideration, and
  16-38  I am instructed to report it back to the Senate with the
  16-39  recommendation that it do not pass, but that the Committee
  16-40  Substitute adopted in lieu thereof do pass and be printed.
  16-41                                                         Zaffirini,
  16-42  Chair
  16-43                               * * * * *
  16-44                               WITNESSES
  16-45                                                  FOR   AGAINST  ON
  16-46  ___________________________________________________________________
  16-47  Name:  Louise Waddill                                          x
  16-48  Representing:  Bd of Nurse Examiners
  16-49  City:  Austin
  16-50  -------------------------------------------------------------------
  16-51  Name:  Sara Keel                                               x
  16-52  Representing:  Bd of Nurse Examiners
  16-53  City:  Houston
  16-54  -------------------------------------------------------------------
  16-55  Name:  Penny Puryear Burt                                      x
  16-56  Representing:  Bd of Nurse Examiners
  16-57  City:  Georgetown
  16-58  -------------------------------------------------------------------
  16-59  Name:  James Willmann                            x
  16-60  Representing:  Tx Nurses Asso
  16-61  City:  Austin
  16-62  -------------------------------------------------------------------
  16-63  Name:  Cyndie Schmitt                                          x
  16-64  Representing:  Sunset Comm
  16-65  City:  Austin
  16-66  -------------------------------------------------------------------
  16-67  Name:  Matthew Wall                              x
  16-68  Representing:  Tx Hospital Asso
  16-69  City:  Austin
  16-70  -------------------------------------------------------------------