1-1 By: Berlanga (Senate Sponsor - Carriker) H.B. No. 2498
1-2 (In the Senate - Received from the House April 20, 1993;
1-3 April 21, 1993, read first time and referred to Committee on Health
1-4 and Human Services; April 28, 1993, reported adversely, with
1-5 favorable Committee Substitute by the following vote: Yeas 9, Nays
1-6 0; April 28, 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. 2498 By: Truan
1-19 A BILL TO BE ENTITLED
1-20 AN ACT
1-21 relating to the regulation of physician assistants; providing a
1-22 criminal penalty.
1-23 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-24 SECTION 1. SHORT TITLE; LEGISLATIVE FINDINGS AND PURPOSE.
1-25 (a) This Act may be cited as the "Physician Assistant Licensing
1-26 Act."
1-27 (b) The legislature finds that the health, safety, and
1-28 welfare of the people of this state are best advanced by the
1-29 establishment of an orderly system for licensing physician
1-30 assistants. The creation of a licensing mechanism and
1-31 establishment of an entity dedicated to regulating physician
1-32 assistants provides a means to ensure the competency of physician
1-33 assistants without a financial burden to the people of this state.
1-34 SECTION 2. DEFINITIONS. In this Act:
1-35 (1) "Board" means the Texas State Board of Medical
1-36 Examiners.
1-37 (2) "Council" means the Physician Assistant Advisory
1-38 Council.
1-39 (3) "Physician assistant" means a person who has
1-40 graduated from a physician assistant or surgeon assistant program
1-41 accredited by the American Medical Association's Committee on
1-42 Allied Health Education and Accreditation or who has passed the
1-43 certifying examination administered by the National Commission on
1-44 Certification of Physician Assistants.
1-45 (4) "Supervising physician" means a medical doctor or
1-46 doctor of osteopathy licensed by the board who supervises a
1-47 physician assistant.
1-48 (5) "Supervision" means overseeing the activities of,
1-49 and accepting responsibility for, the medical services rendered by
1-50 a physician assistant. Supervision does not require the constant
1-51 physical presence of a person providing supervision but includes a
1-52 situation where a person providing supervision and the person being
1-53 supervised are or can easily be in contact with one another by
1-54 radio, telephone, or another telecommunication device.
1-55 SECTION 3. LICENSE REQUIRED. A person may not practice as a
1-56 physician assistant unless the person is licensed under this Act.
1-57 SECTION 4. PHYSICIAN ASSISTANT ADVISORY COUNCIL. (a) The
1-58 Physician Assistant Advisory Council is created as an advisory
1-59 board to the Texas State Board of Medical Examiners.
1-60 (b) The council consists of nine members appointed by the
1-61 governor as follows:
1-62 (1) three members who are currently legally practicing
1-63 as physician assistants and who have at least five years of
1-64 clinical experience as practicing physician assistants;
1-65 (2) three members who are physicians licensed in this
1-66 state who currently supervise physician assistants; and
1-67 (3) three members who are members of the general
1-68 public who are not licensed either as physicians or physician
2-1 assistants.
2-2 (c) A person is not eligible for appointment as a public
2-3 member of the council if the person or the person's spouse:
2-4 (1) is licensed by an occupational regulatory agency
2-5 in the field of health care; or
2-6 (2) is employed by or participates in the management
2-7 of a business entity or other organization that provides health
2-8 care services or that sells, manufactures, or distributes health
2-9 care supplies or equipment.
2-10 (d) Each member of the council is entitled to a per diem as
2-11 set by legislative appropriation for each day that the member
2-12 engages in the business of the council. A member may not receive
2-13 compensation for travel expenses, including expenses for meals and
2-14 lodging, other than transportation expenses. A member is entitled
2-15 to compensation for transportation expenses as provided by the
2-16 General Appropriations Act.
2-17 (e) It is a ground for removal from the council if a member:
2-18 (1) does not have at the time of appointment the
2-19 qualifications required by this section for appointment to the
2-20 council;
2-21 (2) does not maintain during the service on the
2-22 council the qualifications required by this section for appointment
2-23 to the council; or
2-24 (3) fails to attend at least one-half of the regularly
2-25 scheduled council meetings held in a calendar year, excluding
2-26 meetings held while the person was not a committee member.
2-27 (f) A person who is required to register as a lobbyist under
2-28 Chapter 305, Government Code, and its subsequent amendments may not
2-29 serve as a member of the council.
2-30 (g) The validity of an action of the council is not affected
2-31 by the fact that it is taken when a ground for removal of a member
2-32 of the council exists.
2-33 (h) The council is subject to the open meetings law, Chapter
2-34 271, Acts of the 60th Legislature, Regular Session, 1967 (Article
2-35 6252-17, Vernon's Texas Civil Statutes), and its subsequent
2-36 amendments, and the Administrative Procedure and Texas Register Act
2-37 (Article 6252-13a, Vernon's Texas Civil Statutes) and its
2-38 subsequent amendments.
2-39 (i) Members of the council hold office for staggered terms
2-40 of six years expiring February 1 of each odd-numbered year. A
2-41 member is ineligible to serve more than two consecutive full terms
2-42 and may not serve more than a total of three full terms.
2-43 (j) In the case of a vacancy on the council, the governor
2-44 shall appoint a new member to complete an unexpired term.
2-45 (k) The council is subject to Chapter 325, Government Code
2-46 (Texas Sunset Act), and its subsequent amendments. Unless
2-47 continued in existence as provided by that chapter, the council is
2-48 abolished and this Act expires September 1, 2005.
2-49 (l) The council shall select from its membership a presiding
2-50 officer and a secretary to serve for one-year terms.
2-51 (m) Five members of the council constitute a quorum for the
2-52 transaction of the business of the council.
2-53 SECTION 5. POWERS AND DUTIES OF THE COUNCIL. The council
2-54 shall:
2-55 (1) adopt rules as provided by Section 22 of this Act;
2-56 (2) review and approve or reject applications for a
2-57 license;
2-58 (3) review and approve or reject applications for
2-59 renewal of a license;
2-60 (4) issue all licenses;
2-61 (5) deny, suspend, or revoke a license or otherwise
2-62 discipline a license holder;
2-63 (6) prescribe and collect fees authorized under this
2-64 Act; and
2-65 (7) take any action necessary to carry out the
2-66 functions and duties of the council under this Act.
2-67 SECTION 6. FEES. (a) The council shall establish fees that
2-68 are reasonable and necessary to defray the cost of administering
2-69 this Act.
2-70 (b) The council may not maintain unnecessary fund balances,
3-1 and fee amounts shall be set in accordance with this requirement.
3-2 SECTION 7. LICENSE QUALIFICATIONS. The council shall issue
3-3 a license under this Act to an applicant who:
3-4 (1) submits an application on a form prescribed by the
3-5 council;
3-6 (2) pays the application fee as prescribed by the
3-7 council;
3-8 (3) has successfully completed an educational program
3-9 for physician assistants or surgeon assistants accredited by the
3-10 Committee on Allied Health Education and Accreditation or by that
3-11 committee's predecessor or successor entities or has passed the
3-12 Physician Assistant National Certifying Examination administered by
3-13 the National Commission on Certification of Physician Assistants;
3-14 (4) certifies that the applicant is mentally and
3-15 physically able to function safely as a physician assistant;
3-16 (5) does not have a license, certification, or
3-17 registration as a physician assistant in this state or from any
3-18 other licensing authority that is currently revoked or suspended or
3-19 the applicant is not subject to probation or other disciplinary
3-20 action for cause resulting from the applicant's acts as a physician
3-21 assistant, unless the council takes that fact into consideration in
3-22 determining whether to issue the license;
3-23 (6) is of good moral character; and
3-24 (7) submits to the council any other information the
3-25 council considers necessary to evaluate the applicant's
3-26 qualifications.
3-27 SECTION 8. TEMPORARY LICENSE. (a) The council may issue a
3-28 temporary license to an applicant who:
3-29 (1) meets all the qualifications for a license under
3-30 this Act but is waiting for the next scheduled meeting of the
3-31 council for the license to be issued; or
3-32 (2) seeks to temporarily substitute for a licensed
3-33 physician assistant during the licensee's absence, if the
3-34 applicant:
3-35 (A) is licensed or registered in good standing
3-36 in another state, territory, or the District of Columbia;
3-37 (B) submits an application on a form prescribed
3-38 by the council; and
3-39 (C) pays the appropriate fee prescribed by the
3-40 council.
3-41 (b) A temporary license is valid for 45 days from the date
3-42 issued and may be extended only for another 45 days after the date
3-43 the initial temporary license expires.
3-44 SECTION 9. INACTIVE LICENSE. (a) A license holder may have
3-45 the license holder's license placed on inactive status by applying
3-46 to the council. A physician assistant with an inactive license is
3-47 excused from paying renewal fees on the license and may not
3-48 practice as a physician assistant.
3-49 (b) A license holder who practices as a physician assistant
3-50 while on inactive status is considered to be practicing without a
3-51 license.
3-52 (c) A physician assistant may return to active status by
3-53 applying to the council, paying the license renewal fee, and
3-54 complying with the requirements for license renewal under Section
3-55 10 of this Act.
3-56 SECTION 10. RENEWAL. A person who holds a license under
3-57 this Act may, on notification from the council, renew the license
3-58 by:
3-59 (1) paying the renewal fee prescribed by the council;
3-60 (2) submitting the appropriate form; and
3-61 (3) meeting any other requirement established by rules
3-62 adopted by the council.
3-63 SECTION 11. EXEMPTION. This Act does not require a license
3-64 for:
3-65 (1) a physician assistant student enrolled in a
3-66 physician assistant or surgeon assistant educational program
3-67 accredited by the Committee on Allied Health Education and
3-68 Accreditation of the American Medical Association;
3-69 (2) a physician assistant employed in the service of
3-70 the federal government while performing duties related to that
4-1 employment;
4-2 (3) a technician, assistant, or employee of a
4-3 physician who performs delegated tasks in the office of a physician
4-4 or elsewhere but who does not act as a physician assistant or
4-5 represent that the person is a physician assistant; or
4-6 (4) any other licensed health care worker acting
4-7 within the scope of that person's license if the person does not
4-8 use the title "physician assistant" or "P.A." or is not represented
4-9 or designated as a physician assistant.
4-10 SECTION 12. SCOPE OF PRACTICE. (a) The practice of a
4-11 physician assistant includes medical services within the education,
4-12 training, and experience of the physician assistant that are
4-13 delegated by the supervising physician.
4-14 (b) Medical services provided by a physician assistant may
4-15 include:
4-16 (1) obtaining patient histories and performing
4-17 physical examinations;
4-18 (2) ordering or performing diagnostic and therapeutic
4-19 procedures;
4-20 (3) formulating a working diagnosis;
4-21 (4) developing and implementing a treatment plan;
4-22 (5) monitoring the effectiveness of therapeutic
4-23 interventions;
4-24 (6) assisting at surgery;
4-25 (7) offering counseling and education to patients;
4-26 (8) requesting, receiving, and signing for
4-27 professional samples and distributing the samples to patients at a
4-28 site serving medically underserved populations, as provided by
4-29 Section 3.06(d)(5), Medical Practice Act (Article 4495b, Vernon's
4-30 Texas Civil Statutes), and its subsequent amendments, or as
4-31 otherwise authorized by board rule; and
4-32 (9) making appropriate referrals.
4-33 (c) The activities listed in Subsection (b) of this section
4-34 may be performed in any place authorized by a supervising
4-35 physician, including a clinic, hospital, ambulatory surgical
4-36 center, patient home, nursing home, or other institutional setting.
4-37 SECTION 13. SUPERVISION REQUIREMENTS. (a) Supervision by a
4-38 supervising physician must be continuous but does not require the
4-39 physical presence of the supervising physician at the place where
4-40 physician assistant services are performed while the services are
4-41 performed.
4-42 (b) Each team of a physician and physician assistant must
4-43 ensure that:
4-44 (1) the physician assistant's scope of function is
4-45 identified;
4-46 (2) delegation of medical tasks is appropriate to the
4-47 physician assistant's level of competence;
4-48 (3) the relationship between the members of the team
4-49 and the access of the physician assistant to the supervising
4-50 physician is defined; and
4-51 (4) a process for evaluating the physician assistant's
4-52 performance is established.
4-53 (c) A physician assistant may have more than one supervising
4-54 physician.
4-55 SECTION 14. SUPERVISING PHYSICIAN. A supervising physician
4-56 must:
4-57 (1) be licensed as a physician in this state;
4-58 (2) notify the council of the physician's intent to
4-59 supervise a physician assistant; and
4-60 (3) submit a statement to the council that the
4-61 physician will:
4-62 (A) supervise the physician assistant according
4-63 to rules adopted by the council; and
4-64 (B) retain professional and legal responsibility
4-65 for the care rendered by the physician assistant.
4-66 SECTION 15. NOTIFICATION OF INTENT TO PRACTICE. (a) A
4-67 physician assistant licensed under this Act must, before beginning
4-68 practice, submit on a form prescribed by the council notification
4-69 of the license holder's intent to begin practice. Notification
4-70 under this section must include:
5-1 (1) the name, business address, license number, and
5-2 telephone number of the physician assistant's supervising
5-3 physician; and
5-4 (2) the name, business address, license number, and
5-5 telephone number of the physician assistant.
5-6 (b) A physician assistant must notify the council of any
5-7 changes in, or additions to, the person acting as a supervising
5-8 physician for the physician assistant not later than the 30th day
5-9 after the date the change or addition is made.
5-10 SECTION 16. EXCLUSION OF LIMITATION ON EMPLOYMENT. This Act
5-11 does not limit the employment arrangement of a physician assistant
5-12 licensed under this Act.
5-13 SECTION 17. ASSUMPTION OF PROFESSIONAL LIABILITY. (a) A
5-14 physician assistant employed by a physician or a group of
5-15 physicians must be supervised by and be the legal responsibility of
5-16 each employing physician. The legal responsibility for the
5-17 physician assistant's patient care activities remains the
5-18 responsibility of the employing physician, including when the
5-19 physician assistant provides care and treatment for a patient in a
5-20 health care facility.
5-21 (b) A physician assistant employed by a health care facility
5-22 or other entity shall be supervised by a licensed physician. A
5-23 health care facility or other entity that employs a physician
5-24 assistant shares the legal responsibility for the physician
5-25 assistant's acts or omissions with the physician assistant's
5-26 supervising physician.
5-27 SECTION 18. DISCIPLINARY PROCEEDINGS. The council may
5-28 refuse to issue a license, publicly or privately reprimand a
5-29 license holder, or suspend, revoke, or place other restrictions on
5-30 a license of a person who:
5-31 (1) fraudulently or deceptively obtains or attempts to
5-32 obtain a license;
5-33 (2) fraudulently or deceptively uses a license;
5-34 (3) violates any provision of this Act or any rule
5-35 adopted under this Act;
5-36 (4) is convicted of a felony;
5-37 (5) is a habitual user of intoxicants or
5-38 nontherapeutic drugs to the extent that the person cannot safely
5-39 perform as a physician assistant;
5-40 (6) has been adjudicated as mentally incompetent or
5-41 has a mental condition that renders the person unable to safely
5-42 perform as a physician assistant;
5-43 (7) has committed an act of moral turpitude; or
5-44 (8) represents that the person is a physician.
5-45 SECTION 19. ADDITIONAL DISCIPLINARY AUTHORITY. In addition
5-46 to the authority under Section 18 of this Act, the council may, on
5-47 finding that a physician assistant has committed an offense
5-48 described in Section 18 of this Act:
5-49 (1) require a physician assistant to submit to the
5-50 care, counseling, or treatment of a physician designated by the
5-51 council;
5-52 (2) stay enforcement of an order and place the
5-53 physician assistant on probation with the council retaining the
5-54 right to vacate the probationary stay and enforce the original
5-55 order for noncompliance with the terms of probation;
5-56 (3) restore or reissue a license or remove any
5-57 disciplinary or corrective measure that the council may have
5-58 imposed;
5-59 (4) order the physician assistant to perform public
5-60 service; or
5-61 (5) require the physician assistant to complete
5-62 additional training.
5-63 SECTION 20. OFFENSE. (a) A person commits an offense if,
5-64 without holding a license under this Act, the person:
5-65 (1) holds the person out as a physician assistant;
5-66 (2) uses any combination or abbreviation of the term
5-67 "physician assistant" to indicate or imply that the person is a
5-68 physician assistant; or
5-69 (3) acts as a physician assistant without being
5-70 licensed by the council.
6-1 (b) An offense under this section is a felony of the third
6-2 degree.
6-3 SECTION 21. IDENTIFICATION REQUIREMENTS. A physician
6-4 assistant licensed under this Act shall:
6-5 (1) keep the physician assistant's license available
6-6 for inspection at the physician assistant's primary place of
6-7 business; and
6-8 (2) when engaged in the physician assistant's
6-9 professional activities, wear a name tag identifying the physician
6-10 assistant as a physician assistant.
6-11 SECTION 22. RULE-MAKING AUTHORITY. (a) The council shall
6-12 adopt rules that are reasonable and necessary for the performance
6-13 of the council's duties under this Act, as provided by the
6-14 Administrative Procedure and Texas Register Act (Article 6252-13a,
6-15 Vernon's Texas Civil Statutes), and its subsequent amendments,
6-16 including rules:
6-17 (1) setting licensing and other fees;
6-18 (2) establishing renewal dates for licenses; and
6-19 (3) establishing rules and procedures for disciplinary
6-20 actions.
6-21 (b) Rules adopted by the council must:
6-22 (1) be approved or rejected by a majority vote of the
6-23 board; and
6-24 (2) if rejected, be returned to the council for
6-25 revision.
6-26 SECTION 23. RURAL PHYSICIAN ASSISTANT LOAN REIMBURSEMENT
6-27 PROGRAM. (a) The council shall designate annually a portion of
6-28 the revenue generated under this Act from physician assistant
6-29 licensing fees to be set aside to provide student loan
6-30 reimbursement for graduates of physician assistant training
6-31 programs in this state who practice in rural health professional
6-32 shortage areas identified by the Texas Department of Health.
6-33 (b) The Center for Rural Health Initiatives shall establish
6-34 policy for and adopt rules to administer the loan program under
6-35 this section.
6-36 (c) The council shall authorize and the board shall transfer
6-37 annually the funds designated in Subsection (a) of this section to
6-38 the Center for Rural Health Initiatives to administer the loan
6-39 program under this section.
6-40 SECTION 24. CONFORMING AMENDMENT. Section
6-41 3.06(d)(5)(D)(ii), Medical Practice Act (Article 4495b, Vernon's
6-42 Texas Civil Statutes), is amended to read as follows:
6-43 (ii) "Physician assistant" has the meaning
6-44 assigned to that term by Section 2(3), Physician Assistant
6-45 Licensing Act, and its subsequent amendments <means a physician
6-46 assistant recognized by the Board of Medical Examiners as having
6-47 the specialized education and training required under Subsection
6-48 (d), Section 5.02 of this Act>.
6-49 SECTION 25. CONFORMING AMENDMENT. Section 3.10(b), Medical
6-50 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), is
6-51 amended to read as follows:
6-52 (b) The board may not set, charge, collect, receive, or
6-53 deposit any of the following fees in excess of:
6-54 (1) for processing and granting a license by
6-55 reciprocity to a licensee of another state ................... $700
6-56 (2) for processing an application and administration
6-57 of a partial examination for licensure ....................... $700
6-58 (3) for processing an application and administration
6-59 of a complete examination for licensure ...................... $700
6-60 (4) for processing an application and issuance of a
6-61 temporary license ............................................ $200
6-62 (5) for processing an application and issuance of a
6-63 duplicate license ............................................ $200
6-64 (6) for processing an application and issuance of a
6-65 license of reinstatement after a lapse or cancellation of a license
6-66 .............................................................. $700
6-67 (7) for processing an application and issuance of an
6-68 annual registration of a licensee ............................ $200
6-69 (8) for processing and issuance of an institutional
6-70 permit for interns, residents, and others in approved medical
7-1 training programs ............................................ $200
7-2 (9) for processing an application and issuance of an
7-3 endorsement to other state medical boards .................... $200
7-4 (10) for processing and issuance of a license or
7-5 temporary license <permit> to a <physician who supervises a>
7-6 physician assistant .......................................... $200
7-7 (11) for processing and issuance of a permit to a
7-8 physician who supervises an acupuncturist ................... $200.
7-9 SECTION 26. CONFORMING AMENDMENT. Section 5.02, Medical
7-10 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), is
7-11 amended to read as follows:
7-12 Sec. 5.02. Supervision of Physician Assistants. <(a)> The
7-13 board <by rule> shall adopt rules to regulate physician assistants
7-14 and physicians who supervise physician assistants that are
7-15 consistent with the Physician Assistant Licensing Act and its
7-16 subsequent amendments. <standards to regulate the extent to which a
7-17 physician licensed by the board may delegate his responsibilities
7-18 as a physician to a physician assistant. The standards shall take
7-19 into consideration:>
7-20 <(1) the skill of the physician assistant to whom the
7-21 physician is to delegate the responsibility;>
7-22 <(2) the skill of the physician who is to delegate the
7-23 responsibility;>
7-24 <(3) the nature of the responsibility delegated;>
7-25 <(4) the extent and nature of the supervision that the
7-26 physician is to give to the physician assistant to whom the
7-27 responsibility is delegated;>
7-28 <(5) the risks to the patient who is the subject of
7-29 the delegated responsibility; and>
7-30 <(6) other factors considered relevant by the board.>
7-31 <(b) A physician licensed by the board shall comply with the
7-32 standards adopted by the board as provided by this section.>
7-33 <(c)(1) The physician assistants advisory committee is
7-34 established.>
7-35 <(2) The physician assistants advisory committee
7-36 consists of not more than six physician assistants appointed by the
7-37 board. A member of the advisory committee serves for a term of one
7-38 year expiring on May 1 of each year.>
7-39 <(3) The advisory committee shall advise the board on
7-40 matters relating to physician assistants. In order to assure that
7-41 the advisory committee is able to exercise properly its advisory
7-42 powers, the board shall provide the advisory committee with timely
7-43 notice of all board meetings on matters relating to physician
7-44 assistants and a copy of the minutes of all board meetings on
7-45 matters relating to physician assistants. In addition, the board
7-46 may not adopt any rule relating to the practice of physician
7-47 assistants that is not an emergency matter unless the proposed rule
7-48 has been submitted to the advisory committee for review and comment
7-49 at least 30 days prior to the adoption of the rule.>
7-50 <(d) The board shall adopt rules establishing:>
7-51 <(1) any specialized education and training, including
7-52 pharmacology, a physician assistant must have to carry out a
7-53 prescription drug order pursuant to Subdivision (5), Subsection
7-54 (d), Section 3.06, of this Act; and>
7-55 <(2) a system for assigning an identification number
7-56 to a physician assistant who provides the board with evidence of
7-57 completing the required specialized education and training.>
7-58 SECTION 27. CONFORMING AMENDMENT. Section 110.001(3), Civil
7-59 Practice and Remedies Code, is amended to read as follows:
7-60 (3) "Health care professional" means:
7-61 (A) a person who is licensed to practice
7-62 medicine under the Medical Practice Act (Article 4495b, Vernon's
7-63 Texas Civil Statutes);
7-64 (B) a person registered by the Board of Nurse
7-65 Examiners as an advanced nurse practitioner or a certified nurse
7-66 midwife; or
7-67 (C) a person licensed <recognized> by the
7-68 Physician Assistant Advisory Council under the Texas State Board of
7-69 Medical Examiners as a physician assistant.
7-70 SECTION 28. TRANSITION. (a) A person is not required to
8-1 obtain a license under this Act until September 1, 1994.
8-2 (b) The council shall adopt rules under this Act not later
8-3 than January 1, 1994.
8-4 (c) In making the initial appointments to the council, the
8-5 governor shall designate three members for terms expiring February
8-6 1, 1995, three members for terms expiring February 1, 1997, and
8-7 three members for terms expiring February 1, 1999.
8-8 (d) The physician assistants advisory committee created
8-9 under Section 5.02(c), Medical Practice Act (Article 4495b,
8-10 Vernon's Texas Civil Statutes), is abolished on the effective date
8-11 of this Act.
8-12 SECTION 29. EFFECTIVE DATE. This Act takes effect September
8-13 1, 1993, except that Sections 3 and 20 take effect September 1,
8-14 1994.
8-15 SECTION 30. EMERGENCY. The importance of this legislation
8-16 and the crowded condition of the calendars in both houses create an
8-17 emergency and an imperative public necessity that the
8-18 constitutional rule requiring bills to be read on three several
8-19 days in each house be suspended, and this rule is hereby suspended.
8-20 * * * * *
8-21 Austin,
8-22 Texas
8-23 April 28, 1993
8-24 Hon. Bob Bullock
8-25 President of the Senate
8-26 Sir:
8-27 We, your Committee on Health and Human Services to which was
8-28 referred H.B. No. 2498, have had the same under consideration, and
8-29 I am instructed to report it back to the Senate with the
8-30 recommendation that it do not pass, but that the Committee
8-31 Substitute adopted in lieu thereof do pass and be printed.
8-32 Zaffirini,
8-33 Chair
8-34 * * * * *
8-35 WITNESSES
8-36 FOR AGAINST ON
8-37 ___________________________________________________________________
8-38 Name: Terry Boucher x
8-39 Representing: Tx Osteopatic Med Asso
8-40 City: Ft Worth
8-41 -------------------------------------------------------------------
8-42 Name: Frank Santos x
8-43 Representing: Tx Medical Asso
8-44 City: Austin
8-45 -------------------------------------------------------------------
8-46 Name: Justine Strand x
8-47 Representing: Tx Academy of Physician Assist
8-48 City: Austin
8-49 -------------------------------------------------------------------
8-50 Name: Sam Stone x
8-51 Representing: Tx Academy of Physician Assist
8-52 City: Austin
8-53 -------------------------------------------------------------------