1-1  By:  Moncrief                                          S.B. No. 839
    1-2        (In the Senate - Filed March 11, 1993; March 15, 1993, read
    1-3  first time and referred to Committee on Health and Human Services;
    1-4  May 5, 1993, reported adversely, with favorable Committee
    1-5  Substitute by the following vote:  Yeas 8, Nays 0; May 5, 1993,
    1-6  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 S.B. No. 839                 By:  Moncrief
   1-19                         A BILL TO BE ENTITLED
   1-20                                AN ACT
   1-21  relating to the regulation of the practice of vocational nursing
   1-22  and to the continuation of the Board of Vocational Nurse Examiners;
   1-23  providing penalties.
   1-24        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
   1-25        SECTION 1.  Subsection (b), Section 1, Chapter 118, Acts of
   1-26  the 52nd Legislature, 1951 (Article 4528c, Vernon's Texas Civil
   1-27  Statutes), are amended to read as follows:
   1-28              (b)  "Licensed Vocational Nurse" means a person who is
   1-29  licensed under this Act by the Board of Vocational Nurse Examiners.
   1-30        SECTION 2.  Section 5, Chapter 118, Acts of the 52nd
   1-31  Legislature, 1951 (Article 4528c, Vernon's Texas Civil Statutes),
   1-32  is amended to read as follows:
   1-33        Sec. 5.  TERM OF OFFICE, ORGANIZATION, MEETINGS OF BOARD<;
   1-34  CONTINUING EDUCATION>.  (a)  There is hereby created a board to be
   1-35  known as the Board of Vocational Nurse Examiners, consisting of
   1-36  fifteen (15) <twelve (12)> members to be appointed by the Governor
   1-37  and confirmed by the State Senate.  Appointments to the Board shall
   1-38  be made without regard to the race, creed, sex, religion, or
   1-39  national origin of the appointees.
   1-40        Seven (7) members of the Board must be Licensed Vocational
   1-41  Nurses who are graduates of approved schools of vocational nursing,
   1-42  who have been actively engaged in the practice of vocational
   1-43  nursing for five (5) years immediately preceding their
   1-44  appointments, and who are not licensed physicians, registered
   1-45  professional nurses, or hospital administrators.
   1-46        One (1) member of the Board must be a Registered Nurse
   1-47  licensed by the Board of Nurse Examiners who is actively engaged in
   1-48  a teaching, administrative, or supervisory capacity in a vocational
   1-49  nursing educational program and who is not a licensed physician,
   1-50  hospital administrator, or licensed vocational nurse.
   1-51        One (1) member of the Board must be a physician licensed by
   1-52  the Texas State Board of Medical Examiners who has been actively
   1-53  engaged in the practice of medicine for five (5) years immediately
   1-54  preceding appointment and who is not a hospital administrator,
   1-55  registered professional nurse, or licensed vocational nurse.
   1-56        One (1) member of the Board must be a hospital administrator
   1-57  who has been actively engaged in hospital administration for a
   1-58  period of five (5) years and who is not a licensed physician,
   1-59  registered professional nurse, or licensed vocational nurse.
   1-60        Five (5) <Two (2)> members of the Board must be
   1-61  representatives of the general public.  A person is not eligible
   1-62  for appointment as a public member of the Board if the person or
   1-63  the person's spouse:
   1-64              (1)  is registered, certified, or licensed by an
   1-65  occupational regulatory agency in the field of health care;
   1-66              (2)  is employed by or participates in the management
   1-67  of a business entity or other organization regulated by the Board
   1-68  or receiving funds from the Board;
    2-1              (3)  owns or controls, directly or indirectly, more
    2-2  than a 10 percent interest in a business entity or other
    2-3  organization regulated by the Board or receiving funds from the
    2-4  Board; or
    2-5              (4)  uses or receives a substantial amount of tangible
    2-6  goods, services, or funds from the Board, other than compensation
    2-7  or reimbursement authorized by law for Board membership,
    2-8  attendance, or expenses <if the person or the person's spouse is
    2-9  licensed by an occupational regulatory agency in the field of
   2-10  health care or is employed by, participates in the management of,
   2-11  or has, other than as a consumer, a financial interest in a
   2-12  business entity or other organization that provides health-care
   2-13  services or that sells, manufactures, or distributes health-care
   2-14  supplies or equipment>.
   2-15        (b)  The term of office of each member of the Board shall be
   2-16  six (6) years.  A member may not immediately succeed the member's
   2-17  term <himself (or herself)> in office.  In case of death,
   2-18  resignation or vacancy from any cause on the Board, the vacancy of
   2-19  the unexpired term shall be filled by the Governor within sixty
   2-20  (60) days after the occurrence of such vacancy.
   2-21        Each appointee to the Board <of Vocational Nurse Examiners>
   2-22  shall, within fifteen (15) days of the date of his appointment,
   2-23  qualify by taking the constitutional oath of office.
   2-24        (c)(1)  An officer, employee, or paid consultant of a Texas
   2-25  trade association in the field of health care may not be a Board
   2-26  member.
   2-27              (2)  A person who is the spouse of an officer, manager,
   2-28  or paid consultant of a Texas trade association in the field of
   2-29  health care may not be a Board member.
   2-30              (3)  For the purposes of this section, a Texas trade
   2-31  association is a nonprofit, cooperative, and voluntarily joined
   2-32  association of business or professional competitors in this state
   2-33  designed to assist its members and its industry or profession in
   2-34  dealing with mutual business or professional problems and in
   2-35  promoting their common interest.  <A member or employee of the
   2-36  Board may not be an officer, employee, or paid consultant of a
   2-37  national or state trade association in the vocational nursing
   2-38  field.>
   2-39        (d)  A person may not serve as a Board member if the person
   2-40  is required to register as a lobbyist under Chapter 305, Government
   2-41  Code, and its subsequent amendments, because of the person's
   2-42  activities for compensation on behalf of a profession related to
   2-43  the operation of the Board.  <member or employee of the Board may
   2-44  not be related within the second degree by affinity or
   2-45  consanguinity, as determined under Article 5996h, Revised Statutes,
   2-46  to a person who is an officer, employee, or paid consultant of a
   2-47  national or state trade association in the vocational nursing
   2-48  field.>
   2-49        (e)(1)  It is a ground for removal from the Board if a
   2-50  member:
   2-51                    (A) <(1)>  does not have at the time of
   2-52  appointment the qualifications required by Subsection (a) of this
   2-53  section <for appointment to the Board>;
   2-54                    (B) <(2)>  does not maintain during <his> service
   2-55  on the Board the qualifications required by Subsection (a) of this
   2-56  section <for appointment to the Board>;
   2-57                    (C) <(3)>  violates a prohibition established
   2-58  <prescribed> by Subsections <Subsection> (c) and <or> (d) of this
   2-59  section;
   2-60                    (D)  cannot discharge the member's duties for a
   2-61  substantial part of the term for which the member is appointed
   2-62  because of illness or disability; or
   2-63                    (E)  is absent from more than half of the
   2-64  regularly scheduled Board meetings that the member is eligible to
   2-65  attend during a calendar year unless the absence is excused by
   2-66  majority vote of the Board.
   2-67              (2)  The validity of an action of the Board is not
   2-68  affected by the fact that it is taken when a ground for removal of
   2-69  a Board member exists.
   2-70              (3)  If the executive director has knowledge that a
    3-1  potential ground for removal exists, the executive director shall
    3-2  notify the presiding officer of the Board of the ground.  The
    3-3  presiding officer shall then notify the governor that a potential
    3-4  ground for removal exists.
    3-5              <(4)  fails to attend at least half of the regularly
    3-6  scheduled Board meetings held in a calendar year, excluding
    3-7  meetings held while the person was not a Board member.>
    3-8        (f)  The governor shall designate from the members of the
    3-9  Board the President of the Board.  The person designated as
   3-10  President serves in that capacity at the will of the governor.
   3-11  <validity of an action of the Board is not affected by the fact
   3-12  that it was taken when a ground for removal of a member of the
   3-13  Board existed.>
   3-14        <(g)>  The Board shall elect a <President,> Vice-president<,>
   3-15  and Secretary-treasurer yearly at an annual meeting.  The Board may
   3-16  make such rules and regulations as may be necessary to govern its
   3-17  proceedings and to carry in effect the purposes of this law.  The
   3-18  Secretary-treasurer shall be required to keep minutes of each
   3-19  meeting of said Board, a register of the names of all nurses
   3-20  licensed under this law, and books of account of fees received and
   3-21  disbursements; and all minutes, the register of Licensed Vocational
   3-22  Nurses and books of account shall be at all times open to public
   3-23  inspection.  The financial transactions of this Board are subject
   3-24  to audit by the state auditor in accordance with Chapter 321,
   3-25  Government Code.  The Board shall employ a person other than a
   3-26  member of the Board as the executive director of the Board.  The
   3-27  executive director shall perform the administrative functions of
   3-28  the Board.  The Board shall employ other persons that it considers
   3-29  necessary in carrying out the provisions of this law.  The
   3-30  Secretary-treasurer shall be bonded by the Board in such amount as
   3-31  may be recommended by the State Auditor.
   3-32        (g) <(h)  The executive director or his designee shall
   3-33  develop a system of annual performance evaluations based on
   3-34  measurable job tasks.  All merit pay authorized by the executive
   3-35  director must be based on the system established under this
   3-36  subsection.>
   3-37        <(i)>  The Board shall employ a full-time Director of
   3-38  Education, who shall have had at least five (5) years experience in
   3-39  teaching nursing in an accredited school of nursing or an approved
   3-40  program in vocational nursing.  The Board may select either a
   3-41  Licensed Vocational Nurse or a Registered Nurse as the Director of
   3-42  Education.  The duties of the Director of Education shall be to
   3-43  visit and inspect all schools of vocational nursing to determine
   3-44  whether the Board's minimum requirements for vocational nursing
   3-45  programs are being met.  The Board shall prescribe such methods and
   3-46  rules of visiting, and such methods of reporting by the Board
   3-47  <Director of Education> as may in its judgment be deemed proper.
   3-48        (h) <(j)>  Regular meetings of the Board shall be held at
   3-49  least twice a year, one of which shall be designated as an Annual
   3-50  Meeting for election of officers and the reading of auditors'
   3-51  reports.  At least twice each year the Board shall hold
   3-52  examinations in various cities in the state for qualified
   3-53  applicants for licensure.  Examinations may be held under the
   3-54  supervision of a Board member or such other person as the Board may
   3-55  specify.  Not less than sixty (60) days notice of the holding of
   3-56  the examination shall be given by publication in at least three (3)
   3-57  daily newspapers of general circulation, to be selected by the
   3-58  Board; special meetings shall be held upon request of five (5)
   3-59  <four (4)> members of the Board or upon the call of the president;
   3-60  eight (8) <six (6)> members of the Board shall constitute a quorum
   3-61  for the transaction of business, and should a quorum not be present
   3-62  on the day appointed for any meeting, those persons present may
   3-63  adjourn from day to day until a quorum shall be present, providing
   3-64  that such period shall not be longer than three (3) successive
   3-65  days; each member of said Board is entitled to a per diem set by
   3-66  legislative appropriation for each day that the member engages in
   3-67  the business of the Board.  A member may not receive any
   3-68  compensation for travel expenses, including expenses for meals and
   3-69  lodging, other than transportation expenses.  A member is entitled
   3-70  to compensation for transportation expenses as provided by the
    4-1  General Appropriations Act.
    4-2        (i) <(k)>  The Board may not adopt rules restricting
    4-3  competitive bidding or advertising by a licensee of the Board
    4-4  except to prohibit false, misleading, or deceptive practices by the
    4-5  licensee.  The Board may not include in its rules to prohibit
    4-6  false, misleading, or deceptive practices by a licensee a rule
    4-7  that:
    4-8              (1)  restricts the licensee's use of any medium for
    4-9  advertising;
   4-10              (2)  restricts the licensee's personal appearance or
   4-11  use of the person's <his> voice in an advertisement;
   4-12              (3)  relates to the size or duration of an
   4-13  advertisement by the licensee; or
   4-14              (4)  restricts the licensee's advertisement under a
   4-15  trade name.
   4-16        (j) <(l)(1)  The Board may recognize, prepare, or implement
   4-17  continuing education programs for licensees and may require
   4-18  participation in continuing education programs as a condition of
   4-19  renewal of a license.>
   4-20              <(2)  The Board may not require more than a total of 20
   4-21  hours of continuing education in a two-year license period and may
   4-22  not require that more than 10 of those hours consist of classroom
   4-23  instruction in approved programs.  The remaining 10 hours may
   4-24  consist of any combination of classroom instruction,
   4-25  institutional-based instruction, or individualized study.>
   4-26              <(3)  If the Board requires participation in continuing
   4-27  education programs as a condition of renewal of a license, the
   4-28  Board shall by rule establish a system for the approval of programs
   4-29  and providers of continuing education.  In adopting the rules, the
   4-30  board shall consider but is not obligated to approve programs or
   4-31  providers approved or accredited through continuing education
   4-32  accreditation systems established by national or state associations
   4-33  of licensed vocational nurses and nurse in-service programs offered
   4-34  by hospitals accredited by the Joint Commission on Accreditation of
   4-35  Healthcare Organizations, certified by Medicare, or maintained or
   4-36  operated by the federal government or the State of Texas.  The
   4-37  Board may assess programs and providers a fee in an amount
   4-38  reasonable and necessary to defray the costs incurred in approving
   4-39  providers and programs.  The fee collected under this subsection
   4-40  shall be deposited in the Vocational Nurse Examiners Fund.>
   4-41              <(4)  The Board may adopt other rules as necessary to
   4-42  implement this section.>
   4-43        <(m)>  The Board shall prepare information of consumer
   4-44  interest describing the regulatory functions of the Board and the
   4-45  Board's procedures by which consumer complaints are filed with and
   4-46  resolved by the Board.  The Board shall make the information
   4-47  available to the general public and appropriate state agencies.
   4-48        (k) <(n)>  The Board shall enforce this Act.  The Board may
   4-49  retain outside legal counsel to represent the Board.  However,
   4-50  before the Board may retain outside counsel, the Board shall
   4-51  request the attorney general to perform the necessary services and
   4-52  may retain the outside counsel only if the attorney general
   4-53  certifies to the Board that the services cannot be performed.
   4-54        (l) <(o)  A person who is required to register as a lobbyist
   4-55  under Chapter 305, Government Code, may not serve as a member of
   4-56  the Board or act as the general counsel to the Board.>
   4-57        <(p)>  The Board of Vocational Nurse Examiners is subject to
   4-58  Chapter 325, Government Code (Texas Sunset Act).  Unless continued
   4-59  in existence as provided by that chapter, the board is abolished
   4-60  and this Act expires September 1, 2005 <1993>.
   4-61        (m) <(q)>  The Board is subject to the open meetings law,
   4-62  Chapter 271, Acts of the 60th Legislature, Regular Session, 1967,
   4-63  as amended (Article 6252-17, Vernon's Texas Civil Statutes), and
   4-64  the Administrative Procedure and Texas Register Act, as amended
   4-65  (Article 6252-13a, Vernon's Texas Civil Statutes).
   4-66        (n) <(r)>  If the appropriate standing committees of both
   4-67  houses of the legislature acting under Subsection (g), Section 5,
   4-68  Administrative Procedure and Texas Register Act, as amended
   4-69  (Article 6252-13a, Vernon's Texas Civil Statutes), transmit to the
   4-70  Board statements opposing adoption of a rule under that section,
    5-1  the rule may not take effect, or if the rule has already taken
    5-2  effect, the rule is repealed effective on the date the Board
    5-3  receives the committee's statements.
    5-4        (o)(1)  The executive director or the executive director's
    5-5  designee shall develop an intraagency career ladder program.  The
    5-6  program shall require intraagency posting of all non-entry-level
    5-7  positions concurrently with any public posting.
    5-8              (2)  The executive director or the executive director's
    5-9  designee shall develop a system of annual performance evaluations
   5-10  based on measurable job tasks.  All merit pay for Board employees
   5-11  must be based on the system established under this subsection.
   5-12        (p)(1)  The executive director or the executive director's
   5-13  designee shall prepare and maintain a written policy statement to
   5-14  assure implementation of a program of equal employment opportunity
   5-15  under which all personnel transactions are made without regard to
   5-16  race, color, disability, sex, religion, age, or national origin.
   5-17  The policy statement must include:
   5-18                    (A)  personnel policies, including policies
   5-19  relating to recruitment, evaluation, selection, application,
   5-20  training, and promotion of personnel that are in compliance with
   5-21  the Commission on Human Rights Act (Article 5221k, Vernon's Texas
   5-22  Civil Statutes), and its subsequent amendments;
   5-23                    (B)  a comprehensive analysis of the Board work
   5-24  force that meets federal and state guidelines;
   5-25                    (C)  procedures by which a determination can be
   5-26  made of significant underutilization in the Board work force of all
   5-27  persons for whom federal or state guidelines encourage a more
   5-28  equitable balance; and
   5-29                    (D)  reasonable methods to appropriately address
   5-30  those areas of underutilization.
   5-31              (2)  A policy statement prepared under Subdivision (1)
   5-32  of this subsection must cover an annual period, be updated
   5-33  annually, be reviewed by the Commission on Human Rights for
   5-34  compliance with Subdivision (1)(A) of this subsection, and be filed
   5-35  with the governor's office.
   5-36              (3)  The governor's office shall deliver a biennial
   5-37  report to the legislature based on the information received under
   5-38  Subdivision (2)  of this subsection.  The report may be made
   5-39  separately or as part of other biennial reports to the legislature.
   5-40        (q)(1)  The Board shall prepare information of public
   5-41  interest describing the functions of the Board and the Board's
   5-42  procedures by which complaints are filed with and resolved by the
   5-43  Board.  The Board shall make the information available to the
   5-44  public and appropriate state agencies.
   5-45              (2)  The Board by rule shall establish methods by which
   5-46  consumers and service recipients are notified of the name, mailing
   5-47  address, and telephone number of the Board for the purpose of
   5-48  directing complaints to the Board.  The Board may provide for that
   5-49  notification:
   5-50                    (A)  on each registration form, application, or
   5-51  written contract for services of an individual or entity regulated
   5-52  by the Board;
   5-53                    (B)  on a sign prominently displayed in the place
   5-54  of business of each individual or entity regulated by the Board; or
   5-55                    (C)  in a bill for service provided by an
   5-56  individual or entity regulated by the Board.
   5-57              (3)  The Board shall list along with its regular
   5-58  telephone number the toll-free telephone number that may be called
   5-59  to present a complaint about a health professional if the toll-free
   5-60  number is established under other state law.
   5-61        (r)  The Board shall develop and implement policies that
   5-62  provide the public with a reasonable opportunity to appear before
   5-63  the Board and to speak on any issue under the jurisdiction of the
   5-64  Board.
   5-65        (s)  The Board shall prepare and maintain a written plan that
   5-66  describes how a person who does not speak English can be provided
   5-67  reasonable access to the Board's programs.  The Board shall also
   5-68  comply with federal and state laws for program and facility
   5-69  accessibility.
   5-70        (t)(1)  The Board shall establish a training program for the
    6-1  members of the Board.
    6-2              (2)  Before a member of the Board may assume the
    6-3  member's duties and before the member may be confirmed by the
    6-4  senate, the member must complete at least one course of the
    6-5  training program established under this subsection.
    6-6              (3)  A training program established under this
    6-7  subsection shall provide information to a participant regarding:
    6-8                    (A)  the enabling legislation that created the
    6-9  Board;
   6-10                    (B)  the programs operated by the Board;
   6-11                    (C)  the role and functions of the Board;
   6-12                    (D)  the rules of the Board with an emphasis on
   6-13  the rules that relate to disciplinary and investigatory authority;
   6-14                    (E)  the current budget for the Board;
   6-15                    (F)  the results of the most recent formal audit
   6-16  of the Board;
   6-17                    (G)  the requirements of the:
   6-18                          (i)  open meetings law, Chapter 271, Acts
   6-19  of the 60th Legislature, Regular Session, 1967 (Article 6252-17,
   6-20  Vernon's Texas Civil Statutes), and its subsequent amendments;
   6-21                          (ii)  open records law, Chapter 424, Acts
   6-22  of the 63rd Legislature, Regular Session, 1973 (Article 6252-17a,
   6-23  Vernon's Texas Civil Statutes), and its subsequent amendments; and
   6-24                          (iii)  Administrative Procedure and Texas
   6-25  Register Act (Article 6252-13a, Vernon's Texas Civil Statutes) and
   6-26  its subsequent amendments;
   6-27                    (H)  the requirements of the conflict of interest
   6-28  laws and other laws relating to public officials; and
   6-29                    (I)  any applicable ethics policies adopted by
   6-30  the Board or the Texas Ethics Commission.
   6-31              (4)  In developing the training requirements provided
   6-32  for in this subsection, the Board shall consult with the governor's
   6-33  office, the attorney general's office, and the Texas Ethics
   6-34  Commission.
   6-35              (5)  In the event that another state agency or entity
   6-36  is given the authority to establish the training requirements, the
   6-37  Board shall allow that training in lieu of developing its own
   6-38  program.
   6-39        (u)  The Board shall provide to its members and employees, as
   6-40  often as necessary, information regarding their qualifications for
   6-41  office or employment under this article and their responsibilities
   6-42  under applicable laws relating to standards of conduct for state
   6-43  officers or employees.
   6-44        (v)  The Board may enter interagency contracts for any
   6-45  purpose authorized by law.
   6-46        SECTION 3.  Section 6, Chapter 118, Acts of the 52nd
   6-47  Legislature, 1951 (Article 4528c, Vernon's Texas Civil Statutes),
   6-48  is amended to read as follows:
   6-49        Sec. 6.  Examination and Licenses.  (a)  Except as provided
   6-50  in Section 7 of this Act, every person desiring to be licensed as a
   6-51  Licensed Vocational Nurse or use the abbreviation L.V.N. in the
   6-52  State of Texas, shall be required to pass the examination approved
   6-53  <given> by the Board of Vocational Nurse Examiners <or its
   6-54  delegate>.  The applicant shall make application by presenting to
   6-55  <the secretary of> the Board, on forms furnished by the Board,
   6-56  satisfactory sworn evidence that the applicant has had at least two
   6-57  (2) years of high school education or its equivalent and has
   6-58  completed an approved course <of not less than twelve (12) months>
   6-59  in an approved school for educating vocational nurses.  An approved
   6-60  school as used herein shall mean one approved by the Board.
   6-61  Application for examination by the Board or its delegate shall be
   6-62  made at least thirty (30) days prior to the date set for the
   6-63  examination.
   6-64        (b)  The Board in its discretion may waive the requirement in
   6-65  Subsection (a) of this section for completion of a course in an
   6-66  approved school for educating vocational or practical nurses upon
   6-67  presentation of satisfactory sworn evidence that the applicant has
   6-68  completed an acceptable level <at least two (2) years> of education
   6-69  in a nursing school approved by the State Board of Nurse Examiners
   6-70  of Texas or in some other school of professional nurse education
    7-1  located in another state, the District of Columbia, a possession of
    7-2  the United States, or a foreign country.  The Board by rule shall
    7-3  determine acceptable levels of education.  The Board shall have the
    7-4  written portion of the examination, if any, validated by an
    7-5  independent testing professional.  If the applicant received
    7-6  training in another state, the District of Columbia, a possession
    7-7  of the United States, or a foreign country, the applicant must
    7-8  present evidence satisfactory to the Board that the nursing
    7-9  education received is equivalent to that required for licensure as
   7-10  a vocational nurse in this state.
   7-11        (c)  Not later than the 30th day <Within 30 days> after the
   7-12  date a licensing examination is administered under this Act, the
   7-13  Board shall notify each examinee of the results of the examination.
   7-14  However, if an examination is graded or reviewed by a national
   7-15  testing service, the Board shall notify each examinee of the
   7-16  results of the examination within two weeks after the date the
   7-17  Board receives the results from the testing service.  If the notice
   7-18  of the examination results will be delayed for more than 90 days
   7-19  after the examination date, the Board shall notify each examinee of
   7-20  the reason for the delay before the 90th day.  If requested in
   7-21  writing by a person who fails the licensing examination
   7-22  administered under this Act, the Board shall furnish the person
   7-23  with an analysis of the person's performance on the examination or
   7-24  other information which the Board has available to it after the
   7-25  tests are scored.
   7-26        (d)  If an applicant has graduated from an approved
   7-27  educational program in vocational nursing in this state, another
   7-28  state, or the District of Columbia, or successfully completed two
   7-29  years of an associate degree program or diploma program in
   7-30  professional nursing education in this state, another state, or the
   7-31  District of Columbia, the Board may issue to the applicant, pending
   7-32  the results of the licensing examination, a temporary permit to
   7-33  practice vocational nursing under the direct supervision of a
   7-34  licensed vocational nurse, registered professional nurse, or
   7-35  licensed physician.  A permit issued to an applicant who fails the
   7-36  examination expires on the date indicated on the permit.  A permit
   7-37  issued to an applicant who passes the examination expires on the
   7-38  applicant's receipt of a license from the Board.  A permit may not
   7-39  be issued to an applicant who has previously failed an examination
   7-40  administered by the Board or by another state.  <The Board may
   7-41  issue a temporary permit to practice vocational nursing to an
   7-42  applicant who is a vocational or practical nurse who has graduated
   7-43  from an approved program for educating vocational or practical
   7-44  nurses, holds a license as a vocational or practical nurse from
   7-45  another state, the District of Columbia, or a possession of the
   7-46  United States, and has actually been engaged in the practice of
   7-47  vocational or practical nursing within the past five years.  Such
   7-48  an applicant must practice under the direct supervision of a
   7-49  licensed vocational nurse, registered professional nurse, or
   7-50  licensed physician.  A temporary permit issued to an applicant from
   7-51  another state, the District of Columbia, or a possession of the
   7-52  United States expires on receipt of a license from the Board or on
   7-53  the expiration of 90 days, whichever occurs first.  The Board may,
   7-54  by mutual agreement, assign the function of physical distribution
   7-55  of the temporary permits to an agent designated by the Board to act
   7-56  on behalf of the Board.>
   7-57        (e)  Any nurse who is licensed under the provisions of this
   7-58  Act, when on duty in a public or private hospital, nursing home, or
   7-59  licensed health-care facility, shall wear <identifying> insignia
   7-60  identifying the nurse as a licensed vocational nurse <on white caps
   7-61  or uniforms>.
   7-62        SECTION 4.  Section 7, Chapter 118, Acts of the 52nd
   7-63  Legislature, 1951 (Article 4528c, Vernon's Texas Civil Statutes),
   7-64  is amended to read as follows:
   7-65        Sec. 7.  QUALIFICATION FOR LICENSING BY ENDORSEMENT.  (a)  To
   7-66  qualify for a temporary license to practice as a licensed
   7-67  vocational nurse by endorsement, an applicant for licensing must:
   7-68              (1)  submit to the Board an application fee as
   7-69  determined by the Board and a completed application given under
   7-70  oath, in the form prescribed by the Board;
    8-1              (2)  have possessed at the time of initial licensing as
    8-2  a licensed vocational nurse the qualifications necessary to have
    8-3  been eligible for licensing at that time in this state;
    8-4              (3)  have presented to the Board proof of initial
    8-5  licensing by examination and proof that the license and other
    8-6  license or licenses granted to the applicant by any other state
    8-7  have not been suspended, revoked, canceled, surrendered, or
    8-8  otherwise restricted for any reason; and
    8-9              (4)  submit to the Board a notice of sponsorship of the
   8-10  applicant by the holder of a Texas health care professional license
   8-11  under whom the applicant will practice.
   8-12        (b)  A holder of a temporary license under this section shall
   8-13  receive a permanent license if the applicant:
   8-14              (1)  has verified the academic and professional
   8-15  credentials of the applicant; and
   8-16              (2)  satisfies any other requirement set by statute.
   8-17        (c)  The Board shall either grant or deny an application for
   8-18  a permanent license within 180 days after the date of the Board's
   8-19  receipt of all required forms or information.  The Board may extend
   8-20  the 180-day deadline to allow for the receipt and tabulation of
   8-21  pending examination results.
   8-22        (d)  The Board shall adopt rules relating to the conditions
   8-23  of sponsorship under Subsection (a)(4) of this section, including
   8-24  waiver of the requirement in the event of a hardship.  <Any
   8-25  applicant who holds a license as a Vocational Nurse or Practical
   8-26  Nurse issued by the District of Columbia or another state whose
   8-27  requirements are equal to those of Texas, and whose individual
   8-28  qualifications shall be equivalent to those required by this law,
   8-29  may be granted a license to practice nursing as a Licensed
   8-30  Vocational Nurse in this State without examination provided the
   8-31  required fee is paid to the Board by such applicant.>
   8-32        SECTION 5.  Subsections (a), (b), and (c), Section 8, Chapter
   8-33  118, Acts of the 52nd Legislature, 1951 (Article 4528c, Vernon's
   8-34  Texas Civil Statutes), are amended to read as follows:
   8-35        (a)  The Board <board> by rule shall adopt a system under
   8-36  which licenses expire on various dates during the year <every two
   8-37  years>.  <For the year in which the expiration date is changed,
   8-38  license fees payable on September 1 shall be prorated on a monthly
   8-39  basis so that each licensee shall pay only that portion of the
   8-40  license fee which is allocable to the number of months during which
   8-41  the license is valid.  On renewal of the license on the new
   8-42  expiration date, the total license renewal fee is payable.>
   8-43        (b)  At <The Board shall notify each licensee about the
   8-44  expiration date of the person's license at> least 30 days before
   8-45  the expiration of a person's license, the Board <date.  The Board
   8-46  by United States mail> shall send written notice of the impending
   8-47  license expiration to the person, at the person's last known
   8-48  address according to the Board's records <with the notice an
   8-49  application for license renewal to the licensee's address contained
   8-50  in the Board's records.  A licensee whose completed application for
   8-51  renewal is received by the Board after the expiration date of the
   8-52  license shall be charged a late fee>.
   8-53        (c)  If a person's license has been expired for <not more
   8-54  than> 90 days or less, the person may renew the license by paying
   8-55  to the Board the required renewal fee and a fee that is one-half
   8-56  the examination fee for the license.  If a person's license has
   8-57  been expired for more than 90 days but less than one year <two
   8-58  years>, the person may renew the license by paying to the Board all
   8-59  unpaid renewal fees and a fee that is equal to the examination fee
   8-60  for the license.  The Board by rule shall set a length of time
   8-61  beyond which an expired license may not be renewed.  The Board by
   8-62  rule may establish additional requirements that apply to the
   8-63  renewal of a license that has been expired for more than one year
   8-64  but less than the period set by the Board beyond which a license
   8-65  may not be renewed <If a person's license has been expired for two
   8-66  years or more, the person may renew the license by complying with
   8-67  the requirements set forth in substantive rules adopted by the
   8-68  Board>.  The person may obtain a new license by submitting to
   8-69  reexamination and complying with the requirements and procedures
   8-70  for obtaining an original license.  However, the Board may renew
    9-1  without examination an expired license of a person who was licensed
    9-2  in this state, moved to another state, and is currently licensed
    9-3  and has been in practice in the other state for the two years
    9-4  preceding application.  The person must pay to the Board a fee that
    9-5  is equal to the examination fee for the license.
    9-6        SECTION 6.  Chapter 118, Acts of the 52nd Legislature, 1951
    9-7  (Article 4528c, Vernon's Texas Civil Statutes), is amended by
    9-8  adding Section 8A to read as follows:
    9-9        Sec. 8A.  MANDATORY CONTINUING EDUCATION REQUIREMENTS.
   9-10  (a)  To renew a license, a licensee must demonstrate to the
   9-11  satisfaction of the Board completion of the requirement for
   9-12  continuing professional education.
   9-13        (b)  The Board shall adopt rules relating to the operation of
   9-14  the mandatory continuing education programs.  In establishing the
   9-15  requirement for continuing education, the Board shall consider:
   9-16              (1)  factors that lead to the competent performance of
   9-17  professional duties; and
   9-18              (2)  the continuing education needs of licensees.
   9-19        (c)  The Board shall adopt rules relating to the adoption or
   9-20  approval of mandatory continuing education programs and providers
   9-21  and shall adopt rules to evaluate the effectiveness of the programs
   9-22  and a licensee's participation and performance in the programs.
   9-23        SECTION 7.  Section 9, Chapter 118, Acts of the 52nd
   9-24  Legislature, 1951 (Article 4528c, Vernon's Texas Civil Statutes),
   9-25  is amended to read as follows:
   9-26        Sec. 9.  Fees.  (a)  The Board by rule shall establish
   9-27  reasonable and necessary fees so that the fees, in the aggregate,
   9-28  produce sufficient revenue to cover the cost of administering this
   9-29  Act.  The fees set by the Board may be adjusted so that the total
   9-30  fees collected shall be sufficient to meet the expenses of
   9-31  administering this Act.  The Board may not set a fee for an amount
   9-32  less than the amount of that fee on September 1, 1993  <for the
   9-33  administration of this Act in amounts not to exceed:>
   9-34              <(1)  examination and application fee:  $40;>
   9-35              <(2)  reexamination fee:  $40;>
   9-36              <(3)  renewal fee:  $20;>
   9-37              <(4)  endorsement fee:  $40;>
   9-38              <(5)  accreditation of new programs fee:  $75;>
   9-39              <(6)  duplicate temporary permit or license fee:  $10;>
   9-40              <(7)  filing of affidavits in rechange of name fee:
   9-41  $10;>
   9-42              <(8)  endorsement to another state fee:  $40; and>
   9-43              <(9)  reactivating from inactive status fee:  $30>.
   9-44  The Board shall not maintain unnecessary fund balances, and fee
   9-45  amounts shall be set in accordance with this requirement.
   9-46        (b)  All expenses under this Act shall be paid from fees
   9-47  collected by the Board under this Act, and no expense incurred
   9-48  under this Act shall ever be charged against the funds of the State
   9-49  of Texas.
   9-50        (c)  On or before January 1 of each year, the Board shall
   9-51  make in writing to the Governor and the presiding officer of each
   9-52  house of the legislature a complete and detailed report accounting
   9-53  for all funds received and disbursed by the Board during the
   9-54  preceding year.  The annual report must be in the form and reported
   9-55  in the time provided by the General Appropriations Act.
   9-56        SECTION 8.  Chapter 118, Acts of the 52nd Legislature, 1951
   9-57  (Article 4528c, Vernon's Texas Civil Statutes), is amended by
   9-58  adding Sections 10A through 10F to read as follows:
   9-59        Sec. 10A.  RECORDS OF COMPLAINTS.  (a)  The Board shall keep
   9-60  an information file about each complaint filed with the Board.  The
   9-61  Board's information file shall be kept current and contain a record
   9-62  for each complaint of:
   9-63              (1)  all persons contacted in relation to the
   9-64  complaint;
   9-65              (2)  a summary of findings made at each step of the
   9-66  complaint process;
   9-67              (3)  an explanation of the legal basis and reason for a
   9-68  complaint that is dismissed; and
   9-69              (4)  other relevant information.
   9-70        (b)  If a written complaint is filed with the Board that the
   10-1  Board has authority to resolve, the Board, at least as frequently
   10-2  as quarterly and until final disposition of the complaint, shall
   10-3  notify the parties to the complaint of the status of the complaint
   10-4  unless the notice would jeopardize an undercover investigation.
   10-5        (c)  The Board by rule shall adopt a form to standardize
   10-6  information concerning complaints made to the Board.  The Board by
   10-7  rule shall prescribe information to be provided to a person when
   10-8  the person files a complaint with the Board.
   10-9        (d)  The Board shall provide reasonable assistance to a
  10-10  person who wishes to file a complaint with the Board.
  10-11        Sec. 10B.  COMPLAINT INVESTIGATION AND DISPOSITION.  (a)  The
  10-12  Board shall adopt rules concerning the investigation of a complaint
  10-13  filed with the Board.  The rules adopted under this subsection
  10-14  shall:
  10-15              (1)  distinguish between categories of complaints;
  10-16              (2)  ensure that complaints are not dismissed without
  10-17  appropriate consideration;
  10-18              (3)  require that the Board be advised of a complaint
  10-19  that is dismissed and that a letter be sent to the person who filed
  10-20  the complaint explaining the action taken on the dismissed
  10-21  complaint;
  10-22              (4)  ensure that the person who filed the complaint has
  10-23  an opportunity to explain the allegations made in the complaint;
  10-24  and
  10-25              (5)  prescribe guidelines concerning the categories of
  10-26  complaints that require the use of a private investigator and the
  10-27  procedures for the Board to obtain the services of a private
  10-28  investigator.
  10-29        (b)  The Board shall dispose of all complaints in a timely
  10-30  manner.  The Board shall establish a time line for conducting each
  10-31  phase of a complaint that is under the control of the Board not
  10-32  later than the 30th day after the date the complaint is received by
  10-33  the Board.  The time line shall be kept in the information file for
  10-34  the complaint, and all parties shall be notified of the projected
  10-35  time requirements for pursuing the complaint.  A change in the time
  10-36  line must be noted in the complaint information file, and all
  10-37  parties to the complaint must be notified not later than the
  10-38  seventh day after the date the change is made.
  10-39        (c)  The executive director shall notify the Board of a
  10-40  complaint that extends beyond the time prescribed by the Board for
  10-41  resolving the complaint so that the Board may take necessary action
  10-42  on the complaint.
  10-43        Sec. 10C.  INFORMAL PROCEEDINGS.  (a)  The Board by rule
  10-44  shall adopt procedures governing:
  10-45              (1)  informal disposition of a contested case under
  10-46  Subsection (e), Section 13, Administrative Procedure and Texas
  10-47  Register Act (Article 6252-13a, Vernon's Texas Civil Statutes), and
  10-48  its subsequent amendments; and
  10-49              (2)  informal proceedings held in compliance with
  10-50  Subsection (c), Section 18, Administrative Procedure and Texas
  10-51  Register Act (Article 6252-13a, Vernon's Texas Civil Statutes), and
  10-52  its subsequent amendments.
  10-53        (b)  Rules adopted under this section must provide the
  10-54  complainant and the licensee an opportunity to be heard and must
  10-55  require the presence of a representative of the Board's legal staff
  10-56  or of the office of the attorney general to advise the Board or the
  10-57  Board's employees.
  10-58        Sec. 10D.  MONITORING OF LICENSEE.  The Board by rule shall
  10-59  develop a system for monitoring licensees' compliance with the
  10-60  requirements of this Act.  Rules adopted under this section shall
  10-61  include procedures for monitoring a licensee who is ordered by the
  10-62  Board to perform certain acts to ascertain that the licensee
  10-63  performs the required acts and to identify and monitor licensees
  10-64  who represent a risk to the public.
  10-65        Sec. 10E.  ADMINISTRATIVE PENALTIES.  (a)  The Board may
  10-66  impose an administrative penalty against a person licensed or
  10-67  regulated under this Act who violates this Act or a rule or order
  10-68  adopted under this Act.
  10-69        (b)  The penalty for each violation may be in an amount not
  10-70  to exceed $1,000.  Each day a violation continues or occurs is a
   11-1  separate violation for purposes of imposing a penalty.
   11-2        (c)  The amount of the penalty shall be based on:
   11-3              (1)  the seriousness of the violation, including the
   11-4  nature, circumstances, extent, and gravity of any prohibited acts,
   11-5  and the hazard or potential hazard created to the health, safety,
   11-6  or economic welfare of the public;
   11-7              (2)  the economic harm to property or the environment
   11-8  caused by the violation;
   11-9              (3)  the history of previous violations;
  11-10              (4)  the amount necessary to deter future violations;
  11-11              (5)  efforts to correct the violation; and
  11-12              (6)  any other matter that justice may require.
  11-13        (d)  If the executive director determines that a violation
  11-14  has occurred, the executive director may issue to the Board a
  11-15  report that states the facts on which the determination is based
  11-16  and the executive director's recommendation on the imposition of a
  11-17  penalty, including a recommendation on the amount of the penalty.
  11-18        (e)  Within 14 days after the date the report is issued, the
  11-19  executive director shall give written notice of the report to the
  11-20  person.  The notice may be given by certified mail.  The notice
  11-21  must include a brief summary of the alleged violation and a
  11-22  statement of the amount of the recommended penalty and must inform
  11-23  the person that the person has a right to a hearing on the
  11-24  occurrence of the violation, the amount of the penalty, or both the
  11-25  occurrence of the violation and the amount of the penalty.
  11-26        (f)  Within 20 days after the date the person receives the
  11-27  notice, the person in writing may accept the determination and
  11-28  recommended penalty of the executive director or may make a written
  11-29  request for a hearing on the occurrence of the violation, the
  11-30  amount of the penalty, or both the occurrence of the violation and
  11-31  the amount of the penalty.
  11-32        (g)  If the person accepts the determination and recommended
  11-33  penalty of the executive director, the Board by order shall approve
  11-34  the determination and impose the recommended penalty.
  11-35        (h)  If the person requests a hearing or fails to respond
  11-36  timely to the notice, the executive director shall set a hearing
  11-37  and give notice of the hearing to the person.  The hearing shall be
  11-38  held by an administrative law judge of the State Office of
  11-39  Administrative Hearings.  The administrative law judge shall make
  11-40  findings of fact and conclusions of law.  The administrative law
  11-41  judge shall promptly issue to the Board a proposal for a decision
  11-42  about the occurrence of the violation and the amount of a proposed
  11-43  penalty.  Based on the findings of fact, conclusions of law, and
  11-44  proposal for a decision, the Board by order may find that a
  11-45  violation has occurred and impose a penalty or may find that no
  11-46  violation occurred.
  11-47        (i)  The notice of the Board's order given to the person
  11-48  under the Administrative Procedure and Texas Register Act (Article
  11-49  6252-13a, Vernon's Texas Civil Statutes) and its subsequent
  11-50  amendments must include a statement of the right of the person to
  11-51  judicial review of the order.
  11-52        (j)  Within 30 days after the date the Board's order is final
  11-53  as provided by Subsection (c), Section 16, Administrative Procedure
  11-54  and Texas Register Act (Article 6252-13a, Vernon's Texas Civil
  11-55  Statutes), and its subsequent amendments, the person shall:
  11-56              (1)  pay the amount of the penalty;
  11-57              (2)  pay the amount of the penalty and file a petition
  11-58  for judicial review contesting the occurrence of the violation, the
  11-59  amount of the penalty, or both the occurrence of the violation and
  11-60  the amount of the penalty; or
  11-61              (3)  without paying the amount of the penalty, file a
  11-62  petition for judicial review contesting the occurrence of the
  11-63  violation, the amount of the penalty, or both the occurrence of the
  11-64  violation and the amount of the penalty.
  11-65        (k)  Within the 30-day period, a person who acts under
  11-66  Subsection (j)(3) of this section may:
  11-67              (1)  stay enforcement of the penalty by:
  11-68                    (A)  paying the amount of the penalty to the
  11-69  court for placement in an escrow account; or
  11-70                    (B)  giving to the court a supersedeas bond
   12-1  approved by the court for the amount of the penalty and that is
   12-2  effective until all judicial review of the Board's order is final;
   12-3  or
   12-4              (2)  request the court to stay enforcement of the
   12-5  penalty by:
   12-6                    (A)  filing with the court a sworn affidavit of
   12-7  the person stating that the person is financially unable to pay the
   12-8  amount of the penalty and is financially unable to give the
   12-9  supersedeas bond; and
  12-10                    (B)  giving a copy of the affidavit to the
  12-11  executive director by certified mail.
  12-12        (l)  An executive director who receives a copy of an
  12-13  affidavit under Subsection (k)(2) of this section may file with the
  12-14  court, within five days after the date the copy is received, a
  12-15  contest to the affidavit.  The court shall hold a hearing on the
  12-16  facts alleged in the affidavit as soon as practicable and shall
  12-17  stay the enforcement of the penalty on finding that the alleged
  12-18  facts are true.  The person who files an affidavit has the burden
  12-19  of proving that the person is financially unable to pay the amount
  12-20  of the penalty and to give a supersedeas bond.
  12-21        (m)  If the person does not pay the amount of the penalty and
  12-22  the enforcement of the penalty is not stayed, the executive
  12-23  director may refer the matter to the attorney general for
  12-24  collection of the amount of the penalty.
  12-25        (n)  Judicial review of the order of the Board:
  12-26              (1)  is instituted by filing a petition as provided by
  12-27  Section 19, Administrative Procedure and Texas Register Act
  12-28  (Article 6252-13a, Vernon's Texas Civil Statutes), and its
  12-29  subsequent amendments; and
  12-30              (2)  is under the substantial evidence rule.
  12-31        (o)  If the court sustains the occurrence of the violation,
  12-32  the court may uphold or reduce the amount of the penalty and order
  12-33  the person to pay the full or reduced amount of the penalty.  If
  12-34  the court does not sustain the occurrence of the violation, the
  12-35  court shall order that no penalty is owed.
  12-36        (p)  When the judgment of the court becomes final, the court
  12-37  shall proceed under this subsection.  If the person paid the amount
  12-38  of the penalty and if that amount is reduced or is not upheld by
  12-39  the court, the court shall order that the appropriate amount plus
  12-40  accrued interest be remitted to the person.  The rate of the
  12-41  interest is the rate charged on loans to depository institutions by
  12-42  the New York Federal Reserve Bank, and the interest shall be paid
  12-43  for the period beginning on the date the penalty was paid and
  12-44  ending on the date the penalty is remitted.  If the person gave a
  12-45  supersedeas bond and if the amount of the penalty is not upheld by
  12-46  the court, the court shall order the release of the bond.  If the
  12-47  person gave a supersedeas bond and if the amount of the penalty is
  12-48  reduced, the court shall order the release of the bond after the
  12-49  person pays the amount.
  12-50        (q)  A penalty collected under this section shall be remitted
  12-51  to the comptroller for deposit in the general revenue fund.
  12-52        (r)  All proceedings under this section are subject to the
  12-53  Administrative Procedure and Texas Register Act (Article 6252-13a,
  12-54  Vernon's Texas Civil Statutes) and its subsequent amendments.
  12-55        Sec. 10F.  SCHEDULE OF SANCTIONS.  The schedule of sanctions
  12-56  adopted by the Board by rule shall be used by the State Office of
  12-57  Administrative Hearings for any sanction imposed as the result of a
  12-58  hearing conducted by that office.
  12-59        SECTION 9.  Section 11, Chapter 118, Acts of the 52nd
  12-60  Legislature, 1951 (Article 4528c, Vernon's Texas Civil Statutes),
  12-61  is amended by adding Subsection (c) to read as follows:
  12-62        (c)  A person who violates this Act is liable to the state
  12-63  for a civil penalty that does not exceed $1,000 a day.  The civil
  12-64  penalty may be collected in a suit initiated by the Board.
  12-65        SECTION 10.  (a)  The changes in law made by this Act in the
  12-66  qualifications of members of the Board of Vocational Nurse
  12-67  Examiners do not affect the entitlement of a member appointed
  12-68  before September 1, 1993, to continue to hold office for the term
  12-69  for which the member was appointed.  The changes in the
  12-70  qualifications apply only to a member appointed on or after
   13-1  September 1, 1993.
   13-2        (b)  As soon as possible on or after September 1, 1993, the
   13-3  governor shall appoint three additional public members to the Board
   13-4  of Vocational Nurse Examiners.  In making the initial appointments
   13-5  of the new members, the governor shall designate one for a term
   13-6  expiring on the regular expiration date of board members in 1995,
   13-7  one for a term expiring on the regular expiration date of board
   13-8  members in 1997, and one for a term expiring on the regular
   13-9  expiration date of board members in 1999.
  13-10        SECTION 11.  This Act takes effect September 1, 1993.
  13-11        SECTION 12.  The importance of this legislation and the
  13-12  crowded condition of the calendars in both houses create an
  13-13  emergency and an imperative public necessity that the
  13-14  constitutional rule requiring bills to be read on three several
  13-15  days in each house be suspended, and this rule is hereby suspended.
  13-16                               * * * * *
  13-17                                                         Austin,
  13-18  Texas
  13-19                                                         May 5, 1993
  13-20  Hon. Bob Bullock
  13-21  President of the Senate
  13-22  Sir:
  13-23  We, your Committee on Health and Human Services to which was
  13-24  referred S.B. No. 839, have had the same under consideration, and I
  13-25  am instructed to report it back to the Senate with the
  13-26  recommendation that it do not pass, but that the Committee
  13-27  Substitute adopted in lieu thereof do pass and be printed.
  13-28                                                         Zaffirini,
  13-29  Chair
  13-30                               * * * * *
  13-31                               WITNESSES
  13-32                                                  FOR   AGAINST  ON
  13-33  ___________________________________________________________________
  13-34  Name:  Felice Mathisen                           x
  13-35  Representing:  Tx League of Vocational Nurses
  13-36  City:  Texas City
  13-37  -------------------------------------------------------------------
  13-38  Name:  Elise Kahlden                                     x
  13-39  Representing:  Self
  13-40  City:  Columbus
  13-41  -------------------------------------------------------------------
  13-42  Name:  Iva Burgan                                x
  13-43  Representing:  Tx Council Vocation Nurses
  13-44  City:  Alice
  13-45  -------------------------------------------------------------------
  13-46  Name:  Evelyn Robert
  13-47  Representing:  Tx Lic. Vocational Nurses
  13-48  City:  Texas City
  13-49  -------------------------------------------------------------------
  13-50  Name:  Cyndie Schmitt                                          x
  13-51  Representing:  Sunset Commission
  13-52  City:  Austin
  13-53  -------------------------------------------------------------------
  13-54  Name:  Karen Hamlett                             x
  13-55  Representing:  LVN Asso of Tx
  13-56  City:  Austin
  13-57  -------------------------------------------------------------------
  13-58  Name:  Majorie A. Bronk                                        x
  13-59  Representing:  BD of Vocational Nurse Ex
  13-60  City:  Austin
  13-61  -------------------------------------------------------------------
  13-62  Name:  Deborah Williams                          x       x
  13-63  Representing:  Tx League of Vocational Nurse
  13-64  City:  Texas City
  13-65  -------------------------------------------------------------------
  13-66  Name:  Valerie Spurgin                           x
  13-67  Representing:  Tx League of Vocational Nurse
  13-68  City:  Texas City
  13-69  -------------------------------------------------------------------
  13-70  Name:  Mae J. Ferguson                           x       x
   14-1  Representing:  Tx League Vocational Nurses
   14-2  City:  Texas City
   14-3  -------------------------------------------------------------------
   14-4  Name:  Irene B. Ray                                      x
   14-5  Representing:  Tx Lic. Vocational Nurses
   14-6  City:  Texas City
   14-7  -------------------------------------------------------------------
   14-8  Name:  Minnie Urbanek                            x       x
   14-9  Representing:  Tx League of Vocational Nurses
  14-10  City:  La Marque
  14-11  -------------------------------------------------------------------
  14-12                                                  FOR   AGAINST  ON
  14-13  ___________________________________________________________________
  14-14  Name:  Charles Ken Bergeron                      x
  14-15  Representing:  Tx League Vocational Nurses
  14-16  City:  League City
  14-17  -------------------------------------------------------------------