BILL ANALYSIS



C.S.H.B. 1508
By: Van de Putte
04-04-95
Committee Report (Substituted)


BACKGROUND

Under current Texas law, physicians may delegate certain acts to
pharmacists, including medication management.  This relationship
already exists in many inpatient and outpatient clinical settings
such as total parenteral nutrition services, aminoglycoside
antibiotic monitoring services, diabetic clinics, coagulation
clinics, and hypertension clinics to name just a few.  When,
however, this service is performed by a pharmacist under the law as
it exists today, it is deemed to be the "delegated practice of
medicine" under the Medical Practice Act and not the practice of
pharmacy.

Given the highly litigious nature of our society, that definition
is an important distinguishing factor. Pharmacists, like most
health care professionals, find it necessary to protect themselves
from malpractice suits by purchasing professional liability or
druggist liability insurance.  Currently, most pharmacy malpractice
insurance coverage is limited to what state law defines as the
"Practice of Pharmacy" and not delegated medical acts.
Consequently, it is of considerable importance from a liability
perspective that the Texas definition of the "Practice of Pharmacy"
be changed to include the performance of a specific act delegated
to the pharmacist through a written protocol by a practitioner
licensed in this state.

PURPOSE

H.B. 1508, as substituted, would recognize within the Pharmacy
Practice Act acts delegated to the pharmacist by a practitioner
under written protocol. It is not the purpose of this bill to
create independent authority. The practitioner decides whether to
participate in medication management protocols and the practitioner
controls the terms and parameters of the protocol relationship. 
Those who do not comply with the defined parameters would be
disciplined by their respective licensing board.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill grants additional
rulemaking authority to the Texas State Board of Medical Examiners
in SECTION 1 (Section 5, Subdivision (50), Texas Pharmacy Act), and
in SECTION 3 (Section 3.061(a) and (f), Subchapter C, Medical
Practice Act) and to the Texas State Board of Pharmacy in SECTION
2 (Section 17(x), Texas Pharmacy Act).

SECTION BY SECTION ANALYSIS

SECTION 1.   The definition of the practice of pharmacy in Section
5 of the Texas Pharmacy Act (Article 4542a-1, VTCS) is amended by
adding subsection (F) and (50).

     (F)  The performance of a specific act of drug therapy
     management for a patient can be delegated to a pharmacist by
     a licensed physician.

     (50)  Assigns the definition of written protocol currently
     defined by the State Board of Medical Examiner's rule under
     the Medical Practice Act.

SECTION 2.  Subsection (x) is added to Section 17 of the Texas
Pharmacy Act (Art. 4542a-1 VTCS) as follows:

     (x)  Specifies that the Board of Pharmacy shall adopt rules
     regarding records to be maintained by a pharmacist performing
     a specific act under a written protocol.

SECTION 3.  Adds Sec. 3.061 to Subchapter C of the Medical Practice
Act, as follows:

     Sec. 3.061  (a)  Allows physicians to delegate specific acts
     of drug therapy management to qualified and trained
     pharmacists under adequate physician supervision. Outlines the
     circumstances under which such delegation can take place,
     including under protocol as defined by Board of Medical
     Examiners rule.

     (b)  Specifies that the application of drug therapy must
     comply with existing applicable laws.

     (c)  Defines the confines under which physician supervision is
     considered adequate for purposes of this section.

     (d)  States that this section is not meant to be restricted to
     specific health care sites.  States that a physician may
     delegate this authority in a preestablished program of health
     care and in a licensed hospital in accordance with Subsection
     (c) of this section.

     (e)  States that this section may not be construed to limit,
     expand, or change any provision of law concerning or relating
     to therapeutic drug substitution or administration of
     medication.

     (f)  Requires the board by rule to establish the content of
     the written order or protocol. Prohibits the delegation of
     medical diagnosis.

     (g)  Assigns the definition of pharmacist under the Pharmacy
     Practice Act for the purposes of this section.

SECTION 4.  Effective date:  September 1, 1995.

SECTION 5.  Emergency clause.

COMPARISON OF ORIGINAL TO SUBSTITUTE

The substitute bill amends (in SECTION 1) the Texas Pharmacy Act by
adding Subdivision (F) to clarify that the practice of pharmacy
includes "the performance of a specific act of drug therapy
management for a patient delegated to a pharmacist by a written
protocol from a physician licensed in this state..."  Subsection
(50) is added to clarify the definition of written protocol.

In SECTION 2 of the bill, the substitute for H.B. 1508 removes a
stipulation that the Board of Pharmacy shall adopt rules in
conjunction with the Texas State Board of Medical Examiners
regarding the content of a written protocol, and a provision which
states that a practitioner licensed in Texas is not liable for the
actions of a pharmacist practicing under written protocol.

SECTION 3 of the substitute adds a new section to the proposed
bill. The section provides authorization in the Medical Practice
Act for a physician, under certain circumstances, to delegate the
performance of specific acts of drug therapy management to a
pharmacist acting under physician supervision.

SUMMARY OF COMMITTEE ACTION

H.B. 1508 was considered by the committee in a public hearing on
March 28, 1995.

The following persons testified in favor of the bill:
Representative Van de Putte, author of the bill.
Diane Ginsburg, representing self.

The following persons testified neutrally on the bill:
James Willmann, representing Texas Nurses Association.
Anita Bradberry, representing Texas Association for Home Care, Inc.

The bill was left pending in committee on March 28, 1995.

H.B. 1508 was considered by the committee in public hearing on
April 4, 1995, as pending business. The committee considered a
complete substitute for the bill. The substitute was adopted
without objection. The bill was reported favorably as substituted
with the recommendation that it do pass and be printed and be sent
to the Committee on Local and Consent Calendars, by a record vote
of 8 Ayes, 0 Nays, 0 PNV, and 1 Absent.