BILL ANALYSIS



S.B. 659
By: Madla (Van de Putte)
05-04-95
Committee Report (Unamended)


BACKGROUND

Current law authorizes physicians to delegate acts to pharmacists
including medication management.  This relationship already exists
in many inpatient and outpatient clinical settings.  When this
service is performed by a pharmacist, it is viewed as a "delegated
practice of medicine," rather than the practice of pharmacy, under
the Medical Practice Act.  Most pharmacy malpractice insurance
coverage is limited to what state law defines as the "practice of
pharmacy" and not delegated medical acts.

PURPOSE

As proposed, S.B. 659 authorizes a person licensed to practice
medicine to delegate to a qualified pharmacist acting under
physician supervision the performance of specific acts of drug
therapy management; requires the Texas State Board of Pharmacy to
adopt rules regarding the records to be maintained by a pharmacist
performing a specific act under written protocol.

RULEMAKING AUTHORITY

It is the committee's opinion that rulemaking authority is granted
to the Texas State Board of Medical Examiners under SECTIONS 1 and
3 (Section 5(50), Article 4542a-1, V.T.C.S., and Section 3.061(a)
and (f), Article 4495b, V.T.C.S.) and the Texas State Board of
Pharmacy under SECTION 2 (Section 17(x), Article 4542a-1, V.T.C.S.)
of this bill.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 5, Article 4542a-1, V.T.C.S. (Texas
Pharmacy Act), by amending Subdivision (38) and adding Subdivision
(50), to redefine "practice of pharmacy" and define "written
protocol."

SECTION 2. Amends Section 17, Article 4542a-1, V.T.C.S., by adding
Subsection (x), to require the Texas State Board of Pharmacy to
adopt rules regarding records to be maintained by a pharmacist
performing a specific act under a written protocol.

     SECTION 3.     Amends Subchapter C, Article 4495b, V.T.C.S. (Medical
Practice Act), by adding Section 3.061, as follows:

     Sec.  3.061.  DELEGATION OF CERTAIN FUNCTIONS.  (a) Authorizes
     a person licensed to practice medicine to delegate to a
     qualified pharmacist acting under physician supervision the
     performance of specific acts of drug therapy management
     authorized through the physician's order, standing medical
     order, standing delegation order, or other order or protocol
     as defined by the Texas State Board of Medical Examiners
     (board) rule.
     
     (b) Requires the management of drug therapy permitted under
       this section to comply with other applicable law.
       
       (c) Provides that physician supervision is considered to be
       adequate for the purposes of this section if a delegating
       physician meets certain criteria.
       
       (d) Provides that this section does not restrict the use of
       a preestablished health care program or restrict a physician
       from authorizing patient care by a preestablished health
       care program if the patient is institutionalized and the
       care is delivered in a licensed hospital with a staff that
       has standing delegation or medical orders or protocols.
       
       (e) Prohibits this section from being 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 minimum
       content of a written order or protocol.  Prohibits the order
       or protocol from permitting the delegation of medical
       diagnosis.
       
       (g) Defines "pharmacist."
       
SECTION 4. Effective date: September 1, 1995.

SECTION 5. Emergency clause.

SUMMARY OF COMMITTEE ACTION

S.B. 659 was consider by the Public Health Committee in a formal
meeting on May 4, 1995. The bill was reported favorably without
amendment, with the recommendation it do pass and be printed and
sent to the Committee on Local and Consent Calendars, by a record
vote of 7 ayes, 0 nays, 0 PNV, and 2 absent.