BILL ANALYSIS C.S.S.B. 659 By: Madla Health and Human Services 04-20-95 Committee Report (Substituted) 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, C.S.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.