BILL ANALYSIS
S.B. 1302
By: Cain (Berlanga)
May 9, 1995
Committee Report (Unamended)
BACKGROUND
The Physician Assistant Licensing Act (Article 4495b-1, Vernon's
Texas Civil Statutes) established the Physician Assistant Advisory
Council as the regulatory agency subordinate to the Texas State
Board of Medical Examiners. The name of the agency and the language
of the law need to be updated to conform with the Medical Practice
Act and the regulatory, administrative, and disciplinary functions
of the Texas State Board of Medical Examiners.
PURPOSE
S.B. 1302 would amend the Physician Assistant Licensing Act
(Article 4495b-1, Vernon's Texas Civil Statutes), to create the
Texas State Board of Physician Assistant Examiners (board), to
replace the Physician Assistant Advisory Council, expand the
rulemaking authority of the board to provide for educational and
other requirements regarding licensure, expand the authority of a
physician assistant to prescribe certain drugs, and set forth
requirements for disciplinary proceedings.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill grants additional
rulemaking authority to the Texas State Board of Physician
Assistant Examiners in SECTION 1 (Sections 7, 11, and 23, the
Physician Assistant Licensing Act, Article 4495b-1, V.T.C.S.) and
to the Texas Department of Health in SECTION 3 (Section 3.06(d),
Medical Practice Act, Article 4495b, V.T.C.S.).
In addition, SECTION 1 of the bill (Section 23, the Physician
Assistant Licensing Act, Article 4495b-1, V.T.C.S.) states that
rules adopted by the Texas State Board of Physician Assistant
Examiners must be approved or rejected by the Texas State Board of
Medical Examiners.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Physician Assistant Licensing Act (Article 4495b-1, V.T.C.S.) as follows:
Sec. 2. DEFINITIONS. Amends the definitions of "board,"
"physician assistant," "supervising physician," and
"supervision." Replaces the definition of "council" with that
of "medical board." Adds definitions of "alternate physician"
and "state."
Sec. 4. New heading: BOARD OF PHYSICIAN ASSISTANT EXAMINERS.
(a) Creates the Texas State Board of Physician Assistant
Examiners (board), and deletes the Physician Assistant
Advisory Council (council), as an advisory board to the Texas
State Board of Medical Examiners (medical board).
(b)-(c) Make conforming changes reflecting the change from
the council to the board.
(d) Requires the per diem to which each board member is
entitled, if the General Appropriations Act does not
prescribe the amount of the per diem, to consist of actual
expenses for meals, lodging, and transportation plus $100.
Deletes language prohibiting a board member from receiving
compensation for travel expenses.
(e)-(g) Make conforming changes reflecting the change from
the council to the board.
(h) States that the board is subject to the open meetings
law, Chapter 551, Government Code, and its subsequent
amendments, and to Chapter 2001, Government Code,
Administrative Procedure Act, and its subsequent amendments,
rather than the deleted references to Vernon's Texas Civil
Statutes. Makes conforming changes reflecting the change
from the council to the board.
(i)-(l) Make conforming changes reflecting the change from
the council to the board.
(m) Provides that a majority of the members of the board
constitutes a quorum.
Sec. 5. New heading: POWERS AND DUTIES OF THE BOARD. Amends
the reference to the rules adopted to reflect the change in
the numbering of the subsections in this section. Makes
conforming changes reflecting the change from the council to
the board.
Sec. 6. FEES. Makes conforming changes reflecting the change
from the council to the board.
Sec. 7. New heading: LICENSURE QUALIFICATIONS. Makes
conforming changes reflecting the change from the council to
the board. Adds Subsection (8) to require the board to issue
a license under this Act to an applicant who meets any other
requirement established by rules adopted by the board.
Sec. 8. TEMPORARY LICENSE. (a) Authorizes the board to issue
a temporary license to an applicant who has graduated from an
educational program for physician assistants or surgeon
assistants accredited by the committee, or by that committee's
predecessor or successor entities, no later than six months
previous to the application for temporary licensure and who is
waiting for examination results from the National Commission
on Certification of Physician Assistants. Makes conforming
changes reflecting the change from the council to the board.
(b) States that a temporary license is valid for 100 days,
rather than the deleted 45 days, and allows its extension
for another 30 days, rather than 45 days.
Sec. 9. INACTIVE LICENSE. Makes conforming changes reflecting
the change from the council to the board.
Sec. 10. RENEWAL. Makes conforming changes reflecting the
change from the council to the board.
Sec. 11. EXEMPTION. States that this Act does not require a
license for a physician assistant student enrolled in certain
programs accredited by the committee or the American Medical
Association, or, in the event these entities cease to exist,
successor entities as approved and designated by the board
through rulemaking.
Sec. 12. SCOPE OF PRACTICE. Allows medical services provided
by a physician assistant to include, but not be limited to
specified services, including offering counseling and
education to meet patient needs; requesting, receiving, and
signing for the receipt of pharmaceutical sample medications
and medical devices and distributing the devices to patients
in a specific practice setting where the physician assistant
is authorized to prescribe pharmaceutical medications and
medical devices, including at a site serving medically
underserved populations as provided by Sec. 3.06(d)(5),
Medical Practice Act (Article 4495b, V.T.C.S.) or board rule,
and adds or as otherwise authorized by this Act, by state law,
or federal law; and the signing or completion of a
prescription as provided by Sections 3.06(d)(5) or (6),
Medical Practice Act (Article 4495b, V.T.C.S.). Makes
conforming changes reflecting the amendments and additions
herein.
Sec. 14. SUPERVISING PHYSICIAN. Requires a supervising
physician to be currently licensed as a physician in this
state by the medical board with a license that is unrestricted
and active. Makes conforming changes reflecting the change
from the council to the board.
Sec. 15. NOTIFICATION OF INTENT TO PRACTICE. Amends the
notification required of a physician's assistant to specify
that it must include a Texas license number. Makes conforming
changes reflecting the change from the council to the board.
Sec. 17. ASSUMPTION OF PROFESSIONAL LIABILITY. Requires a
physician assistant employed by a physician or a group of
physicians to be supervised by and be the legal responsibility
of each supervising, rather than the deleted employing,
physician.
Sec. 18. DISCIPLINARY PROCEEDINGS. Amends this subsection
allowing the board to reprimand a license holder, or refuse to
issue, suspend, revoke, or place other restrictions on the
license of certain persons, and specifies that this includes
a person who has been adjudicated as having a physical
condition that renders the person unable to safely perform as
a physician assistant, in addition to the stated mental
conditions. The following persons are added: a person who has
acted in an unprofessional or dishonorable manner likely to
deceive, defraud, or injure any member of the public; a person
who has failed to practice as a physician assistant in an
acceptable manner consistent with public health and welfare;
a person who has committed any act that violates the laws of
Texas, if the act is connected with physician assistant
practice; or a person who has had disciplinary action taken by
another state regarding physician assistant practice or had
such action taken by the uniformed services of the United
States.
Sec. 19. ADDITIONAL DISCIPLINARY AUTHORITY. Authorizes the
board, on finding that a physician assistant has committed an
offense under Section 18 of this Act, to require a physician
assistant to submit to the care, counseling, or treatment of
a health care practitioner, rather than physician, designated
by the board; and requires the board to impose any remedial
measures or sanctions authorized by this section. Makes
conforming changes reflecting the change from the council to
the board.
Sec. 20. REHABILITATION ORDER. (a) Authorizes the board to
impose a nondisciplinary rehabilitation order on any licensee
or on any licensure applicant based on certain conditions.
(b) Requires a rehabilitation order entered pursuant to this
section to be a nondisciplinary private order and to contain
findings of fact and conclusions of law. Requires a
rehabilitation order, if entered into by agreement, to be an
agreed disposition or settlement agreement for the purposes
of civil litigation and requires it to be exempt from the
open records law, Chapter 552, Government Code.
(c) Authorizes a rehabilitation order entered pursuant to
this section to impose any terms and conditions authorized
under this Act or otherwise agreed to by the board and the
individual subject to the order.
(d) States that violation of a rehabilitation order may
result in disciplinary action under the provisions of this
Act for contested matters or pursuant to the terms of the
agreed order, and may be grounds for disciplinary action.
(e) Requires the rehabilitation orders entered pursuant to
this section to be kept in a confidential file which shall
be subject to an independent audit. Authorizes audits to be
performed at any time at the direction of the board but
shall be performed at least once every three years. Requires
the audit results to be a public record and to be reported
in a manner that maintains the confidentiality of all
licensees subject to the orders. Requires the audit to be
for the purposes of ensuring that only qualified licensees
are subject to rehabilitation orders.
Sec. 21. OFFENSE. Makes conforming changes reflecting the
change from the council to the board, and this and the
remaining sections are renumbered to reflect the addition of
Sec. 20.
Sec. 22. IDENTIFICATION REQUIREMENTS. Adds a reference to
Texas in regard to the physician assistant's license.
Sec. 23. RULE-MAKING AUTHORITY. Requires rules adopted by
the board to be approved or rejected by the medical board.
Makes conforming change reflecting the change from the council
to the board.
Sec. 24. RURAL PHYSICIAN ASSISTANT LOAN REIMBURSEMENT
PROGRAM. Adds medically underserved areas to the areas covered
under the student loan reimbursement program for graduates of
physician assistant training programs. Makes conforming change
reflecting the change from the council to the board.
Sec. 25. CONFIDENTIALITY. Adds this section as follows: (a)
Makes confidential and not subject to legal compulsion for
release to anyone other than the board, or its employees or
agents involved in license discipline, all complaints, adverse
reports, investigation files, other investigation reports, and
other investigative information possessed, received, or
gathered by the board, or its employees or agents, relating to
a licensee, an application for license, or a criminal
investigation or proceeding.
(b) Requires the board, not later than 30 days after
receiving a written request from a licensee who is the
subject of a formal complaint under this Act, or the
licensee's counsel or record, and who is subject to rule,
statute, or legal precedent, unless good cause is shown for
delay, to provide the licensee with access to all
information in the board's possession that the board intends
to offer into evidence in presenting its case in chief at
the contested hearing on the complaint. Sets forth
exceptions to the information the board is required to
provide. Prohibits the furnishing of information from
constituting a waiver of privilege or confidentiality.
(c) Authorizes investigative information of the board which
relates to licensee discipline to be disclosed to the
appropriate licensing authority in another state or a
territory or country in which the licensee is licensed or
has applied for a license, or to a peer review committee
reviewing an application for privileges or the
qualifications of the licensee with respect to retaining
privileges. Requires the information, if it indicates a
crime may have been committed, to be reported to the proper
law enforcement agency. Requires the board to cooperate with
and assist all law enforcement agencies conducting criminal
investigations of licensees by providing information
relevant to the criminal investigation. Prohibits the
information disclosed to an investigative agency, which
shall be confidential, from being disclosed by the agency
except as necessary to further the investigation.
(d) Requires the board to provide information, on written
request of a health care entity, about a complaint filed
against a licensee that was resolved by certain measures,
and to provide the basis and current status of any complaint
under active investigation.
(e) Requires the board to keep information on file about
each complaint filed with the board. Sets forth
requirements for a complaint relating to a person licensed
by the board.
Sec. 26. PATIENT IDENTITY. Adds this section, requiring the
board, in any disciplinary investigation or proceeding
regarding a physician assistant conducted under or pursuant to
this Act, to protect the identity of any patient whose medical
records are examined and utilized in a public proceeding. Sets
forth an exception.
Sec. 27. SUBPOENAS. This section is added as follows: (a)
Authorizes the executive director or the secretary-treasurer
of the medical board, on behalf of the board, to issue
subpoenas and subpoenas duces tecum for certain purposes.
(b) Requires the failure to comply in a timely manner with
a subpoena issued pursuant to this Act to be grounds for
disciplinary action by the board or certain other licensing
or regulatory agencies, and grounds for denial of an
application for a license, permit, or certification.
Sec. 28. IMMUNITY. States that a person, health care entity,
medical peer review committee, or other entity that without
malice furnishes records, information, or assistance to the
board, is immune from any civil liability arising from such
act.
SECTION 2. Amends Section 671.001(d) and 671.002(a) and (b), Health
and Safety Code. Section 671.001(d) is amended to allow a physician
assistant to determine and pronounce a person dead in specified
situations. Adds that for purposes of this section (671.001), such
policies shall take into account physician assistants who are
credentialed or otherwise permitted to practice at the facility,
institution, or entity.
Sec. 671.002 adds physician assistant to this section on the
limitation of liability.
SECTION 3. Amends Section 3.06(d)(5), Medical Practice Act,
(Article 4495b, V.T.C.S.), to add signing a prescription drug order
or ordering a medical device to the acts a physician is authorized
to delegate. States that the authority of a physician to delegate
the carrying out or signing of prescription drug orders is limited
to dangerous drugs and to the practice locations designated by the
physician in certain orders. Defines "carrying out or signing a
prescription drug order." Adds to the definition of "medically
underserved area" to include definitions set forth by the Texas
Department of Health by rule based on Texas-specific demographics,
geographic factors that affect access to health care, and
environmental health factors. Makes conforming and nonsubstantive
changes.
SECTION 4. Adds Subdivision (6) to Section 3.06(d), Medical
Practice Act (Article 4495b, V.T.C.S.), as follows:
(6)(A) Requires a physician licensed by the board, at a
physician's primary practice site, to be authorized to
delegate to a physician assistant acting under adequate
supervision the act of administering, providing, carrying out,
or signing a prescription drug order for dangerous drugs or
for a medical device as authorized through certain orders.
(B) Requires supervision by a physician to be continuous but
not to be construed as necessarily requiring the constant
physical presence of the supervising physician at a place
where the physician assistant services are performed while
the services are performed.
(C) Requires the carrying out or signing of prescription
drug orders under this subsection to comply with other
applicable laws.
(D) Limits a physician's authority to delegate under this
subsection to certain persons.
(E) Defines "physician assistant," "primary practice site,"
and "carrying out or signing a prescription drug order."
SECTION 5. Emergency clause.
Effective date: upon passage.
SUMMARY OF COMMITTEE ACTION
S.B. 1302 was considered by the Public Health Committee in a public
hearing on May 9, 1995.
The following person testified in favor of the bill:
Sam V. Stone, representing self and Texas Academy of Physician
Assistants.
The bill was reported favorably without amendment, with the
recommendation that it do pass and be printed, by the record vote
of 6 AYES, 0 NAYS, 1 PNV, and 2 ABSENT.