BILL ANALYSIS C.S.S.B. 1302 By: Cain Health and Human Services 4-20-95 Committee Report (Substituted) BACKGROUND Article 4495b-1, V.T.C.S. (Physician Assistant Licensing Act) establishes 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 in conformance with the Medical Practice Act and the regulatory, administrative, and disciplinary functions of the Texas State Board of Medical Examiners. PURPOSE As proposed, C.S.S.B. 1302 amends Article 4495b-1, V.T.C.S. (Physician Assistant Licensing Act), to create the Texas State Board of Physician Assistant Examiners, 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 rulemaking authority is granted to the Texas State Board of Physician Assistant Examiners under SECTION 1 (Sections 7 and 11, Article 4495b-1, V.T.C.S.) and the Texas Department of Health under SECTION 3 (Section 3.06(d), Article 4495b, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Article 4495b-1, V.T.C.S. (Physician Assistant Licensing Act), as follows: Sec. 1. SHORT TITLE; LEGISLATIVE FINDINGS AND PURPOSE. Makes no change. Sec. 2. DEFINITIONS. Defines "alternate physician," "medical board," and "state." Redefines "board," "physician assistant," "supervising physician," and "supervision." Sec. 3. LICENSE REQUIRED. Makes no change. Sec. 4. New heading: BOARD OF PHYSICIAN ASSISTANT EXAMINERS. (a) Creates the Texas State Board of Physician Assistant Examiners (board), rather than the Physician Assistant Advisory Council, as an advisory board to the Texas State Board of Medical Examiners (medical board). (b)-(c) Make conforming changes. (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)-(l) Make conforming and nonsubstantive changes. (m) Provides that a majority of the members of the board constitute a quorum. Sec. 5. New heading: POWERS AND DUTIES OF THE BOARD. Makes conforming changes. Sec. 6. FEES. Makes conforming changes. Sec. 7. New heading: LICENSURE QUALIFICATIONS. Requires the board to issue a license under this Act to a person who has successfully completed an educational program for physician assistants or surgeon assistants accredited by the Committee on Allied Health Education and Accreditation (committee) and, rather than or, has passed the Physician Assistant National Certifying Examination; and to a person who meets any other requirement established by board rules. Makes conforming changes. 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. (b) Validates a temporary license for 100 days, rather than 45, and authorizes its extension for another 30 days, rather than 45. Sec. 9. INACTIVE LICENSE. Makes conforming changes. Sec. 10. RENEWAL. Makes conforming changes. Sec. 11. EXEMPTION. Provides 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. Authorizes medical services provided by a physician assistant to include, but not be limited to, 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 samples and devices to patients in a specific practice setting where the physician assistant is authorized to prescribe pharmaceutical medications and medical devices, at sites authorized by this Act or by state or federal law; and the signing or completion of a prescription. Makes conforming changes. Sec. 13. SUPERVISION REQUIREMENTS. Makes no change. 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. Sec. 15. NOTIFICATION OF INTENT TO PRACTICE. Requires physician assistant notification to the board before an assistant begins practice to include the Texas license number of the physician assistant and the physician assistant's supervising physician. Makes conforming changes. Sec. 16. EXCLUSION OF LIMITATION ON EMPLOYMENT. Makes no change. 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 employing, physician. Makes a conforming change. Sec. 18. DISCIPLINARY PROCEEDINGS. Authorizes the board to reprimand a license holder, or refuse to issue, suspend, revoke, or place other restrictions on the license of a person who has been adjudicated as having a physical condition that renders the person unable to safely perform as a physician assistant; who has acted in an unprofessional or dishonorable manner likely to deceive, defraud, or injure any member of the public; who has failed to practice as a physician assistant in an acceptable manner consistent with public health and welfare; who has committed any act that violates the laws of Texas, if the act is connected with physician assistant practice; or 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. 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 to be exempt from the open records law. (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) Authorizes violation of a rehabilitation order to result in disciplinary action under the provisions of this Act for contested matters or pursuant to the terms of the agreed order; and to be grounds to 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 a conforming change. Sec. 22. IDENTIFICATION REQUIREMENTS. Makes a conforming change. Sec. 23. RULE-MAKING AUTHORITY. Requires rules adopted by the board to be approved or rejected by the medical board. Makes conforming and nonsubstantive changes. Sec. 24. RURAL PHYSICIAN ASSISTANT LOAN REIMBURSEMENT PROGRAM. Requires the medical board to transfer certain funds to the Center for Rural Health Initiatives. Sec. 25. CONFIDENTIALITY. (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. Requires 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. (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. Makes a person, health care entity, medical peer review committee, or other entity that without malice furnishes records, information, or assistance to the board, immune from any civil liability arising from such act. SECTION 2. Amends Section 671.001 and 671.002, Health and Safety Code, to make conforming changes. SECTION 3. Amends Section 3.06(d)(5), Article 4495b, V.T.C.S., to limit the authority of a physician to delegate the carrying out or signing or prescription drug orders to dangerous drugs and to the practice locations designated by the physician in certain orders. Defines "carrying out or signing a prescription drug order." Redefines "medically underserved area." Makes conforming and nonsubstantive changes. SECTION 4. Amends Section 3.06(d), Article 4495b, V.T.C.S., by adding Subdivision (6), 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.