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.