1-1 By: Madla S.B. No. 659
1-2 (In the Senate - Filed February 20, 1995; February 21, 1995,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; April 20, 1995, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 6, Nays 0;
1-6 April 20, 1995, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 659 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the ability of a pharmacist to perform a specific act
1-11 delegated to the pharmacist by a written order or protocol.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Section 5, Texas Pharmacy Act (Article 4542a-1,
1-14 Vernon's Texas Civil Statutes), is amended by amending Subdivision
1-15 (38) and by adding Subdivision (50) to read as follows:
1-16 (38) "Practice of pharmacy" means:
1-17 (A) provision of those acts or services
1-18 necessary to provide pharmaceutical care;
1-19 (B) interpretation and evaluation of
1-20 prescription drug orders or medication orders;
1-21 (C) participation in drug and device selection
1-22 as authorized by law, drug administration, drug regimen review, or
1-23 drug or drug-related research;
1-24 (D) provision of patient counseling; <and>
1-25 (E) responsibility for:
1-26 (i) dispensing of prescription drug orders or distribution
1-27 of medication orders;
1-28 (ii) compounding and labeling of drugs and devices, except
1-29 labeling by a manufacturer, repackager, or distributor of
1-30 nonprescription drugs and commercially packaged prescription drugs
1-31 and devices;
1-32 (iii) proper and safe storage of drugs and devices; or
1-33 (iv) maintenance of proper records for drugs and devices;
1-34 and
1-35 (F) performance of a specific act of drug
1-36 therapy management for a patient delegated to a pharmacist by a
1-37 written protocol from a physician licensed in this state in
1-38 compliance with the Medical Practice Act (Article 4495b, Vernon's
1-39 Texas Civil Statutes).
1-40 (50) "Written protocol" means a physician's order,
1-41 standing medical order, standing delegation order, or other order
1-42 or protocol as defined by rule of the Texas State Board of Medical
1-43 Examiners under the Medical Practice Act (Article 4495b, Vernon's
1-44 Texas Civil Statutes).
1-45 SECTION 2. Section 17, Texas Pharmacy Act (Article 4542a-1,
1-46 Vernon's Texas Civil Statutes), is amended by adding Subsection (x)
1-47 to read as follows:
1-48 (x) The board shall adopt rules regarding records to be
1-49 maintained by a pharmacist performing a specific act under a
1-50 written protocol.
1-51 SECTION 3. Subchapter C, Medical Practice Act (Article
1-52 4495b, Vernon's Texas Civil Statutes), is amended by adding Section
1-53 3.061 to read as follows:
1-54 Sec. 3.061. DELEGATION OF CERTAIN FUNCTIONS. (a) A person
1-55 licensed to practice medicine may delegate to a properly qualified
1-56 and trained pharmacist acting under adequate physician supervision
1-57 the performance of specific acts of drug therapy management
1-58 authorized by the physician through the physician's order, standing
1-59 medical order, standing delegation order, or other order or
1-60 protocol as defined by board rule.
1-61 (b) The management of drug therapy permitted under this
1-62 section must comply with other applicable law, including Section
1-63 17(a)(5), Texas Pharmacy Act (Article 4542a-1, Vernon's Texas Civil
1-64 Statutes).
1-65 (c) Physician supervision is considered to be adequate for
1-66 the purposes of this section if a delegating physician:
1-67 (1) is responsible for the formulation or approval of
1-68 the physician's order, standing medical order, standing delegation
2-1 order, or other order or protocol and periodically reviews the
2-2 order or protocol and the services provided to a patient under the
2-3 order or protocol;
2-4 (2) has established a physician-patient relationship
2-5 with each patient provided drug therapy management by a delegated
2-6 pharmacist;
2-7 (3) is geographically located so as to be able to be
2-8 physically present daily to provide medical care and supervision;
2-9 (4) receives, as appropriate, a periodic status report
2-10 on the patient, including any problem or complication encountered;
2-11 and
2-12 (5) is available through direct telecommunication for
2-13 consultation, assistance, and direction.
2-14 (d) This section does not restrict the use of a
2-15 preestablished health care program or restrict a physician from
2-16 authorizing the provision of patient care by use of a
2-17 preestablished health care program if the patient is
2-18 institutionalized and the care is to be delivered in a licensed
2-19 hospital with an organized medical staff that has authorized
2-20 standing delegation orders, standing medical orders, or protocols.
2-21 (e) This section may not be construed to limit, expand, or
2-22 change any provision of law concerning or relating to therapeutic
2-23 drug substitution or administration of medication, including
2-24 Section 17(a)(5), Texas Pharmacy Act (Article 4542a-1, Vernon's
2-25 Texas Civil Statutes).
2-26 (f) The board by rule shall establish the minimum content of
2-27 a written order or protocol. The order or protocol may not permit
2-28 the delegation of medical diagnosis.
2-29 (g) In this section, "pharmacist" has the meaning assigned
2-30 by the Texas Pharmacy Act (Article 4542a-1, Vernon's Texas Civil
2-31 Statutes).
2-32 SECTION 4. This Act takes effect September 1, 1995.
2-33 SECTION 5. The importance of this legislation and the
2-34 crowded condition of the calendars in both houses create an
2-35 emergency and an imperative public necessity that the
2-36 constitutional rule requiring bills to be read on three several
2-37 days in each house be suspended, and this rule is hereby suspended.
2-38 * * * * *