S.B. No. 673
AN ACT
1-1 relating to health care, including but not limited to powers and
1-2 duties of the center for rural health initiatives, powers and
1-3 duties of registered nurses and physician assistants, managed
1-4 health care plans for certain inmates, and health facilities and
1-5 services for the elderly or disabled; providing penalties.
1-6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-7 SECTION 1. Chapter 105, Health and Safety Code, is amended
1-8 by adding Section 105.007 to read as follows:
1-9 Sec. 105.007. CLEARINGHOUSE. (a) As part of the
1-10 comprehensive health professions resource center, the department
1-11 shall develop and establish a clearinghouse for health
1-12 professionals seeking collaborative practice.
1-13 (b) The department may:
1-14 (1) set and collect a reasonable fee to offset the
1-15 cost of complying with this section;
1-16 (2) solicit, receive, and spend grants, gifts, and
1-17 donations from public and private sources to comply with this
1-18 section; and
1-19 (3) contract with public or private entities in the
1-20 performance of its responsibilities under this section.
1-21 SECTION 2. Subsection (a), Section 106.025, Health and
1-22 Safety Code, is amended to read as follows:
1-23 (a) The center shall:
2-1 (1) educate the public and recommend appropriate
2-2 public policies regarding the continued viability of rural health
2-3 care delivery in this state;
2-4 (2) monitor and work with state and federal agencies
2-5 to assess the impact of proposed rules on rural areas;
2-6 (3) provide impact statements of proposed rules as
2-7 considered appropriate by the center;
2-8 (4) streamline regulations to assist in the
2-9 development of service diversification of health care facilities;
2-10 (5) target state and federal programs to rural areas;
2-11 (6) promote and develop community involvement and
2-12 community support in maintaining, rebuilding, or diversifying local
2-13 health services;
2-14 (7) promote and develop diverse and innovative health
2-15 care service models in rural areas;
2-16 (8) encourage the use of advanced communications
2-17 technology to:
2-18 (A) ensure that rural areas receive the maximum
2-19 benefits of telemedicine and distance learning by promoting a
2-20 transmission rate structure that accommodates rural needs and by
2-21 improving the telecommunications infrastructure in rural areas; and
2-22 (B) provide access to specialty expertise,
2-23 clinical consultation, and continuing education;
2-24 (9) assist rural health care providers, communities,
2-25 and individuals in applying for public and private grants and
3-1 programs;
3-2 (10) encourage the development of regional emergency
3-3 transportation networks;
3-4 (11) work with state agencies, universities, and
3-5 private interest groups to conduct and promote research on rural
3-6 health issues, maintain and collect a timely data base, and develop
3-7 and maintain a rural health resource library;
3-8 (12) solicit the assistance of other offices or
3-9 programs of rural health in this state that are university-based to
3-10 carry out the duties of this chapter;
3-11 (13) disseminate information and provide technical
3-12 assistance to communities, health care providers, and individual
3-13 consumers of health care services; <and>
3-14 (14) develop plans to implement a fee-for-service
3-15 health care professional recruitment service and a medical supplies
3-16 group purchasing program within the center;
3-17 (15) develop and initiate, in conjunction with the
3-18 Texas State Board of Medical Examiners, the Board of Nurse
3-19 Examiners, the Texas Department of Health, the Bureau of State
3-20 Health Data and Policy Analysis, the Texas State Board of Physician
3-21 Assistant Examiners, or other appropriate agencies, a study of
3-22 rural health clinics to:
3-23 (A) determine the efficiency and effectiveness
3-24 of rural health clinics;
3-25 (B) review the health outcomes of rural patients
4-1 treated in rural health clinics and report those outcomes in the
4-2 center's biennial report to the legislature;
4-3 (C) identify and address efficiency barriers for
4-4 the professional clinical relationship of physicians, nurses, and
4-5 physician assistants;
4-6 (D) assess the success of attracting primary
4-7 care physicians and allied health professionals to rural areas; and
4-8 (E) assess the appropriateness of the current
4-9 clinic designation process;
4-10 (16) develop and initiate a quality assessment program
4-11 to evaluate the health outcomes of rural patients treated in rural
4-12 health clinics; and
4-13 (17) encourage the active participation by physicians
4-14 and other health care providers in the early and periodic
4-15 screening, diagnosis, and treatment program.
4-16 SECTION 3. Subchapter A, Chapter 241, Health and Safety
4-17 Code, is amended by adding Section 241.006 to read as follows:
4-18 Sec. 241.006. COORDINATION OF SIGNAGE REQUIREMENTS IMPOSED
4-19 BY STATE AGENCIES. (a) The department is authorized to review
4-20 current and proposed state rules issued by the department or by
4-21 other state agencies that mandate that a hospital place or post a
4-22 notice, poster, or sign in a conspicuous place or in an area of
4-23 high public traffic, concerning the rights of patients or others or
4-24 the responsibilities of the hospital, which is directed at
4-25 patients, patients' families, or others. The purpose of this
5-1 review shall be to coordinate the placement, format, and language
5-2 contained in the required notices in order to:
5-3 (1) eliminate the duplication of information;
5-4 (2) reduce the potential for confusion to patients,
5-5 patients' families, and others; and
5-6 (3) reduce the administrative burden of compliance on
5-7 hospitals.
5-8 (b) Notwithstanding any other law, this section applies to
5-9 all notices, posters, or signs described in Subsection (a).
5-10 SECTION 4. Section 262.034, Health and Safety Code, is
5-11 amended to read as follows:
5-12 Sec. 262.034. FACILITIES AND SERVICES FOR ELDERLY AND
5-13 DISABLED <NURSING HOMES>. (a) <This section applies to an
5-14 authority created by a municipality with a population of more than
5-15 24,000 that is located in a county with a population of 1.5 million
5-16 or more.>
5-17 <(b)> The authority may construct, acquire, own, operate,
5-18 enlarge, improve, furnish, or equip one or more of the following
5-19 types of facilities or services for the care of the elderly or
5-20 disabled:
5-21 (1) a nursing home or similar long-term care facility;
5-22 (2) elderly housing;
5-23 (3) assisted living;
5-24 (4) home health;
5-25 (5) personal care;
6-1 (6) special care;
6-2 (7) continuing care; and
6-3 (8) durable medical equipment <one or more nursing
6-4 homes or similar facilities for the care of the elderly. The
6-5 nursing home or similar facility may be located outside the
6-6 municipal limits>.
6-7 (b) <(c)> The authority may lease or enter into an
6-8 operations or management agreement relating to all or part of a
6-9 <nursing home or similar> facility or service for the care of the
6-10 elderly or disabled that is owned by the authority. The authority
6-11 may sell, transfer, otherwise convey, or close all or part of the
6-12 <nursing home or similar> facility and may discontinue a service.
6-13 (c) <(d)> The authority may issue revenue bonds and other
6-14 notes in accordance with this chapter to acquire, construct, or
6-15 improve a <nursing home or similar> facility for the care of the
6-16 elderly or disabled or to implement the delivery of a service for
6-17 the care of the elderly or disabled.
6-18 (d) <(e)> For the purposes of this section, a <nursing home
6-19 or similar> facility or service described by Subsection (a) <for
6-20 the care of the elderly> is considered to be a hospital project
6-21 under Chapter 223 (Hospital Project Financing Act).
6-22 (e) This section applies only to an authority that owns or
6-23 operates a hospital licensed under Chapter 241 and that is located
6-24 in:
6-25 (1) a county with a population of 35,000 or less;
7-1 (2) those portions of extended municipalities that the
7-2 federal census bureau has determined to be rural; or
7-3 (3) an area that is not delineated as an urbanized
7-4 area by the federal census bureau.
7-5 (f) This section does not authorize the authority to issue
7-6 revenue bonds or other notes in accordance with this chapter to
7-7 construct, acquire, own, enlarge, improve, furnish, or equip a
7-8 facility or service listed in Subsection (a) if a private provider
7-9 of the facility or service is available and accessible in the
7-10 service area of the authority.
7-11 SECTION 5. Chapter 285, Health and Safety Code, is amended
7-12 by adding Subchapter H to read as follows:
7-13 SUBCHAPTER H. LONG-TERM CARE AND RELATED FACILITIES
7-14 Sec. 285.101. FACILITIES OR SERVICES FOR ELDERLY OR
7-15 DISABLED. (a) This subchapter applies only to a hospital,
7-16 hospital district, or authority created and operated under Article
7-17 IX, Texas Constitution, under a special law, or under this title
7-18 that is located in:
7-19 (1) a county with a population of 35,000 or less;
7-20 (2) those portions of extended municipalities that the
7-21 federal census bureau has determined to be rural; or
7-22 (3) an area that is not delineated as an urbanized
7-23 area by the federal census bureau.
7-24 (b) A hospital, hospital district, or authority covered by
7-25 this subchapter may:
8-1 (1) construct, acquire, own, operate, enlarge,
8-2 improve, furnish, or equip one or more of the following types of
8-3 facilities or services for the care of the elderly or disabled:
8-4 (A) a nursing home or similar long-term care
8-5 facility;
8-6 (B) elderly housing;
8-7 (C) assisted living;
8-8 (D) home health;
8-9 (E) personal care;
8-10 (F) special care;
8-11 (G) continuing care; or
8-12 (H) durable medical equipment;
8-13 (2) lease or enter into an operations or management
8-14 agreement relating to all or part of a facility or service
8-15 described in Subdivision (1) that is owned by the hospital district
8-16 or authority;
8-17 (3) close, transfer, sell, or otherwise convey all or
8-18 part of a facility and discontinue services; and
8-19 (4) issue revenue bonds and other notes to acquire,
8-20 construct, or improve a facility for the care of the elderly or
8-21 disabled or to implement the delivery of a service for the care of
8-22 the elderly or disabled.
8-23 (c) For the purpose of this section, a facility or service
8-24 created under Subsection (b) is considered to be a hospital project
8-25 under Chapter 223.
9-1 (d) This section does not authorize a hospital, hospital
9-2 district, or authority to issue revenue bonds or other notes in
9-3 accordance with this chapter to construct, acquire, own, enlarge,
9-4 improve, furnish, or equip a facility or service listed in
9-5 Subsection (b)(1) if a private provider of the facility or service
9-6 is available and accessible in the service area of the hospital,
9-7 hospital district, or authority.
9-8 SECTION 6. Subdivisions (4) and (13), Section 483.001,
9-9 Health and Safety Code, are amended to read as follows:
9-10 (4) "Designated agent" means:
9-11 (A) a licensed nurse, physician assistant,
9-12 pharmacist, or other individual designated by a practitioner to
9-13 communicate prescription drug orders to a pharmacist;
9-14 (B) a licensed nurse, physician assistant, or
9-15 pharmacist employed in a health care facility to whom the
9-16 practitioner communicates a prescription drug order; or
9-17 (C) a registered nurse or physician assistant
9-18 authorized by a practitioner to carry out a prescription drug order
9-19 for dangerous drugs under Section 3.06(d)(5) or (6), Medical
9-20 Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
9-21 (13) "Prescription" means an order from a
9-22 practitioner, or an agent of the practitioner designated in writing
9-23 as authorized to communicate prescriptions, or an order made in
9-24 accordance with Section 3.06(d)(5) or (6), Medical Practice Act
9-25 (Article 4495b, Vernon's Texas Civil Statutes), to a pharmacist for
10-1 a dangerous drug to be dispensed that states:
10-2 (A) the date of the order's issue;
10-3 (B) the name and address of the patient;
10-4 (C) if the drug is prescribed for an animal, the
10-5 species of the animal;
10-6 (D) the name and quantity of the drug
10-7 prescribed;
10-8 (E) the directions for the use of the drug;
10-9 <and>
10-10 <(F) the legibly printed or stamped name,
10-11 address, Federal Drug Enforcement Administration registration
10-12 number, and telephone number of the practitioner at the
10-13 practitioner's usual place of business.>
10-14 (F) the intended use of the drug unless the
10-15 practitioner determines the furnishing of this information is not
10-16 in the best interest of the patient; <and>
10-17 (G) the name, address, and telephone number of
10-18 the practitioner at the practitioner's usual place of business,
10-19 legibly printed or stamped; and
10-20 (H) the name, address, and telephone number of
10-21 the registered nurse or physician assistant, legibly printed or
10-22 stamped, if signed by a registered nurse or physician assistant.
10-23 SECTION 7. Subsection (a), Section 483.042, Health and
10-24 Safety Code, is amended to read as follows:
10-25 (a) A person commits an offense if the person delivers or
11-1 offers to deliver a dangerous drug:
11-2 (1) unless:
11-3 (A) the dangerous drug is delivered or offered
11-4 for delivery by a pharmacist under:
11-5 (i) a prescription issued by a
11-6 practitioner described by Section 483.001(12)(A) or (B); <or>
11-7 (ii) a prescription signed by a registered
11-8 nurse or physician assistant in accordance with Section 3.06(d)(5)
11-9 or (6), Medical Practice Act (Article 4495b, Vernon's Texas Civil
11-10 Statutes); or
11-11 (iii) an original written prescription
11-12 issued by a practitioner described by Section 483.001(12)(C); and
11-13 (B) a label is attached to the immediate
11-14 container in which the drug is delivered or offered to be delivered
11-15 and the label contains the following information:
11-16 (i) the name and address of the pharmacy
11-17 from which the drug is delivered or offered for delivery;
11-18 (ii) the date the prescription for the
11-19 drug is dispensed;
11-20 (iii) the number of the prescription as
11-21 filed in the prescription files of the pharmacy from which the
11-22 prescription is dispensed;
11-23 (iv) the name of the practitioner who
11-24 prescribed the drug and, if applicable, the name of the registered
11-25 nurse or physician assistant who signed the prescription;
12-1 (v) the name of the patient and, if the
12-2 drug is prescribed for an animal, a statement of the species of the
12-3 animal; and
12-4 (vi) directions for the use of the drug as
12-5 contained in the prescription; or
12-6 (2) unless:
12-7 (A) the dangerous drug is delivered or offered
12-8 for delivery by:
12-9 (i) a practitioner in the course of
12-10 practice; or
12-11 (ii) a registered nurse or physician
12-12 assistant in the course of practice in accordance with Section
12-13 3.06(d)(5) or (6), Medical Practice Act (Article 4495b, Vernon's
12-14 Texas Civil Statutes); and
12-15 (B) a label is attached to the immediate
12-16 container in which the drug is delivered or offered to be delivered
12-17 and the label contains the following information:
12-18 (i) the name and address of the
12-19 practitioner who prescribed the drug, and if applicable, the name
12-20 and address of the registered nurse or physician assistant;
12-21 (ii) the date the drug is delivered;
12-22 (iii) the name of the patient and, if the
12-23 drug is prescribed for an animal, a statement of the species of the
12-24 animal; and
12-25 (iv) the name of the drug, the strength of
13-1 the drug, and directions for the use of the drug.
13-2 SECTION 8. Subsection (d), Section 671.001, Health and
13-3 Safety Code, is amended to read as follows:
13-4 (d) A registered nurse or physician assistant may determine
13-5 and pronounce a person dead in situations other than those
13-6 described by Subsection (b) if permitted by written policies of a
13-7 licensed health care facility, institution, or entity providing
13-8 services to that person. Those policies must include physician
13-9 assistants who are credentialed or otherwise permitted to practice
13-10 at the facility, institution, or entity. If the facility,
13-11 institution, or entity has an organized nursing staff and an
13-12 organized medical staff or medical consultant, the nursing staff
13-13 and medical staff or consultant shall jointly develop and approve
13-14 those policies. The board shall adopt rules to govern policies for
13-15 facilities, institutions, or entities that do not have organized
13-16 nursing staffs and organized medical staffs or medical consultants.
13-17 SECTION 9. Section 671.002, Health and Safety Code, is
13-18 amended to read as follows:
13-19 Sec. 671.002. Limitation of Liability. (a) A physician who
13-20 determines death in accordance with Section 671.001(b) or a
13-21 registered nurse or physician assistant who determines death in
13-22 accordance with Section 671.001(d) is not liable for civil damages
13-23 or subject to criminal prosecution for the physician's, <or>
13-24 registered nurse's, or physician assistant's actions or the actions
13-25 of others based on the determination of death.
14-1 (b) A person who acts in good faith in reliance on a
14-2 physician's, <or> registered nurse's, or physician assistant's
14-3 determination of death is not liable for civil damages or subject
14-4 to criminal prosecution for the person's actions.
14-5 SECTION 10. Subtitle A, Title 8, Health and Safety Code, is
14-6 amended by adding Chapter 674 to read as follows:
14-7 CHAPTER 674. OUT-OF-HOSPITAL DO-NOT-RESUSCITATE
14-8 Sec. 674.001. DEFINITIONS. In this chapter:
14-9 (1) "Attending physician" means the physician who has
14-10 primary responsibility for a person's treatment and care.
14-11 (2) "Board" means the Texas Board of Health.
14-12 (3) "Cardiopulmonary resuscitation" includes a
14-13 component of cardiopulmonary resuscitation.
14-14 (4) "Competent" means possessing the ability, based on
14-15 reasonable medical judgment, to understand and appreciate the
14-16 nature and consequences of a treatment decision, including the
14-17 significant benefits and harms of, and reasonable alternatives to,
14-18 a proposed treatment decision.
14-19 (5) "Declarant" means a person who has executed or
14-20 issued an out-of-hospital do-not-resuscitate order under this
14-21 chapter.
14-22 (6) "Department" means the Texas Department of Health.
14-23 (7) "DNR identification device" means an
14-24 identification device specified by the board under Section 674.023
14-25 that is worn for the purpose of identifying a person who has
15-1 executed or issued an out-of-hospital DNR order or on whose behalf
15-2 an out-of-hospital DNR order has been executed or issued under this
15-3 chapter.
15-4 (8) "Durable power of attorney for health care" means
15-5 a document delegating to an agent the authority to make health care
15-6 decisions for a person in accordance with Chapter 135, Civil
15-7 Practice and Remedies Code.
15-8 (9) "Emergency medical services" has the meaning
15-9 assigned by Section 773.003.
15-10 (10) "Emergency medical services personnel" has the
15-11 meaning assigned by Section 773.003.
15-12 (11) "Health care professionals" means physicians,
15-13 nurses, and emergency medical services personnel and, unless the
15-14 context requires otherwise, includes hospital emergency personnel.
15-15 (12) "Incompetent" means lacking the ability, based on
15-16 reasonable medical judgment, to understand and appreciate the
15-17 nature and consequences of a treatment decision, including the
15-18 significant benefits and harms of, and reasonable alternatives to,
15-19 a proposed treatment decision.
15-20 (13) "Life-sustaining procedure" means a medical
15-21 procedure, treatment, or intervention that uses mechanical or other
15-22 artificial means to sustain, restore, or supplant a spontaneous
15-23 vital function and, when applied to a person in a terminal
15-24 condition, serves only to prolong the process of dying. The term
15-25 does not include the administration of medication or the
16-1 performance of a medical procedure considered to be necessary to
16-2 provide comfort or care or to alleviate pain or the provision of
16-3 water or nutrition.
16-4 (14) "Out-of-hospital DNR order":
16-5 (A) means a legally binding out-of-hospital
16-6 do-not-resuscitate order, in the form specified by the board under
16-7 Section 674.003, prepared and signed by the attending physician of
16-8 a person who has been diagnosed as having a terminal condition,
16-9 that documents the instructions of a person or the person's legally
16-10 authorized representative and directs health care professionals
16-11 acting in an out-of-hospital setting not to initiate or continue
16-12 the following life-sustaining procedures:
16-13 (i) cardiopulmonary resuscitation;
16-14 (ii) endotracheal intubation or other
16-15 means of advanced airway management;
16-16 (iii) artificial ventilation;
16-17 (iv) defibrillation;
16-18 (v) transcutaneous cardiac pacing;
16-19 (vi) the administration of cardiac
16-20 resuscitation medications; and
16-21 (vii) other life-sustaining procedures
16-22 specified by the board under Section 674.023(a); and
16-23 (B) does not include authorization to withhold
16-24 medical interventions or therapies considered necessary to provide
16-25 comfort or care or to alleviate pain or to provide water or
17-1 nutrition.
17-2 (15) "Out-of-hospital setting" means any setting
17-3 outside of a licensed acute care hospital in which health care
17-4 professionals are called for assistance, including long-term care
17-5 facilities, in-patient hospice facilities, private homes, and
17-6 vehicles during transport.
17-7 (16) "Physician" means a physician licensed by the
17-8 Texas State Board of Medical Examiners or a properly credentialed
17-9 physician who holds a commission in the uniformed services of the
17-10 United States and who is serving on active duty in this state.
17-11 (17) "Proxy" means a person designated and authorized
17-12 by a directive executed or issued in accordance with Chapter 672 to
17-13 make a treatment decision for another person in the event the other
17-14 person becomes comatose, incompetent, or otherwise mentally or
17-15 physically incapable of communication.
17-16 (18) "Qualified relatives" means those persons
17-17 authorized to execute or issue an out-of-hospital DNR order on
17-18 behalf of a person who is comatose, incompetent, or otherwise
17-19 mentally or physically incapable of communication under Section
17-20 674.008.
17-21 (19) "Statewide out-of-hospital DNR protocol" means a
17-22 set of statewide standardized procedures adopted by the board under
17-23 Section 674.023 for withholding cardiopulmonary resuscitation and
17-24 certain other life-sustaining procedures by health care
17-25 professionals acting in out-of-hospital settings.
18-1 (20) "Terminal condition" means an incurable or
18-2 irreversible condition caused by injury, disease, or illness that
18-3 would produce death without the application of life-sustaining
18-4 procedures, according to reasonable medical judgment, and in which
18-5 the application of life-sustaining procedures serves only to
18-6 postpone the moment of the person's death.
18-7 Sec. 674.002. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE TO
18-8 PHYSICIANS. (a) A competent person who has been diagnosed by a
18-9 physician as having a terminal condition may at any time execute a
18-10 written out-of-hospital DNR order directing health care
18-11 professionals acting in an out-of-hospital setting to withhold
18-12 cardiopulmonary resuscitation and certain other life-sustaining
18-13 procedures designated by the board.
18-14 (b) The declarant must sign the out-of-hospital DNR order in
18-15 the presence of two witnesses, and those witnesses must sign the
18-16 order. The attending physician of the declarant must sign the
18-17 order and shall make the fact of the existence of the order and the
18-18 reasons for execution of the order a part of the declarant's
18-19 medical record.
18-20 (c) A witness must have the same qualifications as those
18-21 provided by Section 672.003(c).
18-22 (d) If the person is incompetent but previously executed or
18-23 issued a directive to physicians in accordance with Chapter 672,
18-24 the physician may rely on the directive as the person's
18-25 instructions to issue an out-of-hospital DNR order and shall place
19-1 a copy of the directive in the person's medical record. The
19-2 physician shall sign the order in lieu of the person signing under
19-3 Subsection (b).
19-4 (e) If the person is incompetent but previously executed or
19-5 issued a directive to physicians in accordance with Chapter 672
19-6 designating a proxy, the proxy may make any decisions required of
19-7 the designating person as to an out-of-hospital DNR order and shall
19-8 sign the order in lieu of the person signing under Subsection (b).
19-9 (f) If the person is now incompetent but previously executed
19-10 or issued a durable power of attorney for health care in accordance
19-11 with Chapter 135, Civil Practice and Remedies Code, designating an
19-12 agent, the agent may make any decisions required of the designating
19-13 person as to an out-of-hospital DNR order and shall sign the order
19-14 in lieu of the person signing under Subsection (b).
19-15 (g) The board, on the recommendation of the department,
19-16 shall by rule adopt procedures for the disposition and maintenance
19-17 of records of an original out-of-hospital DNR order and any copies
19-18 of the order.
19-19 (h) An out-of-hospital DNR order is effective on its
19-20 execution.
19-21 Sec. 674.003. FORM OF OUT-OF-HOSPITAL DNR ORDER. (a) A
19-22 written out-of-hospital DNR order shall be in the standard form
19-23 specified by board rule as recommended by the department.
19-24 (b) The standard form of an out-of-hospital DNR order
19-25 specified by the board must, at a minimum, contain the following:
20-1 (1) a distinctive single-page format that readily
20-2 identifies the document as an out-of-hospital DNR order;
20-3 (2) a title that readily identifies the document as an
20-4 out-of-hospital DNR order;
20-5 (3) the printed or typed name of the person;
20-6 (4) a statement that the physician signing the
20-7 document is the attending physician of the person, that the
20-8 physician has diagnosed the person as having a terminal condition,
20-9 and that the physician is directing health care professionals
20-10 acting in out-of-hospital settings not to initiate or continue
20-11 certain life-sustaining procedures on behalf of the person, and a
20-12 listing of those procedures not to be initiated or continued;
20-13 (5) a statement that the person understands that the
20-14 person may revoke the out-of-hospital DNR order at any time by
20-15 destroying the order and removing the DNR identification device, if
20-16 any, or by communicating to health care professionals at the scene
20-17 the person's desire to revoke the out-of-hospital DNR order;
20-18 (6) places for the printed names and signatures of the
20-19 witnesses and attending physician of the person and the medical
20-20 license number of the attending physician;
20-21 (7) a separate section for execution of the document
20-22 by the legal guardian of the person, the person's proxy, an agent
20-23 of the person having a durable power of attorney for health care,
20-24 or the attending physician attesting to the issuance of an
20-25 out-of-hospital DNR order by nonwritten means of communication or
21-1 acting in accordance with a previously executed or previously
21-2 issued directive to physicians under Section 674.002(d) that
21-3 includes the following:
21-4 (A) a statement that the legal guardian, the
21-5 proxy, the agent, the person by nonwritten means of communication,
21-6 or the physician directs that the listed life-sustaining procedures
21-7 should not be initiated or continued in behalf of the person; and
21-8 (B) places for the printed names and signatures
21-9 of the witnesses and, as applicable, the legal guardian, proxy,
21-10 agent, or physician;
21-11 (8) a separate section for execution of the document
21-12 by at least two qualified relatives of the person when the person
21-13 does not have a legal guardian, proxy, or agent having a durable
21-14 power of attorney for health care and is comatose, incompetent, or
21-15 otherwise mentally or physically incapable of communication,
21-16 including:
21-17 (A) a statement that the relatives of the person
21-18 are qualified to make a treatment decision to withhold
21-19 cardiopulmonary resuscitation and certain other designated
21-20 life-sustaining procedures under Section 674.008 and, based on the
21-21 known desires of the person or a determination of the best interest
21-22 of the person, direct that the listed life-sustaining procedures
21-23 should not be initiated or continued in behalf of the person; and
21-24 (B) places for the printed names and signatures
21-25 of the witnesses and qualified relatives of the person;
22-1 (9) a place for entry of the date of execution of the
22-2 document;
22-3 (10) a statement that the document is in effect on the
22-4 date of its execution and remains in effect until the death of the
22-5 person or until the document is revoked;
22-6 (11) a statement that the document must accompany the
22-7 person during transport;
22-8 (12) a statement regarding the proper disposition of
22-9 the document or copies of the document, as the board determines
22-10 appropriate; and
22-11 (13) a statement at the bottom of the document, with
22-12 places for the signature of each person executing the document,
22-13 that the document has been properly completed.
22-14 (c) The board may, by rule and as recommended by the
22-15 department, modify the standard form of the out-of-hospital DNR
22-16 order described by Subsection (b) in order to accomplish the
22-17 purposes of this chapter.
22-18 Sec. 674.004. ISSUANCE OF OUT-OF-HOSPITAL DNR ORDER BY
22-19 NONWRITTEN COMMUNICATION. (a) A competent person who is an adult
22-20 may issue an out-of-hospital DNR order by nonwritten communication.
22-21 (b) A declarant must issue the nonwritten out-of-hospital
22-22 DNR order in the presence of the attending physician and two
22-23 witnesses. The witnesses must possess the same qualifications as
22-24 those provided by Section 672.003(c).
22-25 (c) The attending physician and witnesses shall sign the
23-1 out-of-hospital DNR order in that place of the document provided by
23-2 Section 674.003(b)(7) and the attending physician shall sign the
23-3 document in the place required by Section 674.003(b)(13). The
23-4 physician shall make the fact of the existence of the
23-5 out-of-hospital DNR order a part of the declarant's medical record
23-6 and the witnesses shall sign that entry in the medical record.
23-7 (d) An out-of-hospital DNR order issued in the manner
23-8 provided by this section is valid and shall be honored by
23-9 responding health care professionals as if executed in the manner
23-10 provided by Section 674.002.
23-11 Sec. 674.005. EXECUTION OF OUT-OF-HOSPITAL DNR ORDER ON
23-12 BEHALF OF A MINOR. The following persons may execute an
23-13 out-of-hospital DNR order on behalf of a minor:
23-14 (1) the minor's parents;
23-15 (2) the minor's legal guardian; or
23-16 (3) the minor's managing conservator.
23-17 Sec. 674.006. DESIRE OF PERSON SUPERSEDES OUT-OF-HOSPITAL
23-18 DNR ORDER. The desire of a competent person, including a competent
23-19 minor, supersedes the effect of an out-of-hospital DNR order
23-20 executed or issued by or on behalf of the person when the desire is
23-21 communicated to responding health care professionals as provided by
23-22 this chapter.
23-23 Sec. 674.007. PROCEDURE WHEN DECLARANT IS INCOMPETENT OR
23-24 INCAPABLE OF COMMUNICATION. (a) This section applies when a
23-25 person 18 years of age or older has executed or issued an
24-1 out-of-hospital DNR order and subsequently becomes comatose,
24-2 incompetent, or otherwise mentally or physically incapable of
24-3 communication.
24-4 (b) If the adult person has designated a person to make a
24-5 treatment decision as authorized by Section 672.003(d), the
24-6 attending physician and the designated person shall comply with the
24-7 out-of-hospital DNR order.
24-8 (c) If the adult person has not designated a person to make
24-9 a treatment decision as authorized by Section 672.003(d), the
24-10 attending physician shall comply with the out-of-hospital DNR order
24-11 unless the physician believes that the order does not reflect the
24-12 person's present desire.
24-13 Sec. 674.008. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR
24-14 ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR INCAPABLE OF
24-15 COMMUNICATION. (a) If an adult person has not executed or issued
24-16 an out-of-hospital DNR order and is comatose, incompetent, or
24-17 otherwise mentally or physically incapable of communication, the
24-18 attending physician and the person's legal guardian, proxy, or
24-19 agent having a durable power of attorney for health care may
24-20 execute an out-of-hospital DNR order on behalf of the person.
24-21 (b) If the person does not have a legal guardian, proxy, or
24-22 agent, the attending physician and at least two qualified relatives
24-23 may execute an out-of-hospital DNR order in the same manner as a
24-24 treatment decision made under Section 672.009(b).
24-25 (c) A decision to execute an out-of-hospital DNR order made
25-1 under Subsection (a) or (b) must be based on knowledge of what the
25-2 person would desire, if known.
25-3 (d) An out-of-hospital DNR order executed under Subsection
25-4 (b) must be made in the presence of at least two witnesses who
25-5 possess the same qualifications that are required by Section
25-6 672.003(c).
25-7 (e) The fact that an adult person has not executed or issued
25-8 an out-of-hospital DNR order does not create a presumption that the
25-9 person does not want a treatment decision made to withhold
25-10 cardiopulmonary resuscitation and certain other designated
25-11 life-sustaining procedures designated by the board.
25-12 Sec. 674.009. COMPLIANCE WITH OUT-OF-HOSPITAL DNR ORDER.
25-13 (a) When responding to a call for assistance, health care
25-14 professionals shall honor an out-of-hospital DNR order in
25-15 accordance with the statewide out-of-hospital DNR protocol and,
25-16 where applicable, locally adopted out-of-hospital DNR protocols not
25-17 in conflict with the statewide protocol if:
25-18 (1) the responding health care professionals discover
25-19 an executed or issued out-of-hospital DNR order form on their
25-20 arrival at the scene; and
25-21 (2) the responding health care professionals comply
25-22 with this section.
25-23 (b) If the person is wearing a DNR identification device,
25-24 the responding health care professionals must comply with Section
25-25 674.010.
26-1 (c) The responding health care professionals must establish
26-2 the identity of the person as the person who executed or issued the
26-3 out-of-hospital DNR order or for whom the out-of-hospital DNR order
26-4 was executed or issued.
26-5 (d) The responding health care professionals must determine
26-6 that the out-of-hospital DNR order form appears to be valid in that
26-7 it includes:
26-8 (1) written responses in the places designated on the
26-9 form for the names, signatures, and other information required of
26-10 persons executing or issuing, or witnessing the execution or
26-11 issuance of, the order;
26-12 (2) a date in the place designated on the form for the
26-13 date the order was executed or issued; and
26-14 (3) the signature of the declarant or persons
26-15 executing or issuing the order and the attending physician in the
26-16 appropriate places designated on the form for indicating that the
26-17 order form has been properly completed.
26-18 (e) If the conditions prescribed by Subsections (a) through
26-19 (d) are not determined to apply by the responding health care
26-20 professionals at the scene, the out-of-hospital DNR order may not
26-21 be honored and life-sustaining procedures otherwise required by law
26-22 or local emergency medical services protocols shall be initiated or
26-23 continued. Health care professionals acting in out-of-hospital
26-24 settings are not required to accept or interpret an out-of-hospital
26-25 DNR order that does not meet the requirements of this chapter.
27-1 (f) The out-of-hospital DNR order form, when available, must
27-2 accompany the person during transport.
27-3 (g) A record shall be made and maintained of the
27-4 circumstances of each emergency medical services response in which
27-5 an out-of-hospital DNR order or DNR identification device is
27-6 encountered, in accordance with the statewide out-of-hospital DNR
27-7 protocol and any applicable local out-of-hospital DNR protocol not
27-8 in conflict with the statewide protocol.
27-9 (h) An out-of-hospital DNR order executed or issued and
27-10 documented or evidenced in the manner prescribed by this chapter is
27-11 valid and shall be honored by responding health care professionals
27-12 unless the person or persons found at the scene:
27-13 (1) identify themselves as the declarant or as the
27-14 attending physician, legal guardian, qualified relative, or agent
27-15 of the person having a durable power of attorney for health care
27-16 who executed or issued the out-of-hospital DNR order on behalf of
27-17 the person; and
27-18 (2) request that cardiopulmonary resuscitation or
27-19 certain other life-sustaining procedures designated by the board be
27-20 initiated or continued.
27-21 (i) If the policies of a health care facility preclude
27-22 compliance with the out-of-hospital DNR order of a person or an
27-23 out-of-hospital DNR order issued by an attending physician on
27-24 behalf of a person who is admitted to or a resident of the
27-25 facility, or if the facility is unwilling to accept DNR
28-1 identification devices as evidence of the existence of an
28-2 out-of-hospital DNR order, that facility shall take all reasonable
28-3 steps to notify the person or, if the person is incompetent, the
28-4 person's guardian or the person or persons having authority to make
28-5 health care treatment decisions on behalf of the person, of the
28-6 facility's policy and shall take all reasonable steps to effect the
28-7 transfer of the person to the person's home or to a facility where
28-8 the provisions of this chapter can be carried out.
28-9 Sec. 674.010. DNR IDENTIFICATION DEVICE. (a) A person who
28-10 has a valid out-of-hospital DNR order under this chapter may wear a
28-11 DNR identification device around the neck or on the wrist as
28-12 prescribed by board rule adopted under Section 674.023.
28-13 (b) The presence of a DNR identification device on the body
28-14 of a person is conclusive evidence that the person has executed or
28-15 issued a valid out-of-hospital DNR order or has a valid
28-16 out-of-hospital DNR order executed or issued on the person's
28-17 behalf. Responding health care professionals shall honor the DNR
28-18 identification device as if a valid out-of-hospital DNR order form
28-19 executed or issued by the person were found in the possession of
28-20 the person.
28-21 Sec. 674.011. DURATION OF OUT-OF-HOSPITAL DNR ORDER. An
28-22 out-of-hospital DNR order is effective until it is revoked as
28-23 prescribed by Section 674.012.
28-24 Sec. 674.012. REVOCATION OF OUT-OF-HOSPITAL DNR ORDER.
28-25 (a) A declarant may revoke an out-of-hospital DNR order at any
29-1 time without regard to the declarant's mental state or competency.
29-2 An order may be revoked by:
29-3 (1) the declarant or someone in the declarant's
29-4 presence and at the declarant's direction destroying the order form
29-5 and removing the DNR identification device, if any;
29-6 (2) a person who identifies himself or herself as the
29-7 legal guardian, as a qualified relative, or as the agent of the
29-8 declarant having a durable power of attorney for health care who
29-9 executed the out-of-hospital DNR order or another person in the
29-10 person's presence and at the person's direction destroying the
29-11 order form and removing the DNR identification device, if any;
29-12 (3) the declarant communicating the declarant's intent
29-13 to revoke the order; or
29-14 (4) a person who identifies himself or herself as the
29-15 legal guardian, a qualified relative, or the agent of the declarant
29-16 having a durable power of attorney for health care who executed the
29-17 out-of-hospital DNR order orally stating the person's intent to
29-18 revoke the order.
29-19 (b) An oral revocation under Subsection (a)(3) or (a)(4)
29-20 takes effect only when the declarant or a person who identifies
29-21 himself or herself as the legal guardian, a qualified relative, or
29-22 the agent of the declarant having a durable power of attorney for
29-23 health care who executed the out-of-hospital DNR order communicates
29-24 the intent to revoke the order to the responding health care
29-25 professionals or the attending physician at the scene. The
30-1 responding health care professionals shall record the time, date,
30-2 and place of the revocation in accordance with the statewide
30-3 out-of-hospital DNR protocol and rules adopted by the board and any
30-4 applicable local out-of-hospital DNR protocol. The attending
30-5 physician or the physician's designee shall record in the person's
30-6 medical record the time, date, and place of the revocation and, if
30-7 different, the time, date, and place that the physician received
30-8 notice of the revocation. The attending physician or the
30-9 physician's designee shall also enter the word "VOID" on each page
30-10 of the copy of the order in the person's medical record.
30-11 (c) Except as otherwise provided by this chapter, a person
30-12 is not civilly or criminally liable for failure to act on a
30-13 revocation made under this section unless the person has actual
30-14 knowledge of the revocation.
30-15 Sec. 674.013. REEXECUTION OF OUT-OF-HOSPITAL DNR ORDER. A
30-16 declarant may at any time reexecute or reissue an out-of-hospital
30-17 DNR order in accordance with the procedures prescribed by Section
30-18 674.002, including reexecution or reissuance after the declarant is
30-19 diagnosed as having a terminal condition.
30-20 Sec. 674.014. CONFLICT WITH NATURAL DEATH ACT OR DURABLE
30-21 POWER OF ATTORNEY FOR HEALTH CARE. To the extent that an
30-22 out-of-hospital DNR order conflicts with a directive or treatment
30-23 decision executed or issued under Chapter 672 or a durable power of
30-24 attorney for health care executed or issued in accordance with
30-25 Chapter 135, Civil Practice and Remedies Code, the instrument
31-1 executed later in time controls.
31-2 Sec. 674.015. EFFECT OF OUT-OF-HOSPITAL DNR ORDER ON
31-3 INSURANCE POLICY AND PREMIUMS. (a) The fact that a person has
31-4 executed or issued an out-of-hospital DNR order under this chapter
31-5 does not:
31-6 (1) restrict, inhibit, or impair in any manner the
31-7 sale, procurement, or issuance of a life insurance policy to that
31-8 person; or
31-9 (2) modify the terms of an existing life insurance
31-10 policy.
31-11 (b) Notwithstanding the terms of any life insurance policy,
31-12 the fact that cardiopulmonary resuscitation or certain other
31-13 life-sustaining procedures designated by the board are withheld
31-14 from an insured person under this chapter does not legally impair
31-15 or invalidate that person's life insurance policy and may not be a
31-16 factor for the purpose of determining the payability of benefits or
31-17 the cause of death under the life insurance policy.
31-18 (c) A physician, health facility, health care provider,
31-19 insurer, or health care service plan may not require a person to
31-20 execute or issue an out-of-hospital DNR order as a condition for
31-21 obtaining insurance for health care services or receiving health
31-22 care services.
31-23 (d) The fact that a person has executed or issued or failed
31-24 to execute or issue an out-of-hospital DNR order under this chapter
31-25 may not be considered in any way in establishing insurance
32-1 premiums.
32-2 Sec. 674.016. LIMITATION ON LIABILITY FOR WITHHOLDING
32-3 CARDIOPULMONARY RESUSCITATION AND CERTAIN OTHER LIFE-SUSTAINING
32-4 PROCEDURES. (a) A health care professional or health care
32-5 facility or entity that in good faith causes cardiopulmonary
32-6 resuscitation or certain other life-sustaining procedures
32-7 designated by the board to be withheld from a person in accordance
32-8 with this chapter is not civilly liable for that action.
32-9 (b) A health care professional or health care facility or
32-10 entity that in good faith participates in withholding
32-11 cardiopulmonary resuscitation or certain other life-sustaining
32-12 procedures designated by the board from a person in accordance with
32-13 this chapter is not civilly liable for that action.
32-14 (c) A health care professional or health care facility or
32-15 entity that in good faith participates in withholding
32-16 cardiopulmonary resuscitation or certain other life-sustaining
32-17 procedures designated by the board from a person in accordance with
32-18 this chapter is not criminally liable or guilty of unprofessional
32-19 conduct as a result of that action.
32-20 (d) A health care professional or health care facility or
32-21 entity that in good faith causes or participates in withholding
32-22 cardiopulmonary resuscitation or certain other life-sustaining
32-23 procedures designated by the board from a person in accordance with
32-24 this chapter and rules adopted under this chapter is not in
32-25 violation of any other licensing or regulatory laws or rules of
33-1 this state and is not subject to any disciplinary action or
33-2 sanction by any licensing or regulatory agency of this state as a
33-3 result of that action.
33-4 Sec. 674.017. LIMITATION ON LIABILITY FOR FAILURE TO
33-5 EFFECTUATE OUT-OF-HOSPITAL DNR ORDER. (a) A health care
33-6 professional or health care facility or entity that has no actual
33-7 knowledge of an out-of-hospital DNR order is not civilly or
33-8 criminally liable for failing to act in accordance with the order.
33-9 (b) A health care professional or health care facility or
33-10 entity is not civilly or criminally liable for failing to
33-11 effectuate an out-of-hospital DNR order.
33-12 (c) If an attending physician refuses to execute or comply
33-13 with an out-of-hospital DNR order, the physician shall inform the
33-14 person, the legal guardian or qualified relatives of the person, or
33-15 the agent of the person having a durable power of attorney for
33-16 health care and, if the person or another authorized to act on
33-17 behalf of the person so directs, shall make a reasonable effort to
33-18 transfer the person to another physician who is willing to execute
33-19 or comply with an out-of-hospital DNR order.
33-20 Sec. 674.018. HONORING OUT-OF-HOSPITAL DNR ORDER DOES NOT
33-21 CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not commit an
33-22 offense under Section 22.08, Penal Code, by withholding
33-23 cardiopulmonary resuscitation or certain other life-sustaining
33-24 procedures designated by the board from a person in accordance with
33-25 this chapter.
34-1 Sec. 674.019. CRIMINAL PENALTY; PROSECUTION. (a) A person
34-2 commits an offense if the person intentionally conceals, cancels,
34-3 defaces, obliterates, or damages another person's out-of-hospital
34-4 DNR order or DNR identification device without that person's
34-5 consent or the consent of the person or persons authorized to
34-6 execute or issue an out-of-hospital DNR order on behalf of the
34-7 person under this chapter. An offense under this subsection is a
34-8 Class A misdemeanor.
34-9 (b) A person is subject to prosecution for criminal homicide
34-10 under Chapter 19, Penal Code, if the person, with the intent to
34-11 cause cardiopulmonary resuscitation or certain other
34-12 life-sustaining procedures designated by the board to be withheld
34-13 from another person contrary to the other person's desires,
34-14 falsifies or forges an out-of-hospital DNR order or intentionally
34-15 conceals or withholds personal knowledge of a revocation and
34-16 thereby directly causes cardiopulmonary resuscitation and certain
34-17 other life-sustaining procedures designated by the board to be
34-18 withheld from the other person with the result that the other
34-19 person's death is hastened.
34-20 Sec. 674.020. PREGNANT PERSONS. A person may not withhold
34-21 cardiopulmonary resuscitation or certain other life-sustaining
34-22 procedures designated by the board under this chapter from a person
34-23 known by the responding health care professionals to be pregnant.
34-24 Sec. 674.021. MERCY KILLING NOT CONDONED. This chapter does
34-25 not condone, authorize, or approve mercy killing or permit an
35-1 affirmative or deliberate act or omission to end life except to
35-2 permit the natural process of dying as provided by this chapter.
35-3 Sec. 674.022. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
35-4 This chapter does not impair or supersede any legal right or
35-5 responsibility a person may have under a constitution, other
35-6 statute, regulation, or court decision to effect the withholding of
35-7 cardiopulmonary resuscitation or certain other life-sustaining
35-8 procedures designated by the board.
35-9 Sec. 674.023. DUTIES OF DEPARTMENT AND BOARD. (a) The
35-10 board shall, on the recommendation of the department, adopt all
35-11 reasonable and necessary rules to carry out the purposes of this
35-12 chapter, including rules:
35-13 (1) adopting a statewide out-of-hospital DNR order
35-14 protocol that sets out standard procedures for the withholding of
35-15 cardiopulmonary resuscitation and certain other life-sustaining
35-16 procedures by health care professionals acting in out-of-hospital
35-17 settings;
35-18 (2) designating life-sustaining procedures that may be
35-19 included in an out-of-hospital DNR order, including all procedures
35-20 listed in Section 674.001(14)(A)(i) through (vi); and
35-21 (3) governing recordkeeping in circumstances in which
35-22 an out-of-hospital DNR order or DNR identification device is
35-23 encountered by responding health care professionals.
35-24 (b) The rules adopted by the board under Subsection (a) are
35-25 not effective until approved by the Texas State Board of Medical
36-1 Examiners.
36-2 (c) Local emergency medical services authorities may adopt
36-3 local out-of-hospital DNR order protocols if the local protocols do
36-4 not conflict with the statewide out-of-hospital DNR order protocol
36-5 adopted by the board.
36-6 (d) The board by rule shall specify a distinctive standard
36-7 design for a necklace and a bracelet DNR identification device that
36-8 signifies, when worn by a person, that the possessor has executed
36-9 or issued a valid out-of-hospital DNR order under this chapter or
36-10 is a person for whom a valid out-of-hospital DNR order has been
36-11 executed or issued.
36-12 (e) The department shall report to the board from time to
36-13 time regarding issues identified in emergency medical services
36-14 responses in which an out-of-hospital DNR order or DNR
36-15 identification device is encountered. The report may contain
36-16 recommendations to the board for necessary modifications to the
36-17 form of the standard out-of-hospital DNR order or the designated
36-18 life-sustaining procedures listed in the standard out-of-hospital
36-19 DNR order, the statewide out-of-hospital DNR order protocol, or the
36-20 DNR identification devices.
36-21 Sec. 674.024. RECOGNITION OF OUT-OF-HOSPITAL DNR ORDER
36-22 EXECUTED OR ISSUED IN OTHER STATE. An out-of-hospital DNR order
36-23 executed, issued, or authorized in another state or a territory or
36-24 possession of the United States in compliance with the law of that
36-25 jurisdiction is effective for purposes of this chapter.
37-1 SECTION 11. Subsection (c), Section 51.918, Education Code,
37-2 is amended to read as follows:
37-3 (c) The Center for Rural Health Initiatives shall develop
37-4 relief service programs for rural physicians and allied health
37-5 personnel to facilitate ready access to continuing medical
37-6 education or practice coverage for purposes other than continuing
37-7 medical education.
37-8 SECTION 12. Subsection (e), Section 58.002, Education Code,
37-9 is amended to read as follows:
37-10 (e) It is the intent of this chapter that <eventually> at
37-11 least 50 percent of <the first year> resident physicians <appointed
37-12 by medical schools> shall be in the <primary care> areas of family
37-13 medicine, general internal medicine, general pediatrics,
37-14 geriatrics, obstetrics/gynecology, and emergency medicine, with 25
37-15 percent of those residents in family practice.
37-16 SECTION 13. Section 1, Chapter 94, Acts of the 51st
37-17 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
37-18 Civil Statutes), is amended to read as follows:
37-19 Sec. 1. (a) A person shall be regarded as practicing
37-20 chiropractic within the meaning of this Act if the person:
37-21 (1) uses objective or subjective means to analyze,
37-22 examine, or evaluate the biomechanical condition of the spine and
37-23 musculoskeletal system of the human body;
37-24 (2) performs nonsurgical, nonincisive <uses
37-25 adjustment, manipulation, or other> procedures, including but not
38-1 limited to adjustment and manipulation, in order to improve the
38-2 subluxation complex or the biomechanics of the musculoskeletal
38-3 system; or
38-4 (3) holds himself out to the public as a chiropractor
38-5 of the human body or uses the term "chiropractor," "chiropractic,"
38-6 "doctor of chiropractic," "D.C.," or any derivative of those terms
38-7 in connection with his name.
38-8 SECTION 14. Subsection (h), Section 3, Chapter 94, Acts of
38-9 the 51st Legislature, Regular Session, 1949 (Article 4512b,
38-10 Vernon's Texas Civil Statutes), is amended to read as follows:
38-11 (h) The members of the Texas Board of Chiropractic Examiners
38-12 shall be divided into three (3) classes, one, two and three, and
38-13 are appointed for staggered six-year terms, with three members'
38-14 terms expiring on February 1 of each odd-numbered year. No person
38-15 may be appointed to serve more than two terms. The president of
38-16 the Board shall be a licensed doctor of chiropractic. Members hold
38-17 office for their terms and until their successors are duly
38-18 appointed and qualified. In case of death or resignation of a
38-19 member of the Board, the Governor shall appoint another to take his
38-20 place for the unexpired term only.
38-21 SECTION 15. Subsection (c), Section 4, Chapter 94, Acts of
38-22 the 51st Legislature, Regular Session, 1949 (Article 4512b,
38-23 Vernon's Texas Civil Statutes), is amended to read as follows:
38-24 (c) The Board shall adopt rules <guidelines> for regulation
38-25 and enforcement of <educational preparation for all aspects of the
39-1 practice of chiropractic. The Board may not adopt a rule relating
39-2 to the meaning of the practice of chiropractic under this Act
39-3 except for:>
39-4 <(1) a rule relating to an adjustment, manipulation,
39-5 or other procedure directly related to improving the subluxation of
39-6 the spine or of the musculoskeletal system as it directly relates
39-7 to improving the subluxation of the spine; or>
39-8 <(2) a rule that defines an unacceptable practice of
39-9 chiropractic and provides for a penalty or sanction under> this
39-10 Act. The Board shall issue all opinions based on a vote of a
39-11 majority of the Board at a regular or called meeting. The issuance
39-12 of a disciplinary action or disciplinary order of the Board is not
39-13 limited by this subsection.
39-14 SECTION 16. Section 5a, Chapter 94, Acts of the 51st
39-15 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
39-16 Civil Statutes), is amended by adding Subsection (c) to read as
39-17 follows:
39-18 (c) A person who violates this section commits an offense.
39-19 An offense under this section is a Class A misdemeanor. If it is
39-20 shown at a trial of an offense under this section that the
39-21 defendant has previously been convicted under this section, the
39-22 offense is a felony of the third degree. Each day of violation
39-23 constitutes a separate offense.
39-24 SECTION 17. Chapter 94, Acts of the 51st Legislature,
39-25 Regular Session, 1949 (Article 4512b, Vernon's Texas Civil
40-1 Statutes), is amended by adding Section 12b to read as follows:
40-2 Sec. 12b. (a) The advisory commission to the Texas Board of
40-3 Chiropractic Examiners is created. The advisory commission shall
40-4 advise the Board on scientific and technical matters regarding new
40-5 and experimental diagnostic and treatment practices, procedures, or
40-6 instruments that are within the definition of chiropractic as set
40-7 out in Section 1 of this Act.
40-8 (b) The advisory commission shall be composed of:
40-9 (1) three persons who are licensees of the Board and
40-10 who are appointed by the Board;
40-11 (2) two licensees from chiropractic colleges in this
40-12 state appointed by the Board from a list submitted by the president
40-13 or governing body of each college;
40-14 (3) two licensees of the Texas State Board of Medical
40-15 Examiners who are designated by that board;
40-16 (4) one licensee of the Board of Nurse Examiners who
40-17 is designated by that board; and
40-18 (5) one licensee of the State Board of Pharmacy who is
40-19 designated by that board.
40-20 (c) Each member of the advisory commission serves at the
40-21 pleasure of the authority that appointed the member to the advisory
40-22 commission.
40-23 (d) The chair of the advisory commission shall be selected
40-24 from among the three members of the Board who are licensed doctors
40-25 of chiropractic.
41-1 (e) The members of the advisory commission shall serve
41-2 without compensation but are entitled to reimbursement for actual
41-3 expenses incurred in carrying out official duties, subject to the
41-4 approval of the chair of the advisory commission.
41-5 SECTION 18. Section 13a, Chapter 94, Acts of the 51st
41-6 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
41-7 Civil Statutes), is amended to read as follows:
41-8 Sec. 13a. (a) The practice of chiropractic shall not be
41-9 construed to include:
41-10 (1) incisive or surgical procedures;
41-11 (2) the prescribing of controlled substances or
41-12 dangerous drugs or any drug that requires a prescription; or
41-13 (3) the use of x-ray therapy or therapy that exposes
41-14 the body to radioactive materials.
41-15 (b) In this Act, "incisive or surgical procedure" includes
41-16 but is not limited to making an incision into any tissue, cavity,
41-17 or organ by any person or implement. It does not include the use
41-18 of a needle for the purpose of drawing blood for diagnostic
41-19 testing. <A chiropractor may not use in the chiropractor's
41-20 practice surgery, drugs that require a prescription to be
41-21 dispensed, x-ray therapy, or therapy that exposes the body to
41-22 radioactive material.>
41-23 SECTION 19. Chapter 94, Acts of the 51st Legislature,
41-24 Regular Session, 1949 (Article 4512b, Vernon's Texas Civil
41-25 Statutes), is amended by adding Section 13b to read as follows:
42-1 Sec. 13b. (a) Notwithstanding any other provision in this
42-2 Act, the Board shall not adopt a process to certify chiropractors
42-3 to perform manipulation under anesthesia.
42-4 SECTION 20. Section 14a, Chapter 94, Acts of the 51st
42-5 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
42-6 Civil Statutes), is amended to read as follows:
42-7 Sec. 14a. The Texas Board of Chiropractic Examiners may
42-8 refuse to admit persons to its examinations and may cancel, revoke
42-9 or suspend licenses or place licensees upon probation for such
42-10 length of time as may be deemed proper by the Board for any one or
42-11 more of the following causes:
42-12 1. For failure to comply with, or the violation of, any of
42-13 the provisions of this Act or of a rule adopted under this Act;
42-14 2. If it is found that said person or persons are in any way
42-15 guilty of deception or fraud in the practice of chiropractic;
42-16 3. The presentation to the Board or use of any license,
42-17 certificate or diploma, which was illegally or fraudulently
42-18 obtained, or the presentation to the Board of any untrue statement
42-19 or any document or testimony which was illegally practiced in
42-20 passing the examination;
42-21 4. Conviction of a crime of the grade of a felony, or one
42-22 which involves moral turpitude, or the procuring or assisting in
42-23 the procuring of an abortion;
42-24 5. Grossly unprofessional conduct or dishonorable conduct of
42-25 a character likely to deceive or defraud the public, habits of
43-1 intemperance or drug addiction, or other habits calculated in the
43-2 opinion of the Board to endanger the lives of patients;
43-3 6. The use of any advertising statement of a character to
43-4 mislead or deceive the public;
43-5 7. Employing or associating with, directly or indirectly,
43-6 any person who, during the period of such employment, commits any
43-7 act constituting the practice of chiropractic when such person is
43-8 not licensed to do so;
43-9 8. The advertising of professional superiority, or the
43-10 advertising of the performance of professional services in a
43-11 superior manner;
43-12 9. The purchase, sale, barter, use, or any offer to
43-13 purchase, sell, barter or use, any chiropractic degree, license,
43-14 certificate, or diploma, or transcript of license, certificate, or
43-15 diploma in or incident to an application to the Board of
43-16 Chiropractic Examiners for license to practice chiropractic;
43-17 10. Altering with fraudulent intent any chiropractic
43-18 license, certificate or diploma, or transcript of chiropractic
43-19 license, certificate or diploma;
43-20 11. The impersonation of, or acting as proxy for, another in
43-21 any examination required by this Act for a chiropractic license;
43-22 12. The impersonation of a licensed practitioner, or the
43-23 permitting or allowing another to use his license or certificate to
43-24 practice chiropractic as defined by statute by a licensed
43-25 practitioner;
44-1 13. Proof of insanity of the holder of a certificate, as
44-2 adjudged by the regularly constituted authorities;
44-3 14. Failure to use proper diligence in the practice of
44-4 chiropractic by the holder of a certificate, or grossly inefficient
44-5 practice of chiropractic;
44-6 15. Failing to clearly differentiate a chiropractic office
44-7 or clinic from any other business or enterprise;
44-8 16. Personally soliciting patients, or causing patients to
44-9 be solicited, by the use of case histories of patients of other
44-10 chiropractors;
44-11 17. Using an accident report prepared by a peace officer in
44-12 a manner prohibited by Section 38.12, Penal Code, for the purpose
44-13 of soliciting patients; <or>
44-14 18. If, when uninvited, a licensee or person designated,
44-15 contracted or paid by licensee directly canvasses, drums, secures
44-16 or solicits by phone, mail or in person patients or potential
44-17 patients who, because of their particular circumstances, are
44-18 vulnerable to undue influence. Circumstances in which patients or
44-19 potential patients may be considered to be vulnerable to undue
44-20 influence include but are not limited to:
44-21 a. when a person is known to the licensee to have
44-22 recently been involved in a motor vehicle accident;
44-23 b. when a person is known to the licensee to have
44-24 recently been involved in a work-related accident; or
44-25 c. when a person is known to the licensee to have
45-1 recently been injured by another person or as a result of another
45-2 person's actions; or
45-3 19. The term "chiropractic physician" may be used for the
45-4 express purpose of filing a claim for necessary services within the
45-5 definition of chiropractic under this Act when the billing for such
45-6 services has universally applied, predetermined coding or
45-7 description requirements that are a prerequisite to appropriate
45-8 reimbursement. A chiropractor may not advertise using the term
45-9 "physician," "chiropractic physician," or any combination or
45-10 derivation of the term "physician."<.>
45-11 SECTION 21. Section 14b, Chapter 94, Acts of the 51st
45-12 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
45-13 Civil Statutes), is amended to read as follows:
45-14 Sec. 14b. The Board may require evidence of proper training,
45-15 precaution, and safety in the use of analytical and diagnostic
45-16 x-ray in conformity with the provisions of Chapter 401, Health and
45-17 Safety Code, and in conformity with all rules and regulations of
45-18 the Texas Radiation Control Agency and the Texas State Department
45-19 of Health. Nothing in this section <herein> shall be deemed to
45-20 alter, modify, or amend the provisions of Section 1 of this Act<,
45-21 Chapter 94, Acts of the 51st Legislature, 1949, as amended (Article
45-22 4512b, Vernon's Texas Civil Statutes),> or to enlarge in any manner
45-23 the scope of the practice of chiropractic or the acts which a
45-24 chiropractor is authorized to perform; and, provided further, that
45-25 nothing in this section <herein> shall be deemed to alter, modify,
46-1 or amend the provisions of Article 4510, Revised Civil Statutes of
46-2 Texas, 1925, as amended. The Board shall implement any federal law
46-3 and state law requirements relating to radiologic training of the
46-4 employees of a chiropractor.
46-5 SECTION 22. Section 14c, Chapter 94, Acts of the 51st
46-6 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
46-7 Civil Statutes), is amended to read as follows:
46-8 Sec. 14c. (a) The Board shall appoint an enforcement
46-9 committee to oversee and conduct the investigation of complaints
46-10 filed with the Board under this Act and to perform other duties
46-11 related to enforcement as directed by the Board. The enforcement
46-12 committee is composed of three<:>
46-13 <(1) two or more> Board members, two <at least one> of
46-14 whom are doctors <is a doctor> of chiropractic and <at least> one
46-15 of whom is a representative of the general public<;>
46-16 <(2) the executive director; and>
46-17 <(3) a representative of the attorney general's
46-18 office>.
46-19 (b) The attorney general shall provide legal counsel to the
46-20 enforcement committee concerning the investigation and disposition
46-21 of complaints and other enforcement matters.
46-22 Sec. 14c.1. (a) The Board shall keep an information file
46-23 about each complaint filed with the Board and referred to the
46-24 enforcement committee. The Board's information file shall contain
46-25 a record for each complaint of:
47-1 (1) all persons contacted in relation to the
47-2 complaints;
47-3 (2) a summary of findings made at each step of the
47-4 complaint process;
47-5 (3) an explanation of the reason for a complaint that
47-6 is dismissed; and
47-7 (4) other relevant information.
47-8 (b) If a written complaint is received by the Board that the
47-9 Board has authority to resolve, the Board, at least as frequently
47-10 as semiannually and until final disposition of the complaint, shall
47-11 notify the parties to the complaint of the status of the complaint
47-12 unless the notice would jeopardize an undercover investigation.
47-13 (c) The Board by rule shall adopt a form to standardize
47-14 information concerning complaints made to the Board. The Board by
47-15 rule shall prescribe information to be provided to a person when
47-16 the person files a complaint received by the Board.
47-17 (d) The Board shall provide reasonable assistance to a
47-18 person who wishes to file a complaint.
47-19 (e) The Board by rule shall adopt procedures concerning the
47-20 retention of information files on licensees and the expunction of
47-21 files on licensees including complaints, adverse reports, and other
47-22 investigative information on licensees.
47-23 Sec. 14c.2. (a) The Board shall adopt rules concerning the
47-24 investigation of complaints <a complaint> filed with the Board.
47-25 The rules adopted under this subsection shall:
48-1 (1) distinguish between categories of complaints;
48-2 (2) ensure that complaints are not dismissed without
48-3 appropriate consideration;
48-4 (3) require that the Board be advised of a complaint
48-5 that is dismissed and that a letter be sent to the person who filed
48-6 the complaint explaining the action taken on the dismissed
48-7 complaint;
48-8 (4) ensure that the person who filed the complaint has
48-9 the <an> opportunity to explain the allegations made in the
48-10 complaint; and
48-11 (5) prescribe guidelines concerning the categories of
48-12 complaints that require the use of a private investigator and the
48-13 procedures for the Board to obtain the services of a private
48-14 investigator.
48-15 (b) <(c)> The Board shall dispose of all complaints in a
48-16 timely manner. The Board shall establish a time line for
48-17 conducting each phase of a complaint that is under the control of
48-18 the Board not later than the 30th day after the date the complaint
48-19 is received by the Board. The time line shall be kept in the
48-20 information file for the complaint and all parties shall be
48-21 notified of the projected time requirements for pursuing the
48-22 complaint. A change in the time line must be noted in the
48-23 complaint information file and all parties to the complaint must be
48-24 notified not later than the seventh day after the date the change
48-25 is made.
49-1 (c) <(d)> The executive director of the Board shall notify
49-2 the Board of a complaint that extends beyond the time prescribed by
49-3 the Board for resolving the complaint so that the Board may take
49-4 necessary action on the complaint.
49-5 SECTION 23. Section 19, Chapter 94, Acts of the 51st
49-6 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Civil
49-7 Statutes), is amended to read as follows:
49-8 Sec. 19. Except as provided by Section 5a of this Act, a
49-9 person who <Whoever> violates any provision of this Act shall be
49-10 guilty of a misdemeanor, and upon conviction shall be punished by a
49-11 fine of not less than Fifty Dollars ($50) nor more than Five
49-12 Hundred Dollars ($500), or by imprisonment in the county jail for
49-13 not more than thirty (30) days.
49-14 SECTION 24. (a) Any rule adopted or proposed for adoption
49-15 by the Texas Board of Chiropractic Examiners on or after September
49-16 1, 1994, must be reviewed and amended in conformance with this Act
49-17 except for a rule relating to:
49-18 (1) procedures for the conduct of a contested case
49-19 held under Chapter 2001, Government Code (Administrative Procedure
49-20 Act); or
49-21 (2) internal operating procedures.
49-22 (b) Not later than December 1, 1996, the Texas Board of
49-23 Chiropractic Examiners shall submit a report to the governor,
49-24 lieutenant governor, and speaker of the house of representatives on
49-25 the results of the review and rulemaking actions under Subsection
50-1 (a) of this section.
50-2 SECTION 25. The comptroller, under the authority of Section
50-3 403.022, Government Code, shall perform a review and shall analyze
50-4 the effectiveness and efficiency of the policy, management, fiscal
50-5 affairs, and operation of the Texas Board of Chiropractic
50-6 Examiners. The report shall be made before January 10, 1997.
50-7 SECTION 26. Section 501.059, Government Code, as added by
50-8 Chapter 238, Acts of the 73rd Legislature, 1993, is amended to read
50-9 as follows:
50-10 Sec. 501.059. Managed Health Care Advisory Committee.
50-11 (a) The Managed Health Care Advisory Committee to the Texas
50-12 Department of Criminal Justice is established.
50-13 (b) The committee consists of:
50-14 (1) two members employed full-time by the department,
50-15 at least one of whom is a physician, appointed by the executive
50-16 director;
50-17 (2) two members employed full-time by The University
50-18 of Texas Medical Branch at Galveston, at least one of whom is a
50-19 physician, appointed by the president of the medical branch; and
50-20 (3) two members employed full-time by the Texas Tech
50-21 University Health Sciences Center, at least one of whom is a
50-22 physician, appointed by the president of the university.
50-23 (c) A committee member serves at the pleasure of the
50-24 appointing official or until termination of the member's employment
50-25 with the entity the member represents.
51-1 (d) An appointment to the committee shall be made without
51-2 regard to the race, creed, sex, religion, or national origin of the
51-3 appointee.
51-4 (e) A committee member serves without compensation but is
51-5 entitled to reimbursement for actual and necessary expenses
51-6 incurred in the performance of the duties of the committee.
51-7 (f) The committee may hire a managed health care
51-8 administrator and may employ personnel necessary for the
51-9 administration of the committee's duties.
51-10 (g) The committee shall develop a managed health care plan
51-11 for all inmates at the institutional division that includes:
51-12 (1) the establishment of a managed care network of
51-13 physicians and hospitals that will serve the institutional division
51-14 as the exclusive health care provider for inmates at each facility
51-15 of the institutional division;
51-16 (2) cost containment studies; <and>
51-17 (3) care case management and utilization management
51-18 studies performed exclusively for the institutional division; and
51-19 (4) concerning the establishment of criteria for
51-20 hospitals, home health, or hospice providers, a provision requiring
51-21 the managed health care plan to accept certification by the
51-22 Medicare program under Title XVIII, Social Security Act, as amended
51-23 (42 U.S.C. Section 1395 et seq.), as an alternative to
51-24 accreditation by the Joint Commission on Accreditation of
51-25 Healthcare Organizations.
52-1 (h) To the extent possible the committee shall integrate the
52-2 managed care network with the public medical schools of this state
52-3 and the component and affiliated hospitals of those medical
52-4 schools.
52-5 (i) For those services for which the public medical schools
52-6 and their components and affiliates cannot provide, the committee
52-7 shall initiate a competitive bidding process for contracts with
52-8 other providers for medical care to inmates confined in the
52-9 institutional division.
52-10 (j) The committee may enter into a contract on behalf of the
52-11 department to fully implement the managed health care plan under
52-12 Subsection (g).
52-13 (k) The department shall pay necessary costs for the
52-14 operation of the committee, including costs of personnel, from
52-15 funds appropriated by the legislature to the department.
52-16 (l) The managed health care plan, inclusive of the health
52-17 care administrator and necessary personnel proposed by the
52-18 committee, must cost the state less than what is presently
52-19 provided, otherwise the status quo shall be maintained.
52-20 SECTION 27. Subdivision (3), Subsection (e), Section 5,
52-21 Psychologists' Certification and Licensing Act (Article 4512c,
52-22 Vernon's Texas Civil Statutes), is amended to read as follows:
52-23 (3) If the executive director has knowledge that a
52-24 potential ground for removal may exist <exists>, the executive
52-25 director shall notify the Board <governor and the attorney general>
53-1 that a potential ground for removal may exist <exists>. The Board
53-2 shall notify the governor and attorney general if a potential
53-3 ground for removal exists.
53-4 SECTION 28. Subsection (d), Section 11, Psychologists'
53-5 Certification and Licensing Act (Article 4512c, Vernon's Texas
53-6 Civil Statutes), is amended to read as follows:
53-7 (d) In addition to the requirements of Subsection (b) or (c)
53-8 of this section, the applicant must meet the following
53-9 qualifications:
53-10 (1) the applicant has attained the age of majority;
53-11 (2) the applicant is of good moral character;
53-12 (3) in the judgment of the Board, the applicant is
53-13 physically and mentally competent to render psychological services
53-14 with reasonable skill and safety and is afflicted with no disease
53-15 or condition, either mental or physical, which would impair
53-16 competency to render psychological services; and
53-17 (4) the applicant:
53-18 (A) has not been convicted of a felony or a
53-19 crime involving moral turpitude;
53-20 (B) does not use drugs or intoxicating liquors
53-21 to an extent that affects the applicant's professional competency;
53-22 (C) has not been guilty of fraud or deceit in
53-23 making the application;
53-24 (D) except as provided by Section 15B of this
53-25 Act, has not aided or abetted a person, not a licensed or certified
54-1 psychologist, in representing that person as a psychologist in this
54-2 state;
54-3 (E) except as provided by Section 15B of this
54-4 Act, has not represented himself or herself to be a psychologist
54-5 licensed in this state at a time he or she was not licensed to
54-6 practice psychology in this state, or practiced psychology in this
54-7 state without a license to practice psychology in this state.
54-8 SECTION 29. Subsections (a) and (b), Section 14,
54-9 Psychologists' Certification and Licensing Act (Article 4512c,
54-10 Vernon's Texas Civil Statutes), are amended to read as follows:
54-11 (a) The Board shall administer oral and written examinations
54-12 to qualified applicants for certification and licensure at least
54-13 once a year. The Board shall have the written portion of the
54-14 examination, if any, validated by an independent testing
54-15 professional. The Board shall determine the subject and scope of
54-16 the examinations and establish appropriate fees for examinations
54-17 administered. Part of the examinations shall test applicant
54-18 knowledge of the discipline and profession of psychology and part
54-19 shall test applicant knowledge of the laws and rules governing the
54-20 profession of psychology in this state. This latter part of the
54-21 examination is to be known as the Board's jurisprudence
54-22 examination. An applicant who fails his examination may be
54-23 reexamined at intervals specified by the Board upon payment of
54-24 another examination fee corresponding to the examination failed.
54-25 (b) Within 30 days after the day on which an <a
55-1 certification> examination is administered under Subsection (a) of
55-2 this section <Act>, the Board shall notify each examinee of the
55-3 results of the examination. However, if an examination is graded
55-4 or reviewed by a national testing service, the Board shall notify
55-5 examinees of the results of the examination within two weeks after
55-6 the day that the Board receives the results from the testing
55-7 service. If the notice of the examination results will be delayed
55-8 for longer than 90 days after the examination date, the Board shall
55-9 notify the examinee of the reason for the delay before the 90th
55-10 day.
55-11 SECTION 30. Section 15A, Psychologists' Certification and
55-12 Licensing Act (Article 4512c, Vernon's Texas Civil Statutes), is
55-13 amended to read as follows:
55-14 Sec. 15A. Endorsement. (a) The Board may grant a temporary
55-15 <provisional> license or certificate to an applicant seeking
55-16 permanent certification or licensure, including individuals seeking
55-17 reciprocity under Section 15B, upon <on> submission to the Board of
55-18 an application in the form prescribed by the Board and payment of
55-19 the required application fees if:
55-20 (1) the individual is licensed, certified, or
55-21 registered as a psychologist or psychological associate by another
55-22 state, the District of Columbia, or a commonwealth or territory of
55-23 the United States and is in good standing with the regulatory
55-24 agency of that jurisdiction;
55-25 (2) the requirements for licensing, certification, or
56-1 registration in the other jurisdiction are substantially equal to
56-2 those prescribed by this Act; and
56-3 (3) the individual has passed a national or other
56-4 examination recognized as equivalent by the Board to the
56-5 examination process required by the Board for permanent licensure
56-6 and certification under this Act <relating to psychology; and>
56-7 <(4) the individual is sponsored by a person licensed
56-8 or certified by the Board under this Act with whom the provisional
56-9 license or certificate holder may practice under this section>.
56-10 (b) <An applicant for a provisional license or certificate
56-11 may be excused from the requirement of Subsection (a)(4) of this
56-12 section if the Board determines that compliance with that
56-13 subsection constitutes a hardship to the applicant.>
56-14 <(c)> A temporary <provisional> license or certificate is
56-15 valid until the date the Board approves or denies the temporary
56-16 <provisional> license or certificate holder's application for a
56-17 permanent license or certificate or for one year if no action is
56-18 taken by the Board.
56-19 (c) If the Board denies the temporary license or certificate
56-20 holder's application for permanent licensure or certification, the
56-21 temporary license or certificate shall automatically expire.
56-22 (d) All temporary licenses and certificates expire one year
56-23 after their issuance. <The Board shall issue a license or
56-24 certificate under this Act to the holder of a provisional license
56-25 or certificate under this section if:>
57-1 <(1) the provisional license or certificate holder
57-2 passes the examination required by Section 14 of this Act;>
57-3 <(2) the Board verifies that the provisional license
57-4 or certificate holder has the academic and experience requirements
57-5 for a license or certificate under this Act; and>
57-6 <(3) the provisional license or certificate holder
57-7 satisfies any other license or certification requirements under
57-8 this Act.>
57-9 <(d) The Board must complete the processing of a provisional
57-10 license or certificate holder's application for a license or
57-11 certificate not later than the 180th day after the date the
57-12 provisional license or certificate is issued.>
57-13 (e) The Board may adopt rules for the temporary
57-14 <provisional> certification or licensing of an individual who holds
57-15 a valid license or the equivalent from another country.
57-16 (f) Any temporary license or certificate issued under this
57-17 section does not constitute a vested property right.
57-18 (g) A holder of a temporary license or certificate issued
57-19 under this Act must display a sign approved by the Board in every
57-20 room where the holder renders psychological services indicating the
57-21 temporary nature of the license or certificate.
57-22 SECTION 31. Section 18, Psychologists' Certification and
57-23 Licensing Act (Article 4512c, Vernon's Texas Civil Statutes), is
57-24 amended to read as follows:
57-25 Sec. 18. Roster of Certified and Licensed Psychologists.
58-1 The <During the month of April of each year, the> Board shall, on
58-2 an annual basis, publish a list of all psychologists certified or
58-3 licensed under this Act. The list shall contain the name and
58-4 address of the psychologist and such other information that the
58-5 Board deems desirable. The list shall be arranged both
58-6 alphabetically and geographically. The Board shall mail a copy of
58-7 this list to each person licensed under this Act, shall place a
58-8 copy on file with the Secretary of State and shall furnish copies
58-9 to the public upon request.
58-10 SECTION 32. Subsection (d), Section 23A, Psychologists'
58-11 Certification and Licensing Act (Article 4512c, Vernon's Texas
58-12 Civil Statutes), is amended to read as follows:
58-13 (d) An executive director who determines that a violation
58-14 may have <has> occurred shall <may> issue to the Board a report
58-15 that states the facts on which the determination is based. The
58-16 Board shall determine whether a violation has occurred. If the
58-17 Board determines that a violation has occurred, the Board shall
58-18 make a recommendation on the imposition of a penalty, including a
58-19 recommendation on the amount of the penalty.
58-20 SECTION 33. Section 25A, Psychologists' Certification and
58-21 Licensing Act (Article 4512c, Vernon's Texas Civil Statutes), is
58-22 amended by adding Subsections (e), (f), (g), and (h) to read as
58-23 follows:
58-24 (e) Except as specifically provided in Subsection (f) of
58-25 this section, a complaint and investigation under Section 8 of this
59-1 Act concerning an individual licensed or certified by the Board and
59-2 all information and materials compiled by the Board in connection
59-3 with a complaint and investigation are not subject to disclosure
59-4 under the open records law, Chapter 552, Government Code, and are
59-5 not subject to disclosure, discovery, subpoena, or other means of
59-6 legal compulsion for their release to any person or entity.
59-7 (f) A complaint or investigation covered by Subsection (e)
59-8 of this section and all information and materials compiled by the
59-9 Board in connection with such a complaint or investigation may be
59-10 disclosed to:
59-11 (1) the Board and its employees or agents involved in
59-12 licensee and/or certificand discipline;
59-13 (2) a party to a disciplinary action against the
59-14 licensee and/or certificand or that party's designated
59-15 representative;
59-16 (3) law enforcement agencies if otherwise required by
59-17 law;
59-18 (4) governmental agencies, if the disclosure is
59-19 required or permitted by law, provided that the agency obtaining
59-20 disclosure shall protect the identity of any patient whose records
59-21 are examined; or
59-22 (5) any legislative committee or its staff directed by
59-23 either or both houses of the legislature, the presiding officers of
59-24 either or both houses of the legislature, or the chairman of the
59-25 legislative committee to make an inquiry regarding state hospitals
60-1 or schools, provided that no information or records that identify a
60-2 patient or client shall be released for any purpose unless proper
60-3 consent is given by the patient and provided that only records
60-4 created by the state hospital or school or its employees shall be
60-5 included under this subsection.
60-6 (g) Not later than 30 days after receiving a written request
60-7 from a licensee or certificand who is entitled to a hearing under
60-8 this Act or from the licensee's or certificand's attorney of
60-9 record, the Board shall provide the licensee or certificand with
60-10 access to all information that the Board intends to offer into
60-11 evidence at the hearing, unless good cause for delay is shown to
60-12 the person presiding as officer in the hearing.
60-13 (h) In any disciplinary investigation or proceeding against
60-14 a licensee or certificand, the Board shall protect the identity of
60-15 any patient whose records are examined, except:
60-16 (1) any patient initiating the disciplinary action; or
60-17 (2) those patients who have submitted a written
60-18 consent to the release of their records.
60-19 SECTION 34. Section 1A, Licensed Professional Counselor Act
60-20 (Article 4512g, Vernon's Texas Civil Statutes), is amended to read
60-21 as follows:
60-22 Sec. 1A. Policy Statement. (a) It is the policy of this
60-23 state that the activities of a person who provides services to the
60-24 public as a counselor and uses the title licensed professional
60-25 counselor should be regulated to protect the health, safety, and
61-1 welfare of the public.
61-2 (b) Nothing in this Act may be construed as permitting the
61-3 practice of medicine as defined by the laws of this state.
61-4 SECTION 35. Subdivisions (6) and (7), Section 2, Licensed
61-5 Professional Counselor Act (Article 4512g, Vernon's Texas Civil
61-6 Statutes), are amended to read as follows:
61-7 (6) "Counseling treatment intervention <services>"
61-8 means the application of cognitive, affective, behavioral,
61-9 psychodynamic, and systemic counseling strategies, including
61-10 strategies for developmental, wellness, and psychological
61-11 dysfunction that reflect a pluralistic society <those acts and
61-12 behaviors coming within the meaning of the practice of counseling>.
61-13 The term shall not be interpreted to permit or include the
61-14 diagnosis or treatment of a physical condition or disorder. The
61-15 term includes: interventions specifically implemented in the
61-16 context of a professional counseling relationship; individual,
61-17 group, and family counseling and psychotherapy; the assessment,
61-18 evaluation, and treatment of persons with mental, emotional, and
61-19 behavioral disorders; guidance and consulting to facilitate normal
61-20 growth and development, including educational and career
61-21 development; the use of functional assessment and counseling for
61-22 persons requesting assistance in adjustment to a disability or
61-23 handicapping condition; research; and referrals. The use of
61-24 specific methods, techniques, or modalities within the practice of
61-25 professional counseling is limited to professional counselors
62-1 appropriately trained in the use of such methods, techniques, or
62-2 modalities.
62-3 (7) "Practice of professional counseling" means the
62-4 application of mental health, psychotherapeutic, and human
62-5 development principles to:
62-6 (A) facilitate human development and adjustment
62-7 throughout the life span;
62-8 (B) prevent, assess, evaluate, and treat mental,
62-9 emotional, or behavioral disorders and associated distresses that
62-10 interfere with mental health;
62-11 (C) conduct assessments and evaluations to
62-12 establish treatment goals and objectives; and
62-13 (D) plan, implement, and evaluate treatment
62-14 plans using counseling treatment interventions <rendering or
62-15 offering to render, to individuals, couples, families, groups,
62-16 organizations, or the general public, counseling or guidance
62-17 services, for compensation, involving the application of
62-18 principles, methods, or procedures of the counseling profession>
62-19 that include:
62-20 (i) <(A)> "counseling" which means
62-21 assisting one or more clients through the therapeutic relationship,
62-22 using a combination of mental health and human development
62-23 principles, methods, and techniques, including the use of
62-24 psychotherapy, to achieve the mental, emotional, physical, social,
62-25 moral, educational, spiritual, or career-related development and
63-1 adjustment of the client throughout the client's life;
63-2 (ii) <(B)> "assessment <appraisal
63-3 activities>" which means selecting, administering, scoring, and
63-4 interpreting instruments designed to assess an individual's
63-5 aptitudes, attitudes, abilities, achievements, interests, <and>
63-6 personal characteristics, disabilities, and mental, emotional, and
63-7 behavioral disorders and the use of methods and techniques for
63-8 understanding human behavior that may include the evaluation,
63-9 assessment, and treatment by counseling methods, techniques, and
63-10 procedures for mental and emotional disorders, alcoholism and
63-11 substance abuse, and <other habit or> conduct disorders but does
63-12 not include the use of standardized projective techniques or permit
63-13 the diagnosis of a physical condition or disorder <in the
63-14 assessment of personality>;
63-15 (iii) <(C)> "<counseling, guidance, and
63-16 personnel> consulting" which means the application of scientific
63-17 principles and procedures in counseling and human development to
63-18 provide assistance in understanding and solving current or
63-19 potential problems that the person seeking consultation may have
63-20 with regard to a third party, including an individual, group, or an
63-21 organization <interpreting or reporting on scientific fact or
63-22 theory in counseling, guidance, and personnel services to provide
63-23 assistance in solving some current or potential problems of
63-24 individuals, couples, families, groups, or organizations>; and
63-25 (iv) <(D)> "referral" which means
64-1 evaluating and identifying needs of a counselee to determine the
64-2 advisability of referral to other specialists, informing the
64-3 counselee of such judgment, and communicating as requested or
64-4 deemed appropriate to such referral sources.
64-5 SECTION 36. Subsection (a), Section 3, Licensed Professional
64-6 Counselor Act (Article 4512g, Vernon's Texas Civil Statutes), is
64-7 amended to read as follows:
64-8 (a) Except as provided by Subsection (b) of this section,
64-9 this Act does not apply to:
64-10 (1) the activities and services of or use of an
64-11 official title by a person employed as a counselor by a federal,
64-12 state, county, or municipal agency or public or private educational
64-13 institution, if the person is performing counseling or
64-14 counseling-related activities within the scope of his employment;
64-15 (2) the activities and services of a student, intern,
64-16 or trainee in counseling pursuing a course of study in counseling
64-17 in a regionally accredited institution of higher education or
64-18 training institution, if these activities and services constitute a
64-19 part of the supervised course of study and the person is designated
64-20 a "counselor intern";
64-21 (3) the activities and services of a nonresident
64-22 rendered not more than 30 days during any year, if the person is
64-23 authorized to perform the activities and services under the law of
64-24 the state or country of his residence;
64-25 (4) the activities and services of members of other
65-1 professions licensed or certified by the state, such as physicians,
65-2 registered nurses, psychologists, certified social workers,
65-3 licensed marriage and family therapists, licensed chemical
65-4 dependency counselors, licensed physician assistants, licensed
65-5 occupational therapists, licensed optometrists in the evaluation
65-6 and remediation of learning or behavioral disabilities associated
65-7 with or caused by a defective or abnormal condition of vision,
65-8 Christian Science practitioners who are recognized by the Church of
65-9 Christ Scientist as registered and published in the Christian
65-10 Science Journal, or other recognized religious practitioners
65-11 performing counseling consistent with the law of the state, their
65-12 training, and any code of ethics of their professions, if they do
65-13 not represent themselves by any title or description in the manner
65-14 prescribed by Section 2 of this Act;
65-15 (5) the activities, services, titles, and descriptions
65-16 of persons licensed to practice law;
65-17 (6) the activities, services, titles, and descriptions
65-18 of persons employed as professionals or who are volunteers in the
65-19 practice of counseling for public and private nonprofit
65-20 organizations or charities who are accountable to the persons'
65-21 sponsoring organization and do not use the title or hold themselves
65-22 out to be licensed counselors; or
65-23 (7) <persons supervised by a physician and recognized
65-24 as physician assistants by the Texas State Board of Medical
65-25 Examiners, if the persons act strictly within their scope of
66-1 practice and do not use the titles covered by Section 15(b)(3) of
66-2 this Act; or>
66-3 <(8)> persons owning, operating, or employed by a
66-4 certified career counseling service regulated under Chapter 222,
66-5 Acts of the 70th Legislature, Regular Session, 1987 (Article
66-6 5221a-8, Vernon's Texas Civil Statutes).
66-7 SECTION 37. Section 10, Licensed Professional Counselor Act
66-8 (Article 4512g, Vernon's Texas Civil Statutes), is amended to read
66-9 as follows:
66-10 Sec. 10. APPLICANT QUALIFICATIONS. (a) A person is a
66-11 qualified applicant if the person:
66-12 (1) is at least 18 years old;
66-13 (2) has submitted an application as required by the
66-14 board, accompanied by the application fee set by the board; the
66-15 board may require that the statements on the application be made
66-16 under oath;
66-17 (3) has a master's or doctorate degree in counseling
66-18 or a related field;
66-19 (4) has successfully completed a graduate degree at a
66-20 regionally accredited institution of higher education and a planned
66-21 graduate program of 48 graduate semester hours or the substantial
66-22 equivalent, including 300 clock hours of supervised practicum that
66-23 is primarily counseling in nature and that meets the specific
66-24 academic course content and training standards established by the
66-25 board. The board shall review and consider the standards as
67-1 developed by the appropriate professional association;
67-2 (5) has completed 24 months or 2,000 hours of
67-3 supervised experience working in a counseling setting that meets
67-4 the requirements established by the board after the completion of
67-5 the 48 graduate semester hour or equivalent graduate program;
67-6 (6) has successfully completed the examination
67-7 required under this Act; and
67-8 (7) has met the requirements prescribed by the board.
67-9 (b) A person may complete not more than six of the 48
67-10 graduate semester hours required under Subsection (a)(4) of this
67-11 section during or after the time the person completes the 2,000
67-12 hours of supervised work experience required under Subsection
67-13 (a)(5) of this section if, at the time the person began the work
67-14 experience, the person possessed a graduate degree and a lesser
67-15 number of hours was required by the law of this state or the law in
67-16 effect where the work experience was performed.
67-17 SECTION 38. The Licensed Professional Counselor Act (Article
67-18 4512g, Vernon's Texas Civil Statutes), is amended by adding Section
67-19 10A to read as follows:
67-20 Sec. 10A. QUALIFICATIONS FOR SPECIALIZATION IN ART THERAPY.
67-21 (a) A person is a qualified applicant for licensing as a
67-22 professional counselor with a specialization in art therapy if the
67-23 person:
67-24 (1) meets the requirements for a license as a
67-25 professional counselor under Section 10 of this Act;
68-1 (2) holds either:
68-2 (A) a master's or doctoral degree in art therapy
68-3 that includes 600 hours of supervised practicum from an accredited
68-4 institution except that on or after September 1, 1996, applicants
68-5 must have 700 hours of supervised practicum from an accredited
68-6 institution;
68-7 (B) a master's degree in a counseling related
68-8 field and has a minimum of 21 semester hours of sequential course
68-9 work in the history, theory, and practice of art therapy and has
68-10 completed 600 hours of supervised practicum from an accredited
68-11 institution except that on or after September 1, 1996, applicants
68-12 must complete 700 hours of supervised practicum from an accredited
68-13 institution;
68-14 (3) has completed 1,000 client contact hours under
68-15 supervision of a nationally registered art therapist or other
68-16 supervisor acceptable to the board as part of the supervised work
68-17 experience requirement in Section 10(a)(5) of this Act; except that
68-18 on or after September 1, 1996, an applicant must complete 1,000
68-19 client contact hours beyond the requirements in Subdivision (2)(A)
68-20 of this subsection under supervision of a licensed professional
68-21 counselor with a specialization in art therapy or 2,000 client
68-22 contact hours beyond the requirements in Subdivision (2)(B) of this
68-23 subsection under supervision of a nationally registered art
68-24 therapist or other supervisor acceptable to the board, and on or
68-25 after September 1, 1998, an applicant must complete 2,000 client
69-1 contact hours of postgraduate experience beyond the requirements in
69-2 Subdivision (2)(B) of this subsection under supervision of a
69-3 licensed professional counselor with a specialization in art
69-4 therapy; and
69-5 (4) has successfully completed the national
69-6 Certification Examination in Art Therapy of the Art Therapy
69-7 Credentials Board.
69-8 (b) The board shall accept an individual course from an art
69-9 therapy program accredited through the American Art Therapy
69-10 Association as satisfying the education requirements under Section
69-11 (10)(a)(4) of this Act if not less than 75 percent of the course
69-12 content is substantially equivalent to the content of a course
69-13 required by board rule.
69-14 (c) A counselor intern pursuing a course of study in an art
69-15 therapy program accredited by the American Art Therapy Association
69-16 may use the designation "art therapy intern."
69-17 SECTION 39. Section 12, Licensed Professional Counselor Act
69-18 (Article 4512g, Vernon's Texas Civil Statutes), is amended by
69-19 adding Subsections (e) and (f) to read as follows:
69-20 (e) An applicant for licensure with a specialization in art
69-21 therapy must submit evidence of the successful completion of the
69-22 examination required by Section 10A of this Act.
69-23 (f) An applicant who meets the requirements for licensing by
69-24 endorsement under Section 18(a) of this Act is exempt from the
69-25 examination administered under this section.
70-1 SECTION 40. Subsection (d), Section 14, Licensed
70-2 Professional Counselor Act (Article 4512g, Vernon's Texas Civil
70-3 Statutes), is amended to read as follows:
70-4 (d) Each year the board shall prepare a registry of licensed
70-5 professional counselors. The registry shall include listings of
70-6 any specializations permitted by law or by board rule. The
70-7 registry shall be made available to the licensees, other state
70-8 agencies, and the general public on request.
70-9 SECTION 41. Section 14, Licensed Professional Counselor Act
70-10 (Article 4512g, Vernon's Texas Civil Statutes), is amended by
70-11 adding Subsection (s) to read as follows:
70-12 (s) The board by rule may provide for the issuance of a
70-13 temporary license to a person who:
70-14 (1) has completed not less than 42 graduate semester
70-15 hours of the education requirements under Section 10(a)(4) of this
70-16 Act in an art therapy program accredited by the American Art
70-17 Therapy Association;
70-18 (2) has completed the supervised work experience
70-19 requirements under Section 10A(a)(3) of this Act;
70-20 (3) has passed the examination required under Section
70-21 10A(a)(4) of this Act;
70-22 (4) is a registered art therapist with the American
70-23 Art Therapy Association and may use the title "A.T.R." in the
70-24 practice of art therapy;
70-25 (5) represents himself or herself to the public as an
71-1 "art therapist";
71-2 (6) limits the scope of practice to art therapy, as
71-3 defined by board rule; and
71-4 (7) files a plan acceptable to the board for a course
71-5 of study to complete the additional graduate semester hours
71-6 necessary to satisfy the education requirements under Section
71-7 10(a)(4) of this Act.
71-8 SECTION 42. Section 15, Licensed Professional Counselor Act
71-9 (Article 4512g, Vernon's Texas Civil Statutes), is amended to read
71-10 as follow:
71-11 Sec. 15. License Required; Penalty. (a) Unless the person
71-12 is exempt under Section 3 of this Act, a person may not engage <on
71-13 or after January 1, 1994,> in the practice of counseling without a
71-14 license issued under this Act.
71-15 (b) A person commits an offense if the person knowingly or
71-16 intentionally:
71-17 (1) engages in the practice of counseling without
71-18 holding a license issued under this Act;
71-19 (2) engages in the practice of counseling after the
71-20 person's license under this Act has expired;
71-21 (3) represents the person by the title "Licensed
71-22 Professional Counselor" or "Licensed Counselor" without being
71-23 licensed under this Act; <or>
71-24 (4) represents the person by the title "Licensed
71-25 Professional Counselor - Art Therapist," "Art Therapist," or by the
72-1 initials "L.P.C. - A.T." or "A.T." without being licensed with a
72-2 specialization in art therapy under Section 10A of this Act or
72-3 without being licensed under Section 14(s) of this Act; or
72-4 (5) makes use of any title, words, letters, or
72-5 abbreviations that imply that the person is licensed under this Act
72-6 if the person is not licensed under this Act.
72-7 (c) An offense under Subsection (b) of this section is a
72-8 Class B misdemeanor.
72-9 SECTION 43. Subsection (a), Section 16, Licensed
72-10 Professional Counselor Act (Article 4512g, Vernon's Texas Civil
72-11 Statutes), as amended by Section 2.06, Chapter 573, and Section 14,
72-12 Chapter 581, Acts of the 73rd Legislature, 1993, is amended to read
72-13 as follows:
72-14 (a) The board shall revoke, suspend, suspend on an emergency
72-15 basis, or refuse to renew the license of a counselor, place on
72-16 probation a counselor whose license has been suspended, or
72-17 reprimand a counselor if the counselor:
72-18 (1) has committed an act in violation of Section
72-19 21.14, Penal Code, or for which liability exists under Chapter 81,
72-20 Civil Practice and Remedies Code;
72-21 (2) has violated this Act or a rule or code of ethics
72-22 adopted by the board;
72-23 (3) is legally committed to an institution because of
72-24 mental incompetence from any cause; or
72-25 (4) <(3)> offers to pay or agrees to accept any
73-1 remuneration, directly or indirectly, to or from any person or
73-2 entity for securing or soliciting a patient or patronage.
73-3 SECTION 44. Subsection (a), Section 18, Licensed
73-4 Professional Counselor Act (Article 4512g, Vernon's Texas Civil
73-5 Statutes), is amended to read as follows:
73-6 (a) The board may grant, on application and payment of fees,
73-7 a provisional license to a person who at the time of application
73-8 holds a valid license <or certificate> as a counselor or art
73-9 therapist issued by another state or any political territory or
73-10 jurisdiction acceptable to the board. An applicant for a
73-11 provisional license under this section must:
73-12 (1) be licensed in good standing as a counselor or art
73-13 therapist in another state, territory, or jurisdiction that has
73-14 licensing requirements that are substantially equivalent to the
73-15 requirements of this Act;
73-16 (2) have passed a national or other examination
73-17 recognized by the board relating to counseling or art therapy; and
73-18 (3) be sponsored by a person licensed by the board
73-19 under this Act with whom the provisional licensee may practice
73-20 under this section.
73-21 SECTION 45. EFFECTIVE DATE. (a) Except as provided by
73-22 Subsections (b) and (c) of this section, the sections of this Act
73-23 amending the Licensed Professional Counselor Act (Article 4512g,
73-24 Vernon's Texas Civil Statutes) take effect September 1, 1995, and
73-25 apply only to an application for licensing as a professional
74-1 counselor filed with the Texas State Board of Examiners of
74-2 Professional Counselors on or after that date. An application
74-3 filed before the effective date of this Act is governed by the law
74-4 in effect at the time the application was made and the former law
74-5 is continued in effect for that purpose.
74-6 (b) The change in law made by this Act to Section 15,
74-7 Licensed Professional Counselor Act (Article 4512g, Vernon's Texas
74-8 Civil Statutes), takes effect September 1, 1996.
74-9 (c) Subsection (f), Section 12, Licensed Professional
74-10 Counselor Act (Article 4512g, Vernon's Texas Civil Statutes), as
74-11 added by this Act, applies only to a person who applies for
74-12 licensing as a professional counselor on or after September 1,
74-13 1993.
74-14 (d) The Texas State Board of Examiners of Professional
74-15 Counselors shall adopt rules under this Act not later than
74-16 November 1, 1995.
74-17 SECTION 46. Subdivisions (19) and (42), Section 5, Texas
74-18 Pharmacy Act (Article 4542a-1, Vernon's Texas Civil Statutes), are
74-19 amended to read as follows:
74-20 (19) "Designated agent" means:
74-21 (A) a licensed nurse, physician assistant,
74-22 pharmacist, or other individual designated by a practitioner, and
74-23 for whom the practitioner assumes legal responsibility, who
74-24 communicates prescription drug orders to a pharmacist;
74-25 (B) a licensed nurse, physician assistant, or
75-1 pharmacist employed in a health care facility to whom the
75-2 practitioner communicates a prescription drug order; or
75-3 (C) a registered nurse or physician assistant
75-4 authorized by a practitioner to carry out a prescription drug order
75-5 for dangerous drugs under Subdivision (5) or (6), Subsection (d),
75-6 Section 3.06, Medical Practice Act (Article 4495b, Vernon's Texas
75-7 Civil Statutes).
75-8 (42) "Prescription drug order" means:
75-9 (A) an order from a practitioner or a
75-10 practitioner's designated agent to a pharmacist for a drug or
75-11 device to be dispensed; or
75-12 (B) an order pursuant to Subdivision (5) or (6),
75-13 Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
75-14 Vernon's Texas Civil Statutes).
75-15 SECTION 47. Section 1.03, Medical Practice Act (Article
75-16 4495b, Vernon's Texas Civil Statutes), is amended by adding
75-17 Subdivision (17) to read as follows:
75-18 (17) "Doctor of osteopathy" and "doctor of osteopathic
75-19 medicine" include a doctor of osteopathic medicine, doctor of
75-20 osteopathy, osteopath, osteopathic physician, and osteopathic
75-21 surgeon.
75-22 SECTION 48. Section 3, Healing Art Identification Act
75-23 (Article 4590e, Vernon's Texas Civil Statutes), is amended to read
75-24 as follows:
75-25 Sec. 3. HEALING ART IDENTIFICATIONS. Every person licensed
76-1 to practice the healing art heretofore or hereafter by either the
76-2 Texas State Board of Medical Examiners, the State Board of Dental
76-3 Examiners, the Texas Board of Chiropractic Examiners, the Texas
76-4 State Board of Examiners in Optometry, the Texas State Board of
76-5 Podiatric Medical <Chiropody> Examiners, and the State Board of
76-6 Naturopathic Examiners shall in the professional use of his name on
76-7 any sign, pamphlet, stationery, letterhead, signature, or on any
76-8 other such means of professional identification, written or
76-9 printed, designate in the manner set forth in this Act the system
76-10 of the healing art which he is by his license permitted to
76-11 practice. The following are the legally required identifications,
76-12 one of which must be used by practitioners of the healing art:
76-13 (1) If licensed by the Texas State Board of Medical
76-14 Examiners on the basis of the degree Doctor of Medicine: physician
76-15 and/or surgeon, M.D.; doctor, M.D.; doctor of medicine, M.D.
76-16 (2) If licensed by the Texas State Board of Medical
76-17 Examiners on the basis of the degree Doctor of Osteopathy:
76-18 physician and/or surgeon, D.O.; Osteopathic physician and/or
76-19 surgeon; doctor, D.O.; doctor of osteopathy; doctor of osteopathic
76-20 medicine; osteopath; D.O.
76-21 (3) If licensed by the State Board of Dental
76-22 Examiners: dentist; doctor, D.D.S.; doctor of dental surgery;
76-23 D.D.S.; doctor of dental medicine, D.M.D.
76-24 (4) If licensed by the Texas Board of Chiropractic
76-25 Examiners: chiropractor; doctor, D.C.; doctor of Chiropractic;
77-1 D.C.
77-2 (5) If licensed by the Texas State Board of Examiners
77-3 in Optometry: optometrist; doctor, optometrist; doctor of
77-4 optometry; O.D.
77-5 (6) If a practitioner of the healing art is licensed
77-6 by the Texas State Board of Podiatric Medical <Podiatry> Examiners,
77-7 he shall use one of the following identifications: chiropodist;
77-8 doctor, D.S.C.; Doctor of Surgical Chiropody; D.S.C.; podiatrist;
77-9 doctor, D.P.M.; Doctor of Podiatric Medicine; D.P.M.
77-10 (7) If licensed by the State Board of Naturopathic
77-11 Examiners: naturopathic physician; physician, N.D.; doctor of
77-12 naturopathy; N.D.; doctor, N.D.
77-13 SECTION 49. Subdivision (5), Subsection (d), Section 3.06,
77-14 Medical Practice Act (Article 4495b, Vernon's Texas Civil
77-15 Statutes), is amended to read as follows:
77-16 (5)(A) At a site serving a medically underserved
77-17 population, a physician licensed by the board shall be authorized
77-18 to delegate to a registered nurse or physician assistant acting
77-19 under adequate physician supervision, the act or acts of
77-20 administering, providing, or carrying out or signing a prescription
77-21 drug order as authorized by the physician through physician's
77-22 orders, standing medical orders, standing delegation orders, or
77-23 other orders or protocols as defined by the board.
77-24 (B)(i) The carrying out or signing of
77-25 prescription drug orders under this subsection shall comply with
78-1 other applicable laws.
78-2 (ii) The authority of a physician to
78-3 delegate the carrying out or signing of prescription drug orders is
78-4 limited to dangerous drugs.
78-5 (C) Protocols and other orders shall be defined
78-6 to promote the exercise of professional judgment by the advanced
78-7 nurse practitioner and physician assistant commensurate with their
78-8 education and experience. Under this subdivision, protocols and
78-9 other orders used by a reasonable and prudent physician exercising
78-10 sound medical judgment:
78-11 (i) need not describe the exact steps that
78-12 an advanced nurse practitioner or a physician assistant must take
78-13 with respect to each specific condition, disease, or symptom; and
78-14 (ii) may state the types or categories of
78-15 medications that may be prescribed or in terms of categories or
78-16 types of medications that may not be prescribed.
78-17 (D) Physician supervision shall be adequate if a
78-18 delegating physician:
78-19 (i) is responsible for the formulation or
78-20 approval of such physician's orders, standing medical orders,
78-21 standing delegation orders, or other orders or protocols and
78-22 periodically reviews such orders and the services provided patients
78-23 under such orders;
78-24 (ii) is on site at least once a week to
78-25 provide medical direction and consultation;
79-1 (iii) receives a daily status report from
79-2 the registered nurse or physician assistant on any problems or
79-3 complications encountered; and
79-4 (iv) is available through direct
79-5 telecommunication for consultation, assistance with medical
79-6 emergencies, or patient referral.
79-7 (E) <(D)> In this subsection:
79-8 (i) "Registered nurse" means a registered
79-9 nurse recognized by the Board of Nurse Examiners as having the
79-10 specialized education and training required under Section 6 <7>,
79-11 Article 4514, Revised Statutes.
79-12 (ii) "Physician assistant" has the meaning
79-13 assigned to that term by Section 2(3), Physician Assistant
79-14 Licensing Act (Article 4495b-1, Vernon's Texas Civil Statutes)<,
79-15 and its subsequent amendments>.
79-16 (iii) "Carrying out or signing a
79-17 prescription drug order" means the completion of <to complete> a
79-18 prescription drug order presigned by the delegating physician, or
79-19 the signing of a prescription by a registered nurse or physician
79-20 assistant after the person has been designated with the board by
79-21 the delegating physician as a person delegated to sign a
79-22 prescription. The following information shall be provided on each
79-23 prescription <by providing the following information>: the
79-24 patient's name and address; the drug to be dispensed; directions to
79-25 the patient in regard to the taking and dosage; the intended use of
80-1 the drug, if appropriate; the name, address, and telephone number
80-2 of the physician; the name, address, telephone and identification
80-3 number of the registered nurse or physician assistant completing or
80-4 signing the prescription drug order; the date; and the number of
80-5 refills permitted. The board may adopt additional methods to carry
80-6 into effect or put into force a physician's prescription or
80-7 delegation of the signing of a prescription under physician's
80-8 orders, standing medical orders, standing delegation orders, or
80-9 other orders or protocols.
80-10 (iv) "A site serving a medically
80-11 underserved population" means:
80-12 (a) a site located in a
80-13 medically underserved area;
80-14 (b) a site located in a
80-15 health manpower shortage area;
80-16 (c) a clinic designated as
80-17 a rural health clinic under the Rural Health Clinic Services Act of
80-18 1977 (Pub. L. No. 95-210);
80-19 (d) a public health clinic
80-20 or a family planning clinic under contract with the Texas
80-21 Department of Human Services or the Texas Department of Health;
80-22 (e) a site located in an
80-23 area in which the Texas Department of Health determines there
80-24 exists an insufficient number of physicians providing services to
80-25 eligible clients of federal, state, or locally funded health care
81-1 programs; or
81-2 (f) a site that the Texas
81-3 Department of Health determines serves a disproportionate number of
81-4 clients eligible to participate in federal, state, or locally
81-5 funded health care programs.
81-6 (v) "Health manpower shortage area" means
81-7 (1) an area in an urban or rural area of Texas (which need not
81-8 conform to the geographic boundaries of a political subdivision and
81-9 which is a rational area for the delivery of health services) which
81-10 the secretary of health and human services determines has a health
81-11 manpower shortage and which is not reasonably accessible to an
81-12 adequately served area; (2) a population group which the secretary
81-13 determines to have such a shortage; or (3) a public or nonprofit
81-14 private medical facility or other facility which the secretary
81-15 determines has such a shortage as delineated in 42 U.S.C. Section
81-16 254(e)(a)(1).
81-17 (vi) "Medically underserved area" means an
81-18 area in Texas with a medically underserved population or an urban
81-19 or rural area designated by the secretary of health and human
81-20 services as an area in Texas with a shortage of personal health
81-21 services or a population group designated by the secretary as
81-22 having a shortage of such services (as defined in 42 U.S.C. Section
81-23 300(e)-1(7)). The term also includes an area defined by rule
81-24 adopted by the Texas Board of Health that is based on demographics
81-25 specific to this state, geographic factors that affect access to
82-1 health care, and environmental health factors.
82-2 (F) <(E)> After making a determination under
82-3 <either> Subdivision (D)(iv)(e), <or> (D)(iv)(f), or (D)(vi) that a
82-4 site serves a medically underserved population, the Texas
82-5 Department of Health shall publish notice of its determination in
82-6 the Texas Register and provide an opportunity for public comment in
82-7 the same manner as for a proposed rule under Chapter 2001,
82-8 Government Code <the Administrative Procedure and Texas Register
82-9 Act (Article 6252-13a, Vernon's Texas Civil Statutes)>.
82-10 (G) <(F)> The authority granted to a physician
82-11 to delegate under this subdivision shall not be construed as
82-12 limiting the authority of a physician to delegate under any other
82-13 subdivision of this subsection.
82-14 (H) <(G)> An advertisement for a site serving a
82-15 medically underserved population shall include the name and
82-16 business address of the supervising physician for the site.
82-17 SECTION 50. Subsection (d), Section 3.06, Medical Practice
82-18 Act (Article 4495b, Vernon's Texas Civil Statutes), is amended by
82-19 adding Subdivision (6) to read as follows:
82-20 (6)(A) At a physician's primary practice site or a
82-21 location as described by Paragraph (H) of this subdivision, a
82-22 physician licensed by the board may delegate to a physician
82-23 assistant or an advanced nurse practitioner acting under adequate
82-24 physician supervision the act or acts of administering, providing,
82-25 carrying out or signing a prescription drug order as authorized
83-1 through physician's orders, standing medical orders, standing
83-2 delegation orders, or other orders or protocols as defined by the
83-3 board. Providing and carrying out or signing a prescription drug
83-4 order under this subdivision is limited to dangerous drugs.
83-5 (B) Protocols and other orders shall be defined
83-6 to promote the exercise of professional judgment by the advanced
83-7 nurse practitioner and physician assistant commensurate with their
83-8 education and experience. Under this subdivision, protocols and
83-9 other orders used by a reasonable and prudent physician exercising
83-10 sound medical judgment:
83-11 (i) need not describe the exact steps that
83-12 an advanced nurse practitioner or a physician assistant must take
83-13 with respect to each specific condition, disease, or symptom; and
83-14 (ii) may state the types or categories of
83-15 medications that may be prescribed or state in terms of categories
83-16 or types of medications that may not be prescribed.
83-17 (C) Physician supervision of the carrying out
83-18 and signing of prescription drug orders shall conform to what a
83-19 reasonable, prudent physician would find consistent with sound
83-20 medical judgment but may vary with the education and experience of
83-21 the advanced nurse practitioner or physician assistant. A
83-22 physician shall provide continuous supervision, but the constant
83-23 physical presence of the physician is not required.
83-24 (D) An alternate physician may provide
83-25 appropriate supervision on a temporary basis as defined and
84-1 established by the board by rule.
84-2 (E) The carrying out or signing of prescription
84-3 drug orders under this subdivision shall comply with other
84-4 applicable laws.
84-5 (F) A physician's authority to delegate the
84-6 carrying out or signing of a prescription drug order at his primary
84-7 practice site under this subdivision is limited to:
84-8 (i) three physician assistants or advanced
84-9 nurse practitioners or their full-time equivalents practicing at
84-10 the physician's primary practice site; and
84-11 (ii) the patients with whom the physician
84-12 has established or will establish a physician-patient relationship,
84-13 but this shall not be construed as requiring the physician to see
84-14 the patient within a specific period of time.
84-15 (G) In this subdivision:
84-16 (i) "Advanced nurse practitioner" has the
84-17 meaning assigned to that term by Section 8, Article 4514, Revised
84-18 Statutes.
84-19 (ii) "Physician assistant" has the meaning
84-20 assigned to that term by Section 2(3), Physician Assistant
84-21 Licensing Act (Article 4495b-1, Vernon's Texas Civil Statutes).
84-22 (iii) "Primary practice site" means:
84-23 (a) the practice location
84-24 where the physician spends the majority of the physician's time;
84-25 (b) a licensed hospital, a
85-1 licensed long-term care facility, and a licensed adult care center
85-2 where both the physician and the physician assistant or advanced
85-3 nurse practitioner are authorized to practice, or an established
85-4 patient's residence; or
85-5 (c) where the physician is
85-6 physically present with the physician assistant or advanced nurse
85-7 practitioner.
85-8 (iv) "Carrying out or signing a
85-9 prescription drug order" means the completion of a prescription
85-10 drug order presigned by a delegating physician or the signing of a
85-11 prescription by a physician assistant or advanced nurse
85-12 practitioner after the person has been designated with the board by
85-13 the delegating physician as a person delegated to sign a
85-14 prescription. The following information shall be provided on each
85-15 prescription: the patient's name and address; the drug to be
85-16 dispensed; directions to the patient in regard to the taking and
85-17 dosage; the intended use of the drug, if appropriate; the name,
85-18 address, and telephone number of the physician; the name, address,
85-19 and telephone and identification number of the physician assistant
85-20 or advanced nurse practitioner completing or signing the
85-21 prescription drug order; the date; and the number of refills
85-22 permitted. The board may adopt additional methods to carry into
85-23 effect or put into force a physician's prescription or delegation
85-24 of the signing of a prescription under physician's orders, standing
85-25 medical orders, standing delegation orders, or other orders or
86-1 protocols.
86-2 (H) A physician licensed by the board shall be
86-3 authorized to delegate, to one or more physician assistants or
86-4 advanced nurse practitioners acting under adequate physician
86-5 supervision whose practice is facility based at a licensed hospital
86-6 or licensed long-term care facility, the carrying out or signing of
86-7 prescription drug orders if the physician is the medical director
86-8 or chief of medical staff of the facility in which the physician
86-9 assistant or advanced nurse practitioner practices, the chair of
86-10 the facility's credentialing committee, a department chair of a
86-11 facility department in which the physician assistant or advanced
86-12 nurse practitioner practices, or a physician who consents to the
86-13 request of the medical director or chief of medical staff to
86-14 delegate the carrying out or signing of prescription drug orders at
86-15 the facility in which the physician assistant or advanced nurse
86-16 practitioner practices. A physician's authority to delegate under
86-17 this paragraph is limited as follows:
86-18 (i) the delegation is pursuant to a
86-19 physician's order, standing medical order, standing delegation
86-20 order, or other order or protocol developed in accordance with
86-21 policies approved by the facility's medical staff or a committee
86-22 thereof as provided in facility bylaws;
86-23 (ii) the delegation occurs in the facility
86-24 in which the physician is the medical director, the chief of
86-25 medical staff, the chair of the credentialing committee, or a
87-1 department chair;
87-2 (iii) the delegation does not permit the
87-3 carrying out or signing of prescription drug orders for the care or
87-4 treatment of the patients of any other physician without the prior
87-5 consent of that physician;
87-6 (iv) delegation in a long-term care
87-7 facility must be by the medical director and the medical director
87-8 is limited to delegating the carrying out and signing of
87-9 prescription drug orders to no more than three advanced nurse
87-10 practitioners or physician assistants or their full-time
87-11 equivalents; and
87-12 (v) under this paragraph, a physician may
87-13 not delegate at more than one licensed hospital or more than two
87-14 long-term care facilities unless approved by the board.
87-15 (I)(i) In a licensed hospital or ambulatory
87-16 surgical center a physician may delegate to a certified registered
87-17 nurse anesthetist the ordering of drugs and devices necessary for a
87-18 certified registered nurse anesthetist to administer an anesthetic
87-19 or an anesthesia-related service ordered by the physician. The
87-20 physician's order for anesthesia or anesthesia-related services
87-21 does not have to be drug-specific, dose-specific, or
87-22 administration-technique-specific. Pursuant to the order and in
87-23 accordance with facility policies or medical staff bylaws, the
87-24 nurse anesthetist may select, obtain, and administer those drugs
87-25 and apply the appropriate medical devices necessary to accomplish
88-1 the order and maintain the patient within a sound physiological
88-2 status.
88-3 (ii) This paragraph shall be liberally
88-4 construed to permit the full use of safe and effective medication
88-5 orders to utilize the skills and services of certified registered
88-6 nurse anesthetists.
88-7 (J)(i) A physician may delegate to a physician
88-8 assistant offering obstetrical services and certified by the board
88-9 as specializing in obstetrics or an advanced nurse practitioner
88-10 recognized by the Texas State Board of Nurse Examiners as a nurse
88-11 midwife the act or acts of administering or providing controlled
88-12 substances to the nurse midwife's or physician assistant's clients
88-13 during intra-partum and immediate post-partum care. The physician
88-14 shall not delegate the use or issuance of a triplicate prescription
88-15 form under the triplicate prescription program, Section 481.075,
88-16 Health and Safety Code.
88-17 (ii) The delegation of authority to
88-18 administer or provide controlled substances under this paragraph
88-19 must be under a physician's order, medical order, standing
88-20 delegation order, or protocol which shall require adequate and
88-21 documented availability for access to medical care.
88-22 (iii) The physicians' orders, medical
88-23 orders, standing delegation orders, or protocols shall provide for
88-24 reporting or monitoring of clients' progress including
88-25 complications of pregnancy and delivery and the administration and
89-1 provision of controlled substances by the nurse midwife or
89-2 physician assistant to the clients of the nurse midwife or
89-3 physician assistant.
89-4 (iv) The authority of a physician to
89-5 delegate under this paragraph is limited to:
89-6 (a) three nurse midwives or
89-7 physician assistants or their full-time equivalents; and
89-8 (b) the designated facility
89-9 at which the nurse midwife or physician assistant provides care.
89-10 (v) The administering or providing of
89-11 controlled substances under this paragraph shall comply with other
89-12 applicable laws.
89-13 (vi) In this paragraph, "provide" means to
89-14 supply one or more unit doses of a controlled substance for the
89-15 immediate needs of a patient not to exceed 48 hours.
89-16 (vii) The controlled substance shall be
89-17 supplied in a suitable container that has been labeled in
89-18 compliance with the applicable drug laws and shall include the
89-19 patient's name and address; the drug to be provided; the name,
89-20 address, and telephone number of the physician; the name, address,
89-21 and telephone number of the nurse midwife or physician assistant;
89-22 and the date.
89-23 (viii) This paragraph does not permit the
89-24 physician or nurse midwife or physician assistant to operate a
89-25 retail pharmacy as defined under the Texas Pharmacy Act (Article
90-1 4542a-1, Vernon's Texas Civil Statutes).
90-2 (ix) This paragraph shall be construed to
90-3 provide a physician the authority to delegate the act or acts of
90-4 administering or providing controlled substances to a nurse midwife
90-5 or physician assistant but not as requiring physician delegation of
90-6 further acts to a nurse midwife or as requiring physician
90-7 delegation of the administration of medications to registered
90-8 nurses or physician assistants other than as provided in this
90-9 paragraph.
90-10 (K) A physician shall not be liable for the act
90-11 or acts of a physician assistant or advanced nurse practitioner
90-12 solely on the basis of having signed an order, a standing medical
90-13 order, a standing delegation order, or other order or protocols
90-14 authorizing a physician assistant or advanced nurse practitioner to
90-15 perform the act or acts of administering, providing, carrying out,
90-16 or signing a prescription drug order unless the physician has
90-17 reason to believe the physician assistant or advanced nurse
90-18 practitioner lacked the competency to perform the act or acts.
90-19 (L) The authority granted to a physician to
90-20 delegate under this subdivision shall not be construed as limiting
90-21 the authority of a physician to delegate under any other
90-22 subdivision of this subsection.
90-23 SECTION 51. Article 4514, Revised Statutes, is amended by
90-24 adding Section 8 to read as follows:
90-25 Sec. 8. APPROVAL OF REGISTERED NURSE FOR ADVANCED STATUS.
91-1 (a) The board shall adopt rules for approval of a registered nurse
91-2 as an advanced nurse practitioner or an advanced practice nurse.
91-3 "Advanced nurse practitioner" or "advanced practice nurse" means a
91-4 registered nurse approved by the board to practice as an advanced
91-5 practice nurse on the basis of completion of an advanced
91-6 educational program. The term includes a nurse practitioner, nurse
91-7 midwife, nurse anesthetist, and clinical nurse specialist.
91-8 (b) The board shall adopt rules for the initial approval and
91-9 biennial renewal of an advanced nurse practitioner to carry out or
91-10 sign prescription drug orders under Section 3.06(d)(5) or (6),
91-11 Medical Practice Act (Article 4495b, Vernon's Texas Civil
91-12 Statutes). The rules at a minimum shall:
91-13 (1) require completion of pharmacology and related
91-14 pathology for initial approval;
91-15 (2) require continuing education in clinical
91-16 pharmacology and related pathology in addition to any continuing
91-17 education otherwise required under Article 4518, Revised Statutes;
91-18 and
91-19 (3) provide for the issuing of a prescription
91-20 authorization number to an advanced nurse practitioner approved
91-21 under this section.
91-22 SECTION 52. Subtitle D, Title 2, Health and Safety Code, is
91-23 amending by adding Chapter 88 to read as follows:
91-24 CHAPTER 88. REPORTS OF CHILDHOOD LEAD POISONING
91-25 Sec. 88.001. DEFINITIONS. In this chapter:
92-1 (1) "Child care" includes a school, preschool,
92-2 kindergarten, nursery school, or other similar activity that
92-3 provides care or instruction for young children.
92-4 (2) "Child care facility" means a public place or a
92-5 residence in which a person furnishes child care.
92-6 (3) "Health authority" means a physician appointed as
92-7 such under Chapter 121.
92-8 (4) "Health professional" means an individual whose:
92-9 (A) vocation or profession is directly or
92-10 indirectly related to the maintenance of health in another
92-11 individual; and
92-12 (B) duties require a specified amount of formal
92-13 education and may require a special examination, certificate or
92-14 license, or membership in a regional or national association.
92-15 (5) "Lead" includes metallic lead and materials
92-16 containing metallic lead with a potential for release in sufficient
92-17 concentrations to pose a threat to public health.
92-18 (6) "Blood lead levels of concern" means the presence
92-19 of blood lead concentrations suspected to be associated with mental
92-20 and physical disorders due to absorption, ingestion, or inhalation
92-21 of lead as specified in the most recent criteria issued by the
92-22 United States Department of Health and Human Services, United
92-23 States Public Health Service, Centers for Disease Control and
92-24 Prevention of the United States Public Health Service.
92-25 (7) "Lead poisoning" means the presence of a confirmed
93-1 venous blood level established by board rule in the range specified
93-2 for medical evaluation and possible pharmacologic treatment in the
93-3 most recent criteria issued by the United States Department of
93-4 Health and Human Services, United States Public Health Service,
93-5 Centers for Disease Control and Prevention of the United States
93-6 Public Health Service.
93-7 (8) "Local health department" means a department
93-8 created under Chapter 121.
93-9 (9) "Physician" means a person licensed to practice
93-10 medicine by the Texas State Board of Medical Examiners.
93-11 (10) "Public health district" means a district created
93-12 under Chapter 121.
93-13 (11) "Regional director" means a physician appointed
93-14 by the board as the chief administrative officer of a public health
93-15 region under Chapter 121.
93-16 Sec. 88.002. CONFIDENTIALITY. (a) Except as specifically
93-17 authorized by this chapter, reports, records, and information
93-18 furnished to a health authority, a regional director, or the
93-19 department that relate to cases or suspected cases of children with
93-20 blood lead levels of concern or lead poisoning are confidential and
93-21 may be used only for the purposes of this chapter.
93-22 (b) Reports, records, and information relating to cases or
93-23 suspected cases of childhood lead poisoning and children with blood
93-24 lead levels of concern are not public information under the open
93-25 records law, Chapter 552, Government Code, and may not be released
94-1 or made public on subpoena or otherwise except as provided by this
94-2 chapter.
94-3 (c) Medical, epidemiologic, or toxicologic information may
94-4 be released:
94-5 (1) for statistical purposes if released in a manner
94-6 that prevents the identification of any person;
94-7 (2) with the consent of each person identified in the
94-8 information;
94-9 (3) to medical personnel, appropriate state agencies,
94-10 health authorities, regional directors, and public officers of
94-11 counties and municipalities as necessary to comply with this
94-12 chapter and related rules;
94-13 (4) to appropriate federal agencies, such as the
94-14 Centers for Disease Control and Prevention of the United States
94-15 Public Health Service, except that the information must be limited
94-16 to the information requested by the agency; or
94-17 (5) to medical personnel to the extent necessary in a
94-18 medical emergency to protect the health or life of the child
94-19 identified in the information.
94-20 (d) The commissioner, a regional director or other
94-21 department employee, a health authority or employee of a public
94-22 health district, a health authority or employee of a county or
94-23 municipal health department, or a public official of a county or
94-24 municipality may not be examined in a civil, criminal, special, or
94-25 other proceeding as to the existence or contents of pertinent
95-1 records of or reports or information about a child identified,
95-2 examined, or treated for lead poisoning or about a child possessing
95-3 blood lead levels of concern by the department, a public health
95-4 district, a local health department, or a health authority without
95-5 the consent of the child's parents, managing conservator, guardian,
95-6 or other person authorized by law to give consent.
95-7 Sec. 88.003. REPORTABLE HEALTH CONDITION. (a) Childhood
95-8 blood lead levels of concern are reportable.
95-9 (b) The board by rule may designate:
95-10 (1) blood lead concentrations in children that must be
95-11 reported; and
95-12 (2) the ages of children for whom the reporting
95-13 requirements apply.
95-14 (c) The board may adopt rules that establish a registry of
95-15 children with blood lead levels of concern and lead poisoning.
95-16 Sec. 88.004. PERSONS REQUIRED TO REPORT. (a) A person
95-17 required to report childhood blood lead levels of concern shall
95-18 report to the department in the manner specified by board rule.
95-19 Except as provided by this section, a person required by this
95-20 section to report must make the report immediately after the person
95-21 gains knowledge of the case or suspected case of a child with a
95-22 blood lead level of concern.
95-23 (b) A physician shall report a case or suspected case of
95-24 childhood lead poisoning or of a child with a blood lead level of
95-25 concern after the physician's first examination of a child for whom
96-1 reporting is required by board rule.
96-2 (c) A person in charge of an independent clinical
96-3 laboratory, a hospital or clinic laboratory, or other facility in
96-4 which a laboratory examination of a specimen derived from the human
96-5 body yields evidence of a child with a blood lead level of concern
96-6 shall report the findings to the department as required by board
96-7 rule.
96-8 (d) If a report is not made as required by Subsection (b) or
96-9 (c), the following persons shall report a case or suspected case of
96-10 a child with lead poisoning or a blood lead level of concern and
96-11 all information known concerning the child:
96-12 (1) the administrator of a hospital licensed under
96-13 Chapter 241;
96-14 (2) a professional registered nurse;
96-15 (3) an administrator or director of a public or
96-16 private child care facility;
96-17 (4) an administrator of a home health agency;
96-18 (5) an administrator or health official of a public or
96-19 private institution of higher education;
96-20 (6) a superintendent, manager, or health official of a
96-21 public or private camp, home, or institution;
96-22 (7) a parent, managing conservator, or guardian; and
96-23 (8) a health professional.
96-24 Sec. 88.005. REPORTING PROCEDURES. (a) The board shall
96-25 prescribe the form and method of reporting under this chapter,
97-1 including a report in writing, by telephone, or by electronic data
97-2 transmission.
97-3 (b) Board rules may require the reports to contain any
97-4 information relating to a case that is necessary for the purposes
97-5 of this chapter, including:
97-6 (1) the child's name, address, age, sex, and race;
97-7 (2) the child's blood lead concentration;
97-8 (3) the procedure used to determine the child's blood
97-9 lead concentration; and
97-10 (4) the name of the attending physician.
97-11 (c) The commissioner may authorize an alternate routing of
97-12 information in particular cases if the commissioner determines that
97-13 the customary reporting procedure would cause the information to be
97-14 unduly delayed.
97-15 Sec. 88.006. REPORTS OF HOSPITALIZATION; DEATH. (a) A
97-16 physician who attends a child during the child's hospitalization
97-17 shall immediately notify the department if the physician knows or
97-18 suspects that the child has lead poisoning or a blood lead level of
97-19 concern and the physician believes the lead poisoning or blood lead
97-20 level of concern resulted from the child's exposure to a dangerous
97-21 level of lead that may be a threat to the public health.
97-22 (b) A physician who attends a child during the child's last
97-23 illness shall immediately notify the department if the physician:
97-24 (1) knows or suspects that the child died of lead
97-25 poisoning; and
98-1 (2) believes the lead poisoning resulted from the
98-2 child's exposure to a dangerous level of lead that may be a threat
98-3 to the public health.
98-4 (c) An attending physician, health authority, or regional
98-5 director, with the consent of the child's survivors, may request an
98-6 autopsy if the physician, health authority, or regional director
98-7 needs further information concerning the cause of death in order to
98-8 protect the public health. The health authority or regional
98-9 director may order the autopsy to determine the cause of death if
98-10 the child's survivors do not consent to the autopsy. The autopsy
98-11 results shall be reported to the department.
98-12 (d) A justice of the peace acting as coroner or a medical
98-13 examiner in the course of an inquest under Chapter 49, Code of
98-14 Criminal Procedure, who finds that a child's cause of death was
98-15 lead poisoning that resulted from exposure to a dangerous level of
98-16 lead that the justice of the peace or medical examiner believes may
98-17 be a threat to the public health shall immediately notify the
98-18 health authority or the regional director in the jurisdiction in
98-19 which the finding is made.
98-20 SECTION 53. Chapter 88, Health and Safety Code, as added by
98-21 this Act, takes effect January 1, 1996.
98-22 SECTION 54. Section 5, Article 4518, Revised Statutes, is
98-23 amended to read as follows:
98-24 Sec. 5. Insofar as any of the following acts require
98-25 substantial specialized judgment and skill and insofar as the
99-1 proper performance of any of the following acts is based upon
99-2 knowledge and application of the principles of biological,
99-3 physical, and social science as acquired by a completed course in
99-4 an approved school of professional nursing, "Professional Nursing"
99-5 shall be defined as the performance for compensation of any nursing
99-6 act (a) in the observation, assessment, intervention, evaluation,
99-7 rehabilitation, care and counsel and health teachings of persons
99-8 who are ill, injured or infirm or experiencing changes in normal
99-9 health processes; (b) in the maintenance of health or prevention of
99-10 illness; (c) in the administration of medications or treatments as
99-11 ordered by a licensed physician, including a podiatric physician
99-12 licensed by the Texas State Board of Podiatric Medical <Podiatry>
99-13 Examiners, or dentist; (d) in the supervision or teaching of
99-14 nursing; (e) in the administration, supervision, and evaluation of
99-15 nursing practices, policies, and procedures; <or> (f) in the
99-16 requesting, receiving, <and> signing for, <professional samples>
99-17 and distributing of prescription drug <the> samples to patients at
99-18 sites at which a registered nurse is authorized to sign
99-19 prescription drug orders <a site serving underserved populations,
99-20 as provided> by Section 3.06(d)(5) or (6), Medical Practice Act
99-21 (Article 4495b, Vernon's Texas Civil Statutes); or (g) in the
99-22 performing of acts delegated by a physician under Section
99-23 3.06(d)(5) or (6), Medical Practice Act (Article 4495b, Vernon's
99-24 Texas Civil Statutes)<, and rules implementing that section>. The
99-25 foregoing shall not be deemed to include acts of medical diagnosis
100-1 or prescription of therapeutic or corrective measures. Nothing in
100-2 this section shall be construed as prohibiting a registered nurse
100-3 recognized by the board as having the specialized education and
100-4 training required under Section 6 <7>, Article 4514, Revised
100-5 Statutes, and functioning under adequate physician supervision from
100-6 carrying out prescription drug orders or treatments under
100-7 physician's orders, standing medical orders, standing delegation
100-8 orders, or other orders or protocols.
100-9 SECTION 55. Subsection (a), Section 6, Texas Health
100-10 Maintenance Organization Act (Article 20A.06, Vernon's Texas
100-11 Insurance Code), is amended to read as follows:
100-12 (a) The powers of a health maintenance organization include,
100-13 but are not limited to, the following:
100-14 (1) the purchase, lease, construction, renovation,
100-15 operation, or maintenance of hospitals, medical facilities, or
100-16 both, and ancillary equipment and such property as may reasonably
100-17 be required for its principal office or for such other purposes as
100-18 may be necessary in the transaction of the business of the health
100-19 maintenance organization;
100-20 (2) the making of loans to a medical group, under an
100-21 independent contract with it in furtherance of its program, or
100-22 corporations under its control, for the purpose of acquiring or
100-23 constructing medical facilities and hospitals, or in the
100-24 furtherance of a program providing health care services to
100-25 enrollees;
101-1 (3) the furnishing of or arranging for medical care
101-2 services only through physicians or groups of physicians who have
101-3 independent contracts with the health maintenance organizations;
101-4 the furnishing of or arranging for the delivery of health care
101-5 services only through providers or groups of providers who are
101-6 under contract with or employed by the health maintenance
101-7 organization or through physicians or providers who have contracted
101-8 for health care services with those physicians or providers, except
101-9 for the furnishing of or authorization for emergency services,
101-10 services by referral, and services to be provided outside of the
101-11 service area as approved by the commissioner; provided, however,
101-12 that a health maintenance organization is not authorized to employ
101-13 or contract with physicians or providers in any manner which is
101-14 prohibited by any licensing law of this state under which such
101-15 physicians or providers are licensed; however, if a hospital,
101-16 facility, agency, or supplier is certified by the Medicare program,
101-17 Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et
101-18 seq.), or accredited by the Joint Commission on Accreditation of
101-19 Healthcare Organizations or another national accrediting body, the
101-20 health maintenance organization shall be required to accept such
101-21 certification or accreditation;
101-22 (4) the contracting with any person for the
101-23 performance on its behalf of certain functions such as marketing,
101-24 enrollment, and administration;
101-25 (5) the contracting with an insurance company licensed
102-1 in this state, or with a group hospital service corporation
102-2 authorized to do business in the state, for the provision of
102-3 insurance, reinsurance, indemnity, or reimbursement against the
102-4 cost of health care and medical care services provided by the
102-5 health maintenance organization;
102-6 (6) the offering of:
102-7 (A) indemnity benefits covering out-of-area
102-8 emergency services; and
102-9 (B) indemnity benefits in addition to those
102-10 relating to out-of-area and emergency services, provided through
102-11 insurers or group hospital service corporations;
102-12 (7) receiving and accepting from government or private
102-13 agencies payments covering all or part of the cost of the services
102-14 provided or arranged for by the organization;
102-15 (8) all powers given to corporations (including
102-16 professional corporations and associations), partnerships, and
102-17 associations pursuant to their organizational documents which are
102-18 not in conflict with provisions of this Act, or other applicable
102-19 law.
102-20 SECTION 56. Subsection (g), Section 14, Texas Health
102-21 Maintenance Organization Act (Article 20A.14, Vernon's Texas
102-22 Insurance Code), is amended to read as follows:
102-23 (g) No type of provider licensed or otherwise authorized to
102-24 practice in this state may be denied participation to provide
102-25 health care services which are delivered by the health maintenance
103-1 organization and which are within the scope of licensure or
103-2 authorization of the type of provider on the sole basis of type of
103-3 license or authorization. However, if a hospital, facility,
103-4 agency, or supplier is certified by the Medicare program, Title
103-5 XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.),
103-6 or accredited by the Joint Commission on Accreditation of
103-7 Healthcare Organizations or another national accrediting body, the
103-8 health maintenance organization shall be required to accept such
103-9 certification or accreditation. This section may not be construed
103-10 to (1) require a health maintenance organization to utilize a
103-11 particular type of provider in its operation; (2) require that a
103-12 health maintenance organization accept each provider of a category
103-13 or type; or (3) require that health maintenance organizations
103-14 contract directly with such providers. Notwithstanding any other
103-15 provision nothing herein shall be construed to limit the health
103-16 maintenance organization's authority to set the terms and
103-17 conditions under which health care services will be rendered by
103-18 providers. All providers must comply with the terms and conditions
103-19 established by the health maintenance organization for the
103-20 provision of health services and for designation as a provider.
103-21 SECTION 57. Section 32.027, Human Resources Code, is amended
103-22 by adding Subsection (i) to read as follows:
103-23 (i) In its establishment of provider criteria for hospitals,
103-24 home health providers, or hospice providers, the department shall
103-25 accept licensure by the Texas Department of Health or certification
104-1 by the Medicare program, Title XVIII of the Social Security Act (42
104-2 U.S.C. Section 1395 et seq.).
104-3 SECTION 58. Subsection (f), Section 3.06, Medical Practice
104-4 Act (Article 4495b, Vernon's Texas Civil Statutes), is amended to
104-5 read as follows:
104-6 (f) Nothing in this Act shall be construed to prohibit a
104-7 <county or municipal corporation or a> hospital <district or
104-8 authority> from entering into an independent contractor agreement
104-9 <contracting> with a physician to provide services at the <a>
104-10 hospital or at other health care facilities owned or <and> operated
104-11 by the <county or municipal corporation or the> hospital <district
104-12 or authority,> from paying the physician a minimum guarantee to
104-13 assure the physician's availability, from billing and collecting
104-14 the physician's professional fees from patients, or from retaining
104-15 the collected professional fees up to the amount of the minimum
104-16 guarantee plus a reasonable collection fee. <This subsection
104-17 applies only to a county or municipal corporation or a hospital
104-18 district or authority which owns and operates a hospital on or
104-19 after the effective date of this subsection or to an entity to
104-20 which a county or municipal corporation or a hospital district or
104-21 authority, to which this subsection applies, leases its hospital on
104-22 or after the effective date of this subsection.>
104-23 SECTION 59. Subsections (g) and (h), Section 3.06, Medical
104-24 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), are
104-25 repealed.
105-1 SECTION 60. Subsection (b), Article 4567, Revised Statutes,
105-2 is amended by amending Subdivision (1) and adding Subdivisions (3)
105-3 and (4) to read as follows:
105-4 (1) "Board" means the Texas State Board of Podiatric
105-5 Medical <Podiatry> Examiners.
105-6 (3) "Podiatrist" means a person licensed under this
105-7 chapter to practice podiatry as described by Subsection (a) of this
105-8 article.
105-9 (4) "Podiatry" means the practice described by
105-10 Subsection (a) of this article and Article 4567b, Revised Statutes,
105-11 and includes podiatric medicine.
105-12 SECTION 61. Article 4567b, Revised Statutes, is amended to
105-13 read as follows:
105-14 Art. 4567b. Practice of podiatry; penalty. Any person shall
105-15 be regarded as practicing podiatry within the meaning of this law,
105-16 and shall be deemed and construed to be a podiatrist, who shall
105-17 treat or offer to treat any disease or disorder, physical injury or
105-18 deformity, or ailment of the human foot by any system or method and
105-19 charge therefore, directly or indirectly, money or other
105-20 compensation, or who shall publicly profess or claim to be a
105-21 chiropodist, podiatrist, podiatric physician, foot specialist,
105-22 doctor or use any title, degree, letter, syllable, word or words
105-23 that would tend to lead the public to believe such person was a
105-24 practitioner authorized to practice or assume the duties incident
105-25 to the practice of podiatry. Whoever professes to be a podiatrist,
106-1 practices or assumes the duties incident to the practice of
106-2 podiatry within the meaning of this law or Article, without first
106-3 obtaining from the Texas State Board of Podiatric Medical
106-4 <Podiatry> Examiners a license authorizing such person to practice
106-5 podiatry, shall be punished by a fine of not less than Fifty
106-6 Dollars ($50), nor more than Five Hundred Dollars ($500), or by
106-7 imprisonment in the county jail of not less than thirty (30) days,
106-8 nor more than six (6) months, or by both fine and imprisonment.
106-9 SECTION 62. Subsections (a), (g), (h), and (j), Article
106-10 4568, Revised Statutes, are amended to read as follows:
106-11 (a) The Texas State Board of Podiatric Medical <Podiatry>
106-12 Examiners shall consist of nine (9) members. Six (6) members must
106-13 be reputable practicing podiatrists who have resided in this state
106-14 and who have been actively engaged in the practice of podiatry for
106-15 five (5) years immediately preceding their appointment. Three (3)
106-16 members must be representatives of the general public. However, a
106-17 public member may not participate in any part of the examination
106-18 process for applicants for a license issued by the Board that
106-19 requires knowledge of the practice of podiatry. Appointments to
106-20 the Board shall be made by the Governor without regard to the race,
106-21 color, disability, sex, religion, or national origin of the
106-22 appointees.
106-23 (g) The term of office of each member of said Board shall be
106-24 six (6) years. At the expiration of the term of each member, his
106-25 successor shall be appointed by the Governor of this State and he
107-1 shall serve for a term of six (6) years, or until his successor
107-2 shall be appointed and qualified. The members of the Texas State
107-3 Board of Podiatric Medical <Podiatry> Examiners shall, before
107-4 entering upon the duties of their offices, qualify, by subscribing
107-5 to, before a notary public or other officer authorized by law to
107-6 administer oaths, and filing with the Secretary of State, the
107-7 constitutional oath of office. They shall, biennially thereafter
107-8 at the first regular scheduled meeting <in the month of January>,
107-9 elect from their number a president, vice-president, and secretary
107-10 <secretary-treasurer>. <The secretary-treasurer, before entering
107-11 upon his duties, shall file a bond with the Secretary of State for
107-12 such sum as will be twice the amount of cash on hand at the time
107-13 the bond is filed; provided, however, that the amount of said bond
107-14 shall, in no case, be less than Five Thousand Dollars ($5,000).
107-15 Said bond shall be payable to the Governor of this State, for the
107-16 benefit of said Board; shall be conditioned upon the faithful
107-17 performance of the duties of such officer; and shall be in such
107-18 form as may be approved by the Attorney General of this State; and
107-19 shall be executed by a surety company, as surety, and be approved
107-20 by the Texas State Board of Podiatry Examiners.>
107-21 (h) Said Texas State Board of Podiatric Medical <Podiatry>
107-22 Examiners shall hold meetings at least twice a year and special
107-23 meetings when necessary at such times and places as the Board deems
107-24 most convenient for applicants for examinations for license.
107-25 Special meetings shall be held upon request of a majority of the
108-1 members of the Board, or upon the call of the president. Five (5)
108-2 members of the Board shall constitute a quorum for the transaction
108-3 of business and should a quorum not be present on the day appointed
108-4 for any meeting, those present may adjourn from day to day until a
108-5 quorum be present.
108-6 (j) The Board shall adopt all reasonable or necessary rules,
108-7 regulations, and bylaws, not inconsistent with the law regulating
108-8 the practice of podiatry, the laws of this State, or of the United
108-9 States, to govern its proceedings and activities, the regulation of
108-10 the practice of podiatry and the enforcement of the law regulating
108-11 the practice of podiatry. If the appropriate standing committees
108-12 of both houses of the legislature acting under Section 2001.032,
108-13 Government Code <5(g), Administrative Procedure and Texas Register
108-14 Act, as amended (Article 6252-13a, Vernon's Texas Civil Statutes)>,
108-15 transmit to the Board statements opposing adoption of a rule under
108-16 that subsection, the rule may not take effect or, if the rule has
108-17 already taken effect, the rule is repealed effective on the date
108-18 the Board receives the committees' statements. The Board shall
108-19 have power to appoint committees from its own membership, the
108-20 duties of which shall be to consider such matters pertaining to the
108-21 enforcement of the law regulating the practice of podiatry and the
108-22 regulations promulgated in accordance therewith as shall be
108-23 referred to said committees, and to make recommendations to the
108-24 Board with respect thereto. The Board may contract with the Texas
108-25 State Board of Medical Examiners or any other appropriate state
109-1 agency for the provision of some or all of the services necessary
109-2 to carry out the activities of the Board. The Board may request
109-3 and, if necessary, <any committee, or any members thereof shall
109-4 have the power to issue subpoenas and to> compel by subpoena the
109-5 attendance of witnesses or examination under oath and the
109-6 production of books, accounts, records, papers, correspondence,
109-7 <and> documents, and other evidence relevant to the investigation
109-8 of an alleged violation of this chapter. If a person fails to
109-9 comply with a subpoena issued under this subsection, the Board,
109-10 through the attorney general, may file suit to enforce the subpoena
109-11 in a district court in Travis County or in a county in which a
109-12 hearing conducted by the Board may be held. If the court
109-13 determines that good cause existed for the issuance of the
109-14 subpoena, the court shall order compliance with the subpoena.
109-15 Failure to obey the order of the court is punishable by the court
109-16 as contempt <to administer oaths and to take testimony concerning
109-17 all matters within its or his jurisdiction>. The Board shall not
109-18 be bound by the strict rules of procedure or by the laws of
109-19 evidence in the conduct of its proceedings, but the determination
109-20 shall be founded upon sufficient legal evidence to sustain it. The
109-21 Board shall have the right to institute an action in its own name
109-22 to enjoin the violation of any of the provisions of the law
109-23 regulating the practice of podiatry or the regulations promulgated
109-24 in accordance therewith, and in such connection a temporary
109-25 injunction may be granted. Said action for an injunction shall be
110-1 in addition to any other action, proceeding or remedy authorized by
110-2 law. The Board shall keep a correct record of all the proceedings
110-3 of the Board, and of all moneys received or expended by the Board,
110-4 which record shall be open to public inspection at all reasonable
110-5 times. The records shall include a record of proceedings relating
110-6 to examination of applicants, and the issuance, renewal, or refusal
110-7 of certificates of registration; and they shall also contain the
110-8 name, age, known place of residence, the name and location of the
110-9 college of podiatric medicine <school of podiatry> from which he
110-10 holds credentials and the time devoted to the study and practice of
110-11 the same, together with such other information as the Board may
110-12 desire to record. Said record shall also show whether applicants
110-13 were rejected or licensed and shall be prima facie evidence of all
110-14 matters therein contained. A certified copy of said record, with
110-15 the hand and seal of the custodian of records <secretary> of said
110-16 Board, shall be admitted as evidence in all courts. Every license
110-17 and annual renewal certificate issued shall be numbered and
110-18 recorded in a book kept by the Board. The records shall be kept by
110-19 the Board.
110-20 The Board shall cause the prosecution of all persons
110-21 violating any of the provisions of the law regulating the practice
110-22 of podiatry and may incur the expense reasonably necessary in that
110-23 behalf.
110-24 SECTION 63. Article 4568b, Revised Statutes, is amended to
110-25 read as follows:
111-1 Art. 4568b. SUNSET PROVISION. The Texas State Board of
111-2 Podiatric Medical <Podiatry> Examiners is subject to Chapter 325,
111-3 Government Code (Texas Sunset Act). Unless continued in existence
111-4 as provided by that chapter, the board is abolished September 1,
111-5 2005.
111-6 SECTION 64. Subsections (a), (c), (d), (f), and (i), Article
111-7 4569, Revised Statutes, are amended to read as follows:
111-8 (a) Except as provided in Article 4569a, Revised Civil
111-9 Statutes of Texas, 1925, all applicants for license to practice
111-10 podiatry in this State must successfully pass an examination
111-11 approved by the Texas State Board of Podiatric Medical <Podiatry>
111-12 Examiners.
111-13 (c) The examinations shall be written and practical <and in
111-14 the English language>, and all applicants who <that> possess the
111-15 qualifications required for an examination shall be issued a
111-16 license by the Board to practice podiatry in this state. The
111-17 passing score for the examination shall be determined by the Board
111-18 using accepted criterion-referenced methods <and who shall pass the
111-19 examinations prescribed with a general average of seventy-five per
111-20 cent (75%) in all subjects and not less than sixty per cent (60%)
111-21 in any one subject shall be issued a license by the Board to
111-22 practice podiatry in this State>. The Board shall have the
111-23 examination validated by an independent testing professional.
111-24 (d) The subjects the applicant must be examined in are
111-25 anatomy, chemistry, dermatology, diagnosis, pharmacology
112-1 <materia-medica>, pathology, physiology, microbiology, orthopedics
112-2 and podiatry, as related <limited in their scope> to ailments of
112-3 the human foot.
112-4 (f) All applicants shall pay to the <secretary-treasurer of
112-5 the> Board an examination fee at least fifteen (15) days before the
112-6 dates of the regular examinations.
112-7 (i) Not later than the 30th day after the date on which a
112-8 licensing examination is administered under this chapter, the
112-9 <secretary-treasurer of the> Board shall notify each examinee of
112-10 the results of the examination. However, if an examination is
112-11 graded or reviewed by a national testing service, the
112-12 <secretary-treasurer of the> Board shall notify examinees of the
112-13 results of the examination not later than the 14th day after the
112-14 date on which the Board receives the results from the testing
112-15 service. If the notice of examination results graded or reviewed
112-16 by a national testing service will be delayed for longer than 90
112-17 days after the examination date, the <secretary-treasurer of the>
112-18 Board shall notify the examinee of the reason for the delay before
112-19 the 90th day.
112-20 SECTION 65. Subsection (b), Article 4569a, Revised Statutes,
112-21 is amended to read as follows:
112-22 (b) In this article a course of study, training, or
112-23 education is considered approved or accredited if it is approved or
112-24 accredited by the Texas State Board of Podiatric Medical <Podiatry>
112-25 Examiners as constituting a bona fide reputable course of training,
113-1 study, or education. In making a decision relating to the approval
113-2 or accreditation of a course of study, training, or education, the
113-3 board shall consider whether the course is approved or accredited
113-4 by the Council on Podiatric Medical Education of the American
113-5 Podiatric Medical <Podiatry> Association or its successor
113-6 organization.
113-7 SECTION 66. Subsections (a), (c), (d), and (e), Article
113-8 4570, Revised Statutes, are amended to read as follows:
113-9 (a) A person desiring to practice podiatry in this state
113-10 shall make written application for a license therefor to the Texas
113-11 State Board of Podiatric Medical <Podiatry> Examiners on a form
113-12 prescribed by the Board. The information submitted shall be
113-13 verified by affidavit of the applicant.
113-14 (c) A podiatry or chiropody school may be considered
113-15 reputable, within the meaning of this Act, if the course of
113-16 instruction embraces four (4) terms of approximately eight (8)
113-17 months each, or the substantial equivalent thereof, and if the
113-18 school meets the approval of the <State> Board <of Podiatry
113-19 Examiners>. All educational attainments or credits for evaluation
113-20 within the meaning of this Act, or applicable under this law, shall
113-21 have been completed within the geographical boundaries of the
113-22 United States, and no educational credits attained in any foreign
113-23 country that are not acceptable to The University of Texas toward a
113-24 Bachelor's Degree, shall be acceptable to the <State> Board <of
113-25 Podiatry Examiners>.
114-1 (d) The <State> Board <of Podiatry Examiners> may refuse to
114-2 admit persons to its examinations, and to issue a license to
114-3 practice podiatry to any person, for any of the following reasons:
114-4 (1) The presentation to the Board of any license,
114-5 certificate, or diploma, which was illegally or fraudulently
114-6 obtained, or when fraud or deception has been practiced in passing
114-7 the examination;<.>
114-8 (2) Conviction of a crime of the grade of a felony or
114-9 any crime which involves moral turpitude, or conviction of a
114-10 violation of Article 4567c, Revised Civil Statutes of Texas, 1925,
114-11 as amended;<.>
114-12 (3) Habits of intemperance, or drug addiction,
114-13 calculated, in the opinion of the Board, to endanger the health,
114-14 well-being, or welfare of patients;<.>
114-15 (4) Grossly unprofessional or dishonorable conduct, of
114-16 a character which in the opinion of the Board is likely to deceive
114-17 or defraud the public;<.>
114-18 (5) The violation, or attempted violation, direct or
114-19 indirect, of any of the provisions of this Act (Title 71, Chapter
114-20 11, Revised Civil Statutes of Texas, 1925, as amended), or any rule
114-21 adopted under this Act, either as a principal, accessory, or
114-22 accomplice;<.>
114-23 (6) The use of any advertising statement of a
114-24 character tending to mislead or deceive the public;<.>
114-25 (7) Advertising professional superiority, or the
115-1 performance of professional service in a superior manner;<.>
115-2 (8) The purchase, sale, barter, or use, or any offer
115-3 to purchase, sell, barter, or use, any podiatry degree, license,
115-4 certificate, diploma, or transcript of license, certificate, or
115-5 diploma, in or incident to an application to the Board <of Podiatry
115-6 Examiners> for a license to practice podiatry;<.>
115-7 (9) Altering, with fraudulent intent, any podiatry
115-8 license, certificate, diploma, or transcript of a podiatry license,
115-9 certificate, or diploma;<.>
115-10 (10) The use of any podiatry license, certificate,
115-11 diploma, or transcript of any such podiatry license, certificate,
115-12 or diploma, which has been fraudulently purchased, issued,
115-13 counterfeited, or materially altered;<.>
115-14 (11) The impersonation of, or acting as proxy for,
115-15 another in any examination required by this Act for a podiatry
115-16 license;<.>
115-17 (12) The impersonation of a licensed practitioner, or
115-18 permitting, or allowing, another to use his license, or certificate
115-19 to practice podiatry in this State, for the purpose of treating, or
115-20 offering to treat, conditions and ailments of the feet of human
115-21 beings by any method;<.>
115-22 (13) Employing, directly or indirectly, any person
115-23 whose license to practice podiatry has been suspended, or
115-24 association in the practice of podiatry with any person or persons
115-25 whose license to practice podiatry has been suspended, or any
116-1 person who has been convicted of the unlawful practice of podiatry
116-2 in Texas or elsewhere;<.>
116-3 (14) The wilful making of any material
116-4 misrepresentation or material untrue statement in the application
116-5 for a license to practice podiatry;<.>
116-6 (15) The inability to practice podiatry with
116-7 reasonable skill and safety to patients by reason of age, illness,
116-8 drunkenness, excessive use of drugs, narcotics, chemicals or any
116-9 other type of material or as a result of any mental or physical
116-10 condition. In enforcing this subsection the Board shall, upon
116-11 probable cause, request a podiatrist to submit to a mental or
116-12 physical examination by medical doctors designated by it. If the
116-13 podiatrist refuses to submit to the examination, the Board shall
116-14 issue an order requiring the podiatrist to show cause why he will
116-15 not submit to the examination and shall schedule a hearing on the
116-16 order within 30 days after notice is served on the podiatrist. The
116-17 podiatrist shall be notified by either personal service or by
116-18 certified mail with return receipt requested. At the hearing, the
116-19 podiatrist and his attorney are entitled to present any testimony
116-20 and other evidence to show why the podiatrist should not be
116-21 required to submit to the examination. After a complete hearing,
116-22 the Board shall issue an order either requiring the podiatrist to
116-23 submit to the examination or withdrawing the request for
116-24 examination;<.>
116-25 (16) The failure to practice podiatry in an acceptable
117-1 manner consistent with public health and welfare;<.>
117-2 (17) Being removed, suspended, or disciplined in
117-3 another manner by the podiatrist's peers in any professional
117-4 podiatry association or society, whether the association or society
117-5 is local, regional, state, or national in scope or being
117-6 disciplined by a licensed hospital or the medical staff of a
117-7 hospital, including removal, suspension, limitation of hospital
117-8 privileges, or other disciplinary action, if any of these actions
117-9 in the opinion of the Board were based on unprofessional conduct or
117-10 professional incompetence that was likely to harm the public,
117-11 provided that the Board finds that the action taken was appropriate
117-12 and reasonably supported by evidence submitted to the association,
117-13 society, hospital, or medical staff; and<.>
117-14 (18) Repeated or recurring meritorious health care
117-15 liability claims against the podiatrist that in the opinion of the
117-16 Board are evidence of professional incompetence likely to injure
117-17 the public.
117-18 (e) Any applicant who is refused admittance to examination
117-19 has the right to try the issue in the District Court of Travis
117-20 County <the county in which he resides or in which any Board member
117-21 resides>.
117-22 SECTION 67. Subsections (a) and (b), Section 1, Article
117-23 4571, Revised Statutes, are amended to read as follows:
117-24 (a) The Texas State Board of Podiatric Medical <Podiatry>
117-25 Examiners shall set and may from time to time change the amount of
118-1 the annual license renewal fee as in the Board's judgment may be
118-2 needed to provide for the reasonable costs and expenses of the
118-3 Board in performing its duties and the administration of the law
118-4 regulating the practice of podiatry. The annual license renewal
118-5 fee shall be paid to the Board.
118-6 (b) The Texas State Board of Podiatric Medical <Podiatry>
118-7 Examiners on or before October <August> first of each year shall
118-8 notify, by mail, all Texas licensed podiatrists at their last known
118-9 address that the annual license renewal fee is due on the following
118-10 November <September> first.
118-11 SECTION 68. Sections 4 and 5, Article 4571, Revised
118-12 Statutes, are amended to read as follows:
118-13 Sec. 4. Reissuance of Lost or Amended License. If any
118-14 license issued by the Board is lost, destroyed or stolen from the
118-15 legally qualified and authorized person to whom it was issued, the
118-16 owner of the license shall report the fact to <the
118-17 Secretary-Treasurer of> the Board, in an affidavit form. The
118-18 affidavit shall set forth detailed information as to the loss,
118-19 destruction or theft, giving dates, place and circumstances. If
118-20 the owner of a license desires to have an amended license issued to
118-21 him because of a lawful change in the name or degree designation of
118-22 the licensee or for any other lawful and sufficient reason, the
118-23 owner of the license shall make application for such amended
118-24 license to <the Secretary-Treasurer of> the Board setting forth the
118-25 reasons the issuance of an amended license is requested. A
119-1 duplicate or amended license shall be issued upon regular
119-2 application of the owner of the original license and payment of a
119-3 fee set by the Board for the duplicate or amended license; however,
119-4 the Board shall not issue a duplicate or amended license until
119-5 sufficient evidence by the owner of the original license has been
119-6 submitted to prove the license has been lost or to establish the
119-7 lawful reason an amended license should be issued, and unless the
119-8 records of the Board show a license had been issued and been in
119-9 full force and effect at the time of such loss, destruction or
119-10 theft, or such request for an amended license. If an amended
119-11 license is issued, the original license shall be returned to the
119-12 Board.
119-13 Sec. 5. DISPLAY OF LICENSE. Every person licensed by the
119-14 <State> Board <of Podiatry Examiners> to practice in the state
119-15 shall conspicuously display both his license and an annual renewal
119-16 certificate for the current year of practice in the place or office
119-17 wherein he practices and shall be required to exhibit such license
119-18 and renewal certificate to a representative of the Board upon such
119-19 representative's official request for its examination or
119-20 inspection.
119-21 SECTION 69. Subsection (a), Section 6, Article 4571, Revised
119-22 Statutes, is amended to read as follows:
119-23 (a) Any licensed podiatrist whose license has been suspended
119-24 or revoked or whose annual renewal certificate has expired while he
119-25 has been engaged in Federal service or on active duty with the Army
120-1 of the United States, the United States Navy, the United States
120-2 Marine Corps, the United States Coast Guard, or the United States
120-3 Air Force, <or the United States Maritime Service or the State
120-4 Militia,> called into service or training of the United States of
120-5 America or in training or education under the supervision of the
120-6 United States preliminary to induction into the military service,
120-7 may have his license renewed without paying any lapsed renewal fee
120-8 or without passing any examination, if, within one (1) year after
120-9 termination of said service, training or education, other than by
120-10 dishonorable discharge, he furnishes the <State> Board <of Podiatry
120-11 Examiners> an affidavit to the effect that he has been so engaged
120-12 and that his service, training or education has been so
120-13 terminated.
120-14 SECTION 70. Article 4573, Revised Statutes, as amended by
120-15 Chapter 52, Acts of the 67th Legislature, Regular Session, 1981,
120-16 and Chapter 14, Acts of the 72nd Legislature, Regular Session,
120-17 1991, is amended by amending Subsections (g) and (h) and by adding
120-18 Subsections (j), (k), (l), (m), and (n) to read as follows:
120-19 (g) At any time while the probationer remains on probation,
120-20 the Board may hold a hearing and, upon majority vote, rescind the
120-21 probation if the terms of the probation have been violated, and
120-22 enforce the Board's original action in revoking, cancelling, or
120-23 suspending the practitioner's license. The hearing to rescind the
120-24 probation shall be called by the President of the Texas State Board
120-25 of Podiatric Medical <Podiatry> Examiners, who shall cause to be
121-1 issued a notice setting a time and place for the hearing and
121-2 containing the charges or complaints against the probationer. The
121-3 notice shall be served on the probationer or his counsel, and any
121-4 person or persons complaining of the probationer or their counsel,
121-5 at least ten (10) days prior to the time set for the hearing. When
121-6 personal service is impossible, or cannot be effected, the same
121-7 provisions for service in lieu of personal service set out in
121-8 Subsection (d) of this Article shall apply. The respondent and any
121-9 person or persons complaining of the respondent have the right to
121-10 appear at the hearing either personally or by counsel, or both, to
121-11 produce witnesses or evidence, to cross-examine witnesses, and to
121-12 have subpoenas issued by the Board. The Board may also issue
121-13 subpoenas on its own motion. The subpoenas of the Board may be
121-14 enforced through any district court having jurisdiction and venue
121-15 in the county where the hearing is held. The Board shall determine
121-16 the charges upon their merits. The order revoking or rescinding
121-17 the probation is not subject to review or appeal.
121-18 (h) <(g)> This article does not apply to a person convicted
121-19 of a felony under Chapter 481, Health and Safety Code, Section
121-20 485.033, Health and Safety Code, or Chapter 483, Health and Safety
121-21 Code.
121-22 (i) <(h)> Upon application, the Board may reissue a license
121-23 to practice podiatry to a person whose license has been cancelled
121-24 or suspended, but the application, in the case of cancellation or
121-25 revocation, may not be made prior to one (1) year after the
122-1 cancellation or revocation, and shall be made in such manner and
122-2 form as the Board may require.
122-3 (j) A complaint, report, investigation file, or other
122-4 investigative information in the possession of or received or
122-5 gathered by the Board or an employee or agent of the Board that
122-6 relates to a license holder, a license application, or a criminal
122-7 investigation or proceeding is privileged, confidential, and not
122-8 subject to discovery, subpoena, or any other legal method of
122-9 compelling release.
122-10 (k) Subject to any other privilege or restriction
122-11 established by law, not later than the 30th day after the date the
122-12 Board receives a written request from a license holder, or the
122-13 license holder's attorney, who is the subject of a formal complaint
122-14 under this article, the Board shall provide the license holder with
122-15 access to all information in the Board's possession that the Board
122-16 intends to offer into evidence at the contested case hearing on the
122-17 complaint. The Board may provide access to the information to the
122-18 license holder after the 30th day after the date the Board receives
122-19 a request only on a showing of good cause. The Board is not
122-20 required under this subsection to provide access to the Board's
122-21 investigative reports or memoranda, release the identity of a
122-22 complainant who will not testify at the hearing, or release
122-23 information that is an attorney's work product or protected by the
122-24 attorney-client privilege or another privilege recognized by the
122-25 Texas Rules of Civil Procedure or Texas Rules of Civil Evidence.
123-1 The furnishing of information under this subsection does not
123-2 constitute a waiver of any privilege or confidentiality provision
123-3 under law.
123-4 (l) Investigative information in the possession of the Board
123-5 that relates to a disciplinary action regarding a license holder
123-6 may be disclosed to:
123-7 (1) a licensing agency regulating the practice of
123-8 podiatric medicine in another state, the District of Columbia, or
123-9 another country in which the license holder is also licensed or has
123-10 applied for a license; or
123-11 (2) a peer review committee reviewing an application
123-12 for privileges or the qualifications of the license holder with
123-13 regard to retaining the license holder's privileges.
123-14 (m) If information obtained by the Board in the course of an
123-15 investigation indicates that a crime may have been committed, that
123-16 information shall be reported to the appropriate law enforcement
123-17 agency. The Board shall cooperate and assist a law enforcement
123-18 agency conducting a criminal investigation of a license holder by
123-19 providing relevant information to the agency. Information provided
123-20 to a law enforcement agency by the Board is confidential and may
123-21 not be disclosed except as necessary to conduct the
123-22 investigation.
123-23 (n) The Board shall provide information to a health care
123-24 entity on the written request of the entity concerning:
123-25 (1) a complaint filed against a license holder that
124-1 was resolved after an investigation by the Board or resolved by an
124-2 agreed settlement; and
124-3 (2) the basis for and status of an active
124-4 investigation concerning a license holder.
124-5 SECTION 71. Subsections (a) and (c), Section 1, Article
124-6 4573b, Revised Statutes, are amended to read as follows:
124-7 (a) Each insurer that delivers or issues for delivery in
124-8 this state professional liability insurance coverage to a
124-9 podiatrist who practices in this state shall furnish to the Texas
124-10 State Board of Podiatric Medical <Podiatry> Examiners the
124-11 information specified in Subsection (b) of this section relating
124-12 to:
124-13 (1) a notice of claim letter or a complaint filed
124-14 against an insured in a court, if the notice of claim letter or the
124-15 complaint seeks the recovery of damages based on the insured's
124-16 conduct in providing or failing to provide medical or health-care
124-17 services; or
124-18 (2) a settlement of a claim or other legal action made
124-19 by the insurer on behalf of the insured.
124-20 (c) If a podiatrist who practices in this state is not
124-21 covered by professional liability insurance or is insured by an
124-22 insurer that is not authorized to write professional liability
124-23 insurance for podiatrists in this state, the podiatrist shall
124-24 submit information to the Texas State Board of Podiatric Medical
124-25 <Podiatry> Examiners relating to any malpractice action brought
125-1 against that podiatrist. The podiatrist shall submit the
125-2 information as required by rules adopted by that board under
125-3 Section 2 of this article.
125-4 SECTION 72. Sections 2, 3, 4, and 5, Article 4573b, Revised
125-5 Statutes, are amended to read as follows:
125-6 Sec. 2. (a) In consultation with the State Board of
125-7 Insurance, the Texas State Board of Podiatric Medical <Podiatry>
125-8 Examiners shall adopt rules for reporting the information required
125-9 under Section 1 of this article and any additional information
125-10 required by the Texas State Board of Podiatric Medical <Podiatry>
125-11 Examiners.
125-12 (b) The Texas State Board of Podiatric Medical <Podiatry>
125-13 Examiners shall consider other claim reports required under state
125-14 or federal law in determining:
125-15 (1) any additional information to be reported;
125-16 (2) the form of such a report; and
125-17 (3) reasonable reporting intervals.
125-18 (c) Additional information that may be required by the Texas
125-19 State Board of Podiatric Medical <Podiatry> Examiners includes:
125-20 (1) the date of a judgment, dismissal, or settlement
125-21 of a malpractice action;
125-22 (2) whether an appeal has been taken, and by which
125-23 party; and
125-24 (3) the amount of any judgment or settlement.
125-25 Sec. 3. Neither liability nor a cause of action for an
126-1 action taken as required under this article arises against:
126-2 (1) an insurer;
126-3 (2) an agent or employee of the insurer;
126-4 (3) a member of the Texas State Board of Podiatric
126-5 Medical <Podiatry> Examiners; or
126-6 (4) an employee or representative of the board.
126-7 Sec. 4. In the trial of an action brought against a
126-8 podiatrist based on the podiatrist's conduct in providing or
126-9 failing to provide medical or health-care services, a report or
126-10 information submitted to the Texas State Board of Podiatric Medical
126-11 <Podiatry> Examiners under this article or the fact that such a
126-12 report or information has been submitted may not be offered in
126-13 evidence or in any manner used in the trial of the action.
126-14 Sec. 5. The Texas State Board of Podiatric Medical
126-15 <Podiatry> Examiners shall review the information relating to a
126-16 podiatrist against whom three or more malpractice claims have been
126-17 reported during any five-year period as if a complaint against that
126-18 podiatrist had been made to that board under Article 4573, Revised
126-19 Statutes.
126-20 SECTION 73. Section 4, Article 4573f, Revised Statutes, is
126-21 amended to read as follows:
126-22 Sec. 4. Written or oral communications made to a podiatric
126-23 peer review committee and the records and proceedings of a peer
126-24 review committee may be disclosed to:
126-25 (1) another podiatric peer review committee;
127-1 (2) an appropriate state or federal agency;
127-2 (3) a national accreditation body; or
127-3 (4) the Texas State Board of Podiatric Medical
127-4 <Podiatry> Examiners or the state board of registration or
127-5 licensure of podiatrists in another state.
127-6 SECTION 74. Subsection (b), Section 5, Article 4573f,
127-7 Revised Statutes, is amended to read as follows:
127-8 (b) If a podiatric peer review committee takes action that
127-9 could result in censure or suspension, restriction, limitation, or
127-10 revocation of a license by the Texas State Board of Podiatric
127-11 Medical <Podiatry> Examiners or a denial of membership or
127-12 privileges in a health care entity, the affected podiatrist shall
127-13 be provided a written copy of the recommendation of the podiatric
127-14 peer review committee and a copy of the final decision, including a
127-15 statement of the basis for the decision.
127-16 SECTION 75. Subsections (a) and (c), Section 7, Article
127-17 4573f, Revised Statutes, are amended to read as follows:
127-18 (a) All persons, including the governing body and medical
127-19 staff of a health care entity, shall comply with a subpoena issued
127-20 by the Texas State Board of Podiatric Medical <Podiatry> Examiners
127-21 for documents or information.
127-22 (c) Failure to comply with a subpoena constitutes grounds
127-23 for disciplinary action against the facility or individual by the
127-24 Texas State Board of Podiatric Medical <Podiatry> Examiners.
127-25 SECTION 76. Section 8, Article 4573f, Revised Statutes, is
128-1 amended to read as follows:
128-2 Sec. 8. A person, health care entity, or podiatric peer
128-3 review committee that participates in podiatric peer review
128-4 activity or furnishes records, information, or assistance to a
128-5 podiatric peer review committee or to the Texas State Board of
128-6 Podiatric Medical <Podiatry> Examiners is immune from any civil
128-7 liability arising from those acts if the acts were made in good
128-8 faith and without malice.
128-9 SECTION 77. Section 6, Chapter 96, Acts of the 60th
128-10 Legislature, Regular Session, 1967 (Article 4575a, Vernon's Texas
128-11 Civil Statutes), is amended to read as follows:
128-12 Sec. 6. The Texas State Board of Podiatric Medical
128-13 <Podiatry> Examiners may institute actions in its own name to
128-14 enjoin a violation of any of the provisions of Chapter 11, Title 71
128-15 of the Revised Civil Statutes of Texas, 1925, as amended,
128-16 consisting of Article 4567 through Article 4575, inclusive, Revised
128-17 Civil Statutes of Texas, 1925, as amended, and to enjoin any person
128-18 from performing an act constituting the practice of podiatry unless
128-19 authorized by law. The Attorney General or any district or county
128-20 attorney shall represent the Texas State Board of Podiatric Medical
128-21 <Podiatry> Examiners in such court action.
128-22 SECTION 78. Subsection (a), Article 60.061, Code of Criminal
128-23 Procedure, as amended by Chapters 790 and 1025, Acts of the 73rd
128-24 Legislature, 1993, is amended to read as follows:
128-25 (a) The Texas State Board of Medical Examiners, the Texas
129-1 State Board of Podiatric Medical <Podiatry> Examiners, the State
129-2 Board of Dental Examiners, the State Board of Pharmacy, and the
129-3 State Board of Veterinary Medical Examiners shall provide to the
129-4 Department of Public Safety through electronic means, magnetic
129-5 tape, or disk, as specified by the department, a list including the
129-6 name, date of birth, and any other personal descriptive information
129-7 required by the department for each person licensed by the
129-8 respective agency. Each agency shall update this information and
129-9 submit to the Department of Public Safety the updated information
129-10 monthly.
129-11 SECTION 79. Subdivision (10), Section 241.003, Health and
129-12 Safety Code, is amended to read as follows:
129-13 (10) "Podiatrist" means a podiatrist licensed by the
129-14 Texas State Board of Podiatric Medical <Podiatry> Examiners.
129-15 SECTION 80. Subsection (f), Section 401.064, Health and
129-16 Safety Code, is amended to read as follows:
129-17 (f) In adopting rules under this section relating to the
129-18 inspection of medical, podiatric medical, dental, veterinary, and
129-19 chiropractic electronic products, the board shall solicit and
129-20 follow the recommendations of the State Board of Dental Examiners
129-21 for the inspections of dental electronic products, the Texas State
129-22 Board of Podiatric Medical <Podiatry> Examiners for the inspection
129-23 of podiatric medical electronic products, the Texas State Board of
129-24 Medical Examiners for the inspection of medical electronic
129-25 products, the Texas State Board of Veterinary Medical Examiners for
130-1 the inspection of medical electronic products used in the practice
130-2 of veterinary medicine, and the State Board of Chiropractic
130-3 Examiners for the inspection of chiropractic electronic products,
130-4 unless in conflict with federal statutes or federal rules.
130-5 SECTION 81. Subsection (a), Section 481.076, Health and
130-6 Safety Code, is amended to read as follows:
130-7 (a) The director may not permit any person to have access to
130-8 information submitted to the Department of Public Safety under
130-9 Section 481.075 except:
130-10 (1) investigators for the Texas State Board of Medical
130-11 Examiners, the Texas State Board of Podiatric Medical <Podiatry>
130-12 Examiners, the State Board of Dental Examiners, the State Board of
130-13 Veterinary Medical Examiners, or the Texas State Board of Pharmacy;
130-14 or
130-15 (2) authorized officers of the Department of Public
130-16 Safety engaged in investigation of suspected criminal violations of
130-17 this chapter who obtain access with the approval of an investigator
130-18 listed in Subdivision (1).
130-19 SECTION 82. Subdivision (12), Section 483.001, Health and
130-20 Safety Code, is amended to read as follows:
130-21 (12) "Practitioner" means a person licensed:
130-22 (A) by the Texas State Board of Medical
130-23 Examiners, State Board of Dental Examiners, Texas State Board of
130-24 Podiatric Medical <Podiatry> Examiners, Texas Optometry Board, or
130-25 State Board of Veterinary Medical Examiners to prescribe and
131-1 administer dangerous drugs;
131-2 (B) by another state in a health field in which,
131-3 under the laws of this state, a licensee may legally prescribe
131-4 dangerous drugs; or
131-5 (C) in Canada or Mexico in a health field in
131-6 which, under the laws of this state, a licensee may legally
131-7 prescribe dangerous drugs.
131-8 SECTION 83. Subsection (B), Section 2, Chapter 397, Acts of
131-9 the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas
131-10 Insurance Code), is amended to read as follows:
131-11 (B) No policy of accident and sickness insurance shall make
131-12 benefits contingent upon treatment or examination by a particular
131-13 practitioner or by particular practitioners of the healing arts
131-14 hereinafter designated unless such policy contains a provision
131-15 designating the practitioner or practitioners who will be
131-16 recognized by the insurer and those who will not be recognized by
131-17 the insurer. Such provision may be located in the "Exceptions" or
131-18 "Exceptions and Reductions" provisions, or elsewhere in the policy,
131-19 or by endorsement attached to the policy, at the insurer's option.
131-20 In designating the practitioners who will and will not be
131-21 recognized, such provision shall use the following terms: Doctor
131-22 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
131-23 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
131-24 Audiologist, Licensed Speech-language Pathologist, Doctor in
131-25 Psychology, Licensed Master Social Worker--Advanced Clinical
132-1 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
132-2 Licensed Marriage and Family Therapist, and Licensed Hearing Aid
132-3 Fitter and Dispenser.
132-4 For purposes of this Act, such designations shall have the
132-5 following meanings:
132-6 Doctor of Medicine: One licensed by the Texas State Board of
132-7 Medical Examiners on the basis of the degree "Doctor of Medicine";
132-8 Doctor of Osteopathy: One licensed by the Texas State Board
132-9 of Medical Examiners on the basis of the degree of "Doctor of
132-10 Osteopathy";
132-11 Doctor of Dentistry: One licensed by the State Board of
132-12 Dental Examiners;
132-13 Doctor of Chiropractic: One licensed by the Texas Board of
132-14 Chiropractic Examiners;
132-15 Doctor of Optometry: One licensed by the Texas Optometry
132-16 Board;
132-17 Doctor of Podiatry: One licensed by the Texas State Board of
132-18 Podiatric Medical <Podiatry> Examiners;
132-19 Licensed Audiologist: One with a master's or doctorate
132-20 degree in audiology from an accredited college or university and
132-21 who is licensed as an audiologist by the State Committee of
132-22 Examiners for Speech-Language Pathology and Audiology;
132-23 Licensed Speech-language Pathologist: One with a master's or
132-24 doctorate degree in speech pathology or speech-language pathology
132-25 from an accredited college or university and who is licensed as a
133-1 speech-language pathologist by the State Committee of Examiners for
133-2 Speech-Language Pathology and Audiology;
133-3 Doctor in Psychology: One licensed by the Texas State Board
133-4 of Examiners of Psychologists and certified as a Health Service
133-5 Provider;
133-6 Licensed Master Social Worker--Advanced Clinical
133-7 Practitioner: One licensed by the Texas State Board of Social
133-8 Worker Examiners as a Licensed Master Social Worker with the order
133-9 of recognition of Advanced Clinical Practitioner;
133-10 Licensed Dietitian: One licensed by the Texas State Board of
133-11 Examiners of Dietitians;
133-12 Licensed Professional Counselor: One licensed by the Texas
133-13 State Board of Examiners of Professional Counselors;
133-14 Licensed Marriage and Family Therapist: One licensed by the
133-15 Texas State Board of Examiners of Marriage and Family Therapists;
133-16 and
133-17 Licensed Hearing Aid Fitter and Dispenser: One licensed by
133-18 the Texas Board of Examiners in the Fitting and Dispensing of
133-19 Hearing Aids.
133-20 SECTION 84. Article 21.52A, Insurance Code, is amended to
133-21 read as follows:
133-22 Art. 21.52A. Certification by Podiatrist. An insurance
133-23 policy that is delivered, issued for delivery, or renewed in this
133-24 state and that provides benefits covering loss of income based on
133-25 an acute and temporary disability caused by sickness or injury may
134-1 not deny payment of those benefits on the ground that the acute and
134-2 temporary disability is certified or attested to by a podiatrist
134-3 licensed by the Texas State Board of Podiatric Medical <Podiatry>
134-4 Examiners if the acute and temporary disability is caused by a
134-5 sickness or injury that may be treated by acts performed by a
134-6 licensed podiatrist under the scope of that license.
134-7 SECTION 85. Subdivision (1), Subsection (a), Section 19,
134-8 Chapter 836, Acts of the 62nd Legislature, Regular Session, 1971
134-9 (Article 4512e, Vernon's Texas Civil Statutes), is amended to read
134-10 as follows:
134-11 (1) A license may be denied, or after hearing,
134-12 suspended or revoked, or a licensee otherwise disciplined if the
134-13 applicant or licensee has:
134-14 (A) provided physical therapy to a person,
134-15 except as provided by Subdivision (2) of this subsection, without
134-16 the referral from a physician licensed to practice medicine by a
134-17 state Board of Medical Examiners, or by a dentist licensed by a
134-18 state Board of Dental Examiners, or a doctor licensed to practice
134-19 chiropractic by a state Board of Chiropractic Examiners or a
134-20 podiatrist licensed by a state Board of Podiatric Medical
134-21 <Podiatry> Examiners, or by any other qualified, licensed
134-22 health-care professional who within the scope of the professional
134-23 licensure is authorized to refer for health care services. The
134-24 professional taking an action under this subdivision is a referring
134-25 practitioner;
135-1 (B) in the case of a physical therapist
135-2 assistant, treated a person other than under the direction of a
135-3 licensed physical therapist;
135-4 (C) used drugs or intoxicating liquors to an
135-5 extent that affects the licensee's or applicant's professional
135-6 competence;
135-7 (D) been convicted of a felony in this state or
135-8 in any other state, territory, or nation; conviction as used in
135-9 this subdivision includes a finding or verdict of guilty, an
135-10 admission of guilt, or a plea of nolo contendere;
135-11 (E) obtained or attempted to obtain a license by
135-12 fraud or deception;
135-13 (F) been grossly negligent in the practice of
135-14 physical therapy or in acting as a physical therapist assistant;
135-15 (G) been adjudged mentally incompetent by a
135-16 court of competent jurisdiction;
135-17 (H) practiced physical therapy in a manner
135-18 detrimental to the public health and welfare; or
135-19 (I) had the licensee's or applicant's license to
135-20 practice physical therapy revoked or suspended or had other
135-21 disciplinary action taken against the licensee or applicant or had
135-22 the licensee's or applicant's application for a license refused,
135-23 revoked, or suspended by the proper licensing authority of another
135-24 state, territory, or nation.
135-25 SECTION 86. Subsection (a), Section 2.08, Medical Radiologic
136-1 Technologist Certification Act (Article 4512m, Vernon's Texas Civil
136-2 Statutes), is amended to read as follows:
136-3 (a) This section applies to the Texas State Board of Medical
136-4 Examiners, the Texas Board of Chiropractic Examiners, the Texas
136-5 State Board of Dental Examiners, the Texas State Board of Podiatric
136-6 Medical <Podiatry> Examiners, and the Board of Nurse Examiners.
136-7 SECTION 87. Subsection (b), Section 1, Article 4512p,
136-8 Revised Statutes, is amended to read as follows:
136-9 (b) The council consists of one representative appointed by
136-10 each of the following:
136-11 (1) the Texas Board of Chiropractic Examiners;
136-12 (2) the State Board of Dental Examiners;
136-13 (3) the Texas Optometry Board;
136-14 (4) the State Board of Pharmacy;
136-15 (5) the Texas State Board of Podiatric Medical
136-16 <Podiatry> Examiners;
136-17 (6) the State Board of Veterinary Medical Examiners;
136-18 (7) the Texas State Board of Medical Examiners;
136-19 (8) the Board of Nurse Examiners;
136-20 (9) the Texas State Board of Examiners of
136-21 Psychologists;
136-22 (10) the Board of Vocational Nurse Examiners;
136-23 (11) the entity that regulates the practice of
136-24 physical therapy;
136-25 (12) the entity that regulates the practice of
137-1 occupational therapy;
137-2 (13) the health licensing division of the Department
137-3 of Public Health; and
137-4 (14) the governor's office.
137-5 SECTION 88. Section 1, Chapter 96, Acts of the 60th
137-6 Legislature, Regular Session, 1967 (Article 4567a, Vernon's Texas
137-7 Civil Statutes), is repealed.
137-8 SECTION 89. (a) This Act takes effect immediately, except
137-9 that Sections 34 through 45 and 60 through 88 take effect September
137-10 1, 1995.
137-11 (b) The changes in law made by Subsection (j), Article 4568,
137-12 Revised Statutes, as amended by this Act, and by Subsections (j),
137-13 (k), (l), (m), and (n), Article 4573, Revised Statutes, as added by
137-14 this Act, apply only to a proceeding commenced by the Texas State
137-15 Board of Podiatric Medical Examiners on or after the effective date
137-16 of this Act. A proceeding commenced before that date is governed
137-17 by the law in effect at the time the proceeding was commenced, and
137-18 the former law is continued in effect for that purpose.
137-19 SECTION 90. The importance of this legislation and the
137-20 crowded condition of the calendars in both houses create an
137-21 emergency and an imperative public necessity that the
137-22 constitutional rule requiring bills to be read on three several
137-23 days in each house be suspended, and this rule is hereby suspended,
137-24 and that this Act take effect and be in force according to its
137-25 terms, and it is so enacted.