1-1 By: Cain S.B. No. 1302
1-2 (In the Senate - Filed March 10, 1995; March 20, 1995, read
1-3 first time and referred to Committee on Health and Human Services;
1-4 April 20, 1995, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 8, Nays 0; April 20, 1995,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1302 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the regulation of physician assistants; providing a
1-11 criminal penalty.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. The Physician Assistant Licensing Act (Article
1-14 4495b-1, Vernon's Texas Civil Statutes), is amended to read as
1-15 follows:
1-16 Sec. 1. SHORT TITLE; LEGISLATIVE FINDINGS AND PURPOSE.
1-17 (a) This Act may be cited as the "Physician Assistant Licensing
1-18 Act."
1-19 (b) The legislature finds that the health, safety, and
1-20 welfare of the people of this state are best advanced by the
1-21 establishment of an orderly system for licensing physician
1-22 assistants. The creation of a licensing mechanism and
1-23 establishment of an entity dedicated to regulating physician
1-24 assistants provides a means to ensure the competency of physician
1-25 assistants without a financial burden to the people of this state.
1-26 Sec. 2. DEFINITIONS. In this Act:
1-27 (1) "Board" means the Texas State Board of Physician
1-28 Assistant <Medical> Examiners.
1-29 (2) "Medical Board" means the Texas State Board of
1-30 Medical Examiners. <"Council" means the Physician Assistant
1-31 Advisory Council.>
1-32 (3) "Physician assistant" means a person who has
1-33 graduated from a physician assistant or surgeon assistant training
1-34 program accredited by the American Medical Association's Committee
1-35 on Allied Health Education and Accreditation and <or> who has
1-36 passed the certifying examination administered by the National
1-37 Commission on Certification of Physician Assistants and who is
1-38 licensed as a physician assistant by the board.
1-39 (4) "Supervising physician" means a physician <medical
1-40 doctor or doctor of osteopathy> licensed by the medical board
1-41 either as a doctor of medicine or doctor of osteopathic medicine
1-42 who is assuming responsibility and legal liability for the services
1-43 rendered by the physician assistant and who has received approval
1-44 from the medical board to supervise <who supervises> a specific
1-45 physician assistant.
1-46 (5) "Alternate physician" means that physician
1-47 designated by the supervising physician to act in his or her stead.
1-48 (6) "Supervision" means overseeing the activities of,
1-49 and accepting responsibility for, the medical services rendered by
1-50 a physician assistant. Supervision does not require the constant
1-51 physical presence of a supervising physician <person providing
1-52 supervision> but includes a situation where a supervising physician
1-53 <person providing supervision> and the person being supervised are
1-54 or can easily be in contact with one another by radio, telephone,
1-55 or another telecommunication device.
1-56 (7) "State" means any state, territory, or insular
1-57 possession of the United States and the District of Columbia.
1-58 Sec. 3. LICENSE REQUIRED. A person may not practice as a
1-59 physician assistant unless the person is licensed under this Act.
1-60 Sec. 4. BOARD OF PHYSICIAN ASSISTANT EXAMINERS <ADVISORY
1-61 COUNCIL>. (a) The Texas State Board of Physician Assistant
1-62 Examiners <Advisory Council> is created as an advisory board to the
1-63 Texas State Board of Medical Examiners.
1-64 (b) The board <council> consists of nine members appointed
1-65 by the governor as follows:
1-66 (1) three members who are currently legally practicing
1-67 as physician assistants and who have at least five years of
1-68 clinical experience as practicing physician assistants;
2-1 (2) three members who are physicians licensed in this
2-2 state who currently supervise physician assistants; and
2-3 (3) three members who are members of the general
2-4 public who are not licensed either as physicians or physician
2-5 assistants.
2-6 (c) A person is not eligible for appointment as a public
2-7 member of the board <council> if the person or the person's spouse:
2-8 (1) is licensed by an occupational regulatory agency
2-9 in the field of health care; or
2-10 (2) is employed by or participates in the management
2-11 of a business entity or other organization that provides health
2-12 care services or that sells, manufactures, or distributes health
2-13 care supplies or equipment.
2-14 (d) Each member of the board <council> is entitled to a per
2-15 diem as set by legislative appropriation for each day that the
2-16 member engages in the business of the board <council>. If the
2-17 General Appropriations Act does not prescribe the amount of the per
2-18 diem, the per diem shall consist of actual expenses for meals,
2-19 lodging, and transportation plus $100. <A member may not receive
2-20 compensation for travel expenses, including expenses for meals and
2-21 lodging, other than transportation expenses. A member is entitled
2-22 to compensation for transportation expenses as provided by the
2-23 General Appropriations Act.>
2-24 (e) It is a ground for removal from the board <council> if a
2-25 member:
2-26 (1) does not have at the time of appointment the
2-27 qualifications required by this section for appointment to the
2-28 board <council>;
2-29 (2) does not maintain during the service on the board
2-30 <council> the qualifications required by this section for
2-31 appointment to the board <council>; or
2-32 (3) fails to attend at least one-half of the regularly
2-33 scheduled board <council> meetings held in a calendar year,
2-34 excluding meetings held while the person was not a board
2-35 <committee> member.
2-36 (f) A person who is required to register as a lobbyist under
2-37 Chapter 305, Government Code, and its subsequent amendments may not
2-38 serve as a member of the board <council>.
2-39 (g) The validity of an action of the board <council> is not
2-40 affected by the fact that it is taken when a ground for removal of
2-41 a member of the board <council> exists.
2-42 (h) The board <council> is subject to the open meetings law,
2-43 Chapter 551, Government Code <271, Acts of the 60th Legislature,
2-44 Regular Session, 1967 (Article 6252-17, Vernon's Texas Civil
2-45 Statutes)>, and its subsequent amendments, and Chapter 2001,
2-46 Government Code (<the> Administrative Procedure <and Texas
2-47 Register> Act), <(Article 6252-13a, Vernon's Texas Civil Statutes)>
2-48 and its subsequent amendments.
2-49 (i) Members of the board <council> hold office for staggered
2-50 terms of six years expiring February 1 of each odd-numbered year.
2-51 A member is ineligible to serve more than two consecutive full
2-52 terms and may not serve more than a total of three full terms.
2-53 (j) In the case of a vacancy on the board <council>, the
2-54 governor shall appoint a new member to complete an unexpired term.
2-55 (k) The board <council> is subject to Chapter 325,
2-56 Government Code (Texas Sunset Act), and its subsequent amendments.
2-57 Unless continued in existence as provided by that chapter, the
2-58 board <council> is abolished and this Act expires September 1,
2-59 2005.
2-60 (l) The board <council> shall select from its membership a
2-61 presiding officer and a secretary to serve for one-year terms.
2-62 (m) A majority of the <Five> members of the board <council>
2-63 constitute a quorum for the transaction of the business of the
2-64 board <council>.
2-65 Sec. 5. POWERS AND DUTIES OF THE BOARD <COUNCIL>. The board
2-66 <council> shall:
2-67 (1) adopt rules as provided by Section 23 <22> of this
2-68 Act;
2-69 (2) review and approve or reject applications for a
2-70 license;
3-1 (3) review and approve or reject applications for
3-2 renewal of a license;
3-3 (4) issue all licenses;
3-4 (5) deny, suspend, or revoke a license or otherwise
3-5 discipline a license holder;
3-6 (6) prescribe and collect fees authorized under this
3-7 Act; and
3-8 (7) take any action necessary to carry out the
3-9 functions and duties of the board <council> under this Act.
3-10 Sec. 6. FEES. (a) The board <council> shall establish fees
3-11 that are reasonable and necessary to defray the cost of
3-12 administering this Act.
3-13 (b) The board <council> may not maintain unnecessary fund
3-14 balances, and fee amounts shall be set in accordance with this
3-15 requirement.
3-16 Sec. 7. LICENSURE <LICENSE> QUALIFICATIONS. The board
3-17 <council> shall issue a license under this Act to an applicant who:
3-18 (1) submits an application on a form prescribed by the
3-19 board <council>;
3-20 (2) pays the application fee as prescribed by the
3-21 board <council>;
3-22 (3) has successfully completed an educational program
3-23 for physician assistants or surgeon assistants accredited by the
3-24 Committee on Allied Health Education and Accreditation or by that
3-25 committee's predecessor or successor entities and <or> has passed
3-26 the Physician Assistant National Certifying Examination
3-27 administered by the National Commission on Certification of
3-28 Physician Assistants;
3-29 (4) certifies that the applicant is mentally and
3-30 physically able to function safely as a physician assistant;
3-31 (5) does not have a license, certification, or
3-32 registration as a physician assistant in this state or from any
3-33 other licensing authority that is currently revoked or suspended or
3-34 the applicant is not subject to probation or other disciplinary
3-35 action for cause resulting from the applicant's acts as a physician
3-36 assistant, unless the board <council> takes that fact into
3-37 consideration in determining whether to issue the license;
3-38 (6) is of good moral character; <and>
3-39 (7) submits to the board <council> any other
3-40 information the board <council> considers necessary to evaluate the
3-41 applicant's qualifications; and
3-42 (8) meets any other requirement established by rules
3-43 adopted by the board.
3-44 Sec. 8. TEMPORARY LICENSE. (a) The board <council> may
3-45 issue a temporary license to an applicant who:
3-46 (1) meets all the qualifications for a license under
3-47 this Act but is waiting for the next scheduled meeting of the board
3-48 <council> for the license to be issued; <or>
3-49 (2) seeks to temporarily substitute for a licensed
3-50 physician assistant during the licensee's absence, if the
3-51 applicant:
3-52 (A) is licensed or registered in good standing
3-53 in another state, territory, or the District of Columbia;
3-54 (B) submits an application on a form prescribed
3-55 by the board <council>; and
3-56 (C) pays the appropriate fee prescribed by the
3-57 board; or
3-58 (3) has graduated from an educational program for
3-59 physician assistants or surgeon assistants accredited by the
3-60 Committee on Allied Health Education and Accreditation or by that
3-61 committee's predecessor or successor entities no later than six
3-62 months previous to the application for temporary licensure and is
3-63 waiting for examination results from the National Commission on
3-64 Certification of Physician Assistants <council>.
3-65 (b) A temporary license is valid for 100 <45> days from the
3-66 date issued and may be extended only for another 30 <45> days after
3-67 the date the initial temporary license expires.
3-68 Sec. 9. INACTIVE LICENSE. (a) A license holder may have
3-69 the license holder's license placed on inactive status by applying
3-70 to the board <council>. A physician assistant with an inactive
4-1 license is excused from paying renewal fees on the license and may
4-2 not practice as a physician assistant.
4-3 (b) A license holder who practices as a physician assistant
4-4 while on inactive status is considered to be practicing without a
4-5 license.
4-6 (c) A physician assistant may return to active status by
4-7 applying to the board <council>, paying the license renewal fee,
4-8 and complying with the requirements for license renewal under
4-9 Section 10 of this Act.
4-10 Sec. 10. RENEWAL. A person who holds a license under this
4-11 Act may, on notification from the board <council>, renew the
4-12 license by:
4-13 (1) paying the renewal fee prescribed by the board
4-14 <council>;
4-15 (2) submitting the appropriate form; and
4-16 (3) meeting any other requirement established by rules
4-17 adopted by the board <council>.
4-18 Sec. 11. EXEMPTION. This Act does not require a license
4-19 for:
4-20 (1) a physician assistant student enrolled in a
4-21 physician assistant or surgeon assistant educational program
4-22 accredited by the Committee on Allied Health Education and
4-23 Accreditation of the American Medical Association or, in the event
4-24 these entities go out of existence, successor entities as approved
4-25 and designated by the board through rulemaking;
4-26 (2) a physician assistant employed in the service of
4-27 the federal government while performing duties related to that
4-28 employment;
4-29 (3) a technician, assistant, or employee of a
4-30 physician who performs delegated tasks in the office of a physician
4-31 or elsewhere but who does not act as a physician assistant or
4-32 represent that the person is a physician assistant; or
4-33 (4) any other licensed health care worker acting
4-34 within the scope of that person's license if the person does not
4-35 use the title "physician assistant" or "P.A." or is not represented
4-36 or designated as a physician assistant.
4-37 Sec. 12. SCOPE OF PRACTICE. (a) The practice of a
4-38 physician assistant includes medical services within the education,
4-39 training, and experience of the physician assistant that are
4-40 delegated by the supervising physician.
4-41 (b) Medical services provided by a physician assistant may
4-42 include but are not limited to:
4-43 (1) obtaining patient histories and performing
4-44 physical examinations;
4-45 (2) ordering or performing diagnostic and therapeutic
4-46 procedures;
4-47 (3) formulating a working diagnosis;
4-48 (4) developing and implementing a treatment plan;
4-49 (5) monitoring the effectiveness of therapeutic
4-50 interventions;
4-51 (6) assisting at surgery;
4-52 (7) offering counseling and education to meet patient
4-53 needs <patients>;
4-54 (8) requesting, receiving, and signing for the receipt
4-55 of pharmaceutical sample medications and medical devices
4-56 <professional samples> and distributing the samples and devices to
4-57 patients in a specific practice setting where the physician
4-58 assistant is authorized to prescribe pharmaceutical medications and
4-59 medical devices, including at a site serving medically underserved
4-60 populations, as provided by Section 3.06(d)(5), Medical Practice
4-61 Act (Article 4495b, Vernon's Texas Civil Statutes), and its
4-62 subsequent amendments, or as otherwise authorized by this Act or as
4-63 authorized by state law, federal law, or board rule; <and>
4-64 (9) the signing or completion of a prescription as
4-65 provided by Sections 3.06(d)(5) or (6), Medical Practice Act
4-66 (Article 4495b, Vernon's Texas Civil Statutes); and
4-67 (10) making appropriate referrals.
4-68 (c) The activities listed in Subsection (b) of this section
4-69 may be performed in any place authorized by a supervising
4-70 physician, including but not limited to a clinic, hospital,
5-1 ambulatory surgical center, patient home, nursing home, or other
5-2 institutional setting.
5-3 Sec. 13. SUPERVISION REQUIREMENTS. (a) Supervision by a
5-4 supervising physician must be continuous but does not require the
5-5 physical presence of the supervising physician at the place where
5-6 physician assistant services are performed while the services are
5-7 performed.
5-8 (b) Each team of a physician and physician assistant must
5-9 ensure that:
5-10 (1) the physician assistant's scope of function is
5-11 identified;
5-12 (2) delegation of medical tasks is appropriate to the
5-13 physician assistant's level of competence;
5-14 (3) the relationship between the members of the team
5-15 and the access of the physician assistant to the supervising
5-16 physician is defined; and
5-17 (4) a process for evaluating the physician assistant's
5-18 performance is established.
5-19 (c) A physician assistant may have more than one supervising
5-20 physician.
5-21 Sec. 14. SUPERVISING PHYSICIAN. A supervising physician
5-22 must:
5-23 (1) be currently licensed as a physician in this state
5-24 by the medical board with a license that is unrestricted and
5-25 active;
5-26 (2) notify the board <council> of the physician's
5-27 intent to supervise a physician assistant; and
5-28 (3) submit a statement to the board <council> that the
5-29 physician will:
5-30 (A) supervise the physician assistant according
5-31 to rules adopted by the board <council>; and
5-32 (B) retain professional and legal responsibility
5-33 for the care rendered by the physician assistant.
5-34 Sec. 15. NOTIFICATION OF INTENT TO PRACTICE. (a) A
5-35 physician assistant licensed under this Act must, before beginning
5-36 practice, submit on a form prescribed by the board <council>
5-37 notification of the license holder's intent to begin practice.
5-38 Notification under this section must include:
5-39 (1) the name, business address, Texas license number,
5-40 and telephone number of the physician assistant's supervising
5-41 physician; and
5-42 (2) the name, business address, Texas license number,
5-43 and telephone number of the physician assistant.
5-44 (b) A physician assistant must notify the board <council> of
5-45 any changes in, or additions to, the person acting as a supervising
5-46 physician for the physician assistant not later than the 30th day
5-47 after the date the change or addition is made.
5-48 Sec. 16. EXCLUSION OF LIMITATION ON EMPLOYMENT. This Act
5-49 does not limit the employment arrangement of a physician assistant
5-50 licensed under this Act.
5-51 Sec. 17. ASSUMPTION OF PROFESSIONAL LIABILITY. (a) A
5-52 physician assistant employed by a physician or a group of
5-53 physicians must be supervised by and be the legal responsibility of
5-54 each supervising <employing> physician. The legal responsibility
5-55 for the physician assistant's patient care activities remains the
5-56 responsibility of the supervising <employing> physician, including
5-57 when the physician assistant provides care and treatment for a
5-58 patient in a health care facility.
5-59 (b) A physician assistant employed by a health care facility
5-60 or other entity shall be supervised by a licensed physician. A
5-61 health care facility or other entity that employs a physician
5-62 assistant shares the legal responsibility for the physician
5-63 assistant's acts or omissions with the physician assistant's
5-64 supervising physician.
5-65 Sec. 18. DISCIPLINARY PROCEEDINGS. The board <council> may
5-66 refuse to issue a license, publicly or privately reprimand a
5-67 license holder, or suspend, revoke, or place other restrictions on
5-68 a license of a person who:
5-69 (1) fraudulently or deceptively obtains or attempts to
5-70 obtain a license;
6-1 (2) fraudulently or deceptively uses a license;
6-2 (3) violates any provision of this Act or any rule
6-3 adopted under this Act;
6-4 (4) is convicted of a felony;
6-5 (5) is a habitual user of intoxicants or
6-6 nontherapeutic drugs to the extent that the person cannot safely
6-7 perform as a physician assistant;
6-8 (6) has been adjudicated as mentally incompetent or
6-9 has a mental or physical condition that renders the person unable
6-10 to safely perform as a physician assistant;
6-11 (7) has committed an act of moral turpitude; <or>
6-12 (8) represents that the person is a physician;
6-13 (9) has acted in an unprofessional or dishonorable
6-14 manner which is likely to deceive, defraud, or injure any member of
6-15 the public;
6-16 (10) has failed to practice as a physician assistant
6-17 in an acceptable manner consistent with public health and welfare;
6-18 (11) has committed any act that is in violation of the
6-19 laws of the State of Texas if the act is connected with practice as
6-20 a physician assistant; a complaint, indictment, or conviction of a
6-21 law violation is not necessary for the enforcement of this
6-22 provision; proof of the commission of the act while in practice as
6-23 a physician assistant or under the guise of practice as a physician
6-24 assistant is sufficient for action by the board under this section;
6-25 or
6-26 (12) has had the person's license suspended, revoked,
6-27 or restricted or who has had other disciplinary action taken by
6-28 another state regarding practice as a physician assistant or had
6-29 disciplinary action taken by the uniformed services of the United
6-30 States, based on acts by the licensee similar to acts described in
6-31 this section; a certified copy of the record of the state or
6-32 uniformed services of the United States taking the action is
6-33 conclusive evidence of it.
6-34 Sec. 19. ADDITIONAL DISCIPLINARY AUTHORITY. In addition to
6-35 the authority under Section 18 of this Act, the board <council>
6-36 may, on finding that a physician assistant has committed an offense
6-37 described in Section 18 of this Act:
6-38 (1) require a physician assistant to submit to the
6-39 care, counseling, or treatment of a health care practitioner
6-40 <physician> designated by the board <council>;
6-41 (2) stay enforcement of an order and place the
6-42 physician assistant on probation with the board <council> retaining
6-43 the right to vacate the probationary stay and enforce the original
6-44 order for noncompliance with the terms of probation or impose any
6-45 other remedial measures or sanctions authorized by this section;
6-46 (3) restore or reissue a license or remove any
6-47 disciplinary or corrective measure that the board <council> may
6-48 have imposed;
6-49 (4) order the physician assistant to perform public
6-50 service; or
6-51 (5) require the physician assistant to complete
6-52 additional training.
6-53 Sec. 20. REHABILITATION ORDER. (a) The board, through an
6-54 agreed order or after a contested proceeding, may impose a
6-55 nondisciplinary rehabilitation order on any licensee or, as a
6-56 prerequisite for issuing a license, on any licensure applicant
6-57 based on one or more of the following:
6-58 (1) intemperate use of drugs or alcohol directly
6-59 resulting from habituation or addiction caused by medical care or
6-60 treatment provided by a physician;
6-61 (2) self-reported intemperate use of drugs or alcohol
6-62 during the last five years immediately preceding the report which
6-63 could adversely affect the reporter's ability to safely practice as
6-64 a physician assistant, but only if the reporting individual has not
6-65 previously been the subject of a substance abuse related order of
6-66 the board;
6-67 (3) judgment by a court of competent jurisdiction that
6-68 the individual is of unsound mind; or
6-69 (4) results from a mental or physical examination, or
6-70 admissions by the individual, indicating that the licensee or
7-1 applicant suffers from a potentially dangerous limitation or an
7-2 inability to safely practice as a physician assistant with
7-3 reasonable skill and safety by reason of illness or as a result of
7-4 any physical or mental condition.
7-5 (b) A rehabilitation order entered pursuant to this section
7-6 shall be a nondisciplinary private order and shall contain findings
7-7 of fact and conclusions of law. A rehabilitation order, if entered
7-8 by agreement, shall be an agreed disposition or settlement
7-9 agreement for purposes of civil litigation and shall be exempt from
7-10 the open records law, Chapter 552, Government Code.
7-11 (c) A rehabilitation order entered pursuant to this section
7-12 may impose a revocation, cancellation, suspension, period of
7-13 probation or restriction, or any other terms and conditions
7-14 authorized under this Act or as otherwise agreed to by the board
7-15 and the individual subject to the order.
7-16 (d) Violation of a rehabilitation order entered pursuant to
7-17 this section may result in disciplinary action under the provisions
7-18 of this Act for contested matters or pursuant to the terms of the
7-19 agreed order. A violation of a rehabilitation order may be grounds
7-20 for disciplinary action based on unprofessional or dishonorable
7-21 conduct or on any of the provisions of this Act which may apply to
7-22 the misconduct which resulted in violation of the rehabilitation
7-23 order.
7-24 (e) The rehabilitation orders entered pursuant to this
7-25 section shall be kept in a confidential file which shall be subject
7-26 to an independent audit by state auditors or private auditors
7-27 contracted with by the board to perform such an audit. Audits may
7-28 be performed at any time at the direction of the board but shall be
7-29 performed at least once every three years. The audit results shall
7-30 be reported in a manner that maintains the confidentiality of all
7-31 licensees who are subject to rehabilitation orders and shall be a
7-32 public record. The audit shall be for the purposes of ensuring
7-33 that only qualified licensees are subject to rehabilitation orders.
7-34 Sec. 21. OFFENSE. (a) A person commits an offense if,
7-35 without holding a license under this Act, the person:
7-36 (1) holds the person out as a physician assistant;
7-37 (2) uses any combination or abbreviation of the term
7-38 "physician assistant" to indicate or imply that the person is a
7-39 physician assistant; or
7-40 (3) acts as a physician assistant without being
7-41 licensed by the board <council>.
7-42 (b) An offense under this section is a felony of the third
7-43 degree.
7-44 Sec. 22 <21>. IDENTIFICATION REQUIREMENTS. A physician
7-45 assistant licensed under this Act shall:
7-46 (1) keep the physician assistant's Texas license
7-47 available for inspection at the physician assistant's primary place
7-48 of business; and
7-49 (2) when engaged in the physician assistant's
7-50 professional activities, wear a name tag identifying the physician
7-51 assistant as a physician assistant.
7-52 Sec. 23 <22>. RULE-MAKING AUTHORITY. (a) The board
7-53 <council> shall adopt rules that are reasonable and necessary for
7-54 the performance of the board's <council's> duties under this Act,
7-55 as provided by Chapter 2001, Government Code (<the> Administrative
7-56 Procedure <and Texas Register> Act <(Article 6252-13a, Vernon's
7-57 Texas Civil Statutes>), and its subsequent amendments, including
7-58 rules:
7-59 (1) setting licensing and other fees;
7-60 (2) establishing renewal dates for licenses; and
7-61 (3) establishing rules and procedures for disciplinary
7-62 actions.
7-63 (b) Rules adopted by the board <council> must:
7-64 (1) be approved or rejected by a majority vote of the
7-65 medical board; and
7-66 (2) if rejected, be returned to the board <council>
7-67 for revision.
7-68 Sec. 24 <23>. RURAL PHYSICIAN ASSISTANT LOAN REIMBURSEMENT
7-69 PROGRAM. (a) The board <council> shall designate annually a
7-70 portion of the revenue generated under this Act from physician
8-1 assistant licensing fees to be set aside to provide student loan
8-2 reimbursement for graduates of physician assistant training
8-3 programs in this state who practice in rural health professional
8-4 shortage areas and medically underserved areas identified by the
8-5 Texas Department of Health.
8-6 (b) The Center for Rural Health Initiatives shall establish
8-7 policies for and adopt rules to administer the loan program under
8-8 this section.
8-9 (c) The board <council> shall authorize and the medical
8-10 board shall transfer annually the funds designated in Subsection
8-11 (a) of this section to the Center for Rural Health Initiatives to
8-12 administer the loan program under this section.
8-13 Sec. 25. CONFIDENTIALITY. (a) All complaints, adverse
8-14 reports, investigation files, other investigation reports, and
8-15 other investigative information in the possession of or received or
8-16 gathered by the board or its employees or agents relating to a
8-17 licensee, an application for license, or a criminal investigation
8-18 or proceeding are privileged and confidential and are not subject
8-19 to discovery, subpoena, or other means of legal compulsion for
8-20 their release to anyone other than the board or its employees or
8-21 agents involved in licensee discipline.
8-22 (b) Not later than 30 days after receiving a written request
8-23 from a licensee who is the subject of a formal complaint initiated
8-24 and filed under this Act or from the licensee's counsel of record
8-25 and subject to any other privileges or restrictions set forth by
8-26 rule, statute, or legal precedent, unless good cause is shown for
8-27 delay the board shall provide the licensee with access to all
8-28 information in its possession that the board intends to offer into
8-29 evidence in presenting its case in chief at the contested hearing
8-30 on the complaint. However, the board is not required to provide
8-31 board investigative reports or investigative memoranda, the
8-32 identity of a nontestifying complainant, attorney-client
8-33 communications, attorney work product, or other materials covered
8-34 by a privilege recognized by the Texas Rules of Civil Procedure or
8-35 the Texas Rules of Civil Evidence. The furnishing of information
8-36 shall not constitute a waiver of privilege or confidentiality under
8-37 this section, this Act, or other applicable law.
8-38 (c) Investigative information in the possession of the board
8-39 or its employees or agents which relates to licensee discipline may
8-40 be disclosed to the appropriate licensing authority in another
8-41 state or a territory or country in which the licensee is licensed
8-42 or has applied for a license or to a peer review committee
8-43 reviewing an application for privileges or the qualifications of
8-44 the licensee with respect to retaining privileges. If the
8-45 investigative information in the possession of the board or its
8-46 employees or agents indicates a crime may have been committed, the
8-47 information shall be reported to the proper law enforcement agency.
8-48 The board shall cooperate with and assist all law enforcement
8-49 agencies conducting criminal investigations of licensees by
8-50 providing information relevant to the criminal investigation to the
8-51 investigating agency. Any information disclosed by the board to an
8-52 investigative agency shall remain confidential and shall not be
8-53 disclosed by the investigating agency except as necessary to
8-54 further the investigation.
8-55 (d) The board shall provide information on the written
8-56 request of a health care entity about a complaint filed against a
8-57 licensee that was resolved after investigation by a disciplinary
8-58 order of the board or by an agreed settlement and shall provide the
8-59 basis of and current status of any complaint under active
8-60 investigation.
8-61 (e) The board shall keep information on file about each
8-62 complaint filed with the board, consistent with this Act. If a
8-63 written complaint is filed with the board relating to a person
8-64 licensed by the board, the board, at least as often as quarterly
8-65 and until final determination of the action to be taken relative to
8-66 the complaint, shall notify, in a manner consistent with this Act,
8-67 the parties to the complaint of the status of the complaint unless
8-68 the notice would jeopardize an active investigation.
8-69 Sec. 26. PATIENT IDENTITY. In any disciplinary
8-70 investigation or proceeding regarding a physician assistant
9-1 conducted under or pursuant to this Act, the board shall protect
9-2 the identity of any patient whose medical records are examined and
9-3 utilized in a public proceeding except for those patients who
9-4 testify in the public proceeding or who submit a written release in
9-5 regard to their records or identity.
9-6 Sec. 27. SUBPOENAS. (a) On behalf of the board, the
9-7 executive director or the secretary-treasurer of the medical board
9-8 may issue subpoenas and subpoenas duces tecum for purposes of
9-9 investigations or contested proceedings related to alleged
9-10 misconduct by physician assistants or alleged violations of this
9-11 Act or other laws related to practice as a physician assistant or
9-12 to the provision of health care under authority of this Act; for
9-13 purposes of issuing, suspending, restricting, revoking, or
9-14 cancelling any license, permit, or certification authorized by this
9-15 Act; and for purposes of denying or granting applications for such
9-16 licenses, permits, or certifications.
9-17 (b) Failure to timely comply with a subpoena issued pursuant
9-18 to this Act shall be grounds for disciplinary action by the board
9-19 or other licensing or regulatory agencies with jurisdiction over
9-20 the individual or entity subject to such a subpoena and grounds for
9-21 denial of an application for a license, permit, or certification.
9-22 Sec. 28. IMMUNITY. A person, health care entity, medical
9-23 peer review committee, or other entity that without malice
9-24 furnishes records, information, or assistance to the board is
9-25 immune from any civil liability arising from such act.
9-26 SECTION 2. Sections 671.001 and 671.002, Health and Safety
9-27 Code, are amended to read as follows:
9-28 Sec. 671.001. Standard Used in Determining Death. (a) A
9-29 person is dead when, according to ordinary standards of medical
9-30 practice, there is irreversible cessation of the person's
9-31 spontaneous respiratory and circulatory functions.
9-32 (b) If artificial means of support preclude a determination
9-33 that a person's spontaneous respiratory and circulatory functions
9-34 have ceased, the person is dead when, in the announced opinion of a
9-35 physician, according to ordinary standards of medical practice,
9-36 there is irreversible cessation of all spontaneous brain function.
9-37 Death occurs when the relevant functions cease.
9-38 (c) Death must be pronounced before artificial means of
9-39 supporting a person's respiratory and circulatory functions are
9-40 terminated.
9-41 (d) A registered nurse or physician assistant may determine
9-42 and pronounce a person dead in situations other than those
9-43 described by Subsection (b) if permitted by written policies of a
9-44 licensed health care facility, institution, or entity providing
9-45 services to that person. If the facility, institution, or entity
9-46 has an organized nursing staff and an organized medical staff or
9-47 medical consultant, the nursing staff and medical staff or
9-48 consultant shall jointly develop and approve those policies. For
9-49 purposes of this section, such policies shall take into account
9-50 physician assistants who are credentialed or otherwise permitted to
9-51 practice at the facility, institution, or entity. The board shall
9-52 adopt rules to govern policies for facilities, institutions, or
9-53 entities that do not have organized nursing staffs and organized
9-54 medical staffs or medical consultants.
9-55 Sec. 671.002. Limitation of Liability. (a) A physician who
9-56 determines death in accordance with Section 671.001(b) or a
9-57 registered nurse or a physician assistant who determines death in
9-58 accordance with Section 671.001(d) is not liable for civil damages
9-59 or subject to criminal prosecution for the physician's, <or>
9-60 registered nurse's, or physician assistant's actions or the actions
9-61 of others based on the determination of death.
9-62 (b) A person who acts in good faith in reliance on a
9-63 physician's, <or> registered nurse's, or physician assistant's
9-64 determination of death is not liable for civil damages or subject
9-65 to criminal prosecution for the person's actions.
9-66 SECTION 3. Subdivision (5), Subsection (d), Section 3.06,
9-67 Medical Practice Act (Article 4495b, Vernon's Texas Civil
9-68 Statutes), is amended to read as follows:
9-69 (5)(A) At a site serving a medically underserved
9-70 population, a physician licensed by the board shall be authorized
10-1 to delegate to a registered nurse or physician assistant acting
10-2 under adequate physician supervision, the act or acts of
10-3 administering, providing, <or> carrying out, or signing a
10-4 prescription drug order or order for a medical device as authorized
10-5 by the physician through physician's orders, standing medical
10-6 orders, standing delegation orders, or other orders or protocols as
10-7 defined by the board.
10-8 (B)(i) The carrying out or signing of
10-9 prescription drug orders under this subsection shall comply with
10-10 other applicable laws.
10-11 (ii) The authority of a physician to
10-12 delegate the carrying out or signing of prescription drug orders is
10-13 limited to dangerous drugs and is limited to the practice locations
10-14 designated by the physician in physician's orders, standing medical
10-15 orders, standing delegation orders, or other orders or protocols
10-16 approved by the board.
10-17 (C) Physician supervision shall be adequate if a
10-18 delegating physician:
10-19 (i) is responsible for the formulation or
10-20 approval of such physician's orders, standing medical orders,
10-21 standing delegation orders, or other orders or protocols and
10-22 periodically reviews such orders and the services provided patients
10-23 under such orders;
10-24 (ii) is on site at least once a week to
10-25 provide medical direction and consultation;
10-26 (iii) receives a daily status report from
10-27 the registered nurse or physician assistant on any problems or
10-28 complications encountered; and
10-29 (iv) is available through direct
10-30 telecommunication for consultation, assistance with medical
10-31 emergencies, or patient referral.
10-32 (D) In this subsection:
10-33 (i) "Registered nurse" means a registered
10-34 nurse recognized by the Board of Nurse Examiners as having the
10-35 specialized education and training required under Section 7,
10-36 Article 4514, Revised Statutes.
10-37 (ii) "Physician assistant" has the meaning
10-38 assigned to that term by Section 2(3), Physician Assistant
10-39 Licensing Act, and its subsequent amendments.
10-40 (iii) "Carrying out or signing a
10-41 prescription drug order" means either the completion of <to
10-42 complete> a prescription drug order presigned by the delegating
10-43 physician or the signing of a prescription by a registered nurse or
10-44 physician assistant after such person has been designated with the
10-45 board by the delegating physician as a person delegated to sign a
10-46 prescription. The following information shall be provided on each
10-47 prescription <by providing the following information>: the
10-48 patient's name and address; the drug to be dispensed; directions to
10-49 the patient in regard to the taking and dosage; the name, address,
10-50 and telephone number of the physician; the name, address, telephone
10-51 and identification number of the registered nurse or physician
10-52 assistant completing or signing the prescription drug order; the
10-53 date; and the number of refills permitted. The board may adopt
10-54 additional methods to carry into effect or put into force a
10-55 physician's prescription or delegation of a prescription under
10-56 physician's orders, standing medical orders, standing delegation
10-57 orders, or other orders or protocols.
10-58 (iv) "A site serving a medically
10-59 underserved population" means:
10-60 (a) a site located in a
10-61 medically underserved area;
10-62 (b) a site located in a
10-63 health manpower shortage area;
10-64 (c) a clinic designated as
10-65 a rural health clinic under the Rural Health Clinic Services Act of
10-66 1977 (Pub. L. No. 95-210);
10-67 (d) a public health clinic
10-68 or a family planning clinic under contract with the Texas
10-69 Department of Human Services or the Texas Department of Health;
10-70 (e) a site located in an
11-1 area in which the Texas Department of Health determines there
11-2 exists an insufficient number of physicians providing services to
11-3 eligible clients of federal, state, or locally funded health care
11-4 programs; or
11-5 (f) a site that the Texas
11-6 Department of Health determines serves a disproportionate number of
11-7 clients eligible to participate in federal, state, or locally
11-8 funded health care programs.
11-9 (v) "Health manpower shortage area" means
11-10 (1) an area in an urban or rural area of Texas (which need not
11-11 conform to the geographic boundaries of a political subdivision and
11-12 which is a rational area for the delivery of health services) which
11-13 the secretary of health and human services determines has a health
11-14 manpower shortage and which is not reasonably accessible to an
11-15 adequately served area; (2) a population group which the secretary
11-16 determines to have such a shortage; or (3) a public or nonprofit
11-17 private medical facility or other facility which the secretary
11-18 determines has such a shortage as delineated in 42 U.S.C. Section
11-19 254(e)(a)(1).
11-20 (vi) "Medically underserved area" means an
11-21 area in Texas with a medically underserved population or an urban
11-22 or rural area designated by the secretary of health and human
11-23 services as an area in Texas with a shortage of personal health
11-24 services or a population group designated by the secretary as
11-25 having a shortage of such services (as defined in 42 U.S.C. Section
11-26 300(e)-1(7)) or as defined by the Texas Department of Health by
11-27 rule based on Texas-specific demographics, geographic factors that
11-28 affect access to health care, and environmental health factors.
11-29 (E) After making a determination under <either>
11-30 Subdivision (D)(iv)(e), <or> (D)(iv)(f), or (D)(vi) that a site
11-31 serves a medically underserved population, the Texas Department of
11-32 Health shall publish notice of its determination in the Texas
11-33 Register and provide an opportunity for public comment in the same
11-34 manner as for a proposed rule under the administrative procedure
11-35 law, Chapter 2001, Government Code <Administrative Procedure and
11-36 Texas Register Act (Article 6252-13a, Vernon's Texas Civil
11-37 Statutes)>.
11-38 (F) The authority granted to a physician to
11-39 delegate under this subdivision shall not be construed as limiting
11-40 the authority of a physician to delegate under any other
11-41 subdivision of this subsection.
11-42 (G) An advertisement for a site serving a
11-43 medically underserved population shall include the name and
11-44 business address of the supervising physician for the site.
11-45 SECTION 4. Subsection (d), Section 3.06, Medical Practice
11-46 Act (Article 4495b, Vernon's Texas Civil Statutes), is amended by
11-47 adding Subdivision (6) to read as follows:
11-48 (6)(A) At a physician's primary practice site, a
11-49 physician licensed by the board shall be authorized to delegate to
11-50 a physician assistant acting under adequate supervision the act or
11-51 acts of administering, providing, carrying out, or signing a
11-52 prescription drug order for dangerous drugs or for a medical device
11-53 as authorized through physician's orders, standing medical orders,
11-54 standing delegation orders, or other orders or protocols as defined
11-55 by the board.
11-56 (B) Supervision by a physician shall be
11-57 continuous but shall not be construed as necessarily requiring the
11-58 constant physical presence of the supervising physician at a place
11-59 where physician assistant services are performed while the services
11-60 are performed.
11-61 (C) The carrying out or signing of prescription
11-62 drug orders under this subsection shall comply with other
11-63 applicable laws.
11-64 (D) A physician's authority to delegate under
11-65 this subsection is limited to:
11-66 (i) two physician assistants or their
11-67 full-time equivalents;
11-68 (ii) the patients with whom the physician
11-69 has established or will establish a physician/patient relationship;
11-70 and
12-1 (iii) physician assistants who are
12-2 maintained and located with the physician at his primary practice
12-3 site.
12-4 (E) In this subsection:
12-5 (i) "Physician assistant" has the meaning
12-6 assigned to that term by Section 2(3), Physician Assistant
12-7 Licensing Act (Article 4495b-1, Vernon's Texas Civil Statutes);
12-8 (ii) "Primary practice site" means:
12-9 (a) the practice location
12-10 where the physician spends the majority of the physician's time and
12-11 which is so designated by the physician;
12-12 (b) a licensed hospital or
12-13 nursing home where both the physician and the physician assistant
12-14 are credentialed to practice; or
12-15 (c) where the physician is
12-16 physically present with the physician assistant.
12-17 (iii) "Carrying out or signing a
12-18 prescription drug order" means either the completing of a
12-19 prescription drug order presigned by a delegating physician or the
12-20 signing of a prescription by a physician assistant after such
12-21 person has been designated with the board by the delegating
12-22 physician as a person delegated to sign a prescription. The
12-23 following information shall be provided on each prescription: the
12-24 patient's name and address; the drug to be dispensed; directions to
12-25 the patient in regard to the taking and dosage; the name, address,
12-26 and telephone number of the physician; the name, address, and
12-27 telephone and identification number of the physician assistant
12-28 completing or signing the prescription drug order; the date; and
12-29 the number of refills permitted. The board may adopt additional
12-30 methods to carry into effect or put into force a physician's
12-31 prescription or delegation of a prescription under physician's
12-32 orders, standing medical orders, standing delegation orders, or
12-33 other orders or protocols.
12-34 SECTION 5. The importance of this legislation and the
12-35 crowded condition of the calendars in both houses create an
12-36 emergency and an imperative public necessity that the
12-37 constitutional rule requiring bills to be read on three several
12-38 days in each house be suspended, and this rule is hereby suspended,
12-39 and that this Act take effect and be in force from and after its
12-40 passage, and it is so enacted.
12-41 * * * * *