Amend SB 1340 by striking all below the enacting clause and
substituting the following:
SECTION 1. (a) The legislature finds that it is necessary
to regulate the provision of anesthesia services in outpatient
surgical settings that are not part of a licensed hospital or a
licensed ambulatory surgical center to protect the health, safety,
and welfare of the public. The legislature further finds that the
provision of anesthesia services in these settings is appropriately
regulated by the professional licensing boards of the licensed
professionals who provide anesthesia services.
(b) It is the purpose of this Act to require the Texas State
Board of Medical Examiners and the Board of Nurse Examiners to
adopt rules for their respective license holders that will regulate
the provision of anesthesia services in outpatient surgical
settings that are not a part of a licensed hospital or licensed
ambulatory surgical center.
SECTION 2. The Medical Practice Act (Article 4495b, Vernon's
Texas Civil Statutes) is amended by adding Subchapter G to read as
follows:
SUBCHAPTER G. ANESTHESIA IN OUTPATIENT SETTING
Sec. 7.01. DEFINITION. In this subchapter, "outpatient
setting" means any facility, clinic, center, office, or other
setting that is not part of a licensed hospital or a licensed
ambulatory surgical center.
Sec. 7.02. RULES. (a) The board shall establish by rule the
minimum standards for the provision of anesthesia services in
outpatient settings by persons licensed by the board.
(b) The rules must be designed to protect the health,
safety, and welfare of the public and must include requirements
relating to:
(1) general anesthesia, regional anesthesia, and
monitored anesthesia care;
(2) patient evaluation, diagnosis, counseling, and
preparation;
(3) patient monitoring to be performed and equipment
to be used during a procedure and during post-procedure monitoring;
(4) emergency procedures, drugs, and equipment,
including education, training, and certification of personnel, as
appropriate, and including protocols for tranfers to a hospital;
(5) the documentation necessary to demonstrate
compliance with this subchapter; and
(6) the period in which protocols or procedures
covered by rules of the board shall be reviewed, updated, or
amended.
(c) The board shall cooperate with the Board of Nurse
Examiners in the adoption of rules under this subchapter to
eliminate to the extent possible conflicts between the rules
adopted by each board.
Sec. 7.03. APPLICABILITY. Rules adopted by the board under
this subchapter do not apply to:
(1) an outpatient setting in which only local
anesthesia, peripheral nerve blocks, or both are used;
(2) an outpatient setting in which only anxiolytics
and analgesics are used and only in doses that do not have the
probability of placing the patient at risk for loss of the
patient's life-preserving protective reflexes;
(3) a licensed hospital;
(4) a licensed ambulatory surgical center;
(5) a clinic located on land recognized as tribal land
by the federal government and maintained or operated by a federally
recognized Indian tribe or tribal organization as listed by the
United States secretary of the interior under 25 U.S.C. Section
479a-1 or as listed under a successor federal statute or
regulation;
(6) a clinic directly maintained or operated by the
United States or by any of its departments, officers, or agencies;
or
(7) an outpatient setting accredited by:
(A) the Joint Commission for Health Care
Organizations relating to ambulatory surgical centers;
(B) the American Association for the
Accreditation of Ambulatory Surgical Facilities; or
(C) the Association for the Accreditation of
Ambulatory Health Care Centers.
Sec. 7.04. COMPLIANCE WITH ANESTHESIA RULES. (a) On or
after August 31, 2000, a physician who practices medicine in this
state and who administers anesthesia or performs a surgical
procedure for which anesthesia services are provided in an
outpatient setting shall comply with the rules adopted under this
subchapter.
(b) The board may require a physician to submit and comply
with a corrective action plan to remedy or address any current or
potential deficiencies with the physician's provision of anesthesia
in an outpatient setting in accordance with this Act or rules of
the board.
Sec. 7.05. ANNUAL REGISTRATION. (a) Beginning September 1,
2000, the board shall require each physician who administers
anesthesia or performs a surgical procedure for which anesthesia
services are provided in an outpatient setting to annually register
with the board on a form prescribed by the board and to pay a fee
to the board in an amount established by the board.
(b) The board shall coordinate the registration required
under this section with the registration required under Section
3.01 of this Act so that the times of registration, payment,
notice, and imposition of penalties for late payment are similar
and provide a minimum of administrative burden to the board and to
physicians.
Sec. 7.06. INSPECTIONS. (a) The board may conduct
inspections to enforce this subchapter, including inspections of an
office site and of documents of a physician's practice that relate
to the provision of anesthesia in an outpatient setting. The board
may contract with another state agency or qualified person to
conduct these inspections.
(b) Unless it would jeopardize an ongoing investigation, the
board shall provide at least five business days' notice before
conducting an on-site inspection under this section.
(c) This section does not require the board to make an
on-site inspection of a physician's office.
Sec. 7.07. REQUESTS FOR INSPECTION AND ADVISORY OPINION. (a)
The board may consider a request by a physician for an on-site
inspection. The board may, in its discretion and on payment of a
fee in an amount established by the board, conduct the inspection
and issue an advisory opinion.
(b) An advisory opinion issued by the board under this
section is not binding on the board, and the board, except as
provided by Subsection (c) of this section, may take any action
under this Act in relation to the situation addressed by the
advisory opinion that the board considers appropriate.
(c) A physician who requests and relies on an advisory
opinion of the board may use the opinion as mitigating evidence in
an action or proceeding to impose an administrative or civil
penalty under this Act. The board or court, as appropriate, shall
take proof of reliance on an advisory opinion into consideration
and mitigate the imposition of administrative or civil penalties
accordingly.
SECTION 3. Section 3.10(b), Medical Practice Act (Article
4495b, Vernon's Texas Civil Statutes), as amended by Chapter 214,
Acts of the 73rd Legislature, Regular Session, 1993, is amended to
read as follows:
(b) The board may not set, charge, collect, receive, or
deposit any of the following fees in excess of:
(1) for processing and granting a license by
reciprocity to a licensee of another
state ..................................... $700
(2) for processing an application and administration
of a partial examination for licensure .... $700
(3) for processing an application and administration
of a complete examination for licensure ... $700
(4) for processing an application and issuance of a
temporary license ......................... $200
(5) for processing an application and issuance of a
duplicate license ......................... $200
(6) for processing an application and issuance of a
license of reinstatement after a lapse or
cancellation of a license ................. $700
(7) for processing an application and issuance of an
annual registration of a licensee ......... $200
(8) for processing and issuance of an institutional
permit for interns, residents, and others in
approved medical training programs ..... $200
(9) for processing an application and issuance of an
endorsement to other state medical
boards .................................... $200
(10) for processing and issuance of a license or
temporary license to a physician
assistant ................................ $200
(11) for processing and issuance of a permit to a
physician who supervises an
acupuncturist ............................ $200
(12) for processing an application and issuance of an
annual registration for anesthesia in an
outpatient setting ....................... $300
SECTION 4. Chapter 7, Title 71, Revised Statutes, is amended
by adding Article 4527e to read as follows:
Art. 4527e. ANESTHESIA IN OUTPATIENT SETTING
Sec. 1. DEFINITION. In this article, "outpatient setting"
means any facility, clinic, center, office, or other setting that
is not part of a licensed hospital or a licensed ambulatory
surgical center.
Sec. 2. RULES. (a) The board shall establish by rule the
minimum standards for the provision of anesthesia services in
outpatient settings by persons licensed by the board.
(b) The rules must be designed to protect the health,
safety, and welfare of the public and must include requirements
relating to:
(1) general anesthesia, regional anesthesia, and
monitored anesthesia care;
(2) patient assessment, counseling, and preparation;
(3) patient monitoring to be performed and equipment
to be used during a procedure and during post-procedure monitoring;
(4) emergency procedures, drugs, and equipment,
including education, training, and certification of personnel, as
appropriate, and including protocols for transfers to a hospital;
(5) the documentation necessary to demonstrate
compliance with this article; and
(6) the period in which protocols or procedures
covered by rules of the board shall be reviewed, updated, or
amended.
(c) The board shall cooperate with the Texas State Board of
Medical Examiners in the adoption of rules under this article to
eliminate to the extent possible conflicts between the rules
adopted by each board.
Sec. 3. APPLICABILITY. Rules adopted by the board under this
article do not apply to:
(1) an outpatient setting in which only local
anesthesia, peripheral nerve blocks, or both are used;
(2) an outpatient setting in which only anxiolytics
and analgesics are used and only in doses that do not have the
probability of placing the patient at risk for loss of the
patient's life-preserving protective reflexes;
(3) a licensed hospital;
(4) a licensed ambulatory surgical center;
(5) a clinic located on land recognized as tribal land
by the federal government and maintained or operated by a federally
recognized Indian tribe or tribal organization as listed by the
United States secretary of the interior under 25 U.S.C. Section
479a-1 or as listed under a successor federal statute or
regulation;
(6) a clinic directly maintained or operated by the
United States or by any of its departments, officers, or agencies;
or
(7) an outpatient setting accredited by:
(A) the Joint Commission for Health Care
Organizations relating to ambulatory surgical centers;
(B) the American Association for the
Accreditation of Ambulatory Surgical Facilities; or
(C) the Association for the Accreditation of
Ambulatory Health Care Centers.
Sec. 4. COMPLIANCE WITH ANESTHESIA RULES. (a) On or after
August 31, 2000, a certified registered nurse anesthetist providing
anesthesia services in an outpatient setting shall comply with the
rules adopted by the board under this article.
(b) The board may require a certified registered nurse
anesthetist to submit and comply with a corrective action plan to
remedy or address any current or potential deficiencies with the
nurse anesthetist's provision of anesthesia in an outpatient
setting in accordance with this chapter or rules of the board.
Sec. 5. BIENNIAL REGISTRATION. (a) Beginning September 1,
2000, the board shall require each certified registered nurse
anesthetist who provides anesthesia services in an outpatient
setting to biennially register with the board on a form prescribed
by the board and to pay a fee to the board in an amount established
by the board.
(b) The board shall coordinate the registration required
under this article with the license renewal provisions under
Article 4526, Revised Statutes, so that the times of registration,
payment, notice, and imposition of penalties for late payment are
similar and provide a minimum of administrative burden to the board
and to certified registered nurse anesthetists.
Sec. 6. INSPECTIONS. (a) The board may conduct inspections
to enforce this article, including inspections of the equipment
owned or leased by a certified registered nurse anesthetist and of
documents of a certified registered nurse anesthetist's practice
that relate to the provision of anesthesia in an outpatient
setting. The board may contract with another state agency or
qualified person to conduct these inspections.
(b) Unless it would jeopardize an ongoing investigation, the
board shall provide at least five business days' notice before
conducting an on-site inspection under this section.
(c) This section does not require the board to make an
on-site inspection of an outpatient setting where a certified
registered nurse anesthetist provides anesthesia.
Sec. 7. REQUESTS FOR INSPECTION AND ADVISORY OPINION. (a)
The board may consider a request by a certified registered nurse
anesthetist for an inspection of equipment owned or leased by the
nurse anesthetist and of documents of the nurse anesthetist's
practice that relate to the provision of anesthesia in an
outpatient setting. The board may, in its discretion and on
payment of a fee in an amount established by the board, conduct the
inspection and issue an advisory opinion.
(b) An advisory opinion issued by the board under this
section is not binding on the board and the board, except as
provided by Subsection (c) of this section, may take any action
under this chapter in relation to the situation addressed by the
advisory opinion that the board considers appropriate.
(c) A certified registered nurse anesthetist who requests
and relies on an advisory opinion of the board may use the opinion
as mitigating evidence in an action or proceeding by the board to
impose an administrative penalty or assess a monetary fine under
this chapter. The board shall take proof of reliance on an
advisory opinion into consideration and mitigate the imposition of
administrative penalties or the assessment of a monetary fine
accordingly.
SECTION 5. The Texas State Board of Medical Examiners and
Board of Nurse Examiners may permit the registration requirements
imposed under Subchapter G, Medical Practice Act (Article 4495b,
Vernon's Texas Civil Statutes), as added by this Act, and under
Article 4527e, Revised Statutes, as added by this Act, to be
staggered and phased in so that not later than September 1, 2002,
all physicians and certified registered nurse anesthetists required
to register under those laws will be in compliance.
SECTION 6. (a) The rules required under Subchapter G,
Medical Practice Act (Article 4495b, Vernon's Texas Civil
Statutes), as added by this Act, and under Article 4527e, Revised
Statutes, as added by this Act, must be adopted by the Texas State
Board of Medical Examiners and Board of Nurse Examiners, as
appropriate, not later than January 7, 2000.
(b) The boards shall report to the speaker of the house of
representatives and the lieutenant governor on the implementation
and enforcement of those rules and of the laws added by this Act
not later than January 1, 2001. The report must include any
suggested amendments or changes to the laws added by this Act to
make those laws more effective or efficient.
SECTION 7. This Act takes effect September 1, 1999.
SECTION 8. The importance of this legislation and the
crowded condition of the calendars in both houses create an
emergency and an imperative public necessity that the
constitutional rule requiring bills to be read on three several
days in each house be suspended, and this rule is hereby
suspended.