SRC-JXG S.B. 1207 76(R)   BILL ANALYSIS


Senate Research Center   S.B. 1207
By: Cain
Health Services
4/11/1999
As Filed


DIGEST 

Currently, under the Medical Practice Act of Texas, physicians are
licensed. The Medical Practice Act assures that physicians who are seeking
licensure in Texas by way of endorsement, or original licenses that are
reviewed, examined, and evaluated according to the appropriate standards.
The Texas Board of Medical Examiners (board) is the state agency created by
the legislature to carry out the constitutional mandate of Section 31,
Article XVI, Texas Constitution, which requires the legislature to pass
laws for malpractice. The mission of the board is to assure the safety of
its citizens through the appropriate regulation of physicians who practice
medicine in Texas. The Medical Practice Act has been amended to adapt to
the changing social, educational, and economic times, since its inception.
S.B. 1207 would consolidate relevant sections of the Medical Practice Act,
by creating coherent sections with all the necessary provisions for
licensure of physicians.  

PURPOSE

As proposed, S.B. 1207 sets forth licensure requirements for physicians.

RULEMAKING AUTHORITY

Rulemaking authority is granted to the Texas Board of Medical Examiners in
SECTION 2 (Sections 3.01(b)(m), 3.03(b)(c)(f), 3.04(3)(c)(6), 3.05(e)(g),
Article 4495(b), V.T.C.S.). 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 2.09, Article 4495b, V.T.C.S., (Medical Practice
Act), by amending Subsections (d), (h), (k), and (t) and adding Subsection
(bb), to require the record to show whether applicants were denied or
licensed. Requires a certified copy of those permanent records, with the
hand or seal of the executive director, rather than secretary treasurer, of
the Texas State Board of Medical Examiners (board), to be admitted in
evidence in all courts. Authorizes the board to submit to the Department of
Public Safety a complete set of fingerprints of every applicant for a
license. Requires the board to place all receipts collected under authority
of this Act. Requires the board on request of a licensee issue
certification of state board examination grades to the Federation of State
Medical Boards of the United States and charge a reasonable fee for the
issuance. Requires the executive director of the board to file a surety
bond with the board. Requires the bond to be in an amount no less than
$10,000, be in compliance with the insurance laws of the state, and be
payable to the state for the use of the state, if the executive director
does not faithfully discharge the duties of the office. Requires the board
to pay the premium on the bond. Deletes text regarding license cancellation
or suspension. Deletes text regarding fees received put into the medical
licensing fund. Makes conforming changes. 

SECTION 2. Amends Sections 3.01-3.05, Article 4495b, V.T.C.S., as follows:

Sec. 3.01. New heading: ANNUAL REGISTRATION OF PHYSICIANS. Requires all
persons now lawfully qualified to practice medicine in this state, or who
are hereafter licensed for the practice of medicine by the board, to
register annually as practitioners with the board. Requires the initial
annual registration permit to be issued with the license. Requires the
annual registration permit fee as established by board rule to apply to all
physicians licensed by the board, whether or not they are practicing within
the borders of this state, except retired physicians as provided by rules
of the board. Provides that a physician  licensed by the board whose only
practice is voluntary charity care is exempt from the annual registration
permit fee as provided by rules of the board. Requires the board to mail an
annual registration permit renewal application to each practitioner at the
practitioner's last known address according to the records of the board at
least 30 days prior to the expiration date of the annual registration
permit. Requires the board to provide for a 30-day grace period for
renewing the annual registration permit from the date of the expiration of
the annual registration permit. Authorizes a licensee to renew the annual
registration permit by submitting to the board, on or before the expiration
date of the annual registration permit, the required renewal application
and renewal fee. Requires each annual registration permit renewal
application to include the name and mailing address of the licensee, the
place or places where the licensee is engaged in the practice of medicine,
and other necessary information prescribed by the board. Requires the
renewal application to include a description of any investigations the
licensee knows are in progress and of any sanctions imposed by or
disciplinary matters pending in the state, district, territory, country, or
service, if the licensee is licensed for the practice of medicine in
another state, the District of Columbia, a territory of the United States,
Canada, any other country, or the uniformed services of the United States.
Requires on receipt of a renewal application and all required fees, the
board, after ascertaining, either from the records of the board or from
other sources considered by it to be reliable, that the applicant is a
licensed practitioner of medicine in this state, to issue to the licensee
an annual registration permit certifying that the licensee has filed the
renewal application, has paid the annual registration permit fee for the
year in question, and has completed the requirements for annual
registration. Authorizes a licensee to renew his or her annual registration
permit by submitting to the board the required renewal application, renewal
fee, and a $50 penalty fee, if a licensee's annual registration permit has
been expired for 90 days or less. Authorizes the licensee to renew the
annual registration permit by submitting to the board the required renewal
application, renewal fee, and a $100 penalty fee, if a licensee's annual
registration permit has been expired for longer than 90 days but less than
one year. Provides that the license is considered to have been canceled,
and the licensee may not renew the annual registration permit, if a
licensee's annual registration permit has been expired for one year or
longer. Authorizes each physician whose license is considered canceled to
obtain a new license by submitting to reexamination and complying with the
requirements, fees, and procedures for obtaining a license. Authorizes the
board to issue a new license without examination to a person whose license
is considered canceled for less than two years. Authorizes the board, by
rule, to adopt a system under which annual registration permits expire on
various dates during the year. Requires annual registration permit fees to
be prorated, for the year in which the expiration date is changed. Provides
that the total annual registration permit fee is payable, on renewal of the
annual registration on the new expiration date. Requires the filing of the
renewal application, the payment of the required fees, and issuance of the
permit to not entitle the holder to practice medicine in Texas, unless the
holder has been previously licensed as a practitioner by the board, as
prescribed by law, and the license to practice medicine is in full force
and effect. Prohibits the annual registration permit required by this Act
from being treated as evidence that the holder is lawfully entitled to
practice medicine, in any prosecution for the unlawful practice of
medicine. Provides that practicing medicine as defined in this Act without
an annual registration permit for the current year as provided in this Act
has the same force and effect as and is subject to all penalties of
practicing medicine without a license. Deletes text regarding registration
with the board, licenses, renewing licenses, and fees. Deletes text
regarding unlawful practice of medicine, annual registration fee, and
application for licensure.  

Sec. 3.02. New heading: PHYSICIAN IN TRAINING PERMITS. Authorizes
physicians not otherwise licensed by the board who are participating in
graduate medical education training programs approved by the board to be
issued physician in training permits as provided by rules of the board.
Provides that this permit does not authorize the performance of medical
acts except as the acts are performed as part of graduate medical education
training programs and under the supervision of a licensed practitioner of
medicine. Provides that the board has jurisdiction to discipline a
physician whose physician in training permit has expired if the violation
of the law occurred during the time that the permit was valid. Requires the
permit to be executory and the board to retain jurisdiction, if an
investigation is open when the  permit expires. Deletes text regarding
application for receipt or renewal fees, and authorizing the board to adopt
a system for expired registration dates. 

Sec. 3.03. New heading: LICENSURE OF PHYSICIANS. Authorizes the board to
grant a license to practice medicine to any physician who qualifies under
this Act. Requires an application for a license to be in writing and on
forms prescribed by the board. Authorizes the board to allow or require
applicants, by board rule, to use the Credentials Verification Service
offered by the Federation of State Medical Boards of the United States.
Requires the application forms to be accompanied by all fees, documents,
and photographs required by board rule. Requires applicants for a license
to subscribe to an oath in writing before an officer authorized by law to
administer oaths. Provides that the written oath is part of the
application. Provides that an applicant may not be issued a license if
certain conditions exist. Requires an applicant to present satisfactory
proof to the board that each medical school attended is substantially
equivalent to a Texas medical school as determined by board rule. Requires
an applicant who is a graduate of a medical school that is located outside
the United States and Canada to present satisfactory proof to the board
that the applicant meets certain requirements. Requires all medical or
osteopathic medical education received by the applicant in the United
States to be accredited by an accrediting body officially recognized by the
United States Department of Education as the accrediting body for medical
education leading to the doctor of medicine degree or the doctor of
osteopathy degree in the United States. Provides that this subsection does
not apply to postgraduate medical education or training. Authorizes an
applicant who is unable to comply with the requirements of Subsection (h)
of this section to be eligible for an unrestricted license if the applicant
meets certain conditions. Requires the executive director to review each
application for licensure and to recommend to the board all applicants
eligible for licensure. Requires the executive director to also report to
the board the names of all applicants determined to be ineligible for
licensure, together with the reasons for each recommendation. Authorizes an
applicant deemed ineligible for licensure by the executive director to
request review of such recommendation by a committee of the board within 20
days of receipt of such notice, and the executive director to refer any
application to the committee for a recommendation concerning eligibility.
Authorizes the committee to refer any application for determination of
eligibility to the full board. Provides that if the committee finds the
applicant ineligible for licensure, such recommendation, together with the
reasons for the recommendation, to be submitted to the board unless the
applicant requests a hearing with 20 days of receipt of notice of the
committee's determination. Requires the hearing to be before an
administrative law judge of the State Office of Administrative Hearings and
to comply with Chapter 2001, Government Code, and the rules of the State
Office of Administrative Hearing (office) and the board, if the applicant
requests a hearing. Requires the board, after receiving the administrative
law judge's proposed findings of fact and conclusions of law, determine the
eligibility of the applicant for licensure. Requires a physician whose
application for licensure is denied by the board to receive a written
statement containing the reasons for the board's action. Provides that
examination questions that may be used in the future, examinations other
than the one taken by the person requesting it, and deliberations and
records relating to the professional character and fitness of applicants
are exempted from the open meeting law, Chapter 551, Government Code, and
the public information law, Chapter 552, Government Code. Provides that all
reports received or gathered by the board on each applicant are
confidential and are not subject to disclosure under the public information
law, Chapter 552, Government Code. Authorizes the board to disclose such
reports to appropriate licensing authorities in other states. Requires the
board to report all licensure actions to appropriate licensing authorities
in other states and to the Federation of State Medical Boards of the United
States. Authorizes the board to require applicants to comply with other
requirements that the board considers appropriate, in addition to the
requirements prescribed by this Act. Deletes text regarding payment of a
fee by the applicants and the requirements of an application for license.  

Sec. 3.04. New heading: QUALIFICATIONS OF LICENSEES. Requires an applicant
to present satisfactory proof to the board that the applicant is of good
professional character and has not violated Section 3.08 of this Act; and
has completed the entire primary, secondary, and premedical education
required in the country of medical school graduation, if the  medical
school is located outside the United States or Canada; or substantially
equivalent courses as determined, by board rule; is a graduate of a medical
school located inside the United States or Canada and approved by the board
who has successfully complete one year of graduate medical training
approved by the board in the United States or Canada or is a graduate of a
medical school located outside the United States or Canada who has
successfully completed three years of graduate medical training approved by
the board in the United States or Canada; has successfully passed within
three attempts an examination accepted or administered by the board; and
has successfully passed a Texas medical jurisprudence examination as
determined by board rule. Deletes text regarding applications for
examinations and licensure requirements for applicants. Makes conforming
changes and nonsubstantive changes.  

Sec. 3.05. New heading: EXAMINATIONS ACCEPTED OR ADMINISTERED. Authorizes
the board to administer or accept certain examinations for licensure as
determined by rule. Requires all examinations used by the board for
licensure to practice medicine to be in writing. Requires applicants who
wish to request reasonable accommodations due to a disability to submit the
request on filing the application. Requires examinations to include
subjects generally required of candidates for the degree of doctor of
medicine or doctor of osteopathy conferred by schools in Texas. Requires
the board to administer the Texas medical jurisprudence examination to all
applicants. Authorizes the minimum passing grade for all examinations used
by the board to be determined, by rule. Provides that examinations
administered to evaluate basic medical knowledge and clinical competency to
be prepared by a national testing service or the board and validated by
qualified independent testing professionals. Authorizes all questions,
answers, and grades to be preserved for one year as the board may direct,
by rule. Requires all applicants to be given due notice of the date and
place of the examination if administered by the board. Requires each
examinee to be notified of the results of the examination, within 120 days
after the day on which an examination is administered by the board.
Requires the board to notify each examinee of the results of the
examination no later than 30 days after the date the board receives the
results from the testing service, if an examination is graded or reviewed
by national testing service. Requires all parts of the Medical Council or
Canada Examination, the National Board of Osteopathic Medical Examiners
examination, the National Board of Medical Examiners examination, the
Federation Licensing Examination after May 1985, and the United States
Medical Licensing Examination to be passed within seven years. Requires
each part of any examination used for licensure to be passed within three
attempts. Deletes text regarding examination requirements. Makes conforming
changes. 

SECTION 3. Amends Section 3.10, Article 4495b, V.T.C.S., to require all
receipts collected by the board to be placed in the state treasury.
Requires the fees deposited to be credited to the appropriations of the
board and to be spent only for the enforcement of this Act, the prohibition
of the unlawful practice of medicine, the dissemination of information to
prevent the violation of the laws, and the prosecution of those who violate
the laws. Authorizes all distributions to be made only on written approval
of the executive director of the board or his designated representative.
Provides that the board may not set, charge, collect, receive, or deposit
fees in excess of certain amounts. Authorizes the amount to set and collect
a sales charge for making copies of records in the office of the board and
for any material published by the board. Provides that the financial
transactions of the board are subject to audit by the state auditor in
accordance with Chapter 321, Government Code. Requires the board to file
annually with the governor and the presiding officer of each house of the
legislature a complete and detailed written report accounting for all funds
received and disbursed by the board during the preceding fiscal year.
Requires the  annual report to be in the form and reported in the time
provided  by the General Appropriations Act. Deletes text regarding the
medical registration fund, depositing certain fees, and a written report
accounting for all fund disbursed to the board.  

SECTION 4. Amends Section 3.11A, Article 4495b, V.T.C.S., as follows: 

Sec. 3.11A. New heading: SURCHARGE; DISPOSITION. Requires an additional
$200 surcharge to be added to the fee for license and first annual
registration permit, renewal of annual registration permit, and reinstated
license after cancellation for cause. Requires a  certain surcharge, rather
than fee, to be deposited to the foundation school fund and general revenue
fund. Deletes text regarding certain disposition of fees.   

SECTION 5. Repealer: Section 2.10, Chapter 36, Acts of the 73rd
Legislature, Regular Session,             1993 (Creation of Funds) 
           Repealer: Section 3.0305, Article 4495b, V.T.C.S. (Temporary
License for Out-of-                        State Practitioners) 
          Repealer: Section 3.031, Article 4495b, V.T.C.S. (Temporary
reciprocal license for             physicians employed by Texas Department
of Mental Health and Mental Retardation) 

SECTION 6. Emergency clause.
           Effective date: upon passage.