SRC-SLL, ARR S.B. 1340 76(R)BILL ANALYSIS Senate Research CenterS.B. 1340 By: Carona Health Services 9/2/1999 Enrolled DIGEST Currently, in Texas some physicians have failed to maintain certain appropriate safety standards regarding the use of anesthesia their office, and as a result have placed patients at risk for complications or even death. S.B. 1340 directs the Texas Board of Medical Examiners to establish minimum standards for office procedures involving anesthesia. PURPOSE As enrolled, S.B. 1340 regulates anesthesia in certain outpatient settings and provides administrative penalties. RULEMAKING AUTHORITY Rulemaking authority is granted to the Texas Board of Medical Examiners in SECTION 2 (Section 7.02, Article 4495b, V.T.C.S.) and the Board of Nurse Examiners in SECTION 4 (Section 2, Article 4527e, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Sets forth the findings of the legislature. Requires the Texas State Board of Medical Examiners (board) and the Board of Nurse Examiners to adopt rules to regulate the provision of anesthesia services in outpatient surgical settings that are not part of a licensed hospital or licensed ambulatory surgical center. SECTION 2. Amends Article 4495b, V.T.C.S. (The Medical Practice Act), by adding Subchapter G, as follows: SUBCHAPTER G. ANESTHESIA IN OUTPATIENT SETTING Sec. 7.01. DEFINITION. Defines "outpatient setting." Sec. 7.02 RULES. Requires the board to establish, by rule, the minimum standards for provision of anesthesia services in outpatient settings by persons licensed by the board. Requires the rules to include certain provisions. Sec. 7.03. APPLICABILITY. Sets forth the applicability of rules adopted by the board under this subchapter. Sec. 7.04. COMPLIANCE WITH ANESTHESIA RULES. Requires a physician practicing medicine in this state and who administers anesthesia or performs a surgical procedure for which anesthesia services are provided in an outpatient setting to comply with the rules adopted under this subchapter, on or after August 31, 2000. Authorizes the board to 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. Requires the board to 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 prescribed form by the board and to pay a fee in an amount established by the board, beginning September 1, 2000. Requires the board to coordinate the registration required 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. Authorizes the board to conduct inspections to enforce this subchapter, including inspection of the office site and documents related to the provision of anesthesia in an outpatient setting. Authorizes the board to contract with another state agency or qualified person to conduct these inspections. Requires the board to provide at least five business days notice prior to conducting an on-site inspection, unless if would jeopardize an ongoing investigation. Provides that 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. Sets forth provisions regarding requests by a physician for an on-site inspection and the issuance of an advisory opinion by the board. SECTION 3. Amends Section 3.10(b), Article 4495b, V.T.C.S., by adding Subparagraph (12), to set forth certain fees, including a fee of $300 for processing an application and registration for anesthesia in an outpatient setting. SECTION 4. Amends Chapter 7, Title 71, V.T.C.S., by adding Article 4527e, as follows: Art. 4527e. ANESTHESIA IN OUTPATIENT SETTING Sec. 1. DEFINITION. Defines "outpatient setting." Sec. 2. RULES. Requires the Board of Nurse Examiners (examiners) to establish, by rule, the minimum standards for the provision of anesthesia services in outpatient settings by persons licensed by the board. Requires the rules to be designed to protect the health, safety, and welfare of the public and to include certain requirements. Sec. 3. APPLICABILITY. Sets forth the applicability of rules adopted under this article. Sec. 4. COMPLIANCE WITH ANESTHESIA RULES. Requires a certified registered nurse anesthetist (nurse) providing anesthesia services in an outpatient setting on or after August 31, 2000, to comply with the rules adopted by the examiners under this article. Authorizes the examiners to require a nurse to submit and comply with a corrective action plan to remedy or address any current or potential deficiencies with the nurse's provision of anesthesia in an outpatient setting in accordance with this chapter or rules of the examiners. Sec. 5. BIENNIAL REGISTRATION. Sets forth provisions regarding the biennial registration of nurses who provide anesthesia in outpatient settings. Sec. 6. INSPECTIONS. Authorizes the examiners to conduct inspections to enforce this article. Authorizes the examiners to contract with another state agency or qualified person to conduct these inspections. Requires the examiners to provide at least five business days' notice before conducting an on-site inspection unless it would jeopardize an ongoing investigation. Provides that this section does not require the examiners to make an on-site inspection of an outpatient setting where a nurse provides anesthesia. Sec. 7. REQUESTS FOR INSPECTION AND ADVISORY OPINION. Sets forth provisions regarding requests by a nurse for an inspection of certain items and the issuance of an advisory opinion by the examiners. SECTION 5. Authorizes the board and the examiners to permit the registration requirements under Subchapter G, Article 4495b, V.T.C.S., as added by this Act, to be staggered and phased in so that not later than September 1, 2002 all physicians and nurses required to register under those laws will be in compliance. SECTION 6. Requires the rules required under Subchapter G, Article 4495b, V.T.C.S., as added by this Act, to be adopted by January 7, 2000. Requires the board to report to the speaker of the house and the lieutenant governor on the implementation and enforcement of the rules and the laws added by this Act by January 1, 2001. Requires the report to include any suggested amendments or changes to this Act to make it more effective or efficient. SECTION 7. Effective date: September 1, 1999. SECTION 8. Emergency clause.