76R13567 E
By McCall H.B. No. 3217
Substitute the following for H.B. No. 3217:
By Hilderbran C.S.H.B. No. 3217
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of the practice of medicine.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 2.09, Medical Practice Act (Article
1-5 4495b, Vernon's Texas Civil Statutes), is amended by amending
1-6 Subsections (d), (h), (k), and (t) and adding Subsection (bb) to
1-7 read as follows:
1-8 (d) The board shall preserve a record of its proceedings
1-9 which shall be a public record. [The board shall also maintain
1-10 records showing the name, age, place, and duration of residence of
1-11 each applicant, the time spent in medical study in respective
1-12 medical schools, and the years and schools from which degrees were
1-13 granted.] The record shall [also] show whether applicants were
1-14 denied a license [rejected] or licensed and shall be prima facie
1-15 evidence of all matters contained in the record. A certified copy
1-16 of those permanent records, with the hand and seal of the executive
1-17 director [secretary-treasurer] of the board, shall be admitted in
1-18 evidence in all courts.
1-19 (h) The board may receive criminal records or reports from
1-20 any law enforcement agency or source pertaining to its licensees or
1-21 any applicant for license. The board may [shall] submit to the
1-22 Department of Public Safety a complete set of fingerprints of every
1-23 applicant for a license, and the Department of Public Safety shall
1-24 cause them to be classified and checked against those in their
2-1 fingerprint files and shall [forthwith] certify their findings
2-2 concerning the criminal record of the applicant or shall report the
2-3 lack of a criminal record, as the case may be, to the board. All
2-4 criminal records and reports received from the Department of Public
2-5 Safety shall be for the exclusive use of the board and shall be
2-6 privileged and shall not be released or otherwise disclosed to any
2-7 person or agency by the board except on court order. [Any
2-8 applicant for licensure or any licensee whose license is subject to
2-9 revocation, cancellation, or suspension because of adverse
2-10 information contained in the criminal records or reports shall be
2-11 afforded the opportunity for a hearing before the board prior to
2-12 any action on the application for license or revocation,
2-13 cancellation, or suspension of license.]
2-14 (k) The board by rule shall establish reasonable and
2-15 necessary fees so that the fees, in the aggregate, produce
2-16 sufficient revenue to cover the cost of administering this Act.
2-17 The fees set by the board may be adjusted so that the total fees
2-18 collected shall be sufficient to meet the expenses of administering
2-19 this Act. The board may not set a fee for an amount less than the
2-20 amount of that fee on September 1, 1993. The board may not waive
2-21 collection of any fee or penalty. The board shall place all money
2-22 [fees] received under authority of this Act[, not otherwise
2-23 specified, into the medical licensing fund] in the state treasury.
2-24 The board is authorized and shall by annual budget determine the
2-25 manner of handling the funds and the purpose, consistent with this
2-26 Act, for which the same may be used. The budgeted expenses
2-27 authorized by the board shall be paid out of funds received by the
3-1 board and are not a charge upon the general revenue of the state.
3-2 (t) The board shall on request of a licensee issue
3-3 certification on endorsement of its license to other states and
3-4 charge a reasonable fee for the issuance. The board shall, on the
3-5 request of a licensee, issue certification of the licensee's state
3-6 board examination grades to the Federation of State Medical Boards
3-7 and shall charge a reasonable fee for the issuance of that
3-8 certificate.
3-9 (bb) The executive director shall file a surety bond with
3-10 the board. The board shall pay the premium on the bond. The bond
3-11 must be:
3-12 (1) in an amount of not less than $10,000;
3-13 (2) in compliance with the insurance laws of this
3-14 state; and
3-15 (3) payable to the state for the use of the state if
3-16 the executive director does not faithfully discharge the executive
3-17 director's duties under this Act.
3-18 SECTION 2. Subchapter C, Medical Practice Act (Article
3-19 4495b, Vernon's Texas Civil Statutes), is amended by adding Section
3-20 3.015 to read as follows:
3-21 Sec. 3.015. ANNUAL REGISTRATION OF PHYSICIANS. (a) A
3-22 person qualified to practice medicine in this state, or who is
3-23 licensed for the practice of medicine by the board, shall register
3-24 annually as a practitioner with the board. The initial annual
3-25 registration permit shall be issued with the license.
3-26 (b) The annual registration permit fee as set by board rule
3-27 shall apply to each physician licensed by the board, whether or not
4-1 the physician is practicing in this state, other than a retired
4-2 physician or a physician licensed by the board whose only practice
4-3 is voluntary charity care exempted as provided by rules adopted by
4-4 the board.
4-5 (c) The board shall mail an annual registration permit
4-6 renewal application to each practitioner at the practitioner's last
4-7 known address according to the records of the board not later than
4-8 the 30th day before the expiration date of the annual registration
4-9 permit.
4-10 (d) The board shall allow a 30-day grace period for renewing
4-11 the annual registration permit. The grace period begins on the
4-12 date of the expiration of the annual registration permit.
4-13 (e) A licensee may renew the licensee's annual registration
4-14 permit by submitting to the board, on or before the expiration date
4-15 of the annual registration permit, the required renewal application
4-16 and renewal fee. Each annual registration permit renewal
4-17 application must include the name and mailing address of the
4-18 licensee, the address of each place where the licensee is engaged
4-19 in the practice of medicine, and other necessary information
4-20 required by the board.
4-21 (f) If the licensee is licensed to practice medicine by
4-22 another state, the District of Columbia, a territory of the United
4-23 States, another country, or the uniformed services of the United
4-24 States, the renewal application must include a description of any
4-25 investigations the licensee knows are in progress and of any
4-26 sanctions imposed by or disciplinary matters pending in the state,
4-27 district, territory, country, or service.
5-1 (g) On receipt of a renewal application, and the appropriate
5-2 fee, the board, after ascertaining, either from the records of the
5-3 board or from other sources considered by the board to be reliable,
5-4 that the applicant is a licensed practitioner of medicine in this
5-5 state, shall issue to the licensee an annual registration permit
5-6 certifying that the licensee has filed the renewal application and
5-7 has paid the annual registration permit fee for that year and has
5-8 completed the requirements for annual registration.
5-9 (h) If a licensee's annual registration permit has been
5-10 expired for 90 days or less, the licensee may renew the licensee's
5-11 annual registration permit by submitting to the board the required
5-12 renewal application, renewal fee, and a $50 late fee.
5-13 (i) If a licensee's annual registration permit has been
5-14 expired for longer than 90 days but less than one year, the
5-15 licensee may renew the licensee's annual registration permit by
5-16 submitting to the board the required renewal application, renewal
5-17 fee, and a $100 late fee.
5-18 (j) If a licensee's annual registration permit has been
5-19 expired for more than one year and an investigation is not pending
5-20 with regard to the licensee, the licensee's license is canceled and
5-21 the licensee may not renew the licensee's annual registration
5-22 permit. A physician whose license is canceled under this
5-23 subsection may obtain a new license by submitting to reexamination
5-24 and complying with the requirements, fees, and procedures for
5-25 obtaining a license. The board may issue a new license without
5-26 examination to a person whose license is canceled for less than two
5-27 years.
6-1 (k) The board by rule may adopt a system under which annual
6-2 registration permits expire on various dates during the year. For
6-3 the year in which the expiration date is changed, annual
6-4 registration permit fees shall be prorated. On renewal of the
6-5 annual registration on the new expiration date, the total annual
6-6 registration permit fee is payable.
6-7 (l) The filing of the renewal application, the payment of
6-8 the appropriate fee, and the issuance of the registration permit do
6-9 not entitle the registration applicant to practice medicine in this
6-10 state. The applicant must also have been previously licensed as a
6-11 practitioner by the board, as prescribed by law, and the
6-12 applicant's license to practice medicine must be in full force and
6-13 effect. In a prosecution for the unlawful practice of medicine,
6-14 the annual registration permit required by this Act may not be
6-15 treated as evidence that the holder of the registration permit is
6-16 lawfully entitled to practice medicine.
6-17 (m) Practicing medicine as defined in this Act without an
6-18 annual registration permit for the current year is subject to all
6-19 penalties under this Act of practicing medicine without a license.
6-20 SECTION 3. Subchapter C, Medical Practice Act (Article
6-21 4495b, Vernon's Texas Civil Statutes), is amended by adding
6-22 Section 3.021 to read as follows:
6-23 Sec. 3.021. PHYSICIAN-IN-TRAINING PERMITS. A physician not
6-24 otherwise licensed by the board who participates in a graduate
6-25 training program approved by the board may be issued a
6-26 physician-in-training permit as provided by board rule. The permit
6-27 does not authorize the performance of medical acts unless an act is
7-1 performed as part of a graduate medical education training program
7-2 and under the supervision of a licensed practitioner of medicine.
7-3 The board may discipline a physician whose permit has expired if
7-4 the violation of the law occurred during the time that the permit
7-5 was valid. If an investigation is pending on the date that the
7-6 permit expires, the board may retain jurisdiction over the
7-7 investigation.
7-8 SECTION 4. Subchapter C, Medical Practice Act (Article
7-9 4495b, Vernon's Texas Civil Statutes), is amended by adding Section
7-10 3.035 to read as follows:
7-11 Sec. 3.035. LICENSURE OF PHYSICIANS. (a) The board may
7-12 grant a license to practice medicine to any physician who qualifies
7-13 under this Act.
7-14 (b) An application for a license must be in writing and on
7-15 forms prescribed by the board. The board may allow or require by
7-16 board rule an applicant to use the Federation of State Medical
7-17 Boards' Credentials Verification System.
7-18 (c) The application form must be accompanied by all fees,
7-19 documents, and photographs required by board rule.
7-20 (d) An applicant for a license must subscribe to an oath in
7-21 writing before an officer authorized by law to administer oaths.
7-22 The written oath is a part of the application.
7-23 (e) An applicant is not eligible for a license if:
7-24 (1) the applicant holds a medical license that is
7-25 currently restricted for cause, canceled for cause, suspended for
7-26 cause, or revoked by a state of the United States, a province of
7-27 Canada, or a uniformed service of the United States;
8-1 (2) an investigation or a proceeding has been
8-2 instituted against the applicant for the restriction, cancellation,
8-3 suspension, or revocation in a state of the United States, a
8-4 province of Canada, or a uniformed service of the United States; or
8-5 (3) a prosecution is pending against the applicant in
8-6 any state, federal, or Canadian court for any offense that under
8-7 the laws of this state is a felony or a misdemeanor that involves
8-8 moral turpitude.
8-9 (f) Each applicant shall present proof satisfactory to the
8-10 board that any medical school attended by the applicant outside
8-11 this state is substantially equivalent to a medical school of this
8-12 state, as determined by board rule.
8-13 (g) An applicant who is a graduate of a medical school that
8-14 is located outside the United States or Canada shall present proof
8-15 satisfactory to the board that the applicant:
8-16 (1) is a graduate of a school whose curriculum meets
8-17 the requirements for an approved medical school as determined by a
8-18 committee of experts selected by the Texas Higher Education
8-19 Coordinating Board;
8-20 (2) has successfully completed three years of graduate
8-21 medical training in the United States or Canada that was approved
8-22 by the board;
8-23 (3) is eligible for a license to practice medicine in
8-24 the country in which the school is located except for any
8-25 citizenship requirements;
8-26 (4) possesses a valid certificate issued by the
8-27 Educational Commission for Foreign Medical Graduates; and
9-1 (5) has the ability to communicate in English.
9-2 (h) All medical or osteopathic medical education received by
9-3 the applicant in the United States must be accredited by an
9-4 accrediting body officially recognized by the United States
9-5 Department of Education as the accrediting body for medical
9-6 education leading to the doctor of medicine degree or the doctor of
9-7 osteopathy degree in the United States. This subsection does not
9-8 apply to postgraduate medical education or training.
9-9 (i) An applicant who is unable to comply with the
9-10 requirements of Subsection (h) of this section may be eligible for
9-11 an unrestricted license if the applicant:
9-12 (1) received the applicant's medical education in a
9-13 hospital or teaching institution sponsoring or participating in a
9-14 program of graduate medical education that is accredited by the
9-15 Accrediting Council for Graduate Medical Education, the American
9-16 Osteopathic Association, or the Texas State Board of Medical
9-17 Examiners in the same subjects as the medical or osteopathic
9-18 medical education as defined by board rule; or
9-19 (2) is a specialty board certified by a board approved
9-20 by the American Osteopathic Association or the American Board of
9-21 Medical Specialties.
9-22 (j) The executive director shall review each license
9-23 application and shall recommend to the board each applicant
9-24 eligible for licensure. The executive director also shall report
9-25 to the board the name of each applicant determined to be ineligible
9-26 for a license, accompanied by the reasons for the recommendation.
9-27 (k) An applicant considered ineligible for a license by the
10-1 executive director may request review of the recommendation by a
10-2 committee of the board not later than the 20th day after receipt of
10-3 the notice, and the executive director may refer any application to
10-4 the committee for a recommendation concerning eligibility. If the
10-5 committee finds the applicant ineligible for a license, that
10-6 recommendation, together with the reasons for the recommendation,
10-7 shall be submitted to the full board unless the applicant requests
10-8 a hearing not later than the 20th day after the date of receipt of
10-9 notice of the committee's determination. The hearing shall be
10-10 before an administrative law judge of the State Office of
10-11 Administrative Hearings and shall comply with Chapter 2001,
10-12 Government Code, the rules of the State Office of Administrative
10-13 Hearings, and the rules of the board. The committee may refer any
10-14 application for determination of eligibility to the full board.
10-15 The board shall, after receiving the administrative law judge's
10-16 proposed findings of fact and conclusions of law, determine the
10-17 eligibility of the applicant. The board shall issue a written
10-18 statement containing the reasons for the board's action to a
10-19 physician whose application is denied by the board.
10-20 (l) Examination questions that may be used in the future,
10-21 examinations other than the one taken by the person requesting the
10-22 examination, and deliberations and records relating to the
10-23 professional character and fitness of applicants are confidential
10-24 and are not subject to disclosure under Chapters 551 and 552,
10-25 Government Code.
10-26 (m) A report received or information gathered by the board
10-27 on an applicant is confidential and is not subject to disclosure
11-1 under Chapter 552, Government Code. However, the board may
11-2 disclose the report to the appropriate licensing authorities in
11-3 other states. The board shall report all licensure actions to
11-4 appropriate licensing authorities in other states and to the
11-5 Federation of State Medical Boards.
11-6 (n) In addition to the requirements prescribed by this
11-7 section, the board may require applicants to comply with other
11-8 requirements that the board considers appropriate.
11-9 SECTION 5. Subchapter C, Medical Practice Act (Article
11-10 4495b, Vernon's Texas Civil Statutes), is amended by adding Section
11-11 3.038 to read as follows:
11-12 Sec. 3.038. QUALIFICATIONS OF LICENSE APPLICANT. To be
11-13 eligible for issuance of a license, each applicant must present
11-14 proof satisfactory to the board that the applicant:
11-15 (1) is at least 21 years of age;
11-16 (2) is of good professional character and has not
11-17 violated Section 3.08 of this Act;
11-18 (3) has completed:
11-19 (A) 60 semester hours of college courses other
11-20 than in medical school that are acceptable to The University of
11-21 Texas at Austin for credit on a bachelor of arts degree or a
11-22 bachelor of science degree;
11-23 (B) the entire primary, secondary, and
11-24 pre-medical education required in the country of medical school
11-25 graduation, if the medical school is located outside the United
11-26 States or Canada; or
11-27 (C) substantially equivalent courses as
12-1 determined by board rule;
12-2 (4) is a graduate of a medical school that is located:
12-3 (A) in the United States or Canada that is
12-4 approved by board rule and has successfully completed one year of
12-5 graduate medical training in the United States or Canada that is
12-6 approved by board rule; or
12-7 (B) outside the United States or Canada and has
12-8 successfully completed three years of graduate medical training in
12-9 the United States or Canada that is approved by board rule;
12-10 (5) has successfully passed, after not more than three
12-11 attempts, an examination accepted or administered by the board; and
12-12 (6) has successfully passed a Texas medical
12-13 jurisprudence examination as determined by board rule.
12-14 SECTION 6. Subchapter C, Medical Practice Act (Article
12-15 4495b, Vernon's Texas Civil Statutes), is amended by adding
12-16 Section 3.055 to read as follows:
12-17 Sec. 3.055. EXAMINATIONS ACCEPTED OR ADMINISTERED. (a) The
12-18 board may administer or accept the following examinations for
12-19 licensure as determined by rule:
12-20 (1) a state board licensing examination;
12-21 (2) the Medical Council of Canada examination or its
12-22 successor;
12-23 (3) the National Board of Osteopathic Medical
12-24 Examiners examination or its successor;
12-25 (4) the National Board of Medical Examiners
12-26 examination or its successor;
12-27 (5) the Federation Licensing examination with a
13-1 weighted average for one sitting on or before June 1, 1985;
13-2 (6) the Federation Licensing examination after June 1,
13-3 1985;
13-4 (7) the United States Medical Licensing examination
13-5 or its successor; or
13-6 (8) a combination of the National Board of Medical
13-7 Examiners examination and Federation Licensing examination after
13-8 June 1, 1985, or the United States Medical Licensing examination,
13-9 Federation Licensing examination after June 1, 1985, and National
13-10 Board of Medical Examiners examination, as determined by board
13-11 rule.
13-12 (b) Each examination used by the board for a license to
13-13 practice medicine shall be given in writing in English and in a
13-14 manner that is fair and impartial to each individual and to each
13-15 school or system of medicine. An applicant who wishes to request a
13-16 reasonable accommodation due to a disability shall submit the
13-17 request on filing the application.
13-18 (c) The examination shall include subjects generally taught
13-19 by medical schools, a knowledge of which is commonly and generally
13-20 required of candidates for the degree of doctor of medicine or
13-21 doctor of osteopathy conferred by schools in this state.
13-22 (d) The board shall administer the Texas medical
13-23 jurisprudence examination to all applicants.
13-24 (e) The minimum passing grade for each examination used by
13-25 the board shall be determined by board rule.
13-26 (f) Examinations administered to evaluate basic medical
13-27 knowledge and clinical competency shall be prepared by a national
14-1 testing service or prepared by the board and validated by qualified
14-2 independent testing professionals.
14-3 (g) All questions, answers, and grades shall be preserved
14-4 for one year as directed by the board by rule.
14-5 (h) Each applicant shall be given notice of the date and
14-6 place of the examination if the examination is administered by the
14-7 board.
14-8 (i) Not later than the 120th day after the date on which an
14-9 examination is administered by the board, each examinee shall be
14-10 notified of the results of the examination. However, if an
14-11 examination is graded or reviewed by a national testing service,
14-12 the board shall notify each examinee of the results of the
14-13 examination not later than the 30th day after the date the board
14-14 receives the results from the testing service.
14-15 (j) All parts of the National Board of Osteopathic Medical
14-16 Examiners, National Board of Medical Examiners, Medical Council of
14-17 Canada, and Federation Licensing examinations after June 1, 1985,
14-18 and United States Medical Licensing examinations must be passed not
14-19 later than the seventh anniversary of the initial attempt to pass
14-20 the licensing examination, except that an applicant who is a
14-21 graduate of a program designed to lead to a doctor of philosophy
14-22 degree and either a doctor of medicine degree or doctor of
14-23 osteopathy degree must pass each part of those examinations not
14-24 later than the second anniversary of the date the applicant is
14-25 awarded a doctor of medicine degree or a doctor of osteopathy
14-26 degree.
14-27 (k) All parts of any examination used for licensure must be
15-1 passed within three attempts.
15-2 SECTION 7. Subchapter C, Medical Practice Act (Article
15-3 4495b, Vernon's Texas Civil Statutes), is amended by adding Section
15-4 3.105 to read as follows:
15-5 Sec. 3.105. FEES. (a) Except as provided by Section 3.115
15-6 of this Act, each fee, charge, and penalty received by the board
15-7 shall be deposited in the medical licensing fund account in the
15-8 general revenue fund and may be spent only for the enforcement of
15-9 this Act, the prohibition of the unlawful practice of medicine, the
15-10 dissemination of information to prevent the violation of the laws,
15-11 and the prosecution of those who violate the laws. All
15-12 distributions may be made only on written approval of the executive
15-13 director of the board or the executive director's designated
15-14 representative.
15-15 (b) The board may set, charge, collect, receive, and deposit
15-16 any of the following fees, not to exceed the stated limit:
15-17 (1) license, $900;
15-18 (2) first annual registration permit, $200;
15-19 (3) temporary license, $200;
15-20 (4) renewal of annual registration permit, $200;
15-21 (5) physician-in-training permit, $200;
15-22 (6) endorsement to other state medical boards, $200;
15-23 (7) duplicate license, $200; and
15-24 (8) reinstated license after cancellation for cause,
15-25 $700.
15-26 (c) The board may set and collect a charge for making copies
15-27 of records in the office of the board and for any material
16-1 published by the board.
16-2 (d) The financial transactions of the board are subject to
16-3 audit by the state auditor in accordance with Chapter 321,
16-4 Government Code.
16-5 (e) The board shall file annually with the governor and the
16-6 presiding officer of each house of the legislature a complete and
16-7 detailed written report accounting for all funds received and
16-8 disbursed by the board during the preceding fiscal year. The
16-9 annual report must be in the form and reported in the time provided
16-10 by the General Appropriations Act.
16-11 SECTION 8. Subchapter C, Medical Practice Act (Article
16-12 4495b, Vernon's Texas Civil Statutes), is amended by adding Section
16-13 3.115 to read as follows:
16-14 Sec. 3.115. DISPOSITION OF CERTAIN FEES. (a) An additional
16-15 $200 fee shall apply to each of the following fees:
16-16 (1) license;
16-17 (2) first annual registration permit;
16-18 (3) renewal of annual registration permit; and
16-19 (4) reinstated license after cancellation for cause.
16-20 (b) Of each fee collected, $50 shall be deposited to the
16-21 credit of the foundation school fund and $150 shall be deposited to
16-22 the credit of the general revenue fund. This subsection applies to
16-23 the disposition of the stated portion of each fee regardless of any
16-24 other provision of law providing for a different disposition of
16-25 funds.
16-26 SECTION 9. The following sections of the Medical Practice
16-27 Act (Article 4495b, Vernon's Texas Civil Statutes) are repealed:
17-1 (1) Section 2.10, as added by Chapter 36, Acts of the
17-2 73rd Legislature, Regular Session, 1993;
17-3 (2) Section 3.01;
17-4 (3) Section 3.02;
17-5 (4) Section 3.03;
17-6 (5) Section 3.0305;
17-7 (6) Section 3.031;
17-8 (7) Section 3.04;
17-9 (8) Section 3.05;
17-10 (9) Section 3.10; and
17-11 (10) Section 3.11A.
17-12 SECTION 10. This Act takes effect September 1, 1999.
17-13 SECTION 11. The importance of this legislation and the
17-14 crowded condition of the calendars in both houses create an
17-15 emergency and an imperative public necessity that the
17-16 constitutional rule requiring bills to be read on three several
17-17 days in each house be suspended, and this rule is hereby suspended.