By: Carona S.B. No. 883
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
AN ACT
1-1 Relating to the regulation of anesthesia in certain out patient
1-2 settings; providing administrative and civil penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. The Medical Practice Act, (Article 4495b,
1-5 Vernon's Texas Civil Statutes) is amended to add a new subchapter G
1-6 to read as follows:
1-7 Section 7.01. Finding and Purposes. The legislature finds
1-8 that the practice of medicine is a dynamic art and science that
1-9 involves highly technical, rapidly changing standards of care. The
1-10 legislature further finds that the regulation of in office surgical
1-11 procedures would benefit the health, safety, and general welfare of
1-12 the public. It is therefore the purpose of this Act to require the
1-13 Texas State Board of Medical Examiners to adopt rules to regulate
1-14 the use of anesthesia for in other settings.
1-15 Section 7.02. Rules. (a) The board shall establish by rule
1-16 the minimum standards for provision of anesthesia for in office
1-17 procedures.
1-18 (b) The rules shall include:
1-19 (1) Requirements for general, regional and
1-20 conscious sedation;
1-21 (2) Patient counseling and preparation,
1-22 including patient assessment, history and physical, and any
2-1 necessary laboratory tests;
2-2 (3) patient monitoring to be performed and
2-3 monitoring equipment to be used during the procedure during post
2-4 procedure monitoring;
2-5 (4) The personnel necessary for all phases of
2-6 anesthesia and monitoring of patients, including education,
2-7 training and licensure as appropriate;
2-8 (5) Medical supervision and coordination of
2-9 patient care responsibility;
2-10 (6) Emergency procedures, drugs and equipment,
2-11 including, education, training, certification, as appropriate, and
2-12 protocols for transfers to a hospital;
2-13 (7) The documentation requirements necessary to
2-14 demonstrate compliance with this Subchapter; and
2-15 (8) The time frame to review, update, or amend
2-16 protocols or procedures covered by rules of the board.
2-17 Section 7.03. Application. The requirement to comply with
2-18 rules adopted by the board under this Subchapter do not apply to:
2-19 (1) An in office setting using only local
2-20 anesthesia or peripheral nerve blocks or both;
2-21 (2) An in office setting using only anxiolytics
2-22 and analgesics in doing that do not have the probability of placing
2-23 the patient at risk for loss of the patient's life preserving
2-24 protective reflexes.
2-25 (3) A licensed hospital;
2-26 (4) An ambulatory surgical center that is
3-1 certified to participate in the Medicare program under Title XVIII
3-2 (42 USC, sec. 1395, et seq. of the Federal Social Security Act;
3-3 (5) Any clinic conducted, maintained, or
3-4 operated by a federally recognized Indian tribe or tribal
3-5 organization, as defined in Section 450 or 1601 or Title 25 of the
3-6 United State Code, and located on land recognized as tribal land by
3-7 the federal government; and
3-8 (6) Any clinic directly conducted, maintained,
3-9 or operated by the United States or by any of its departments,
3-10 officers, or agencies.
3-11 Section 7.04. Compliance with Anesthesia Rules. (a) on or
3-12 after September 1, 2000, a physician or surgeon practicing medicine
3-13 in this state and performing in office surgical procedures shall
3-14 comply with the rules adopted under this subchapter.
3-15 (b) A failure to comply with the rules adopted under
3-16 this Subchapter shall be grounds for disciplinary action under
3-17 Section 3.08 of Subchapter C of this Act, an administrative penalty
3-18 under Section 4.125 of Subchapter D of this Act and a Civil Penalty
3-19 under Section 4.126 of Subchapter D, of this Act.
3-20 (c) The board, in its discretion, may require a
3-21 physician to submit and comply with a corrective action plan to
3-22 remedy or address any current or potential deficiencies with the
3-23 physicians in office provision of anesthesia as required by this
3-24 Act or a rule of the board.
3-25 Section 7.05. Annual Registration. (a) on or after
3-26 September 1, 2000, each physician who performs in office procedures
4-1 using anesthesia shall register with the board on a form adopted by
4-2 the board and shall pay a fee as established by the board. The
4-3 payment shall be made to the board. The physician shall register
4-4 annually each year thereafter.
4-5 (b) The board shall coordinate the registration
4-6 required under this Subchapter with the registration required under
4-7 Section 3.01 of Subchapter C of this Act so that times of
4-8 registration, payment, notice and penalties for late payment are
4-9 similar and provide a minimum of administrative burden to the board
4-10 and physician.
4-11 Section 7.06. Inspection. (a) The board shall have the
4-12 authority to conduct examinations including examinations of the
4-13 office site and related documents of a physician's practice as it
4-14 relates to in office procedures.
4-15 (b) Unless it would jeopardize an ongoing
4-16 investigation, the board shall provide at lease five business days
4-17 notice prior to conducting an on site examination.
4-18 (c) This Section shall not be construed to require the
4-19 board to make a site visit of a physician's office.
4-20 (d) (1) The board may consider a request by a
4-21 physician for an on site visit. The board, in its sole discretion,
4-22 and upon payment of a fee established by the board, may conduct
4-23 such examination and provide an advisory opinion.
4-24 (2) An advisory opinion by the board is not to
4-25 be construed as binding on the board and the board, except as
4-26 provided in Subdivision (3) of this Subsection, may take any action
5-1 it deems appropriate.
5-2 (3) A physician who requests and relies upon an
5-3 advisory opinion of the board, may use such opinion as mitigation
5-4 evidence against an administrative or civil penalty that may be
5-5 imposed by the board under this Act. The board shall take proof of
5-6 such reliance into its consideration and mitigate such
5-7 administrative or civil penalties accordingly.
5-8 SECTION 2. Subsection (b), Section 3.10, Medical Practice Act
5-9 (Article 4495b, Vernon's Texas Civil Statute) is amended by adding
5-10 a new subparagraph (12) to read as follows:
5-11 (1) for processing and granting a license by
5-12 reciprocity of a licensee of another state.....................$700
5-13 (2) for processing an application and administration
5-14 of a partial examination for licensure.........................$700
5-15 (3) for processing an application and administration
5-16 of a complete examination for licensure........................$700
5-17 (4) for processing an application and issuance of a
5-18 temporary license..............................................$200
5-19 (5) for processing an application and issuance of a
5-20 duplicate license..............................................$200
5-21 (6) for processing an application and issuance of a
5-22 license of reinstatement after a lapse or cancellation of a license
5-23 ...............................................................$700
5-24 (7) for processing an application and issuance of an
5-25 annual registration of a license...............................$200
5-26 (8) for processing and issuance of an institutional
6-1 permit for interns, residents, and others in approved medical
6-2 training programs..............................................$200
6-3 (9) for processing an application and issuance of an
6-4 endorsement to other state medical boards......................$200
6-5 (10) for processing and issuance of a license or
6-6 temporary license to a physician assistant.....................$200
6-7 (11) for processing and issuance of a permit to a
6-8 physician who supervises an acupuncturist......................$200
6-9 (12) for processing an application and issuance of an
6-10 annual registration for in office anesthesia of a license.....$300.
6-11 SECTION 3. The board may permit the annual registration
6-12 requirement under SECTION 1 of this Act to be staggered and phased
6-13 in over a period of one year so that by September 1, 2001 all
6-14 physicians required to register under this Act will be in
6-15 compliance.
6-16 SECTION 4. The rules required by SECTION 1 of this Act must
6-17 be adopted by January 7, 2000.
6-18 SECTION 5. The board shall report to the Speaker of the
6-19 House and the Lt. Governor on the implementation and enforcement of
6-20 the rules and this Act by January 1, 2001. The report shall
6-21 include any suggested amendments or changes to this Act to make it
6-22 more effective or efficient.
6-23 SECTION 6. This Act takes effect September 1, 1999.
6-24 SECTION 7. The importance of this legislation and the
6-25 crowded condition of the calendars in both houses create an
6-26 emergency and an imperative public necessity that the
7-1 constitutional rule requiring bills to be read on three several
7-2 days in each house be suspended, and this rule is hereby suspended.