By: Carona S.B. No. 1340
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the regulation of anesthesia in certain outpatient
1-2 settings.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. (a) The legislature finds that it is necessary
1-5 to regulate the provision of anesthesia services in outpatient
1-6 surgical settings that are not part of a licensed hospital or a
1-7 licensed ambulatory surgical center to protect the health, safety,
1-8 and welfare of the public. The legislature further finds that the
1-9 provision of anesthesia services in these settings is appropriately
1-10 regulated by the professional licensing boards of the licensed
1-11 professionals who provide anesthesia services.
1-12 (b) It is the purpose of this Act to require the Texas State
1-13 Board of Medical Examiners and the Board of Nurse Examiners to
1-14 adopt rules for their respective license holders that will regulate
1-15 the provision of anesthesia services in outpatient surgical
1-16 settings that are not a part of a licensed hospital or licensed
1-17 ambulatory surgical center.
1-18 SECTION 2. The Medical Practice Act (Article 4495b, Vernon's
1-19 Texas Civil Statutes) is amended by adding Subchapter G to read as
1-20 follows:
1-21 SUBCHAPTER G. ANESTHESIA IN OUTPATIENT SETTING
1-22 Sec. 7.01. DEFINITION. In this subchapter, "outpatient
1-23 setting" means any facility, clinic, center, office, or other
1-24 setting that is not part of a licensed hospital or a licensed
2-1 ambulatory surgical center.
2-2 Sec. 7.02. RULES. (a) The board shall establish by rule
2-3 the minimum standards for the provision of anesthesia services in
2-4 outpatient settings by persons licensed by the board.
2-5 (b) The rules must be designed to protect the health,
2-6 safety, and welfare of the public and must include requirements
2-7 relating to:
2-8 (1) general anesthesia, regional anesthesia, and
2-9 monitored anesthesia care;
2-10 (2) patient evaluation, diagnosis, counseling, and
2-11 preparation;
2-12 (3) patient monitoring to be performed and equipment
2-13 to be used during a procedure and during post-procedure monitoring;
2-14 (4) emergency procedures, drugs, and equipment,
2-15 including education, training, and certification of personnel, as
2-16 appropriate, and including protocols for transfers to a hospital;
2-17 (5) the documentation necessary to demonstrate
2-18 compliance with this subchapter; and
2-19 (6) the period in which protocols or procedures
2-20 covered by rules of the board shall be reviewed, updated, or
2-21 amended.
2-22 (c) The board shall cooperate with the Board of Nurse
2-23 Examiners in the adoption of rules under this subchapter to
2-24 eliminate to the extent possible conflicts between the rules
2-25 adopted by each board.
2-26 Sec. 7.03. APPLICABILITY. Rules adopted by the board under
3-1 this subchapter do not apply to:
3-2 (1) an outpatient setting in which only local
3-3 anesthesia, peripheral nerve blocks, or both are used;
3-4 (2) an outpatient setting in which only anxiolytics
3-5 and analgesics are used and only in doses that do not have the
3-6 probability of placing the patient at risk for loss of the
3-7 patient's life-preserving protective reflexes;
3-8 (3) a licensed hospital;
3-9 (4) a licensed ambulatory surgical center;
3-10 (5) a clinic located on land recognized as tribal land
3-11 by the federal government and maintained or operated by a federally
3-12 recognized Indian tribe or tribal organization as listed by the
3-13 United States secretary of the interior under 25 U.S.C. Section
3-14 479a-1 or as listed under a successor federal statute or
3-15 regulation;
3-16 (6) a clinic directly maintained or operated by the
3-17 United States or by any of its departments, officers, or agencies;
3-18 or
3-19 (7) an outpatient setting accredited by:
3-20 (A) the Joint Commission on Accreditation of
3-21 Healthcare Organizations relating to ambulatory surgical centers;
3-22 (B) the American Association for the
3-23 Accreditation of Ambulatory Surgery Facilities; or
3-24 (C) the Accreditation Association for Ambulatory
3-25 Health Care.
3-26 Sec. 7.04. COMPLIANCE WITH ANESTHESIA RULES. (a) On or
4-1 after August 31, 2000, a physician who practices medicine in this
4-2 state and who administers anesthesia or performs a surgical
4-3 procedure for which anesthesia services are provided in an
4-4 outpatient setting shall comply with the rules adopted under this
4-5 subchapter.
4-6 (b) The board may require a physician to submit and comply
4-7 with a corrective action plan to remedy or address any current or
4-8 potential deficiencies with the physician's provision of anesthesia
4-9 in an outpatient setting in accordance with this Act or rules of
4-10 the board.
4-11 Sec. 7.05. ANNUAL REGISTRATION. (a) Beginning September 1,
4-12 2000, the board shall require each physician who administers
4-13 anesthesia or performs a surgical procedure for which anesthesia
4-14 services are provided in an outpatient setting to annually register
4-15 with the board on a form prescribed by the board and to pay a fee
4-16 to the board in an amount established by the board.
4-17 (b) The board shall coordinate the registration required
4-18 under this section with the registration required under Section
4-19 3.01 of this Act so that the times of registration, payment,
4-20 notice, and imposition of penalties for late payment are similar
4-21 and provide a minimum of administrative burden to the board and to
4-22 physicians.
4-23 Sec. 7.06. INSPECTIONS. (a) The board may conduct
4-24 inspections to enforce this subchapter, including inspections of an
4-25 office site and of documents of a physician's practice that relate
4-26 to the provision of anesthesia in an outpatient setting. The board
5-1 may contract with another state agency or qualified person to
5-2 conduct these inspections.
5-3 (b) Unless it would jeopardize an ongoing investigation, the
5-4 board shall provide at least five business days' notice before
5-5 conducting an on-site inspection under this section.
5-6 (c) This section does not require the board to make an
5-7 on-site inspection of a physician's office.
5-8 Sec. 7.07. REQUESTS FOR INSPECTION AND ADVISORY OPINION.
5-9 (a) The board may consider a request by a physician for an on-site
5-10 inspection. The board may, in its discretion and on payment of a
5-11 fee in an amount established by the board, conduct the inspection
5-12 and issue an advisory opinion.
5-13 (b) An advisory opinion issued by the board under this
5-14 section is not binding on the board, and the board, except as
5-15 provided by Subsection (c) of this section, may take any action
5-16 under this Act in relation to the situation addressed by the
5-17 advisory opinion that the board considers appropriate.
5-18 (c) A physician who requests and relies on an advisory
5-19 opinion of the board may use the opinion as mitigating evidence in
5-20 an action or proceeding to impose an administrative or civil
5-21 penalty under this Act. The board or court, as appropriate, shall
5-22 take proof of reliance on an advisory opinion into consideration
5-23 and mitigate the imposition of administrative or civil penalties
5-24 accordingly.
5-25 SECTION 3. Subsection (b), Section 3.10, Medical Practice
5-26 Act (Article 4495b, Vernon's Texas Civil Statutes), as amended by
6-1 Chapter 214, Acts of the 73rd Legislature, Regular Session, 1993,
6-2 is amended to read as follows:
6-3 (b) The board may not set, charge, collect, receive, or
6-4 deposit any of the following fees in excess of:
6-5 (1) for processing and granting a license by
6-6 reciprocity to a licensee of another
6-7 state ..................................... $700
6-8 (2) for processing an application and administration
6-9 of a partial examination for licensure .... $700
6-10 (3) for processing an application and administration
6-11 of a complete examination for licensure ... $700
6-12 (4) for processing an application and issuance of a
6-13 temporary license ......................... $200
6-14 (5) for processing an application and issuance of a
6-15 duplicate license ......................... $200
6-16 (6) for processing an application and issuance of a
6-17 license of reinstatement after a lapse or
6-18 cancellation of a license ................. $700
6-19 (7) for processing an application and issuance of an
6-20 annual registration of a licensee ......... $200
6-21 (8) for processing and issuance of an institutional
6-22 permit for interns, residents, and others in
6-23 approved medical training programs ..... $200
6-24 (9) for processing an application and issuance of an
6-25 endorsement to other state medical
6-26 boards .................................... $200
7-1 (10) for processing and issuance of a license or
7-2 temporary license to a physician
7-3 assistant ................................ $200
7-4 (11) for processing and issuance of a permit to a
7-5 physician who supervises an
7-6 acupuncturist ............................ $200
7-7 (12) for processing an application and issuance of an
7-8 annual registration for anesthesia in an
7-9 outpatient setting ..................... $300.
7-10 SECTION 4. Chapter 7, Title 71, Revised Statutes, is amended
7-11 by adding Article 4527e to read as follows:
7-12 Art. 4527e. ANESTHESIA IN OUTPATIENT SETTING
7-13 Sec. 1. DEFINITION. In this article, "outpatient setting"
7-14 means any facility, clinic, center, office, or other setting that
7-15 is not part of a licensed hospital or a licensed ambulatory
7-16 surgical center.
7-17 Sec. 2. RULES. (a) The board shall establish by rule the
7-18 minimum standards for the provision of anesthesia services in
7-19 outpatient settings by persons licensed by the board.
7-20 (b) The rules must be designed to protect the health,
7-21 safety, and welfare of the public and must include requirements
7-22 relating to:
7-23 (1) general anesthesia, regional anesthesia, and
7-24 monitored anesthesia care;
7-25 (2) patient assessment, counseling, and preparation;
7-26 (3) patient monitoring to be performed and equipment
8-1 to be used during a procedure and during post-procedure monitoring;
8-2 (4) emergency procedures, drugs, and equipment,
8-3 including education, training, and certification of personnel, as
8-4 appropriate, and including protocols for transfers to a hospital;
8-5 (5) the documentation necessary to demonstrate
8-6 compliance with this article; and
8-7 (6) the period in which protocols or procedures
8-8 covered by rules of the board shall be reviewed, updated, or
8-9 amended.
8-10 (c) The board shall cooperate with the Texas State Board of
8-11 Medical Examiners in the adoption of rules under this article to
8-12 eliminate to the extent possible conflicts between the rules
8-13 adopted by each board.
8-14 Sec. 3. APPLICABILITY. Rules adopted by the board under
8-15 this article do not apply to:
8-16 (1) an outpatient setting in which only local
8-17 anesthesia, peripheral nerve blocks, or both are used;
8-18 (2) an outpatient setting in which only anxiolytics
8-19 and analgesics are used and only in doses that do not have the
8-20 probability of placing the patient at risk for loss of the
8-21 patient's life-preserving protective reflexes;
8-22 (3) a licensed hospital;
8-23 (4) a licensed ambulatory surgical center;
8-24 (5) a clinic located on land recognized as tribal land
8-25 by the federal government and maintained or operated by a federally
8-26 recognized Indian tribe or tribal organization as listed by the
9-1 United States secretary of the interior under 25 U.S.C. Section
9-2 479a-1 or as listed under a successor federal statute or
9-3 regulation;
9-4 (6) a clinic directly maintained or operated by the
9-5 United States or by any of its departments, officers, or agencies;
9-6 or
9-7 (7) an outpatient setting accredited by:
9-8 (A) the Joint Commission on Accreditation of
9-9 Healthcare Organizations relating to ambulatory surgical centers;
9-10 (B) the American Association for the
9-11 Accreditation of Ambulatory Surgery Facilities; or
9-12 (C) the Accreditation Association for Ambulatory
9-13 Health Care.
9-14 Sec. 4. COMPLIANCE WITH ANESTHESIA RULES. (a) On or after
9-15 August 31, 2000, a certified registered nurse anesthetist providing
9-16 anesthesia services in an outpatient setting shall comply with the
9-17 rules adopted by the board under this article.
9-18 (b) The board may require a certified registered nurse
9-19 anesthetist to submit and comply with a corrective action plan to
9-20 remedy or address any current or potential deficiencies with the
9-21 nurse anesthetist's provision of anesthesia in an outpatient
9-22 setting in accordance with this chapter or rules of the board.
9-23 Sec. 5. BIENNIAL REGISTRATION. (a) Beginning September 1,
9-24 2000, the board shall require each certified registered nurse
9-25 anesthetist who provides anesthesia services in an outpatient
9-26 setting to biennially register with the board on a form prescribed
10-1 by the board and to pay a fee to the board in an amount established
10-2 by the board.
10-3 (b) The board shall coordinate the registration required
10-4 under this article with the license renewal provisions under
10-5 Article 4526, Revised Statutes, so that the times of registration,
10-6 payment, notice, and imposition of penalties for late payment are
10-7 similar and provide a minimum of administrative burden to the board
10-8 and to certified registered nurse anesthetists.
10-9 Sec. 6. INSPECTIONS. (a) The board may conduct inspections
10-10 to enforce this article, including inspections of the equipment
10-11 owned or leased by a certified registered nurse anesthetist and of
10-12 documents of a certified registered nurse anesthetist's practice
10-13 that relate to the provision of anesthesia in an outpatient
10-14 setting. The board may contract with another state agency or
10-15 qualified person to conduct these inspections.
10-16 (b) Unless it would jeopardize an ongoing investigation, the
10-17 board shall provide at least five business days' notice before
10-18 conducting an on-site inspection under this section.
10-19 (c) This section does not require the board to make an
10-20 on-site inspection of an outpatient setting where a certified
10-21 registered nurse anesthetist provides anesthesia.
10-22 Sec. 7. REQUESTS FOR INSPECTION AND ADVISORY OPINION.
10-23 (a) The board may consider a request by a certified registered
10-24 nurse anesthetist for an inspection of equipment owned or leased by
10-25 the nurse anesthetist and of documents of the nurse anesthetist's
10-26 practice that relate to the provision of anesthesia in an
11-1 outpatient setting. The board may, in its discretion and on
11-2 payment of a fee in an amount established by the board, conduct the
11-3 inspection and issue an advisory opinion.
11-4 (b) An advisory opinion issued by the board under this
11-5 section is not binding on the board and the board, except as
11-6 provided by Subsection (c) of this section, may take any action
11-7 under this chapter in relation to the situation addressed by the
11-8 advisory opinion that the board considers appropriate.
11-9 (c) A certified registered nurse anesthetist who requests
11-10 and relies on an advisory opinion of the board may use the opinion
11-11 as mitigating evidence in an action or proceeding by the board to
11-12 impose an administrative penalty or assess a monetary fine under
11-13 this chapter. The board shall take proof of reliance on an
11-14 advisory opinion into consideration and mitigate the imposition of
11-15 administrative penalties or the assessment of a monetary fine
11-16 accordingly.
11-17 SECTION 5. The Texas State Board of Medical Examiners and
11-18 Board of Nurse Examiners may permit the registration requirements
11-19 imposed under Subchapter G, Medical Practice Act (Article 4495b,
11-20 Vernon's Texas Civil Statutes), as added by this Act, and under
11-21 Article 4527e, Revised Statutes, as added by this Act, to be
11-22 staggered and phased in so that not later than September 1, 2002,
11-23 all physicians and certified registered nurse anesthetists required
11-24 to register under those laws will be in compliance.
11-25 SECTION 6. (a) The rules required under Subchapter G,
11-26 Medical Practice Act (Article 4495b, Vernon's Texas Civil
12-1 Statutes), as added by this Act, and under Article 4527e, Revised
12-2 Statutes, as added by this Act, must be adopted by the Texas State
12-3 Board of Medical Examiners and Board of Nurse Examiners, as
12-4 appropriate, not later than January 7, 2000.
12-5 (b) The Texas State Board of Medical Examiners and the Board
12-6 of Nurse Examiners shall report to the speaker of the house of
12-7 representatives and the lieutenant governor on the implementation
12-8 and enforcement of those rules and of the laws added by this Act
12-9 not later than January 1, 2001. The report must include any
12-10 suggested amendments or changes to the laws added by this Act to
12-11 make those laws more effective or efficient.
12-12 SECTION 7. This Act takes effect September 1, 1999.
12-13 SECTION 8. The importance of this legislation and the
12-14 crowded condition of the calendars in both houses create an
12-15 emergency and an imperative public necessity that the
12-16 constitutional rule requiring bills to be read on three several
12-17 days in each house be suspended, and this rule is hereby suspended.
12-18 COMMITTEE AMENDMENT NO. 1
12-19 Amend S.B. 1340 as follows:
12-20 (1) In SECTION 2 of the bill, in added Section 7.03(3),
12-21 Medical Practice Act, insert the following between "licensed
12-22 hospital" and the semicolon (engrossed version, page 3, line 8):
12-23 ", including an outpatient facility of the hospital that is
12-24 separately located apart from the hospital".
12-25 (2) In SECTION 2 of the bill, in added Section 7.03, Medical
12-26 Practice Act, insert the following as a new Subdivision (6) of
13-1 Section 7.03 (engrossed version, page 3, between lines 15 and 16)
13-2 and renumber the existing Subdivisions (6) and (7) of Section 7.03
13-3 appropriately (engrossed version, page 3, lines 16 and 19):
13-4 "(6) a facility maintained or operated by a state or
13-5 local governmental entity;".
13-6 (3) In SECTION 4 of the bill, in added Section 3(3), Article
13-7 4527e, Revised Statutes, insert the following between "licensed
13-8 hospital" and the semicolon (engrossed version, page 8, line 22):
13-9 ", including an outpatient facility of the hospital that is
13-10 separately located apart from the hospital".
13-11 (4) In SECTION 4 of the bill, in added Section 3, Article
13-12 4527e, Revised Statutes, insert the following as a new Subdivision
13-13 (6) of Section 3 (engrossed version, page 9, between lines 3 and 4)
13-14 and renumber the existing Subdivisions (6) and (7) of Section 3
13-15 appropriately (engrossed version, page 9, lines 4 and 7):
13-16 "(6) a facility maintained or operated by
13-17 a state or local governmental entity;".
13-18 76R13503 JRD-F Maxey