By Capelo                                             H.B. No. 1183
         77R2814 GJH-F                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to the regulation of surgical assistants; granting
 1-3     rulemaking authority; providing penalties.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1. Subtitle C, Title 3, Occupations Code, is amended
 1-6     by adding Chapter 206 to read as follows:
 1-7                      CHAPTER 206. SURGICAL ASSISTANTS
 1-8                      SUBCHAPTER A. GENERAL PROVISIONS
 1-9           Sec. 206.001. DEFINITIONS. In this chapter:
1-10                 (1)  "Advisory board" means the Board of Surgical
1-11     Assistants.
1-12                 (2)  "Delegating physician" means a physician who is
1-13     licensed by the medical board either as a doctor of medicine or
1-14     doctor of osteopathic medicine and who assumes responsibility and
1-15     legal liability for the services rendered by a surgical assistant.
1-16                 (3)  "Medical board" means the Texas State Board of
1-17     Medical Examiners.
1-18                 (4)  "Surgical assistant" means a person who provides
1-19     aid to a delegating physician in exposure, hemostasis, and other
1-20     technical functions that assist the physician in performing a safe
1-21     operation with optimal results for the patient.
1-22           Sec. 206.002.  APPLICABILITY. A person is not required to
1-23     hold a license under this chapter if the person is:
1-24                 (1)  a student enrolled in a surgical assistant
 2-1     education program approved by the medical board who is assisting in
 2-2     a surgical operation that is an integral part of the program of
 2-3     study;
 2-4                 (2)  a surgical assistant employed in the service of
 2-5     the federal government while performing duties related to that
 2-6     employment;
 2-7                 (3)  a person acting under the delegated authority of a
 2-8     licensed physician; or
 2-9                 (4)  a licensed health care worker acting within the
2-10     scope of the person's license.
2-11           Sec. 206.003.  APPLICATION OF SUNSET ACT.  The Board of
2-12     Surgical Assistants is subject to Chapter 325, Government Code
2-13     (Texas Sunset Act).  Unless continued in existence as provided by
2-14     that chapter, the advisory board is abolished and this chapter
2-15     expires September 1, 2011.
2-16              (Sections 206.004-206.050 reserved for expansion
2-17                 SUBCHAPTER B. BOARD OF SURGICAL ASSISTANTS
2-18           Sec. 206.051.  ADVISORY BOARD. The Board of Surgical
2-19     Assistants is created as an advisory board to the Texas State Board
2-20     of Medical Examiners and is not subject to Chapter 2110, Government
2-21     Code.
2-22           Sec. 206.052.  APPOINTMENT OF ADVISORY BOARD. (a)  The
2-23     advisory board consists of nine members appointed by the governor
2-24     as follows:
2-25                 (1)  three members must be practicing surgical
2-26     assistants who have at least five years of clinical experience as
2-27     surgical assistants;
 3-1                 (2)  three members must be physicians licensed in this
 3-2     state who supervise surgical assistants; and
 3-3                 (3)  three members must be members of the public who
 3-4     are not licensed as physicians or surgical assistants.
 3-5           (b)  Appointments to the advisory board shall be made without
 3-6     regard to the race, color, disability, sex, religion, age, or
 3-7     national origin of the appointees.
 3-8           Sec. 206.053.  PUBLIC MEMBER ELIGIBILITY. A person is not
 3-9     eligible for appointment as a public member of the advisory board
3-10     if the person or the person's spouse:
3-11                 (1)  is licensed by an occupational regulatory agency
3-12     in the field of health care; or
3-13                 (2)  is employed by or participates in the management
3-14     of a business entity or other organization that provides health
3-15     care services or that sells, manufactures, or distributes health
3-16     care supplies or equipment.
3-17           Sec. 206.054.  MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a)  In
3-18     this section, "Texas trade association" means a cooperative and
3-19     voluntarily joined association of business or professional
3-20     competitors in this state designed to assist its members and its
3-21     industry or profession in dealing with mutual business or
3-22     professional problems and in promoting their common interest.
3-23           (b)  A person may not be a member of the advisory board and
3-24     may not be an advisory board employee employed in a "bona fide
3-25     executive, administrative, or professional capacity," as that
3-26     phrase is used for purposes of establishing an exemption to the
3-27     overtime provisions of the federal Fair Labor Standards Act of 1938
 4-1     (29 U.S.C. Section 201 et seq.), and its subsequent amendments, if:
 4-2                 (1)  the person is an officer, employee, or paid
 4-3     consultant of a Texas trade association in the field of surgical
 4-4     assisting; or
 4-5                 (2)  the person's spouse is an officer, manager, or
 4-6     paid consultant of a Texas trade association in the field of
 4-7     surgical assisting.
 4-8           (c)  A person may not be a member of the advisory board or
 4-9     act as the general counsel to the advisory board if the person is
4-10     required to register as a lobbyist under Chapter 305, Government
4-11     Code, because of the person's activities for compensation on behalf
4-12     of a profession related to the operation of the advisory board.
4-13           Sec. 206.055.  TERMS; VACANCY. (a)  Members of the advisory
4-14     board are appointed for staggered six-year terms. The terms of
4-15     three members expire on February 1 of each odd-numbered year.
4-16           (b)  If a vacancy occurs during a member's term, the governor
4-17     shall appoint a new member to fill the unexpired term.
4-18           (c)  An advisory board member may not serve more than two
4-19     consecutive full terms.
4-20           Sec. 206.056.  GROUNDS FOR REMOVAL. (a)  It is a ground for
4-21     removal from the advisory board that a member:
4-22                 (1)  does not have at the time of appointment the
4-23     qualifications required by Sections 206.052 and 206.053;
4-24                 (2)  does not maintain during service on the board the
4-25     qualifications required by Sections 206.052 and 206.053;
4-26                 (3)  is ineligible for membership under Section
4-27     206.054;
 5-1                 (4)  cannot, because of illness or disability,
 5-2     discharge the member's duties for a substantial part of the
 5-3     member's term; or
 5-4                 (5)  is absent from more than half of the regularly
 5-5     scheduled advisory board meetings that the member is eligible to
 5-6     attend during a calendar year without an excuse approved by a
 5-7     majority vote of the advisory board.
 5-8           (b)  The validity of an action of the advisory board is not
 5-9     affected by the fact that it is taken when a ground for removal of
5-10     an advisory board member exists.
5-11           Sec. 206.057.  OFFICERS. (a)  The governor shall designate
5-12     biennially an advisory board member as the presiding officer of the
5-13     advisory board to serve in that capacity at the will of the
5-14     governor.
5-15           (b)  The advisory board shall elect biennially from among its
5-16     members an assistant presiding officer and secretary-treasurer.
5-17           Sec. 206.058.  PER DIEM. (a)  An advisory board member may
5-18     not receive compensation for service on the advisory board.
5-19           (b)  An advisory board member is entitled to:
5-20                 (1)  the per diem set by the General Appropriations Act
5-21     for each day that the member performs duties as an advisory board
5-22     member; and
5-23                 (2)  reimbursement for expenses as provided by the
5-24     General Appropriations Act.
5-25           Sec. 206.059.  MEETINGS. (a)  The advisory board shall meet
5-26     at least twice each year.
5-27           (b)  The advisory board may meet at other times at the call
 6-1     of the presiding officer or as provided by advisory board rule.
 6-2           Sec. 206.060.  TRAINING REQUIREMENTS. (a)  A person who is
 6-3     appointed to and qualifies for office as an advisory board member
 6-4     may not vote, deliberate, or be counted as a member in attendance
 6-5     at a meeting of the advisory board until the person completes a
 6-6     training program that complies with this section.
 6-7           (b)  The training program must provide the person with
 6-8     information regarding:
 6-9                 (1)  the legislation that created the advisory board
6-10     and the medical board;
6-11                 (2)  the programs operated by the advisory board;
6-12                 (3)  the role and functions of the advisory board;
6-13                 (4)  the rules of the medical board, with an emphasis
6-14     on the rules that relate to disciplinary and investigatory
6-15     authority;
6-16                 (5)  the current budget for the advisory board;
6-17                 (6)  the results of the most recent formal audit of the
6-18     advisory board;
6-19                 (7)  the requirements of:
6-20                       (A)  the open meetings law, Chapter 551,
6-21     Government Code;
6-22                       (B)  the public information law, Chapter 552,
6-23     Government Code;
6-24                       (C)  the administrative procedure law, Chapter
6-25     2001, Government Code; and
6-26                       (D)  other laws relating to public officials,
6-27     including conflict of interest laws; and
 7-1                 (8)  any applicable ethics policies adopted by the
 7-2     medical board or the Texas Ethics Commission.
 7-3           (c)  A person appointed to the advisory board is entitled to
 7-4     reimbursement, as provided by the General Appropriations Act, for
 7-5     travel expenses incurred in attending the training program
 7-6     regardless of whether the attendance at the program occurs before
 7-7     or after the person qualifies for office.
 7-8              (Sections 206.061-206.100 reserved for expansion
 7-9     SUBCHAPTER C. POWERS AND DUTIES OF ADVISORY BOARD AND MEDICAL BOARD
7-10           Sec. 206.101.  GENERAL POWERS AND DUTIES. (a)  Subject to the
7-11     advice and approval of the medical board, the advisory board shall:
7-12                 (1)  establish qualifications for a surgical assistant
7-13     to practice in this state;
7-14                 (2)  establish minimum educational and training
7-15     requirements necessary for the advisory board to recommend that the
7-16     medical board issue a license to practice as a surgical assistant;
7-17                 (3)  administer an examination for a license to
7-18     practice as a surgical assistant;
7-19                 (4)  develop requirements for  licensure by endorsement
7-20     of other states;
7-21                 (5)  prescribe the application form for a license to
7-22     practice as a surgical assistant;
7-23                 (6)  make recommendations on an application for a
7-24     license to practice as a surgical assistant;
7-25                 (7)  develop and implement policies that clearly
7-26     separate the policymaking responsibilities of the advisory board
7-27     and the management responsibilities of the executive director and
 8-1     the staff of the medical board;
 8-2                 (8)  develop an approved program of continuing
 8-3     education and the manner in which attendance at all approved
 8-4     courses, clinics, forums, lectures, programs, or seminars is
 8-5     monitored, recorded, and submitted to the advisory board; and
 8-6                 (9)  recommend additional rules as are necessary for
 8-7     the administration and enforcement of this chapter.
 8-8           (b)  Notwithstanding Subsection (a), the advisory board has
 8-9     no independent rulemaking authority.
8-10           Sec. 206.102.  ANNUAL REPORT.  (a)  The advisory board shall
8-11     prepare annually a complete and detailed written report accounting
8-12     for all funds received and disbursed by the medical board under
8-13     this chapter during the preceding fiscal year.
8-14           (b)  The annual report must meet the reporting requirements
8-15     applicable to financial reporting provided in the General
8-16     Appropriations Act.
8-17           Sec. 206.103.  IMMUNITY AND REPORTING REQUIREMENTS. (a)  A
8-18     medical peer review committee in this state, a surgical assistant,
8-19     a surgical assistant student, or a physician practicing medicine in
8-20     this state shall report relevant information to the advisory board
8-21     related to the acts of a surgical assistant in this state if, in
8-22     that person's opinion, a surgical assistant poses a continuing
8-23     threat to the public welfare through the person's practice as a
8-24     surgical assistant.  The duty to report under this section may not
8-25     be nullified through contract.
8-26           (b)  A person who, without malice, furnishes records,
8-27     information, or assistance to the advisory board under this section
 9-1     is immune from any civil liability arising from that action.
 9-2              (Sections 206.104-206.150 reserved for expansion
 9-3          SUBCHAPTER D. PUBLIC INTEREST INFORMATION; COMPLAINT AND
 9-4                          INVESTIGATIVE INFORMATION
 9-5           Sec. 206.151.  PUBLIC PARTICIPATION. (a)  Subject to the
 9-6     advice and approval of the medical board, the advisory board shall
 9-7     develop and implement policies that provide the public with a
 9-8     reasonable opportunity to appear before the advisory board and
 9-9     speak on any issue under the advisory board's jurisdiction.
9-10           (b)  The executive director of the advisory board shall
9-11     prepare and maintain a written plan that describes how a person who
9-12     does not speak English may be provided reasonable access to the
9-13     advisory board's programs and services.
9-14           Sec. 206.152.  PUBLIC INTEREST INFORMATION. (a)  The advisory
9-15     board shall prepare information of public interest describing the
9-16     functions of the advisory board and the procedures by which
9-17     complaints are filed and resolved.
9-18           (b)  The advisory board shall make the information available
9-19     to the public and appropriate state agencies.
9-20           Sec. 206.153.  COMPLAINTS. (a)  The advisory board by rule
9-21     shall establish methods by which consumers and service recipients
9-22     are notified of the name, mailing address, and telephone number of
9-23     the advisory board for the purpose of directing complaints to the
9-24     advisory board.
9-25           (b)  The advisory board shall list with its regular telephone
9-26     number any toll-free telephone number established under other state
9-27     law that may be called to present a complaint about a health
 10-1    professional.
 10-2          Sec. 206.154.  RECORDS OF COMPLAINTS. (a)  The advisory board
 10-3    shall maintain a file on each written complaint filed with the
 10-4    advisory board.  The file must include:
 10-5                (1)  the name of the person who filed the complaint;
 10-6                (2)  the date the complaint is received by the advisory
 10-7    board;
 10-8                (3)  the subject matter of the complaint;
 10-9                (4)  the name of each person contacted in relation to
10-10    the complaint;
10-11                (5)  a summary of the results of the review or
10-12    investigation of the complaint; and
10-13                (6)  an explanation of the reason the file was closed,
10-14    if the agency closed the file without taking action other than to
10-15    investigate the complaint.
10-16          (b)  The advisory board shall provide to the person filing
10-17    the complaint and to each person who is a subject of the complaint
10-18    a copy of the advisory board's policies and procedures relating to
10-19    complaint investigation and resolution.
10-20          (c)  The advisory board, at least quarterly and until final
10-21    disposition of the complaint, shall notify the person filing the
10-22    complaint and each person who is a subject of the complaint of the
10-23    status of the investigation unless the notice would jeopardize an
10-24    undercover investigation.
10-25          Sec. 206.155.  LICENSE HOLDER ACCESS TO COMPLAINT
10-26    INFORMATION. (a)  The advisory board shall provide a license holder
10-27    who is the subject of a formal complaint filed under this chapter
 11-1    with access to all information in its possession that the advisory
 11-2    board intends to offer into evidence in presenting its case in
 11-3    chief at the contested hearing on the complaint, subject to any
 11-4    other privilege or restriction established by rule, statute, or
 11-5    legal precedent.  The advisory board shall provide the information
 11-6    not later than the 30th day after receipt of a written request from
 11-7    the license holder or the license holder's counsel, unless good
 11-8    cause is shown for delay.
 11-9          (b)  Notwithstanding Subsection (a), the advisory board is
11-10    not required to provide:
11-11                (1)  advisory board investigative reports;
11-12                (2)  investigative memoranda;
11-13                (3)  the identity of a nontestifying complainant;
11-14                (4)  attorney-client communications;
11-15                (5)  attorney work product; or
11-16                (6)  other material covered by a privilege recognized
11-17    by the Texas Rules of Civil Procedure or the Texas Rules of
11-18    Evidence.
11-19          (c)  The provision of information does not constitute a
11-20    waiver of privilege or confidentiality under this chapter or other
11-21    law.
11-22          Sec. 206.156.  HEALTH CARE ENTITY REQUEST FOR INFORMATION. On
11-23    the written request of a health care entity, the advisory board
11-24    shall provide to the entity:
11-25                (1)  information about a complaint filed against a
11-26    license holder  that was resolved after investigation by:
11-27                      (A)  a disciplinary order of the medical board;
 12-1    or
 12-2                      (B)  an agreed settlement; and
 12-3                (2)  the basis of and current status of any complaint
 12-4    under active investigation.
 12-5          Sec. 206.157.  CONFIDENTIALITY OF INVESTIGATIVE INFORMATION.
 12-6    A complaint, adverse report, investigation file, other  report, or
 12-7    other investigative information in the possession of or received or
 12-8    gathered by the advisory board, advisory board employee, or agent
 12-9    relating to a license holder, a license application, or a criminal
12-10    investigation or proceeding is privileged and confidential and is
12-11    not subject to discovery, subpoena, or other means of legal
12-12    compulsion for release to any person other than the advisory board
12-13    or advisory board employee or agent involved in license holder
12-14    discipline.
12-15          Sec. 206.158.  PERMITTED DISCLOSURE OF INVESTIGATIVE
12-16    INFORMATION. (a)  Investigative information in the possession of
12-17    the advisory board, advisory board employee, or agent that relates
12-18    to the discipline of a license holder may be disclosed to:
12-19                (1)  a licensing authority in another state or a
12-20    territory or country in which the license holder  is licensed or
12-21    has applied for a license; or
12-22                (2)  a peer review committee reviewing:
12-23                      (A)  an application for privileges; or
12-24                      (B)  the qualifications of the licensee with
12-25    respect to retaining privileges.
12-26          (b)  If the investigative information in the possession of
12-27    the advisory board or an advisory board employee or agent indicates
 13-1    a crime may have been committed, the advisory board shall report
 13-2    the information to the proper law enforcement agency.  The advisory
 13-3    board shall cooperate with and assist all law enforcement agencies
 13-4    conducting criminal investigations of a license holder by providing
 13-5    information relevant to the investigation.  Confidential
 13-6    information disclosed by the advisory board to a law enforcement
 13-7    agency remains confidential and may not be disclosed by the law
 13-8    enforcement agency except as necessary to further the
 13-9    investigation.
13-10             (Sections 206.159-206.200 reserved for expansion
13-11            SUBCHAPTER E.  LICENSE REQUIREMENTS AND EXEMPTIONS
13-12          Sec. 206.201.  LICENSE REQUIRED. (a)  A person may not
13-13    practice as a surgical assistant unless the person is licensed
13-14    under this chapter.
13-15          (b)  Unless the person holds a license under this chapter, a
13-16    person may not use, in connection with the person's name:
13-17                (1)  the title "Licensed Surgical Assistant"; or
13-18                (2)  any other designation that would imply that the
13-19    person is a licensed surgical assistant.
13-20          Sec. 206.202.  LICENSE APPLICATION. An applicant for a
13-21    license must:
13-22                (1)  file a written application with the advisory board
13-23    on a form prescribed by the medical board; and
13-24                (2)  pay the application fee set by the medical board.
13-25          Sec. 206.203.  LICENSE ELIGIBILITY. (a)  Except as provided
13-26    by Section 206.206, to be eligible for a license, a person must:
13-27                (1)  be of good moral character;
 14-1                (2)  have not been convicted of a felony or a crime
 14-2    involving moral turpitude;
 14-3                (3)  not use drugs or alcohol to an extent that affects
 14-4    the applicant's professional competency;
 14-5                (4)  not have had a license or certification revoked by
 14-6    a licensing agency or by a certifying professional organization;
 14-7    and
 14-8                (5)  not have engaged in fraud or deceit in applying
 14-9    for a license under this chapter.
14-10          (b)  In addition to meeting the requirements of Subsection
14-11    (a), a person must pass the examination required by this chapter
14-12    and:
14-13                (1)  complete a surgical assistant educational program
14-14    approved by the medical board;
14-15                (2)  complete a surgical technologist educational
14-16    program approved by the medical board and provide proof acceptable
14-17    to the medical board that the person has first assisted a total of
14-18    at least 1,500 hours during the 24 months preceding the date of
14-19    application; or
14-20                (3)  provide proof acceptable to the medical board that
14-21    the person has:
14-22                      (A)  passed the following basic science courses
14-23    in a curriculum approved by the medical board:
14-24                            (i)  anatomy and physiology;
14-25                            (ii)  aseptic technique;
14-26                            (iii)  pharmacology;
14-27                            (iv)  surgical anatomy;
 15-1                            (v)  operative procedures;
 15-2                            (vi)  draping or prepping techniques;
 15-3                            (vii)  positioning of the operative
 15-4    patient; and
 15-5                            (viii)  local regional and general
 15-6    anesthesia techniques; and
 15-7                      (B)  acted as a first assistant at surgical
 15-8    procedures for at least 1,500 hours during the 24 months preceding
 15-9    the date of application.
15-10          Sec. 206.204.  EXAMINATION. To be eligible to take the
15-11    license examination, an applicant must:
15-12                (1)  file an application on a form prescribed by the
15-13    medical board not later than the 90th day before the date of the
15-14    examination; and
15-15                (2)  pay the examination fee set by the medical board
15-16    to cover the cost of administering the examination.
15-17          Sec. 206.205.  EXAMINATION RESULTS.  (a)  Not later than the
15-18    30th day after the date a person takes a licensing examination, the
15-19    advisory board shall notify the person of the results of the
15-20    examination.
15-21          (b)  If the examination is graded or reviewed by a testing
15-22    service:
15-23                (1)  the advisory board shall notify the person of the
15-24    results of the examination not later than the 14th day after the
15-25    date the advisory board receives the results from the testing
15-26    service; and
15-27                (2)  if notice of the examination results will be
 16-1    delayed for longer than 90 days after the examination date, the
 16-2    advisory board shall notify the person of the reason for the delay
 16-3    before the 90th day.
 16-4          (c)  The advisory board may require a testing service to
 16-5    notify a person of the results of the person's examination.
 16-6          Sec. 206.206.  SPECIAL ELIGIBILITY FOR LICENSE.  A person may
 16-7    be licensed as a surgical assistant under this chapter without
 16-8    meeting the requirements of Section 206.203 if the person:
 16-9                (1)  is a resident of this state;
16-10                (2)  is at least 21 years of age;
16-11                (3)  provides proof acceptable to the medical board
16-12    that the person has acted as a first assistant at surgical
16-13    procedures for at least 1,500 hours during the 24 months preceding
16-14    the date of application under this section;
16-15                (4)  provides proof acceptable to the medical board
16-16    that the person has successfully completed the basic science
16-17    courses listed under Section 206.203(b) in a curriculum approved by
16-18    the medical board;
16-19                (5)  derives the majority of the person's income as a
16-20    surgical assistant; and
16-21                (6)  applies for a license under this section before
16-22    September 1, 2002.
16-23          Sec. 206.207.  TEMPORARY LICENSE.  (a)  The advisory board
16-24    may, through the executive director of the medical board, issue a
16-25    temporary license to an applicant who:
16-26                (1)  submits an application on a form prescribed by the
16-27    medical board;
 17-1                (2)  has passed an examination recognized by the
 17-2    advisory board relating to the practice of surgical assisting;
 17-3                (3)  pays the appropriate fee set by the medical board;
 17-4                (4)  if licensed in another state, is in good standing
 17-5    as a surgical assistant; and
 17-6                (5)  meets all the qualifications for a license under
 17-7    this chapter and is waiting for the next scheduled meeting of the
 17-8    medical board for the license to be issued.
 17-9          (b)  A temporary license is valid until the 100th day after
17-10    the date issued and may be extended until the 130th day after the
17-11    date issued.
17-12          Sec. 206.208.  ASSISTANCE BY MEDICAL BOARD.  The medical
17-13    board shall provide administrative and clerical employees as
17-14    necessary to enable the advisory board to administer this
17-15    subchapter.
17-16          Sec. 206.209.  FEES. (a)  The medical board shall set and
17-17    collect fees in amounts that are reasonable and necessary to cover
17-18    the costs of administering and enforcing this chapter without the
17-19    use of any other funds generated by the medical board.
17-20          (b)  Fees collected by the medical board under this chapter
17-21    shall be deposited by the medical board in the state treasury to
17-22    the credit of an account in the general revenue fund and may be
17-23    spent to cover the costs of administering and enforcing this
17-24    chapter.  At the end of each fiscal biennium, the comptroller shall
17-25    transfer any surplus money remaining in the account to the general
17-26    revenue fund.
17-27          (c)  All money paid to the medical board under this chapter
 18-1    is subject to Subchapter F, Chapter 404, Government Code.
 18-2          Sec. 206.210.  ISSUANCE AND RENEWAL OF LICENSE.  (a)  After
 18-3    consulting the advisory board, the medical board shall issue a
 18-4    surgical assistant license in this state to a person who meets the
 18-5    requirements of this chapter and the rules adopted under this
 18-6    chapter.
 18-7          (b)  The medical board may waive any prerequisite to
 18-8    obtaining a license for an applicant after reviewing the
 18-9    applicant's credentials and determining that the applicant holds a
18-10    valid license from another state that has license requirements
18-11    substantially equivalent to those of this state.
18-12          Sec. 206.211.  LICENSE RENEWAL.  (a)  The medical board by
18-13    rule shall provide for the annual renewal of a surgical assistant
18-14    license.
18-15          (b)  The medical board by rule may adopt a system under which
18-16    licenses expire on various dates during the year. For the year in
18-17    which the license expiration date is changed, license fees shall be
18-18    prorated on a monthly basis so that each license holder pays only
18-19    that portion of the license fee that is allocable to the number of
18-20    months during which the license is valid. On renewal of the license
18-21    on the new expiration date, the total license renewal fee is
18-22    payable.
18-23          Sec. 206.212.  NOTICE OF LICENSE RENEWAL.  At least 30 days
18-24    before the expiration of a person's license, the advisory board
18-25    shall send written notice of the impending license expiration to
18-26    the person at the license holder's last known address according to
18-27    the records of the advisory board.
 19-1          Sec. 206.213.  PROCEDURE FOR RENEWAL.  (a)  A person who is
 19-2    otherwise eligible to renew a license may renew an unexpired
 19-3    license by paying the required renewal fee to the medical board
 19-4    before the expiration date of the license. A person whose license
 19-5    has expired may not engage in activities that require a license
 19-6    until the license has been renewed under this section.
 19-7          (b)  If the person's license has been expired for 90 days or
 19-8    less, the person may renew the license by paying to the medical
 19-9    board one and one-half times the required renewal fee.
19-10          (c)  If the person's license has been expired for longer than
19-11    90 days but less than one year, the person may renew the license by
19-12    paying to the medical board two times the required renewal fee.
19-13          (d)  If the person's license has been expired for one year or
19-14    longer, the person may not renew the license.  The person may
19-15    obtain a new license by complying with the requirements and
19-16    procedures for obtaining an original license.
19-17          Sec. 206.214.  RENEWAL OF EXPIRED LICENSE BY OUT-OF-STATE
19-18    PRACTITIONER.  (a)  If the person was licensed in this state, moved
19-19    to another state, and is currently licensed and has been in
19-20    practice in the other state for the two years preceding
19-21    application, the person may renew an expired license without
19-22    reexamination.
19-23          (b)  The person must pay to the medical board a fee that is
19-24    equal to two times the required renewal fee for the license.
19-25          Sec. 206.215.  LICENSE HOLDER INFORMATION.  (a)  Each license
19-26    holder shall file with the advisory board:
19-27                (1)  the license holder's mailing address;
 20-1                (2)  the address of the license holder's residence;
 20-2                (3)  the mailing address of each of the license
 20-3    holder's offices; and
 20-4                (4)  the address for the location of each of the
 20-5    license holder's offices if that address is different from the
 20-6    office's mailing address.
 20-7          (b)  A license holder shall:
 20-8                (1)  notify the advisory board of a change of the
 20-9    license holder's residence or business address; and
20-10                (2)  provide the advisory board with the license
20-11    holder's new address not later than the 30th day after the date the
20-12    address change occurs.
20-13             (Sections 206.216-206.250 reserved for expansion
20-14                      SUBCHAPTER F. SCOPE OF PRACTICE
20-15          Sec. 206.251.  SCOPE OF PRACTICE.  (a)  The practice of a
20-16    surgical assistant includes medical services delegated by the
20-17    supervising physician that are within the education, training, and
20-18    experience of the surgical assistant.
20-19          (b)  Medical services provided by a surgical assistant may
20-20    include:
20-21                (1)  moving and positioning patients for surgery;
20-22                (2)  retracting tissue and exposing the operative field
20-23    during operative procedures;
20-24                (3)  clamping, dividing, and tying tissues to control
20-25    bleeding during surgical entry;
20-26                (4)  keeping the operative site dry;
20-27                (5)  affording the surgeon the best possible exposure
 21-1    of the anatomy incident to the procedure;
 21-2                (6)  assisting in closure of the incision;
 21-3                (7)  applying sutures and wound dressings; and
 21-4                (8)  any other surgical duties authorized and
 21-5    supervised by the delegating physician.
 21-6          (c)  The activities listed in Subsection (b) may be performed
 21-7    in any place authorized by a delegating licensed physician,
 21-8    including a clinic, hospital, ambulatory surgical center, or other
 21-9    institutional setting.
21-10          Sec. 206.252.  EXCLUSION OF LIMITATION ON EMPLOYMENT.  This
21-11    chapter does not limit the employment arrangement of a surgical
21-12    assistant licensed under this chapter.
21-13          Sec. 206.253.  PRACTICE OF MEDICINE PROHIBITED.  This chapter
21-14    does not permit the practice of medicine, as defined by Subtitle B,
21-15    Title 3, Occupations Code, by a person issued a license under this
21-16    chapter.
21-17             (Sections 206.254-206.300 reserved for expansion
21-18                  SUBCHAPTER G.  DISCIPLINARY PROCEEDINGS
21-19          Sec. 206.301.  DISCIPLINARY ACTIONS BY THE MEDICAL BOARD. (a)
21-20    The medical board may revoke, suspend, or refuse to issue or renew
21-21    a license or may limit the scope of practice of a license holder if
21-22    the license holder acts as a surgical assistant in violation of
21-23    this chapter or a rule of the medical board.
21-24          (b)  The medical board may place on probation a person whose
21-25    license is suspended.  If a license suspension is probated, the
21-26    medical board may require the person to:
21-27                (1)  report regularly to the medical board on matters
 22-1    that are the basis of the probation;
 22-2                (2)  limit practice to the areas prescribed by the
 22-3    medical board; or
 22-4                (3)  continue or review professional education until
 22-5    the person attains a degree of skill satisfactory to the medical
 22-6    board in those areas that are the basis of the probation.
 22-7          Sec. 206.302.  CONDUCT RELATED TO FRAUD OR MISREPRESENTATION.
 22-8    The medical board may take action under Section 206.301 against an
 22-9    applicant or license holder who:
22-10                (1)  fraudulently or deceptively obtains or attempts to
22-11    obtain a license;
22-12                (2)  fraudulently or deceptively uses a license;
22-13                (3)  fraudulently alters any surgical assistant
22-14    license, certificate, or diploma;
22-15                (4)  uses any surgical assistant license, certificate,
22-16    or diploma that has been fraudulently purchased, issued, or
22-17    counterfeited or that has been materially altered;
22-18                (5)  directly or indirectly  aids or abets the practice
22-19    as a surgical assistant by any person not duly licensed by the
22-20    medical board to practice as a surgical assistant; or
22-21                (6)  unlawfully advertises in a false, misleading, or
22-22    deceptive manner as defined by Section 101.201.
22-23          Sec. 206.303.  CONDUCT RELATED TO A VIOLATION OF LAW. (a)
22-24    The medical board may take action under Section 206.301 against an
22-25    applicant or license holder who:
22-26                (1)  violates this chapter or a rule adopted under this
22-27    chapter;
 23-1                (2)  is convicted of a felony, placed on deferred
 23-2    adjudication, or placed in a pretrial diversion program; or
 23-3                (3)  violates state law if the violation is connected
 23-4    with practice as a surgical assistant.
 23-5          (b)  A complaint, indictment, or conviction of a law
 23-6    violation is not necessary for the medical board to act under
 23-7    Subsection (a)(3).  Proof of the commission of the act while in
 23-8    practice as a surgical assistant or under the guise of practice as
 23-9    a surgical assistant is sufficient for action by the medical board.
23-10          Sec. 206.304.  CONDUCT INDICATING LACK OF FITNESS. (a)  The
23-11    medical board may take action under Section 206.301 against an
23-12    applicant or license holder who:
23-13                (1)  habitually uses drugs or intoxicating liquors to
23-14    the extent that, in the medical board's opinion, the person cannot
23-15    safely perform as a surgical assistant;
23-16                (2)  has been adjudicated as mentally incompetent;
23-17                (3)  has a mental or physical condition that renders
23-18    the person unable to safely perform as a surgical assistant;
23-19                (4)  has committed an act of moral turpitude;
23-20                (5)  has failed to practice as a surgical assistant in
23-21    an acceptable manner consistent with public health and welfare;
23-22                (6)  represents that the person is a physician;
23-23                (7)  has acted in an unprofessional or dishonorable
23-24    manner that is likely to deceive, defraud, or injure any member of
23-25    the public;
23-26                (8)  has had the person's license or other
23-27    authorization to practice as a surgical assistant suspended,
 24-1    revoked, or restricted;
 24-2                (9)  has had other disciplinary action taken by another
 24-3    state or by the uniformed services of the United States regarding
 24-4    practice as a surgical assistant;
 24-5                (10)  is removed or suspended or has disciplinary
 24-6    action taken by the person's peers in any professional association
 24-7    or society or is being disciplined by a licensed hospital or
 24-8    medical staff of a hospital, including removal, suspension,
 24-9    limitation of privileges, or other disciplinary action, if that
24-10    action, in the opinion of the medical board, was based on
24-11    unprofessional conduct or professional incompetence that was likely
24-12    to harm the public;
24-13                (11)  has repeated or recurring meritorious health care
24-14    liability claims that, in the medical board's opinion, are evidence
24-15    of professional incompetence likely to harm the public; or
24-16                (12)  sexually abuses or exploits another person during
24-17    the license holder's practice as a surgical assistant.
24-18          (b)  For the purpose of Subsection (a)(9), a certified copy
24-19    of the record of the state or uniformed services of the United
24-20    States taking the action constitutes conclusive evidence of that
24-21    action.
24-22          (c)  An action described by Subsection (a)(10)  does not
24-23    constitute state action on the part of the association, society, or
24-24    hospital medical staff.
24-25          Sec. 206.305.  PROTECTION OF PATIENT IDENTITY. In a
24-26    disciplinary investigation or proceeding conducted under this
24-27    chapter, the advisory board shall protect the identity of each
 25-1    patient whose medical records are examined and used in a public
 25-2    proceeding unless the patient:
 25-3                (1)  testifies in the public proceeding; or
 25-4                (2)  submits a written release in regard to the
 25-5    patient's records or identity.
 25-6          Sec. 206.306.  HEARING. A license holder is entitled to a
 25-7    hearing before an administrative law judge of the State Office of
 25-8    Administrative Hearings before a sanction is imposed under this
 25-9    chapter.
25-10          Sec. 206.307.  SCHEDULE OF SANCTIONS. (a)  The medical board
25-11    by rule shall adopt a broad schedule of sanctions for violations
25-12    under this chapter.
25-13          (b)  The State Office of Administrative Hearings shall use
25-14    the schedule for a sanction imposed as the result of a hearing
25-15    conducted by that office.
25-16             (Sections 206.308-206.350 reserved for expansion
25-17         SUBCHAPTER H.  OTHER PENALTIES AND ENFORCEMENT PROVISIONS
25-18          Sec. 206.351.  CIVIL PENALTY. (a)  A person who violates
25-19    Section 206.201 or 206.253  or a rule or order adopted by the
25-20    medical board under this chapter is liable for a civil penalty not
25-21    to exceed $1,000 a day.
25-22          (b)  At the request of the advisory board or medical board,
25-23    the attorney general shall bring an action to recover a civil
25-24    penalty authorized under this section.
25-25          Sec. 206.352.  CRIMINAL PENALTY. (a)  A person required to
25-26    hold a license under this chapter commits an offense if the person
25-27    knowingly acts as a surgical assistant without holding a license
 26-1    issued under this chapter.
 26-2          (b)  An offense under this section is a felony of the third
 26-3    degree.
 26-4          Sec. 206.353.  INJUNCTION. The board may seek an injunction
 26-5    against a violation of this chapter or medical board rule.
 26-6          SECTION 2. Subsection (B), Section 2, Chapter 397, Acts of
 26-7    the 54th Legislature, Regular Session, 1955 (Article 3.70-2,
 26-8    Vernon's Texas Insurance Code), is amended to read as follows:
 26-9          (B)  No policy of accident and sickness insurance shall make
26-10    benefits contingent upon treatment or examination by a particular
26-11    practitioner or by particular practitioners of the healing arts
26-12    hereinafter designated unless such policy contains a provision
26-13    designating the practitioner or practitioners who will be
26-14    recognized by the insurer and those who will not be recognized by
26-15    the insurer.  Such provision may be located in the "Exceptions" or
26-16    "Exceptions and Reductions" provisions, or elsewhere in the policy,
26-17    or by endorsement attached to the policy, at the insurer's option.
26-18    In designating the practitioners who will and will not be
26-19    recognized, such provision shall use the following terms:  Doctor
26-20    of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
26-21    Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
26-22    Audiologist, Licensed Speech-language Pathologist, Doctor in
26-23    Psychology, Licensed Master Social Worker--Advanced Clinical
26-24    Practitioner, Licensed Dietitian, Licensed Professional Counselor,
26-25    Licensed Marriage and Family Therapist, Licensed Chemical
26-26    Dependency Counselor, Licensed Hearing Instrument Fitter and
26-27    Dispenser, Advanced Practice Nurse, Physician Assistant, Licensed
 27-1    Occupational Therapist, Licensed Physical Therapist, Licensed
 27-2    Acupuncturist, [and] Licensed Psychological Associate, and Licensed
 27-3    Surgical Assistant.
 27-4          For purposes of this Act, such designations shall have the
 27-5    following meanings:
 27-6          Doctor of Medicine:  One licensed by the Texas State Board of
 27-7    Medical Examiners on the basis of the degree "Doctor of Medicine";
 27-8          Doctor of Osteopathy:  One licensed by the Texas State Board
 27-9    of Medical Examiners on the basis of the degree of "Doctor of
27-10    Osteopathy";
27-11          Doctor of Dentistry:  One licensed by the State Board of
27-12    Dental Examiners;
27-13          Doctor of Chiropractic:  One licensed by the Texas Board of
27-14    Chiropractic Examiners;
27-15          Doctor of Optometry:  One licensed by the Texas Optometry
27-16    Board;
27-17          Doctor of Podiatry:  One licensed by the Texas State Board of
27-18    Podiatric Medical Examiners;
27-19          Licensed Audiologist:  One with a master's or doctorate
27-20    degree in audiology from an accredited college or university and
27-21    who is licensed as an audiologist by the State Board of Examiners
27-22    for Speech-Language Pathology and Audiology;
27-23          Licensed Speech-language Pathologist:  One with a master's or
27-24    doctorate degree in speech pathology or speech-language pathology
27-25    from an accredited college or university and who is licensed as a
27-26    speech-language pathologist by the State Board of Examiners for
27-27    Speech-Language Pathology and Audiology;
 28-1          Doctor in Psychology:  One licensed by the Texas State Board
 28-2    of Examiners of Psychologists and certified as a Health Service
 28-3    Provider;
 28-4          Licensed Master Social Worker--Advanced Clinical
 28-5    Practitioner:  One licensed by the Texas State Board of Social
 28-6    Worker Examiners as a Licensed Master Social Worker with the order
 28-7    of recognition of Advanced Clinical Practitioner;
 28-8          Licensed Dietitian:  One licensed by the Texas State Board of
 28-9    Examiners of Dietitians;
28-10          Licensed Professional Counselor:  One licensed by the Texas
28-11    State Board of Examiners of Professional Counselors;
28-12          Licensed Marriage and Family Therapist:  One licensed by the
28-13    Texas State Board of Examiners of Marriage and Family Therapists;
28-14          Licensed Chemical Dependency Counselor:  One licensed by the
28-15    Texas Commission on Alcohol and Drug Abuse;
28-16          Licensed Hearing Instrument Fitter and Dispenser:  One
28-17    licensed by the State Committee of Examiners in the Fitting and
28-18    Dispensing of Hearing Instruments;
28-19          Advanced Practice Nurse:  One licensed by the Board of Nurse
28-20    Examiners as a registered nurse and recognized by that board as an
28-21    advanced practice nurse;
28-22          Physician Assistant:  One licensed by the Texas State Board
28-23    of Physician Assistant Examiners;
28-24          Licensed Occupational Therapist:  One licensed by the Texas
28-25    Board of Occupational Therapy Examiners;
28-26          Licensed Physical Therapist:  One licensed by the Texas Board
28-27    of Physical Therapy Examiners;
 29-1          Licensed Acupuncturist:  One licensed by the Texas State
 29-2    Board of Medical Examiners as an acupuncturist;  [and]
 29-3          Licensed Psychological Associate:  One licensed by the Texas
 29-4    State Board of Examiners of Psychologists and practicing under the
 29-5    supervision of a licensed psychologist; and
 29-6          Licensed Surgical Assistant: One licensed by the Texas State
 29-7    Board of Medical Examiners as a surgical assistant.
 29-8          SECTION 3. Section 1, Article 21.52, Insurance Code, is
 29-9    amended by adding Subsection (u) to read as follows:
29-10          (u)  "Surgical assistant" means a person licensed by the
29-11    Texas State Board of Medical Examiners as a surgical assistant.
29-12          SECTION 4. Section 3(a), Article 21.52, Insurance Code, as
29-13    amended by Chapters 428 and 888,  Acts of the 76th Legislature,
29-14    Regular Session, 1999, is amended to read as follows:
29-15          (a)  Any person who is issued, who is a party to, or who is a
29-16    beneficiary under any health insurance policy delivered, renewed,
29-17    or issued for delivery in this state by any insurance company,
29-18    association, or organization to which this article applies may
29-19    select:
29-20                (1)  a licensed doctor of podiatric medicine, a
29-21    licensed dentist, or a doctor of chiropractic to perform the
29-22    medical or surgical services or procedures scheduled in the policy
29-23    which fall within the scope of the license of that practitioner;
29-24                (2)  a licensed doctor of optometry to perform the
29-25    services or procedures scheduled in the policy which fall within
29-26    the scope of the license of that doctor of optometry;
29-27                (3)  an occupational therapist to provide the services
 30-1    scheduled in the policy which fall within the scope of the license
 30-2    of that occupational therapist;
 30-3                (4)  a physical therapist to provide the services
 30-4    scheduled in the policy which fall within the scope of the license
 30-5    of that physical therapist;
 30-6                (5)  a licensed audiologist to measure hearing for the
 30-7    purpose of determining the presence or extent of a hearing loss and
 30-8    to provide aural rehabilitation services to a person with a hearing
 30-9    loss if those services or procedures are scheduled in the policy;
30-10                (6)  a licensed speech-language pathologist to evaluate
30-11    speech and language and to provide habilitative and rehabilitative
30-12    services to restore speech or language loss or to correct a speech
30-13    or language impairment if those services or procedures are
30-14    scheduled in the policy;
30-15                (7)  a licensed master social worker--advanced clinical
30-16    practitioner to provide the services that fall within the scope of
30-17    the license of such certified practitioner and which are specified
30-18    as services within the terms of the policy of insurance, including
30-19    the provision of direct, diagnostic, preventive, or clinical
30-20    services to individuals, families, and groups whose functioning is
30-21    threatened or affected by social or psychological stress or health
30-22    impairment, if those services or procedures are scheduled in the
30-23    policy;
30-24                (8)  a licensed dietitian including a provisional
30-25    licensed dietitian under a licensed dietitian's supervision to
30-26    provide the services that fall within the scope of the license of
30-27    that dietitian if those services are scheduled in the policy;
 31-1                (9)  a licensed professional counselor to provide the
 31-2    services that fall within the scope of the license of that
 31-3    professional if those services are scheduled in the policy;
 31-4                (10)  a licensed marriage and family therapist to
 31-5    provide the services that fall within the scope of the license of
 31-6    that professional if those services are scheduled in the policy;
 31-7                (11)  a psychologist to perform the services or
 31-8    procedures scheduled in the policy that fall within the scope of
 31-9    the license of that psychologist;
31-10                (12)  a licensed chemical dependency counselor to
31-11    perform the services or procedures scheduled in the policy that
31-12    fall within the scope of the license of that practitioner;
31-13                (13) [(12)]  a licensed acupuncturist to perform the
31-14    services or procedures scheduled in the policy that fall within the
31-15    scope of the license of that practitioner;
31-16                (14) [(13)]  an advanced practice nurse to provide the
31-17    services scheduled in the policy that fall within the scope of the
31-18    license of that practitioner;
31-19                (15) [(14)]  a physician assistant to provide the
31-20    services scheduled in the policy that fall within the scope of the
31-21    license of that practitioner;
31-22                (16) [(15)]  a licensed hearing instrument fitter and
31-23    dispenser to provide the services or procedures scheduled in the
31-24    policy that fall within the scope of the license of that
31-25    practitioner;
31-26                (17)  a licensed surgical assistant to provide the
31-27    services or procedures scheduled in the policy that fall within the
 32-1    scope of the license of that practitioner;  or
 32-2                (18) [(16)]  a licensed psychological associate to
 32-3    provide the services that fall within the scope of the license of
 32-4    that professional if those services are scheduled in the policy.
 32-5          SECTION 5. (a)  Notwithstanding Section 206.201 and
 32-6    Subchapter H, Chapter 206, Occupations Code, as added by this Act,
 32-7    a person is not required to obtain a license under Chapter 206,
 32-8    Occupations Code, as added by this Act, until September 1, 2002.
 32-9          (b)  The Texas State Board of Medical Examiners shall adopt
32-10    rules under Chapter 206, Occupations Code, as added by this Act,
32-11    not later than January 1, 2002.
32-12          (c)  In making the initial appointments to the Board of
32-13    Surgical Assistants, the governor shall designate three members for
32-14    terms expiring February 1, 2003, three members for terms expiring
32-15    February 1, 2005, and  three members for terms expiring February 1,
32-16    2007.
32-17          SECTION 6. Section 2, Chapter 397, Acts of the 54th
32-18    Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
32-19    Insurance Code), and Article 21.52, Insurance Code, as amended by
32-20    this Act, apply only to an insurance policy, contract, or evidence
32-21    of coverage delivered, issued for delivery, or renewed on or after
32-22    January 1, 2003.  A policy, contract, or evidence of coverage
32-23    delivered, issued for delivery, or renewed before January 1, 2003,
32-24    is governed by the law as it existed immediately before the
32-25    effective date of this Act, and that law is continued in effect for
32-26    that purpose.
32-27          SECTION 7. This Act takes effect September 1, 2001.