By Armbrister S.B. No. 818
77R2791 GJH-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the prescriptive authority of certain psychologists.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 301.002(2), Occupations Code, is amended
1-5 to read as follows:
1-6 (2) "Professional nursing" means the performance for
1-7 compensation of an act that requires substantial specialized
1-8 judgment and skill, the proper performance of which is based on
1-9 knowledge and application of the principles of biological,
1-10 physical, and social science as acquired by a completed course in
1-11 an approved school of professional nursing. The term does not
1-12 include acts of medical diagnosis or prescription of therapeutic or
1-13 corrective measures. Professional nursing involves:
1-14 (A) the observation, assessment, intervention,
1-15 evaluation, rehabilitation, care and counsel, or health teachings
1-16 of a person who is ill, injured, infirm, or experiencing a change
1-17 in normal health processes;
1-18 (B) the maintenance of health or prevention of
1-19 illness;
1-20 (C) the administration of a medication or
1-21 treatment as ordered by a physician, podiatrist, psychologist who
1-22 holds a prescriptive authority certificate, or dentist;
1-23 (D) the supervision or teaching of nursing;
1-24 (E) the administration, supervision, and
2-1 evaluation of nursing practices, policies, and procedures;
2-2 (F) the requesting, receiving, signing for, and
2-3 distribution of prescription drug samples to patients at sites in
2-4 which a registered nurse is authorized to sign prescription drug
2-5 orders as provided by Subchapter B, Chapter 157; and
2-6 (G) the performance of an act delegated by a
2-7 physician under Section 157.052, 157.053, 157.054, 157.058, or
2-8 157.059.
2-9 SECTION 2. Section 501.002, Occupations Code, is amended to
2-10 read as follows:
2-11 Sec. 501.002. DEFINITIONS. In this chapter:
2-12 (1) "Board" means the Texas State Board of Examiners
2-13 of Psychologists.
2-14 (2) "Licensed specialist in school psychology" means a
2-15 person who holds a license to engage in the practice of psychology
2-16 under Section 501.260.
2-17 (3) "Prescription drug" has the meaning assigned by
2-18 Section 551.003.
2-19 (4) "Prescription drug order" has the meaning assigned
2-20 by Section 551.003.
2-21 (5) "Prescriptive authority certificate" means a
2-22 certificate issued by the board that grants the authority to a
2-23 psychologist to issue a prescription drug order or to administer or
2-24 dispense a prescription drug.
2-25 (6) "Provisional license holder" means a person who
2-26 holds a license to engage in the practice of psychology under
2-27 Section 501.253.
3-1 (7) [(4)] "Psychological associate" means a person who
3-2 holds a license to engage in the practice of psychology issued
3-3 under Section 501.259.
3-4 (8) [(5)] "Psychologist" means a person who holds a
3-5 license to engage in the practice of psychology issued under
3-6 Section 501.252.
3-7 SECTION 3. Section 501.003(c), Occupations Code, is amended
3-8 to read as follows:
3-9 (c) The practice of psychology:
3-10 (1) includes providing or offering to provide services
3-11 to an individual or group, including providing computerized
3-12 procedures, that include the application of established principles,
3-13 methods, and procedures of describing, explaining, and ameliorating
3-14 behavior;
3-15 (2) addresses normal behavior and involves evaluating,
3-16 preventing, and remediating psychological, emotional, mental,
3-17 interpersonal, learning, and behavioral disorders of individuals or
3-18 groups, as well as the psychological disorders that accompany
3-19 medical problems, organizational structures, stress, and health;
3-20 (3) includes:
3-21 (A) using projective techniques,
3-22 neuropsychological testing, counseling, career counseling,
3-23 psychotherapy, hypnosis for health care purposes, hypnotherapy, and
3-24 biofeedback; [and]
3-25 (B) evaluating and treating mental or emotional
3-26 disorders and disabilities by psychological techniques and
3-27 procedures; and
4-1 (C) acting under the authority granted by a
4-2 prescriptive authority certificate; and
4-3 (4) is based on:
4-4 (A) a systematic body of knowledge and
4-5 principles acquired in an organized program of graduate study; and
4-6 (B) the standards of ethics established by the
4-7 profession.
4-8 SECTION 4. Subchapter F, Chapter 501, Occupations Code, is
4-9 amended by adding Section 501.265 to read as follows:
4-10 Sec. 501.265. PRESCRIPTIVE AUTHORITY CERTIFICATE. (a) A
4-11 psychologist may not issue a prescription drug order, administer or
4-12 dispense a prescription drug, or represent that the person holds a
4-13 prescriptive authority certificate unless the person holds a
4-14 prescriptive authority certificate under this section.
4-15 (b) To be eligible for a certificate under this section, a
4-16 psychologist must apply to the board and demonstrate that the
4-17 person:
4-18 (1) is a health service provider as determined by
4-19 board rule;
4-20 (2) has completed a postdoctoral training program in
4-21 psychopharmacology from an institution of higher education or a
4-22 provider of continuing education approved by the board that at a
4-23 minimum satisfies the training recommendations of the American
4-24 Psychological Association; and
4-25 (3) has sufficient knowledge and skill to exercise
4-26 prescriptive authority by passing an examination under this section
4-27 approved by the board.
5-1 (c) The board shall adopt rules to protect the public health
5-2 that require a psychologist who holds a certificate under this
5-3 section to consult with a patient's treating physician within a
5-4 reasonable time after the psychologist issues a prescription drug
5-5 order for or administers or dispenses a prescription drug to the
5-6 patient.
5-7 SECTION 5. Section 551.003(34), Occupations Code, is amended
5-8 to read as follows:
5-9 (34) "Practitioner" means:
5-10 (A) a person licensed, certified, or registered
5-11 to prescribe, distribute, administer, or dispense a prescription
5-12 drug or device in the course of professional practice in this
5-13 state, including a physician, dentist, podiatrist, psychologist, or
5-14 veterinarian but excluding a person licensed under this subtitle;
5-15 (B) a person licensed by another state, Canada,
5-16 or the United Mexican States in a health field in which, under the
5-17 law of this state, a license or certificate holder in this state
5-18 may legally prescribe a dangerous drug; or
5-19 (C) a person practicing in another state and
5-20 licensed by another state as a physician, dentist, veterinarian,
5-21 psychologist, or podiatrist, who has a current federal Drug
5-22 Enforcement Administration registration number and who may legally
5-23 prescribe a Schedule II, III, IV, or V controlled substance, as
5-24 specified under Chapter 481, Health and Safety Code, in that other
5-25 state.
5-26 SECTION 6. Section 481.002(39), Health and Safety Code, is
5-27 amended to read as follows:
6-1 (39) "Practitioner" means:
6-2 (A) a physician, dentist, veterinarian,
6-3 podiatrist, scientific investigator, psychologist, or other person
6-4 licensed, registered, or otherwise permitted to distribute,
6-5 dispense, analyze, conduct research with respect to, or administer
6-6 a controlled substance in the course of professional practice or
6-7 research in this state;
6-8 (B) a pharmacy, hospital, or other institution
6-9 licensed, registered, or otherwise permitted to distribute,
6-10 dispense, conduct research with respect to, or administer a
6-11 controlled substance in the course of professional practice or
6-12 research in this state; or
6-13 (C) a person practicing in and licensed by
6-14 another state as a physician, dentist, veterinarian, psychologist,
6-15 or podiatrist, having a current Federal Drug Enforcement
6-16 Administration registration number, who may legally prescribe
6-17 Schedule II, III, IV, or V controlled substances in that state.
6-18 SECTION 7. Section 483.001(12), Health and Safety Code, is
6-19 amended to read as follows:
6-20 (12) "Practitioner" means a person licensed or
6-21 certified:
6-22 (A) by the Texas State Board of Medical
6-23 Examiners, State Board of Dental Examiners, Texas State Board of
6-24 Podiatric Medical Examiners, Texas Optometry Board, Texas State
6-25 Board of Examiners of Psychologists, or State Board of Veterinary
6-26 Medical Examiners to prescribe and administer dangerous drugs;
6-27 (B) by another state in a health field in which,
7-1 under the laws of this state, a licensee may legally prescribe
7-2 dangerous drugs; or
7-3 (C) in Canada or Mexico in a health field in
7-4 which, under the laws of this state, a licensee may legally
7-5 prescribe dangerous drugs.
7-6 SECTION 8. Sections 576.025(b), (c), (e), and (f), Health
7-7 and Safety Code, are amended to read as follows:
7-8 (b) Consent to the administration of psychoactive medication
7-9 given by a patient or by a person authorized by law to consent on
7-10 behalf of the patient is valid only if:
7-11 (1) the consent is given voluntarily and without
7-12 coercive or undue influence;
7-13 (2) the treating physician or a psychologist who holds
7-14 a prescriptive authority certificate, or a person designated by the
7-15 physician or psychologist, provided the following information, in a
7-16 standard format approved by the department, to the patient and, if
7-17 applicable, to the patient's representative authorized by law to
7-18 consent on behalf of the patient:
7-19 (A) the specific condition to be treated;
7-20 (B) the beneficial effects on that condition
7-21 expected from the medication;
7-22 (C) the probable health and mental health
7-23 consequences of not consenting to the medication;
7-24 (D) the probable clinically significant side
7-25 effects and risks associated with the medication;
7-26 (E) the generally accepted alternatives to the
7-27 medication, if any, and why the physician or psychologist
8-1 recommends that they be rejected; and
8-2 (F) the proposed course of the medication;
8-3 (3) the patient and, if appropriate, the patient's
8-4 representative authorized by law to consent on behalf of the
8-5 patient is informed in writing that consent may be revoked; and
8-6 (4) the consent is evidenced in the patient's clinical
8-7 record by a signed form prescribed by the facility or by a
8-8 statement of the treating physician or psychologist described by
8-9 Subdivision (2), or a person designated by the physician or the
8-10 psychologist, that documents that consent was given by the
8-11 appropriate person and the circumstances under which the consent
8-12 was obtained.
8-13 (c) If the treating physician or psychologist designates
8-14 another person to provide the information under Subsection (b),
8-15 then, not later than two working days after that person provides
8-16 the information, excluding weekends and legal holidays, the
8-17 physician or psychologist shall meet with the patient and, if
8-18 appropriate, the patient's representative who provided the consent,
8-19 to review the information and answer any questions.
8-20 (e) In prescribing psychoactive medication, a treating
8-21 physician or psychologist described by Subsection (b)(2) shall:
8-22 (1) prescribe, consistent with clinically appropriate
8-23 medical care, the medication that has the fewest side effects or
8-24 the least potential for adverse side effects, unless the class of
8-25 medication has been demonstrated or justified not to be effective
8-26 clinically; and
8-27 (2) administer the smallest therapeutically acceptable
9-1 dosages of medication for the patient's condition.
9-2 (f) If a physician or psychologist described by Subsection
9-3 (b)(2) issues an order to administer psychoactive medication to a
9-4 patient without the patient's consent because the patient is having
9-5 a medication-related emergency:
9-6 (1) the physician or psychologist shall document in
9-7 the patient's clinical record in specific medical or behavioral
9-8 terms the necessity of the order and that the physician or
9-9 psychologist has evaluated but rejected other generally accepted,
9-10 less intrusive forms of treatment, if any; and
9-11 (2) treatment of the patient with the psychoactive
9-12 medication shall be provided in the manner, consistent with
9-13 clinically appropriate medical care, least restrictive of the
9-14 patient's personal liberty.
9-15 SECTION 9. This Act takes effect September 1, 2001.