1-1 AN ACT
1-2 relating to the authority of certain advanced practice nurses and
1-3 physician assistants to prescribe drugs.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subsection (e), Section 157.053, Occupations
1-6 Code, is amended to read as follows:
1-7 (e) A physician's authority to delegate the carrying out or
1-8 signing of a prescription drug order [at the physician's primary
1-9 practice site under this section] is limited to:
1-10 (1) three physician assistants or advanced practice
1-11 nurses or their full-time equivalents practicing at the physician's
1-12 primary practice site or at an alternate practice site under
1-13 Section 157.0541; and
1-14 (2) the patients with whom the physician has
1-15 established or will establish a physician-patient relationship.
1-16 SECTION 2. Subchapter B, Chapter 157, Occupations Code, is
1-17 amended by adding Sections 157.0541 and 157.0542 to read as
1-18 follows:
1-19 Sec. 157.0541. PRESCRIBING AT ALTERNATE SITES. (a) In this
1-20 section, "alternate site" means a practice site:
1-21 (1) where services similar to the services provided at
1-22 the delegating physician's primary practice site are provided; and
1-23 (2) located within 60 miles of the delegating
1-24 physician's primary practice site.
1-25 (b) At an alternate site, a physician licensed by the board
2-1 may delegate to an advanced practice nurse or physician assistant,
2-2 acting under adequate physician supervision, the act of
2-3 administering, providing, or carrying out or signing a prescription
2-4 drug order as authorized through a physician's order, a standing
2-5 medical order, a standing delegation order, or another order or
2-6 protocol as defined by the board. The authority of a physician to
2-7 delegate the carrying out or signing of prescription drug orders
2-8 under this section is limited to dangerous drugs.
2-9 (c) Physician supervision is adequate for the purposes of
2-10 this section if the delegating physician:
2-11 (1) is on-site with the advanced practice nurse or
2-12 physician assistant at least 20 percent of the time;
2-13 (2) reviews at least 10 percent of the medical charts
2-14 at the site; and
2-15 (3) is available through direct telecommunication for
2-16 consultation, patient referral, or assistance with a medical
2-17 emergency.
2-18 (d) An alternate physician may provide appropriate
2-19 supervision to an advanced practice nurse or physician assistant
2-20 under this section on a temporary basis as provided by board rule.
2-21 (e) The combined number of advanced practice nurses and
2-22 physician assistants to whom a physician may delegate under this
2-23 section and at a primary practice site under Section 157.053 may
2-24 not exceed three physician assistants or advanced practice nurses
2-25 or the full-time equivalent of three physician assistants or
2-26 advanced practice nurses.
3-1 Sec. 157.0542. BOARD WAIVER OF DELEGATION REQUIREMENTS.
3-2 (a) On determining that the conditions of Subsection (b) have been
3-3 met, the board may waive or modify any of the site or supervision
3-4 requirements for a physician to delegate the carrying out or
3-5 signing of prescription drug orders to an advanced practice nurse
3-6 or physician assistant under Sections 157.052, 157.053, 157.054,
3-7 and 157.0541, or under board rules. The board may not waive the
3-8 limitation on the number of primary or alternate practice sites at
3-9 which a physician may delegate the carrying out or signing of
3-10 prescription drug orders or the number of advanced practice nurses
3-11 or physician assistants to whom a physician may delegate the
3-12 carrying out or signing of prescription drug orders.
3-13 (b) The board may grant a waiver under Subsection (a) if the
3-14 board determines that:
3-15 (1) the practice site where the physician is seeking
3-16 to delegate prescriptive authority is unable to meet the
3-17 requirements of this chapter or board rules or compliance would
3-18 cause an undue burden without a corresponding benefit to patient
3-19 care;
3-20 (2) safeguards exist for patient care and for
3-21 fostering a collaborative practice between the physician and the
3-22 advanced practice nurses and physician assistants; and
3-23 (3) if the requirement for which the waiver is sought
3-24 is the amount of time the physician is on-site, the frequency and
3-25 duration of time the physician is on-site when the advanced
3-26 practice nurse or physician assistant is present is sufficient for
4-1 collaboration to occur, taking into consideration the other ways
4-2 the physician collaborates with the advanced practice nurse or
4-3 physician assistant, including at other sites.
4-4 (c) The board shall establish procedures for granting
4-5 waivers under this section. At a minimum, the procedures must
4-6 include a process for providing, if the board denies a waiver, a
4-7 written explanation for the denial and identifying modifications
4-8 that would make the waiver acceptable and a process for revoking,
4-9 suspending, or modifying a waiver previously granted. The process
4-10 for revoking, suspending, or modifying a waiver must include notice
4-11 and an opportunity for a hearing. The board may probate an order
4-12 to revoke, suspend, or modify a waiver.
4-13 (d) The board shall appoint an advisory committee to review
4-14 and make recommendations on applications for waivers under this
4-15 section. Each committee member must be actively practicing as a
4-16 physician, an advanced practice nurse, or a physician assistant in
4-17 collaborative practices under which the advanced practice nurse or
4-18 physician assistant is authorized by the physician to sign or carry
4-19 out prescription drug orders under this subchapter. The committee
4-20 consists of 15 members appointed as follows:
4-21 (1) five advanced practice nurses appointed from a
4-22 list of persons recommended by professional associations
4-23 representing advanced practice nurses;
4-24 (2) five physician assistants appointed from a list of
4-25 persons recommended by professional associations representing
4-26 physician assistants; and
5-1 (3) five physicians appointed from a list of persons
5-2 recommended by professional associations representing physicians.
5-3 (e) The advisory committee shall recommend whether to grant
5-4 a waiver after making the determinations required of the board
5-5 under Subsection (a). The board may grant a waiver only if the
5-6 committee recommends that the waiver be granted, unless the board
5-7 determines good cause exists to grant a waiver the committee does
5-8 not recommend.
5-9 (f) The advisory committee may recommend that the board
5-10 approve a waiver with modifications.
5-11 (g) An advisory committee recommendation of the approval of
5-12 a waiver, with or without modifications, requires a vote of at
5-13 least:
5-14 (1) three advanced practice nurse committee members;
5-15 (2) three physician assistant committee members; and
5-16 (3) three physician committee members.
5-17 (h) This section expires September 1, 2005.
5-18 SECTION 3. Subsection (b), Section 204.202, Occupations
5-19 Code, is amended to read as follows:
5-20 (b) Medical services provided by a physician assistant may
5-21 include:
5-22 (1) obtaining patient histories and performing
5-23 physical examinations;
5-24 (2) ordering or performing diagnostic and therapeutic
5-25 procedures;
5-26 (3) formulating a working diagnosis;
6-1 (4) developing and implementing a treatment plan;
6-2 (5) monitoring the effectiveness of therapeutic
6-3 interventions;
6-4 (6) assisting at surgery;
6-5 (7) offering counseling and education to meet patient
6-6 needs;
6-7 (8) requesting, receiving, and signing for the receipt
6-8 of pharmaceutical sample prescription medications and distributing
6-9 the samples to patients in a specific practice setting in which the
6-10 physician assistant is authorized to prescribe pharmaceutical
6-11 medications and sign prescription drug orders as provided by
6-12 Section 157.052, 157.053, [or] 157.054, 157.0541, or 157.0542 or as
6-13 otherwise authorized by physician assistant board rule;
6-14 (9) signing or completing a prescription as provided
6-15 by Subchapter B, Chapter 157; and
6-16 (10) making appropriate referrals.
6-17 SECTION 4. Subdivision (2), Section 301.002, Occupations
6-18 Code, is amended to read as follows:
6-19 (2) "Professional nursing" means the performance for
6-20 compensation of an act that requires substantial specialized
6-21 judgment and skill, the proper performance of which is based on
6-22 knowledge and application of the principles of biological,
6-23 physical, and social science as acquired by a completed course in
6-24 an approved school of professional nursing. The term does not
6-25 include acts of medical diagnosis or prescription of therapeutic or
6-26 corrective measures. Professional nursing involves:
7-1 (A) the observation, assessment, intervention,
7-2 evaluation, rehabilitation, care and counsel, or health teachings
7-3 of a person who is ill, injured, infirm, or experiencing a change
7-4 in normal health processes;
7-5 (B) the maintenance of health or prevention of
7-6 illness;
7-7 (C) the administration of a medication or
7-8 treatment as ordered by a physician, podiatrist, or dentist;
7-9 (D) the supervision or teaching of nursing;
7-10 (E) the administration, supervision, and
7-11 evaluation of nursing practices, policies, and procedures;
7-12 (F) the requesting, receiving, signing for, and
7-13 distribution of prescription drug samples to patients at sites in
7-14 which a registered nurse is authorized to sign prescription drug
7-15 orders as provided by Subchapter B, Chapter 157; and
7-16 (G) the performance of an act delegated by a
7-17 physician under Section 157.052, 157.053, 157.054, 157.0541,
7-18 157.0542, 157.058, or 157.059.
7-19 SECTION 5. Subdivision (34), Section 551.003, Occupations
7-20 Code, is amended to read as follows:
7-21 (34) "Practitioner" means:
7-22 (A) a person licensed or registered to
7-23 prescribe, distribute, administer, or dispense a prescription drug
7-24 or device in the course of professional practice in this state,
7-25 including a physician, dentist, podiatrist, or veterinarian but
7-26 excluding a person licensed under this subtitle;
8-1 (B) a person licensed by another state, Canada,
8-2 or the United Mexican States in a health field in which, under the
8-3 law of this state, a license holder in this state may legally
8-4 prescribe a dangerous drug; [or]
8-5 (C) a person practicing in another state and
8-6 licensed by another state as a physician, dentist, veterinarian, or
8-7 podiatrist, who has a current federal Drug Enforcement
8-8 Administration registration number and who may legally prescribe a
8-9 Schedule II, III, IV, or V controlled substance, as specified under
8-10 Chapter 481, Health and Safety Code, in that other state; or
8-11 (D) an advanced practice nurse or physician
8-12 assistant to whom a physician has delegated the authority to carry
8-13 out or sign prescription drug orders under Section 157.052,
8-14 157.053, 157.054, 157.0541, or 157.0542.
8-15 SECTION 6. Subdivision (12), Section 483.001, Health and
8-16 Safety Code, is amended to read as follows:
8-17 (12) "Practitioner" means a person licensed:
8-18 (A) by the Texas State Board of Medical
8-19 Examiners, State Board of Dental Examiners, Texas State Board of
8-20 Podiatric Medical Examiners, Texas Optometry Board, or State Board
8-21 of Veterinary Medical Examiners to prescribe and administer
8-22 dangerous drugs;
8-23 (B) by another state in a health field in which,
8-24 under the laws of this state, a licensee may legally prescribe
8-25 dangerous drugs; [or]
8-26 (C) in Canada or Mexico in a health field in
9-1 which, under the laws of this state, a licensee may legally
9-2 prescribe dangerous drugs; or
9-3 (D) an advanced practice nurse or physician
9-4 assistant to whom a physician has delegated the authority to carry
9-5 out or sign prescription drug orders under Section 157.052,
9-6 157.053, 157.054, 157.0541, or 157.0542, Occupations Code.
9-7 SECTION 7. Subsection (b), Section 483.003, Health and
9-8 Safety Code, is amended to read as follows:
9-9 (b) On making that finding, the Texas Board of Health may
9-10 limit the availability of the abused drug by permitting its
9-11 dispensing only on the prescription of a practitioner described by
9-12 Section 483.001(12)(A), [or] (B), or (D).
9-13 SECTION 8. Section 483.004, Health and Safety Code, is
9-14 amended to read as follows:
9-15 Sec. 483.004. COMMISSIONER OF HEALTH EMERGENCY AUTHORITY
9-16 RELATING TO DANGEROUS DRUGS. If the commissioner of health has
9-17 compelling evidence that an immediate danger to the public health
9-18 exists as a result of the prescription of a dangerous drug by
9-19 practitioners described by Section 483.001(12)(C), the commissioner
9-20 may use the commissioner's existing emergency authority to limit
9-21 the availability of the drug by permitting its prescription only by
9-22 practitioners described by Section 483.001(12)(A), [or] (B), or
9-23 (D).
9-24 SECTION 9. The Texas State Board of Medical Examiners shall
9-25 submit a report to the legislature not later than December 1, 2004,
9-26 of the number of waiver applications received and the number of
10-1 waiver applications granted under Section 157.0542, Occupations
10-2 Code, as added by this Act.
10-3 SECTION 10. This Act takes effect immediately if it receives
10-4 a vote of two-thirds of all the members elected to each house, as
10-5 provided by Section 39, Article III, Texas Constitution. If this
10-6 Act does not receive the vote necessary for immediate effect, this
10-7 Act takes effect September 1, 2001.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1166 passed the Senate on
March 29, 2001, by the following vote: Yeas 30, Nays 0, one
present, not voting.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1166 passed the House on
April 26, 2001, by the following vote: Yeas 146, Nays 0, two
present, not voting.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor