1-1 By: Madla S.B. No. 1166
1-2 (In the Senate - Filed March 6, 2001; March 8, 2001, read
1-3 first time and referred to Committee on Health and Human Services;
1-4 March 20, 2001, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 8, Nays 0; March 20, 2001,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1166 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the authority of certain advanced practice nurses and
1-11 physician assistants to prescribe drugs.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Subsection (e), Section 157.053, Occupations
1-14 Code, is amended to read as follows:
1-15 (e) A physician's authority to delegate the carrying out or
1-16 signing of a prescription drug order [at the physician's primary
1-17 practice site under this section] is limited to:
1-18 (1) three physician assistants or advanced practice
1-19 nurses or their full-time equivalents practicing at the physician's
1-20 primary practice site or at an alternate practice site under
1-21 Section 157.0541; and
1-22 (2) the patients with whom the physician has
1-23 established or will establish a physician-patient relationship.
1-24 SECTION 2. Subchapter B, Chapter 157, Occupations Code, is
1-25 amended by adding Sections 157.0541 and 157.0542 to read as
1-26 follows:
1-27 Sec. 157.0541. PRESCRIBING AT ALTERNATE SITES. (a) In this
1-28 section, "alternate site" means a practice site:
1-29 (1) where services similar to the services provided at
1-30 the delegating physician's primary practice site are provided; and
1-31 (2) located within 60 miles of the delegating
1-32 physician's primary practice site.
1-33 (b) At an alternate site, a physician licensed by the board
1-34 may delegate to an advanced practice nurse or physician assistant,
1-35 acting under adequate physician supervision, the act of
1-36 administering, providing, or carrying out or signing a prescription
1-37 drug order as authorized through a physician's order, a standing
1-38 medical order, a standing delegation order, or another order or
1-39 protocol as defined by the board. The authority of a physician to
1-40 delegate the carrying out or signing of prescription drug orders
1-41 under this section is limited to dangerous drugs.
1-42 (c) Physician supervision is adequate for the purposes of
1-43 this section if the delegating physician:
1-44 (1) is on-site with the advanced practice nurse or
1-45 physician assistant at least 20 percent of the time;
1-46 (2) reviews at least 10 percent of the medical charts
1-47 at the site; and
1-48 (3) is available through direct telecommunication for
1-49 consultation, patient referral, or assistance with a medical
1-50 emergency.
1-51 (d) An alternate physician may provide appropriate
1-52 supervision to an advanced practice nurse or physician assistant
1-53 under this section on a temporary basis as provided by board rule.
1-54 (e) The combined number of advanced practice nurses and
1-55 physician assistants to whom a physician may delegate under this
1-56 section and at a primary practice site under Section 157.053 may
1-57 not exceed three physician assistants or advanced practice nurses
1-58 or the full-time equivalent of three physician assistants or
1-59 advanced practice nurses.
1-60 Sec. 157.0542. BOARD WAIVER OF DELEGATION REQUIREMENTS.
1-61 (a) On determining that the conditions of Subsection (b) have been
1-62 met, the board may waive or modify any of the site or supervision
1-63 requirements for a physician to delegate the carrying out or
1-64 signing of prescription drug orders to an advanced practice nurse
2-1 or physician assistant under Sections 157.052, 157.053, 157.054,
2-2 and 157.0541, or under board rules. The board may not waive the
2-3 limitation on the number of primary or alternate practice sites at
2-4 which a physician may delegate the carrying out or signing of
2-5 prescription drug orders or the number of advanced practice nurses
2-6 or physician assistants to whom a physician may delegate the
2-7 carrying out or signing of prescription drug orders.
2-8 (b) The board may grant a waiver under Subsection (a) if the
2-9 board determines that:
2-10 (1) the practice site where the physician is seeking
2-11 to delegate prescriptive authority is unable to meet the
2-12 requirements of this chapter or board rules or compliance would
2-13 cause an undue burden without a corresponding benefit to patient
2-14 care;
2-15 (2) safeguards exist for patient care and for
2-16 fostering a collaborative practice between the physician and the
2-17 advanced practice nurses and physician assistants; and
2-18 (3) if the requirement for which the waiver is sought
2-19 is the amount of time the physician is on-site, the frequency and
2-20 duration of time the physician is on-site when the advanced
2-21 practice nurse or physician assistant is present is sufficient for
2-22 collaboration to occur, taking into consideration the other ways
2-23 the physician collaborates with the advanced practice nurse or
2-24 physician assistant, including at other sites.
2-25 (c) The board shall establish procedures for granting
2-26 waivers under this section. At a minimum, the procedures must
2-27 include a process for providing, if the board denies a waiver, a
2-28 written explanation for the denial and identifying modifications
2-29 that would make the waiver acceptable and a process for revoking,
2-30 suspending, or modifying a waiver previously granted. The process
2-31 for revoking, suspending, or modifying a waiver must include notice
2-32 and an opportunity for a hearing. The board may probate an order
2-33 to revoke, suspend, or modify a waiver.
2-34 (d) The board shall appoint an advisory committee to review
2-35 and make recommendations on applications for waivers under this
2-36 section. Each committee member must be actively practicing as a
2-37 physician, an advanced practice nurse, or a physician assistant in
2-38 collaborative practices under which the advanced practice nurse or
2-39 physician assistant is authorized by the physician to sign or carry
2-40 out prescription drug orders under this subchapter. The committee
2-41 consists of 15 members appointed as follows:
2-42 (1) five advanced practice nurses appointed from a
2-43 list of persons recommended by professional associations
2-44 representing advanced practice nurses;
2-45 (2) five physician assistants appointed from a list of
2-46 persons recommended by professional associations representing
2-47 physician assistants; and
2-48 (3) five physicians appointed from a list of persons
2-49 recommended by professional associations representing physicians.
2-50 (e) The advisory committee shall recommend whether to grant
2-51 a waiver after making the determinations required of the board
2-52 under Subsection (a). The board may grant a waiver only if the
2-53 committee recommends that the waiver be granted, unless the board
2-54 determines good cause exists to grant a waiver the committee does
2-55 not recommend.
2-56 (f) The advisory committee may recommend that the board
2-57 approve a waiver with modifications.
2-58 (g) An advisory committee recommendation of the approval of
2-59 a waiver, with or without modifications, requires a vote of at
2-60 least:
2-61 (1) three advanced practice nurse committee members;
2-62 (2) three physician assistant committee members; and
2-63 (3) three physician committee members.
2-64 (h) This section expires September 1, 2005.
2-65 SECTION 3. Subsection (b), Section 204.202, Occupations
2-66 Code, is amended to read as follows:
2-67 (b) Medical services provided by a physician assistant may
2-68 include:
2-69 (1) obtaining patient histories and performing
3-1 physical examinations;
3-2 (2) ordering or performing diagnostic and therapeutic
3-3 procedures;
3-4 (3) formulating a working diagnosis;
3-5 (4) developing and implementing a treatment plan;
3-6 (5) monitoring the effectiveness of therapeutic
3-7 interventions;
3-8 (6) assisting at surgery;
3-9 (7) offering counseling and education to meet patient
3-10 needs;
3-11 (8) requesting, receiving, and signing for the receipt
3-12 of pharmaceutical sample prescription medications and distributing
3-13 the samples to patients in a specific practice setting in which the
3-14 physician assistant is authorized to prescribe pharmaceutical
3-15 medications and sign prescription drug orders as provided by
3-16 Section 157.052, 157.053, [or] 157.054, 157.0541, or 157.0542 or as
3-17 otherwise authorized by physician assistant board rule;
3-18 (9) signing or completing a prescription as provided
3-19 by Subchapter B, Chapter 157; and
3-20 (10) making appropriate referrals.
3-21 SECTION 4. Subdivision (2), Section 301.002, Occupations
3-22 Code, is amended to read as follows:
3-23 (2) "Professional nursing" means the performance for
3-24 compensation of an act that requires substantial specialized
3-25 judgment and skill, the proper performance of which is based on
3-26 knowledge and application of the principles of biological,
3-27 physical, and social science as acquired by a completed course in
3-28 an approved school of professional nursing. The term does not
3-29 include acts of medical diagnosis or prescription of therapeutic or
3-30 corrective measures. Professional nursing involves:
3-31 (A) the observation, assessment, intervention,
3-32 evaluation, rehabilitation, care and counsel, or health teachings
3-33 of a person who is ill, injured, infirm, or experiencing a change
3-34 in normal health processes;
3-35 (B) the maintenance of health or prevention of
3-36 illness;
3-37 (C) the administration of a medication or
3-38 treatment as ordered by a physician, podiatrist, or dentist;
3-39 (D) the supervision or teaching of nursing;
3-40 (E) the administration, supervision, and
3-41 evaluation of nursing practices, policies, and procedures;
3-42 (F) the requesting, receiving, signing for, and
3-43 distribution of prescription drug samples to patients at sites in
3-44 which a registered nurse is authorized to sign prescription drug
3-45 orders as provided by Subchapter B, Chapter 157; and
3-46 (G) the performance of an act delegated by a
3-47 physician under Section 157.052, 157.053, 157.054, 157.0541,
3-48 157.0542, 157.058, or 157.059.
3-49 SECTION 5. Subdivision (34), Section 551.003, Occupations
3-50 Code, is amended to read as follows:
3-51 (34) "Practitioner" means:
3-52 (A) a person licensed or registered to
3-53 prescribe, distribute, administer, or dispense a prescription drug
3-54 or device in the course of professional practice in this state,
3-55 including a physician, dentist, podiatrist, or veterinarian but
3-56 excluding a person licensed under this subtitle;
3-57 (B) a person licensed by another state, Canada,
3-58 or the United Mexican States in a health field in which, under the
3-59 law of this state, a license holder in this state may legally
3-60 prescribe a dangerous drug; [or]
3-61 (C) a person practicing in another state and
3-62 licensed by another state as a physician, dentist, veterinarian, or
3-63 podiatrist, who has a current federal Drug Enforcement
3-64 Administration registration number and who may legally prescribe a
3-65 Schedule II, III, IV, or V controlled substance, as specified under
3-66 Chapter 481, Health and Safety Code, in that other state; or
3-67 (D) an advanced practice nurse or physician
3-68 assistant to whom a physician has delegated the authority to carry
3-69 out or sign prescription drug orders under Section 157.052,
4-1 157.053, 157.054, 157.0541, or 157.0542.
4-2 SECTION 6. Subdivision (12), Section 483.001, Health and
4-3 Safety Code, is amended to read as follows:
4-4 (12) "Practitioner" means a person licensed:
4-5 (A) by the Texas State Board of Medical
4-6 Examiners, State Board of Dental Examiners, Texas State Board of
4-7 Podiatric Medical Examiners, Texas Optometry Board, or State Board
4-8 of Veterinary Medical Examiners to prescribe and administer
4-9 dangerous drugs;
4-10 (B) by another state in a health field in which,
4-11 under the laws of this state, a licensee may legally prescribe
4-12 dangerous drugs; [or]
4-13 (C) in Canada or Mexico in a health field in
4-14 which, under the laws of this state, a licensee may legally
4-15 prescribe dangerous drugs; or
4-16 (D) an advanced practice nurse or physician
4-17 assistant to whom a physician has delegated the authority to carry
4-18 out or sign prescription drug orders under Section 157.052,
4-19 157.053, 157.054, 157.0541, or 157.0542, Occupations Code.
4-20 SECTION 7. Subsection (b), Section 483.003, Health and
4-21 Safety Code, is amended to read as follows:
4-22 (b) On making that finding, the Texas Board of Health may
4-23 limit the availability of the abused drug by permitting its
4-24 dispensing only on the prescription of a practitioner described by
4-25 Section 483.001(12)(A), [or] (B), or (D).
4-26 SECTION 8. Section 483.004, Health and Safety Code, is
4-27 amended to read as follows:
4-28 Sec. 483.004. COMMISSIONER OF HEALTH EMERGENCY AUTHORITY
4-29 RELATING TO DANGEROUS DRUGS. If the commissioner of health has
4-30 compelling evidence that an immediate danger to the public health
4-31 exists as a result of the prescription of a dangerous drug by
4-32 practitioners described by Section 483.001(12)(C), the commissioner
4-33 may use the commissioner's existing emergency authority to limit
4-34 the availability of the drug by permitting its prescription only by
4-35 practitioners described by Section 483.001(12)(A), [or] (B), or
4-36 (D).
4-37 SECTION 9. The Texas State Board of Medical Examiners shall
4-38 submit a report to the legislature not later than December 1, 2004,
4-39 of the number of waiver applications received and the number of
4-40 waiver applications granted under Section 157.0542, Occupations
4-41 Code, as added by this Act.
4-42 SECTION 10. This Act takes effect immediately if it receives
4-43 a vote of two-thirds of all the members elected to each house, as
4-44 provided by Section 39, Article III, Texas Constitution. If this
4-45 Act does not receive the vote necessary for immediate effect, this
4-46 Act takes effect September 1, 2001.
4-47 * * * * *