78R238 JMM-D
By: Noriega H.B. No. 3451
A BILL TO BE ENTITLED
AN ACT
relating to the prescriptive authority of certain psychologists.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 301.002(2), Occupations Code, is
amended to read as follows:
(2) "Professional nursing" means the performance for
compensation of an act that requires substantial specialized
judgment and skill, the proper performance of which is based on
knowledge and application of the principles of biological,
physical, and social science as acquired by a completed course in an
approved school of professional nursing. The term does not include
acts of medical diagnosis or prescription of therapeutic or
corrective measures. Professional nursing involves:
(A) the observation, assessment, intervention,
evaluation, rehabilitation, care and counsel, or health teachings
of a person who is ill, injured, infirm, or experiencing a change in
normal health processes;
(B) the maintenance of health or prevention of
illness;
(C) the administration of a medication or
treatment as ordered by a physician, podiatrist, psychologist who
holds a prescriptive authority certificate, or dentist;
(D) the supervision or teaching of nursing;
(E) the administration, supervision, and
evaluation of nursing practices, policies, and procedures;
(F) the requesting, receiving, signing for, and
distribution of prescription drug samples to patients at sites in
which a registered nurse is authorized to sign prescription drug
orders as provided by Subchapter B, Chapter 157; and
(G) the performance of an act delegated by a
physician under Section 157.052, 157.053, 157.054, 157.0541,
157.0542, 157.058, or 157.059.
SECTION 2. Section 501.002, Occupations Code, is amended
to read as follows:
Sec. 501.002. DEFINITIONS. In this chapter:
(1) "Board" means the Texas State Board of Examiners
of Psychologists.
(2) "Licensed specialist in school psychology" means a
person who holds a license to engage in the practice of psychology
under Section 501.260.
(3) "Prescription drug" has the meaning assigned by
Section 551.003.
(4) "Prescription drug order" has the meaning assigned
by Section 551.003.
(5) "Prescriptive authority certificate" means a
certificate issued by the board that grants the authority to a
psychologist to issue a prescription drug order, to administer or
dispense a prescription drug, and to order tests to monitor the use
of prescription drugs.
(6) "Provisional license holder" means a person who
holds a license to engage in the practice of psychology under
Section 501.253.
(7) [(4)] "Psychological associate" means a person
who holds a license to engage in the practice of psychology issued
under Section 501.259.
(8) [(5)] "Psychologist" means a person who holds a
license to engage in the practice of psychology issued under
Section 501.252.
SECTION 3. Section 501.003(c), Occupations Code, is
amended to read as follows:
(c) The practice of psychology:
(1) includes providing or offering to provide services
to an individual or group, including providing computerized
procedures, that include the application of established
principles, methods, and procedures of describing, explaining, and
ameliorating behavior;
(2) addresses normal behavior and involves
evaluating, preventing, and remediating psychological, emotional,
mental, interpersonal, learning, and behavioral disorders of
individuals or groups, as well as the psychological disorders that
accompany medical problems, organizational structures, stress, and
health;
(3) includes:
(A) using projective techniques,
neuropsychological testing, counseling, career counseling,
psychotherapy, hypnosis for health care purposes, hypnotherapy,
and biofeedback; [and]
(B) evaluating and treating mental or emotional
disorders and disabilities by psychological techniques and
procedures; and
(C) acting under the authority granted by a
prescriptive authority certificate; and
(4) is based on:
(A) a systematic body of knowledge and principles
acquired in an organized program of graduate study; and
(B) the standards of ethics established by the
profession.
SECTION 4. Subchapter F, Chapter 501, Occupations Code, is
amended by adding Section 501.265 to read as follows:
Sec. 501.265. PRESCRIPTIVE AUTHORITY CERTIFICATE. (a) A
psychologist may not issue a prescription drug order, administer or
dispense a prescription drug, order tests to monitor the use of
prescription drugs, or represent that the person holds a
prescriptive authority certificate unless the person holds a
prescriptive authority certificate under this section.
(b) To be eligible for a certificate under this section, a
psychologist must apply to the board and demonstrate that the
person:
(1) is a provider of health services as determined by
the American Psychological Association;
(2) has completed a postdoctoral training program in
psychopharmacology from an institution of higher education or a
provider of continuing education approved by the board that at a
minimum satisfies the training recommendations of the American
Psychological Association; and
(3) has sufficient knowledge and skill to exercise
prescriptive authority by passing an examination under this section
approved by the board.
(c) The board shall adopt rules to protect the public health
that require a psychologist who holds a certificate under this
section to consult with a patient's treating physician within a
reasonable time after the psychologist issues a prescription drug
order for or administers or dispenses a prescription drug to the
patient.
SECTION 5. Section 551.003(34), Occupations Code, is
amended to read as follows:
(34) "Practitioner" means:
(A) a person licensed, certified, or registered
to prescribe, distribute, administer, or dispense a prescription
drug or device in the course of professional practice in this state,
including a physician, dentist, podiatrist, psychologist, or
veterinarian but excluding a person licensed under this subtitle;
(B) a person licensed by another state, Canada,
or the United Mexican States in a health field in which, under the
law of this state, a license or certificate holder in this state may
legally prescribe a dangerous drug;
(C) a person practicing in another state and
licensed by another state as a physician, dentist, veterinarian,
psychologist, or podiatrist, who has a current federal Drug
Enforcement Administration registration number and who may legally
prescribe a Schedule II, III, IV, or V controlled substance, as
specified under Chapter 481, Health and Safety Code, in that other
state; or
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.052,
157.053, 157.054, 157.0541, or 157.0542.
SECTION 6. Section 481.002(39), Health and Safety Code, is
amended to read as follows:
(39) "Practitioner" means:
(A) a physician, dentist, veterinarian,
podiatrist, scientific investigator, psychologist, or other person
licensed, registered, or otherwise permitted to distribute,
dispense, analyze, conduct research with respect to, or administer
a controlled substance in the course of professional practice or
research in this state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
dispense, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state; or
(C) a person practicing in and licensed by
another state as a physician, dentist, veterinarian, psychologist,
or podiatrist, having a current Federal Drug Enforcement
Administration registration number, who may legally prescribe
Schedule II, III, IV, or V controlled substances in that state.
SECTION 7. Section 483.001(12), Health and Safety Code, is
amended to read as follows:
(12) "Practitioner" means a person licensed or
certified:
(A) by the Texas State Board of Medical
Examiners, State Board of Dental Examiners, Texas State Board of
Podiatric Medical Examiners, Texas Optometry Board, Texas State
Board of Examiners of Psychologists, or State Board of Veterinary
Medical Examiners to prescribe and administer dangerous drugs;
(B) by another state in a health field in which,
under the laws of this state, a licensee may legally prescribe
dangerous drugs;
(C) in Canada or Mexico in a health field in
which, under the laws of this state, a licensee may legally
prescribe dangerous drugs; or
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.052,
157.053, 157.054, 157.0541, or 157.0542, Occupations Code.
SECTION 8. Sections 576.025(b), (c), (e), and (f), Health
and Safety Code, are amended to read as follows:
(b) Consent to the administration of psychoactive
medication given by a patient or by a person authorized by law to
consent on behalf of the patient is valid only if:
(1) the consent is given voluntarily and without
coercive or undue influence;
(2) the treating physician or a psychologist who holds
a prescriptive authority certificate, or a person designated by the
physician or psychologist, provided the following information, in a
standard format approved by the department, to the patient and, if
applicable, to the patient's representative authorized by law to
consent on behalf of the patient:
(A) the specific condition to be treated;
(B) the beneficial effects on that condition
expected from the medication;
(C) the probable health and mental health
consequences of not consenting to the medication;
(D) the probable clinically significant side
effects and risks associated with the medication;
(E) the generally accepted alternatives to the
medication, if any, and why the physician or psychologist
recommends that they be rejected; and
(F) the proposed course of the medication;
(3) the patient and, if appropriate, the patient's
representative authorized by law to consent on behalf of the
patient is informed in writing that consent may be revoked; and
(4) the consent is evidenced in the patient's clinical
record by a signed form prescribed by the facility or by a statement
of the treating physician or psychologist described by Subdivision
(2), or a person designated by the physician or the psychologist,
that documents that consent was given by the appropriate person and
the circumstances under which the consent was obtained.
(c) If the treating physician or psychologist designates
another person to provide the information under Subsection (b),
then, not later than two working days after that person provides the
information, excluding weekends and legal holidays, the physician
or psychologist shall meet with the patient and, if appropriate,
the patient's representative who provided the consent, to review
the information and answer any questions.
(e) In prescribing psychoactive medication, a treating
physician or psychologist described by Subsection (b)(2) shall:
(1) prescribe, consistent with clinically appropriate
medical care, the medication that has the fewest side effects or the
least potential for adverse side effects, unless the class of
medication has been demonstrated or justified not to be effective
clinically; and
(2) administer the smallest therapeutically
acceptable dosages of medication for the patient's condition.
(f) If a physician or psychologist described by Subsection
(b)(2) issues an order to administer psychoactive medication to a
patient without the patient's consent because the patient is having
a medication-related emergency:
(1) the physician or psychologist shall document in
the patient's clinical record in specific medical or behavioral
terms the necessity of the order and that the physician or
psychologist has evaluated but rejected other generally accepted,
less intrusive forms of treatment, if any; and
(2) treatment of the patient with the psychoactive
medication shall be provided in the manner, consistent with
clinically appropriate medical care, least restrictive of the
patient's personal liberty.
SECTION 9. This Act takes effect September 1, 2003.