84R5924 TSR-D
 
  By: Davis of Harris H.B. No. 2267
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the requirement to obtain a license to practice as an
  anesthesiologist assistant; providing administrative and criminal
  penalties; imposing fees.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Subchapter B, Chapter 157,
  Occupations Code, is amended to read as follows:
  SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE REGISTERED NURSES,
  [AND] PHYSICIAN ASSISTANTS, AND ANESTHESIOLOGIST ASSISTANTS
         SECTION 2.  Section 157.051, Occupations Code, is amended by
  adding Subdivision (1-a) to read as follows:
               (1-a)  "Anesthesiologist assistant" means a person who
  holds a license issued under Chapter 207.
         SECTION 3.  Subchapter B, Chapter 157, Occupations Code, is
  amended by adding Section 157.061 to read as follows:
         Sec. 157.061.  DELEGATION TO ANESTHESIOLOGIST ASSISTANTS.
  (a)  In a licensed hospital or ambulatory surgical center, a board
  certified anesthesiologist may delegate to an anesthesiologist
  assistant the ordering of drugs and devices necessary for the
  anesthesiologist assistant to administer an anesthetic or an
  anesthesia-related service.
         (b)  Under the anesthesiologist's order and in accordance
  with facility policies or medical staff bylaws, an anesthesiologist
  assistant may select, obtain, and administer the drugs and apply
  the medical devices appropriate to accomplish the
  anesthesiologist's order and maintain the patient within a sound
  physiological status.
         (c)  This section shall be liberally construed to permit the
  full use of safe and effective medication orders to use the skills
  and services of anesthesiologist assistants.
         SECTION 4.  Subtitle C, Title 3, Occupations Code, is
  amended by adding Chapter 207 to read as follows:
  CHAPTER 207. ANESTHESIOLOGIST ASSISTANTS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 207.001.  SHORT TITLE. This chapter may be cited as the
  Anesthesiologist Assistant Licensing Act.
         Sec. 207.002.  DEFINITIONS. In this chapter:
               (1)  "Anesthesiologist" means a physician licensed by
  the Texas Medical Board who specializes in anesthesiology.
               (2)  "Anesthesiologist assistant" means a person who
  holds a license issued under this chapter.
               (3)  "Anesthesiologist assistant board" means the
  Texas Anesthesiologist Assistant Board.
               (4)  "Anesthesiologist assistant practice protocol"
  means a written agreement of jointly agreed protocols or a standing
  order between a supervising anesthesiologist and an
  anesthesiologist assistant that provides for the delegation of
  health care services from a supervising anesthesiologist to an
  anesthesiologist assistant and the review of those services.
               (5)  "Anesthesiology" means the practice of medicine
  that specializes in the relief of pain during and after surgical
  procedures and childbirth, during certain chronic disease
  processes, and during the resuscitation and critical care of
  patients in the operating room and intensive care environments.
               (6)  "Direct supervision" means supervision by an
  anesthesiologist who is present in the facility in which the
  anesthesiologist assistant is performing anesthesia services and
  is immediately available to provide assistance and direction while
  anesthesia services are being performed.
               (7)  "Immediately available" means in the same physical
  location or facility in which the services are provided.
               (8)  "Medical board" means the Texas Medical Board.
               (9)  "Physician" means a person licensed by the Texas
  Medical Board to practice medicine and surgery or osteopathic
  medicine and surgery.
         Sec. 207.003.  APPLICATION OF SUNSET ACT. The Texas
  Anesthesiologist Assistant Board is subject to Chapter 325,
  Government Code (Texas Sunset Act). Unless continued in existence
  as provided by that chapter, the board is abolished and this chapter
  expires September 1, 2027.
         Sec. 207.004.  APPLICABILITY OF CHAPTER. (a) A person is
  not required to hold a license issued under this chapter to practice
  as:
               (1)  a technician, assistant, or employee of a
  physician who performs delegated tasks but does not act as an
  anesthesiologist assistant or represent that the person is an
  anesthesiologist assistant; or
               (2)  any other licensed health care worker acting
  within the scope of that person's license if the person:
                     (A)  does not use the title "anesthesiologist
  assistant" or the initials "A.A." or "A.A.-C"; or
                     (B)  is not represented or designated as an
  anesthesiologist assistant.
         (b)  This chapter does not limit the employment arrangement
  of an anesthesiologist assistant.
  SUBCHAPTER B. TEXAS ANESTHESIOLOGIST ASSISTANT BOARD
         Sec. 207.051.  ANESTHESIOLOGIST ASSISTANT BOARD. (a) The
  Texas Anesthesiologist Assistant Board is an advisory board to the
  medical board.
         (b)  The anesthesiologist assistant board shall:
               (1)  guide, advise, and make recommendations to the
  medical board; and
               (2)  assist the medical board in carrying out this
  chapter.
         (c)  The medical board is responsible for the ongoing
  examination of the scope of practice and promoting the continuing
  role of anesthesiologist assistants in the delivery of health care
  services.
         Sec. 207.052.  APPOINTMENT OF BOARD. The anesthesiologist
  assistant board consists of six members appointed by the governor
  with the advice and consent of the senate as follows:
               (1)  one member who is a physician;
               (2)  one anesthesiologist assistant;
               (3)  two anesthesiologists;  and
               (4)  two members who represent the public and are not
  licensed or trained in a health care profession.
         Sec. 207.053.  PUBLIC MEMBER ELIGIBILITY. A person is not
  eligible for appointment as a public member of the anesthesiologist
  assistant board if the person or the person's spouse:
               (1)  is registered, certified, or licensed by an
  occupational regulatory agency in the field of health care;
               (2)  is employed by or participates in the management
  of a business entity or other organization regulated by the medical
  board or receiving funds from the medical board or anesthesiologist
  assistant board;
               (3)  owns or controls, directly or indirectly, more
  than a 10 percent interest in a business entity or other
  organization regulated by the medical board or anesthesiologist
  assistant board or receiving funds from the medical board or
  anesthesiologist assistant board; or
               (4)  uses or receives a substantial amount of tangible
  goods, services, or money from the medical board or
  anesthesiologist assistant board, other than compensation or
  reimbursement authorized by law for anesthesiologist assistant
  board membership, attendance, or expenses.
         Sec. 207.054.  MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a)
  In this section, "Texas trade association" means a cooperative and
  voluntarily joined association of business or professional
  competitors in this state designed to assist its members and its
  industry or profession in dealing with mutual business or
  professional problems and in promoting their common interest.
         (b)  A person may not be a member of the anesthesiologist
  assistant board or an employee of the medical board employed in a
  "bona fide executive, administrative, or professional capacity,"
  as that phrase is used for purposes of establishing an exemption to
  the overtime provisions of the federal Fair Labor Standards Act of
  1938 (29 U.S.C. Section 201 et seq.) if:
               (1)  the person is an officer, employee, manager, or
  paid consultant of a Texas trade association in the field of health
  care; or
               (2)  the person's spouse is an officer, board member,
  employee, or paid consultant of a Texas trade association in the
  field of health care.
         (c)  A person may not be a member of the anesthesiologist
  assistant board if the person is required to register as a lobbyist
  under Chapter 305, Government Code, because of the person's
  activities for compensation on behalf of a profession related to
  the operation of the medical board or anesthesiologist assistant
  board.
         Sec. 207.055.  MEMBERSHIP REQUIREMENTS. Each member of the
  anesthesiologist assistant board must be a citizen of the United
  States and a resident of this state. Each physician member of the
  anesthesiologist assistant board must be licensed to practice
  medicine in this state.
         Sec. 207.056.  TERMS; VACANCIES. (a) Members of the
  anesthesiologist assistant board serve staggered three-year terms.  
  The terms of two members expire on January 31 each year.
         (b)  An anesthesiologist assistant board member who is an
  anesthesiologist assistant or a physician may not serve more than
  two consecutive terms.
         (c)  If a vacancy occurs during a member's term, the governor
  shall appoint a new member to serve the unexpired term.
         Sec. 207.057.  OFFICERS; MEETINGS. (a) The
  anesthesiologist assistant board shall hold an open annual meeting
  and elect a presiding officer and secretary from among its members.
         (b)  The anesthesiologist assistant board may hold
  additional meetings as necessary provided that notice of each
  meeting is given to each member not less than 10 days before the
  date of the meeting.
         Sec. 207.058.  APPLICABILITY OF OTHER LAW.  (a)  Chapter
  2110, Government Code, does not apply to the anesthesiologist
  assistant board.
         (b)  Except as otherwise provided by this chapter, the
  anesthesiologist assistant board is subject to Chapters 551 and
  2001, Government Code.
         Sec. 207.059.  GROUNDS FOR REMOVAL. (a) It is a ground for
  removal from the anesthesiologist assistant board that a member:
               (1)  does not have at the time of taking office the
  qualifications required by Sections 207.052, 207.053, and 207.055;
               (2)  does not maintain during service on the
  anesthesiologist assistant board the qualifications required by
  Sections 207.052, 207.053, and 207.055;
               (3)  is ineligible for membership under Section
  207.054;
               (4)  cannot, because of illness or disability,
  discharge the member's duties for a substantial part of the member's
  term; or
               (5)  is absent from more than half of the regularly
  scheduled anesthesiologist assistant board meetings that the
  member is eligible to attend during a calendar year without an
  excuse approved by a majority vote of the anesthesiologist
  assistant board.
         (b)  The validity of an action of the anesthesiologist
  assistant board is not affected by the fact that it is taken when a
  ground for removal of an anesthesiologist assistant board member
  exists.
         (c)  If the executive director of the medical board has
  knowledge that a potential ground for removal of an
  anesthesiologist assistant board member exists, the executive
  director shall notify the presiding officer of the anesthesiologist
  assistant board of the potential ground. The presiding officer
  shall then notify the governor and the attorney general that a
  potential ground for removal exists. If the potential ground for
  removal involves the presiding officer, the executive director
  shall notify the next highest officer of the anesthesiologist
  assistant board, who shall notify the governor and the attorney
  general that a potential ground for removal exists.
         Sec. 207.060.  TRAINING. (a) A person who is appointed to
  and qualifies for office as a member of the anesthesiologist
  assistant board may not vote, deliberate, or be counted as a member
  in attendance at a meeting of the anesthesiologist assistant board
  until the person completes a training program that complies with
  this section.
         (b)  The training program must provide the person with
  information regarding:
               (1)  this chapter;
               (2)  the results of the most recent formal audit of the
  anesthesiologist assistant board;
               (3)  the requirements of laws relating to open
  meetings, public information, administrative procedure, and
  conflicts of interest; and
               (4)  any applicable ethics policies adopted by the
  medical board or the Texas Ethics Commission.
         (c)  A person appointed to the anesthesiologist assistant
  board is entitled to reimbursement, as provided by the General
  Appropriations Act, for travel expenses incurred in attending the
  training program regardless of whether the attendance at the
  program occurs before or after the person qualifies for office.
         Sec. 207.061.  QUALIFICATIONS AND STANDARDS OF CONDUCT
  INFORMATION. The executive director of the medical board or the
  executive director's designee shall provide, as often as necessary,
  to members of the anesthesiologist assistant board information
  regarding their:
               (1)  qualifications for office under this chapter; and
               (2)  responsibilities under applicable laws relating
  to standards of conduct for state officers.
         Sec. 207.062.  COMPENSATION; REIMBURSEMENT. An
  anesthesiologist assistant board member may not receive
  compensation for service on the anesthesiologist assistant board
  but is entitled to receive reimbursement under the General
  Appropriations Act for transportation and related expenses
  incurred while conducting the anesthesiologist assistant board's
  business.
  SUBCHAPTER C. POWERS AND DUTIES OF ANESTHESIOLOGIST
  ASSISTANT BOARD AND MEDICAL BOARD
         Sec. 207.101.  GENERAL POWERS AND DUTIES OF ANESTHESIOLOGIST
  ASSISTANT BOARD. The anesthesiologist assistant board shall:
               (1)  adopt rules that are reasonable and necessary for
  the performance of the board's duties under this chapter, as
  provided by Chapter 2001, Government Code, including rules to
  establish:
                     (A)  licensing and other fees;
                     (B)  license renewal dates; and
                     (C)  procedures for disciplinary actions;
               (2)  review and approve or reject each application for
  the issuance or renewal of a license;
               (3)  issue each license;
               (4)  deny, suspend, or revoke a license or otherwise
  discipline a license holder; and
               (5)  take any action necessary to carry out the
  functions and duties of the board under this chapter.
         Sec. 207.102.  GUIDELINES FOR EARLY INVOLVEMENT IN
  RULEMAKING PROCESS. (a) The anesthesiologist assistant board
  shall adopt guidelines to establish procedures for receiving input
  during the rulemaking process from individuals and groups that have
  an interest in matters under the anesthesiologist assistant board's
  jurisdiction. The guidelines must provide an opportunity for those
  individuals and groups to provide input before the anesthesiologist
  assistant board submits the rule to the medical board for approval.
         (b)  A rule adopted by the medical board may not be
  challenged on the grounds that the anesthesiologist assistant board
  did not comply with this section. If the anesthesiologist
  assistant board was unable to solicit a significant amount of input
  from the public or affected persons early in the rulemaking
  process, the anesthesiologist assistant board shall state in
  writing the reasons why the anesthesiologist assistant board was
  unable to do so.
         Sec. 207.103.  POWERS AND DUTIES OF MEDICAL BOARD RELATING
  TO ANESTHESIOLOGIST ASSISTANTS. (a) The medical board shall adopt
  rules consistent with this chapter to regulate anesthesiologist
  assistants and anesthesiologists who supervise anesthesiologist
  assistants.
         (b)  The medical board, by a majority vote, shall approve or
  reject each rule adopted by the anesthesiologist assistant board.
  If approved, the rule may take effect. If the rule is rejected, the
  medical board shall return the rule to the anesthesiologist
  assistant board for revision.
         Sec. 207.104.  RULES ON CONSEQUENCES OF CRIMINAL CONVICTION.
  The anesthesiologist assistant board shall adopt rules and
  guidelines as necessary to comply with Chapter 53, except to the
  extent the requirements of this chapter are stricter than the
  requirements of Chapter 53.
         Sec. 207.105.  ASSISTANCE BY MEDICAL BOARD. (a) The medical
  board shall provide administrative and clerical employees as
  necessary to enable the anesthesiologist assistant board to
  administer this chapter.
         (b)  Subject to the advice and approval of the medical board,
  the anesthesiologist assistant board shall develop and implement
  policies that clearly separate the policy-making responsibilities
  of the anesthesiologist assistant board and the management
  responsibilities of the executive director and the staff of the
  medical board.
         Sec. 207.106.  FEES. The medical board shall set and collect
  fees in amounts that are reasonable and necessary to cover the costs
  of administering and enforcing this chapter without the use of any
  other funds generated by the medical board.
         Sec. 207.107.  RULES RESTRICTING ADVERTISING OR COMPETITIVE
  BIDDING. (a) The medical board may not adopt rules under this
  chapter restricting advertising or competitive bidding by a license
  holder except to prohibit false, misleading, or deceptive
  practices.
         (b)  In its rules to prohibit false, misleading, or deceptive
  practices, the medical board may not include a rule that:
               (1)  restricts the use of any medium for advertising;
               (2)  restricts the use of a license holder's personal
  appearance or voice in an advertisement;
               (3)  relates to the size or duration of an
  advertisement by the license holder; or
               (4)  restricts the license holder's advertisement under
  a trade name.
         Sec. 207.108.  ANNUAL REPORT. (a) The medical board shall
  prepare annually a complete and detailed written report accounting
  for all funds received and disbursed by the medical board or the
  anesthesiologist assistant board under this chapter during the
  preceding fiscal year.
         (b)  The annual report must meet the reporting requirements
  applicable to financial reporting provided in the General
  Appropriations Act.
         Sec. 207.109.  TECHNOLOGY POLICY. The medical board shall
  implement a policy requiring the anesthesiologist assistant board
  to use appropriate technological solutions to improve the
  anesthesiologist assistant board's ability to perform its
  functions. The policy must ensure that the public is able to
  interact with the anesthesiologist assistant board on the Internet.
         Sec. 207.110.  NEGOTIATED RULEMAKING AND ALTERNATIVE
  DISPUTE RESOLUTION POLICY. The medical board shall develop and
  implement a policy to encourage the use of:
               (1)  negotiated rulemaking procedures under Chapter
  2008, Government Code, for the adoption of medical board rules for
  the anesthesiologist assistant board; and
               (2)  appropriate alternative dispute resolution
  procedures under Chapter 2009, Government Code, to assist in the
  resolution of internal and external disputes under the
  anesthesiologist assistant board's jurisdiction.
         Sec. 207.111.  PUBLIC INTEREST INFORMATION. (a) The
  anesthesiologist assistant board shall prepare information of
  public interest describing the functions of the anesthesiologist
  assistant board and the procedures by which complaints are filed
  with and resolved by the anesthesiologist assistant board.
         (b)  The anesthesiologist assistant board shall make the
  information available to the public and appropriate state agencies.
         Sec. 207.112.  PUBLIC PARTICIPATION. Subject to the advice
  and approval of the medical board, the anesthesiologist assistant
  board shall develop and implement policies that provide the public
  with a reasonable opportunity to appear before the anesthesiologist
  assistant board and to speak on any issue under the jurisdiction of
  the anesthesiologist assistant board.
         Sec. 207.113.  RECORDS OF COMPLAINTS. (a) The
  anesthesiologist assistant board shall maintain a system to
  promptly and efficiently act on complaints filed with the board.
  The board shall maintain:
               (1)  information about the parties to the complaint and
  the subject matter of the complaint;
               (2)  a summary of the results of the review or
  investigation of the complaint; and
               (3)  information about the disposition of the
  complaint.
         (b)  The anesthesiologist assistant board shall make
  information available describing its procedures for complaint
  investigation and resolution.
         (c)  The anesthesiologist assistant board shall periodically
  notify the parties of the status of the complaint until final
  disposition of the complaint, unless the notice would jeopardize an
  active investigation.
  SUBCHAPTER D. LICENSE REQUIREMENTS; EXEMPTIONS; RENEWALS
         Sec. 207.151.  LICENSE REQUIRED. A person may not practice
  as an anesthesiologist assistant in this state unless the person
  holds an anesthesiologist assistant license issued under this
  chapter.
         Sec. 207.152.  ISSUANCE OF LICENSE. (a) The
  anesthesiologist assistant board shall issue a license to an
  applicant who:
               (1)  meets the eligibility requirements of Section
  207.153;
               (2)  submits an application on a form prescribed by the
  board;
               (3)  pays the required application fee;
               (4)  certifies that the applicant is mentally and
  physically able to function safely as an anesthesiologist
  assistant; and
               (5)  submits to the board any other information the
  board considers necessary to evaluate the applicant's
  qualifications.
         (b)  The anesthesiologist assistant board may delegate
  authority to medical board employees to issue licenses under this
  chapter to applicants who clearly meet all licensing requirements.
  If the medical board employees determine that the applicant does
  not clearly meet all licensing requirements, the application shall
  be returned to the anesthesiologist assistant board. A license
  issued under this subsection does not require formal
  anesthesiologist assistant board approval.
         Sec. 207.153.  ELIGIBILITY REQUIREMENTS. (a) To be eligible
  for a license under this chapter, an applicant must:
               (1)  successfully complete an educational program
  accredited by the Commission on Accreditation of Allied Health
  Education Programs or another national accrediting agency approved
  by the medical board;
               (2)  pass the Certifying Examination for
  Anesthesiologist Assistants as administered by the National
  Commission for Certification of Anesthesiologist Assistants or
  another national testing service and examination approved by the
  medical board;
               (3)  be of good moral character; and
               (4)  meet any other requirement established by
  anesthesiologist assistant board rule.
         (b)  In addition to the requirements of Subsection (a), an
  applicant is not eligible for a license, unless the
  anesthesiologist assistant board takes into consideration in
  determining whether to issue the license, if the applicant:
               (1)  has been issued a license, certificate, or
  registration as an anesthesiologist assistant in this state or from
  a licensing authority in another state that is revoked or
  suspended; or
               (2)  is subject to probation or other disciplinary
  action for cause in this state or another state resulting from the
  applicant's acts as an anesthesiologist assistant.
         Sec. 207.154.  EXEMPTION FROM LICENSING REQUIREMENT FOR
  CERTAIN ANESTHESIOLOGIST ASSISTANTS. A person is not required to
  hold a license issued under this chapter to practice as:
               (1)  an anesthesiologist assistant student enrolled in
  an anesthesiologist assistant educational program accredited by
  the Commission on Accreditation of Allied Health Education Programs
  or another national accrediting agency approved by the medical
  board; or
               (2)  an anesthesiologist assistant employed in the
  service of the federal government while performing duties related
  to that employment.
         Sec. 207.155.  TEMPORARY LICENSE. (a) The anesthesiologist
  assistant board may issue a temporary license to an applicant who:
               (1)  meets all the qualifications for a license under
  this chapter but is waiting for the license to be issued at the next
  scheduled meeting of the board;
               (2)  seeks to temporarily substitute for a licensed
  anesthesiologist assistant during the license holder's absence, if
  the applicant:
                     (A)  is licensed or registered in good standing in
  another state;
                     (B)  submits an application on a form prescribed
  by the board; and
                     (C)  pays the appropriate fee prescribed by the
  board; or
               (3)  has graduated from an educational program for
  anesthesiologist assistants described by Section 207.153(a)(1) not
  later than six months before applying for a temporary license and is
  waiting for examination results from the National Commission for
  Certification of Anesthesiologist Assistants or another national
  testing service approved by the medical board.
         (b)  A temporary license may be valid for not more than one
  year after the date issued as determined by anesthesiologist
  assistant board rule.
         Sec. 207.156.  LICENSE RENEWAL. (a) On notification from
  the anesthesiologist assistant board, a person who holds a license
  under this chapter may renew the license by:
               (1)  paying the required renewal fee;
               (2)  submitting the appropriate form; and
               (3)  meeting any other requirement established by board
  rule.
         (b)  The anesthesiologist assistant board by rule may adopt a
  system under which licenses expire on various dates during the
  year.
         (c)  A person who is otherwise eligible to renew a license
  may renew an unexpired license by paying the required renewal fee to
  the anesthesiologist assistant board before the expiration date of
  the license. A person whose license has expired may not engage in
  activities that require a license until the license has been
  renewed.
         (d)  A person whose license has been expired for 90 days or
  less may renew the license by paying to the anesthesiologist
  assistant board a fee that is equal to 1-1/2 times the renewal fee
  for the license.
         (e)  A person whose license has been expired for more than 90
  days but less than one year may renew the license by paying to the
  anesthesiologist assistant board a fee equal to two times the
  renewal fee for the license.
         (f)  A person who was licensed in this state, moved to
  another state, and is currently licensed and has been in practice in
  the other state for the two years preceding the date of the
  application may obtain a new license by paying to the
  anesthesiologist assistant board a fee that is equal to two times
  the normally required renewal fee for the license.
         Sec. 207.157.  CONTINUING EDUCATION REQUIREMENTS. The
  anesthesiologist assistant board by rule shall establish
  continuing education requirements for an anesthesiologist
  assistant licensed under this chapter.  The rules may require a
  license holder, as a condition for license renewal, to successfully
  complete the continuing education required to maintain
  certification by the National Commission for Certification of
  Anesthesiologist Assistants or another national certification
  agency selected by the board.
         Sec. 207.158.  INACTIVE STATUS. (a) A person licensed under
  this chapter may place the person's license on inactive status by
  applying to the anesthesiologist assistant board. A person whose
  license is on inactive status is not required to pay renewal fees
  for the license.
         (b)  The holder of a license on inactive status may not
  practice as an anesthesiologist assistant. A violation of this
  subsection is considered to be practicing without a license.
         (c)  A person whose license is on inactive status under this
  section may return the person's license to active status by:
               (1)  applying to the anesthesiologist assistant board;
               (2)  paying the fee established by the board for
  returning a license to active status;  and
               (3)  satisfying any other requirements established by
  the board.
         (d)  The anesthesiologist assistant board by rule shall
  establish a limit on the length of time an anesthesiologist
  assistant's license may remain on inactive status.
  SUBCHAPTER E. PRACTICE BY LICENSE HOLDER
         Sec. 207.201.  SCOPE OF PRACTICE. (a) An anesthesiologist
  assistant may assist the supervising anesthesiologist in
  developing and implementing an anesthesia care plan for a patient.
  In providing assistance to the supervising anesthesiologist, an
  anesthesiologist assistant may:
               (1)  obtain from the patient a comprehensive patient
  history, perform relevant elements of a physical examination, and
  present the patient's history to the supervising anesthesiologist;
               (2)  pretest and calibrate anesthesia delivery systems
  and obtain and interpret information from the systems and monitors,
  in consultation with an anesthesiologist;
               (3)  initiate multiparameter monitoring before
  anesthesia or in other acute care settings under anesthesiologist
  supervision, including American Society of Anesthesiologists
  standard monitors and arterial and venous catheters, and may use
  and interpret data from central venous, pulmonary artery, and
  intracranial catheters and other monitors or devices that are
  indicated;
               (4)  establish basic and advanced airway
  interventions, including intubation of the trachea and the
  performance of ventilatory support;
               (5)  administer intermittent vasoactive drugs and
  start and adjust vasoactive infusions;
               (6)  administer anesthetic drugs, adjuvant drugs, and
  accessory drugs;
               (7)  assist and initiate with the supervising
  anesthesiologist the performance of epidural anesthetic
  procedures, spinal anesthetic procedures, and other regional
  anesthetic techniques;
               (8)  administer blood, blood products, and supportive
  fluids;
               (9)  provide initial cardiopulmonary resuscitation in
  response to a life-threatening situation as directed by a physician
  or protocol until the supervising anesthesiologist arrives;
               (10)  participate in administrative, research, and
  clinical teaching activities as authorized by the supervising
  anesthesiologist; or
               (11)  perform other tasks not prohibited by law that
  are delegated by a licensed anesthesiologist and that the
  anesthesiologist assistant has been trained and is proficient to
  perform.
         (b)  An anesthesiologist shall at all times accept and be
  responsible for the oversight of the health care services rendered
  by the anesthesiologist assistant.
         (c)  This chapter does not prevent a third-party payor from
  reimbursing the employer of an anesthesiologist assistant for
  covered services rendered by the anesthesiologist assistant.
         Sec. 207.202.  CERTAIN PROHIBITED PRACTICES. An
  anesthesiologist assistant may not:
               (1)  prescribe medication or a controlled substance;
               (2)  administer any drug, medicine, device, or therapy
  the supervising anesthesiologist is not qualified or authorized to
  prescribe; or
               (3)  practice or attempt to practice without the
  supervision of an anesthesiologist or in any location where the
  supervising anesthesiologist is not immediately available for
  consultation, assistance, and intervention.
         Sec. 207.203.  IDENTIFICATION REQUIREMENTS. (a) An
  anesthesiologist assistant must be clearly identified as an
  anesthesiologist assistant and may not use or permit to be used on
  the anesthesiologist assistant's behalf the term:
               (1)  "doctor," "Dr.," or "doc," or another term that
  identifies the person as a physician or surgeon;  or
               (2)  "physician assistant" or "P.A." or another term
  that may imply that the anesthesiologist assistant is a physician
  assistant.
         (b)  An anesthesiologist assistant may not refer to a license
  as "board-certified" or use any other terminology that may imply
  that the anesthesiologist assistant is a physician or surgeon.
         (c)  A student in an anesthesiologist assistant training
  program shall be identified as a student anesthesiologist assistant
  or an anesthesiologist assistant student. A student may not use or
  permit to be used on the student's behalf the term "intern,"
  "resident," or "fellow," or another term that identifies the
  student as a physician or surgeon.
         Sec. 207.204.  SUPERVISION REQUIREMENTS. (a) An
  anesthesiologist assistant shall practice only under the direct
  supervision of an anesthesiologist who is physically present or
  immediately available. A supervising anesthesiologist may
  supervise not more than four anesthesiologist assistants
  consistent with federal rules or regulations for reimbursement for
  anesthesia services. An anesthesiologist assistant may have more
  than one supervising anesthesiologist.
         (b)  Each anesthesiologist who agrees to act as the
  supervising anesthesiologist of an anesthesiologist assistant
  shall adopt a written practice protocol that delineates the
  services the anesthesiologist assistant may provide and the manner
  in which the anesthesiologist will supervise the anesthesiologist
  assistant. The protocol must be based on relevant quality
  assurance standards, including regular review by the supervising
  anesthesiologist of the medical records of the patients cared for
  by the anesthesiologist assistant.
         (c)  The supervising anesthesiologist shall oversee the
  anesthesiologist assistant in accordance with the terms of the
  protocol and rules adopted by the anesthesiologist assistant board
  for the supervision of an anesthesiologist assistant. The board
  may randomly audit or inspect any written practice protocol under
  which an anesthesiologist assistant works.
         Sec. 207.205.  REQUIREMENTS OF SUPERVISING
  ANESTHESIOLOGIST. (a) A supervising anesthesiologist must:
               (1)  hold an unrestricted and active license as a
  physician in this state;
               (2)  be engaged full-time in the medical specialty of
  anesthesiology; and
               (3)  be certified by the American Board of Medical
  Specialties, the Bureau of Osteopathic Specialists in
  Anesthesiology, or another national certifying board approved by
  the medical board.
         (b)  An individual who does not meet the criteria under
  Subsection (a) may not supervise or delegate any task to an
  anesthesiologist assistant.
         Sec. 207.206.  ASSUMPTION OF PROFESSIONAL LIABILITY. (a)
  Each supervising anesthesiologist retains legal responsibility for
  an anesthesiologist assistant's patient care activities, including
  the provision of care and treatment to a patient in a health care
  facility.
         (b)  If an anesthesiologist assistant is employed by an
  entity, including a health care facility, the entity shares the
  legal responsibility for the anesthesiologist assistant's acts or
  omissions with the anesthesiologist assistant's supervising
  anesthesiologist.
         Sec. 207.207.  FACILITY LIMITATIONS OF FUNCTIONS. The
  governing body of each facility in which anesthesiologist
  assistants practice may limit the functions and activities that an
  anesthesiologist assistant may perform in the facility.
  SUBCHAPTER F. COMPLAINTS AND INVESTIGATIVE INFORMATION
         Sec. 207.251.  COMPLAINT INFORMATION AND STATUS. (a) The
  anesthesiologist assistant board shall keep information on file
  about each complaint filed with the board.
         (b)  If a written complaint is filed with the
  anesthesiologist assistant board relating to a person licensed by
  the board, the board, as often as quarterly and until final
  determination of the action to be taken on the complaint, shall
  notify the parties to the complaint of the status of the complaint
  unless the notice would jeopardize an active investigation.
         Sec. 207.252.  CONDUCT OF INVESTIGATION. (a)  The
  anesthesiologist assistant board shall complete a preliminary
  investigation of a complaint filed with the board not later than the
  30th day after the date of receiving the complaint.
         (b)  The anesthesiologist assistant board shall first
  determine whether the anesthesiologist assistant constitutes a
  continuing threat to the public welfare. On completion of the
  preliminary investigation, the board shall determine whether to
  officially proceed on the complaint.
         (c)  If the anesthesiologist assistant board fails to
  complete the preliminary investigation in the time required by this
  section, the board's official investigation of the complaint is
  considered to commence on that date.
         Sec. 207.253.  LICENSE HOLDER ACCESS TO COMPLAINT
  INFORMATION. (a) The anesthesiologist assistant board shall
  provide a license holder who is the subject of a formal complaint
  filed under this chapter with access to all information in its
  possession that the board intends to offer into evidence in
  presenting its case at the contested hearing on the complaint,
  subject to any other privilege or restriction established by rule,
  statute, or legal precedent. The board shall provide the
  information not later than the 30th day after receipt of a written
  request from the license holder or the license holder's counsel,
  unless good cause is shown for delay.
         (b)  Notwithstanding Subsection (a), the anesthesiologist
  assistant board is not required to provide:
               (1)  board investigative reports;
               (2)  investigative memoranda;
               (3)  the identity of a nontestifying complainant;
               (4)  attorney-client communications;
               (5)  attorney work product; or
               (6)  other material covered by a privilege recognized
  by the Texas Rules of Civil Procedure or the Texas Rules of
  Evidence.
         (c)  The provision of information does not constitute a
  waiver of privilege or confidentiality under this chapter or other
  law.
         Sec. 207.254.  HEALTH CARE ENTITY REQUEST FOR INFORMATION.
  On the written request of a health care entity, the
  anesthesiologist assistant board shall provide to the entity:
               (1)  information about a complaint filed against a
  license holder that was resolved after investigation by:
                     (A)  a disciplinary order of the board; or
                     (B)  an agreed settlement; and
               (2)  the basis of and current status of any complaint
  under active investigation.
         Sec. 207.255.  CONFIDENTIALITY OF INVESTIGATIVE
  INFORMATION. A complaint, adverse report, investigation file,
  other report, or other investigative information in the possession
  of or received or gathered by the anesthesiologist assistant board
  or a board employee or agent relating to a license holder, a license
  application, or a criminal investigation or proceeding is
  privileged and confidential and is not subject to discovery,
  subpoena, or other means of legal compulsion for release to any
  person other than the board or a board employee or agent involved in
  license holder discipline.
         Sec. 207.256.  PERMITTED DISCLOSURE OF INVESTIGATIVE
  INFORMATION. (a) Investigative information in the possession of an
  anesthesiologist assistant board employee or agent that relates to
  the discipline of a license holder may be disclosed to:
               (1)  a licensing authority in another state or country
  in which the license holder is licensed or has applied for a
  license; or
               (2)  a peer review committee reviewing:
                     (A)  an application for privileges; or
                     (B)  the qualifications of the license holder with
  respect to retaining privileges.
         (b)  If investigative information in the possession of the
  anesthesiologist assistant board or a board employee or agent
  indicates that a crime may have been committed, the board shall
  report the information to the proper law enforcement agency. The
  board shall cooperate with and assist each law enforcement agency
  conducting a criminal investigation of a license holder by
  providing information relevant to the investigation. Confidential
  information disclosed by the board to a law enforcement agency
  under this subsection remains confidential and may not be disclosed
  by the law enforcement agency except as necessary to further the
  investigation.
  SUBCHAPTER G. DISCIPLINARY PROCEEDINGS
         Sec. 207.301.  DISCIPLINE AUTHORITY OF BOARD. (a) On a
  determination that an applicant or license holder committed an act
  described in Section 207.302, the anesthesiologist assistant board
  by order shall take any of the following actions:
               (1)  deny the person's application for a license or
  license renewal or revoke the person's license or other
  authorization;
               (2)  require the person to submit to the care,
  counseling, or treatment of a health care practitioner designated
  by the board;
               (3)  stay enforcement of an order and place the person
  on probation;
               (4)  require the person to complete additional
  training;
               (5)  suspend, limit, or restrict the person's license,
  including:
                     (A)  limiting the practice of the person to, or
  excluding from the practice, one or more specified activities of
  the practice as an anesthesiologist assistant; or
                     (B)  stipulating periodic board review;
               (6)  assess an administrative penalty;
               (7)  order the person to perform public service; or
               (8)  administer a public reprimand.
         (b)  If the anesthesiologist assistant board stays
  enforcement of an order and places a person on probation, the board
  retains the right to vacate the probationary stay and enforce the
  original order for noncompliance with the terms of probation or
  impose any other remedial measure or sanction authorized by this
  section.
         (c)  The anesthesiologist assistant board may restore or
  reissue a license or remove any disciplinary or corrective measure
  that the board has imposed.
         Sec. 207.302.  CONDUCT INDICATING LACK OF FITNESS. The
  anesthesiologist assistant board may take action under Section
  207.301 against an applicant or license holder who:
               (1)  uses or unlawfully possesses a controlled
  substance or alcoholic beverage to the extent that the person
  cannot safely perform as an anesthesiologist assistant;
               (2)  has been finally adjudicated and found guilty, or
  entered a plea of guilty or nolo contendere, in a criminal
  prosecution under the laws of any state or of the United States, for
  an offense reasonably related to the qualifications, functions, or
  duties of an anesthesiologist assistant, for an offense for which
  an essential element is fraud, dishonesty, or an act of violence, or
  for an offense involving moral turpitude;
               (3)  has used fraud, deception, misrepresentation, or
  bribery in:
                     (A)  securing a certificate of registration or
  authority issued under other law, a permit issued under other law,
  or a license issued under this chapter;  or
                     (B)  obtaining permission to take an examination
  given or required under this chapter;
               (4)  obtains or attempts to obtain a fee, charge,
  tuition, or other compensation by fraud, deception, or
  misrepresentation;
               (5)  has acted with incompetence, misconduct, gross
  negligence, fraud, misrepresentation, or dishonesty in the
  performance of the functions and duties of an anesthesiologist
  assistant;
               (6)  has violated or has assisted or enabled another
  person to violate any provision of this chapter or a rule adopted
  under this chapter;
               (7)  has impersonated a person holding a certificate of
  registration or authority, permit, or license, or allowed a person
  to use a certificate of registration or authority, permit, license,
  or diploma from any school;
               (8)  is subject to disciplinary action relating to
  practice as an anesthesiologist assistant by another state,
  territory, federal agency, or country on grounds for which
  revocation or suspension is also authorized in this state;
               (9)  has been adjudicated as mentally incompetent;
               (10)  assists or enables another person to practice or
  offer to practice as an anesthesiologist assistant if the person is
  not licensed and currently eligible to practice under this chapter;
               (11)  is issued a certificate of registration or
  authority under other law, a permit under other law, or a license
  under this chapter based on a material mistake of fact;
               (12)  violates a professional trust or confidence;  or
               (13)  violates any ethical standard for an
  anesthesiologist assistant as defined by board rule.
         Sec. 207.303.  PHYSICAL OR MENTAL EXAMINATION. (a) The
  anesthesiologist assistant board shall adopt guidelines, in
  conjunction with persons interested in or affected by this section,
  to enable the board to evaluate circumstances in which an
  anesthesiologist assistant or applicant may be required to submit
  to an examination for mental or physical health conditions, alcohol
  and substance abuse, or professional behavior problems.
         (b)  The anesthesiologist assistant board shall refer an
  anesthesiologist assistant or applicant with a physical or mental
  health condition to the most appropriate medical specialist for
  evaluation. The board may not require an anesthesiologist
  assistant or applicant to submit to an examination by a physician
  having a specialty specified by the board unless medically
  indicated. The board may not require an anesthesiologist assistant
  or applicant to submit to an examination to be conducted an
  unreasonable distance from the person's home or place of business
  unless the anesthesiologist assistant or applicant resides and
  works in an area in which there are a limited number of appropriate
  medical specialists able to perform an appropriate examination.
         (c)  The guidelines adopted under this section do not impair
  or remove the anesthesiologist assistant board's power to make an
  independent licensing decision.
         Sec. 207.304.  PROTECTION OF PATIENT IDENTITY. In a
  disciplinary investigation or proceeding conducted under this
  chapter, the anesthesiologist assistant board shall protect the
  identity of each patient whose medical records are examined and
  used in a public proceeding, unless the patient:
               (1)  testifies in the public proceeding; or
               (2)  submits a written release with regard to the
  patient's records or identity.
         Sec. 207.305.  TEMPORARY SUSPENSION. (a) The presiding
  officer of the anesthesiologist assistant board, with board
  approval, shall appoint a three-member disciplinary panel
  consisting of board members to determine whether a person's license
  to practice as an anesthesiologist assistant should be temporarily
  suspended.
         (b)  If the disciplinary panel determines from the evidence
  or information presented to the panel that a person licensed to
  practice as an anesthesiologist assistant would, by the person's
  continuation in practice, constitute a continuing threat to the
  public welfare, the disciplinary panel shall temporarily suspend
  the license of that person.
         (c)  A license may be suspended under this section without
  notice or hearing on the complaint if:
               (1)  institution of proceedings for a hearing before
  the anesthesiologist assistant board is initiated simultaneously
  with the temporary suspension; and
               (2)  a hearing is held under Chapter 2001, Government
  Code, and this chapter as soon as possible.
         (d)  Notwithstanding Chapter 551, Government Code, the
  disciplinary panel may hold a meeting by telephone conference call
  if immediate action is required and convening the panel at one
  location is inconvenient for any member of the panel.
         Sec. 207.306.  SURRENDER OF LICENSE. (a) The
  anesthesiologist assistant board may accept the voluntary
  surrender of a license.
         (b)  A surrendered license may not be returned to the license
  holder unless the anesthesiologist assistant board determines,
  under board rules, that the former holder of the license is
  competent to resume practice.
         (c)  The anesthesiologist assistant board by rule shall
  establish guidelines for determining the competency of a former
  license holder to return to practice.
  SUBCHAPTER H. PENALTIES AND ENFORCEMENT PROVISIONS
         Sec. 207.351.  ADMINISTRATIVE PENALTY. (a) The
  anesthesiologist assistant board by order may impose an
  administrative penalty against a person licensed under this chapter
  who violates this chapter or a rule or order adopted under this
  chapter.
         (b)  The penalty may be in an amount not to exceed $2,000.
  Each day a violation continues or occurs is a separate violation for
  purposes of imposing a penalty.
         (c)  The anesthesiologist assistant board shall base the
  amount of the penalty on:
               (1)  the severity of patient harm;
               (2)  the severity of economic harm to any person;
               (3)  the severity of any environmental harm;
               (4)  increased potential for harm to the public;
               (5)  any attempted concealment of misconduct;
               (6)  any premeditated or intentional misconduct;
               (7)  the motive for the violation;
               (8)  prior misconduct of a similar or related nature;
               (9)  the license holder's disciplinary history;
               (10)  prior written warnings or written admonishments
  from any government agency or official regarding statutes or
  regulations relating to the misconduct;
               (11)  violation of a board order;
               (12)  failure to implement remedial measures to correct
  or mitigate harm from the misconduct;
               (13)  lack of rehabilitative potential or likelihood of
  future misconduct of a similar nature;
               (14)  relevant circumstances increasing the
  seriousness of the misconduct; and
               (15)  any other matter that justice may require.
         (d)  The anesthesiologist assistant board by rule shall
  prescribe the procedure by which it may impose an administrative
  penalty. A proceeding under this section is subject to Chapter
  2001, Government Code.
         (e)  If the anesthesiologist assistant board by order
  determines that a violation has occurred and imposes an
  administrative penalty, the board shall give notice to the person
  of the board's order. The notice must include a statement of the
  person's right to judicial review of the order.
         Sec. 207.352.  CRIMINAL PENALTY. (a) A person commits an
  offense if, without holding a license issued under this chapter,
  the person:
               (1)  represents that the person is an anesthesiologist
  assistant;
               (2)  uses any combination or abbreviation of the term
  "anesthesiologist assistant" to indicate or imply that the person
  is an anesthesiologist assistant; or
               (3)  acts as an anesthesiologist assistant.
         (b)  An offense under this section is a felony of the third
  degree.
         Sec. 207.353.  CEASE AND DESIST ORDER. (a) If it appears to
  the anesthesiologist assistant board that a person who is not
  licensed under this chapter is violating this chapter, a rule
  adopted under this chapter, or another state statute or rule
  relating to anesthesiologist assistant practice, the board after
  notice and opportunity for a hearing may issue a cease and desist
  order prohibiting the person from engaging in the activity.
         (b)  A violation of an order under this section constitutes
  grounds for imposing an administrative penalty under this
  subchapter.
         SECTION 5.  As soon as practicable after the effective date
  of this Act, the governor shall appoint six members to the Texas
  Anesthesiologist Assistant Board in accordance with Chapter 207,
  Occupations Code, as added by this Act. In making the initial
  appointments, the governor shall designate two members for terms
  expiring January 31, 2017, two members for terms expiring January
  31, 2018, and two members for terms expiring January 31, 2019.
         SECTION 6.  Not later than June 1, 2016, the Texas Medical
  Board with the advice of the Texas Anesthesiologist Assistant Board
  shall adopt the rules, procedures, and fees necessary to administer
  Chapter 207, Occupations Code, as added by this Act.
         SECTION 7.  Notwithstanding Chapter 207, Occupations Code,
  as added by this Act, an anesthesiologist assistant is not required
  to hold a license under that chapter to practice as an
  anesthesiologist assistant in this state before September 1, 2016.
         SECTION 8.  (a)  Except as provided by Subsection (b) of this
  section, this Act takes effect September 1, 2015.
         (b)  Sections 207.151 and 207.352, Occupations Code, as
  added by this Act, take effect September 1, 2016.