|
Texas State
Board of Medical Examiners
Physician Assistants
Chapter 185.1-185.30
185.1.
Purpose.
The purpose
of these rules is to create a system of licensing and regulating
physician assistants as a means to ensure the competency of physician
assistants without a financial burden to the people of Texas.
Furthermore, the purpose of these rules and regulations is to also
encourage the more effective utilization of the skills of physicians by
enabling them to delegate health care tasks to qualified physician
assistants. These sections are not intended to, and shall not be
construed to, restrict the physician from delegating technical and
clinical tasks to technicians, other assistants, or employees who
perform delegated tasks in the office of a physician and who are not
rendering services as a physician assistant or identifying themselves as
a physician assistant. Nothing in these rules and regulations
shall be construed to relieve the supervising physician of the
professional or legal responsibility for the care and treatment of his
or her patients.
185.2.
Definitions.
The
following words and terms, when used in this chapter, shall have the
following meanings, unless the context clearly indicates
otherwise.
(1) Act -
The Physician Assistant Licensing Act, Texas Occupations Code
Annotated, Title 3, Subtitle C, Chapter 204 as amended.
(2)
Agency – The divisions, departments, and employees of the Texas State
Board of Medical Examiners, the Texas State Board of Physician
Assistant Examiners, and the Texas State Board of Acupuncture
Examiners.
(3)
Alternate physician – A physician providing appropriate supervision on
a temporary basis not to exceed fourteen consecutive days.
(4) APA -
The Administrative Procedure Act, Texas Government Code, Chapter 2001
as amended.
(5)
Applicant – A party seeking a license from the Texas State Board of
Physician Assistant Examiners.
(6) Board
or the “physician assistant board” ‑ The Texas State Board of
Physician Assistant Examiners.
(7)
Medical Board ‑ The Texas State Board of Medical Examiners.
(8)
Medical Practice Act – Texas Occupations Code Annotated, Title 3,
Subtitle B, as amended.
(9) Open
Meetings Act – Texas Government Code Annotated, Chapter 551 as
amended.
(10)
Party – The physician assistant board and each person named or
admitted as a party in a SOAH hearing or contested case before the
physician assistant board.
(11)
Physician assistant ‑ A person licensed as a physician assistant by
the Texas State Board of Physician Assistant Examiners.
(12)
State - Any state, territory, or insular possession of the United
States and the District of Columbia.
(13)
Submit - The term used to indicate that a completed item has been
actually received and date-stamped by the board along with all
required documentation and fees, if any.
(14)
Supervising physician ‑ A physician licensed by the medical board
either as a doctor of medicine or doctor of osteopathic medicine who
assumes responsibility and legal liability for the services rendered
by the physician assistant, and who has received approval from the
medical board to supervise a specific physician assistant.
(15)
Supervision ‑ Overseeing the activities of, and accepting
responsibility for, the medical services rendered by a physician
assistant. Supervision does not require the constant physical
presence of the supervising physician but includes a situation where a
supervising physician and the person being supervised are, or can
easily be, in contact with one another by radio, telephone, or another
telecommunication device.
185.3.
Meetings.
(a) The
board may meet up to four times a year, with a minimum of two times a
year to carry out the mandates of the Act.
(b) Special
meetings may be called by the presiding officer of the board, by
resolution of the board, or upon written request to the presiding
officer of the board signed by at least three members of the
board.
(c) Board
and committee meetings shall, to the extent possible, be conducted
pursuant to the provisions of Robert's Rules of Order Newly Revised
unless, by rule, the board adopts a different procedure.
(d) All
elections and any other issues requiring a vote of the board shall be
decided by a simple majority of the members present. A quorum for
transaction of any business by the board shall be one more than half the
board's membership at the time of the meeting. If more than two
candidates contest an election or if no candidate receives a majority of
the votes cast on the first ballot, a second ballot shall be conducted
between the two candidates receiving the highest number of
votes.
(e) The
board, at a regular meeting or special meeting, may elect from its
membership a presiding officer and a secretary for one
year.
(f) The
board, at a regular meeting or special meeting, upon majority vote of
the members present, may remove the presiding officer or the secretary
from office.
(g) The following are standing and permanent
committees of the board. The responsibilities and authority of these
committees shall include those duties and powers as defined in
paragraphs (1) (3) of this subsection and such other responsibilities
and authority which the board may from time to time delegate to these
committees.
(1)
Licensure Committee.
(A)
Draft and review proposed rules regarding licensure, and make
recommendations to the board regarding changes or implementation of
such rules.
(B)
Draft and review proposed rules pertaining to the overall licensure
process, and make recommendations to the board regarding changes or
implementation of such rules.
(C)
Receive and review applications for licensure in the event the
eligibility for licensure of an applicant is in
question.
(D)
Present the results of reviews of applications for licensure, and
make recommendations to the board regarding licensure of applicants
whose eligibility is in question.
(E)
Make recommendations to the board regarding matters brought to the
attention of the Licensure Committee.
(2)
Disciplinary and Ethics Committee.
(A)
Draft and review proposed rules regarding the discipline of
physician assistants and enforcement of the Physician Assistant
Licensing Act.
(B)
Oversee the disciplinary process and give guidance to the board and
staff regarding methods to improve the disciplinary process and more
effectively enforce the Physician Assistant Licensing
Act.
(C)
Monitor the effectiveness, appropriateness, and timeliness of the
disciplinary process.
(D)
Make recommendations regarding resolution and disposition of
specific cases and approve, adopt, modify, or reject recommendations
from staff or representatives of the board regarding actions to be
taken on pending cases. Approve dismissals of complaints and closure
of investigations.
(E) Draft and review proposed ethics
guidelines and rules for the practice of physician assistants, and
make recommendations to the board regarding the adoption of such
ethics guidelines and rules.
(F)
Make recommendations to the board and staff regarding policies,
priorities, budget, and any other matters related to the
disciplinary process and enforcement of the Physician Assistant
Licensing Act.
(G)
Make recommendations to the board regarding matters brought to the
attention of the Disciplinary and Ethics
Committee.
(3) Long
Range Planning Committee.
(A)
Formulate and make recommendations to the board concerning future
board goals and objectives and the establishment of priorities and
methods for their accomplishment.
(B)
Study and make recommendations to the board regarding the role and
responsibility of the board officers and committees.
(C)
Study and make recommendations to the board regarding ways to
improve the efficiency and effectiveness of the administration of
the board.
(D)
Study and make recommendations to the board regarding board rules or
any area of a board function that, in the judgment of the committee
needs consideration.
(E)
Study and make recommendations to the board regarding legislative
changes pertinent to the practice of Physician
Assistants.
(F)
Study and make recommendations to the board regarding financial
issues.
(h)
Meetings of the board and of its committees are open to the public
unless such meetings are conducted in executive session pursuant to
the Open Meetings Act, the Physician Assistant Licensing Act, or the
Medical Practice Act. In order that board meetings may be conducted
safely, efficiently, and with decorum, members of the public shall
refrain at all times from smoking or using tobacco products, eating,
or reading newspapers and magazines. Members of the public may not
engage in disruptive activity that interferes with board proceedings,
including excessive movement within the meeting room, noise or loud
talking, and resting of feet on tables and chairs. The public shall
remain within those areas designated as open to the public. Members of
the public shall not address or question board members during meetings
unless recognized by the board's presiding officer pursuant to a
published agenda item.
(i)
Journalists have the same right of access as other members of the
public to board meetings conducted in open session, and are also
subject to the rules of conduct described in subsection (h) of this
section. Observers of any board meeting may make audio or visual
recordings of such proceedings conducted in open session subject to
the following limitations: the board's presiding officer may request
periodically that camera operators extinguish their artificial lights
to allow excessive heat to dissipate; camera operators may not
assemble or disassemble their equipment while the board is in session
and conducting business; persons seeking to position microphones for
recording board proceedings may not disrupt the meeting or disturb
participants; journalists may conduct interviews in the reception area
of the medical board's offices or, at the discretion of the board's
presiding officer, in the meeting room after recess or adjournment; no
interview may be conducted in the hallways of the medical board's
offices; and the board's presiding officer may exclude from a meeting
any person who, after being duly warned, persists in conduct described
in this subsection and subsection (h) of this section.
(j) The
secretary of the board shall assume the duties of the presiding
officer in the event of the presiding officer's absence or
incapacity.
(k) In
the event of the absence or temporary incapacity of the presiding
officer, and the secretary, the members of the board may elect another
member to act as the presiding officer of a board meeting or may elect
an interim acting presiding officer for the duration of the absences
or incapacity.
(l) Upon
the death, resignation, removal or permanent incapacity of the
presiding officer or the secretary, the board shall elect from its
membership an officer to fill the vacant position. Such an election
shall be conducted as soon as practicable at a regular or special
meeting of the board.
185.4.
Procedural Rules for Licensure Applicants.
(a) Except
as otherwise provided in this section, an individual shall be licensed
by the board before the individual may function as a physician
assistant. A license shall be granted to an applicant
who:
(1)
submits an application on forms approved by the
board;
(2) pays
the appropriate application fee as prescribed by the board;
(3)
has successfully completed an educational program for physician
assistants or surgeon assistants accredited by the Commission on
Accreditation of Allied Health Education Programs, or by that
committee's predecessor or successor entities, and holds a valid and
current certificate issued by the National Commission on Certification
of Physician Assistants (“NCCPA”);
(4)
certifies that the applicant is mentally and physically able to
function safely as a physician assistant;
(5) does
not have a license, certification, or registration as a physician
assistant in this state or from any other licensing authority that is
currently revoked or on suspension or the applicant is not subject to
probation or other disciplinary action for cause resulting from the
applicant's acts as a physician assistant, unless the board takes that
fact into consideration in determining whether to issue the
license;
(6) is of
good moral character;
(7)
submits to the board any other information the board considers
necessary to evaluate the applicant's qualifications; and
(8) meets
any other requirement established by rules adopted by the
board.
(b) The
following documentation shall be submitted as a part of the licensure
process:
(1) Name
Change. Any applicant who submits documentation showing a name
other than the name under which the applicant has applied must present
certified copies of marriage licenses, divorce decrees, or court
orders stating the name change. In cases where the applicant's
name has been changed by naturalization the applicant should send the
original naturalization certificate by certified mail to the board for
inspection.
(2)
Certification. Each applicant for licensure must
submit:
(A) a
letter of verification of current NCCPA certification sent directly
from NCCPA, and
(B) a
certificate of successful completion of an educational program
submitted directly from the program on a form provided by the
board.
(3)
Verification from other states. Each applicant for licensure who
is licensed, registered, or certified in another state must have that
state submit directly to the board, on a form provided by the board,
that the physician assistant's license, registration, or certification
is current and in full force and that the license, registration, or
certification has not been restricted, canceled, suspended, or
revoked. The other state shall also include a description of any
sanctions imposed by or disciplinary matters pending in the
state.
(4) State
License Registration. Each applicant, if licensed, registered,
or certified in another state as a physician assistant, must submit a
copy of the license registration certificate to the board. The
license, registration, or certificate number and the date of
expiration must be visible on the copy.
(5)
Arrest Records. If an applicant has ever been arrested, a copy
of the arrest and arrest disposition needs to be requested from the
arresting authority and that authority must submit copies directly to
the board.
(6)
Malpractice. If an applicant has ever been named in a
malpractice claim filed with any liability carrier or if an applicant
has ever been named in a malpractice suit, the applicant
must:
(A)
have each liability carrier complete a form furnished by this board
regarding each claim filed against the applicant's
insurance;
(B) for
each claim that becomes a malpractice suit, have the attorney
representing the applicant in each suit submit a letter directly to
the board explaining the allegation, dates of the allegation, and
current status of the suit. If the suit has been closed, the
attorney must state the disposition of the suit, and if any money
was paid, the amount of the settlement. The letter shall be
accompanied by supporting documentation including court records if
applicable. If such letter is not available, the applicant
will be required to furnish a notarized affidavit explaining why
this letter cannot be provided; and
(C)
provide a statement, composed by the applicant, explaining the
circumstances pertaining to patient care in defense of the
allegations.
(7)
Additional Documentation. Additional documentation as is deemed
necessary to facilitate the investigation of any application for
licensure must be submitted.
(c) The executive director shall review each
application for licensure and shall recommend to the board all
applicants eligible for licensure. The executive director also
shall report to the board the names of all applicants determined to be
ineligible for licensure, together with the reasons for each
recommendation. An applicant deemed ineligible for licensure by
the executive director may request review of such recommendation by a
committee of the board within 20 days of receipt of such notice, and the
executive director may refer any application to said committee for a
recommendation concerning eligibility. If the committee finds the
applicant ineligible for licensure, such recommendation, together with
the reasons therefor, shall be submitted to the board unless the
applicant requests a hearing within 20 days of receipt of notice of the
committee's determination. The hearing shall be before an
administrative law judge of the State Office of Administrative Hearings
and shall comply with the Administrative Procedure Act and its
subsequent amendments and the rules of the State Office of
Administrative Hearings and the board. The committee may refer any
application for determination of eligibility to the full board.
The board shall, after receiving the administrative law judge's proposed
findings of fact and conclusions of law, determine the eligibility of
the applicant for licensure. A physician assistant whose
application for licensure is denied by the board shall receive a written
statement containing the reasons for the board's action. All
reports received or gathered by the board on each applicant are
confidential and are not subject to disclosure under the Public
Information Act. The board may disclose such reports to appropriate
licensing authorities in other states.
(d) All
physician assistant applicants shall provide sufficient documentation to
the board that the applicant has, on a full-time basis, actively
practiced as a physician assistant, has been a student at an acceptable
approved physician assistant program, or has been on the active teaching
faculty of an acceptable approved physician assistant program, within
either of the last two years preceding receipt of an application for
licensure. The term "full-time basis," for purposes of this
section, shall mean at least 20 hours per week for 40 weeks duration
during a given year. Applicants who do not meet the requirements
of subsections (a) and (b) of this section may, in the discretion of the
board, be eligible for an unrestricted license or a restricted license
subject to one or more of the following conditions or restrictions as
set forth in paragraphs (1)-(4) of this subsection:
(1)
completion of specified continuing medical education hours approved
for Category 1 credits by a CME sponsor approved by the American
Academy of Physician Assistants;
(2)
limitation and/or exclusion of the practice of the applicant to
specified activities of the practice as a physician
assistant;
(3)
remedial education; and
(4) such
other remedial or restrictive conditions or requirements which, in the
discretion of the board are necessary to ensure protection of the
public and minimal competency of the applicant to safely practice as a
physician assistant.
(e)
Applicants for licensure:
(1) whose
application for licensure which has been filed with the board office
and which is in excess of two years old from the date of receipt,
shall be considered inactive. Any fee previously submitted with
the application shall be forfeited. Any further application
procedure for licensure will require submission of a new application
and inclusion of the current licensure fee;
(2) who
in any way falsify the application may be required to appear before
the board;
(3) on
whom adverse information is received by the board may be required to
appear before the board;
(4) shall
be required to comply with the board's rules and regulations which are
in effect at the time the completed application form and fee are filed
with the board;
(5) may
be required to sit for additional oral or written examinations that,
in the opinion of the board, are necessary to determine competency of
the applicant;
(6) must
have the application of licensure complete in every detail 20 days
prior to the board meeting in which they are considered for
licensure. Applicants may qualify for a Temporary License prior
to being considered by the board for licensure, as required by §185.7
of this title (relating to Temporary License);
(7) who
previously held a Texas health care provider license may be required
to complete additional forms as
required.
185.5.
Relicensure.
If a
physician assistant's license has been expired for one year, it is
considered to have been canceled, unless an investigation is
pending. The physician assistant may obtain a new license by
complying with the requirements and procedures for obtaining an original
license.
185.6.
Annual Renewal of License.
(a)
Physician assistants licensed under the Physician Assistant Licensing
Act shall register annually and pay a fee. A physician assistant
may, on notification from the board, renew an unexpired license by
submitting the required form and documents and by paying the required
renewal fee to the board on or before the expiration date of the permit.
The fee shall accompany the required form which legibly sets forth the
licensee's name, mailing address, business address, and other necessary
information prescribed by the board.
(b) The
following documentation shall be submitted as part of the renewal
process:
(1)
Continuing Medical Education. As a prerequisite to the annual
registration of a physician assistant's license, 40 hours of
continuing medical education (CME) are required to be completed in the
following categories:
(A) at
least one‑half of the hours are to be from formal courses that are
designated for Category I credit by a CME sponsor approved by the
American Academy of Physician Assistants.
(B) The
remaining hours may be from Category II composed of informal
self‑study, attendance at hospital lectures, grand rounds, case
conferences, or by providing volunteer medical services at a site
serving a medically underserved population, other than at a site
that is the primary practice site of the license holder, and shall
be recorded in a manner that can be easily transmitted to the board
upon request.
(2) A
physician assistant must report on the annual registration form if she
or he has completed the required continuing medical education during
the previous year. A licensee may carry forward CME credit hours
earned prior to annual registration which are in excess of the 40 hour
annual requirement and such excess hours may be applied to the
following years' requirements. A maximum of 80 total excess
credit hours may be carried forward and shall be reported according to
whether the hours are Category I and/or Category II. Excess CME
credit hours of any type may not be carried forward or applied to an
annual report of CME more than two years beyond the date of the annual
registration following the period during which the hours were
earned.
(3) A
physician assistant may request in writing an exemption for the
following reasons:
(A)
catastrophic illness;
(B)
military service of longer than one year's duration outside the
United States;
(C)
residence of longer than one year's duration outside the United
States; or
(D) good cause shown on written application of the
licensee that gives satisfactory evidence to the board that the
licensee is unable to comply with the requirement for continuing
medical education.
(4)
Exemptions are subject to the approval of the licensure committee of
the board.
(5) A
temporary exception under paragraph (3) of this subsection may not
exceed one year but may be renewed annually, subject to the approval
of the board.
(6) This
section does not prevent the board from taking disciplinary action
with respect to a licensee or an applicant for a license by requiring
additional hours of continuing medical education or of specific course
subjects.
(7) The
board may require written verification of both formal and informal
credits from any licensee within 30 days of request. Failure to
provide such verification may result in disciplinary action by the
board.
(8)
Unless exempted under the terms of this section, a physician assistant
licensee's apparent failure to obtain and timely report the 40 hours
of CME as required and provided for in this section shall result in
nonrenewal of the license until such time as the physician assistant
obtains and reports the required CME hours; however, the executive
director of the board may issue to such a physician assistant a
temporary license numbered so as to correspond to the nonrenewed
license. Such a temporary license shall be issued at the
direction of the executive director for a period of no longer than 90
days. A temporary license issued pursuant to this subsection may
be issued to allow the physician assistant who has not obtained or
timely reported the required number of hours an opportunity to correct
any deficiency so as not to require termination of ongoing patient
care.
(c)
Falsification of an affidavit or submission of false information to
obtain renewal of a license shall subject a physician assistant to
denial of the renewal and/or to discipline pursuant to the Physician
Assistant Licensing Act, §§204.301-.303.
(d) If the
renewal fee and completed application form are not received on or before
the expiration date of the permit, the fees set forth in Chapter 175 of
this title (Fees, Penalties, and Applications) shall apply.
(e) The
board shall not waive fees or penalties.
(f) The
board shall stagger annual registration of physician assistants
proportionally on a periodic basis.
(g)
Practicing as a physician assistant as defined in the Physician
Assistant Licensing Act without an annual registration permit for the
current year as provided for in the board rules has the same force and
effect as and is subject to all penalties of practicing as a physician
assistant without a license.
(h)
Physician assistants shall inform the board of address changes within
two weeks of the effective date of the address
change.
185.7.
Temporary License.
(a) The
board, or its designee may issue a temporary license to an applicant
who:
(1) meets
all the qualifications for a license under the Physician Assistant
Licensing Act but is waiting for the next scheduled meeting of the
board for the license to be issued;
(2) seeks
to temporarily substitute for a licensed physician assistant during
the licensee's absence, if the applicant:
(A) is
licensed or registered in good standing in another state, territory,
or the District of Columbia;
(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 physician assistants or
surgeon assistants accredited by the Commission on Accreditation of
Allied Health Education Programs or by the committee's predecessor or
successor entities no later than six months previous to the
application for temporary licensure and is waiting for examination
results from the National Commission on Certification of Physician
Assistants.
(b) A
temporary license may be valid for not more than one year from the date
issued
185.8.
Inactive License.
(a) A
license holder may have the license holder's license placed on inactive
status by applying to the board. A physician assistant with an
inactive license is excused from paying renewal fees on the license and
may not practice as a physician assistant in Texas.
(b) In
order for a license holder to be placed on inactive status, the license
holder must have a current annual registration permit.
(c) A
license holder who practices as a physician assistant while on inactive
status is considered to be practicing without a license.
(d) A
physician assistant may return to active status by applying to the
board, paying the license renewal fee, complying with the requirements
for license renewal under the Physician Assistant Licensing Act and
complying with subsection (e) of this section.
(e) A
physician assistant applicant applying to return to active status shall
provide sufficient documentation to the board that the applicant has, on
a full-time basis as defined in §185.4(d) of this chapter, actively
practiced as a physician assistant or has been on the active teaching
faculty of an acceptable approved physician assistant program, within
either of the two years preceding receipt of an application for
reactivation. Applicants who do not meet this requirement may, in
the discretion of the board, be eligible for the reactivation of a
license subject to one or more of the following conditions or
restrictions as set forth in paragraphs (1)-(5) of this
subsection:
(1)
current certification by the National Commission on the Certification
of Physician Assistants;
(2)
completion of specified continuing medical education hours approved
for Category 1 credits by a CME sponsor approved by the American
Academy of Physician Assistants;
(3)
limitation and/or exclusion of the practice of the applicant to
specified activities of the practice as a physician
assistant;
(4)
remedial education; and
(5)
such other remedial or restrictive conditions or requirements which,
in the discretion of the board are necessary to ensure protection of
the public and minimal competency of the applicant to safely practice
as a physician assistant.
185.9.
Reissuance of License Following Revocation.
(a) The
applicant must complete in every detail the application for reissuance
of a license following revocation including payment of the required
application fee.
(b) The
applicant must appear before the board to state the reasons for the
request for reissuance of license.
(c)
Application for reissuance of a license following revocation cannot be
considered more often than annually.
(d)
Reissuance of a license following revocation shall be at the discretion
of the board upon a showing by the applicant that reissuance is in the
best interest of the public.
(e) A
person may not apply for reissuance of a license that was revoked before
the first anniversary date on which the revocation became
effective.
185.10. Physician Assistant Scope of Practice.
The
physician assistant shall provide, within the education, training, and
experience of the physician assistant, medical services that are
delegated by the supervising physician. The activities listed in
paragraphs (1)‑(9) of this subsection may be performed in any place
authorized by a supervising physician, including, but not limited to a
clinic, hospital, ambulatory surgical center, patient home, nursing
home, or other institutional setting. Medical services provided by
a physician assistant may include, but are not limited to:
(1)
obtaining patient histories and performing physical
examinations;
(2)
ordering and/or performing diagnostic and therapeutic
procedures;
(3)
formulating a working diagnosis;
(4)
developing and implementing a treatment plan;
(5)
monitoring the effectiveness of therapeutic interventions;
(6)
assisting at surgery;
(7)
offering counseling and education to meet patient needs;
(8)
requesting, receiving, and signing for the receipt of pharmaceutical
sample prescription medications and distributing the samples to
patients in a specific practice setting where the physician assistant
is authorized to prescribe pharmaceutical medications and sign
prescription drug orders at a site, as provided by the Medical
Practice Act, Chapter 157, and its subsequent amendments, or as
otherwise authorized by this Act or board rule;
(9) the
signing or completion of a prescription as provided by the Medical
Practice Act, Chapter 157; and
(10)
making appropriate
referrals.
185.11.
Tasks Not Permitted to be Delegated to a Physician Assistant.
Except at
sites designated by the Medical Practice Act, Chapter 157, the
supervising physician shall not allow a physician assistant to prescribe
or supply medication.
185.12.
Identification Requirements.
A physician
assistant licensed by the board shall keep the physician assistant's
Texas license available for inspection at the physician assistant's
primary place of business and shall, when engaged in professional
activities, wear a name tag identifying the physician assistant as a
physician assistant.
185.13.
Notification of Intent to Practice and Supervise.
(a) A
physician assistant licensed under the Physician Assistant Licensing Act
must, before beginning practice or upon changing practice, submit
notification of the license holder's intent to begin practice.
Notification under this section must include:
(1) the
name, business address, Texas physician assistant license number, and
telephone number of the physician assistant; and
(2) the
name, business address, Texas medical license number, and telephone
number of the supervising physician;
(b) A
physician assistant must submit notification of any changes in, or
additions to, the person acting as a supervising physician for the
physician assistant not later than the 30th day after the date the
change or addition is made.
(c) For the
purposes of this section, a single form prescribed by the board shall be
used to provide notification of the license holder's intent to begin
practice or any changes in, or additions to, the person acting as a
supervising physician.
(d) If a
supervising physician will be unavailable to supervise the physician
assistant as required by this section, arrangements shall be made for an
alternate physician to provide that supervision. The alternate physician
providing that supervision shall affirm in writing and document through
a log where the physician assistant is located that he or she is
familiar with the protocols or standing delegation orders in use and is
accountable for adequately supervising care provided pursuant to those
protocols or standing delegation orders. The log shall be kept
with the protocols or standing orders. The log shall contain dates
of the alternate physician supervision and be signed by the alternate
physician acknowledging this responsibility. The physician
assistant is responsible for verifying that the alternate physician is a
licensed Texas physician holding an unrestricted and active
license.
185.14.
Physician Supervision.
(a)
Supervision shall be continuous, but shall not be construed as
necessarily requiring the constant physical presence of the supervising
physician at a place where physician assistant services are performed
while the services are performed. Telecommunication shall always
be available.
(b) It is
the obligation of each team of physician(s) and physician assistant(s)
to ensure that:
(1) the
physician assistant's scope of practice is identified;
(2)
delegation of medical tasks is appropriate to the physician
assistant's level of competence;
(3) the
relationship between the members of the team is defined;
(4) the
relationship of, and access to, the supervising physician is
defined;
(5) a
process for evaluation of the physician assistant's performance is
established; and
(6) the
physician assistant's annual registration permit is
current.
(c) A
physician assistant may have more than one supervising
physician.
(d)
Physician assistants must utilize mechanisms which provide medical
authority when such mechanisms are indicated, including, but not limited
to, standing delegation orders, standing medical orders, protocols, or
practice guidelines.
185.15.
Supervising Physician.
(a) A
physician assistant may only be supervised by a physician
who:
(1) is
currently licensed as a physician in this state by the medical board.
The license must be unrestricted and active;
(2) has
notified the board of the physician's intent to supervise a physician
assistant; and
(3) has
submitted a statement to the board that the physician
will:
(A)
supervise the physician assistant according to rules adopted by the
board; and
(B)
retain professional and legal responsibility for the care rendered
by the physician assistant.
(b) A
physician assistant may be supervised by an alternate supervising
physician in the absence of the supervising physician consistent with
this chapter, the Texas Medical Practice Act, the Physician Assistant
Licensing Act, board rules, medical board rules, and any standing
orders or protocols established in accordance with these statutes and
rules.
185.16.
Employment Guidelines.
(a) Except
as otherwise provided in this section, a physician may supervise up to
five physician assistants, or their full-time equivalents. "Full time"
shall mean no more than 50 hours per week.
(b) A
physician assistant may not independently bill patients for the services
provided by the physician assistant except where provided by
law.
(c) Except
at a site serving medically underserved populations, a physician
assistant shall not practice at a site where that physician assistant's
supervising physician is not present at least 20 percent of the site's
listed business hours unless the supervising physician has obtained a
waiver under '193.6(i) of this title (relating to
Waivers).
(d) A
physician who provides medical services in preventive medicine, disease
management, health and wellness education, or similar services in an
accredited academic/teaching institution listed in paragraphs (1)-(10)
of this subsection, or its affiliates, may be denoted as the supervising
physician for more than five physician assistants in that institution or
its affiliates, provided the supervising physician determines that the
physician assistants are properly trained to deliver the services, that
the services are of such a nature that they may be safely and
competently delivered by the supervised physician assistants, and the
proper paperwork has been filed with the Texas State Board of Medical
Examiners. The supervision of physician assistants must comply with all
institutional rules and there must be accurate and timely internal
institutional records, which are available upon request within 24 hours
to the Texas State Board of Medical Examiners, which list the name and
license number of the physician who is specifically assigned to actively
supervise each physician assistant at one of the following
institutions:
(1)
University of Texas Medical Branch at Galveston;
(2)
University of Texas Southwestern Medical Center at
Dallas;
(3)
University of Texas Health Science Center at Houston;
(4)
University of Texas Health Science Center at San
Antonio;
(5)
University of Texas Health Center at Tyler;
(6)
University of Texas M.D. Anderson Cancer Center;
(7) Texas
A&M University College of Medicine;
(8) Texas
Tech University School of Medicine;
(9)
Baylor College of Medicine; or
(10)
University of North Texas Health Science Center at Fort
Worth.
(e) A
physician who holds the position of Medical Director, Chief of Staff, or
Emergency Room Department Chair at a licensed hospital may be denoted as
the supervising physician for more than five physician assistants for
the purpose of staffing a hospital emergency room. This physician may
then delegate the direct supervision of the physician assistant to staff
physicians providing medical services within the emergency room,
provided that the supervising physician determines that the physician
assistants are properly trained to deliver services, that the services
are of such a nature that they may be safely and competently delivered
by the supervised physician assistants, and that the proper paperwork
has been filed with the Texas State Board of Medical Examiners. The
supervision of physician assistants must comply with all institutional
rules and there must be accurate and timely internal institutional
records, which are available upon request within 24 hours to the Texas
State Board of Medical Examiners, which list the name and license number
of the physician who is specifically assigned to actively supervise each
physician assistant.
(f) The
provisions of subsections (a), (d), and (e) of this section relating to
the number of physician assistants authorized to be supervised shall not
be interpreted to change or modify rules or statutes relating to the
number of physician assistants to whom prescriptive authority may be
delegated.
185.17.
Grounds for Denial of Licensure and for Disciplinary Action.
The board
may refuse to issue a license to any person and may, following notice of
hearing and a hearing as provided for in the Administrative Procedure
Act, take disciplinary action against any physician assistant
who:
(1)
fraudulently or deceptively obtains or attempts to obtain a
license;
(2)
fraudulently or deceptively uses a license;
(3)
violates the Physician Assistant Licensing Act, or any rules relating
to the practice of a physician assistant;
(4) is
convicted of a felony, or has imposition of deferred adjudication or
pre-trial diversion;
(5)
habitually uses drugs or intoxicating liqueurs to the extent that, in
the opinion of the board, the person cannot safely perform as a
physician assistant;
(6) has
been adjudicated as mentally incompetent or has a mental or physical
condition that renders the person unable to safely perform as a
physician assistant;
(7) has
committed an act of moral turpitude. An act involving moral
turpitude shall be defined as an act involving baseness, vileness, or
depravity in the private and social duties one owes to others or to
society in general, or an act committed with knowing disregard for
justice, honesty, principles, or good morals;
(8)
represents that the person is a physician;
(9) has
acted in an unprofessional or dishonorable manner which is likely to
deceive, defraud, or injure any member of the public;
(10) has
failed to practice as a physician assistant in an acceptable manner
consistent with public health and welfare;
(11) has
committed any act that is in violation of the laws of the State of
Texas if the act is connected with practice as a physician assistant;
a complaint, indictment, or conviction of a law violation is not
necessary for the enforcement of this provision; proof of the
commission of the act while in practice as a physician assistant or
under the guise of practice as a physician assistant is sufficient for
action by the board under this section;
(12) has
had the person's license or other authorization to practice as a
physician assistant suspended, revoked, or restricted or who has had
other disciplinary action taken by another state regarding practice as
a physician assistant or had disciplinary action taken by the
uniformed services of the United States. A certified copy of the
record of the state or uniformed services of the United States taking
the action is conclusive evidence of it;
(13)
fails to keep complete and accurate records of purchases and disposal
of drugs listed in Chapter 483, Health and Safety Code, as required by
Chapter 483, Health and Safety Code, or any subsequent rules. A
failure to keep the records for a reasonable time is grounds for
disciplinary action against the license of a physician
assistant. The board or its representative may enter and inspect
a physician assistant's place of practice during reasonable business
hours for the purpose of verifying the correctness of these records
and of taking inventory of the drugs on hand;
(14)
writes a false or fictitious prescription or a dangerous drug as
defined by Chapter 483, Health and Safety Code;
(15)
prescribes , dispenses, or administers a drug or treatment that is
nontherapeutic in nature or nontherapeutic in the manner the drug or
treatment is prescribed, dispensed, or administered;
(16)
unlawfully advertises in a false, misleading, or deceptive
manner. Advertisements shall be defined as false, misleading, or
deceptive consistent with §101.201 of the Texas Occupations
Code;
(17)
alters, with fraudulent intent, any physician assistant license,
certificate, or diploma;
(18) uses
any physician assistant license, certificate, or diploma that has been
fraudulently purchased, issued, or counterfeited or that has been
materially altered;
(19) aids
or abets, directly or indirectly, the practice as a physician
assistant by any person not duly licensed to practice as a physician
assistant by the board;
(20) is
removed or suspended or has disciplinary action taken by his peers in
any professional association or society, whether the association or
society is local, regional, state, or national in scope, or is being
disciplined by a licensed hospital or medical staff of a hospital,
including removal, suspension, limitation of privileges, or other
disciplinary action, if that action, in the opinion of the board, was
based on unprofessional conduct or professional incompetence that was
likely to harm the public. This action does not constitute state
action on the part of the association, society, or hospital medical
staff;
(21) has
repeated or recurring meritorious health care liability claims that in
the opinion of the board evidence professional incompetence likely to
harm the public; or
(22)
through his practice as a physician assistant sexually abuses or
exploits another person.
185.18.
Discipline of Physician Assistants.
(a) The
board, upon finding a physician assistant has committed any of the acts
set forth in §185.17 of this title (relating to Grounds for Denial of
Licensure and for Disciplinary Action), shall enter an order imposing
one or more of the allowable actions set forth under §204.301 of the
Act.
(b)
Disciplinary Guidelines.
(1)
Chapter 190 of this title (relating to Disciplinary Guidelines) shall
apply to physician assistants regulated under this chapter to be used
as guidelines for the following areas as they relate to the denial of
licensure or disciplinary action of a licensee:
(A)
practice inconsistent with public health and welfare;
(B)
unprofessional and dishonorable conduct;
(C)
disciplinary actions by state boards and peer groups;
(D) repeated and recurring meritorious health care
liability claims; and
(E)
aggravating and mitigating factors.
(2) If
the provisions of Chapter 190 conflict with the Act or rules under
this chapter, the Act and provisions of this chapter shall
control.
185.19.
Administrative Penalties.
(a) The
board by order may impose an administrative penalty, subject to the
provisions of the Administrative Procedure Act, against a person
licensed or regulated under the Physician Assistant Licensing Act who
violates the Act or a rule or order adopted under the Act.
(b) The
penalty for a violation may be in an amount not to exceed $5,000.
Each day a violation continues or occurs is a separate violation for
purposes of imposing a penalty.
(c) The
amount of the penalty shall be based on factors set forth under
§204.351(c) of the Act, and Chapter 190 of this title (relating to
Disciplinary Guidelines).
185.20.
Complaint Procedure Notification.
Chapter 188
of this title (relating to Complaint Procedure Notification) shall
govern physician assistants with regard to methods of notification for
filing complaints with the agency. If the provisions of Chapter
188 conflict with the Act or rules under this chapter, the Act and
provisions of this chapter shall control.
185.21.
Investigations.
(a)
Confidentiality. All complaints, adverse reports, investigation
files, other investigation reports, and other investigative information
in the possession of, or received, or gathered by the board or its
employees or agents relating to a licensee, an application for license,
or a criminal investigation or proceeding are privileged and
confidential and are not subject to discovery, subpoena, or other means
of legal compulsion for their release to anyone other than the board or
its employees or agents involved in licensee discipline.
(b) Patient
identity. In any disciplinary investigation or proceeding
regarding a physician assistant conducted under or pursuant to the Act,
the board shall protect the identity of any patient whose medical
records are examined and utilized in a public proceeding except for
those patients who testify in the public proceeding or who submit a
written release in regard to their records or identity.
(c)
Permitted disclosure of investigative information.
Investigative information in the possession of the board or its
employees or agents which relates to licensee discipline and information
contained in such files may not be disclosed except in the following
circumstances:
(1) to
the appropriate licensing or regulatory authorities in other states or
the District of Columbia or a territory or country where the physician
assistant is licensed, registered, or certified or has applied for a
license or to a peer review committee reviewing an application for
privileges or the qualifications of the licensee with respect to
retaining privileges;
(2) to
appropriate law enforcement agencies if the investigative information
indicates a crime may have been committed and the board shall
cooperate with and assist all law enforcement agencies conducting
criminal investigations of licensees by providing information relevant
to the criminal investigation to the investigating agency and any
information disclosed by the board to an investigative agency shall
remain confidential and shall not be disclosed by the investigating
agency except as necessary to further the investigation;
(3) to a
health‑care entity upon receipt of written request. Disclosures
by the board to a health‑care entity shall include only information
about a complaint filed against a physician assistant that was
resolved after investigation by a disciplinary order of the board or
by an agreed settlement, and the basis and current status of any
complaint under active investigation; and
(4) to
other persons if required during the
investigation.
(d)
Complaints. The board shall keep information on file about each
complaint filed with the board, consistent with the Act. If a
written complaint is filed with the board that the board has the
authority to resolve relating to a person licensed by the board, the
board, at least as frequently as quarterly and until final determination
of the action to be taken relative to the complaint, shall notify in a
manner consistent with the Act, the parties to the complaint of the
status of the complaint unless the notice would jeopardize an active
investigation.
(e) Renewal
of licenses. A licensee shall furnish a written explanation of his
or her answer to any question asked on the application for license
renewal, if requested by the board. This explanation shall include
all details as the board may request and shall be furnished within 14
days of the date of the board's request.
185.22.
Impaired Physician Assistants.
(a) Mental
or physical examination requirement.
(1) The
board may require a licensee to submit to a mental and/or physical
examination by a physician or physicians designated by the board if
the board has probable cause to believe that the licensee is
impaired. Impairment is present if one appears to be unable to
practice with reasonable skill and safety to patients by reason of
age, illness, drunkenness, excessive use of drugs, narcotics,
chemicals, or any other type of material; or as a result of any mental
or physical condition.
(2)
Probable cause may include, but is not limited to, any one of the
following:
(A)
sworn statements from two people, willing to testify before the
board, the medical board, or the State Office of
Administrative Hearings that a certain licensee is
impaired;
(B) a
sworn statement from an official representative of the Texas Academy
of Physician Assistants stating that the representative is willing
to testify before the board that a certain licensee is
impaired;
(C)
evidence that a licensee left a treatment program for alcohol or
chemical dependency before completion of that program;
(D)
evidence that a licensee is guilty of intemperate use of drugs or
alcohol;
(E)
evidence of repeated arrests of a licensee for
intoxication;
(F)
evidence of recurring temporary commitments of a licensee to a
mental institution; or
(G) medical records indicating that a licensee has an
illness or condition which results in the inability to function
properly in his or her practice.
(b)
Rehabilitation Orders.
(1) The
board, through an agreed order or after a contested proceeding, may
impose a nondisciplinary rehabilitation order on any licensee or, as a
prerequisite for issuing a license, on any licensure applicant.
Chapter 180 of this title (relating to Rehabilitation Orders)shall
govern procedures relating to physician assistants who are found
eligible for a rehabilitation order. If the provisions of
Chapter 180 conflict with the Act or rules under this chapter, the Act
and provisions of this chapter shall control.
(2) A
rehabilitation order entered pursuant to this section may impose a
revocation, cancellation, suspension, period of probation or
restriction, or any other terms and conditions authorized under this
Act or as otherwise agreed to by the board and the individual subject
to the order.
(3)
Violation of a rehabilitation order entered pursuant to this section
may result in disciplinary action under the provisions of this Act for
contested matters or pursuant to the terms of the agreed order.
A violation of a rehabilitation order may be grounds for disciplinary
action based on unprofessional or dishonorable conduct or on any of
the provisions of this Act which may apply to the misconduct which
resulted in violation of the rehabilitation order.
(4) The
rehabilitation orders entered pursuant to this section shall be kept
in a confidential file which shall be subject to an independent audit
by state auditors or private auditors contracted with by the board to
perform such an audit. Audits may be performed at any time at
the direction of the board but shall be performed at least once every
three years. The audit results shall be reported in a manner
that maintains the confidentiality of all licensees who are subject to
rehabilitation orders and shall be a public record. The audit
shall be for the purposes of ensuring that only qualified licensees
are subject to rehabilitation orders.
185.23.
Third Party Reports to the Board.
(a) Any
peer review committee in this state, any physician assistant licensed to
practice in this state, any physician assistant student, or any
physician licensed to practice medicine or otherwise lawfully practicing
medicine in this state shall report relevant information to the board
related to the acts of any physician assistant in this state if, in the
opinion of the medical peer review committee, physician assistant,
physician assistant student, or a physician, a physician assistant poses
a continuing threat to the public welfare through his practice as a
physician assistant. The duty to report under this section shall
not be nullified through contract.
(b)
Professional Review Actions. A written report of a professional
review action taken by a peer review committee or a health‑care entity
provided to the board must contain the results and circumstances of the
professional review action. Such results and circumstances shall
include:
(1) the
specific basis for the professional review action, whether or not such
action was directly related to the care of individual patients; and
(2) the
specific limitations imposed upon the physician assistant's clinical
privileges, upon membership in the professional society or
association, and the duration of such
limitations.
(c)
Reporting a Physician Assistant’s Continuing Threat to the
Public.
(1)
Relevant information shall be reported to the board indicating that a
physician assistant's practice poses a continuing threat to the public
welfare and shall include a narrative statement describing the time,
date, and place of the acts or omissions on which the report is
based.
(2) A
report that a physician assistant's practice constitutes a continuing
threat to the public welfare shall be made to the board as soon as
possible after the peer review committee or the physician involved
reaches that conclusion and is able to assemble the relevant
information.
(d)
Reporting Professional Liability Claims.
(1)
Reporting responsibilities. The reporting form must be completed
and forwarded to the board for each defendant physician assistant
against whom a professional liability claim or complaint has been
filed. The information is to be reported by insurers or other
entities providing professional liability insurance for a physician
assistant. If a nonadmitted insurance carrier does not report or
if the physician assistant has no insurance carrier, reporting shall
be the responsibility of the physician assistant.
(2)
Separate reports required and identifying information. One
separate report shall be filed for each defendant physician assistant
insured. When Part II is filed, it shall be accompanied by the
completed Part I or other identifying information as described in
paragraph (4)(A) of this subsection.
(3) Time
frames and attachments. The information in Part I of the form
must be provided within 30 days of receipt of the claim or suit.
A copy of the claim letter or petition must be attached. The
information in Part II must be reported within 105 days after
disposition of the claim. Disposed claims shall be defined as
those claims where a court order has been entered, a settlement
agreement has been reached, or the complaint has been dropped or
dismissed.
(4)
Alternate reporting formats. The information may be reported
either on the form provided or in any other legible format which
contains at least the requested data.
(A) If
the reporter elects to use a reporting format other than the board's
form for data required in Part II, there must be enough
identification data available to staff to match the closure report
to the original file. The data required to accomplish this
include:
(i) name and license number of defendant physician
assistant(s); and
(ii)
name of plaintiff.
(B) A
court order or a copy of the settlement agreement is an acceptable
alternative submission for Part II. An order or settlement
agreement should contain the necessary information to match the
closure information to the original file. If the order or
agreement is lacking some of the required data, the additional
information may be legibly written on the order or
agreement.
(5)
Penalty. Failure by a licensed insurer to report under this
section shall be referred to the State Board of Insurance.
(6)
Definition. For the purposes of this subsection a professional
liability claim or complaint shall be defined as a cause of action
against a physician assistant for treatment, lack of treatment, or
other claimed departure from accepted standards of health care or
safety which proximately results in injury to or death of the patient,
whether the patient's claim or cause of action sounds in tort or
contract.
(7)
Claims not required to be reported. Examples of claims that are
not required to be reported under this chapter but which may be
reported include, but are not limited to, the following:
(A)
product liability claims (i.e. where a physician assistant invented
a device which may have injured a patient but the physician
assistant has had no personal physician assistant‑patient
relationship with the specific patient claiming injury by the
device);
(B)
antitrust allegations;
(C)
allegations involving improper peer review activities;
(D) civil rights violations; or
(8)
Voluntary Reporting. Claims that are not required to be reported
under this chapter may, however, be voluntarily reported.
(9)
Reporting Form. The reporting form shall be as
follows:
TEXAS STATE BOARD OF
PHYSICIAN ASSISTANT EXAMINERS
P.O. Box 2018,
MC-263
Austin, Texas
78768-2018
PROFESSIONAL LIABILITY
CLAIMS REPORT
FILE ONE REPORT FOR
EACH DEFENDANT PHYSICIAN ASSISTANT
PART
I COMPLETE FOR ALL CLAIMS OR COMPLAINTS AND FILE WITH THE
TEXAS STATE BOARD OF PHYSICIAN ASSISTANT EXAMINERS WITHIN 30 DAYS
FROM RECEIPT OF COMPLAINT OR CLAIM. INCLUDE COPY OF CLAIM
LETTER AND/OR PLAINTIFF'S COMPLAINT.
1. Name and address of insurer:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
2. Defendant physician assistant:
__________________________________________________________________
License
number:_________________
3. Plaintiff's name:
__________________________________________________________________
4. Policy number:
__________________________________________________________________
5. Date claim reported to insurer/self‑insured
physician assistant:
_______________________________
6. Type of complaint:___________ claim only
____________ lawsuit
7. Initial reserve amount after
investigation:
____________________________________
(If
this is not determined within 30 days, report this data within 105
days of filing the Part I report with the board)
_________________________________________
Person
completing this report (SIGNATURE)
_________________________________________
________________
Person
completing this report (PRINT NAME) Phone
number
PART
II COMPLETE AFTER DISPOSITION OF THE CLAIM AS DEFINED IN
22 T.A.C., INCLUDING DISMISSALS OR SETTLEMENTS. FILE
WITH THE TEXAS STATE BOARD OF PHYSICIAN ASSISTANT EXAMINERS WITHIN
105 DAYS AFTER DISPOSITION OF THE CLAIM. A COPY OF A COURT
ORDER OR SETTLEMENT AGREEMENT MAY BE USED AS PROVIDED IN 22
T.A.C.
8. Date of disposition:________________
9. Type of Disposition:
_______
(1) Settlement
_______
(2) Judgment after trial
_______
(3) Other (please specify)
_____________________________________
10.
Amount of indemnity agreed upon or ordered on behalf of this
defendant:
$
_______________________. Note: If percentage of fault was not
determined by the court or insurer in the case of multiple
defendants, the insurer may report the total amount paid for the
claim followed by a slash and the number of insured defendants.
(Example: $100,000/3)
11.
Appeal, if known: _____Yes _____ No. If yes, which party:
______________________________________________________________
_________________________________________
Person
completing this report (SIGNATURE)
_________________________________________
_______________
Person
completing this report (PRINT NAME) Phone
number
(10)
Professional Liability Suits and Claims. Following receipt of a
notice of claim letter or a complaint filed in court against a
licensee that is reported to the board, the licensee shall furnish to
the board the following information within 14 days of the date of
receipt of the board's request for said information:
(A) a
completed questionnaire to provide summary information concerning
the suit or claim;
(B) a
completed questionnaire to provide information deemed necessary in
assessing the licensee's competency;
(C)
information on the status of any suit or claim previously reported
to either the board or the medical
board.
(e)
Immunity and Reporting Requirements. A person, health care entity,
medical peer review committee, or other entity that without malice
furnishes records, information, or assistance to the board is immune
from any civil liability arising from such act.
185.24.
Procedure.
Chapter 187
of this title (relating to Procedural Rules) shall govern procedures
relating to physician assistants where applicable. If the
provisions of Chapter 187 conflict with the Act or rules under this
chapter, the Act and provisions of this chapter shall
control.
185.25.
Compliance.
Chapter 189
of this title (relating to Compliance) shall be applied to physician
assistants who are under board orders. If the provisions of
Chapter 189 conflict with the Act or rules under this chapter, the Act
and provisions of this chapter shall control.
Effective
January 8,
2004. |
