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Inside This Issue: Please Keep Watching the TMB Website for More Information on the New Requirements

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October 2013 Significant Changes Coming to Prescriptive Delegation Requirements Senate Bill 406, passed in May 2013 by the 83rd Legislature, website at: www.tmb.state.tx.us/rules/Legislative-Update_% creates a new model for prescriptive delegation through 2083rd-Legislature_2013.pdf. prescriptive authority agreements. Starting November 1, prescriptive authority agreements are required for physician Other Legislative Changes delegation of prescribing and ordering of a drug or device to In addition to Senate Bill 406, there are a number of other bills physician assistants (PAs) and advanced practice registered impacting physician regulation including Senate Bill 978 which nurses (APRNs) in all practice settings with the exception of authorizes TMB to adopt rules regulating the use of local facility-based practices. anesthesia in outpatient settings using total dosage amounts The agreements must include several types of information such that exceed 50% of the recommended maximum safe dosage as a description of practice settings, types or categories of per outpatient visits. drugs/devices that may be prescribed, a general plan for Senate Bill 1643 amends the Texas Prescription Drug addressing consultation and referral, the general process for Monitoring Program administered by DPS by lengthening the communication and sharing of information, and a plan for chart amount of time records are kept from one year to three years; review and periodic face-to-face meetings between the mid- authorizing access to prescription information through a level providers and the physician. The legislation also caps the health information exchange; authorizing access beyond combined number of PAs and APRNs with whom a physician midlevel practitioners (PAs/APRNs) to registered and may enter into a prescriptive authority agreement at seven, vocational nurses and pharmacy technicians; and authorizing with certain exceptions. dispensing history information to be kept in medical Senate Bill 406 also requires the TMB, Nursing Board, and records. House Bill 1803 combines renewal of DPS controlled Physician Assistant Board to develop a process to exchange substance registration for physicians with TMB physician information about licensees who have entered into these license registration. These two bills also make clarifications to agreements. TMB is required to make available to the public an pain management clinic registration requirements. online searchable list of physicians and mid-level practitioners House Bill 945 requires hospitals to adopt policies requiring who have entered into prescriptive authority agreements and health care providers to wear photo identification badges identify the physician with whom each mid-level practitioner during all patient encounters. The badge must indicate the has an agreement. type of license held by the provider and if the provider is a TMB’s proposed rules to implement Senate Bill 406 (Chpt. 193, student, intern, trainee, or resident. Standing Delegation Orders), which include initial stakeholder TMB’s proposed rules to implement many of these and other input, are available for public comment. bills are available for public comment via the TMB website at: For more information, visit the TMB website at: www.tmb.state.tx.us/rules/Medical-Board-Rule-Changes- www.tmb.state.tx.us/rules/Medical-Board-Rule-193-Changes- Proposed-8-30-13.pdf. The board will be reviewing public Proposed-8-30-13.pdf. The board will be reviewing public comment on these rules at its December 5, 2013 meeting. comment on the rules at its October 18, 2013 meeting. Inside this Issue: Please keep watching the TMB website for more information on the new requirements. The board will be developing New Board Members 2 answers to frequently asked questions as well as updating the current supervision and prescriptive delegation registration Board Rule Changes 3 system to reflect changes from the bill. Please note that physicians and physician assistants are still required to Formal Complaints 4-8 register supervision and delegation information with the TMB. New Licensees 8 An overview of legislation impacting physicians and TMB Disciplinary Actions 9-24 regulations, as well as links to bill text, is available on the TMB 1 New Medical, PA and Acupuncture Board Members Devinder Bhatia, M.D., of Houston is a board- also medical director of CareFlite Dallas/Fort Worth, a member of the certified thoracic surgeon and president of CareFlite Dallas Medical Advisory Board, and chair of the Physicians Southeast Texas Cardiovascular P.A. He is a Advisory Group for Stroke, Trauma, and STEMI's Regional Advisory former clinical assistant professor in the Council. Dr. Simonson received a bachelor's degree from Texas University of Texas Health Science Center at Wesleyan University, a Doctor of Osteopathic Medicine from North Houston Department of Cardiothoracic and Texas State University, now the University of North Texas Health Vascular Surgery. He is a member of the Society Science Center Texas College of Osteopathic Medicine. of Thoracic Surgeons, Society for Vascular Karl Swann, M.D. of San Antonio is a Board Surgery, and Southern Thoracic Surgical Association. He is also a Certified Neurosurgeon with Neurosurgical member of the Peripheral Vascular Surgery Society, Society for Clinical Associates of San Antonio since 1986. He has Vascular Surgery, Michael E. DeBakey International Surgical Society, and served as Chairman of the Department of Houston Northwest Medical Center Executive Committee. Dr. Bhatia Neurosurgery at the Methodist Hospital System received a bachelor's degree from the University of Arkansas and a in San Antonio and is a Clinical Assistant medical degree from the University of Arkansas for Medical Sciences, Professor of Neurosurgery at the University of and completed his cardiothoracic and peripheral vascular surgery Texas Health Science Center at San Antonio. He is fellowships at Carolinas Medical Center. a member of the American Association of Neurological Surgeons, The Frank Denton of Conroe is president of Denton Congress of Neurological Surgeons, The Texas Medical Association, The Investment Corporation, an investment company Texas Association of Neurological Surgeons, The North American Spine with commercial real estate, bond and equity Society, and the Bexar County Medical Society. Dr. Swann is a Phi Beta holdings. For over 25 years Mr. Denton worked Kappa graduate of The University of Michigan College of Literature, for a Fortune 500 company and was responsible Sciences and Arts and an Alpha Omega Alpha graduate of The for 40 manufacturing plants located in seven University of Michigan Medical School. He completed his residency in states with over 5,000 employees. Mr. Denton Neurological Surgery at the Harvard Medical School - Massachusetts served as chairman of the Texas Commission of General Hospital. Licensing and Regulation from 2006 to 2013. TDLR’s seven-member Physician Assistant Board commission is responsible for the licensing and regulation of 32 different industries and occupations, licensing over 700,000 Texas Blayne Rush of Frisco, is president of Ambulatory citizens. Mr. Denton was elected in 2003 to the board of directors of Alliance LLC and Rush Search Partners Ltd. He the Texas Association of Business in Austin, served on its executive received a bachelor's degree and master's degree board and was chairman of its small business committee. Mr. Denton is in health promotion from McNeese State past chairman of the Conroe/Lake Conroe Chamber of Commerce, University and a Master of Business chairman of Leadership Montgomery County and served on their Administration from Amber University Graduate executive boards. He has previously served as board member and vice School of Business. president of the Conroe Industrial Development Corporation, treasurer Acupuncture Board of the Montgomery County United Way and held leadership positions in several state and national trade associations. Mr. Denton received a Rodrigo Ceballos, M.D. of El Paso is a native of bachelor's degree from Sam Houston State University. Laredo. He is a family physician and licensed acupuncturist currently serving as the Integrative Robert B. Simonson, D.O., of Duncanville is past Medicine Coordinator of the Interdisciplinary president of Physicians Emergency Care Pain Management Center for William Beaumont Associated, and chair of the Methodist Dallas Army Medical Center at Fort Bliss. He received his Medical Center Department of Emergency bachelor's degree in biology from Texas A&M Medicine. He is also an associate clinical International University at Laredo, his master's degree in Oriental professor at the University of Texas (UT) Medicine from Academy of Oriental Medicine at Austin and his medical Southwestern Medical Center and an adjunct degree from the University of Texas School of Medicine at San Antonio. clinical instructor at the UT Arlington School of He completed his residency in Family Medicine from UT Southwestern Nursing. He is a member of the Texas Medical at Brackenridge Hospital in Austin. His interests include development of Association, American College of Emergency Physicians, Air Medical curriculum for integrative medicine and acupuncture and he serves as a Physicians Association, and Methodist Dallas Medical Center Executive clinical assistant professor for the Texas Tech Paul L. Foster School of Committee. He is a board member of the American Board of Emergency Medicine Department of Family and Community Medicine in El Paso. Medicine
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