82R4623 JAM-D
By: Uresti S.B. No. 1566
A BILL TO BE ENTITLED
AN ACT
relating to the licensure of anesthesiologist assistants;
providing penalties.
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 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, 2023.
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.
[Sections 207.005-207.050 reserved for expansion]
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
conflict 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.
[Sections 207.063-207.100 reserved for expansion]
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.
[Sections 207.114-207.150 reserved for expansion]
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 by its successor; 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
accrediting agency 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. 205.157. 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. 205.158. 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.
[Sections 207.159-207.200 reserved for expansion]
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.
[Sections 207.208-207.250 reserved for expansion]
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.
[Sections 207.257-207.300 reserved for expansion]
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.
[Sections 207.307-207.350 reserved for expansion]
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, 2014, two members for terms expiring January
31, 2015, and two members for terms expiring January 31, 2016.
SECTION 6. Not later than June 1, 2012, 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, 2012.
SECTION 8. (a) Except as provided by Subsection (b) of this
section, this Act takes effect September 1, 2011.
(b) Sections 207.151 and 207.352, Occupations Code, as
added by this Act, take effect September 1, 2012.