The Texas Medical Practice Act allows physicians to delegate the prescribing or ordering of drugs or devices under strictly defined circumstances. Failure to follow state law and Texas Medical Board (TMB) rules for delegating prescriptive authority can result in disciplinary action against a physician.
If you are facing allegations that you have violated a rule or law related to your profession, you should consult an experienced Texas Medical Board defense attorney. Your attorney can represent your interests from the outset of any investigation and during disciplinary proceedings by the TMB. You can benefit from legal representation throughout this process.
What are the Prescription Delegation Limitations in Texas
Under Tex. Occ. Code §157.012, a physician may delegate prescriptive authority to an advance practice registered nurse (APRN) or physician assistant (PA) acting under adequate physician supervision according to a prescriptive authority agreement between the two parties. Prescriptive authority agreements are impermissible unless they meet the following requirements:
- If applicable, the Texas Board of Nursing (TBON) has approved the APRN’s prescriptive authority;
- The APRN or PA holds an active license in good standing and is not prohibited from executing a prescriptive authority agreement; and
- All parties have disclosed any prior discipline by the TMB, the TBON, or the Texas Physician Assistant Board.
Furthermore, a physician may not simultaneously enter prescriptive authority agreements with more than seven or the equivalent of seven full-time APRNs or PAs. However, this limitation does not apply if the physician is in a practice serving a medically underserved population or a facility-based practice in a hospital.
Prescriptive authority agreements also must meet the following criteria:
- be in writing and signed and dated by the parties to the agreement;
- state the name, address, and all professional license numbers of the parties to the agreement;
- state the nature of the practice, practice locations, or practice settings;
- identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;
- provide a general plan for addressing consultation and referral;
- provide a plan for addressing patient emergencies;
- state the general process for communication and the sharing of information between the physician and the APRN or PA to whom the physician has delegated prescriptive authority related to the care and treatment of patients;
- if alternate physician supervision is to be utilized, designate one or more alternate physicians who may:
- provide appropriate supervision temporarily per the requirements established by the prescriptive authority agreement and the requirements of this subchapter; and
- participate in the prescriptive authority quality assurance and improvement plan meetings required under this section; and
- describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that include the following:
- chart review, with the number of charts to be reviewed determined by the physician and APRN or PA; and
- periodic meetings between the APRN or PA and the physician that must be documented, occur at least once per month, and share information, needed changes, and issues relating to referrals.
Finally, the parties to the prescriptive authority agreement and any amendments must review, sign, and date it at least annually. All physicians must register all APRNs and PAs they supervise with the TMB before the delegation begins. Likewise, all PAs must register with the physicians supervising them with the TMB before the delegation begins. These registrations occur through the TMB’s Online Supervision and Prescriptive Delegation Registration System.
What are the Requirements for the Delegation of Controlled Substances?
Tex. Occ. Code §157.011 limits the prescriptive delegation authority of physicians to nonprescription drugs, dangerous drugs, and some controlled substances under some circumstances.
A physician may delegate the prescription of a controlled substance only if it is a controlled substance listed in Schedule III, IV, or V of the Department of State Health Services, for a period not to exceed 90 days. If the prescription is for a refill, the APRN or PA may issue the refill only after consulting with the delegating physician and noting the consultation in the patient’s chart. Any prescriptions for controlled substances for a child under the age of two may also only be issued after consulting with the delegating physician and noting the consultation in the patient’s chart.
If the controlled substance is a Schedule II controlled substance, a physician may delegate prescriptive authority for the drug only in the context of a hospital facility-based practice according to the hospital’s policies and as part of a patient’s intended hospital stay of 24 hours or more, or as emergency room treatment. Alternatively, a physician can delegate prescriptive authority for a Schedule II controlled substance as part of a plan of care for the treatment of a person who has a certified terminal illness and has elected to receive and is receiving hospice care.
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Collaboration Between TMB, TBON, and the Texas Physician Assistant Board
Tex. Occ. Code §157.0513 requires that the TMB, TBON, and Texas Physician Assistant Board create a process by which they exchange information concerning those physicians, APRNs, and PAs who enter prescriptive authority agreements. Furthermore, each board shall notify the other if any party to such an agreement becomes involved in an investigation involving the delegation and supervision of prescriptive authority and the outcome of that investigation. Such notice may cause the other licensing boards to open similar investigations. Likewise, each board shall maintain and share a list of license holders subject to final adverse disciplinary actions for acts involving the delegation and supervision of prescriptive authority.
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Discipline for Violating Prescriptive Delegation Laws
Under Tex. Occ. Code §164.053(8)-(9), physicians engage in unprofessional or dishonorable conduct if they fail to adequately supervise those whom they are supervising or delegate professional medical responsibility or acts if they know or have reason to know that the person is not qualified by training, experience, or licensure to perform the responsibility or acts. Sanctions for this type of violation under 22 Tex. Admin. Code §190.14(9) may include a remedial plan requiring the completion of 12 hours of CME in supervision and delegation, the development and production of all delegation orders to the TMB director, and payment of a $500 administration fee. More severe penalties for this type of violation may include the previously mentioned sanctions, monitoring of the physician’s practice, removal of delegation and supervision authority, assessment of an administrative penalty of $2,000 per violation, and completion of the jurisprudence exam.
We Are Here to Defend You Throughout Your Disciplinary Proceedings
Facing an investigation and potential disciplinary proceedings before the TMB can be a difficult and stressful experience. Disciplinary proceedings can have an adverse effect on your medical license. We can help you resolve your disciplinary investigation in the most positive manner possible. Get legal assistance from an experienced Texas Medical Board defense lawyer today. Contact Bertolino LLP at (512) 515-9518 or visit us online.