Important regulations regarding prescribing medication 1

Licensed physicians in Texas must adhere to strict regulations regarding prescribing medication. Texas State agencies have been cracking down on prescription medications for years. Failure to comply with the Texas Medical Board’s (TMB) rules and other laws and regulations on prescribing medication could be costly to your career.
Treatment of Chronic Pain
Pursuant to the Texas Administrative Code rule on the Minimum Requirements for the Treatment of Chronic Pain, a physician’s treatment of a patient’s pain will be evaluated by considering whether the treatment meets the generally accepted standard of care and whether the minimum requirements of the code section have been met.
The minimum requirements include, but are not limited to:

  • Evaluation of the patient.
    • A physician is responsible for obtaining a medical history and a physical examination that includes a problem-focused exam specific to the chief presenting complaint of the patient.
    • The medical record shall document the medical history and physical examination. In the case of chronic pain, the medical record must document:
      • The nature and intensity of the pain;
      • Current and past treatments for pain;
      • Underlying or coexisting diseases and conditions;
      • The effect of the pain on physical and psychological function;
      • Any history and potential for substance abuse or diversion; and
      • The presence of one or more recognized medical indications for the use of a dangerous or scheduled drug.
    • Prior to prescribing dangerous drugs or controlled substances for the treatment of chronic pain, a physician must consider reviewing prescription data and history related to the patient, if any, contained in the Prescription Drug Monitoring Program and consider obtaining at a minimum a baseline toxicology drug screen to determine the presence of drugs in a patient, if any.
  • Treatment plan for chronic pain. The physician is responsible for a written treatment plan that is documented in the medical records. 22 Tex. Admin. Code. §170.3.

You can review the full list of the minimum requirements for the treatment of chronic pain here.
Delegation of Prescriptive Authority
Licensed physicians in Texas have the ability to delegate prescriptive authority to Advanced Practice Registered Nurses (APRN) and Physician Assistants (PA).
Physicians who delegate prescriptive authority to APRN’s or PA’s must register with the TMB, and the prescribing APRN or PA must hold a valid DEA registration. By law, prescriptive delegation requires adequate supervision. What constitutes “adequate supervision” is not expressly defined in the code; however, there are a number of specific methods aimed at ensuring prescriptive authority quality assurance, such as chart review and periodic face-to-face meetings between the APRN or PA and the physician.  Tex. Occ. Code Ann §157.0512(e)(9).
Further, a prescriptive authority agreement must be in place between a physician and a APRN or PA who has been delegated prescriptive authority.  3 Tex. Occ. Code Ann §157.051(14). The prescriptive authority agreement must be in writing, signed by both parties, and address a number of other important things. Review the full list of what the agreement must include in Sec 157.0512(e) of the Medical Practice Act.
Further Considerations Regarding Prescribing Medication

  • Do not write a prescription for a treat a patient for a medical condition outside the scope of your specialty.
  • Do not prescribe medication without appropriately documenting the treatment and prescription in the patient’s medical record.
  • Do not write a prescription for a patient who is located in another state unless you are licensed to practice medicine in that state and are complying with the rules and regulations of that state and its medical board.

Duty to Comply with the Rules and Regulations Regarding Prescribing Medication
As a licensed physician with the TMB, you have a duty to comply with the laws and rules on prescribing medication. Violating a regulation on prescribing medication could lead to an array of consequences that could include licensing issues with the TMB or even criminal charges.
If you have been notified of a complaint filed against you with the Texas Medical Board, BERTOLINO LLP can help. We are experienced TMB license defense attorneys and we know how to navigate the TMB’s complaint process. We are prepared to represent you at any legal hearing or proceeding regarding your professional license.
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