If you are a licensed physician in Texas you have the ability to delegate prescriptive authority to an Advanced Practice Registered Nurse (APRN) or a Physician Assistant (PA). However, there are a number of regulations that must be followed. Failure to fully comply with the Texas Medical Board's (TMB) rules on prescriptive delegation could be costly to your career.
Requirement to Register with the TMB
Physicians who delegate prescriptive authority to APRNs or PAs must register with the TMB.
The TMB offers an online prescriptive delegation registration system. The online system can be used to register prescriptive authority and to file the requisite notice of intent to practice and supervise required of physicians. The online registration system may be accessed here.
Requirement for Adequate Supervision
All prescriptive delegation requires adequate supervision under the Texas Medical Practice Act. While “adequate supervision” is not expressly defined in the code, there are a number of specific methods enumerated to ensure prescriptive authority quality assurance (Tex. Occ. Code Ann §157.0512(e)(9)). These methods include chart review and periodic face-to-face meetings between the APRN or PA and the physician. The face-to-face meetings must include “the sharing of information relating to patient treatment and care, needed changes in patient care plans,” and “discussion of patient care improvement.” (Tex. Occ. Code Ann §157.0512(f)(1).)
Prescriptive Authority Agreement
As of November 1, 2013, a prescriptive authority agreement must be in place between a physician and an APRN or PA who has been delegated prescriptive authority. A prescriptive authority agreement (PAA) ‘means an agreement entered into by a physician and an advanced practice registered nurse or physician assistant through which the physician delegates to the advanced practice registered nurse or physician assistant the act of prescribing or ordering a drug or device.” (Tex. Occ. Code Ann §157.051(14).)
There are a number of important things that must be included and addressed in a PAA. It must be in writing, signed and dated by both parties. It must include the professional license numbers of the parties and identify the types of categories of drugs that may be prescribed by the APRN or PA. These are only a few of the many requirements of a PAA. Review the full list of what a PAA must include in Sec 157.0512(e) of the Medical Practice Act (see page 10 on the provided link).
As a licensed physician with the TMB, you have a duty to comply with the rules for prescriptive delegation. The rules and regulations on the Authority of Physicians to Delegate Certain Medical Acts are codified in Chapter 157 of the Medical Practices Act.
Hire an Experienced Medical License Defense Attorney
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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