CHAPTER 157. AUTHORITY OF PHYSICIAN TO DELEGATE CERTAIN MEDICAL ACTS
OCCUPATIONS CODE
TITLE 3. HEALTH PROFESSIONS
SUBTITLE B. PHYSICIANS
CHAPTER 157. AUTHORITY OF PHYSICIAN TO DELEGATE CERTAIN MEDICAL
ACTS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 157.001. GENERAL AUTHORITY OF PHYSICIAN TO DELEGATE. (a)
A physician may delegate to a qualified and properly trained
person acting under the physician's supervision any medical act
that a reasonable and prudent physician would find within the
scope of sound medical judgment to delegate if, in the opinion of
the delegating physician:
(1) the act:
(A) can be properly and safely performed by the person to whom
the medical act is delegated;
(B) is performed in its customary manner; and
(C) is not in violation of any other statute; and
(2) the person to whom the delegation is made does not represent
to the public that the person is authorized to practice medicine.
(b) The delegating physician remains responsible for the medical
acts of the person performing the delegated medical acts.
(c) The board may determine whether:
(1) an act constitutes the practice of medicine, not
inconsistent with this chapter; and
(2) a medical act may be properly or safely delegated by
physicians.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.002. GENERAL DELEGATION OF ADMINISTRATION AND PROVISION
OF DANGEROUS DRUGS. (a) In this section:
(1) "Administering" means the direct application of a drug to
the body of a patient by injection, inhalation, ingestion, or any
other means.
(2) "Provision" means the supply of one or more unit doses of a
drug, medicine, or dangerous drug.
(b) A physician may delegate to any qualified and properly
trained person acting under the physician's supervision the act
of administering or providing dangerous drugs in the physician's
office, as ordered by the physician, that are used or required to
meet the immediate needs of the physician's patients. The
administration or provision of the dangerous drugs must be
performed in compliance with laws relating to the practice of
medicine and state and federal laws relating to those dangerous
drugs.
(c) A physician may also delegate to any qualified and properly
trained person acting under the physician's supervision the act
of administering or providing dangerous drugs through a facility
licensed by the Texas State Board of Pharmacy, as ordered by the
physician, that are used or required to meet the immediate needs
of the physician's patients. The administration of those
dangerous drugs must be in compliance with laws relating to the
practice of medicine, professional nursing, and pharmacy and
state and federal drug laws. The provision of those dangerous
drugs must be in compliance with:
(1) laws relating to the practice of medicine, professional
nursing, and pharmacy;
(2) state and federal drug laws; and
(3) rules adopted by the Texas State Board of Pharmacy.
(d) In the provision of services and the administration of
therapy by public health departments, as officially prescribed by
the Texas Department of Health for the prevention or treatment of
specific communicable diseases or health conditions for which the
Texas Department of Health is responsible for control under state
law, a physician may delegate to any qualified and properly
trained person acting under the physician's supervision the act
of administering or providing dangerous drugs, as ordered by the
physician, that are used or required to meet the needs of the
patients. The provision of those dangerous drugs must be in
compliance with laws relating to the practice of medicine,
professional nursing, and pharmacy. An order for the prevention
or treatment of a specific communicable disease or health
condition for which the Texas Department of Health is responsible
for control under state law may not be inconsistent with this
chapter and may not be used to perform an act or duty that
requires the exercise of independent medical judgment.
(e) The administration or provision of the drugs may be
delegated through a physician's order, a standing medical order,
a standing delegation order, or another order defined by the
board.
(f) Subsections (b) and (c) do not authorize a physician or a
person acting under the supervision of a physician to keep a
pharmacy, advertised or otherwise, for the retail sale of
dangerous drugs, other than as authorized under Section 158.003,
without complying with the applicable laws relating to the
dangerous drugs.
(g) A drug or medicine provided under Subsection (b) or (c) must
be supplied in a suitable container labeled in compliance with
applicable drug laws. A qualified and trained person, acting
under the supervision of a physician, may specify at the time of
the provision of the drug the inclusion on the container of the
date of the provision and the patient's name and address.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.003. EMERGENCY CARE. The authority to delegate medical
acts to a properly qualified person as provided by this
subchapter applies to emergency care provided by emergency
medical personnel certified by the Texas Department of Health.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.004. DELEGATION REGARDING CERTAIN CARE FOR NEWBORNS;
LIABILITY. (a) It is the policy of this state that the
prevention of ophthalmia neonatorum in newborn infants is of
paramount importance for the protection of the health of the
children of this state.
(b) The authority to delegate medical acts to a midwife under
Chapter 203 applies to the possession and administration of eye
prophylaxis for the prevention of ophthalmia neonatorum.
(c) A physician who issues a standing delegation order to a
midwife under Chapter 203 is not liable in connection with an act
performed under that standing delegation order if the midwife
provides proof of licensure under that chapter before the order
is issued.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch.
1240, Sec. 53, eff. September 1, 2005.
Sec. 157.005. PERFORMANCE OF DELEGATED ACT NOT PRACTICING
WITHOUT MEDICAL LICENSE. A person to whom a physician delegates
the performance of a medical act is not considered to be
practicing medicine without a license by performing the medical
act unless the person acts with knowledge that the delegation and
the action taken under the delegation is a violation of this
subtitle.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.006. LIMITATION ON BOARD RULES REGARDING DELEGATION.
The board shall promote a physician's exercise of professional
judgment to decide which medical acts may be safely delegated by
not adopting rules containing, except as absolutely necessary,
global prohibitions or restrictions on the delegation of medical
acts.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.007. APPLICABILITY OF OTHER LAWS. An act delegated by
a physician under this chapter must comply with other applicable
laws.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE NURSES AND
PHYSICIAN ASSISTANTS
Sec. 157.051. DEFINITIONS. In this subchapter:
(1) "Advanced practice nurse" has the meaning assigned to that
term by Section 301.152. The term includes an advanced nurse
practitioner.
(2) "Carrying out or signing a prescription drug order" means
completing a prescription drug order presigned by the delegating
physician, or the signing of a prescription by a registered nurse
or physician assistant.
(2-a) "Controlled substance" has the meaning assigned to that
term by Section 481.002, Health and Safety Code.
(2-b) "Dangerous drug" has the meaning assigned to that term by
Section 483.001, Health and Safety Code.
(3) "Physician assistant" means a person who holds a license
issued under Chapter 204.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by Acts 2003, 78th Leg., ch. 88, Sec. 1, eff. May 20,
2003.
Amended by:
Acts 2005, 79th Leg., Ch.
269, Sec. 1.27, eff. September 1, 2005.
Sec. 157.0511. PRESCRIPTION DRUG ORDERS. (a) A physician's
authority to delegate the carrying out or signing of a
prescription drug order under this subchapter is limited to:
(1) dangerous drugs; and
(2) controlled substances to the extent provided by Subsection
(b).
(b) A physician may delegate the carrying out or signing of a
prescription drug order for a controlled substance only if:
(1) the prescription is for a controlled substance listed in
Schedule III, IV, or V as established by the commissioner of
public health under Chapter 481, Health and Safety Code;
(2) the prescription, including a refill of the prescription, is
for a period not to exceed 90 days;
(3) with regard to the refill of a prescription, the refill is
authorized after consultation with the delegating physician and
the consultation is noted in the patient's chart; and
(4) with regard to a prescription for a child less than two
years of age, the prescription is made after consultation with
the delegating physician and the consultation is noted in the
patient's chart.
(b-1) The board shall adopt rules that require a physician who
delegates the carrying out or signing of a prescription drug
order under this subchapter to register with the board the name
and license number of the physician assistant or advanced
practice nurse to whom a delegation is made. The board may
develop and use an electronic online delegation registration
process for registration under this subsection.
(c) This subchapter does not modify the authority granted by law
for a licensed registered nurse or physician assistant to
administer or provide a medication, including a controlled
substance listed in Schedule II as established by the
commissioner of public health under Chapter 481, Health and
Safety Code, that is authorized by a physician under a
physician's order, standing medical order, standing delegation
order, or protocol.
Added by Acts 2003, 78th Leg., ch. 88, Sec. 2, eff. May 20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
269, Sec. 1.28, eff. September 1, 2005.
Acts 2009, 81st Leg., R.S., Ch.
746, Sec. 1, eff. September 1, 2009.
Sec. 157.052. PRESCRIBING AT SITES SERVING CERTAIN MEDICALLY
UNDERSERVED POPULATIONS. (a) In this section:
(1) "Health manpower shortage area" means:
(A) an urban or rural area of this state that:
(i) is not required to conform to the geographic boundaries of a
political subdivision but is a rational area for the delivery of
health service;
(ii) the secretary of health and human services determines has a
health manpower shortage; and
(iii) is not reasonably accessible to an adequately served area;
(B) a population group that the secretary of health and human
services determines has a health manpower shortage; or
(C) a public or nonprofit private medical facility or other
facility that the secretary of health and human services
determines has a health manpower shortage, as described by 42
U.S.C. Section 254e(a)(1).
(2) "Medically underserved area" means:
(A) an area in this state with a medically underserved
population;
(B) an urban or rural area designated by the secretary of health
and human services as an area in this state with a shortage of
personal health services or a population group designated by the
secretary as having a shortage of those services, as described by
42 U.S.C. Section 300e-1(7); or
(C) an area defined as medically underserved by rules adopted by
the Texas Board of Health based on:
(i) demographics specific to this state;
(ii) geographic factors that affect access to health care; and
(iii) environmental health factors.
(3) "Registered nurse" means a registered nurse recognized by
the Texas Board of Nursing as having the specialized education
and training required under Section 301.152.
(4) "Site serving a medically underserved population" means:
(A) a site located in a medically underserved area;
(B) a site located in a health manpower shortage area;
(C) a clinic designated as a rural health clinic under 42 U.S.C.
Section 1395x(aa);
(D) a public health clinic or a family planning clinic under
contract with the Texas Department of Human Services or the Texas
Department of Health;
(E) a site located in an area in which the Texas Department of
Health determines there is an insufficient number of physicians
providing services to eligible clients of federal, state, or
locally funded health care programs; or
(F) a site that the Texas Department of Health determines serves
a disproportionate number of clients eligible to participate in
federal, state, or locally funded health care programs.
(b) After making a determination under this section that a site
serves a medically underserved population, the Texas Department
of Health shall publish notice of its determination in the Texas
Register and provide an opportunity for public comment in the
manner provided for a proposed rule under Chapter 2001,
Government Code.
(c) At a site serving a medically underserved population, a
physician licensed by the board may delegate to a registered
nurse or physician assistant acting under adequate physician
supervision the act of administering, providing, or carrying out
or signing a prescription drug order, as authorized by the
physician through a physician's order, a standing medical order,
a standing delegation order, or another order or protocol as
defined by the board.
(d) An advertisement for a site serving a medically underserved
population must include the name and business address of the
supervising physician for the site.
(e) Physician supervision is adequate for the purposes of this
section if a delegating physician:
(1) is responsible for the formulation or approval of the
physician's order, standing medical order, standing delegation
order, or other order or protocol, and periodically reviews the
order and the services provided patients under the order;
(2) is on-site to provide medical direction and consultation at
least once every 10 business days during which the advanced
practice nurse or physician assistant is on-site providing care;
(3) receives a daily status report from the advanced practice
nurse or physician assistant on any problem or complication
encountered; and
(4) is available through direct telecommunication for
consultation, patient referral, or assistance with a medical
emergency.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by Acts 2003, 78th Leg., ch. 88, Sec. 3, eff. May 20,
2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 32, eff. September 1, 2007.
Sec. 157.053. PRESCRIBING AT PHYSICIAN PRIMARY PRACTICE SITES.
(a) In this section, "primary practice site" means:
(1) the practice location of a physician at which the physician
spends the majority of the physician's time;
(2) a licensed hospital, a licensed long-term care facility, or
a licensed adult care center where both the physician and the
physician assistant or advanced practice nurse are authorized to
practice;
(3) a clinic operated by or for the benefit of a public school
district to provide care to the students of that district and the
siblings of those students, if consent to treatment at that
clinic is obtained in a manner that complies with Chapter 32,
Family Code;
(4) the residence of an established patient;
(5) another location at which the physician is physically
present with the physician assistant or advanced practice nurse;
or
(6) a location where a physician assistant or advanced practice
nurse who practices on-site with the physician more than 50
percent of the time and in accordance with board rules provides:
(A) health care services for established patients;
(B) without remuneration, voluntary charity health care services
at a clinic run or sponsored by a nonprofit organization; or
(C) without remuneration, voluntary health care services during
a declared emergency or disaster at a temporary facility operated
or sponsored by a governmental entity or nonprofit organization
and established to serve persons in this state.
(b) At a physician's primary practice site, a physician licensed
by the board may delegate to a physician assistant or an advanced
practice nurse acting under adequate physician supervision the
act of administering, providing, or carrying out or signing a
prescription drug order as authorized through a physician's
order, a standing medical order, a standing delegation order, or
another order or protocol as defined by the board.
(c) Physician supervision of the carrying out and signing of
prescription drug orders must conform to what a reasonable,
prudent physician would find consistent with sound medical
judgment but may vary with the education and experience of the
particular advanced practice nurse or physician assistant. A
physician shall provide continuous supervision, but the constant
physical presence of the physician is not required.
(d) An alternate physician may provide appropriate supervision
on a temporary basis as defined and established by board rule.
(e) A physician's authority to delegate the carrying out or
signing of a prescription drug order is limited to:
(1) four physician assistants or advanced practice nurses or
their full-time equivalents practicing at the physician's primary
practice site or at an alternate practice site under Section
157.0541 unless a waiver is granted under Section 157.0542(b-1);
and
(2) the patients with whom the physician has established or will
establish a physician-patient relationship.
(f) For purposes of Subsection (e)(2), the physician is not
required to see the patient within a specific period.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by Acts 2001, 77th Leg., ch. 112, Sec. 1, eff. May 11,
2001; Acts 2003, 78th Leg., ch. 88, Sec. 4, eff. May 20, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
746, Sec. 2, eff. September 1, 2009.
Sec. 157.054. PRESCRIBING AT FACILITY-BASED PRACTICE SITES. (a)
A physician licensed by the board may delegate, to one or more
physician assistants or advanced practice nurses acting under
adequate physician supervision whose practice is facility-based
at a licensed hospital or licensed long-term care facility, the
administration or provision of a drug and the carrying out or
signing of a prescription drug order if the physician is:
(1) the medical director or chief of medical staff of the
facility in which the physician assistant or advanced practice
nurse practices;
(2) the chair of the facility's credentialing committee;
(3) a department chair of a facility department in which the
physician assistant or advanced practice nurse practices; or
(4) a physician who consents to the request of the medical
director or chief of medical staff to delegate the carrying out
or signing of a prescription drug order at the facility in which
the physician assistant or advanced practice nurse practices.
(b) A physician's authority to delegate under Subsection (a) is
limited as follows:
(1) the delegation must be made under a physician's order,
standing medical order, standing delegation order, or another
order or protocol developed in accordance with policies approved
by the facility's medical staff or a committee of the facility's
medical staff as provided by the facility bylaws;
(2) the delegation must occur in the facility in which the
physician is the medical director, the chief of medical staff,
the chair of the credentialing committee, or a department chair;
(3) the delegation may not permit the carrying out or signing of
prescription drug orders for the care or treatment of the
patients of any other physician without the prior consent of that
physician;
(4) delegation in a long-term care facility must be by the
medical director and is limited to the carrying out and signing
of prescription drug orders to not more than four advanced
practice nurses or physician assistants or their full-time
equivalents; and
(5) a physician may not delegate at more than one licensed
hospital or more than two long-term care facilities unless
approved by the board.
(c) Physician supervision of the carrying out and signing of
prescription drug orders must conform to what a reasonable,
prudent physician would find consistent with sound medical
judgment but may vary with the education and experience of the
particular advanced practice nurse or physician assistant. A
physician shall provide continuous supervision, but the constant
physical presence of the physician is not required.
(d) An alternate physician may provide appropriate supervision
on a temporary basis as defined and established by board rule.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by Acts 2003, 78th Leg., ch. 88, Sec. 5, eff. May 20,
2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
746, Sec. 3, eff. September 1, 2009.
Sec. 157.0541. PRESCRIBING AT ALTERNATE SITES. (a) In this
section, "alternate site" means a practice site:
(1) where services similar to the services provided at the
delegating physician's primary practice site are provided; and
(2) located within 75 miles of the delegating physician's
residence or primary practice site.
(b) At an alternate site, a physician licensed by the board may
delegate to an advanced practice nurse or physician assistant,
acting under adequate physician supervision, the act of
administering, providing, or carrying out or signing a
prescription drug order as authorized through a physician's
order, a standing medical order, a standing delegation order, or
another order or protocol as defined by the board.
(c) Physician supervision is adequate for the purposes of this
section if:
(1) the delegating physician:
(A) is on-site with the advanced practice nurse or physician
assistant at least 10 percent of the hours of operation of the
site each month that the physician assistant or advanced practice
nurse is acting with delegated prescriptive authority and is
available while on-site to see, diagnose, treat, and provide care
to those patients for services provided or to be provided by the
physician assistant or advanced practice nurse to whom the
physician has delegated prescriptive authority; and
(B) is not prohibited by contract from seeing, diagnosing, or
treating a patient for services provided or to be provided by the
physician assistant or advanced practice nurse under delegated
prescriptive authority;
(2) the delegating physician reviews at least 10 percent of the
medical charts, including through electronic review of the charts
from a remote location, for each advanced practice nurse or
physician assistant at the site; and
(3) the delegating physician is available through direct
telecommunication for consultation, patient referral, or
assistance with a medical emergency.
(d) An alternate physician may provide appropriate supervision
to an advanced practice nurse or physician assistant under this
section on a temporary basis as provided by board rule.
(e) Unless a waiver is granted under Section 157.0542(b-1), the
combined number of advanced practice nurses and physician
assistants to whom a physician may delegate under this section
and at a primary practice site under Section 157.053 may not
exceed four physician assistants or advanced practice nurses or
the full-time equivalent of four physician assistants or advanced
practice nurses.
Added by Acts 2001, 77th Leg., ch. 112, Sec. 2, eff. May 11,
2001. Amended by Acts 2003, 78th Leg., ch. 88, Sec. 6, eff. May
20, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
746, Sec. 4, eff. September 1, 2009.
Sec. 157.0542. BOARD WAIVER OF DELEGATION REQUIREMENTS.
(a) On determining that the conditions of Subsection (b) have
been met, the board may waive or modify any of the site or
supervision requirements for a physician to delegate the carrying
out or signing of prescription drug orders to an advanced
practice nurse or physician assistant under Sections 157.052,
157.053, 157.054, and 157.0541, or under board rules. The board
may not waive the limitation on the number of primary or
alternate practice sites at which a physician may delegate the
carrying out or signing of prescription drug orders or the number
of advanced practice nurses or physician assistants to whom a
physician may delegate the carrying out or signing of
prescription drug orders, except as provided by Subsection
(b-1)(1).
(b) The board may grant a waiver under Subsection (a) if the
board determines that:
(1) the practice site where the physician is seeking to delegate
prescriptive authority is unable to meet the requirements of this
chapter or board rules or compliance would cause an undue burden
without a corresponding benefit to patient care;
(2) safeguards exist for patient care and for fostering a
collaborative practice between the physician and the advanced
practice nurses and physician assistants; and
(3) if the requirement for which the waiver is sought is the
amount of time the physician is on-site, the frequency and
duration of time the physician is on-site when the advanced
practice nurse or physician assistant is present is sufficient
for collaboration to occur, taking into consideration the other
ways the physician collaborates with the advanced practice nurse
or physician assistant, including at other sites.
(b-1) If the board determines that the types of health care
services provided by a physician assistant or advanced practice
nurse under Section 157.0541 are limited in nature and duration
and are within the scope of delegated authority under this
subchapter, as defined by board rule, and that patient health
care will not be adversely affected, the board may modify or
waive:
(1) the limitation on the number of physician assistants or
advanced practice nurses, or their full-time equivalents, if the
board does not authorize more than six physician assistants or
advanced practice nurses or their full-time equivalents;
(2) the mileage limitation; or
(3) the on-site supervision requirements, except that the
physician must be available on-site at regular intervals and when
on-site the physician must be available to treat patients.
(b-2) A modification or waiver granted under this section may
not validate or authorize a contract provision that prohibits a
physician from seeing, diagnosing, or treating any patient.
(b-3) In granting a modification or waiver under Subsection
(b-1), the board may not limit the authority of the physician to
delegate to less than the requirements established under Section
157.0541(a)(2) or Section 157.0541(e) or greater than the
requirements established under Section 157.0541(c)(1)(A).
(c) The board shall establish procedures for granting waivers
under this section. At a minimum, the procedures must include a
process for providing, if the board denies a waiver, a written
explanation for the denial and identifying modifications that
would make the waiver acceptable and a process for revoking,
suspending, or modifying a waiver previously granted. The process
for revoking, suspending, or modifying a waiver must include
notice and an opportunity for a hearing. The board may probate an
order to revoke, suspend, or modify a waiver.
(d) Repealed by Acts 2005, 79th Leg., Ch. 269, Sec. 1.49, eff.
September 1, 2005.
(e) Repealed by Acts 2005, 79th Leg., Ch. 269, Sec. 1.49, eff.
September 1, 2005.
(f) Repealed by Acts 2005, 79th Leg., Ch. 269, Sec. 1.49, eff.
September 1, 2005.
(g) Repealed by Acts 2005, 79th Leg., Ch. 269, Sec. 1.49, eff.
September 1, 2005.
(h) Repealed by Acts 2005, 79th Leg., Ch. 269, Sec. 1.49, eff.
September 1, 2005.
Added by Acts 2001, 77th Leg., ch. 112, Sec. 2, eff. May 11,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
269, Sec. 1.49, eff. September 1, 2005.
Acts 2009, 81st Leg., R.S., Ch.
746, Sec. 5, eff. September 1, 2009.
Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other order
shall be defined in a manner that promotes the exercise of
professional judgment by the advanced practice nurse and
physician assistant commensurate with the education and
experience of that person. Under this section, an order or
protocol used by a reasonable and prudent physician exercising
sound medical judgment:
(1) is not required to describe the exact steps that an advanced
practice nurse or a physician assistant must take with respect to
each specific condition, disease, or symptom; and
(2) may state the types or categories of medications that may be
prescribed or the types or categories of medications that may not
be prescribed.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.056. PRESCRIPTION INFORMATION. The following
information must be provided on each prescription subject to this
subchapter:
(1) the patient's name and address;
(2) the drug to be dispensed;
(3) directions to the patient regarding the taking of the drug
and the dosage;
(4) the intended use of the drug, if appropriate;
(5) the name, address, and telephone number of the physician;
(6) the name, address, telephone number, and identification
number of the registered nurse or physician assistant completing
or signing the prescription drug order;
(7) the date; and
(8) the number of refills permitted.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.057. ADDITIONAL IMPLEMENTATION METHODS. The board may
adopt additional methods to implement:
(1) a physician's prescription; or
(2) the delegation of the signing of a prescription under a
physician's order, standing medical order, standing delegation
order, or other order or protocol.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.058. DELEGATION TO CERTIFIED REGISTERED NURSE
ANESTHETIST. (a) In a licensed hospital or ambulatory surgical
center, a physician may delegate to a certified registered nurse
anesthetist the ordering of drugs and devices necessary for the
nurse anesthetist to administer an anesthetic or an
anesthesia-related service ordered by the physician.
(b) The physician's order for anesthesia or anesthesia-related
services is not required to specify a drug, dose, or
administration technique.
(c) Pursuant to the physician's order and in accordance with
facility policies or medical staff bylaws, the nurse anesthetist
may select, obtain, and administer those drugs and apply the
medical devices appropriate to accomplish the order and maintain
the patient within a sound physiological status.
(d) This section shall be liberally construed to permit the full
use of safe and effective medication orders to use the skills and
services of certified registered nurse anesthetists.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec. 157.059. DELEGATION REGARDING CERTAIN OBSTETRICAL SERVICES.
(a) In this section, "provide" means to supply, for a term not
to exceed 48 hours, one or more unit doses of a controlled
substance for the immediate needs of a patient.
(b) A physician may delegate to a physician assistant offering
obstetrical services and certified by the board as specializing
in obstetrics or an advanced practice nurse recognized by the
Texas Board of Nursing as a nurse midwife the act of
administering or providing controlled substances to the physician
assistant's or nurse midwife's clients during intrapartum and
immediate postpartum care.
(c) The physician may not delegate the use of a prescription
sticker or the use or issuance of an official prescription form
under Section 481.075, Health and Safety Code.
(d) The delegation of authority to administer or provide
controlled substances under Subsection (b) must be under a
physician's order, medical order, standing delegation order, or
protocol that requires adequate and documented availability for
access to medical care.
(e) The physician's orders, medical orders, standing delegation
orders, or protocols must require the reporting of or monitoring
of each client's progress, including complications of pregnancy
and delivery and the administration and provision of controlled
substances by the nurse midwife or physician assistant to the
clients of the nurse midwife or physician assistant.
(f) The authority of a physician to delegate under this section
is limited to:
(1) four nurse midwives or physician assistants or their
full-time equivalents; and
(2) the designated facility at which the nurse midwife or
physician assistant provides care.
(g) The controlled substance must be supplied in a suitable
container that is labeled in compliance with the applicable drug
laws and must include:
(1) the patient's name and address;
(2) the drug to be provided;
(3) the name, address, and telephone number of the physician;
(4) the name, address, and telephone number of the nurse midwife
or physician assistant; and
(5) the date.
(h) This section does not authorize a physician, physician
assistant, or nurse midwife to operate a retail pharmacy as
defined under Subtitle J.
(i) This section authorizes a physician to delegate the act of
administering or providing a controlled substance to a nurse
midwife or physician assistant but does not require physician
delegation of:
(1) further acts to a nurse midwife; or
(2) the administration of medications by a physician assistant
or registered nurse other than as provided by this section.
(j) This section does not limit the authority of a physician to
delegate the carrying out or signing of a prescription drug order
involving a controlled substance under this subchapter.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by Acts 2003, 78th Leg., ch. 88, Sec. 7, eff. May 20,
2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 33, eff. September 1, 2007.
Acts 2009, 81st Leg., R.S., Ch.
746, Sec. 6, eff. September 1, 2009.
Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED ACT. Unless the
physician has reason to believe the physician assistant or
advanced practice nurse lacked the competency to perform the act,
a physician is not liable for an act of a physician assistant or
advanced practice nurse solely because the physician signed a
standing medical order, a standing delegation order, or another
order or protocol authorizing the physician assistant or advanced
practice nurse to administer, provide, carry out, or sign a
prescription drug order.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER C. DELEGATION TO PHARMACISTS
Sec. 157.101. DELEGATION TO PHARMACIST. (a) In this section,
"pharmacist" has the meaning assigned by Section 551.003.
(b) A physician may delegate to a properly qualified and trained
pharmacist acting under adequate physician supervision the
performance of specific acts of drug therapy management
authorized by the physician through the physician's order,
standing medical order, standing delegation order, or other order
or protocol as defined by board rule.
(b-1) A delegation under Subsection (b) may include the
implementation or modification of a patient's drug therapy under
a protocol, including the authority to sign a prescription drug
order for dangerous drugs, if:
(1) the delegation follows a diagnosis, initial patient
assessment, and drug therapy order by the physician;
(2) the pharmacist practices in a hospital, hospital-based
clinic, or an academic health care institution;
(3) the hospital, hospital-based clinic, or academic health care
institution in which the pharmacist practices has bylaws and a
medical staff policy that permit a physician to delegate to a
pharmacist the management of a patient's drug therapy;
(4) the pharmacist provides the name, address, and telephone
number of the pharmacist and of the delegating physician on each
prescription signed by the pharmacist; and
(5) the pharmacist provides a copy of the protocol to the Texas
State Board of Pharmacy.
(c) Physician supervision is considered to be adequate for the
purposes of this section if a delegating physician:
(1) is responsible for the formulation or approval of the
physician's order, standing medical order, standing delegation
order, or other order or protocol and periodically reviews the
order or protocol and the services provided to a patient under
the order or protocol;
(2) has established a physician-patient relationship with each
patient who is provided drug therapy management by a delegated
pharmacist;
(3) is geographically located so as to be able to be physically
present daily to provide medical care and supervision;
(4) receives, as appropriate, a periodic status report on each
patient, including any problem or complication encountered; and
(5) is available through direct telecommunication for
consultation, assistance, and direction.
(d) This section does not restrict the use of a preestablished
health care program or restrict a physician from authorizing the
provision of patient care by use of a preestablished health care
program if the patient is institutionalized and the care is to be
delivered in a licensed hospital with an organized medical staff
that has authorized standing delegation orders, standing medical
orders, or protocols.
(e) This section does not limit, expand, or change any provision
of law relating to therapeutic drug substitution or
administration of medication, including Section 554.004.
(f) The board by rule shall establish the minimum content of a
written order or protocol. The order or protocol may not permit
the delegation of medical diagnosis.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
271, Sec. 1, eff. September 1, 2009.