The Texas Medical Board (TMB) licenses and regulates physicians and other medical professionals. As part of its duties, the TMB receives complaints about physicians allegedly violating the laws and rules that govern them. It also brings formal disciplinary action against physicians as needed. While complaints may cover various types of violations, one such area that may result in complaints is prescriptive authority agreements. Obtaining experienced legal counsel to represent your interests in disciplinary proceedings before the TMB can be a significant step in reaching a positive outcome in your case. As a result, if you are facing a complaint before the TMB, whether it involves a prescriptive authority agreement or another topic, you should consult a medical license attorney for help.
Delegation of Prescriptive Authority to APRNs and PAs
Tex. Occ. Code §157.051 et seq. addresses the ability of a physician to delegate the prescribing and ordering of drugs and devices to advanced practice registered nurses (APRNs) and physician assistants (PAs). Individuals in these positions must act under adequate physician supervision. Prescriptive authority is limited to nonprescription drugs, dangerous drugs, and controlled substances, with some limitations.
Prescriptive Authority Agreements
The delegation of prescriptive authority can only occur if there is a prescriptive authority agreement between the physician and the APRN and/or PA. These agreements must 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.
Additionally, the agreements must meet the following minimum requirements to be legally valid under Texas law:
- 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 advanced practice registered nurse or physician assistant 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 on a temporary basis in accordance with 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 includes the following:
- Chart review, with the number of charts to be reviewed determined by the physician and advanced practice registered nurse or physician assistant; and
- Periodic monthly meetings between the advanced practice registered nurse or physician assistant and the physician that are documented and involve sharing of information relating to patient treatment and care, needed changes in patient care plans, issues relating to referrals, and discussion of patient care improvement.
Except in the case of a medically underserved area or a facility-based practice in a hospital, a physician may not simultaneously enter into a prescriptive authority agreement with more than a total or the full-time equivalent of seven APRNs and PAs combined.
All parties to the prescriptive authority agreement and any amendments must review, sign, and date it at least once per year. The delegating physician must register all participating APRNs and PAs with the TMB before any delegation occurs.
Involvement by Licensing Boards in Prescriptive Agreements
Under Tex. Occ. Code §157.0513, the TMB, TBON, and the Texas Physician Assistant Board must establish a process to exchange information about all physicians, APRNs, and PAs who enter prescriptive authority agreements. Each Board must notify the others if any party to such an agreement becomes involved in an investigation concerning a prescriptive authority agreement and the outcome of that investigation. Upon receipt of a notice of investigation, any of these Boards may enter a site where a party to a prescriptive agreement practices to inspect and audit records or activities related to the agreement. The inspection must occur with reasonable notice and at a reasonable time to minimize the disruption to patient care. No such inspection may occur if it would jeopardize the pending investigation.
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Each Board must also maintain and share a list of licensees subject to final disciplinary action involving prescriptive authority agreements and those prohibited from entering into them. Finally, the Boards of APRNs and PAs who are subject to prescriptive authority agreements that authorize the prescribing of opioids must ensure that these individuals complete at least two hours of continuing education annually concerning safe and effective pain management related to the prescription of opioids and other controlled substances.
We Can Advocate on Your Behalf in Proceedings Before the TMB
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The physician license lawyers of Bertolino LLP can help guide you through the disciplinary complaint process. No matter what allegations you face, we are here to represent your interests and work to minimize the negative effects of a complaint on your license and career. We can help resolve the case against you and maintain your medical license. Call us today at (512) 515-9518 to reach the offices of Bertolino LLP or contact us online.
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