2003 Legislative Compendium: Scope of Practice

[ Prescriptive Authority for Psychologists | Prescription Drug Delegation | Emergency Contraception Therapy by Pharmacists | Clinical Nutritionists | Regulation of Surgical Technologists | Licensing and Regulation of Surgical Assistants | Acupuncture ]

Heading into the 78th legislative session, a top priority for medicine was the prevention of scope of practice expansions for nonphysicians. Despite the expectation that scope battles would loom large this session as a result of anticipated action by psychologists and acupuncturists, in particular, scope issues were tepid compared with the incendiary battles of previous sessions. Early education and grassroots efforts by TMA and the Texas Society of Psychiatric Physicians quelled desire to give psychologists prescriptive authority, resulting in the early and unremarkable death of the psychologists' bill. Similarly, after several fits and starts, the acupuncture bill died without ever getting a hearing. 

On the horizon…

Looking ahead, scope battles certainly will reemerge in 2005 as the Texas State Board of Medical Examiners (TSBME) and other clinical regulatory boards undergo sunset review. Additionally, the moratorium on scope bills between the ophthalmologists and optometrists expires in 2005, opening the gate for a potentially bruising fight. TMA will continue to work aggressively with specialty societies to thwart any efforts by nonphysicians to practice medicine.

Impact of scope of practice bills on the practice of medicine: Unless "MD" or "DO" is after a clinician's name, he or she won't be practicing medicine.

PRESCRIPTIVE AUTHORITY FOR PSYCHOLOGISTS

House Bill 3451 by Rep. Rick Noriega (D-Houston) would have given psychologists prescriptive authority. Certification for this new authority would have required postdoctoral training in psychopharmacology, demonstration of sufficient knowledge to exercise this authority, and physician consultations in a reasonable time after issuing a prescription drug order. Luckily, due to the lateness of its filing and leadership's aggressive legislative agenda, there simply was not enough time to tackle this issue.

PRESCRIPTION DRUG DELEGATION

HB 1095 by Rep. Jaime Capelo (D-Corpus Christi) permits physicians to delegate to Advanced Practice Nurses or Physician Assistants the carrying out or signing of prescription drug orders for controlled substances, provided certain conditions are met. Previously, physicians only had authority to delegate the carrying out or signing of prescription drug orders for Dangerous Drugs. The conditions with respect to controlled substances are as follows:

Controlled substance is listed on Schedule III, IV or V of Texas Controlled Substances Act;

Period of prescription is for no more than 30 days;

If prescription is for a refill, there is consultation with delegation physician, which is to be noted in patient's chart; and

If prescription is for a child less than two years of age, the prescription may only be made after consultation with the delegating physician and the consultation is noted in the patient's chart.

The Texas Department of Insurance is to adopt a standardized form for verification of APN and PA credentials.

EMERGENCY CONTRACEPTION THERAPY BY PHARMACISTS

Two bills were filed to allow pharmacists to dispense emergency contraception to patients: HB 1381 by Rep. Senfronia Thompson (D-Houston) and Senate Bill 1338 by Sen. Jeff Wentworth (R-San Antonio). Modeling efforts in other states, HB 1381 attempted to allow pharmacists the authority to initiate emergency contraceptive drug therapy under standing orders from a physician. This bill established a training and certification program for pharmacists providing these services and required that they (1) provide patients with a fact sheet on the proper method for using the drug and information on possible contraindications and (2) inform the physician with whom they have an agreement.

CLINICAL NUTRITIONISTS

HB 1834 by Rep. Toby Goodman (R-Arlington) would have established a new class of health care providers called "clinical nutritionists" and created the Board of Examiners of Clinical Nutritionists, which was attached administratively to the Texas Department of Health. HB 1834 created a "title act," specifying that only a licensed clinical nutritionist could use that title.

Among other things, clinical nutritionists were required to have knowledge of basic concepts of human physiology and anatomy as well as pharmacological and environmental effects on nutritional status and to understand the process of evaluating and interpreting a client's clinical data. Although this bill seems to have been filed as a favor from Representative Goodman, other members have since expressed interest in it and may try harder to get it passed next session.

REGULATION OF SURGICAL TECHNOLOGISTS

HB 2834 by Rep. Bill Zedler (R-Arlington) attempted to license and regulate surgical technologists. The practice of surgical technicians would be to provide surgical medical services delegated by a supervising physician. Surgical technicians would have been required to complete accredited education programs and pass the national surgical technician certifying examination. This bill failed to advance, in part due to its late start, freshman author, and opposition from various medical groups.

LICENSING AND REGULATION OF SURGICAL ASSISTANTS

SB 769 by Sen. John Carona (R-Dallas) and Rep. Jaime Capelo (D-Corpus Christi) made technical corrections to the current statute and was the only "scope of practice" bill on TMA's track that the governor signed. It simply provides that a surgical assistant's license expires on the second anniversary of the date of issuance.

ACUPUNCTURE

SB 1266 by Sen. Ken Armbrister (D-Victoria) would have greatly expanded the scope of practice for acupuncturists. The committee substitute for SB 1266 attempted to redefine acupuncture, remove TSBME oversight of the acupuncture board, and change evaluation/referral standards for patient care.

After extensive staff review of the proposed legislative changes and several meetings with representatives for acupuncturists, the Council on Legislation engaged an ad hoc committee on acupuncture to provide specialized physician input. Led by Richard Hausner, MD, the ad hoc committee recommended that TMA firmly oppose any attempts by the acupuncturists to increase their scope of practice.

Upon learning of TMA's concerns, Senator Armbrister graciously agreed to postpone further consideration of his bill indefinitely, and the session ended without it ever receiving a public hearing. In preparation for next session's sunset review of the Medical Practice Act, channels of communication will remain open to allow for discussion of legislative changes acupuncturists will seek. However, TMA will continue to cautiously guard against any perceived expansion of scope that could harm patients.

Scope of practice TMA staff contacts:

-Stephen Brown, associate director, Legislative Affairs Department, (512) 370-1367
-Jenny Fowler, associate director, Legislative Affairs Department, (512) 370-1368
-C.J. Francisco, JD, senior counsel, Office of the General Counsel, (512) 370-1339

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