[ Baylor 5.01 Employed Physicians | Parental Notification/Abortion | Abortion Facility Regulation | Physician Disclosure | Minimum Standards for Outpatient Anesthesia Procedures | Texas State Board of Medical Examiners | Medical Records | Physician Social Security Numbers | Drug Enforcement Agency Numbers ]
Baylor 5.01 Employed Physicians
Baylor Medical School, a private medical school, filed a bill to allow them to employ physicians to provide medical care in conjunction with their teaching and research responsibilities. They said they wanted to be put in the same position as state medical schools who they claimed could employ physicians. Harris County had physicians on both sides of the issue and was essentially neutral. TMA opposed the legislation. Eventually a compromise was reached which allowed Baylor to retain the earnings of its physicians (to avoid violation of the prohibition on the corporate practice of medicine) while building in many of the safeguards contained in the 5.01(a) provisions of the Medical Practice Act, including certification by the Board of Medical Examiners.
Baylor can collect patient care revenues generated by faculty at clinics owned or operated by the school within its historical geographical service area. Should Baylor develop clinics outside its historical geographical service area in the future, this bill would not apply to those clinics.
SB 30 by Senator Shapiro requires unmarried minors who wish to have a non-emergency abortion to have their physician give 48 hours notice to their parent, guardian, or managing conservator, or to get approval from a court before the abortion can be performed. The bill exempts certain individuals who live separate and apart from their parents and are self-supporting and manage their own financial affairs.
Physicians will be required to give notice, in person or by telephone, to the minor's parent or court-appointed managing conservator or guardian at least 48 hours before performing an abortion on the minor. If a parent or guardian cannot be notified after reasonable effort, the physician will be allowed to perform the abortion. A physician will be required to include an affidavit in the patient's medical record that, according to his or her best information and belief, actual or constructive notice has been provided, which will create a conclusive presumption that the physician has met the law's requirements.
A physician will be allowed to perform an abortion on a minor without notifying a parent and without judicial approval if the abortion is necessary to prevent death or to avoid a serious risk of substantial and irreversible impairment of a major bodily function. The physician would have to certify in writing to TDH and in the patient's record the medical indications supporting the physician's judgment that those circumstances existed.
The penalty for a physician failing to comply with the notice provisions is a fine ranging from $1 to $10,000. Any violation must be shown to have been intentional and requires a proof standard of "beyond a reasonable doubt." The bill that passed the Senate and passed out of House committee provided that a violation was a Class A misdemeanor involving jail time up to one year and a fine of $4,000. This was taken out on the House floor and the fine only provision substituted.
A pregnant minor wishing to have an abortion performed without parental notification will be able to apply to a court for permission to have the abortion performed. If one of the following three conditions are found to be present, the court will have to give the minor permission to have the abortion without consent: 1) notifying the parent or guardian would not be in the minor's best interest, 2) the minor was mature and capable of giving informed consent, or 3) notification might lead to physical, sexual, or emotional abuse of the minor. If the court finds none of these three conditions to be true, the court will not be permitted to authorize the abortion without parental notification.
Abortion Facility Regulation
Additionally, a change was made in the abortion facilities law requiring offices that perform more than 300 abortions per year (excluding abortions involving an emergency) to register as an abortion facility. Current law only requires offices to register if abortions constitute more than 50 percent of the office practice.
HB 110 by Representative Maxey allows for easy-access disclosure of information about physicians that otherwise would be available from the TSBME. Physician-specific information, such as name, specialty, and medical education background, will be posted on the Internet. Other information that will be available includes practice hours, special services offered by the physician, education, and the names of hospitals where the physician has staff privileges. Malpractice information is limited to the results of the required investigation by the TSBME when a physician has three or more claims in a five-year period. The claims themselves cannot be disclosed. Though sometimes referred to as the "physician profiling" bill, the bill does not collect or release information relating to physician practice outcomes or quality.
Minimum Standards for Outpatient Anesthesia Procedures
Senator Carona and Representative Gray co-sponsored SB 1340 which directs the TSBME and the Texas State Board of Nurse Examiners to establish by rule minimal safety standards for the provision of anesthesia services in outpatient settings. These standards must address patient evaluation and preparation, patient monitoring procedures and equipment, emergency procedures and equipment, and documentation requirements. The TSBME and the TSBNE are required to coordinate their rulemaking to avoid inconsistencies between rules adopted by each. Physicians and certified registered nurse anesthetists who perform outpatient procedures involving the use of anesthesia must register with their respective boards and pay a fee. On-site inspections are not required, but may be conducted by either board upon request or at the discretion of the board. Rules must be adopted by Jan. 7, 2000.
Texas State Board of Medical Examiners
Two measures involving clean-up and modernization of the Medical Practice Act were filed and passed at the request of the TSBME. The measures provide some administrative flexibility needed for the board to function effectively. Also included was a provision relating to allowing the board to go to a national exam as opposed to being limited to an exam administered by the board.
The usual assortment of bills providing for free medical records were filed. A bill providing that a patient could not be required to pay for medical records that did not exceed 10 pages was defeated in committee. Veterans did manage to pass a bill requiring that records be provided without charge in circumstance where a veteran was applying for disability benefits with the federal government. This is similar to the provisions in current law where applicants for Social Security disability and other governmental disability benefit programs are provided records without charge. These benefits include medical as well as indemnity benefits. The veteran must show proof of the application for disability and may request only one set of records.
Physician Social Security Numbers
A bill was passed which provided that a physician's Social Security number is confidential and cannot be released by the TSBME. An earlier attorney general's opinion had ruled that this was public information.
Drug Enforcement Agency Numbers
This bill prohibits insurance carriers and others from using a physician's Drug Enforcement Agency number for any other purpose than that allowed under federal law. They could not use the number for claims purposes or any other reason.
Medical Licensure/Discipline Staff Contacts
CJ Francisco, Office of the General Counsel: (512) 370-1339
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