[
Prescriptive Authority for
Psychologists
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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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