Texas Physician Licensure Seminar
                                      3/19/2007

1. Governance
      a. Statute
        ...
§155.152.      Issuance Of New License On Change Of Name
       b. Board Rules
               i. Rules are adopted by the ...
a. Medical Education
       i. Domestic
          Graduate of a medical school approved by the board (an LCME or AOA
     ...
complete what is called a Fifth Pathway Internship. This substitutes for
           not having an actual diploma from thei...
ii. is a member of the Bureau of Osteopathic
                                                 Specialists; or
            ...
Claims     Suits
                Pending                                    No        Yes
                Final - No Payme...
1. importance of honest answers
                     2. consequences of falsification
              ii. National Practitio...
record of a physician's credentials. FCVS will send a standard portfolio to
           state boards, hospitals, managed ca...
vi. Applicants must complete the online application, not a company they hire
             to handle the licensure process ...
4. Gaps in professional history are identified and applicants asked to
                   account for them. If it involves...
i. More than 10 years since last licensing or monitored board certification
                   exam (remedy is to take the...
3. Licensure – 1 Manager, 2 Team Leaders, 4 Specialists, 4
                  Licensure Analyst IIs, 6 Licensure Analyst Is...
ii. Most postgraduate training programs begin 7/1 of each year, so physician
     in training permits are in high demand t...
Appendix A. Texas Occupations Code
                              CHAPTER 155. LICENSE TO PRACTICE MEDICINE
               ...
any offense that under the laws of this state is a felony                qualifying examination and has satisfactorily
   ...
American Osteopathic Association, that exceeds                   Section 155.006, Occupations Code, as
             the re...
(a)        The board shall adopt rules for the issuance of a                 (2)       the Medical Council of Canada Exami...
§155.055. NOTICE OF EXAMINATION RESULTS                                              public university-sponsored graduate ...
(c)         A physician is eligible for a temporary license              licensed by the board who is participating in a g...
Appendix B. Texas Occupations Code
                     CHAPTER 164. DISCIPLINARY ACTIONS AND PROCEDURES

                ...
(C)         materially altered;                               the date the physician received or created the
            (...
(8)        fails to supervise adequately the activities        while in the practice of medicine or under the guise of the...
Appendix A
Appendix A
Appendix A
Appendix A
Appendix A
Appendix A
Appendix A
Appendix A
Appendix A
Appendix A
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Appendix A
Appendix A
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Appendix A
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Appendix A

  1. 1. Texas Physician Licensure Seminar 3/19/2007 1. Governance a. Statute i. Laws relating to licensure, registration, and discipline of physicians ii. Can only be changed by the legislature; board cannot waive requirements set in statute iii. Generally broad and give authority to Texas Medical Board (TMB) to write rules to specify how to implement the laws iv. Statute contained in Texas Occupations Code v. TMB Web site link – www.tmb.state.tx.us – Laws, Rules and Guidelines/Texas Statutes/Texas Occupations Code vi. Mainly Chapter 155, License to Practice Medicine - Texas Occupations Code – See Appendix A for current language. Subchapter A. License Requirements §155.001. License Required §155.002. Issuance Of License §155.003. General Eligibility Requirements §155.0031.Application Procedures And Requirements §155.004. Additional Eligibility Requirements For Graduates Of Certain Foreign Medical Schools §155.005. Eligibility Requirements Of Foreign Medical School Students In Fifth Pathway Program §155.006. Issuance Of Limited License §155.007. Application Process §155.008. Criminal Record Check §155.009. Limited License For Practice Of Administrative Medicine Subchapter B. License Examination §155.051. Examination Required §155.0511.Examinations Administered Or Accepted By Board §155.052. General Examination Procedures §155.053. Public Member Participation In Examination §155.054. Examination Subjects §155.055. Notice Of Examination Results §155.056. Examination Attempt Limits §155.057. Preservation Of Examination Materials §155.058. Application Of Open Records And Open Meetings Law To Examination Procedures Subchapter C. Certain Temporary Licenses Or Permits §155.1025.Expedited Process For Certain Applicants §155.104. Temporary Licenses §155.105. Physician-In-Training Permit §155.106. Certification Of License To Other States §155.107. Certification Of Examination Grades Subchapter D. Issuance Of New Or Duplicate License §155.151. Duplicate License
  2. 2. §155.152. Issuance Of New License On Change Of Name b. Board Rules i. Rules are adopted by the TMB ii. Board cannot waive requirements in rule unless rules specifically allow it iii. Process to change rules involves: 1. gathering stakeholder input; 2. discussion by the TMB; 3. publication of proposed additions, deletions, or changes in the Texas Register for at least 30 days; 4. hearing before the TMB with opportunity for public to comment and possible changes made; 5. posting of rules to be adopted in the Texas Register; and, iv. final adoption of proposals v. Texas Administrative Code vi. TMB Web site link – www.tmb.state.tx.us – Laws, Rules and Guidelines/Board Rules vii. Mainly Chapter 163, Licensure – Texas Administrative Code, Title 22, Part 9 - See Appendix C for current language; also Chapter 172, Temporary and Limited Licenses – See Appendix D for current language. Chapter 163. Licensure §163.1. Definitions. §163.2. Full Texas Medical License. §163.4. Procedural Rules for Licensure Applicants. §163.5. Licensure Documentation. §163.6. Examinations Accepted for Licensure. §163.10. Relicensure. §163.11. Active Practice of Medicine. §163.13. Expedited Licensure Process. Chapter 172. Temporary and Limited Licenses Subchapter A. General Provisions and Definitions §172.1. Purpose. §172.2. Construction and Definitions. Subchapter B. Temporary Licenses §172.3. Distinguished Professors Temporary License. §172.4. State Health Agency Temporary License. §172.5. Visiting Physician Temporary Permit. §172.6. Visiting Professor Temporary License. §172.7. National Health Service Corps Temporary License. §172.8. Faculty Temporary License. §172.9. Postgraduate Research Temporary License. §172.10. Department of State Health Services Medically Underserved Area (DSHS-MUA) Temporary License. §172.11. Temporary Licensure—Regular. Subchapter C. Limited Licenses §172.12. Telemedicine License. §172.13. Conceded Eminence. 2. Eligibility Requirements
  3. 3. a. Medical Education i. Domestic Graduate of a medical school approved by the board (an LCME or AOA accredited school). Statute: §155.003(a)(4) Statute: §155.0031(d) Rule: §163.2(a)(4) Rule: §163.1(1) ii. International Medical Graduate (IMG) 1. Must be graduate of an acceptable unapproved medical school (substantially equivalent and not disapproved by another state licensing agency unless the applicant can demonstrate the determination was unfounded) or meet remedy. Rule: §163.2(b)(4) Rule: §163.1(2) 2. All medical schools attended are substantially equivalent to a Texas medical school and meet THECB curriculum requirements. Statute: §155.0031(d) Statute: §155.004(1) Rule: §163.1(12) 3. Schools Whose Graduates Do Not Have To Prove Substantial Equivalence Of Their Education a. TMB Web site link – http://www.tmb.state.tx.us/professionals/physicians/applica nts/physicianapplicants.php – Schools Whose Graduates Do Not Have To Prove Substantial Equivalence Of Their Education b. Because the medical education provided at international medical schools changes, the schools included on this list are subject to change at any time. For the same reason, the TMB may still require graduates of schools on this list to provide additional information about their medical education. c. Applicants who must demonstrate substantial equivalence of their medical education undergo a more thorough review of their medical education. The current information initially requested is: d. Questionnaire to be completed by medical school(s) e. Questionnaire to be completed by applicant f. Information from licensing authority in country of graduation regarding medical school and authority of graduates to practice g. Applicants in this situation can expect their applications to take more time to complete. iii. Fifth Pathway Fifth Pathway physicians do not actually ever graduate from medical school. Generally they’re US citizens who attended a Mexican medical school. Rather than complete the required social service in Mexico to obtain a license to practice medicine in Mexico, they return to the US. Prior to being accepted into a postgraduate residency program, they must
  4. 4. complete what is called a Fifth Pathway Internship. This substitutes for not having an actual diploma from their medical school. There are a few other differences in requirements. Statute: §155.005 Rule: §163.2(c) Fifth Pathway Program b. Additional Requirements for International Medical Graduates (IMGs) Statute: §155.004 Rule: §163.2(b)(8) – (11) i. ECFMG Certification ii. iii. Eligibility to practice medicine in country of graduation iv. Ability to communicate in English c. Postgraduate Training i. US/Canadian (Domestic) Graduates– 1 year of approved training in the US or Canada Statute: §155.003(a)(5) Rule: §163.2(a)(5) ii. International Medical School Graduates (IMGs) – 3 years of approved, continuous, and progressive training in the US or Canada Statute: §155.003(a)(5) Statute: 155.004(2) Rule: §163.2(b)(5) Rule: §163.1. Definitions d. Examinations i. Must pass national licensing examination Statute: §155.003(a)(6) Rule: §163.2(a)(6) Rule: §163.2(b)(6) ii. Only certain examinations are accepted 1. Current exams are USMLE (for either MDs or DOs) and COMLEX (for DOs only) 2. Physicians who have been licensed for some time may have taken one of the older exams or a combination of exams. All are listed in the rule. Rule: §163.6 iii. Attempt Limits Currently there is a maximum of three attempts per step of a licensing examination. iv. Time limit on passing all parts of the exam and remedies 1. Must pass each part of an examination within seven years. 2. MD/PhD or DO/PhD (dual degree program) must pass each part of an examination not later than the second anniversary of the date the applicant completed the required graduate medical training (1 year for domestic graduates; 3 years for IMGs) 3. The time frame to pass each part of the examination is extended to 10 years and the anniversary date to pass each part of the examination described by is extended to the 10th anniversary if the applicant: a. is specialty board certified by a specialty board that: i. is a member of the American Board of medical Specialties; or
  5. 5. ii. is a member of the Bureau of Osteopathic Specialists; or b. has been issued a faculty temporary license, as prescribed by board rule, and has practiced under such a license for a minimum of 12 months and, at the conclusion of the 12- month period, has been recommended to the board by the chief administrative officer and the president of the institution in which the applicant practiced under the faculty temporary license v. Must pass Texas Medical Jurisprudence Examination Statute: §155.003(a)(7) Rule: §163.2(a)(7) Rule: §163.2(b)(7) e. Professional Character i. Must present proof that the applicant is of good professional character by not having violated Sections 164.051 (Grounds For Denial Or Disciplinary Action), 164.052 (Prohibited Practices By Physician Or License Applicant), or 164.053 (Unprofessional Or Dishonorable Conduct) of the MPA. Statute: §155.003(a)(2) Rule: §163.2(a)(2) Rule: §163.2(b)(2) ii. Physicians who hold restricted, suspended, or revoked licenses in other states Statute: §155.003(e) iii. Physicians who have investigations that may lead to the restriction, cancellation, suspension, or revocation of a license in another state Statute: §155.003(e) iv. Physicians who have prosecutions pending against them Statute: §155.003(e) v. Recent changes to medical liability reporting requirements 1. Old Reporting Requirements: Any claim or lawsuit based on medical professional liability, pending or final. Claims Suits Pending Yes Yes Final - No Payment on Behalf of Yes Yes Applicant Final – Payment on Behalf of Applicant Yes Yes 2. New Reporting Requirements: a. Any claim filed in a lawsuit based on medical professional liability, b. Any settlement of a claim without the filing of a lawsuit, and c. Any settlement of a professional liability lawsuit.
  6. 6. Claims Suits Pending No Yes Final - No Payment on Behalf of No Yes Applicant Final – Payment on Behalf of Applicant Yes Yes 3. Licensure Application and Documentation Used to collect information from the applicant and third parties to demonstrate compliance with eligibility requirements. a. Application Form The application MUST be completed by the applicant who certifies at the end of the application that all answers are truthful, that changes to an applicant’s status will be provided to the TMB within 10 days, that allows the TMB to do background checks, etc. b. Additional Licensure Forms These forms supplement the online application. See forms on the TMB web site. c. Other documentation, generally requested in instructions for completing additional licensure forms 4. Demonstration of Compliance with Statute and Rule: Documentation Statute: §155.0031 – Application Procedures And Requirements Rule: §163.5 – Licensure Documentation a. Medical Education i. Licensure Form D - Dean's Certification ii. Medical School Transcript iii. Fifth Pathway Certificate iv. Fifth Pathway Letter v. Licensure Form J - Clinical Clerkship Affidavit vi. Educational Commission for Foreign Medical Graduates (ECFMG) Certificate vii. Licensure Form M - ECFMG viii. Licensure Form N - AACRAO Credentials Evaluation (American Association of Collegiate Registrars and Admissions Officers) Review – Foreign Education Evaluation ix. http://www.aacrao.org/ x. Eligibility to Practice in Country of Graduation b. Postgraduate Training i. Postgraduate Training Certificates ii. Licensure Form L - Evaluations and Verification of Postgraduate Training iii. Licensure Form P - Post Graduate Medical Education, Closed Programs c. Examinations i. Examination Transcripts ii. Texas Medical Jurisprudence examination (JP) score report d. Professional Character i. Application Form – “Yes” answers
  7. 7. 1. importance of honest answers 2. consequences of falsification ii. National Practitioner Data Bank and Health Integrity Data Bank Reports iii. Licensure Form AA - Additional Licenses iv. Licensure Form I - Medical Professional Liability Claims Report v. Licensure Form L - Evaluations and Verification of Postgraduate Training vi. Licensure Form Q - Work Experience, Closed Programs vii. Licensure Form R - Arrest/Criminal History viii. Licensure Form S - Disciplinary Action History ix. Licensure Form U - Actions/Investigations x. Licensure Form V - Professionalism xi. Licensure Form W - Mental and Physical Health xii. Criminal Background Check – conducted by TMB staff xiii. AMA profiles and FSMB Disciplinary Action Reports – conducted by TMB staff; applicants may be asked to supply additional documentation. e. Other i. Alternate Name Documentation ii. Birth Certificate or Passport iii. Personal Appearances iv. Licensure Form B - Photo Affidavit Used only rarely. Licensure analyst will inform applicant if it is needed. v. Reissuance Applicants 1. Documentation that the reissuance of a license is in the applicant’s best interest and the best interest of the public. 2. Documentation that would have occurred since original licensure or any documentation that is non-static. vi. Relicensure Applicants Documentation that would have occurred since original licensure or any documentation that is non-static. vii. Specialty Board Certification Documentation 5. Licensure Process Rule: §163.4 – Procedural Rules for Licensure Applicants. a. FCVS i. The Federation Credentials Verification Service (FCVS) is a service created by the Federation of State Medical Boards to streamline the credentialing and licensing process. FCVS is not a requirement for Texas licensure and is in no way a guarantee of licensure or of an expedited application process in Texas. FCVS will be of the greatest benefit to an applicant who is applying from a school that will not issue multiple sets of documents or will be applying to several other states in addition to Texas. The Federation of State Medical Boards collects information regarding an applicant's identity, medical education, postgraduate training, licensure examination history, ECFMG certification, and board action history. This information is verified by the FCVS and maintained as a primary source
  8. 8. record of a physician's credentials. FCVS will send a standard portfolio to state boards, hospitals, managed care plans, or professional societies at the applicant's request. ii. Applicants should contact the Federation of State Medical Boards directly concerning service fees and processing times. FCVS processing time is in addition to the standard application processing time, as this information is required before processing of the licensure application can begin. b. Online Application i. The fee is 805, which can be paid online via the online application process by credit card or electronic check. This fee does NOT include the first registration fee after license issuance (more about that later). ii. TMB Web site link – Apply for Your License Online iii. Before proceeding with an application, applicants should visit the Texas Medical Board's web site to determine eligibility, obtain a checklist of required supplemental documentation, and view Frequently Asked Questions. iv. There is no "save" feature for this application. It will have to be completed and paid for in one sitting. We suggest applicants print each page as soon as it is completed, to give a reference should the applicant need to start over, and the applicant will have a complete print copy once the online application is submitted. v. Applicants should have the following documentation on hand before proceeding with this application: 1. Social Security number 2. ECFMG number, if applicant is an international medical school graduate 3. Texas license number, if applicant was previously licensed in Texas 4. The name(s) of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists specialty board(s) and year(s) of certification, if the applicant is specialty board certified 5. The following information relative to the applicant’s work history (professional affiliations for the last five years and all U.S. and Canadian post-graduate training) a. type of position (for example - intern, resident, fellow or staff) b. name of the department in which the applicant trained or held privileges c. name of the hospital where the training/affiliation took place d. address of the hospital where the training/affiliation took place e. phone number for the department where the training/affiliation took place f. start date of the training/affiliation - mm/dd/yyyy (if are unsure, use the first day of the month) g. end date of the training/affiliation - mm/dd/yyyy (if are unsure, use the first day of the month)
  9. 9. vi. Applicants must complete the online application, not a company they hire to handle the licensure process or some other third party. It’s the applicant who is swearing to the oath at the end of the application that the information submitted is true and correct. c. Submission of Additional Documentation i. Due to the volume of mail, applicants are encouraged to gather the supplemental documentation they are going to submit in one packet and mail it at the same time. ii. Documentation from third parties may be submitted directly to the board from the third party, or via the applicant if the third party seals the documentation in an envelope, places his/her signature on the flap of the envelope, and the unopened enveloped is submitted to the board by the applicant d. Screening i. The TMB has developed a process to screen applications prior to assignment to a licensure analyst. This screening process is only to determine if, based on the information provided in the application, expected items were submitted. The content of the items is not reviewed for acceptability until the application is assigned to a licensure analyst. The applicant’s licensure analyst may determine that additional items or additional information related to a licensure requirement, not requested during the screening process, must be submitted. ii. Applicants will be contacted by email as soon as their applications are screened. They will be informed which, if any, expected items are lacking from the application. Please note, an application cannot be assigned to a licensure analyst until all of the items requested during the screening process are received. iii. Upon successfully passing through the screening process, the applicant will be notified by email and the application will be assigned to a licensure analyst. Processing time after that will vary, depending on the acceptability of submitted items and the complexity of the application. Some factors that can increase complexity are Yes answers to questions on the Professionalism, Medical Liability section of the application. However, due to the large number of applications we receive, there may be a waiting period of several weeks after completion of the screening process and before applicants are contacted by their licensure analyst with the results of the initial review of the application. iv. Anyone may call the Customer Information Center at (512) 305-7030 to request an estimate of the current number of weeks between completion of screen and initial review by a licensure analyst. e. Licensure Processing i. Analyst assigned application based on complexity and analyst experience ii. Application processed – analyst reviews application and all submitted documentation for completeness. Often lacking items are discovered: 1. Explanations submitted by physicians on additional licensure forms are incomplete 2. Evaluations are incomplete (missing signature or not fully answered) 3. Supporting documentation and explanations regarding medical liability do not contain enough detail for a determination
  10. 10. 4. Gaps in professional history are identified and applicants asked to account for them. If it involves other professional affiliations that the applicant did not note on the application form, additional evaluations may be required. iii. Sometimes updates are requested by analysts, for example, updated NPDP/HIPDB reports if the application has become old iv. Applications expire one year after filing. Requests for extensions are sometimes granted, depending on circumstances. f. Temporary and Permanent License Issuance Statute: §155.104 - Temporary Licenses Rule: §172.11. Temporary Licensure—Regular. i. Regular temporary licenses, by rule, are only available to applicants who have completed every step of the licensure process with the exception of having the board members approve issuance of a permanent license. Currently, issuance of permanent licenses is done at every board meeting. There are six per year, about every two months or so. ii. In addition to a complete application, the applicant must sign an affidavit regarding temporary licensure and pay a temporary license fee ($50). iii. Once the board approves permanent licensure, physicians can expect to receive confirmation with their license number and wall certificate within 2 weeks. Sometimes the wall certificates take a little longer to produce, and may follow the confirmation letter by a few weeks. iv. New licensees are staggered into the biennial registration system. When a licensee registers, the licensee is issued a permit to practice for a period of time. For the first registration after licensure, an applicant’s registration period will be prorated for a length of time between 9 and 24 months. Thereafter, all registrations will be two years in length. v. Important: Registration fees for the newly issued license are due within 90 days of the issuance date. Instructions are provided in the confirmation letter regarding online registration. If this is not done, the license will become delinquent, and eventually be cancelled. g. Applicants with issues concerning eligibility i. Statutory Ineligibility ii. Some applicants do not meet statutory requirements for licensure and this is easily demonstrated. In cases like these, the licensure analysts notify the applicant as soon as the file is processed. Reminder – staff who screen applications are not looking for eligibility. This will not be determined until the application file is seen by a licensure analyst. Examples include: iii. Too many licensing examination attempts iv. Not enough acceptable postgraduate training v. Licensing examination modules not passed within required amount of time vi. Status of license in another state is restricted or revoked, etc. h. Non-compliance with Eligibility Requirements under Board Rule While not statutory, board rules have the force of law. Some rules are not spelled out in statute, yet must be met for an applicant to be eligible for licensure. In most cases, remedies are available and the licensure analyst informs the applicant of the situation. If there are remedies, and the applicant chooses not to use them, the applicant is ineligible under board rule. Examples include:
  11. 11. i. More than 10 years since last licensing or monitored board certification exam (remedy is to take the SPEX exam) ii. Out of the active practice of medicine (remedy is usually to complete a mini-residency) i. File Reviews and Determinations of Eligibility Whenever there are questions about an applicant’s eligibility, a review must be conducted before a license can be issued. There are different levels of review. i. Licensure Manager Review 1. can approve things like single arrests, single incidents of academic probation, etc. 2. can notify applicant of statutory ineligibility or ineligibility under board rule. ii. Executive Director File Group Review 1. can approve most eligibility issues 2. can refer applicants for review by consultant for standard of care 3. can refer applicant files for review by forensic psychiatrists 4. can refer applicants for evaluation by forensic psychiatrists 5. can refer applicants for medical evaluation 6. can recommend mini-residency 7. can notify applicant of statutory ineligibility or ineligibility under board rule (when applicant appeals Licensure Manager’s determination of ineligibility) 8. can refer to Licensure Committee of the board for a determination 9. can request more information be provided by analyst or applicant j. Appeal Process Statute: §155.007. Application Process i. If an applicant is determined ineligible, or a recommendation is made that the applicant does not want to accept, the appeal process is set out in statute. ii. Appeal staff determination to Executive Director iii. Appeal Executive Director determination to the board (via the Licensure Committee) iv. Appeal board determination to State Office of Administrative Hearings (SOAH) v. Appeal board determination after SOAH proposal heard to district court vi. Issues Affecting Length of Licensure Process 6. Issues Affecting Length of Licensure Process a. Staffing resources i. State agencies have a cap on the number of FTEs (full-time equivalents) allowed under law ii. State agencies have budgetary constraints; the state budgeting cycle is biennial and begins well in advance of the year for which funds are requested and appropriated. The TMB’s legislative appropriations request (budget request) is developed and submitted in even numbered years, for the biennium to begin approximately 18 months later. So the option of adding staff or technology is often not immediately available. iii. Current Staffing 1. 1 Director, 1 Assistant to the Director 2. CIC – 1 Supervisor, 1 Specialist, 7 CIC Representatives, 2 Registration Technicians, 2 Licensure Support Specialists
  12. 12. 3. Licensure – 1 Manager, 2 Team Leaders, 4 Specialists, 4 Licensure Analyst IIs, 6 Licensure Analyst Is iv. Budgetary constraints and turnover cause 1 or more positions to be vacant much of the time. b. Physician licensure workload % Chg SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG TOTAL from Prev Yr FY 274 309 275 345 467 393 2,063 2007 FY 342 370 352 304 439 394 411 319 318 216 266 295 4,026 35% 2006 FY 192 179 211 195 259 309 341 329 273 255 206 243 2,992 2% 2005 FY 198 232 158 218 249 289 365 298 245 244 221 230 2,947 15% 2004 FY 174 177 150 188 248 211 278 293 258 209 190 185 2,561 0% 2003 FY 142 204 199 211 272 303 303 310 171 137 154 146 2,552 4% 2002 FY 135 175 163 130 209 257 289 271 209 222 190 196 2,446 14% 2001 FY 112 114 108 154 159 208 263 217 243 203 188 181 2,150 21% 2000 FY 101 123 118 119 140 160 230 192 168 161 133 127 1,772 1999 c. Other duties of staff take time away from physician licensure i. Processing of applications for physician in training permits, physician assistant (PA) licenses, acupuncturist licenses, surgical assistant licenses, acudetox permits, non-certified radiologic technologist registrations, non-profit health organization certifications ii. Preparation for 6 meetings of the TMB each year, 4 meetings of the Physician Assistant Board each year, and 4 meetings of the Acupuncture Board each year. iii. Registration of licenses and permits for physicians, PAs, acupuncturists, surgical assistants, acudetox specialists, non-certified radiologic technicians, non-profit health organizations. Populations in some of these groups as of 2/28/07 are: Total Number of Individual Licensed: Physicians 64,584 Physicians 58,728 Physicians in Training 5,856 Total Number of Individual Licensed: Acupuncturists 806 Total Number of Individual Licensed: PAs 4,119 Total Number of Individual Licensed: Surgical Assistants 244 Total Number of Business Facilities Licensed 242 iv. Customer Information Center Responsibilities Monthly Averages for Certain Tasks – FY 06 All Types of Verifications and Calls 280,728 Responses from General Agency E-Mail Account 704 Responses from Screen-CIC E-Mail Account 1,102 Applications initially screened 281 Screened applicants to reach successful status 240 d. Peak times i. Spring to summer are peak times for physicians applying for postgraduate resident training permits and physician licensure.
  13. 13. ii. Most postgraduate training programs begin 7/1 of each year, so physician in training permits are in high demand to begin on that date. iii. On the other hand, most postgraduate training programs end 6/30 of each year, so those graduates want to get fully licensed as soon as possible after that and begin work.
  14. 14. Appendix A. Texas Occupations Code CHAPTER 155. LICENSE TO PRACTICE MEDICINE (C) substantially equivalent courses as CHAPTER 155. LICENSE TO PRACTICE MEDICINE determined by board rule; (4) is a graduate of a medical school located in SUBCHAPTER A. LICENSE REQUIREMENTS the United States or Canada and approved by the board; The changes in law made by this article (5) has either: governing the eligibility of a person for a (A) successfully completed one year of license under Subtitle B, Title 3, Occupations graduate medical training approved by the board Code, apply only to an application for a in the United States or Canada; or license filed on or after the effective date of (B) graduated from a medical school this Act. A license application filed before the located outside the United States or Canada and effective date of this Act is governed by the has successfully completed three years of law in effect at the time the application was graduate medical training approved by the board filed, and the former law is continued in effect in the United States or Canada; for that purpose. (6) has passed an examination accepted or administered by the board; and §155.001. LICENSE REQUIRED (7) has passed a Texas medical jurisprudence A person may not practice medicine in this state unless the examination as determined by board rule. person holds a license issued under this subtitle. (b) All medical or osteopathic medical education an applicant receives in the United States must be accredited §155.002. ISSUANCE OF LICENSE by an accrediting body officially recognized by the United (a) The board, at its sole discretion, may issue a States Department of Education as the accrediting body for license to practice medicine to a person who: medical education leading to the doctor of medicine degree (1) submits to the board a license application or the doctor of osteopathy degree. This subsection does as required by this chapter; not apply to postgraduate medical education or training. (2) presents satisfactory proof that the person (c) An applicant who is unable to meet the meets the eligibility requirements established by this requirement established by Subsection (b) may be eligible chapter; and for an unrestricted license if the applicant: (3) satisfies the examination requirements of (1) received medical education in a hospital or Section 155.051. teaching institution sponsoring or participating in a (b) The board may delegate authority to board program of graduate medical education accredited by employees to issue licenses under this subtitle to applicants the Accreditation Council for Graduate Medical who clearly meet all licensing requirements. If the board Education, the American Osteopathic Association, or employees determine that the applicant does not clearly the board in the same subject as the medical or meet all licensing requirements, the application shall be osteopathic medical education as defined by board returned to the board. A license issued under this rule; or subsection does not require formal board approval. (2) is specialty board certified by a specialty board approved by the American Osteopathic §155.003. GENERAL ELIGIBILITY REQUIREMENTS Association or the American Board of Medical (a) To be eligible for a license under this chapter, an Specialties. applicant must present proof satisfactory to the board that (d) In addition to the other requirements prescribed the applicant: by this subtitle, the board may require an applicant to (1) is at least 21 years of age; comply with other requirements that the board considers (2) is of good professional character and has appropriate. not violated Section 164.051, 164.052, or 164.053; (e) An applicant is not eligible for a license if: (3) has completed: (1) the applicant holds a medical license that is (A) at least 60 semester hours of college currently restricted for cause, canceled for cause, courses, other than courses in medical school, suspended for cause, or revoked by a state, a that are acceptable to The University of Texas at province of Canada, or a uniformed service of the Austin for credit on a bachelor of arts degree or a United States; bachelor of science degree; (2) an investigation or a proceeding is instituted against (B) the entire primary, secondary, and the applicant for the restriction, cancellation, suspension, or premedical education required in the country of revocation in a state, a province of Canada, or a uniformed medical school graduation, if the medical school service of the United States; or is located outside the United States or Canada; (3) a prosecution is pending against the or applicant in any state, federal, or Canadian court for
  15. 15. any offense that under the laws of this state is a felony qualifying examination and has satisfactorily or a misdemeanor that involves moral turpitude. completed one academic year of supervised clinical training for foreign medical students, as defined by the §155.0031. APPLICATION PROCEDURES AND American Medical Association Council on Medical REQUIREMENTS Education (Fifth Pathway Program), under the (a) An application for a license must be in writing direction of the medical school in the United States; and on forms prescribed by the board. The board may allow (5) has attained a passing score on the or require applicants, by board rule, to use the Federation Educational Commission for Foreign Medical Credentials Verification Service offered by the Federation of Graduates examination or another examination, if State Medical Boards of the United States. required by the board; (b) The application forms must be accompanied by (6) has successfully completed at least three all fees, documents, and photographs required by board years of graduate medical training in the United States rule. or Canada that was approved by the board as of the (c) Applicants for a license must subscribe to an date the training was completed; and oath in writing before an officer authorized by law to (7) has passed the license examination under administer oaths. The written oath is part of the application. Subchapter B required by the board of each applicant. (d) An applicant must present proof satisfactory to (b) An applicant who satisfies the requirements of the board that each medical school attended is substantially this section is not required to: equivalent to a Texas medical school as determined by (1) meet any requirement of the foreign medical board rule. school beyond completion of the didactic work; or (2) be certified by the Educational Commission §155.004. ADDITIONAL ELIGIBILITY REQUIREMENTS FOR for Foreign Medical Graduates. GRADUATES OF CERTAIN FOREIGN MEDICAL SCHOOLS (c) A hospital that is licensed by this state, that is A license applicant who is a graduate of a medical school that is operated by this state or a political subdivision of this state, located outside the United States and Canada must present or that directly or indirectly receives state financial proof satisfactory to the board that the applicant: assistance may not require a person who has been a (1) is a graduate of a school whose curriculum student of a foreign medical school but has not graduated meets the requirements for an unapproved medical from the school to satisfy any requirements other than school as determined by a committee of experts those listed in Subsection (a) before beginning an selected by the Texas Higher Education Coordinating internship or residency. Board; (d) For purposes of licensing under this chapter, a (2) has successfully completed at least three document granted by a medical school located outside the years of graduate medical training in the United States United States issued after the completion of all the didactic or Canada that was approved by the board; work of the medical school is considered the equivalent of a (3) is eligible for a license to practice medicine degree of doctor of medicine or doctor of osteopathy on in the country in which the school is located, except for certification by the medical school in the United States in any citizenship requirements; which the training was received that the person to whom (4) holds a valid certificate issued by the the document was issued satisfactorily completed the Educational Commission for Foreign Medical requirements listed in Subsection (a)(4). Graduates; and (5) is able to communicate in English. §155.006. ISSUANCE OF LIMITED LICENSE (a) The board may adopt rules and prescribe fees §155.005. ELIGIBILITY REQUIREMENTS OF FOREIGN related to the issuance of a license under this section that is MEDICAL SCHOOL STUDENTS IN FIFTH PATHWAY limited in scope to an applicant by virtue of the applicant’s PROGRAM conceded eminence and authority in the applicant’s (a) To be eligible for a license under this chapter, an specialty. applicant who has been a student of a foreign medical (b) An applicant is eligible for a limited license under school must present proof satisfactory to the board that the this section on presenting proof satisfactory to the board applicant: that the applicant: (1) meets the requirements of Section 155.003; (1) is recommended to the board by the dean, (2) has studied medicine in a medical school president, or chief academic officer of: located outside the United States and Canada that is (A) a school of medicine in this state; acceptable to the board; (B) The University of Texas Health Center (3) has completed all of the didactic work of the at Tyler; foreign medical school but has not graduated from the (C) The University of Texas M.D. school; Anderson Cancer Center; or (4) has attained a score satisfactory to a (D) a program of graduate medical medical school in the United States approved by the education, accredited by the Accreditation Liaison Committee on Medical Education on a Council for Graduate Medical Education or the
  16. 16. American Osteopathic Association, that exceeds Section 155.006, Occupations Code, as the requirements for eligibility for first board added by this article, not later than March 1, certification in the discipline; 2006. (2) is expected to receive an appointment at the institution or program making the recommendation §155.007. APPLICATION PROCESS under Subdivision (1); (a) The executive director shall review each (3) has not failed a licensing examination that application for a license and shall: would prevent the applicant from obtaining a full (1) recommend to the board each applicant license not limited in scope in this state; eligible for a license; and (4) has passed a Texas medical jurisprudence (2) report to the board the name of each examination as determined by board rule; applicant determined to be ineligible for a license, (5) has successfully completed at least one together with the reasons for that determination. year of approved subspecialty training accredited by (b) An applicant determined to be ineligible for a the Accreditation Council for Graduate Medical license by the executive director may request review of that Education or the American Osteopathic Association; determination by a committee of the board. The applicant (6) is of good professional character, is not must request the review not later than the 20th day after the subject to denial of a license under Section 164.051, date the applicant receives notice of the determination. and has not engaged in conduct described by Section (c) The executive director may refer an application to 164.052 or 164.053; and the board committee for a recommendation concerning (7) meets any other requirements prescribed by eligibility. If the committee determines that the applicant is board rule adopted under this section. ineligible for a license, the committee shall submit that (c) In adopting rules under this section, the board determination, together with the reasons for the may adopt rules that prescribe additional qualifications for determination, to the board unless the applicant requests a an applicant, including education and examination hearing not later than the 20th day after the date the requirements, conditions of employment, and application applicant receives notice of the determination. procedures. The board by rule may qualify, restrict, or (d) The committee may refer an application for otherwise limit a license issued under this section. determination of eligibility to the full board. (d) The board by rule may define “conceded (e) A hearing requested under Subsection (c) shall eminence and authority in the applicant’s specialty.” In be held before an administrative law judge of the State adopting rules under this subsection, the board shall Office of Administrative Hearings and must comply with: consider criteria that include a person’s: (1) Chapter 2001, Government Code; and (1) academic appointments; (2) the rules of: (2) length of time in a profession; (A) the State Office of Administrative (3) scholarly publications; and Hearings; and (4) professional accomplishments. (B) the board. (e) The board may require that the holder of a (f) After receipt of the administrative law judge’s license under this section serve a six-month probationary proposed findings of fact and conclusions of law, the board period during which medical services provided by the shall determine the applicant’s eligibility. The board shall license holder are supervised by another licensed provide an applicant who is denied a license a written physician. statement containing the reasons for the board’s action. (f) The holder of a license under this section shall (g) Each report received or gathered by the board on be limited to the practice of only a specialty of medicine for a license applicant is confidential and is not subject to which the license holder has trained and qualified, as disclosure under Chapter 552, Government Code. The determined by the board. The license holder may not board may disclose a report to an appropriate licensing practice medicine outside of the setting of the institution or authority in another state. The board shall report all program that recommended the license holder under licensing actions to appropriate licensing authorities in other Subsection (b)(1); states and to the Federation of State Medical Boards of the (g) The holder of a license under this section may United States. not change the license holder’s practice setting to a new institution or program unless the license holder applies for a §155.008. CRIMINAL RECORD CHECK new license under this section with the recommendation of The board may submit to the Department of Public Safety a that institution or program as required by Subsection (b)(1). complete set of fingerprints of each license applicant, and the (h) A license holder under this section may obtain a department shall classify and check the fingerprints against full license not limited in scope to practice medicine in this those in the department’s fingerprint records. The department state by meeting all applicable eligibility requirements for shall certify to the board its findings regarding the criminal record that license. of the applicant or the applicant’s lack of a criminal record. The Texas Medical Board shall adopt rules §155.009. LIMITED LICENSE FOR PRACTICE OF necessary to implement the requirements of ADMINISTRATIVE MEDICINE
  17. 17. (a) The board shall adopt rules for the issuance of a (2) the Medical Council of Canada Examination license that limits the license holder to the practice of (LMCC) or its successor; administrative medicine. The board’s rules under this (3) the National Board of Osteopathic Medical section must include provisions for eligibility for the license, Examiners (NBOME) examination or its successor; issuance and renewal of the license, the fees applicable to (4) the National Board of Medical Examiners the license, continuing education requirements, and the (NBME) examination or its successor; scope of practice of a person who holds the license. (5) the Federation Licensing Examination (b) An applicant for a license under this section must (FLEX) with a weighted average in one sitting before meet all of the requirements for issuance of a license under June 1985; Section 155.002. (6) the Federation Licensing Examination (c) A license holder under this section who seeks to (FLEX) after May 1985; practice medicine under an unrestricted license that is not (7) the United States Medical Licensing limited to the practice of administrative medicine must Examination (USMLE) or its successor; provide proof to the board that the license holder has the (8) a combination of the examinations clinical competence to practice medicine under that license described by Subdivisions (3) and (6) as determined and must meet all applicable eligibility requirements for that by board rule; or license. The board may require the license holder to pass (9) a combination of the examinations any examination the board determines necessary. described by Subdivisions (4), (6), and (7) as determined by board rule. SUBCHAPTER B. LICENSE EXAMINATION §155.052. GENERAL EXAMINATION PROCEDURES §155.051. EXAMINATION REQUIRED (a) Each examination administered to evaluate basic (a) Except as provided by Subsection (b), an medical knowledge and clinical competency must be applicant for a license to practice medicine in this state prepared by a national testing service or the board and must pass each part of an examination described by validated by qualified independent testing professionals. Section 155.0511(2), (3), (4), (6), or (7) within seven years. The examination must be in writing and in English. (b) An applicant who is a graduate of a program (b) A license examination must be entirely fair and designed to lead to both a doctor of philosophy degree and impartial to all persons and to each school or system of a doctor of medicine degree or doctor of osteopathy degree medicine. must pass each part of an examination described by (c) An applicant who wishes to request reasonable Section 155.0511(2), (3), (4), (6), or (7) not later than the accommodations due to a disability must submit the request second anniversary of the date the applicant completed the on filing the application. graduate medical training described by Section 155.003(a) (d) The board by rule shall determine the passing (5). grade for each examination used by the board. (c) The time frame to pass each part of the (e) The board shall give each license applicant examination described by Subsection (a) is extended to 10 notice of the date and place of the examination, if years and the anniversary date to pass each part of the administered by the board. examination described by Subsection(b) is extended to the 10th anniversary if the applicant: §155.053. PUBLIC MEMBER PARTICIPATION IN (1) is specialty board certified by a specialty EXAMINATION board that: (a) A public member of the board may not participate (A) is a member of the American Board of in the preparation of an examination used to examine the medical Specialties; or academic and professional credentials of a license (B) is a member of the Bureau of applicant or to examine the applicant orally or in writing. Osteopathic Specialists; or (b) Each public member shall be given notice of, and (2) has been issued a faculty temporary may be present at, each examination or deliberation license, as prescribed by board rule, and has practiced concerning the results of an examination and may under such a license for a minimum of 12 months and, participate in the development and establishment of the at the conclusion of the 12-month period, has been procedures and criteria for each examination. recommended to the board by the chief administrative officer and the president of the institution in which the §155.054. EXAMINATION SUBJECTS applicant practiced under the faculty temporary (a) Each license examination must include subjects license. generally taught by medical schools, a knowledge of which is commonly and generally required of each candidate for §155.0511. EXAMINATIONS ADMINISTERED OR ACCEPTED the degree of doctor of medicine or doctor of osteopathy BY BOARD conferred by schools in this state. The board may administer or accept the following examinations (b) The board shall administer the Texas medical for licensing as determined by rule: jurisprudence examination to all applicants. (1) a state board licensing examination;
  18. 18. §155.055. NOTICE OF EXAMINATION RESULTS public university-sponsored graduate medical The board shall notify each examinee of the results of a licensing education program; examination not later than the 120th day after the date the (B) serve on the faculty of the public examination is administered by the board. However, if an university-sponsored graduate medical education examination is graded or reviewed by a national testing service, program; and the board shall notify each examinee of the results of the (C) engage in the practice of medicine and examination not later than the 30th day after the date the board teaching in a specialty field of medicine that is receives the results from the testing service. necessary to obtain or maintain the accreditation of the public university-sponsored graduate §155.056. EXAMINATION ATTEMPT LIMITS medical education program by the Accreditation (a) An applicant must pass each part of an Council for Graduate Medical Education. examination within three attempts (b) The board shall notify the Texas Department of (b) The board shall adopt rules that prescribe how Health on receipt of an application for expedited processing the limit on the number of examination attempts under under Subsection (a)(2). Subsection (a) shall apply to an applicant who seeks a license and who attempts more than one type of §155.103. REPEALED examination . §155.104. TEMPORARY LICENSES §155.057. PRESERVATION OF EXAMINATION MATERIALS (a) The board may adopt rules and set fees relating The board shall preserve all examination questions, answers, to granting temporary licenses and extending the expiration and grades as directed by board rule until the first anniversary of dates of temporary licenses. The board by rule shall set a the date of the examination. time limit for the term of a temporary license. (b) The board may issue a faculty temporary license §155.058. APPLICATION OF OPEN RECORDS AND OPEN to practice medicine to a physician appointed by a medical MEETINGS LAW TO EXAMINATION PROCEDURES school in this state as provided by this section. The (a) The following are exempt from Chapters 551 and physician: 552, Government Code: (1) must hold a current medical license that is (1) examination questions that may be used in unrestricted and not subject to a disciplinary order or the future; probation in another state or Canadian province or (2) examinations; and have completed at least three years of postgraduate (3) deliberations and records relating to the residency; professional character and fitness of applicants. (2) may not hold a medical license in another (b) Subsection (a)(2) does not prohibit the board state or a Canadian province that has any restriction, from providing an examination to an applicant who has disciplinary orders, or probation; taken that examination. (3) must pass the Texas medical jurisprudence examination; and SUBCHAPTER C. CERTAIN TEMPORARY LICENSES OR (4) must hold a salaried faculty position of at PERMITS least the level of assistant professor and be working full-time at one of the following institutions: §155.101. REPEALED (A) The University of Texas Medical Branch at Galveston §155.102. REPEALED (B) The University of Texas Southwestern Medical Center at Dallas; §155.1025. EXPEDITED PROCESS FOR CERTAIN (C) The University of Texas Health APPLICANTS Science Center at Houston; (a) The board shall adopt rules for expediting any (D) The University of Texas Health application for a license under this subtitle made by a Science Center at San Antonio; person who is licensed to practice medicine in another state (E) The University of Texas Health Center or country and who submits an affidavit with the application at Tyler; stating that: (F) The University of Texas M.D. (1) the applicant intends to practice in a rural community, Anderson Cancer Center; as determined by the Office of Rural Community Affairs; or (G) Texas A&M University College of (2) the applicant intends to: Medicine; (A) accept employment with an entity (H) Texas Tech University School of located in a medically underserved area or health Medicine; professional shortage area, designated by the (I) Baylor College of Medicine; or United States Department of Health and Human (J) The University of North Texas Health Services, and affiliated with or participating in a Science Center at Fort Worth.
  19. 19. (c) A physician is eligible for a temporary license licensed by the board who is participating in a graduate under Subsection (b) if the physician holds a faculty medical education training program approved by the board. position of at least the level of assistant professor and (b) A physician-in-training permit does not authorize works at least part-time at an institution listed in Subsection the performance of a medical act by the permit holder (b)(4) and: unless the act is performed: (1) the physician is on active duty in the United (1) as a part of the graduate medical education States armed forces; and training program; and (2) the physician’s practice under the temporary (2) under the supervision of a physician. license will fulfill critical needs of the citizens of this (c) The board has jurisdiction to discipline a permit state. holder whose permit has expired if the violation of the law (d) A physician who is issued a temporary license occurred during the time the permit was valid. If an under Subsection (b) must sign an oath on a form investigation is open when the permit expires, the permit prescribed by the board swearing that the physician: shall be executory and the board may retain jurisdiction. (1) has read and is familiar with this subtitle and board rules; §155.106. CERTIFICATION OF LICENSE TO OTHER (2) will abide by the requirements of this subtitle STATES and board rules while practicing under the physician’s On the request of a license holder, the board shall issue a temporary license; and certificate that endorses the license issued by the board to other (3) will be subject to the disciplinary procedures states. The board shall charge a fee for the issuance of the of the board. certificate. (e) A physician holding a temporary license under Subsection (b) and the physician’s medical school must file §155.107. CERTIFICATION OF EXAMINATION GRADES affidavits with the board affirming acceptance of the terms On the request of a license holder, the board shall issue and limits imposed by the board on the medical activities of certification of state board examination grades to the Federation the physician. of State Medical Boards of the United States. The board shall (f) A temporary license issued under Subsection (b) charge a reasonable fee for the issuance. is valid for one year. (g) the holder of a temporary license issued under SUBCHAPTER D. ISSUANCE OF NEW OR DUPLICATE Subsection (b) is limited to the teaching confines of the LICENSE applying medical school as a part of the physician's duties §155.151. DUPLICATE LICENSE and responsibilities assigned by the school and may not (a) If a license issued under this subtitle is lost or practice medicine outside of the setting of the medical destroyed, the license holder may apply to the board for a school or an affiliate of the medical school. The physician duplicate license. The application must be on a form may participate in the full activities of the department of any prescribed by the board, accompanied by an affidavit of the hospital for which the physician’s medical school has full loss or destruction that states that the applicant is the responsibility for clinical, patient care, and teaching person to whom the license was issued and other activities. information concerning the loss or destruction of the license (h) The application for a temporary license under as required by the board. Subsection (b) must be made by the chairman of the (b) On payment of a fee set by the board, the board department of the medical school in which the physician shall issue a duplicate license to the person. teaches and must contain the information and documentation requested by the department. The §155.152. ISSUANCE OF NEW LICENSE ON CHANGE OF application must be endorsed by the dean of the medical NAME school or the president of the institution. The board may issue a new license to a license holder if the (i) Three years in a teaching faculty position at an license holder changes the license holder’s name. institution listed in Subsection (b)(4) may be treated as equivalent to three years of an approved postgraduate residency program if, at the conclusion of the three-year period, the physician presents recommendations on the physician’s behalf from the chief administrative officer and the president of the institution. (j) A physician who holds a temporary license issued under Subsection (b) and who wishes to receive a permanent unrestricted license, including any examination requirements. §155.105. PHYSICIAN-IN-TRAINING PERMIT (a) The board as provided by board rule may issue a physician-in-training permit to a physician not otherwise
  20. 20. Appendix B. Texas Occupations Code CHAPTER 164. DISCIPLINARY ACTIONS AND PROCEDURES SUBCHAPTER B. LICENSE DENIAL AND DISCIPLINARY ACTIONS prohibited under Section 164.052 or are similar to §164.051. GROUNDS FOR DENIAL OR DISCIPLINARY acts described by this subsection. ACTION (b) Action taken by a professional medical (a) The board may refuse to admit a person to its association, society, or hospital medical staff under examination or refuse to issue a license to practice Subsection (a)(7) does not constitute state action. medicine and may take disciplinary action against a (c) A certified copy of the record of another state person if the person: that takes action described by Subsection (a)(9) or (d) is (1) commits an act prohibited under Section conclusive evidence of that action. 164.052; (d) The board shall revoke a license issued under (2) is convicted of, or is placed on deferred this subtitle if the license holder held a license to practice adjudication community supervision or deferred medicine in another state that has been revoked by the disposition for: licensing authority in that state. (A) a felony; or (B) a misdemeanor involving moral §164.052. PROHIBITED PRACTICES BY PHYSICIAN OR turpitude; LICENSE APPLICANT (3) commits or attempts to commit a direct or (a) A physician or an applicant for a license to indirect violation of a rule adopted under this practice medicine commits a prohibited practice if that subtitle, either as a principal, accessory, or person: accomplice; (1) submits to the board a false or (4) is unable to practice medicine with misleading statement, document, or certificate in an reasonable skill and safety to patients because of: application for a license; (A) illness; (2) presents to the board a license, (B) drunkenness; certificate, or diploma that was illegally or (C) excessive use of drugs, narcotics, fraudulently obtained; chemicals, or another substance; or (3) commits fraud or deception in taking or (D) a mental or physical condition; passing an examination; (5) is found by a court judgment to be of (4) uses alcohol or drugs in an intemperate unsound mind; manner that, in the board’s opinion, could endanger (6) fails to practice medicine in an a patient’s life; acceptable professional manner consistent with (5) commits unprofessional or dishonorable public health and welfare; conduct that is likely to deceive or defraud the (7) is removed, suspended, or is subject to public, as provided by Section 164.053, or injure the disciplinary action taken by the person’s peers in a public; local, regional, state, or national professional (6) uses an advertising statement that is medical association or society, or is disciplined by a false, misleading, or deceptive; licensed hospital or medical staff of a hospital, (7) advertises professional superiority or the including removal, suspension, limitation of hospital performance of professional service in a superior privileges, or other disciplinary action, if the board manner if that advertising is not readily subject to finds that the action: verification; (A) was based on unprofessional (8) purchases, sells, barters, or uses, or conduct or professional incompetence that offers to purchase, sell, barter, or use, a medical was likely to harm the public; and degree, license, certificate, or diploma, or a (B) was appropriate and reasonably transcript of a license, certificate, or diploma in or supported by evidence submitted to the board; incident to an application to the board for a license (8) is subject to repeated or recurring to practice medicine; meritorious health care liability claims that in the (9) alters, with fraudulent intent, a medical board’s opinion evidence professional license, certificate, or diploma, or a transcript of a incompetence likely to injure the public; or medical license, certificate, or diploma; (9) except as provided by Subsection (d), (10) uses a medical license, certificate, or holds a license to practice medicine subject to diploma, or a transcript of a medical license, disciplinary action by another state, or subject to certificate, or diploma that has been: disciplinary action by the uniformed services of the (A) fraudulently purchased or issued; United States, based on acts by the person that are (B) counterfeited; or Revised 01/04/2007 20 of 39
  21. 21. (C) materially altered; the date the physician received or created the (11) impersonates or acts as proxy for another documentation for the record. person in an examination required by this subtitle (b) For purposes of Subsection (a)(12), conduct for a medical license; that subverts or attempts to subvert the medical licensing (12) engages in conduct that subverts or examination process includes, as prescribed by board attempts to subvert an examination process rules, conduct that violates: required by this subtitle for a medical license; (1) the security of the examination materials; (13) impersonates a physician or permits (2) the standard of test administration; or another to use the person’s license or certificate to (3) the accreditation process. practice medicine in this state; (14) directly or indirectly employs a person §164.053. UNPROFESSIONAL OR DISHONORABLE whose license to practice medicine has been CONDUCT suspended, canceled, or revoked; (a) For purposes of Section 164.052(a)(5), (15) associates in the practice of medicine unprofessional or dishonorable conduct likely to deceive with a person: or defraud the public includes conduct in which a (A) whose license to practice medicine physician: has been suspended, canceled, or revoked; or (1) commits an act that violates any state or (B) who has been convicted of the federal law if the act is connected with the unlawful practice of medicine in this state or physician’s practice of medicine; elsewhere; (2) fails to keep complete and accurate (16) performs or procures a criminal abortion, records of purchases and disposals of: aids or abets in the procuring of a criminal abortion, (A) drugs listed in Chapter 481, Health attempts to perform or procure a criminal abortion, and Safety Code; or or attempts to aid or abet the performance or (B) controlled substances scheduled in procurement of a criminal abortion; the Comprehensive Drug Abuse Prevention (17) directly or indirectly aids or abets the and Control Act of 1970 (21 U.S.C. Section practice of medicine by a person, partnership, 801 et seq.); association, or corporation that is not licensed to (3) writes prescriptions for or dispenses to a person practice medicine by the board; who: (18) performs an abortion on a woman who is (A) is known to be an abuser of narcotic pregnant with a viable unborn child during the third drugs, controlled substances, or dangerous trimester of the pregnancy unless: drugs; or (A) the abortion is necessary to prevent (B) the physician should have known the death of the woman; was an abuser of narcotic drugs, controlled (B) the viable unborn child has a substances, or dangerous drugs; severe, irreversible brain impairment; or (4) writes false or fictitious prescriptions for: (C) the woman is diagnosed with a (A) dangerous drugs as defined by significant likelihood of suffering imminent Chapter 483, Health and Safety Code; or severe, irreversible brain damage or imminent (B) controlled substances scheduled in severe, irreversible paralysis; or Chapter 481, Health and Safety Code, or the (19) performs an abortion on an unemancipated minor Comprehensive Drug Abuse Prevention and without the written consent of the child’s parent, managing Control Act of 1970 (21 U.S.C. Section 801 et conservator, or legal guardian or without a court order, as seq.); provided by Section 33.003 or 33.004, Family Code, (5) prescribes or administers a drug or authorizing the minor to consent to the abortion, unless the treatment that is nontherapeutic in nature or physician concludes that on the basis of the physician’s good nontherapeutic in the manner the drug or treatment faith clinical judgment, a condition exists that complicates the is administered or prescribed; medical condition of the pregnant minor and necessitates the (6) prescribes, administers, or dispenses in a immediate abortion of her pregnancy to avert her death or to manner inconsistent with public health and welfare: avoid a serious risk of substantial impairment of a major bodily (A) dangerous drugs as defined by function and that there is insufficient time to obtain the consent Chapter 483, Health and Safety Code; or of the child’s parent, managing conservator or legal guardian. (B) controlled substances scheduled in (c) The board shall adopt the forms necessary for Chapter 481, Health and Safety Code, or the physicians to obtain the consent required for an abortion Comprehensive Drug Abuse Prevention and to be performed on an unemancipated minor under Control Act of 1970 (21 U.S.C. Section 801 et Subsection (a). The form executed to obtain consent or seq.); any other required documentation must be retained by (7) violates Section 311.0025, Health and the physician until the later of the fifth anniversary of the Safety Code; date of the minor’s majority or the seventh anniversary of Revised 01/04/2007 21 of 39
  22. 22. (8) fails to supervise adequately the activities while in the practice of medicine or under the guise of the of those acting under the supervision of the practice of medicine is sufficient for the board’s action. physician; or (c) Subsection (a)(3) does not apply to a person (9) delegates professional medical the physician is treating for: responsibility or acts to a person if the delegating (1) the person’s use of narcotics after the physician knows or has reason to know that the physician notifies the board in writing of the name person is not qualified by training, experience, or and address of the person being treated; or licensure to perform the responsibility or acts. (2) intractable pain under the Intractable (b) A complaint, indictment, or conviction of a Pain Treatment Act (Article 4495c, Revised violation of law is not necessary for the enforcement of Statutes). Subsection (a)(1).Proof of the commission of the act Revised 01/04/2007 22 of 39

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