OCCUPATIONS CODE
CHAPTER 157. AUTHORITY OF PHYSICIAN TO DELEGATE CERTAIN MEDICAL
ACTS
SUBCHAPTER A. GENERAL PROVISIONS
§ 157.001. GENERAL AUTHORITY OF PHYSICIAN TO
DELEGATE. (a) A physician may delegate to a qualified and
properly trained person acting under the physician's supervision
any medical act that a reasonable and prudent physician would find
within the scope of sound medical judgment to delegate if, in the
opinion of the delegating physician:
(1) the act:
(A) can be properly and safely performed by the
person to whom the medical act is delegated;
(B) is performed in its customary manner; and
(C) is not in violation of any other statute; and
(2) the person to whom the delegation is made does not
represent to the public that the person is authorized to practice
medicine.
(b) The delegating physician remains responsible for the
medical acts of the person performing the delegated medical acts.
(c) The board may determine whether:
(1) an act constitutes the practice of medicine, not
inconsistent with this chapter; and
(2) a medical act may be properly or safely delegated
by physicians.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.002. GENERAL DELEGATION OF ADMINISTRATION AND
PROVISION OF DANGEROUS DRUGS. (a) In this section:
(1) "Administering" means the direct application of a
drug to the body of a patient by injection, inhalation, ingestion,
or any other means.
(2) "Provision" means the supply of one or more unit
doses of a drug, medicine, or dangerous drug.
(b) A physician may delegate to any qualified and properly
trained person acting under the physician's supervision the act of
administering or providing dangerous drugs in the physician's
office, as ordered by the physician, that are used or required to
meet the immediate needs of the physician's patients. The
administration or provision of the dangerous drugs must be
performed in compliance with laws relating to the practice of
medicine and state and federal laws relating to those dangerous
drugs.
(c) A physician may also delegate to any qualified and
properly trained person acting under the physician's supervision
the act of administering or providing dangerous drugs through a
facility licensed by the Texas State Board of Pharmacy, as ordered
by the physician, that are used or required to meet the immediate
needs of the physician's patients. The administration of those
dangerous drugs must be in compliance with laws relating to the
practice of medicine, professional nursing, and pharmacy and state
and federal drug laws. The provision of those dangerous drugs must
be in compliance with:
(1) laws relating to the practice of medicine,
professional nursing, and pharmacy;
(2) state and federal drug laws; and
(3) rules adopted by the Texas State Board of
Pharmacy.
(d) In the provision of services and the administration of
therapy by public health departments, as officially prescribed by
the Texas Department of Health for the prevention or treatment of
specific communicable diseases or health conditions for which the
Texas Department of Health is responsible for control under state
law, a physician may delegate to any qualified and properly trained
person acting under the physician's supervision the act of
administering or providing dangerous drugs, as ordered by the
physician, that are used or required to meet the needs of the
patients. The provision of those dangerous drugs must be in
compliance with laws relating to the practice of medicine,
professional nursing, and pharmacy. An order for the prevention or
treatment of a specific communicable disease or health condition
for which the Texas Department of Health is responsible for control
under state law may not be inconsistent with this chapter and may
not be used to perform an act or duty that requires the exercise of
independent medical judgment.
(e) The administration or provision of the drugs may be
delegated through a physician's order, a standing medical order, a
standing delegation order, or another order defined by the board.
(f) Subsections (b) and (c) do not authorize a physician or
a person acting under the supervision of a physician to keep a
pharmacy, advertised or otherwise, for the retail sale of dangerous
drugs, other than as authorized under Section 158.003, without
complying with the applicable laws relating to the dangerous drugs.
(g) A drug or medicine provided under Subsection (b) or (c)
must be supplied in a suitable container labeled in compliance with
applicable drug laws. A qualified and trained person, acting under
the supervision of a physician, may specify at the time of the
provision of the drug the inclusion on the container of the date of
the provision and the patient's name and address.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.003. EMERGENCY CARE. The authority to delegate
medical acts to a properly qualified person as provided by this
subchapter applies to emergency care provided by emergency medical
personnel certified by the Texas Department of Health.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.004. DELEGATION REGARDING CERTAIN CARE FOR
NEWBORNS; LIABILITY. (a) It is the policy of this state that the
prevention of ophthalmia neonatorum in newborn infants is of
paramount importance for the protection of the health of the
children of this state.
(b) The authority to delegate medical acts to a midwife
under Chapter 203 applies to the possession and administration of
eye prophylaxis for the prevention of ophthalmia neonatorum.
(c) A physician who issues a standing delegation order to a
midwife under Chapter 203 is not liable in connection with an act
performed under that standing delegation order if the midwife
provides proof of documentation under that chapter before the order
is issued.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.005. PERFORMANCE OF DELEGATED ACT NOT PRACTICING
WITHOUT MEDICAL LICENSE. A person to whom a physician delegates
the performance of a medical act is not considered to be practicing
medicine without a license by performing the medical act unless the
person acts with knowledge that the delegation and the action taken
under the delegation is a violation of this subtitle.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.006. LIMITATION ON BOARD RULES REGARDING
DELEGATION. The board shall promote a physician's exercise of
professional judgment to decide which medical acts may be safely
delegated by not adopting rules containing, except as absolutely
necessary, global prohibitions or restrictions on the delegation of
medical acts.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.007. APPLICABILITY OF OTHER LAWS. An act
delegated by a physician under this chapter must comply with other
applicable laws.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS
§ 157.051. DEFINITIONS. In this subchapter:
(1) "Advanced practice nurse" has the meaning assigned
to that term by Section 301.152. The term includes an advanced
nurse practitioner.
(2) "Carrying out or signing a prescription drug
order" means completing a prescription drug order presigned by the
delegating physician, or the signing of a prescription by a
registered nurse or physician assistant after that person has been
designated to the board by the delegating physician as a person
delegated to sign a prescription.
(2-a) "Controlled substance" has the meaning assigned
to that term by Section 481.002, Health and Safety Code.
(2-b) "Dangerous drug" has the meaning assigned to
that term by Section 483.001, Health and Safety Code.
(3) "Physician assistant" means a person who holds a
license issued under Chapter 204.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999. Amended
by Acts 2003, 78th Leg., ch. 88, § 1, eff. May 20, 2003.
§ 157.0511. PRESCRIPTION DRUG ORDERS. (a) A
physician's authority to delegate the carrying out or signing of a
prescription drug order under this subchapter is limited to:
(1) dangerous drugs; and
(2) controlled substances to the extent provided by
Subsection (b).
(b) A physician may delegate the carrying out or signing of
a prescription drug order for a controlled substance only if:
(1) the prescription is for a controlled substance
listed in Schedules III, IV, or V as established by the commissioner
of public health under Chapter 481, Health and Safety Code;
(2) the prescription is for a period not to exceed 30
days;
(3) with regard to the refill of a prescription, the
refill is authorized after consultation with the delegating
physician and the consultation is noted in the patient's chart; and
(4) with regard to a prescription for a child less than
two years of age, the prescription is made after consultation with
the delegating physician and the consultation is noted in the
patient's chart.
(c) This subchapter does not modify the authority granted by
law for a licensed registered nurse or physician assistant to
administer or provide a medication, including a controlled
substance listed in Schedule II as established by the commissioner
of public health under Chapter 481, Health and Safety Code, that is
authorized by a physician under a physician's order, standing
medical order, standing delegation order, or protocol.
Added by Acts 2003, 78th Leg., ch. 88, § 2, eff. May 20, 2003.
§ 157.052. PRESCRIBING AT SITES SERVING CERTAIN
MEDICALLY UNDERSERVED POPULATIONS. (a) In this section:
(1) "Health manpower shortage area" means:
(A) an urban or rural area of this state that:
(i) is not required to conform to the
geographic boundaries of a political subdivision but is a rational
area for the delivery of health service;
(ii) the secretary of health and human
services determines has a health manpower shortage; and
(iii) is not reasonably accessible to an
adequately served area;
(B) a population group that the secretary of
health and human services determines has a health manpower
shortage; or
(C) a public or nonprofit private medical
facility or other facility that the secretary of health and human
services determines has a health manpower shortage, as described by
42 U.S.C. Section 254e(a)(1).
(2) "Medically underserved area" means:
(A) an area in this state with a medically
underserved population;
(B) an urban or rural area designated by the
secretary of health and human services as an area in this state with
a shortage of personal health services or a population group
designated by the secretary as having a shortage of those services,
as described by 42 U.S.C. Section 300e-1(7); or
(C) an area defined as medically underserved by
rules adopted by the Texas Board of Health based on:
(i) demographics specific to this state;
(ii) geographic factors that affect access
to health care; and
(iii) environmental health factors.
(3) "Registered nurse" means a registered nurse
recognized by the Board of Nurse Examiners as having the
specialized education and training required under Section 301.152.
(4) "Site serving a medically underserved population"
means:
(A) a site located in a medically underserved
area;
(B) a site located in a health manpower shortage
area;
(C) a clinic designated as a rural health clinic
under 42 U.S.C. Section 1395x(aa);
(D) a public health clinic or a family planning
clinic under contract with the Texas Department of Human Services
or the Texas Department of Health;
(E) a site located in an area in which the Texas
Department of Health determines there is an insufficient number of
physicians providing services to eligible clients of federal,
state, or locally funded health care programs; or
(F) a site that the Texas Department of Health
determines serves a disproportionate number of clients eligible to
participate in federal, state, or locally funded health care
programs.
(b) After making a determination under this section that a
site serves a medically underserved population, the Texas
Department of Health shall publish notice of its determination in
the Texas Register and provide an opportunity for public comment in
the manner provided for a proposed rule under Chapter 2001,
Government Code.
(c) At a site serving a medically underserved population, a
physician licensed by the board may delegate to a registered nurse
or physician assistant acting under adequate physician supervision
the act of administering, providing, or carrying out or signing a
prescription drug order, as authorized by the physician through a
physician's order, a standing medical order, a standing delegation
order, or another order or protocol as defined by the board.
(d) An advertisement for a site serving a medically
underserved population must include the name and business address
of the supervising physician for the site.
(e) Physician supervision is adequate for the purposes of
this section if a delegating physician:
(1) is responsible for the formulation or approval of
the physician's order, standing medical order, standing delegation
order, or other order or protocol, and periodically reviews the
order and the services provided patients under the order;
(2) is on-site to provide medical direction and
consultation at least once every 10 business days during which the
advanced practice nurse or physician assistant is on-site providing
care;
(3) receives a daily status report from the advanced
practice nurse or physician assistant on any problem or
complication encountered; and
(4) is available through direct telecommunication for
consultation, patient referral, or assistance with a medical
emergency.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999. Amended
by Acts 2003, 78th Leg., ch. 88, § 3, eff. May 20, 2003.
§ 157.053. PRESCRIBING AT PHYSICIAN PRIMARY PRACTICE
SITES. (a) In this section, "primary practice site" means:
(1) the practice location of a physician at which the
physician spends the majority of the physician's time;
(2) a licensed hospital, a licensed long-term care
facility, or a licensed adult care center where both the physician
and the physician assistant or advanced practice nurse are
authorized to practice;
(3) a clinic operated by or for the benefit of a public
school district to provide care to the students of that district and
the siblings of those students, if consent to treatment at that
clinic is obtained in a manner that complies with Chapter 32, Family
Code;
(4) the residence of an established patient; or
(5) another location at which the physician is
physically present with the physician assistant or advanced
practice nurse.
(b) At a physician's primary practice site, a physician
licensed by the board may delegate to a physician assistant or an
advanced practice nurse acting under adequate physician
supervision the act of administering, providing, or carrying out or
signing a prescription drug order as authorized through a
physician's order, a standing medical order, a standing delegation
order, or another order or protocol as defined by the board.
(c) Physician supervision of the carrying out and signing of
prescription drug orders must conform to what a reasonable, prudent
physician would find consistent with sound medical judgment but may
vary with the education and experience of the particular advanced
practice nurse or physician assistant. A physician shall provide
continuous supervision, but the constant physical presence of the
physician is not required.
(d) An alternate physician may provide appropriate
supervision on a temporary basis as defined and established by
board rule.
(e) A physician's authority to delegate the carrying out or
signing of a prescription drug order is limited to:
(1) three physician assistants or advanced practice
nurses or their full-time equivalents practicing at the physician's
primary practice site or at an alternate practice site under
Section 157.0541; and
(2) the patients with whom the physician has
established or will establish a physician-patient relationship.
(f) For purposes of Subsection (e)(2), the physician is not
required to see the patient within a specific period.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999. Amended
by Acts 2001, 77th Leg., ch. 112, § 1, eff. May 11, 2001; Acts
2003, 78th Leg., ch. 88, § 4, eff. May 20, 2003.
§ 157.054. PRESCRIBING AT FACILITY-BASED PRACTICE
SITES. (a) A physician licensed by the board may delegate, to one
or more physician assistants or advanced practice nurses acting
under adequate physician supervision whose practice is
facility-based at a licensed hospital or licensed long-term care
facility, the administration or provision of a drug and the
carrying out or signing of a prescription drug order if the
physician is:
(1) the medical director or chief of medical staff of
the facility in which the physician assistant or advanced practice
nurse practices;
(2) the chair of the facility's credentialing
committee;
(3) a department chair of a facility department in
which the physician assistant or advanced practice nurse practices;
or
(4) a physician who consents to the request of the
medical director or chief of medical staff to delegate the carrying
out or signing of a prescription drug order at the facility in which
the physician assistant or advanced practice nurse practices.
(b) A physician's authority to delegate under Subsection
(a) is limited as follows:
(1) the delegation must be made under a physician's
order, standing medical order, standing delegation order, or
another order or protocol developed in accordance with policies
approved by the facility's medical staff or a committee of the
facility's medical staff as provided by the facility bylaws;
(2) the delegation must occur in the facility in which
the physician is the medical director, the chief of medical staff,
the chair of the credentialing committee, or a department chair;
(3) the delegation may not permit the carrying out or
signing of prescription drug orders for the care or treatment of the
patients of any other physician without the prior consent of that
physician;
(4) delegation in a long-term care facility must be by
the medical director and is limited to the carrying out and signing
of prescription drug orders to not more than three advanced
practice nurses or physician assistants or their full-time
equivalents; and
(5) a physician may not delegate at more than one
licensed hospital or more than two long-term care facilities unless
approved by the board.
(c) Physician supervision of the carrying out and signing of
prescription drug orders must conform to what a reasonable, prudent
physician would find consistent with sound medical judgment but may
vary with the education and experience of the particular advanced
practice nurse or physician assistant. A physician shall provide
continuous supervision, but the constant physical presence of the
physician is not required.
(d) An alternate physician may provide appropriate
supervision on a temporary basis as defined and established by
board rule.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999. Amended
by Acts 2003, 78th Leg., ch. 88, § 5, eff. May 20, 2003.
§ 157.0541. PRESCRIBING AT ALTERNATE SITES. (a) In
this section, "alternate site" means a practice site:
(1) where services similar to the services provided at
the delegating physician's primary practice site are provided; and
(2) located within 60 miles of the delegating
physician's primary practice site.
(b) At an alternate site, a physician licensed by the board
may delegate to an advanced practice nurse or physician assistant,
acting under adequate physician supervision, the act of
administering, providing, or carrying out or signing a prescription
drug order as authorized through a physician's order, a standing
medical order, a standing delegation order, or another order or
protocol as defined by the board.
(c) Physician supervision is adequate for the purposes of
this section if the delegating physician:
(1) is on-site with the advanced practice nurse or
physician assistant at least 20 percent of the time;
(2) reviews at least 10 percent of the medical charts
at the site; and
(3) is available through direct telecommunication for
consultation, patient referral, or assistance with a medical
emergency.
(d) An alternate physician may provide appropriate
supervision to an advanced practice nurse or physician assistant
under this section on a temporary basis as provided by board rule.
(e) The combined number of advanced practice nurses and
physician assistants to whom a physician may delegate under this
section and at a primary practice site under Section 157.053 may not
exceed three physician assistants or advanced practice nurses or
the full-time equivalent of three physician assistants or advanced
practice nurses.
Added by Acts 2001, 77th Leg., ch. 112, § 2, eff. May 11, 2001.
Amended by Acts 2003, 78th Leg., ch. 88, § 6, eff. May 20, 2003.
§ 157.0542. BOARD WAIVER OF DELEGATION REQUIREMENTS.
Text of section effective until September 1, 2005
(a) On determining that the conditions of Subsection (b)
have been met, the board may waive or modify any of the site or
supervision requirements for a physician to delegate the carrying
out or signing of prescription drug orders to an advanced practice
nurse or physician assistant under Sections 157.052, 157.053,
157.054, and 157.0541, or under board rules. The board may not
waive the limitation on the number of primary or alternate practice
sites at which a physician may delegate the carrying out or signing
of prescription drug orders or the number of advanced practice
nurses or physician assistants to whom a physician may delegate the
carrying out or signing of prescription drug orders.
(b) The board may grant a waiver under Subsection (a) if the
board determines that:
(1) the practice site where the physician is seeking
to delegate prescriptive authority is unable to meet the
requirements of this chapter or board rules or compliance would
cause an undue burden without a corresponding benefit to patient
care;
(2) safeguards exist for patient care and for
fostering a collaborative practice between the physician and the
advanced practice nurses and physician assistants; and
(3) if the requirement for which the waiver is sought
is the amount of time the physician is on-site, the frequency and
duration of time the physician is on-site when the advanced
practice nurse or physician assistant is present is sufficient for
collaboration to occur, taking into consideration the other ways
the physician collaborates with the advanced practice nurse or
physician assistant, including at other sites.
(c) The board shall establish procedures for granting
waivers under this section. At a minimum, the procedures must
include a process for providing, if the board denies a waiver, a
written explanation for the denial and identifying modifications
that would make the waiver acceptable and a process for revoking,
suspending, or modifying a waiver previously granted. The process
for revoking, suspending, or modifying a waiver must include notice
and an opportunity for a hearing. The board may probate an order to
revoke, suspend, or modify a waiver.
(d) The board shall appoint an advisory committee to review
and make recommendations on applications for waivers under this
section. Each committee member must be actively practicing as a
physician, an advanced practice nurse, or a physician assistant in
collaborative practices under which the advanced practice nurse or
physician assistant is authorized by the physician to sign or carry
out prescription drug orders under this subchapter. The committee
consists of 15 members appointed as follows:
(1) five advanced practice nurses appointed from a
list of persons recommended by professional associations
representing advanced practice nurses;
(2) five physician assistants appointed from a list of
persons recommended by professional associations representing
physician assistants; and
(3) five physicians appointed from a list of persons
recommended by professional associations representing physicians.
(e) The advisory committee shall recommend whether to grant
a waiver after making the determinations required of the board
under Subsection (a). The board may grant a waiver only if the
committee recommends that the waiver be granted, unless the board
determines good cause exists to grant a waiver the committee does
not recommend.
(f) The advisory committee may recommend that the board
approve a waiver with modifications.
(g) An advisory committee recommendation of the approval of
a waiver, with or without modifications, requires a vote of at
least:
(1) three advanced practice nurse committee members;
(2) three physician assistant committee members; and
(3) three physician committee members.
(h) This section expires September 1, 2005.
Added by Acts 2001, 77th Leg., ch. 112, § 2, eff. May 11, 2001.
§ 157.055. ORDERS AND PROTOCOLS. A protocol or other
order shall be defined in a manner that promotes the exercise of
professional judgment by the advanced practice nurse and physician
assistant commensurate with the education and experience of that
person. Under this section, an order or protocol used by a
reasonable and prudent physician exercising sound medical
judgment:
(1) is not required to describe the exact steps that an
advanced practice nurse or a physician assistant must take with
respect to each specific condition, disease, or symptom; and
(2) may state the types or categories of medications
that may be prescribed or the types or categories of medications
that may not be prescribed.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.056. PRESCRIPTION INFORMATION. The following
information must be provided on each prescription subject to this
subchapter:
(1) the patient's name and address;
(2) the drug to be dispensed;
(3) directions to the patient regarding the taking of
the drug and the dosage;
(4) the intended use of the drug, if appropriate;
(5) the name, address, and telephone number of the
physician;
(6) the name, address, telephone number, and
identification number of the registered nurse or physician
assistant completing or signing the prescription drug order;
(7) the date; and
(8) the number of refills permitted.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.057. ADDITIONAL IMPLEMENTATION METHODS. The
board may adopt additional methods to implement:
(1) a physician's prescription; or
(2) the delegation of the signing of a prescription
under a physician's order, standing medical order, standing
delegation order, or other order or protocol.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.058. DELEGATION TO CERTIFIED REGISTERED NURSE
ANESTHETIST. (a) In a licensed hospital or ambulatory surgical
center, a physician may delegate to a certified registered nurse
anesthetist the ordering of drugs and devices necessary for the
nurse anesthetist to administer an anesthetic or an
anesthesia-related service ordered by the physician.
(b) The physician's order for anesthesia or
anesthesia-related services is not required to specify a drug,
dose, or administration technique.
(c) Pursuant to the physician's order and in accordance with
facility policies or medical staff bylaws, the nurse anesthetist
may select, obtain, and administer those drugs and apply the
medical devices appropriate to accomplish the order and maintain
the patient within a sound physiological status.
(d) This section shall be liberally construed to permit the
full use of safe and effective medication orders to use the skills
and services of certified registered nurse anesthetists.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
§ 157.059. DELEGATION REGARDING CERTAIN OBSTETRICAL
SERVICES. (a) In this section, "provide" means to supply, for a
term not to exceed 48 hours, one or more unit doses of a controlled
substance for the immediate needs of a patient.
(b) A physician may delegate to a physician assistant
offering obstetrical services and certified by the board as
specializing in obstetrics or an advanced practice nurse recognized
by the Board of Nurse Examiners as a nurse midwife the act of
administering or providing controlled substances to the physician
assistant's or nurse midwife's clients during intrapartum and
immediate postpartum care.
(c) The physician may not delegate the use of a prescription
sticker or the use or issuance of an official prescription form
under Section 481.075, Health and Safety Code.
(d) The delegation of authority to administer or provide
controlled substances under Subsection (b) must be under a
physician's order, medical order, standing delegation order, or
protocol that requires adequate and documented availability for
access to medical care.
(e) The physician's orders, medical orders, standing
delegation orders, or protocols must require the reporting of or
monitoring of each client's progress, including complications of
pregnancy and delivery and the administration and provision of
controlled substances by the nurse midwife or physician assistant
to the clients of the nurse midwife or physician assistant.
(f) The authority of a physician to delegate under this
section is limited to:
(1) three nurse midwives or physician assistants or
their full-time equivalents; and
(2) the designated facility at which the nurse midwife
or physician assistant provides care.
(g) The controlled substance must be supplied in a suitable
container that is labeled in compliance with the applicable drug
laws and must include:
(1) the patient's name and address;
(2) the drug to be provided;
(3) the name, address, and telephone number of the
physician;
(4) the name, address, and telephone number of the
nurse midwife or physician assistant; and
(5) the date.
(h) This section does not authorize a physician, physician
assistant, or nurse midwife to operate a retail pharmacy as defined
under Subtitle J.
(i) This section authorizes a physician to delegate the act
of administering or providing a controlled substance to a nurse
midwife or physician assistant but does not require physician
delegation of:
(1) further acts to a nurse midwife; or
(2) the administration of medications by a physician
assistant or registered nurse other than as provided by this
section.
(j) This section does not limit the authority of a physician
to delegate the carrying out or signing of a prescription drug order
involving a controlled substance under this subchapter.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999. Amended
by Acts 2003, 78th Leg., ch. 88, § 7, eff. May 20, 2003.
§ 157.060. PHYSICIAN LIABILITY FOR DELEGATED
ACT. Unless the physician has reason to believe the physician
assistant or advanced practice nurse lacked the competency to
perform the act, a physician is not liable for an act of a physician
assistant or advanced practice nurse solely because the physician
signed a standing medical order, a standing delegation order, or
another order or protocol authorizing the physician assistant or
advanced practice nurse to administer, provide, carry out, or sign
a prescription drug order.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
SUBCHAPTER C. DELEGATION TO PHARMACISTS
§ 157.101. DELEGATION TO PHARMACIST. (a) In this
section, "pharmacist" has the meaning assigned by Section 551.003.
(b) A physician may delegate to a properly qualified and
trained pharmacist acting under adequate physician supervision the
performance of specific acts of drug therapy management authorized
by the physician through the physician's order, standing medical
order, standing delegation order, or other order or protocol as
defined by board rule.
(c) Physician supervision is considered to be adequate for
the purposes of this section if a delegating physician:
(1) is responsible for the formulation or approval of
the physician's order, standing medical order, standing delegation
order, or other order or protocol and periodically reviews the
order or protocol and the services provided to a patient under the
order or protocol;
(2) has established a physician-patient relationship
with each patient who is provided drug therapy management by a
delegated pharmacist;
(3) is geographically located so as to be able to be
physically present daily to provide medical care and supervision;
(4) receives, as appropriate, a periodic status report
on each patient, including any problem or complication encountered;
and
(5) is available through direct telecommunication for
consultation, assistance, and direction.
(d) This section does not restrict the use of a
preestablished health care program or restrict a physician from
authorizing the provision of patient care by use of a
preestablished health care program if the patient is
institutionalized and the care is to be delivered in a licensed
hospital with an organized medical staff that has authorized
standing delegation orders, standing medical orders, or protocols.
(e) This section does not limit, expand, or change any
provision of law relating to therapeutic drug substitution or
administration of medication, including Section 554.004.
(f) The board by rule shall establish the minimum content of
a written order or protocol. The order or protocol may not permit
the delegation of medical diagnosis.
Acts 1999, 76th Leg., ch. 388, § 1, eff. Sept. 1, 1999.
