HBA-JRA S.B. 1340 76(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 1340 By: Carona Public Health 4/26/1999 Engrossed BACKGROUND AND PURPOSE Currently, some Texas physicians have failed to maintain appropriate safety standards regarding the use of anesthesia in their offices and, as a result, have placed patients at risk for complications or even death. S.B. 1340 requires the Texas State Board of Medical Examiners and the Board of Nurse Examiners to establish minimum standards for provision of anesthesia in outpatient settings and requires physicians and certified registered nurse anesthetists who provide anesthesia services to register with their respective boards. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly granted to the Texas State Board of Medical Examiners in SECTION 2 (Section 7.02, Article 4495b, V.T.C.S.) and to the Board of Nurse Examiners in SECTION 4 (Sec. 2, Article 4527e, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Sets forth the findings of the legislature and the purpose of this Act. SECTION 2. Amends Article 4495b, V.T.C.S. (Medical Practice Act), by adding Subchapter G, as follows: SUBCHAPTER G. ANESTHESIA IN OUTPATIENT SETTING Sec. 7.01. DEFINITION. Defines "outpatient setting" in this subchapter. Sec. 7.02. RULES. Requires the Texas State Board of Medical Examiners (board) to establish, by rule, the minimum standards for provision of anesthesia in outpatient settings by person licensed by the board. Provides that the rules must be designed to protect the health, safety, and welfare of the public and must include certain requirements. Requires the board to cooperate with the Board of Nurse Examiners in the adoption of rules under this subchapter to eliminate conflicts between the rules adopted by each board. Sec. 7.03. APPLICABILITY. Sets forth entities to which the rules adopted by the board under this subchapter are not applicable. Sec. 7.04. COMPLIANCE WITH ANESTHESIA RULES. Requires a physician who practices medicine in this state and who administers anesthesia or performs a surgical procedure for which anesthesia services are provided in an outpatient setting to comply with the rules adopted under this subchapter on or after August 31, 2000. Authorizes the board to require a physician to submit and comply with a corrective action plan to remedy or address any current or potential deficiencies with the physician's provision of anesthesia in an outpatient setting in accordance with this Act or rules of the board. Sec. 7.05. ANNUAL REGISTRATION. Requires each physician who administers anesthesia or performs a surgical procedure for which anesthesia services are provided in an outpatient setting to annually register with and pay a fee to the board beginning September 1, 2000. Requires the board to coordinate the times of registration, payment, notice, and imposition of penalties for late payment for registration required under this section with those of registration required under Section 3.01 of this Act. Sec. 7.06. INSPECTIONS. Authorizes the board to conduct inspections to enforce this subchapter, including inspections of the office site and related documents of a physician's practice as it relates to the provision of anesthesia in an outpatient setting. Authorizes the board to contract with another state agency or qualified person to conduct these inspections. Requires the board to provide at least five business days' notice prior to conducting an onsite examination, unless it would jeopardize an ongoing investigation. Provides that this section does not require the board to make an on-site inspection of a physician's office. Sec. 7.07. REQUESTS FOR INSPECTION AND ADVISORY OPINION. Authorizes the board to consider a request by a physician for an on-site inspection. Authorizes the board to conduct the inspection and issue an advisory opinion in its discretion and on payment of a fee. Provides that such an advisory opinion is not binding and authorizes the board to take any action under this Act in relation to the situation addressed by the advisory opinion that the board considers appropriate. Authorizes a physician who requests and relies on such an advisory opinion to use the opinion as mitigating evidence in an action or proceeding to impose an administrative or civil penalty under this Act. Requires the board or court, as appropriate, to take proof of reliance on an advisory opinion into consideration and mitigate the imposition of administrative or civil penalties accordingly. SECTION 3. Amends Section 3.10(b), Article 4495b, V.T.C.S. (Medical Practice Act), to prohibit the board from setting, charging, collecting, receiving, or depositing a fees in excess of $300 for processing an application and issuance of an annual registration for anesthesia in an outpatient setting. SECTION 4. Amends Chapter 7, Title 71, V.T.C.S., by adding Article 4527e, as follows: Art. 4527e. ANESTHESIA IN OUTPATIENT SETTING Sec. 1. DEFINITION. Defines "outpatient setting" in this article. Sec. 2. RULES. Requires the Board of Nurse Examiners (board) to establish, by rule, the minimum standards for provision of anesthesia services in outpatient settings by person licensed by the board. Provides that the rules must be designed to protect the health, safety, and welfare of the public and must include certain requirements. Requires the board to cooperate with the Texas State Board of Medical Examiners in the adoption of rules under this subchapter to eliminate conflicts between the rules adopted by each board. Sec. 3. APPLICABILITY. Sets forth entities to which the rules adopted by the board under this subchapter are not applicable. Sec. 4. COMPLIANCE WITH ANESTHESIA RULES. Requires a certified registered nurse anesthetist providing anesthesia services in an outpatient setting to comply with the rules adopted under this subchapter on or after August 31, 2000. Authorizes the board to require a certified registered nurse anesthetist to submit and comply with a corrective action plan to remedy or address any current or potential deficiencies with the nurse anesthetist's provision of anesthesia in an outpatient setting in accordance with this chapter or rules of the board. Sec. 5. BIENNIAL REGISTRATION. Requires each certified registered nurse anesthetist who provides anesthesia services in an outpatient setting to biennially register with and pay a fee to the board beginning September 1, 2000. Requires the board to coordinate the times of registration, payment, notice, and imposition of penalties for late payment for registration required under this section with those of license renewal provisions under Article 4526, V.T.C.S. Sec. 6. INSPECTIONS. Authorizes the board to conduct inspections to enforce this subchapter, including inspections of the equipment owned or leased by a certified registered nurse anesthetist and related documents of a certified registered nurse anesthetist's practice as it relates to the provision of anesthesia in an outpatient setting. Authorizes the board to contract with another state agency or qualified person to conduct these inspections. Requires the board to provide at least five business days' notice prior to conducting an on-site examination, unless it would jeopardize an ongoing investigation. Provides that this section does not require the board to make an on-site inspection of an outpatient setting where a certified registered nurse anesthetist provides anesthesia. Sec. 7. REQUESTS FOR INSPECTION AND ADVISORY OPINION. Authorizes the board to consider a request by a certified registered nurse anesthetist for inspection. Authorizes the board to conduct the inspection and issue an advisory opinion in its discretion and on payment of a fee. Provides that such an advisory opinion is not binding and authorizes the board to take any action under this Act in relation to the situation addressed by the advisory opinion that the board considers appropriate. Authorizes a certified registered nurse anesthetist who requests and relies on such an advisory opinion to use the opinion as mitigating evidence in an action or proceeding by the board to impose an administrative or assess a monetary fine under this Act. Requires the board to take proof of reliance on an advisory opinion into consideration and mitigate the imposition of administrative or assess a monetary fine accordingly. SECTION 5. Authorizes the Texas State Board of Medical Examiners and the Board of Nurse Examiners to permit the registration requirement imposed under Subchapter G, Article 4495b, V.T.C.S. (Medical Practice Act), as added by this Act, and under Article 4527e, V.T.C.S., as added by this Act, to be staggered and phased in so that by September 1, 2002, all physicians and certified registered nurse anesthetists required to register under those laws will be in compliance. SECTION 6. Provides that the rules required under Subchapter G, Article 4495b, V.T.C.S. (Medical Practice Act), as added by this Act, and under Article 4527e, V.T.C.S., as added by this Act, must be adopted by the Texas State Board of Medical Examiners and the Board of Nurse Examiners by January 7, 2000. Requires the Texas State Board of Medical Examiners and the Board of Nurse Examiners to report, including any suggested amendments to the laws added by this Act to make those laws more effective or efficient, to the speaker of the house of representatives and the lieutenant governor on the implementation and enforcement of those rules and of the laws added by this Act by January 1, 2001. SECTION 7. Effective date: September 1, 1999. SECTION 8. Emergency clause.