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RULE §190.8Violation Guidelines

When substantiated by credible evidence, the following acts, practices, and conduct are considered to be violations of the Act. The following shall not be considered an exhaustive or exclusive listing.

  (1) Practice Inconsistent with Public Health and Welfare. Failure to practice in an acceptable professional manner consistent with public health and welfare within the meaning of the Act includes, but is not limited to:

    (A) failure to treat a patient according to the generally accepted standard of care;

    (B) negligence in performing medical services;

    (C) failure to use proper diligence in one's professional practice;

    (D) failure to safeguard against potential complications;

    (E) improper utilization review;

    (F) failure to timely respond in person when on-call or when requested by emergency room or hospital staff;

    (G) failure to disclose reasonably foreseeable side effects of a procedure or treatment;

    (H) failure to disclose reasonable alternative treatments to a proposed procedure or treatment;

    (I) failure to obtain informed consent from the patient or other person authorized by law to consent to treatment on the patient's behalf before performing tests, treatments, procedures, or autopsies as required under Chapter 49 of the Code of Criminal Procedure;

    (J) termination of patient care without providing reasonable notice to the patient;

    (K) prescription or administration of a drug in a manner that is not in compliance with Chapter 200 of this title (relating to Standards for Physicians Practicing Complementary and Alternative Medicine) or, that is either not approved by the Food and Drug Administration (FDA) for use in human beings or does not meet standards for off-label use, unless an exemption has otherwise been obtained from the FDA;

    (L) prescription of any dangerous drug or controlled substance without first establishing a valid practitioner-patient relationship. Establishing a practitioner-patient relationship is not required for:

      (i) a physician to prescribe medications for sexually transmitted diseases for partners of the physician's established patient, if the physician determines that the patient may have been infected with a sexually transmitted disease; or

      (ii) a physician to prescribe dangerous drugs and/or vaccines for post-exposure prophylaxis of disease for close contacts of a patient if the physician diagnoses the patient with one or more of the following infectious diseases listed in subclauses (I) - (VII) of this clause, or is providing public health medical services pursuant to a memorandum of understanding entered into between the board and the Department of State Health Services. For the purpose of this clause, a "close contact" is defined as a member of the patient's household or any person with significant exposure to the patient for whom post-exposure prophylaxis is recommended by the Centers for Disease Control and Prevention, Texas Department of State Health Services, or local health department or authority ("local health authority or department" as defined under Chapter 81 of the Texas Health and Safety Code). The physician must document the treatment provided to the patient's close contact(s) in the patient's medical record. Such documentation at a minimum must include the close contact's name, drug prescribed, and the date that the prescription was provided.

        (I) Influenza;

        (II) Invasive Haemophilus influenzae Type B;

        (III) Meningococcal disease;

        (IV) Pertussis;

        (V) Scabies;

        (VI) Varicella zoster; or

        (VII) a communicable disease determined by the Texas Department of State Health Services to:

          (-a-) present an immediate threat of a high risk of death or serious long-term disability to a large number of people; and

          (-b-) create a substantial risk of public exposure because of the disease's high level of contagion or the method by which the disease is transmitted.

    (M) inappropriate prescription of dangerous drugs or controlled substances to oneself, family members, or others in which there is a close personal relationship that would include the following:

      (i) prescribing or administering dangerous drugs or controlled substances without taking an adequate history, performing a proper physical examination, and creating and maintaining adequate records; and

      (ii) prescribing controlled substances in the absence of immediate need. "Immediate need" shall be considered no more than 72 hours.

    (N) providing on-call back-up by a person who is not licensed to practice medicine in this state or who does not have adequate training and experience.

    (O) delegating the performance of nerve conduction studies to a person who is not licensed as a physician or physical therapist without:

      (i) first selecting the appropriate nerve conductions to be performed;

      (ii) ensuring that the person performing the study is adequately trained;

      (iii) being onsite during the performance of the study; and

      (iv) being immediately available to provide the person with assistance and direction.

  (2) Unprofessional and Dishonorable Conduct. Unprofessional and dishonorable conduct that is likely to deceive, defraud, or injure the public within the meaning of the Act includes, but is not limited to:

    (A) violating a board order;

    (B) failing to comply with a board subpoena or request for information or action;

    (C) providing false information to the board;

    (D) failing to cooperate with board staff;

    (E) engaging in sexual contact with a patient;

    (F) engaging in sexually inappropriate behavior or comments directed towards a patient;

    (G) becoming financially or personally involved with a patient in an inappropriate manner;

    (H) referring a patient to a facility, laboratory, or pharmacy without disclosing the existence of the licensee's ownership interest in the entity to the patient;

    (I) using false, misleading, or deceptive advertising;

    (J) providing medically unnecessary services to a patient or submitting a billing statement to a patient or a third party payer that the licensee knew or should have known was improper. "Improper" means the billing statement is false, fraudulent, misrepresents services provided, or otherwise does not meet professional standards;

    (K) behaving in an abusive or assaultive manner towards a patient or the patient's family or representatives that interferes with patient care or could be reasonably expected to adversely impact the quality of care rendered to a patient;

    (L) failing to timely respond to communications from a patient;

    (M) failing to complete the required amounts of CME;

    (N) failing to maintain the confidentiality of a patient;

    (O) failing to report suspected abuse of a patient by a third party, when the report of that abuse is required by law;

    (P) behaving in a disruptive manner toward licensees, hospital personnel, other medical personnel, patients, family members or others that interferes with patient care or could be reasonably expected to adversely impact the quality of care rendered to a patient;

    (Q) entering into any agreement whereby a licensee, peer review committee, hospital, medical staff, or medical society is restricted in providing information to the board; and

    (R) commission of the following violations of federal and state laws whether or not there is a complaint, indictment, or conviction:

      (i) any felony;

      (ii) any offense in which assault or battery, or the attempt of either is an essential element;

      (iii) any criminal violation of the Medical Practice Act or other statutes regulating or pertaining to the practice of medicine;

      (iv) any criminal violation of statutes regulating other professions in the healing arts that the licensee is licensed in;

      (v) any misdemeanor involving moral turpitude as defined by paragraph (6) of this section;

      (vi) bribery or corrupt influence;

      (vii) burglary;

      (viii) child molestation;

      (ix) kidnapping or false imprisonment;

      (x) obstruction of governmental operations;

      (xi) public indecency; and


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