Tag Archives: APRN prescriptive privileges

Texas nursing license defense lawyerIn response to the growing opioid epidemic, state and federal agencies are cracking down on all potential medication sources – that includes advanced practice registered nurses (APRNs) with prescriptive authority. Often targeted by the Texas Board of Nursing (BON), these healthcare professionals are encouraged to proactively protect their license from suspension and revocation.

Is the new prescription monitoring program, which may eventually become mandatory for all APRNs with prescriptive authority for certain controlled substances, a tool that can help with this, as the state claims, or is it yet another way to track and target pain management professionals? History suggests the latter, but if properly informed, APRNs may still be able to use this program to their advantage. Learn more with help from the following information.

The Texas Prescription Monitoring Program

The Texas Prescription Monitoring Program (PMP) is one of the key points in Senate Bill 305, which proposes an amendment to the Nursing Practice Act. If passed, it would require that APRNs with prescriptive authority for certain controlled substances use the system prior to writing a prescription for barbiturates, opioids, benzodiazepines, or carisoprodol. The BON says this will cut down on polypharmacy issues and, in turn, enhance safety for the nurses in question - and they are correct, at least in theory. However, there are still risks of which APRNs should be aware. 

Understanding the Potential Risks of the PMP

In an ideal world, the PMP would be only be used as a tool to improve public safety and protect the reputation of outstanding clinicians. Sadly, this may not be the case. If the bill is passed, APRNs may be disciplined for not using the PMP for each prescription written. Alternatively, if an issue arises – such as unauthorized prescriptions being written under an APRN’s specific DEA number – that nurse could be disciplined for not catching the problem him or herself. Another potential issue is that the BON could use the system to monitor and track how many prescriptions you write each month. If you have an influx of new pain management patients, you may be unfairly flagged and targeted for an investigation.

Protecting Your Texas Nursing License from Suspension or Revocation

There are many strategies that nurses can employ to protect their licenses from suspension or revocation, but the most critical is taking preventative measures to ensure you and your practice are ready for an investigation at any given moment. Backed by nearly 30 years of experience in the medical-legal arena, Oscar San Miguel, Attorney at Law, can assist you with implementing such a plan. Our seasoned Texas nursing license defense lawyer can also protect your rights and nursing license, should an investigation ever occur. Secure assistance now. Schedule a free and personalized consultation by calling 512-228-7946 today.


Texas nursing license defense attorneyOpioid and the abuse of other prescription drugs are at an all-time high in the United States. Pill mills are one of the major sources of these drugs. As a result, federal agencies, state agencies, and even licensing agencies have started cracking down on the prescribing of pain medications. In fact, facilities that work with the chronically ill are facing intense scrutiny, as are advanced practice registered nurses since they work under prescriptive delegation. This extra attention, though not generally warranted, places the licensing status of nurses at risk. Learn more about the investigation process, and how to protect your nursing license, with help from the following information.  

Investigations Can Be More Like Fishing Expeditions

Investigations for matters relating to prescriptive authority or the “excessive” writing of pain prescriptions may be closed if the Texas Board of Nursing lacks evidence. Alternatively, the investigation could go another way. Something you say could be misinterpreted as evidence in a prescription abuse case. Or the investigation could turn into a fishing expedition. The investigator might start looking for any sort of infraction. They could even use what seems like an innocent conversation to gather evidence against you for a matter completely unrelated to their initial query. This is why it is so critical that you understand the investigative process, its risk to your nursing license, and how to protect it.

Protecting Your Nursing License

First and foremost, you must understand that the Board of Nursing is not an ally. They are not interested in preserving your practice or providing you with leniency. They are in place to protect the public, and they can be almost manipulative in their investigation tactics. Moreover, they are unlikely to inform you of your rights - particularly your right to consult an attorney before ever speaking with them.. In fact, some may even attempt to use their authority or an air of urgency to coerce you into speaking with them before you have had the chance to obtain legal counsel. Do not let them do this to you! Know your rights.

Even if you do not presently have an attorney, you have the right to politely inform the investigator that your attorney will be in touch. Then you should contact one immediately, before they have the chance to try and contact you again. All contact will then be fielded by your attorney to ensure you do not provide any information that has not been requested. Further, an attorney may be able to help mitigate any mistakes that may have spurred the investigation.

Contact Our Texas Nursing License Defense Lawyer

If you have been contacted by the Texas Board of Nursing, contact Oscar San Miguel, Attorney at Law, today. Backed by more than 20 years of medical-legal experience, our Texas nursing license defense lawyer can effectively represent you in your case. Skilled and dedicated, we will fight to protect your license and best interest. Call 512-228-7946 for a consultation.


Texas professional license defense attorney, APRN prescriptive privilegesThe Texas Medical Board Rules allow for physicians to delegate some prescriptive authority to Advanced Practical Registered Nurses (APRN). However, the procedures and conditions for this delegation must be carefully followed to avoid possible board discipline of both the physician and the APRN. Additionally, physicians are limited in the number of APRNs and Physician Assistants (PAs) to whom they can delegate prescriptive power.

When Can APRNs Prescribe?

APRNs can only prescribe when a physician has delegated prescriptive power to them through either a written Prescriptive Authority Agreement (PAA) or a Facility Based Protocol. 

Once the written document is executed, APRNs can use their prescriptive power as appropriate, subject to several limitation involving controlled substances. Physicians are able to delegate prescription of:

  • Nonprescription drugs;
  • Prescription drugs;
  • Medical devices (dangerous drugs);
  • Durable medical equipment; and
  • Schedule III-V Controlled Substances (subject to limitations).

What Are the Special Limitations Surrounding Controlled Substances?

There are four limitations on the ability of an APRN to delegate controlled substances. These limitations include the following:

  1. The prescription duration must be for 90 days or less, including refills;
  2. Continued treatment beyond the 90 days,with the same substance requires a physician consultation;
  3. The delegating physician must be consulted for any prescriptions for children ages two and under; and
  4. Any consultation with a physician must be noted in the patient’s medical record.

Written Agreements 

Texas Medical Board Rules carefully describe the specific requirements for a valid PAA or Facility Based Protocol. Any PAA must have all of the following for it to have any legal effect: 

  • Contact information for the delegating physician and any APRNs or PAs, including full names, license numbers and addresses;
  • Description of the medical practice;
  • A listing of the categories of drugs the APRN or PA may prescribe or a listing of the categories of drugs the APRN or PA cannot prescribe;
  • A plan for referrals and consultations;
  • A plan for dealing with patient emergencies;
  • Description of the communications process for sharing information relating to the care and treatment of patients; and
  • A plan for prescription authority quality assurance and improvement.

The quality assurance and improvement plan must include: 

  • Chart review, including how many charts will be reviewed and how the physician will review the charts;
  • Monthly meetings; and
  • Description of how to document implementation of all quality assurance improvement plan activities. 

The PAA is only good for a year at a time. The plan must be reviewed and signed every year, even if no revisions are made.

If you are facing any type of professional discipline, please contact a knowledgeable and experienced Texas professional license defense attorney right away. The longer you wait to get help, the more difficult your case may be. Call Oscar San Miguel, Attorney at Law today at 512-228-7946.



Austin, Texas Professional License Defense Attorney Oscar San Miguel represents clients who are located in Austin, Houston, Dallas, San Antonio, El Paso, Fort Worth, Arlington, Amarillo, Lubbock, Brownsville, Laredo, Harlingen, McAllen, Round Rock, Longview, Travis County, Harris County, Dallas County, Tarrant County, Bexar County, Fort Bend County, Montgomery County, Cameron County, Nueces County, El Paso County, Potter County, Lubbock County, Grayson County, Collin County and throughout Texas.
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