Tag Archives: prescriptive authority

Texas medical license defense lawyerSometimes, the mistakes that physicians make are not related to negligence. Instead, they are the actions of a protective and thoughtful doctor – one that wanted to protect or help their patients. Sadly, not even the best of intentions can save physicians from disciplinary action. Learn more about the well-intentioned mistakes that a doctor can make, and how an experienced medical license defense lawyer can help mitigate against the consequences that one may face after an investigation by the Texas Medical Board.

Doctor Faces Discipline for Signing Blank Prescription Forms

When an influential physician had to leave for a trip, he signed several prescription forms and then left them in a locked drawer for his nurse. The goal was to ensure that his opioid-addicted patients had access to the medication they needed. He did not want to risk them relapsing.

Unfortunately, the drug was a controlled substance (Suboxone). Furthermore, he had violated a concrete rule: physicians are not to sign blank prescription pads, for any reason, or under any circumstance. Ultimately, his license was suspended, and now his patients are left with no choice but to search for another physician. News sources state that he is the only doctor in the area permitted to write Suboxone prescriptions, so they may have to search for a while.

How You Can Avoid Facing the Same Fate

Mistakes related to prescription authority often lead to disciplinary action for physicians, but it is far from the only best-intentioned mistake that one can make. Other areas of practice that may lead to an investigation and/or disciplinary action include:

  • Trying to comfort an ailing patient, which may lead to accusations of overstepping professional boundaries;
  • Delegating tasks to a staff member that fails to follow through;
  • Offering a hopeful but unrealistic prognosis or treatment option; and
  • Providing a service that extends beyond the typical standard of care.

Whatever the situation, it is crucial that you speak to an experienced attorney as soon as you learn of an investigation. Alternatively, if you believe your license could be at risk because of a recent situation, you can discuss the matter with an attorney to determine how you may mitigate against disciplinary action, possibly before the investigation starts.

Contact Our Texas Medical License Defense Lawyer

If you are facing an investigation with the Texas Medical Board, contact Oscar San Miguel, Attorney at Law, for assistance. Dedicated to protecting your practice, our Texas medical license defense attorney can protect your rights. In every situation, we aggressively pursue the most favorable outcome possible. Obtain the representation you deserve. Schedule your free consultation by calling 512-228-7946 today.


Texas professional license defense attorney, prescriptive delegationWhile physician assistants and advanced practice nurses can be granted authority to prescribe medications, the Texas Medical Board has several restrictions in place to ensure patient safety. In some cases, those restrictions may not even apply to the PA or APN directly, but violations could still impact their licensing status. As such, it is critical that these licensed professionals understand the rules and regulations regarding prescriptive delegation and authority.

Fulfilling Your Personal and Professional Obligations

To be considered for prescriptive authority, licensed PAs and APNs must first hold a full, active, and unrestricted license that is not currently under an order from the Board. In addition, authority can only be granted by an overseeing, delegating physician. The two-step process cannot be completed without their assistance, and it is not considered valid unless the authorization has been fully registered with the TMB. Failure to complete all steps before prescribing medications could lead to an investigation and disciplinary action for the licensed PA or APN.

In addition to fulfilling all registration requirements, all authorized PAs and APNs must hold their own DPS and DEA numbers to prescribe controlled substances, including all scheduled drugs and Dangerous Drugs. Additionally, when each prescription is written, it must contain the name of the delegating physician. Failure to comply can result in a termination of your license suspension, revocation, denial of renewal from the TMB, or a termination of your DPS or DEA number.

Is Your Delegating Physician Authorized?

In addition to imposing certain restrictions on which PAs and APNs are able to receive prescriptive authority, the TMB imposes certain criteria on the delegating physician. For example, the delegating physician must provide what is considered “adequate supervision,” and they are only allowed to supervise up to seven full-time equivalent PAs, and only for 50 clinical hours per PA, per week. Those who exceed that amount are considered in violation and could be subject to an investigation and disciplinary action from the TMB. The authorized PA may also face negative actions from the Board.

Under Investigation or Facing Disciplinary Action? Our Attorneys Can Help

Has a physician’s oversight led to an investigation on your license? Are you concerned that you could face disciplinary action? Backed by more than 20 years of experience in the medical-legal arena, Oscar San Miguel, Attorney at Law, is dedicated to protecting your license. Get the aggressive, comprehensive representation you deserve. Call 512-228-7946 and schedule your free initial consultation with a skilled Texas professional license defense attorney today.


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.


Texas professional license defense attorney, nurse-anesthetistsFacilities that perform outpatient procedures and require outpatient anesthetics are bound by rules and regulations set by the Texas Medical Board. As such, licensed professional administering services within such a facility should be aware of the registration, delegation, and prescriptive authority guidelines and requirements to ensure they are working in compliance with standard of care practices. Moreover, each licensed professional should understand how the rules and regulations apply to their position and facility.

Physician Registration for Office-Based Anesthesia

According to TMB regulations, physicians must register for office-based anesthesia if they are providing level II-IV anesthesia services in an outpatient setting, as well as those performing procedures for which level II-IV anesthesia services are generally provided. This includes, but is not limited to, analgesics and anxiolytics.

Nurses Anesthetists and Prescriptive Authority

Because nurses are required to have physician delegation to order or administer anesthetic drugs or anesthesia-related devices, they are not typically required to obtain prescriptive authority or register delegation with TMB. This also applies to outpatient anesthesia settings since devices applied or services administered are ordered for use by the attending surgeon. It is important to note, however, that delegation is limited to the hospital or ambulatory surgery center in which they are credentialed to practice.

One exception in which CRNAs would need to obtain prescriptive authority is if they are practicing in a setting in which they, themselves, are writing prescriptions while working under a physician. In this case, CRNAs are bound by the same regulations and requirements as any prescribing physician. This includes the requirement to obtain prescriptive authority and to register with the Texas Medical Board. If controlled substances will be prescribed by CRNAs, they must also obtain the same required DEA and DPS registrations as prescribing physicians.

Regardless of whether or not they are required to obtain prescriptive authority or delegation, all parties administering, ordering, prescribing, and/or handling anesthesia or anesthesia-related equipment must follow the standards and guidelines set for the type of services provided, as well as those set for their facility (including storage, certification requirements, and the availability of age-appropriate equipment).

Rules Regarding Delegation of Prescriptive Authority

To eliminate any confusion or miscommunication within a facility, it is important to know who actually has the power to delegate prescriptive authority. In a hospital setting, those able to delegate prescriptive authority include:

  • The hospital medical director;

  • The chief of medical staff;

  • The chair of credentialing committee;

  • A department chair; or

  • A physician who consents to request of the medical director or chief of medical staff to delegate.

Contact an Experienced Texas Professional License Defense Attorney Today

If you are a Texas health care professional with further questions regarding prescriptive authority, delegation, or the rules and requirements for either nurses or physicians, contact a Texas professional license defense attorney today. With more than 20 years of experience and wisdom in the medical-legal field, Oscar San Miguel, Attorney at Law, can provide the kind of professionalism and knowledge your case needs. Call 512-228-7946 to schedule an appointment today.



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