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controlled substance prescriptionAmericans continue to abuse controlled substance prescription medications, including hydrocodone combination products (HCPs). As a result, the DEA has recently moved HCPs from Schedule III to Schedule II under the federal Controlled Substances Act.

Physicians should be aware of this change and how to remain compliant with all federal and state guidelines in order to serve their patients and protect their license to practice medicine.

While hydrocodone is itself a Schedule II drug, HCPs (hydrocodone plus other substances, such as aspirin or acetaminophen) had been classified as less-restrictive Schedule III drugs. However, it was found that HCPs have a high risk of abuse, which can lead to serious consequences for the abuser, including physiological or psychological dependence. Surveys of 8th through 12th graders from 2002 to 2011 revealed that twice as many students abused the Schedule III HCP Vicodin as abused Schedule II Oxycontin. These data confirm that HCPs are some of the most dangerous medications on the market, resulting in the decision to switch HCPs to the more tightly controlled Schedule II.

The DEA rule also specifies the regulatory controls applicable to Schedule II substances including HCPs, as well as the sanctions that apply to those who mishandle them. Licensees of the Texas Medical Board, the Texas Board of Nursing, and the Texas State Board of Pharmacy must also comply with state law requirements. These include the requirement that prescriptions written for HCPs must be written on an official Department of Public Safety (DPS) prescription form and no refills may be authorized. Advanced practiced medical nurses and physician assistants may not prescribe HCPs unless they are providing care to hospice patients or are practicing in hospital facility-based practices under Texas law. They also must be registered with the DEA and DPS.

If you have encountered difficulty following state and federal laws concerning the prescribing of controlled substances, you should contact an experienced Texas license defense attorney as soon as possible. Oscar San Miguel, Attorney at Law, can help you protect your license to practice in Texas.

KSTAR programA nurse who has been issued a Texas Board of Nursing Order for violating the Nursing Practice Act faces a great deal of uncertainty about the impact of the Order on his or her nursing license. But a new pilot program, the Knowledge, Skills, Training, Assessment and Research (KSTAR) Pilot Program, allows some nurses to correct any deficiencies in their nursing practice. The program also ensures nurses meet minimum competency by successfully completing the program and can prevent recurring problems stemming from future violations.

The KSTAR Pilot Program was adopted by the Texas Board of Nursing in April 2014 and became effective on July 30, 2014. It is a two-year pilot program that is modeled after a successful program for doctors, and was developed in consultation with Texas A&M Health Sciences Center College of Nursing and the Rural and Community Health Institute. It is used as an alternative to disciplinary actions for violations of the Nursing Practice Act that result in Board Orders of a warning or below. Enrollment in the program is still considered disciplinary and is reportable.

The program uses individualized competency assessments and targeted remediation plans and is completed at the nurse’s own pace. A participating nurse must travel twice to Round Rock, Texas. The first session consists of two days of assessment and training, and the second consists of one day of reassessment and evaluation. The participant must complete their individualized educational plan between the two visits using web-based training modules. The timeframe is expected to be three to four months. However, the nurse must enroll in the KSTAR program within 45 days of the date of the TBN Order, and must complete the program within one year after signing the Order.

Each participant will be assigned a KSTAR nursing coach who will engage in periodic phone conversations with the participant. Participants are required to pay for the program themselves.

A nurse who is facing disciplinary action by the Texas Board of Nursing is advised to contact experienced Texas professional license attorney Oscar San Miguel as early in the process as possible. Having your rights represented from the beginning of the process can help lead to a positive outcome.

Texas board of nursing complaintsHaving a complaint filed against you is one of the most stressful and upsetting things that can happen in a nurse’s career. But complaints are routinely filed. According to the Texas Board of Nursing (TBN), over 16,000 confidential complaints are received each year.

Thankfully, not every complaint results in a disciplinary action or even an investigation. Some complaints do not adequately identify the nurse, are not within the TBN’s jurisdiction, are too minor to warrant an investigation, or if proven would not warrant a violation of the Nursing Practice Act (NPA).

The TBN notifies a nurse of an investigation and allegations unless such notification would compromise the investigation. The nurse is given the chance to respond to the complaint and to demonstrate compliance with the NPA. The TBN gathers evidence and contacts witnesses, and on occasion will conduct an on-site investigation if mail and phone are insufficient. Investigations typically take between five and 12 months to complete.

After the investigation is complete, the case is either closed or the TBN determines that a sanction is needed to protect the public. If the case is closed, the complaint and evidence are expunged. If it is determined that sanctions are needed, an order will be issued that includes both the sanction and requirements for retention of the nurse’s license. Sanctions may include remedial education, fines, warning, reprimand, suspension, probation, and/or revocation. Orders are generally public information, and will remain permanently in the nurse’s licensure records except in the case of a deferred disciplinary order that has been fully completed.

Both informal and formal settlement processes are available to a nurse against whom an order has been imposed. An informal settlement occurs when the nurse is offered a proposed agreed order that inform the nurse of the findings, conclusions, sanction, and requirements for continued safe practice. The nurse can agree to the order, which then is put to the TBN for ratification. Most agreed orders are so ratified, but occasionally the Board may modify or reject the order. If the nurse does not agree with the order, he or she may suggest revisions to the order, which may be accepted by the TBN.

In some cases informal settlement conferences may be held. Most of the time the conference ends with a recommended disposition of the case; if necessary, new orders are mailed to the nurses. As with other proposed orders, the nurse can agree or suggest revisions. Once the TBN ratifies an order, it becomes final and the terms take effect. Both the nurse and the last known employer receive a copy of the final Board order, and the complainant is notified of the result. The result is also written about in the TBN quarterly newsletter and reported to the National Practitioner Data Bank and the National Council of State Boards of Nursing, Inc.

If the nurse and the TBN do not reach an agreement after an informal settlement attempt, the Board files official charges to which the nurse is required to respond in writing. If the nurse does not respond, the Board may proceed toward a default revocation of the nurse’s license. If the nurse does respond, negotiations continue until a hearing before an Administrative Law Judge is held. After the hearing, if a settlement is not reached, the judge proposes a decision that contains a finding of fact and conclusion of law. The TBN may then impose penalties or close the case with no action.

Clearly, the complaint process is a long and difficult one, and a nurse against whom a complaint has been filed should consult with an expert attorney as soon as notification of the complaint is received. If a complaint has been filed against you, you need experienced Austin professional license defense attorney Oscar San Miguel on your side to represent your interests. Call 512-228-7946 to make sure your rights are protected.

texas nursing license lawyerBeing confronted with allegations of substance abuse or a psychiatric disorder can lead to a cascade of events that can wreak havoc on a nurse’s career and even jeopardize a nurse's professional license. However, in many instances the nurse has a choice: accept a referral to participate in the Texas Peer Assistance Program for Nurses (TPAPN) or face being reported to the Texas Board of Nursing.

TPAPN is a voluntary, confidential program that consists of total abstinence monitored by compliance with treatment recommendations, specific return-to-work restrictions, self-help meetings, and random drug tests. It is available to nurses with substance abuse or dependency, and those who have been diagnosed with anxiety disorders, major depression, bipolar disorder, schizophrenia, and schizoaffective disorder.

TPAPN has recently extended the length of required participation in the program from two years to three years for licensed vocational nurses (LVNs) and registered nurses (RNs) and from three years to five years for advanced practice registered nurses (APRNs). While this change was made in light of research indicating that the longer-term monitoring results in positive behavioral changes for recovery, it means a longer period of consequences—and a longer period of paying for the costs of treatment and drug screenings—for a participating nurse.

Other recent changes to the program have been made to make the consequences less onerous for participants. These changes include the ability to potentially continue nursing practice upon entering the program, the possibility of working night shifts, and shorter period of delay in returning to work for a nurse who has a short-term prescription for a controlled substance that is due to a medical condition.

If you are a nurse who is facing allegations of substance abuse or dependency or a psychiatric disorder, you do not need to face your options alone. Contact Oscar San Miguel, Attorney at Law, an experienced Texas nursing license defense attorney who will help you weigh your options and reach a successful conclusion.

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