The Texas regulations of physicians are found in the Texas Occupations Code, Title 3, Subtitle B. A person may not practice medicine in this state unless the person holds a license issued under this subtitle[i]. The board, at its sole discretion, may issue a license to practice medicine to a person who:
(1) submits to the board a license application as required by this chapter;
(2) presents satisfactory proof that the person meets the eligibility requirements established by this chapter; and
(3) satisfies the examination requirements of Section 155.051.
The board may delegate authority to board employees to issue licenses under this subtitle to applicants who clearly meet all licensing requirements. If the board employees determine that the applicant does not clearly meet all licensing requirements, the application shall be returned to the board. A license issued under this subsection does not require formal board approval[ii].
To be eligible for a license under this chapter, an applicant must present proof satisfactory to the board that the applicant:
(1) is at least 21 years of age;
(2) is of good professional character and has not violated Section 164.051, 164.052, or 164.053;
(3) has completed:
(A) at least 60 semester hours of college courses, other than courses in medical school, that are acceptable to The University of Texas at Austin for credit on a bachelor of arts degree or a bachelor of science degree;
(B) the entire primary, secondary, and premedical education required in the country of medical school graduation, if the medical school is located outside the United States or Canada; or
(C) substantially equivalent courses as determined by board rule;
(4) is a graduate of a medical school located in the United States or Canada and approved by the board;
(5) has either:
(A) successfully completed one year of graduate medical training approved by the board in the United States or Canada; or
(B) graduated from a medical school located outside the United States or Canada and has successfully completed three years of graduate medical training approved by the board in the United States or Canada;
(6) has passed an examination accepted or administered by the board; and
(7) has passed a Texas medical jurisprudence examination as determined by board rule.
All medical or osteopathic medical education an applicant receives in the United States must be accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree. This subsection does not apply to postgraduate medical education or training. An applicant who is unable to meet the requirement established by Subsection (b) may be eligible for an unrestricted license if the applicant:
(1) received medical education in a hospital or teaching institution sponsoring or participating in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the board in the same subject as the medical or osteopathic medical education as defined by board rule; or
(2) is specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties. In addition to the other requirements prescribed by this subtitle, the board may require an applicant to comply with other requirements that the board considers appropriate. An applicant is not eligible for a license if:
(1) the applicant holds a medical license that is currently restricted for cause, canceled for cause, suspended for cause, or revoked by a state, a province of Canada, or a uniformed service of the United States;
(2) an investigation or a proceeding is instituted against the applicant for the restriction, cancellation, suspension, or revocation in a state, a province of Canada, or a uniformed service of the United States; or
(3) a prosecution is pending against the applicant in any state, federal, or Canadian court for any offense that under the laws of this state is a felony or a misdemeanor that involves moral turpitude[iii].
Pursuant to Tex. Occ. Code § 155.051, except as provided by Subsection (b), an applicant for a license to practice medicine in this state must pass each part of an examination described by Section 155.0511(2), (3), (4), (6), or (7) within seven years. An applicant who is a graduate of a program designed to lead to both a doctor of philosophy degree and a doctor of medicine degree or doctor of osteopathy degree must pass each part of an examination described by Section 155.0511(2), (3), (4), (6), or (7) not later than the second anniversary of the date the applicant completed the graduate medical training described by Section 155.003(a)(5). The time frame to pass each part of the examination described by Subsection (a) is extended to 10 years and the anniversary date to pass each part of the examination described by Subsection (b) is extended to the 10th anniversary if the applicant:
(1) is specialty board certified by a specialty board that:
(A) is a member of the American Board of Medical Specialties; or
(B) is a member of the Bureau of Osteopathic Specialists; or
(2) has been issued a faculty temporary license, as prescribed by board rule, and has practiced under such a license for a minimum of 12 months and, at the conclusion of the 12-month period, has been recommended to the board by the chief administrative officer and the president of the institution in which the applicant practiced under the faculty temporary license.
The board may adopt rules and set fees relating to granting temporary licenses and extending the expiration dates of temporary licenses. The board by rule shall set a time limit for the term of a temporary license. The board may issue a faculty temporary license to practice medicine to a physician as provided by this section. The physician:
(1) must hold a current medical license that is unrestricted and not subject to a disciplinary order or probation in another state or a Canadian province or have completed at least three years of postgraduate residency;
(2) may not hold a medical license in another state or a Canadian province that has any restrictions, disciplinary orders, or probation;
(3) must pass the Texas medical jurisprudence examination; and
(4) must hold a salaried faculty position equivalent to at least the level of assistant professor and be working full-time at one of the approved institutions:
(A) The University of Texas Medical Branch at Galveston;
(B) The University of Texas Southwestern Medical Center at Dallas;
(C) The University of Texas Health Science Center at Houston;
(D) The University of Texas Health Science Center at San Antonio;
(E) The University of Texas Health Center at Tyler;
(F) The University of Texas M. D. Anderson Cancer Center;
(G) Texas A&M University College of Medicine;
(H) the Schools of Medicine at Texas Tech University Health Sciences Center;
(I) Baylor College of Medicine;
(J) the University of North Texas Health Science Center at Fort Worth;
(K) an institutional sponsor of a graduate medical education program accredited by the Accreditation Council for Graduate Medical Education; or
(L) a nonprofit health corporation certified under Section 162.001 and affiliated with a program described by Paragraph (K).
A physician is eligible for a temporary license under Subsection (b) if the physician holds a faculty position of at least the level of assistant professor and works at least part-time at an institution listed in Subsection (b)(4) and:
(1) the physician is on active duty in the United States armed forces; and
(2) the physician’s practice under the temporary license will fulfill critical needs of the citizens of this state.
A physician who is issued a temporary license under Subsection (b) must sign an oath on a form prescribed by the board swearing that the physician:
(1) has read and is familiar with this subtitle and board rules;
(2) will abide by the requirements of this subtitle and board rules while practicing under the physician’s temporary license; and
(3) will be subject to the disciplinary procedures of the board.
A physician holding a temporary license under Subsection (b) and the physician’s institution must file affidavits with the board affirming acceptance of the terms and limits imposed by the board on the medical activities of the physician. A temporary license issued under Subsection (b) is valid for one year. The holder of a temporary license issued under Subsection (b) is limited to the teaching confines of the applying institution as a part of the physician’s duties and responsibilities assigned by the institution and may not practice medicine outside of the setting of the institution or an affiliate of the institution. The physician may participate in the full activities of the department of any hospital for which the physician’s institution has full responsibility for clinical, patient care, and teaching activities. The application for a temporary license under Subsection (b) must be made by the chairman of the department of the institution in which the physician teaches, or the person holding the equivalent position at the institution where the physician teaches, and must contain the information and documentation requested by the department. The application must be endorsed by the dean of the medical school or the president of the institution. Three years in a teaching faculty position at an institution listed in Subsection (b)(4) may be treated as equivalent to three years of an approved postgraduate residency program if, at the conclusion of the three-year period, the physician presents recommendations on the physician’s behalf from the chief administrative officer and the president of the institution. A physician who holds a temporary license issued under Subsection (b) and who wishes to receive a permanent unrestricted license must meet the requirements for issuance of a permanent unrestricted license, including any examination requirements[iv].
Tex. Occ. Code § 156.001 provides that each person licensed to practice medicine in this state must register with the board every two years. The initial registration permit shall be issued with the license. The board by rule may adopt a system under which licenses expire on various dates during the year. Except as provided by Section 156.002, the application for registration must be accompanied by a registration permit fee in an amount set by the board regardless of whether the person is practicing medicine in this state. A license holder may renew the registration permit by submitting to the board, on or before the expiration date of the registration permit, the required renewal application and registration renewal fee. Each registration permit renewal application must include:
(1) the license holder’s name, mailing address, and, if one is available, address for receipt of electronic mail;
(2) the primary place at which the license holder is engaged in the practice of medicine; and
(3) other necessary information as prescribed by board rule.
If the license holder is licensed to practice medicine by another state or country or by the uniformed services of the United States, the registration renewal application must include a description of any investigation the license holder knows is in progress and any sanction imposed by or disciplinary matter pending in the state, country, or service regarding the license holder. In addition to the information required by Subsection (c), a license holder shall submit to the board with the registration permit renewal application information not reported on a license application or a previous permit renewal application relating to a felony conviction, a conviction for a Class A or Class B misdemeanor, or a deferred adjudication for a felony offense or Class A or Class B misdemeanor offense for:
- Medicare, Medicaid or insurance fraud;
- the Texas Controlled Substances Act or intoxication or alcoholic beverage offenses;
- sexual or assaultive offenses; and
- tax fraud or evasion.
Practicing medicine after the expiration of the 30-day grace period under Section 156.004 following expiration of a registration permit that has not been renewed for the current registration period as provided by this subchapter has the same effect as, and is subject to all penalties of, practicing medicine without a license. In a prosecution for the unlawful practice of medicine, the receipt showing payment of the registration fee required by this chapter does not constitute evidence that the receipt holder is lawfully entitled to practice medicine[v].
Consent for the release of confidential information must be in writing and signed by:
(1) the patient;
(2) a parent or legal guardian of the patient if the patient is a minor;
(3) a legal guardian of the patient if the patient has been adjudicated incapacitated to manage the patient’s personal affairs;
(4) an attorney ad litem appointed for the patient, as authorized by:
(A) Subtitle C, Title 7, Health and Safety Code;
(B) Subtitle D, Title 7, Health and Safety Code;
(C) Chapter XIII, Texas Probate Code; or
(D) Chapter 107, Family Code; or
(5) a personal representative of the patient if the patient is deceased.
The written consent must specify:
(1) the billing records, medical records, or other information to be covered by the release;
(2) the reasons or purposes for the release; and
(3) the person to whom the information is to be released.
The patient, or other person authorized to consent, is entitled to withdraw the consent to the release of any information. Withdrawal of consent does not affect any information disclosed before the written notice of the withdrawal. A patient may not bring an action against a physician for a disclosure made by the physician in good faith reliance on an authorized consent if the physician did not have written notice that the authorization was revoked. A person who receives information made confidential by this subtitle may disclose the information only to the extent consistent with the authorized purposes for which consent to release the information is obtained[vi].
Pursuant to Tex. Occ. Code § 164.051, the board may refuse to admit a person to its examination or refuse to issue a license to practice medicine and may take disciplinary action against a person if the person:
(1) commits an act prohibited under Section 164.052;
(2) is convicted of, or is placed on deferred adjudication community supervision or deferred disposition for:
(A) a felony; or
(B) a misdemeanor involving moral turpitude;
(3) commits or attempts to commit a direct or indirect violation of a rule adopted under this subtitle, either as a principal, accessory, or accomplice;
(4) is unable to practice medicine with reasonable skill and safety to patients because of:
(C) excessive use of drugs, narcotics, chemicals, or another substance; or
(D) a mental or physical condition;
(5) is found by a court judgment to be of unsound mind;
(6) fails to practice medicine in an acceptable professional manner consistent with public health and welfare;
(7) is removed, suspended, or is subject to disciplinary action taken by the person’s peers in a local, regional, state, or national professional medical association or society, or is disciplined by a licensed hospital or medical staff of a hospital, including removal, suspension, limitation of hospital privileges, or other disciplinary action, if the board finds that the action:
(A) was based on unprofessional conduct or professional incompetence that was likely to harm the public; and
(B) was appropriate and reasonably supported by evidence submitted to the board;
(8) is subject to repeated or recurring meritorious health care liability claims that in the board’s opinion evidence professional incompetence likely to injure the public; or
(9) except as provided by Subsection (d), holds a license to practice medicine subject to disciplinary action by another state, or subject to disciplinary action by the uniformed services of the United States, based on acts by the person that are prohibited under Section 164.052 or are similar to acts described by this subsection.
Action taken by a professional medical association, society, or hospital medical staff under Subsection (a)(7) does not constitute state action. A certified copy of the record of another state that takes action described by Subsection (a)(9) or (d) is conclusive evidence of that action. The board shall revoke a license issued under this subtitle if the license holder held a license to practice medicine in another state that has been revoked by the licensing authority in that state.
A physician or an applicant for a license to practice medicine commits a prohibited practice if that person:
(1) submits to the board a false or misleading statement, document, or certificate in an application for a license;
(2) presents to the board a license, certificate, or diploma that was illegally or fraudulently obtained;
(3) commits fraud or deception in taking or passing an examination;
(4) uses alcohol or drugs in an intemperate manner that, in the board’s opinion, could endanger a patient’s life;
(5) commits unprofessional or dishonorable conduct that is likely to deceive or defraud the public, as provided by Section 164.053, or injure the public;
(6) uses an advertising statement that is false, misleading, or deceptive;
(7) advertises professional superiority or the performance of professional service in a superior manner if that advertising is not readily subject to verification;
(8) purchases, sells, barters, or uses, or offers to purchase, sell, barter, or use, a medical degree, license, certificate, or diploma, or a transcript of a license, certificate, or diploma in or incident to an application to the board for a license to practice medicine;
(9) alters, with fraudulent intent, a medical license, certificate, or diploma, or a transcript of a medical license, certificate, or diploma;
(10) uses a medical license, certificate, or diploma, or a transcript of a medical license, certificate, or diploma that has been:
(A) fraudulently purchased or issued;
(B) counterfeited; or
(C) materially altered;
(11) impersonates or acts as proxy for another person in an examination required by this subtitle for a medical license;
(12) engages in conduct that subverts or attempts to subvert an examination process required by this subtitle for a medical license;
(13) impersonates a physician or permits another to use the person’s license or certificate to practice medicine in this state;
(14) directly or indirectly employs a person whose license to practice medicine has been suspended, canceled, or revoked;
(15) associates in the practice of medicine with a person:
(A) whose license to practice medicine has been suspended, canceled, or revoked; or
(B) who has been convicted of the unlawful practice of medicine in this state or elsewhere;
(16) performs or procures a criminal abortion, aids or abets in the procuring of a criminal abortion, attempts to perform or procure a criminal abortion, or attempts to aid or abet the performance or procurement of a criminal abortion;
(17) directly or indirectly aids or abets the practice of medicine by a person, partnership, association, or corporation that is not licensed to practice medicine by the board;
(18) performs an abortion on a woman who is pregnant with a viable unborn child during the third trimester of the pregnancy unless:
(A) the abortion is necessary to prevent the death of the woman;
(B) the viable unborn child has a severe, irreversible brain impairment; or
(C) the woman is diagnosed with a significant likelihood of suffering imminent severe, irreversible brain damage or imminent severe, irreversible paralysis; or
(19) performs an abortion on an unemancipated minor without the written consent of the child’s parent, managing conservator, or legal guardian or without a court order, as provided by Section 33.003 or 33.004, Family Code, authorizing the minor to consent to the abortion, unless the physician concludes that on the basis of the physician’s good faith clinical judgment, a condition exists that complicates the medical condition of the pregnant minor and necessitates the immediate abortion of her pregnancy to avert her death or to avoid a serious risk of substantial impairment of a major bodily function and that there is insufficient time to obtain the consent of the child’s parent, managing conservator, or legal guardian.
For purposes of Subsection (a)(12), conduct that subverts or attempts to subvert the medical licensing examination process includes, as prescribed by board rules, conduct that violates:
(1) the security of the examination materials;
(2) the standard of test administration; or
(3) the accreditation process.
The board shall adopt the forms necessary for physicians to obtain the consent required for an abortion to be performed on an unemancipated minor under Subsection (a). The form executed to obtain consent or any other required documentation must be retained by the physician until the later of the fifth anniversary of the date of the minor’s majority or the seventh anniversary of the date the physician received or created the documentation for the record[vii].
For purposes of Section 164.052(a)(5), unprofessional or dishonorable conduct likely to deceive or defraud the public includes conduct in which a physician:
(1) commits an act that violates any state or federal law if the act is connected with the physician’s practice of medicine;
(2) fails to keep complete and accurate records of purchases and disposals of:
(A) drugs listed in Chapter 481, Health and Safety Code; or
(B) controlled substances scheduled in the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);
(3) writes prescriptions for or dispenses to a person who:
(A) is known to be an abuser of narcotic drugs, controlled substances, or dangerous drugs; or
(B) the physician should have known was an abuser of narcotic drugs, controlled substances, or dangerous drugs;
(4) writes false or fictitious prescriptions for:
(A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or
(B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);
(5) prescribes or administers a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed;
(6) prescribes, administers, or dispenses in a manner inconsistent with public health and welfare:
(A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or
(B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);
(7) violates Section 311.0025, Health and Safety Code;
(8) fails to supervise adequately the activities of those acting under the supervision of the physician; or
(9) delegates professional medical responsibility or acts to a person if the delegating physician knows or has reason to know that the person is not qualified by training, experience, or licensure to perform the responsibility or acts.(b) A complaint, indictment, or conviction of a violation of law is not necessary for the enforcement of Subsection (a)(1). Proof of the commission of the act while in the practice of medicine or under the guise of the practice of medicine is sufficient for the board’s action. Subsection (a)(3) does not apply to a person the physician is treating for:
(1) the person’s use of narcotics after the physician notifies the board in writing of the name and address of the person being treated; or
(2) intractable pain under the Intractable Pain Treatment Act (Article 4495c, Revised Statutes)[viii].
Tex. Occ. Code § 164.061 provides that the board may accept the voluntary surrender of a license. A surrendered license may not be returned unless the board determines, under board rules, that the license holder is competent to resume practice. If it appears to the board that a person who is not licensed under this subtitle is violating this subtitle, a rule adopted under this subtitle, or another state statute or rule relating to the practice of medicine, the board after notice and opportunity for a hearing may issue a cease and desist order prohibiting the person from engaging in the activity. A violation of an order under this section constitutes grounds for imposing an administrative penalty under this chapter[ix].
Furthermore, if it appears that a person is in violation of or is threatening to violate this subtitle or a rule or order adopted by the board, the attorney general may institute an action for a civil penalty of $ 1,000 for each violation. Each day a violation continues constitutes a separate violation. An action filed under this section must be filed in a district court in Travis County or the county in which the violation occurred[x]. Pursuant to Tex. Occ. Code § 165.151, a person commits an offense if the person violates this subtitle or a rule of the board. If another penalty is not specified for the offense, an offense under this section is a Class A misdemeanor.
[i] Tex. Occ. Code § 155.001.
[ii] Tex. Occ. Code § 155.002.
[iii] Tex. Occ. Code § 155.003.
[iv] Tex. Occ. Code § 155.104.
[v] Tex. Occ. Code § 156.008.
[vi] Tex. Occ. Code § 159.005.
[vii] Tex. Occ. Code § 164.052.
[viii] Tex. Occ. Code § 164.053.
[ix] Tex. Occ. Code § 165.052.
[x] Tex. Occ. Code § 165.101.