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Texas nurse practitioners and physician's assistants must be supervised by a doctor

When they aren't supervised, it sometimes spells trouble for patient safety

Nurse practitioners (NP) and physician’s assistants (PA) are mid-level providers who often practice on the front-line. They have more training than a nurse, but less training than a doctor, and frequently fill a gateway role in seeing patients on their first visits related to an illness or medical condition.

Some NPs and PAs work for physician medical practices. It’s common for medical practices to staff with three, four, or more NPs or PAs per doctor. This means that when most patients call for an appointment, the front-office staff will suggest an appointment with a nurse practitioner or physician’s assistant, because it will be easier to get in with them.

Other mid-level providers practice in a more independent outpatient clinic role. For example, CVS MinuteClinics are staffed with nurse practitioners. This type of clinic has a focus on episodic or occasional treatment of short-term illnesses, such as an ear infection, strep throat, the flu, or cold. Many patients choose this route to healthcare because the providers have more convenient hours, including weekends; don’t require appointments; and are relatively inexpensive.

Whether in a doctor’s office or freestanding clinic, though, Texas law requires mid-level providers to be supervised by a licensed physician.

Texas Occupations Code Section 157.001 allows a physician to delegate any medical act to a qualified and properly trained person acting under the physician’s supervision, so long as it’s reasonably prudent to do so and doesn’t compromise patient safety. The statute also provides that the delegating physician remains responsible for any negligence by the nurse practitioner or physician’s assistant performing the delegated medical act.

Under the standard of care, a supervising physician must review diagnostic radiology results (x-rays, CT scans, and MRI scans) and lab results ordered by an NP or PA and regularly review medical records to ensure that the care being provided to patients is adequate and safe.

In addition, physician’s assistants and nurse practitioners aren’t allowed to write prescriptions for patients without the delegation of prescriptive authority from a licensed physician, which must be reported to the Texas Medical Board. This type of physician delegation must be in writing in a prescriptive authority agreement.

As in other areas of healthcare, there is an intense ongoing lobbying effort by nurse practitioners and physician’s assistants to have the Texas legislature eliminate the requirement for physician supervision. In my opinion, although I believe that mid-level providers are valuable members of our healthcare system, eliminating physician supervision would be dangerous and misguided. The reason is simple: mid-level providers, as their name suggests, have intermediate levels of training that don’t meet the levels of education and experience required to become a licensed physician.

If you’ve been seriously injured because of care provided by a mid-level provider, such as a nurse practitioner, certified registered nurse anesthetist (CRNA), or physician’s assistant, then contact a top-rated skilled Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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