Editors



Current Editors: Tim Allen and Keith Wagner



Past Editors: Kristyna Gleghorn, Dung Mac, Alex Acosta, William Tausend, Sheila Jalalat, Rebecca Philips, Chelsea Altinger, Lindsey Hunter, Alison Wiesenthal, Leslie Scroggins, Mara Dacso, Ashley Group, Fadi Constantine, Emily Fridlington, Joslyn Witherspoon, Tasneem Poonawalla.

Thursday, October 17, 2013

Texas Medical Board Considers Restrictions on Dermatology Practice


In a move that could adversely impact dermatology practice in Texas for patients, the Texas Medical Board (TMB) is considering a proposal that would limit the amount of local anesthesia used in dermatology offices across the state. The proposed amendments to §192.1 and §192.2 currently read:
 
CHAPTER 192. OFFICE BASED ANESTHESIA 22 TAC §192.1 The Board proposes amendments to §192.1, relating to Definitions. The amendment add language providing that the administration of certain local anesthesia, peripheral nerve blocks, or both in a total dosage amount that exceeds 50 percent of the recommended maximum safe dosage per outpatient visit is a level II service, in accordance with SB 978 (83rd Reg. Session).
 
CHAPTER 192. OFFICE BASED ANESTHESIA 22 TAC §192.2
The Board proposes amendments to §192.2, relating to Provision of Anesthesia Services in Outpatient Settings.
The amendment provides that rules under Chapter 192 do not apply to outpatient settings in which only local anesthesia, peripheral nerve blocks, or both are used in a total dosage amount that does not exceed 50 percent of the recommended maximum safe dosage per outpatient visit, in accordance with SB 978 (83rd Reg. Session)
 
These new regulations would restrict the use of local anesthesia to doses that are 50% or less of the maximum does, even though there is much evidence based medicine that the maximum does is safe in Level 1 outpatient settings (see Arch Dermatol 2004;140:1379-1382). According to the new proposal, local anesthetic in excess of half the maximum does would require additional patient monitoring (Level 2), that is not currently available in most dermatology offices. This new regulation could greatly limit the availability of Mohs surgery for Texans with skin cancer, since Mohs surgery may require multiple excisions under local anesthesia on the same day to completely remove the skin cancer and additional local anesthesia for the wound repair. Those interested in contacting the TMB about this matter may email them by November 29, 2013 at: Rules.Development@tmb.state.tx.us  The TMB will meet on December 5, 2013 about this new proposed regulation at the William P. Hobby Building, 333 Guadalupe Street, Tower 2, Suite 225, Austin, Texas, 78701. Those who want to voice their opinion at this public meeting to the TMB may signup to do so.