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.