H.B. No. 1434         AN ACT   relating to limitations on pelvic examinations; authorizing   disciplinary action, including an administrative penalty.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle H, Title 2, Health and Safety Code, is   amended by adding Chapter 167A to read as follows:   CHAPTER 167A. PELVIC EXAMINATIONS          Sec. 167A.001.  DEFINITIONS. In this chapter:                (1)  "Health care practitioner" means a physician,   physician assistant, or advanced practice registered nurse   licensed to practice in this state.                (2)  "Patient's legally authorized representative"    means:                      (A)  a parent, managing conservator, or guardian   of a patient, if the patient is a minor;                      (B)  a guardian of the patient, if the patient has   been adjudicated incompetent to manage the patient's personal   affairs; or                      (C)  an agent of the patient authorized under a   durable power of attorney for health care.                (3)  "Pelvic examination" means a physical examination   by a health care practitioner of a patient's external and internal   reproductive organs, genitalia, or rectum.          Sec. 167A.002.  LIMITATIONS ON CERTAIN PELVIC EXAMINATIONS.   (a)  A health care practitioner may not perform or delegate to   another individual, including a student training to become a health   care practitioner, the performance of a pelvic examination on an   anesthetized or unconscious patient unless:                (1)  the pelvic examination is within the standard   scope of a procedure or diagnostic examination scheduled to be   performed on the patient;                (2)  the patient or the patient's legally authorized   representative gives informed consent for the pelvic examination as   provided by Subsection (b);                 (3)  the pelvic examination is necessary for diagnosis   or treatment of the patient's medical condition; or                (4)  the pelvic examination is for the purpose of   collecting evidence.          (b)  To obtain informed consent to perform a pelvic   examination on an unconscious or anesthetized patient, a health   care practitioner must:                (1)  provide the patient or the patient's legally   authorized representative with a written or electronic informed   consent form that:                      (A)  may be included as a distinct or separate   section of a general informed consent form;                       (B)  contains the following heading at the top of   the form in at least 18-point boldface type: "CONSENT FOR   EXAMINATION OF PELVIC REGION";                      (C)  specifies the nature and purpose of the   pelvic examination;                       (D)  informs the patient or the patient's legally   authorized representative that a medical student or resident may be   present if the patient or the patient's legally authorized   representative authorizes the student or resident to:                              (i)  perform the pelvic examination; or                             (ii)  observe or otherwise be present at the   pelvic examination, either in person or through electronic means;                       (E)  allows the patient or the patient's legally   authorized representative the opportunity to consent to or refuse   to consent to the pelvic examination; and                      (F)  allows a patient or a patient's legally   authorized representative that consents to a pelvic examination   under Paragraph (E) the opportunity to authorize or refuse to   authorize:                             (i)  a medical student or resident to   perform the pelvic examination; or                            (ii)  a medical student or resident to   observe or otherwise be present at the pelvic examination, either   in person or through electronic means;                (2)  obtain the signature of the patient or the   patient's legally authorized representative on the informed   consent form; and                (3)  sign the informed consent form.           Sec. 167A.003.  DISCIPLINARY ACTION. The appropriate   licensing authority may take disciplinary action against a health   care practitioner who violates Section 167A.002, including   imposing an administrative penalty, as if the practitioner violated   an applicable licensing law.          SECTION 2.  Section 164.052(a), Occupations Code, is amended   to read as follows:          (a)  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;                (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, unless the   abortion is necessary due to a medical emergency, as defined by   Section 171.002, Health and Safety Code;                (20)  otherwise performs an abortion on an   unemancipated minor in violation of Chapter 33, Family Code;                (21)  performs or induces or attempts to perform or   induce an abortion in violation of Subchapter C, F, or G, Chapter   171, Health and Safety Code; [or]                (22)  in complying with the procedures outlined in   Sections 166.045 and 166.046, Health and Safety Code, wilfully   fails to make a reasonable effort to transfer a patient to a   physician who is willing to comply with a directive; or                (23)  performs or delegates to another individual the   performance of a pelvic examination on an anesthetized or   unconscious patient in violation of Section 167A.002, Health and   Safety Code.          SECTION 3.  Section 301.452(b), Occupations Code, is amended   to read as follows:          (b)  A person is subject to denial of a license or to   disciplinary action under this subchapter for:                (1)  a violation of this chapter, a rule or regulation   not inconsistent with this chapter, or an order issued under this   chapter;                (2)  fraud or deceit in procuring or attempting to   procure a license to practice professional nursing or vocational   nursing;                (3)  a conviction for, or placement on deferred   adjudication community supervision or deferred disposition for, a   felony or for a misdemeanor involving moral turpitude;                (4)  conduct that results in the revocation of   probation imposed because of conviction for a felony or for a   misdemeanor involving moral turpitude;                (5)  use of a nursing license, diploma, or permit, or   the transcript of such a document, that has been fraudulently   purchased, issued, counterfeited, or materially altered;                (6)  impersonating or acting as a proxy for another   person in the licensing examination required under Section 301.253   or 301.255;                (7)  directly or indirectly aiding or abetting an   unlicensed person in connection with the unauthorized practice of   nursing;                (8)  revocation, suspension, or denial of, or any other   action relating to, the person's license or privilege to practice   nursing in another jurisdiction or under federal law;                (9)  intemperate use of alcohol or drugs that the board   determines endangers or could endanger a patient;                (10)  unprofessional conduct in the practice of nursing   that is likely to deceive, defraud, or injure a patient or the   public;                (11)  adjudication of mental incompetency;                (12)  lack of fitness to practice because of a mental or   physical health condition that could result in injury to a patient   or the public; [or]                (13)  performing or delegating to another individual   the performance of a pelvic examination on an anesthetized or   unconscious patient in violation of Section 167A.002, Health and   Safety Code; or                 (14)  failure to care adequately for a patient or to   conform to the minimum standards of acceptable nursing practice in   a manner that, in the board's opinion, exposes a patient or other   person unnecessarily to risk of harm.          SECTION 4.  The changes in law made by this Act apply only to   a pelvic examination performed on or after the effective date of   this Act. A pelvic examination performed before the effective date   of this Act is governed by the law in effect when the pelvic   examination occurred, and the former law is continued in effect for   that purpose.          SECTION 5.  This Act takes effect September 1, 2021.       ______________________________ ______________________________      President of the Senate Speaker of the House                   I certify that H.B. No. 1434 was passed by the House on April   28, 2021, by the following vote:  Yeas 145, Nays 0, 1 present, not   voting.     ______________________________   Chief Clerk of the House                 I certify that H.B. No. 1434 was passed by the Senate on May   19, 2021, by the following vote:  Yeas 31, Nays 0.     ______________________________   Secretary of the Senate       APPROVED:  _____________________                      Date                           _____________________                    Governor