Section 139.53 - Medical and Clinical Services(a) Surgical abortion. (1) The medical consultant shall be responsible for implementing and supervising the medical and clinical policies of the facility.(2) All medical and clinical services of the facility, with the exception of the abortion procedure, shall be provided under the direction of a physician or registered nurse who assumes responsibility for the clinical employees' performance in the facility.(3) A licensed abortion facility shall ensure that a surgical consent form is signed by the patient prior to the procedure being started, that the patient is informed of the risks and the benefits of the procedure, and that the patient recognizes the alternatives to abortion. Informed consent shall be in accordance with rules adopted by the Texas Medical Disclosure Panel under § 601.2 of this title (relating to Procedures Requiring Full Disclosure of Specific Risks and Hazards--List A), § 601.4 of this title (relating to Disclosure and Consent Form), and Health and Safety Code § 171.011 (relating to Informed Consent Required), and §171.012 (relating to Voluntary Informed Consent).(4) A licensed abortion facility shall ensure that the attending physician, advanced practice registered nurse, or physician assistant has obtained and documented a preoperative history, physical exam, and laboratory studies, including verification of pregnancy.(5) A licensed abortion facility shall ensure that: (A) the attending physician examines each patient immediately prior to surgery to evaluate the risk to the procedure; and(B) the person administering the anesthetic agent(s) examines the patient immediately prior to surgery to evaluate the risk of anesthesia.(6) The administration of anesthesia shall be in accordance with § 139.59 of this subchapter (relating to Anesthesia Services).(7) A surgical abortion shall be performed only by a physician.(8) A physician, advanced practice registered nurse, physician assistant, registered nurse, or licensed vocational nurse shall be in the facility whenever there is a patient in the procedure room or recovery room. While a patient is in the procedure room or recovery room she shall not be left unattended.(9) The recovery room(s) at the facility shall be supervised by a physician, advanced practice registered nurse, physician assistant, or registered nurse. This supervisor shall be available for recovery room staff within a recommended 10 minutes with a maximum required 15 minutes while any patient is in the recovery room.(10) A physician shall be available for the facility while any patient is in the recovery room within a recommended 10 minutes and a maximum required 15 minutes.(11) The facility shall ensure that a patient is fully reactive and her vital signs are stable before discharging the patient from the facility upon written order by the attending physician.(12) All fetal tissue shall be examined grossly at the time of the procedure. In the absence of visible fetal parts or placenta, the tissue may be examined by magnification for the detection of villi. If this examination is inconclusive, the tissue shall be sent to a pathology lab. The results of the tissue examination shall be recorded in the patient's clinical record.(13) A facility shall meet the requirements set forth by the department in §§ 1.131- 1.137 of this title (relating to Definition, Treatment, and Disposition of Special Waste from Health Care-Related Facilities).(b) Medical abortion. (1) The medical consultant shall be responsible for implementing and supervising the medical and clinical policies of the facility.(2) All medical and clinical services of the facility, with the exception of the abortion procedure, shall be provided under the direction of a physician or registered nurse who assumes responsibility for the clinical employees' performance in the facility.(3) A licensed abortion facility shall ensure:(A) the physician(s) providing medical abortion is able to accurately date a pregnancy;(B) the physician(s) is able to determine that the pregnancy is not an ectopic gestation;(C) the physician(s) is able to provide surgical intervention or provide for the patient to receive a surgical abortion if necessary; and(D) patients have access to medical facilities equipped to provide blood transfusion and patient resuscitation, if necessary.(4) A licensed abortion facility shall ensure follow-up examination and services are provided to patients requesting medical abortion.(5) A licensed abortion facility shall ensure that the attending physician, advanced practice registered nurse, or physician assistant has obtained and documented a pre-procedure history, physical exam, and laboratory studies, including verification of pregnancy.(6) A licensed abortion facility shall ensure:(A) written consent is obtained from the patient prior to the commencement of the abortion procedure in accordance with § 139.50 of this chapter (relating to Disclosure Requirements);(B) the patient is informed of the risks and benefits of the procedure;(C) the patient is informed of the possibility that a surgical abortion may be required;(D) the patient is informed of the alternatives to abortion; and(E) informed consent is in accordance with rules adopted by the Texas Medical Disclosure Panel under § 601.2 of this title, § 601.4 of this title, and Health and Safety Code § 171.011 and § 171.012.(7) A licensed abortion facility shall provide the patient with written discharge instructions including a direct referral to a physician who shall accept the patient for surgical abortion.(8) A medical abortion shall be performed only by a physician.(c) Requirements of a physician. A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that: (1) is located not further than 30 miles from the location at which the abortion is performed or induced; and(2) provides obstetrical or gynecological health care services.25 Tex. Admin. Code § 139.53
The provisions of this §139.53 adopted to be effective June 28, 2009, 34 TexReg 4125; amended to be effective January 1, 2014, 38 TexReg 9577; Amended by Texas Register, Volume 47, Number 46, November 18, 2022, TexReg 7703, eff. 11/24/2022