Delegation is a poignant issue and prominent concern in medical board complaint investigations. Delegation, as defined by the medical community, allows physicians to assign responsibilities and actions to properly trained individuals who are acting under the physician’s supervision. The individuals must be properly trained and physicians must act reasonably when delegating assignments. Under the Texas Medical Board Rules §157.001, delegation is permitted if the act in question:

Can be properly and safely performed by the person to whom the medical act is delegated

Is performed in its customary manner

Is not in violation of any other statute

The person to whom the delegation is made does not represent to the public that the person is authorized to practice medicine

The delegating physician remains responsible for the medical acts of the person performing the delegated medical acts

Delegation Violations

Delegation and violations have become a hot issue of debate for medical boards. In Texas, specifically, the Texas Medical Board Rules §157.0001 outline the regulations of how delegation must be handled. Unfortunately, it is common for unscrupulous clinic owners to convince naïve physicians that unlicensed foreign physicians can examine patients and issue prescriptions in the physician’s name.

Not only can this be considered a violation on behalf of those who delegate the medical acts, but it also subjects unlicensed medical employees to violations themselves, including possible charges of aiding and abetting. In cases such as this, supervising physicians must be held accountable and medical staff deserve to be defended properly in the event that they are called to hearings or peer reviews. Delegation as it applies to medical staff is as follows:


Delegation will involve performance of a medical act that requires substantial specialized judgment and skill. Proper performance is based on knowledge and application of biological, physical and social science principles acquired through completion of a certified course. Delegation for nurses will not include medical diagnosis or the prescription of therapeutic or corrective measures. APNS can delegate diagnosis and treatment according to delegation protocols, including prescription drugs Schedules III-V.

Physician Assistants

A physician assistant’s practice can include medical services delegated by a supervising physician that are within the education, training and experience of the physician assistant. Delegation can also include diagnosis and treatment adhering to protocol, including prescription drugs Schedules III-V.

Other delegation violations and issues that may arise can include FTE and facility maximums, patient relationships, supervision requirements, alternate supervising physicians, and advertising requirements.

Protect Your Rights

Delegation violations will vary from case to case, but consequences are almost always severe. Whether you are facing formal actions from a medical board as a nurse, physician assistant or a physician who has been alleged to violate delegation protocol, you need an experienced medical board defense attorney who can inform you about what you can expect and assist you in preparing for a review or hearing. Contact the Tew Law Firm today.