Untitled Texas Attorney General Opinion

The Attorney General of Texas

April 1, 1981 .

rfWWHITE

aney General

Honorable Chet Brooks Chairman Opinion No. NW-318

Senate Committee on Human Resources

Archives Building Re: Delegation of medical acts

Austin, Texas 787H by means of standing orders

Dear Senator Brooks

You first ask:

In the absence of statutory language permitting

delegation of medical acts, does the Board of Medical

Examiners have the authority to promulgate ales

relating to the dalegatton of medical acts to non-

physicians?

200ilasAm.hnr382

urlul.Tx.77003 - Article 4512a, V.T.C.S., which was enacted by the sixty-sixth lqisla-

- ture, requires the Board of Medical Examiners to adopt standards regulating

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the extent to which a phyaicianL responsibilities may be delegated to a

8 Bmadrry. Suit. 312

physician assistant No other provision of the Medical Practice Act speaks

rte&. lx. 7Mol to the delegation of medical acts However, authority for such delegations

dnl7.6238 and for board regulation thereof can bs found implicit in the Medical

Practice Act and in statutes governing other healing arts

DON.lWlh.SUlUB

CAwn. TX. 7csol The board may cancel, revoke, or suspend the license of any physician

Iuw1u47 who permits another to practice under his license or who sick the practice of

mediche by an tmlicensed person. V.T.C.S. arts. 4505(l2), (15); 4506. In

exercising this authority, the- board must distinguish between lawful

delegations of medical acts and delegations which constitute grounds for

disc~plinaq action against the physician. In Thompson v. Texas State Board

of Medical Examiners, 570 S.W. 123 (Tex. Civ. App. - ‘Qler 1978, writ rePd

nr.e.), two physictans appealed from lfcense revocations for allowing

unlfcensed pe-&ns to practice acupuncture in their offices. The court

upheld a board pollcy statement which prohibited physicians from delegating

authority to perform acupuncture to unlicensed persons. It noted that the

board condoned the use of urlioansed persons to administer fnnoculations and

draw blood, and held that the board could constitutionally treat the

administration of acupuncture different3 7. cr. +drews v. Ballard, C..A. No.

R-77-999 6.D. Tex. July 9, 1990) restriction agarnst delqatlon of

acupuncture is unconstitutional). The board may promulgate ~1s

identifying the medical acts which may and may not be delegated. See -

V.T.C.S. art 4509; Attorney General Opinion H-1093 (1977).

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Honorable Chet Brooks - Psge TWO (MW-318)

Statutes regulating other health professiorrs recognize that physicians may

delegate medical acts to other persons. For example, the statute regulating physical

therapists does not apply to employees performing services u&r the direct

supervision of a physician in n hcepitaL V.T.C.S. art. 4512e, 56. A limnsed physician

may treat injuries by means of physical therapy, article 4512e, section 6, V.T.C.S., and

he may delegate hfs authority to do so to someone not licensed as a physician or a

physical therapist. See Attorney General Opinion H-368 09741 Similar exemptions for

acts done by an unhinsed person at the direction of a licensed physician ape found In

other statutes. See V.T.C.S. art. 4526 (nursfng); art. 4552-5.17 (optometry). These

pmvisiorw fndicat= legislative assumption that physicians could delegate medical acts

involving treatment to non-physicians. The Board of Medical Examiners may regulate

such delegations under its broad authority to regulate the practice of medicine.

V.T.C.S. art. 4509.

You ask several questions about rules promulgated by the Board of Medical

Examiners on the delegation of health care tasks to qualified non-physicians. Rubs

366.17.00.001-.005,5 Tex. Reg. 1338,1339, 1390 (198OL Rule .004 requires that standing

delegation orders be “in keeping with sound medical practice.” Rule .005 prohibits the

use of standing delegation orders “which authorize the exercise of independent medical

judgment or treatment” A physician wh~$l;~~m~is prohibition.is subject to having

his license suspended or revoked. “sound medical practt& and

“independent medical judgment” are not defined. You ask whether the use of these

undefined terms renders the ale unconstitutionally vague for failing to provide

physicians adequate notice of what acts can and cannot be delegated by standing

delegation orders For the reasons stated below, we do not believe these nrles are

thereby rendered unconstitutionally vague.

The ~1s of an administrative agency will be construed in the same manner as

are statutes. Railroad Commission v. Shell Oil Co., 161S.W. 2d 1022 (Tex 1942). They

will be interpreted in a manner to uphold them, if this can reasonably be done. rd, at

1026.

The courts have upheld language in the Medical Practices Act stating grounds for

license revocation, despite claims that it was void for uncertainty. A predecessor of

article 4505 authorized the board to refuse or revoke a license for conviction of a

felony, commission of a crime involving moral turpitude or “other grossly un-

professional or dishonorable conduct of a character likely to deceive or defraud the

public.” This language was not void for uncertainty because the legislature intended

the conduct it described to be similar in nature to the crimes referred to in the same

provision Morse v. State Board of Medical Examiners, 122 SW. 446 (Tex. Civ. App.

1909, writ rePdL Moreover, the use of ‘general language was necessaryto fully protect

the public, because of the impossibility of enumerating in detail every distinct act

intended to be pmhlbited. Berry v. State, 135 S.W. 631 (Tex. Civ. App. 19ll, writ ref’d)

See abo Jordan v. State Board of lnsursnce, 334 S.W. 2d 278, 280 (Ten 1960). (“not

worthy of the public confidence” an acceptable standard of measurement).

In our opinion, the nrles are not rendered unconstitutionally vague by their use of

the undefined terms “sound medical practice” and “independent medical judgment.”

Honorable Chet Bmka - Page Three (NW-318)

These terms receive some definition from the enumeration h Rule .004 of services,

which may be provided by non-physicians under standing order% In addition, the rules

must be read against the beckground of the statute they implement The legislature

enacted the Medical Practice Act in exercise of its power to protect the public health.

Ex carte Halsted, 182 S.W. 2d 479 (Tex. Grim. App. 1944). The requirement that

delegations of health aervlcas be made “with due regard for the safety of the patient

and in keeping with sound medical practice” serves to protect the public health, and

shwld be interpreted by practitioners in light of that goal Whst constitutes “sound

medical practice” will have to be deeided on the facts of each case, just as

malpractice, a ground for license revocation, must be identified on a case-by-case

basis. See V.T.C.S. art 4512. However, those terms are not therefore void for

vague&F

Rule .005 states that a physician who uses standing orders which authorize the

exercise of independent medical judgment shall be subject to discipline under article

4505(12) and OS), the provisions on permitting another to practice under his license and

on aiding the practice of medicine by an unlicensed person. The term “independent

medical judgment” is used to identify impermissible delegations of medical acts We

believe it 1s used to interpret the statutory definition of the practice of medicine.

When read together with the statute, we do not believe this term Is void for vagueness.

Rule .004 of the rules promulgated by the Board 61 Medical Examiners

enumerates acts which can be authorized under standing delegation orders, Several of

- __ these.are identified in Attorney General Opinion H-1295 (l976) or article 4516(S)as acts

of professional nursing. ~Yournext several questions relate to the possibility that the

Board of Medical Examiners may be attempting to regulate the practice of nursing.

You point out that the supervision of nursing and nursing practices is the practice of

professional nursing. V.T.C.S. art 4518, SS(dL

Question 4: In light of the fact that article 4516(S) identifies

the supervision of nursing as the practice of professional

nursing, &es the &legation and supervision of nursing acts

constitute the practice of medicine 89 defiiti by articles 4510

and 45108, so as to be subject to regulation by the Board of

hledlcal Examiners?

This office noted in Attorney General Opinion H-27 (l973) that there is some

overlap between the practice of medicine and the practice of nursing. Much of what a

professional nurses license authorizes the holder to do could ako be done by a

physicisn under hi license, .such as observing the side, maintaining health and

preventing illness, administering medicines and treatmen& G Baker v. State, 240

S.W. 924 (Tex. Crim. App. ‘192B 0icensed physician ten practice any branch of

medicine including optometry). Thus, the health services fn westion are not

exclusiwly acts of professional nursing. A physician may perform them under his

license and in appropriate cases may delegate their performance to persons licensed

neither as a physician nor as a professional nurse. He has delegated and supervised

medical acts, subject to re@ation by the Board of Medical Examiners, Although the

same ects might also be nursing actsj the physician delegating those acts to an

unlicensed person has not engaged in the supervision of nursing.

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Honorable Chet Brooks - Page Four (NW-318)

Your next three questions deal with the exemption found in article 4528 and we

will arswer them together.

Question 5: Does either the Board of Medical Examiners oi the

Board of Nurse Examiners have authority to regulate profes-

sional nursing care provided rnder that part of article 4528

whfeh exempts ‘acts done under the control or supervision or at

the instnmtion of one licensed by the Texas Board of Medical

Examiners’?

Question 6: Does either the Board of Medical Examiners or the

Board of Nurse Examiners have authority to regulate unlicensed

persons providing professional nursing care Mder that exemp-

tion?

Question 7: Does either the Board of Medical Examiners or the

Board of Nurse Examiners have authority to regulate physicians

controlling, supervising or instructing inlicensed persons

providing professional nursing care under that exemption?

Article 4528 of cow= exempts “acts done under the control or supervision or at

the instruction of one licensed by the Texas State Board of hledical Examiners.” The

Board-of Nurse Examiners has no jurisdiction over an unlicensed person functioning

within this exemption.

The Board of Medical Examiners has ‘the power to regulate the supervising

physician who delegates the performance of health services. See Thompson v. Texas

State Board of Medical Examiners, supra. It could indirectly raate the activities of

the unlicensed person by determining what medical acts may be delegated to him. If

the unlicensed person performs nondelegable medical acts, hs would be practicing

medicine without a lioense. The Board of Medical Examiners could sue him to enjoin

. his unlawful practice of medicine. V.T.C.S. art. 4509. k Ashby v. Board of Medical

Examiners of Texas, 142 S.W. 2d 371 (Tex Civ. App. - Austin l940, writ reTd). The

unlicensed person working under a physician% supervision is therefore accountable to

the board when he performs medical services which may not be delegated.

You next ask:

Question 8: Is the physician controlling, supervising or instruct-

mg unhcensed persons providing professional nursing care under

that exemption legally liable for the acts of those persons?

In our opinion, the supervising physician may have legal 1iabBity for the acts of

these persons. The Bability of a physician for the negligence of others is determined

by examining the principle of agency law. Spaxer v. Worlev Hospital, Inc;, 547 SW.

2d 562 (Tex I9771 The master is liable for the torts of his servant committed in the

course of his employment Newspapers, Inc. v. Love, 380 S.W. 2d 562 (Tex. 1964). The

master’s vicarious liability for his employee’s torts is bssed upon his right to control

.

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Honorable Chet Brooks - Page Pive (Ml+319)

the details of the work rd, The supervisingphysician need not be the actual employer

of the servant in order to be viceriou~y liable for~his torts, so lwg as he has the right

to control the details of the work Sparger v. Worley Hospital, inc., s_upra. The

physician who controb, superviass, or instructs unlicensed persons providmg nursing

care tmder the article 4529 exemption has the right to control the details of their

work. The tnlicensed person can perform nursing acts cnly with a physician%

cooperation, which may be conditioned upon control of the details of the work. A prior

opinion of this office 8tated that article 4528 required the responsible physhzian to

personally assume control and supervision of the employee or instruct him in what is to

be done, and remain reasonably available to see the nursing acts are properly

performed. Attorney General Opinion H-395 (1974). Thug the supervising physician

not only has the power to control the details of the work, but he is responsible for

seeing that it is properly done. In enacting this exemption, the legislature may have

had b mind that the protection to the public afforded by a rays& license was

tnnecesssy where a licensed physician was responsible for the performance of nursing

acts We believe that physicians supervising unlicensed persons under the article 452%

exemption will ordinarily be liable for the acts of those persons.

Your next three questions relate to portion of Rule 386.17.00.004, which reads in

. pertinent part as follows:

.004. Scope of Standing Orders, Providing the, authorizing

._. L. physician Is satisfied as to the ability and competence of those

-_ for whom the, physician is assuming responsibility, and with due

regard for the’safety of the patient and in keeping with sound

medical practice, standing delegation orders may be authorized

for the performance of duties which do not require the exercise

of independent medical judgment and may include authority to

undertake the following:

. ...

‘(4) the administration or providing. of drugs ordered by

direct personal or voice communication by the authorizing

physician who &all assume responsibility for the patient’s

welfare, providing such administration or provision of drugs

shall be in compliance with other state or federal laws, end

providii father that presigned prescriptions &all not be

utilized by the authorizing physician except under the following

conditions:

(A)the prescription shall be prepared in full compliance

with Section (2)g, Article 4476-l4, Vernon% Annotated Civil

Statutes (the Texas Dangerous Drug Law), except for the

inclusion of the name of the patient and date of insuance;

fB) the prescription shall be for one of the following

classes or types of drugs

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Xonorable Chet Brooks - Page Si (Mw-318)

(I) oral contraceptives;

(ii) diaphragms and contraceptive creams and jelliee;

(iii) topical anti-infectives for vaginal use;

(iv) oral anti-parasitic drugs for treatment ot pin-

worms;

(v) topical anti-parasitic drugs;

(vi) rz~~t~c diugs for treatment of venereal

i

(C)the prescriptiolrs may not be Issued for any controlled

substance;

(D) the providing of the drugs shall be in compliance with

the Texas Pharmacy Act and ales adopted by the Texas State

Board of Pharmacy;

(5) the administration of immunization vaccines providing

the recipient is free of any condition for which the immuniza-

tion is contraindicated;

(6) the providing of information regarding hygiene and the

administration or providing of medications for health problems

resulting from a lack of hygiene, including the institution of

treatment for conditions such as scabies, ringworm, pSnworm,

had lice, diaper rash, and other minor skin disorders provided

the administration or providing of drugs adheres to the

provisions of Rule .004(4) of this rule;

(7) the provision of services and the administration of

therapy by public health departments as officially prescribed by

the Texas Department of Health for the prevention or treat-

ment of specific communicable diseases or health conditions for

which the Texas Department of Health is responsible for control

under state law;

(8) the issuance of medications which do not require a

prescription (over the counter medications) for the symptomatic

relief of minor illnesses provided that such medications are

packaged and labeled fn compliance with state and federal laws

and regulations. 5 Ter Reg. 1390 (1980)

You ask

Question 9: To the extent sections (4). (S), (6), (7) and (9) of

Rule .004 permit the providing of medications without a

prescription for the individual patient, did the Board of Medical

Examiners exceed its statutory authority?

Honorable Chet Brooks - Page Seven (taW-318)

As will be shown by the discussion below, we believe that section (4) does not

permit the providing of medications without a prescription for the individual patient.

ln Attorney General Opinion H-1295 (l978), this office stated that as a general Nle,

“the provision of medication pursuant to standing orders, without a physiciank

prescription for the individual patient, would constitute the practice of medicine. . . .”

The opinion did not address whether some medications might provide an exception to

the general nrle.

We interpret section (4) of Rule .004 as requiring the physician to decide that a

particular course of medication should be applied to an individual patient. In cases

where the ~ysiciank agent was to administer the medication to the patient, no

written prescription would be needed, and the physicians verbal order to administer

the substance could constitute a “prescription for the individual patient” as required by

Attorney General Opinion H-1295. Prescriptions may, in some cases, be phoned into a

pharmacy by a physician’s agent, see article 4476-14;section 2(g), V.T.C.S., and the

physician in such cases may verba&?nstruct his agent to make the calt Section (4)

does permit a physician to order medication without having seen the patient. This mle

is broad and one can easily posit illegal eppli&iOns of it. For instance where the

physician could not diagnose the illness and prescribe medication without seeing the

patient and the assistant actually decided what medication to use, the assistant would

be practicing medicine without a license. However, there are many permissible

applications, for example, where the physician can make a diagnosis based on test

reports and examination findings, or where the patient has been under his care

-. previously and needs treatment for a recurring condition. We find no absolute

prohibition against a physician’s prescribing for someone without seeing him, although

under some circumstances this could constitute unprofessional conduct or malpractice.

Cf. Simmons v. State, 353 S.W. 2d 215 (Tex. Grim. App. 1962) (prescription obtained

through a telephone call).

Therefore, we believe that section (4) of Rule .004 does not permit the providing

of medications without a prescription for the individual patient. Section (6) of Rule

-004 requires that the administration of drugs adhere to the provisions of Rule .004(4);

thus section (6) does not permit the providing of medications without a prescription for

the individual patient.

Section (5) of Rule .004 permits the administration of immunization vaccines

providing the recipient is free of any condition for which the immtmization is

contraindicated. No provision is made for prescription for individual patients. We

believe a qualified non-physician may administer immunizations even though his

supervising doctor has not ma& individual determinations as to each person’s need for

the vaccine. The non-physician has not engaged in the practice of medicine as defined

by article 4510 and 45lOa. He has not diagnosed or treated any disorder, physical

deformity, or injury. The immrslization is given to a healthy person, to prevent him

from getting a disease. We believe a non-physician may also determine that a person

is free from conditions for which vaccine is contraindicated, if he can obtain that

information by questioning the person without having to diagnose any illness himself.

The administration of a prescription vaccine must comply with the Dangerous

DN~S Act, article 4476-14, V.T.C.S. The act regulates the possession and distribution

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Honorable Chet Brooks - Page Eight Ww-318)

of prescription drugs as well ra other specifically

named drugs Section 2. It permits

physician and their agents and employees to possess dangerous drugs for use in their

practice or the performance of their official &ties. Thus, a non-physician could

administer vaccine in compliance with the Dangerous Drug Act if he did so es the

agent or employee of a physician in hi practice or in the performance of official

duties.

%eeiton ‘(7) of Rule 364 applies to a broad range of health services provided

tmder the authority of the Department of Health. Unlike section (41, this section

would permit non-physicians to provide medications to a patient without a doctor%

prescription There certainly are legal applications of this rule, such es the provision

of prescription immunizations.

However, public health departments do provide services and treatment which

could not legally be provided on standing orders without a doctork prescription. Public

health departments treat tuberculosis, see article 4437a, section 6A, V.T.C.S., but we

do not believe every kind of treatment G that disease may be administered without a

doctor’s prescription. Rule .904, however, limits the use of standing delegation orders

to the performance of duties which do not require the exercise of independent medical

judgment. The inclusion of this limitation is necessary to insure that Rule ,004 is

consistent with the Medical Practice Act, and that the Board of Medical Examiners did

not exceed its statutory authority by enacting it.

Section (8) involves only over-the-counter drugs; thus the prohibitions of the

Pharmacy Act and the state drug laws are not relevant here. The provision of non-

prescription &ugs to treat a disease, disorder, or injuries for compensation may

constitute the practice of medicine. -See V.T.C.S. art. 4510.

Question 10: Is the use of.presigned prescriptions permitted by

the pharmacy and drug laws of this state and if so, &es the

Board of Medical Examiners or the Pharmacy Board have the

authority to regulate the use of such presiped prescriptions?

No provision of the pharmacy or drug laws of this state prohibits the use of a

presigned prescription. Each board would have some authority to regulate the use of

presigned prescriptions by its practitioners, for example to prevent use of unsigned

prescriptions under circumstances that would constitute tmprofessional conduct or a

violation of the law. V.T.C.S. art. 4505,4506, 4542a, S12. Rule .004(4) of the board’s

NkS allows for the administration or providing of drugs under certain conditions. You

Ask

Question 11: Under the drug laws and Pharmacy Law ES

currently enacted, what acts can a non-physician legally do that

could be said to constitute the ‘providing’of drugs?

To “provide” is commonly used interchangeably with supply or furnish. Webster’s Third

New International Dictionary la27 (l96B.

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Honorable Chet Brooks - Page Nine (m-319)

Article 45421, V.T.C.S., states in partr

It shall be unlawful for any person who is not a reglstered

pharmacist under the provisions of this Act to compound, mix,

manufacture, combine, prepare, label, sell, or distribute at

retail or wholesale any drugs or medicines, except in original

packages. . . . (HI owever, . . . nothing in this Act shall apply to

or interfere with any licensed practitioner of medicine. . . who

shall supply his or her patients, es a physician, dentist, or

chkopJdist, and by them employed as such, with such remedies

as he or she may desire. . . . Section 0.

Under this provision, a non-physician may provide drugs or medicines in original

pa&ages.

The Dangerous Dntgs Act defines prescription to include a telephone order, in

cases of emergency, by a physician’s agent designated in writing to the pharmacist.

V.T.C.S. art 447644, S2@. A non-physician under this language may provide drugs to

a patient b calling in a prescription.’ The agents and employees of physicians may also

possess dangerous drugs for ube in the practice. V.T.C.S. art 4476-l4, S4

The Cantrolled Sbtances Act permits the administration of a controlled

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substance to a patient by a physician’s a ent or employee when done in the physician’s

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presence. V.T.C.S. art. 4476-15, SSl.O2($ (A), 3.03. In addition, the agent or employee

of a registered dispenser of a controlled substance may possess controlled substance if

actiq in the usual course of business

Other statutes authorize non-physicians to “provide” drugs A nurse may

administer medications or treatments as prescribed by a licensed physiCian or dentist.

V.T.CS. art. 4518, SS(c). & Attorney’ General Opinions H-1295 (1978); H-737 (l975L

Someone who is not licensed as a nurse may administer medications under the control

and supervision of a physician. V.T.C.S. art. 4526; Attorney General Opinion H-27

W73).

Rule .003 of the ~1s provides as follows:

903. Exclusion from Rules. These ~1s shall mt be

applicable mr shall they .restrict the use of pm-established

programs of health care, nor shall they restrict physicians from

authorizing the provision of patient care by use of pre-

established programs under the following circumstances: 5 Tex.

Reg. 1339 (l98OL

The circumstances listed include, for example, care rendered as part of disaster relief

when charges for the services are not made, and care rendered by an institution with

an organized medical staff which has approved standing &legatees orders You ask

the following questions about these exclusions:

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Honorable Chet Brooks - Page Ten (Rw-318)

Question 12: k Rule .003 to be construed as a positive grant of

authorrty to use ktanding delegation orders,’ ‘standing medical

orders’ and other ‘preestablished health care pKgrams’Zm the

circumstances listed and if so, what are the legal restrictIons, if

any, on the use of ‘standing delegation orders,‘%tanding medical

orders’ and other ‘preestablished health .care programs’ in the

circumstances listed?

Question 13: Can persons ftmctioning under one Of the

exclustors listed in Rule .003 of the board’s Nk provide

medications not prescribed for an individual patient?

Question 14: Does the prohibition in Rule .005 concerning the

‘exercise of independent medical judgment’ apply to the

exceptions identified in Rule .003?

Question 15: Does Rule .003(l) unconstitutionally discriminate

against physiciaro who practice in private officea or in clinics

where the patient is not institutionalized or which do not have

an organized medical staff2

In cur opinion, Rule .003 merely means that the Board of Medical Examiners has

not addressed the delivery of medical care under the circumstances listed. Physicians

delegating the performance of medical services under those circumstances must

comply with the Medical Practice Act itself, as must every physician They are not

limited by the board’s rules under question, nor do they have the guidance provided by

such ~1s for physicti working in settings where the ~lrz do apply. Thus, persons

ftnctioning tmder one of the exclusions may provide medications to the extent

permitted by the Medical Practices Act, the Pharmacy Act, the Dangerous DNgs Act,

and the Controlled Substances Act. Since we do not constnre Rule .003 as a positive

grant of authority to any class of physicians, we do mt believe it violates the equal

protection clauses of the United States and Texas Constitutions by singling out one

class of persons for benefits See also Thompsxt v. Board of Medical Examiners, supra.

We need not answer your two remaining questions, which are premised on the

assumption that Rule .003 provides exemptions for those persons which it enumerates.

You have attached appendices A, B and C describing specific fact situations in

which standing delqation orders might be used. You ask whether such orders may

legally be used tmder those circumstances. However, since these questions require the

resolution of fact questions, which cannot be done in sn Attorney Gmeral Opinion, we

will mt answer them.

SUMMARY

The Board of Medical Examiners has implied statutory

authority to regulate the delegation of medical acts to non-

physicians. Board ales which use the terms “in keeping wjth

Honorable Chet Brooks - Page Eleven (Nh’-316)

sound medical practice” and %dependent medical judgment”

are mt therefore mid for vagueness. Under certain ckcum-

stances, the Board of Medical Examiners has authority to

rqulate the activities of an tmlioensed pemon performing

health services tmder the supervision of a physician. A

physician supervising an tmllcensed person providing medical

care tnder article 4526, V.T.C.S., will ordinarily be liable for

the acts of that person. The use of presigned prescriptions is

mt prohibited by the pharmacy and drug laws of this state.

Rule 386.17.00.004 promulgated by the Board of Medical

Examiners does mt attempt to authorize the practice of

mediclne by non-physicians. Rule 386.17.00.003 of the board

does mt constitute a Srant of authority to anyone or a

limitation of anyone’s authurity to use standing obligation

orders.

_.

MARK WHITE

_ - Attorney General of Texas

-_

JOHN W. FAINTER, JR.

First Assistant Attorney General

RICHARD E. GRAY IB

Executive Assistant Attorney General

Prepared by Susan L. Garrison

Assistant Attorney General

APPROVED:

OPlNION CGMMD’TEE

Susan L. Garrison, Chairman

Ride Gilpin

p. 1023