ASA Urges Texas Medical Board to Strengthen Ketamine Safety Requirements

On June 9, 2026, the American Society of Anesthesiologists (ASA) submitted formal comments to the Texas Medical Board (TMB) on proposed rules governing parenteral ketamine therapy (PKT), urging revisions to ensure appropriate physician supervision and patient safety.

The proposal appropriately prohibits the prescribing of PKT for home use, an important safeguard given the risks associated with ketamine administration outside a medically supervised setting. However, ASA raised significant concerns about other aspects of the rule that would permit inadequate physician oversight in clinical environments.

As drafted, the rule authorizes remote physician supervision and delayed in-person response in settings involving administration of a drug classified as a general anesthetic. ASA emphasized that these provisions establish an inadequate standard of care and place patients at unnecessary risk.

Specifically, ASA noted:

• Remote supervision is insufficient. The proposal allows physician availability via two-way audiovisual communication. ASA noted that virtual presence does not ensure timely, hands-on assessment or intervention during acute patient deterioration.
• Delayed response times are unsafe. The proposal allows an off-site physician up to 30 minutes to arrive at the site of administration. ASA stressed that complications associated with ketamine—such as respiratory depression, airway compromise, and cardiovascular instability—can occur rapidly and require immediate care.

ASA urged the Board to revise the rule to require direct, in-person physician supervision. At a minimum:

• Ketamine administration should occur under the direct supervision of a qualified physician physically present on-site; and
• The supervising physician must be immediately available for in-person evaluation and intervention, with the capacity for immediate bedside presence.

Ketamine is approved by the Food and Drug Administration (FDA) as a general anesthetic and carries well-established risks. Patient responses are variable and may be unpredictable, particularly in non-traditional care settings.

ASA reiterated that its top priority is patient safety and cautioned that allowing remote supervision or delayed physician presence risks normalizing a lower standard of care and puts patients at risk. ASA urged TMB to adopt clear, enforceable requirements to ensure safe administration of PKT.

See also:

• ASA Statement on Ketamine for the Treatment of Chronic Pain
• ASA Guidance on the Safe Use of Ketamine Outside of Acute Pain Management and Procedural Sedation
• ASA Statement on Definition of ʺImmediately Availableʺ When Medically Directing