(a) No more than 24 electroconvulsive therapy treatments may be administered to a given patient in any 12-month period, dated from the date of the first treatment except as provided in this subsection.      
        (1) Exceptions to this limitation require, prior to the additional treatments:                  (A) for state facilities, the written approval of the department's medical director, who shall consider the recommendations of an independent, fully qualified psychiatrist who is not affiliated with the department except in a consultative capacity; or                   (B) for all other providers, the written concurrence of a fully qualified psychiatrist not involved in the patient's care.         
        (2) All reports of such  consultations shall become  a part of the patient's permanent medical record.       
      (b) The number of ECTs to be given in  eight consecutive weeks shall ordinarily be limited to 15. In those cases in which it is considered clinically advantageous to exceed these numbers of treatments in any given series, the attending physician shall obtain a second consultative opinion from a fully qualified psychiatrist who is not directly associated with the patient's care.     
     Source Note:        The provisions of this §405.109 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790