Texas podiatrists win case to expand scope of practice

The state's physicians vow to appeal a ruling that gives podiatrists the authority to do procedures on the ankle's boney tissue.

By Myrle Croasdale — Posted Oct. 10, 2005

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The Texas Orthopaedic Assn. and the Texas Medical Assn. will fight a recent Texas court decision that defines the foot as including the ankle.

If the groups are unsuccessful in getting the August trial court ruling overturned, Texas podiatrists will be able to continue doing ankle surgery legally.

At the center of the legal battle is the Texas State Board of Podiatric Medical Examiners' definition of "foot," which Texas physicians say was expanded to include the ankle without the board going through the appropriate legislative process.

Mark Scioli, MD, an orthopedic surgeon speaking for the TOA, said the podiatry board unilaterally had broadened its scope of practice when it should have asked the state Legislature. He said the lawmaking body alone has the authority to change statutes that define licensed professionals' scope.

Before the Texas trial court ruling, then-Texas Attorney General John Cornyn issued an opinion in 2001 stating that the podiatry board had acted outside its authority when it adopted a rule redefining podiatrists' scope of practice. The TOA and TMA supported the opinion.

"Only the Texas Legislature, not an unelected administrative body, has the authority to establish or change the scope of practice for podiatrists, physicians or any other health care professionals. TMA agrees with the attorney general's opinion and believes the court decision is flawed," TMA President Robert T. Gunby Jr., MD, said in a statement.

Dr. Scioli said Texas physicians were not trying to tell podiatrists what procedures they could do. Instead, he said, physicians want the podiatry board to go through the state Legislature if it wants to change the laws defining podiatry.

That being said, the TOA also opposes the new definition itself.

"Their definition opens the door for those who aren't quite fully trained to do certain procedures, and it will confuse credentialing committees at hospitals," Dr. Scioli said.

He said 3% of the 12,000 podiatrists in the United States have what he would consider the appropriate technical qualifications to do the kind of ankle procedures implied in the Texas podiatrists' definition of foot.

"For us as orthopedists and in medicine in general, we want to protect the patients in Texas," Dr. Scioli said. "What I'm concerned about is the fact that the way this rule is written, it potentially will allow those who are not trained to do certain procedures to get away with them."

The Texas State Board of Podiatric Medical Examiners and Texas Podiatric Medical Assn. did not respond to telephone requests for interviews.

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