Texas physicians challenge new chiropractic rules

The state medical association's lawsuit asks the court to stop chiropractors from making diagnoses and performing medical procedures.

By Myrle Croasdale — Posted Oct. 2, 2006

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The Texas Medical Assn. sued the Texas Board of Chiropractic Examiners Sept. 14 in an Austin district court to stop chiropractors from diagnosing disease, performing clinical needle electromyography and performing spinal manipulation under anesthesia.

The lawsuit comes after the Texas Board of Chiropractic Examiners in May adopted scope-of-practice rules that allow chiropractors to make diagnoses and perform these procedures.

"In our view, the rule expands the scope of practice of chiropractors into the practice of medicine," said David Bragg, the TMA's trial counsel for the lawsuit. "The board simply changed the language of the rules without a change in the underlying statute. Diagnosis was inserted into the list of things chiropractors are allowed to do. That's a radical change in the way in which health care is delivered."

Instead of limiting chiropractors to assessing and evaluating patients, now they may diagnose patients' medical conditions, Bragg said. He said that is something chiropractors are not trained to do and the state does not permit. The new scope-of-practice definition also allows chiropractors to perform surgery, which he said was another violation of state law.

Jeb Boyt, Texas assistant attorney general and the Texas Board of Chiropractic Examiners' attorney, disagrees with the claims in the lawsuit. He said the board overhauled legislation governing chiropractors as it went through a sunset review process and adopted scope-of-practice rules as mandated by the legislature. "The board simply codified the chiropractors' existing scope of practice," Boyt said, and there was no intent to expand or change their scope. "Anyone who does analysis does diagnosis; nothing new has been added."

In the June 2 issue of the Texas Register, board commentators defended their use of the word "diagnoses." "For decades, chiropractors have also been required by insurance carriers, Medicare, Medicaid, and the workman's compensation system to provide a diagnosis," they said.

But Landon W. Homer, MD, TMA president, said in a statement that the adoption of this scope-of-practice definition undermines the Texas Medical Practice Act. "To protect public safety, the Texas Constitution and state law sharply distinguish the practice of medicine from activities of chiropractors and other limited-licenses practitioners," Dr. Homer said. "The scope of practice of allied health professionals should not exceed what is safely permitted by their education, training and skills."

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