The Texas Supreme Court has ruled in favor of the state's chiropractic board with regard to scope of practice – a decision rendered, according to the court's decision, in a decade-long case that is part of "'a long history of professional, scientific, or economic antagonism between chiropractors and the medical community, and resultant disputes, spanning all three branches of government, regarding where any legal line between chiropractic and the practice of medicine is or should be.'"1
Per the court's ruling:
The Texas Chiropractic Act (the Act) draws that line by defining the practice of chiropractic to include evaluating the musculoskeletal system and improving the subluxation complex. The Texas Board of Chiropractic Examiners (the Board) has issued rules defining both terms as involving nerves in addition to muscles and bones. Another Board rule authorizes chiropractors to perform an eye-movement test for neurological problems that is known by the acronym VONT. The Texas Medical Association (TMA) asserts that only physicians may perform VONT. But as we recently stated, "every act that a physician may do is not automatically the unlawful practice of medicine when done by a non-physician, and terminology in one field may overlap with that of another." We conclude that the challenged rules, read in context, do not exceed the statutory scope of chiropractic practice. We reverse that part of the court of appeals' judgment declaring the rules invalid and render judgment that they are valid.
Put in simpler terms by the Texas Chiropractic Association using the court's language, the court ruled that the Texas Board of Chiropractic Examiners "could reasonably consider neural involvement in the musculoskeletal system in defining the scope of chiropractic" and that the TBCE rule "merely recognizes the reality that musculoskeletal dysfunctions cannot be diagnosed or treated without considering associated nerves."2
The Texas Board of Chiropractic Examiners explained the importance of the court's ruling:3 "The decision properly affirmed the validity of the Board's scope of practice rule, which the court clearly said does not exceed our statutory scope of chiropractic practice. The court unequivocally held that the Board's rules do not violate Occupations Code Chapter 201 or run counter to the chapter's objectives set by the Texas Legislature, and in fact carefully observe the statutory boundary between the medical and chiropractic professions. This decision, which recognizes the common-sense and long-standing inclusion of associated nerves in chiropractic diagnosis and treatment, preserves and strengthens the essence of chiropractic. Thanks to the court's decision, our licensees can now fulfill their duties as vital portal-of-entry healthcare providers in Texas without fear."
Prior to the high court's decision, Texas chiropractors had been pursuing legislative action (SB 293) to clarify the role of the nervous system in chiropractic practice. As longtime state and federal chiropractic legislative veteran (and Texan) Dr. James Edwards explains, "In response to the lawsuit by the Texas Medical Association, the 'nerve bill' was a legislative effort to attempt to ensure that examination and treatment of the nervous system by a Texas doctor of chiropractic was within the state scope of practice. The Texas Supreme Court made that effort moot since it ruled that under current state statutes, Texas doctors of chiropractic already have that authority."4
As might be expected the Texas Medical Association "is considering options on how to proceed"5 despite the Texas Supreme Court's decision.
References
- Texas Board of Chiropractic Examiners; Patrick Fortner, In His Official Capacity as the Board's Executive Director; and Texas Chiropractic Association, Petitioners, v. Texas Medical Association, Respondent, on Petition for Review From the Court of Appeals for the Third District of Texas. Argued Sept. 16, 2020.
- "Texas Supreme Court Issues Landmark Decision Protecting Rights of Texas Chiropractors." Texas Chiropractic Association, Feb. 3, 2021.
- Texas Board of Chiropractic Examiners statement on Texas Supreme Court's ruling, Feb. 1, 2021. Signed by TBCM President Mark R. Bronson, DC, FIANM.
- Email correspondence with Dr. James Edwards, Feb. 2, 2021.
- Berlin J. "State Supreme Court Sides With Chiropractors on Neurological Test." www.tex med.org, Feb. 2, 2021.
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