Texas Board Pushes Expanded Scope

In light of the Texas Association of Acupuncture and Oriental Medicine (TAAOM) taking the Texas Board of Chiropractic Examiners (TBCE) to court recently, the light has been turned on exposing just how out-of-control the TBCE really is. Relatively untouched since a landmark amendment in 2005, the TBCE has crossed the line other health care communities are fighting back!

Scope of Practice Rule

In a wild turn of events, the Texas Legislature mandated that the TBCE adopt their own rules in 2005 to clarify what activities are in- and out-of-scope. (See Act of May 27, 2005, 79th Leg., R.S., ch. 1020, § 1, 2005 Tex. Gen. Laws 3464, 3465 & § 8, 2005 Tex. Gen. Laws at 3466). As expected, the TBCE took full advantage of the mandate and initiated a “Scope of Practice” rule permitting Texas DCs to perform both MUA and needle EMG. (See 22 Tex. Admin. Code § 75.17).

After years of trying to fight this law, the TMA finally sued the TBCE in 2012 in an effort to prohibit Texas DCs from performing needle electromyography (needle EMG), manipulation under anesthesia (MUA), and to diagnose biomechanical conditions of the spine and musculoskeletal system. Insisting that the Scope of Practice Rule exceeded the authority allotted under the Texas Constitution, the trial court initially granted summary judgment in favor of the TMA, however, it did not address TMA’s constitutional agreement. After the Texas Chiropractic Association intervened and the TBCE appealed this decision, the Texas Court of Appeals affirmed its decision over needle EMG and MUA, but reversed the trial court’s decision concerning “diagnosis.”

This led the TMA to appeal to the Texas Supreme Court, insisting that DCs are not trained to diagnosis the full-spectrum of biomechanical disorders of the spine and musculoskeletal system, but the Court declined a hearing. According to David Bragg, JD, an attorney representing TMA in the case, allowing chiropractors to diagnose medical conditions is a public health risk:

The scope-of-practice rule the chiropractic board developed authorizes chiropractors in Texas to diagnose a whole host of medical conditions that they, by their own admission, can't treat. The rule is so broad chiropractors can diagnose cancers, muscular dystrophy, and even Lou Gehrig's disease. We [TMA] don't think chiropractors have any business doing this.

Common sense says that the TMA is correct with its assertion that as chiropractors we are woefully trained to be primary care physicians in Chiropractic College. Without prescriptive rights, thorough training in advanced diagnostics, and the vital hands-on experience of hospital residencies, DCs simply should not try to fill that role. Being one of the only natural health disciplines in the U.S. that do not prescribe drugs and surgery, subluxation-based chiropractors should fight against scope expansion such as this with gusto.

Giving a deposition on behalf of the TMA this past July, Beaumont orthopedic surgeon David Teuscher, MD emphasized that the Texas Chiropractic Act limits chiropractors to an examination, evaluation, or analysis of the biomechanical condition of the spine and the musculoskeletal system. In regards to diagnosing these conditions through needle EMG and other modalities, Teuscher contends that, "Judge Yelenosky got it right. If you're going to stick needles in people's muscles, you need to be a medical doctor who specializes in those types of procedures and who has the appropriate training and board certification."

According to the AMA, the “TMA will now be pressing its constitutional arguments regarding § 75.17(d) in the trial court on remand. On September 13, 2013, TMA filed an amended complaint.  The case is set for trial in September 2014.”

TBCE Out of Control

In addition to expanding the scope to include “diagnosis,” needle EMG, MUA and acupuncture, the TBCE has displayed some very disturbing behavior that is not known by many in the profession.

Just last February – during the Texas House of Representatives Committee on Appropriations – TCBE Executive Director, Yvette Yarbrough discussed at length the apparent “need” that the Texas Board has for armed police support. Evidently, as outlined in her in-depth analysis, $366,800 was needed to fund two more field investigators that carry guns, $10,000 for pay raises for key employees, and for an administrative assistant that would support Yarbrough directly because she is bogged down with administrative work. Ultimately, this would give 30% of their employees a 25% pay raise and increase their 13-person team by roughly 20% to meet their need for “peace officers.” As was stated in the ending remarks of the testimony, this is not only unnecessary it is also bad business. If all of American businesses were run the way that the TBCE is, we’d all be “in trouble” one key spokesperson remarked. Here is a transcript from the House testimony:

• Rep. Brian Hughes: "Explain to me what you’re going to use the law enforcement officers for.” 

• Yvette Yarbrough: “…To have actual eyes on the scene and boots on the ground to report back to us, for a lack of better phraseology. We will, sometimes, call on local law enforcement to report what they are seeing….Even though we have statutory authority to inspect facilities, sometimes we meet resistance and this would help us in that regard; and additionally help us in obtaining some information…If we had ‘Certified Peace Officer’ status, I believe that would help in regard to obtaining information about [Medicare and private insurance] fraud in order to regulate from our end.” 

• Rep. Brian Hughes: “Ok, I’m still not sure people would need to be ‘Peace Certified.’ Other doctors only see law enforcement when they are guilty of something other than an allegation, but I’ll move on...” 

In a nutshell, the TBCE embarrassed themselves and the chiropractic profession terribly and were shut down by the Texas House. In the words of Representative Drew Springer: 

The Board is now saying that they want to increase the taxes – they call it fees on these small businesses [chiropractic offices] – and they're also saying they want to increase the salaries of their employees $10,000 each. At the same time, chiropractors are seeing a decrease in the amount they receive while additional regulations are hoisted upon them and are being portrayed as being one in twenty “bad apples” [that require armed police support]....I adamantly disagree with this.

To watch the entire House hearing CLICK HERE, the TCBE portion of it begins at 1:27:45 and ends at 2:04.

Call to Action

At this point, the subluxation-focused faction of the chiropractic profession needs to unite and uphold a standard that will stand up against this type of insanity.

The International Federation of Chiropractors and Organizations (IFCO) continues to support chiropractic principles, fight against scope expansion, primary care and the medicalization of chiropractic. Show your support, join the IFCO today.