“Performing EMG is extremely difficult and requires a lot of training. An in- correct diagnosis can harm patients by resulting in delayed or inappropriate treatment and diminished quality of life,” Dr. Austin said. EMG took center stage, along with manipulation under anesthesia (MUA),
in 2006 when the Texas Medical Association sued to invalidate the Texas Board of Chiropractic Examiners’ (TBCE’s) rules permitting chiropractors to make diagnoses and to perform EMG and MUA. An appellate court determined earlier this year Texas chiropractors may not perform EMG or MUA, a decision that supports arguments from TMA and the
Texas Medical Board (TMB) that the chiropractic board exceeded its legal au- thority when it adopted the rules. However, the appeals court justices ruled the “diagnosis” of “biomechanical conditions of the spine or musculoskel- etal system” is within chiropractors’ scope of practice. TMA asked the Texas Supreme Court in August to reverse the ruling on diagnosis. A decision was pending at press time.
S
cope-of-practice expansion attempts have long been a point of contention between TMA and some nonphysician practitioners (NPPs). The association doesn’t oppose scope expansion outright, however. TMA
will consider NPPs’ licensure expansion efforts when they improve patient care and adhere to safety guidelines, when they have appropriate training, when a physician remains the supervisor of the health care team, and when TMB provides appropriate regulatory oversight. TMA works to prevent scope expansion efforts beyond what NPPs’ education, training, and skills safely permit. Additionally, TMA has always maintained that expanding
chiropractors’ or any other practitioner group’s scope of prac- tice requires legislative action to amend state laws governing licensees in Texas. It is not something the regulatory boards can do on their own. TBCE Executive Director Yvette Yarbrough says her board
is “very aware that any expansion of scope of practice must be done through the legislature,” adding that “any perception that the board is currently attempting to circumvent legislation is
18 TEXAS MEDICINE October 2012
not accurate. On the contrary, my personal observation is that the current board is very diligent in adherence to the Texas Occupations Code.” David Teuscher, MD, a Beaumont orthopedic surgeon and a member of the TMA Board of Trustees, sees it differently. “The public views physicians as the captain of the medical team. As long as we’re protecting patients, we’re doing what’s right for Texas. We have to ensure unqualified people aren’t harming patients by performing tests and treatments they’re not trained to do,” he said.
“Chiropractic neurology” dropped Dr. Austin is an outspoken opponent of inappropriate scope- of-practice expansion by chiropractors. As a member of the TMA Council on Legislation, she testified for the association at a TBCE meeting in opposition to scope expansion rules and before the 2011 legislature against a bill that would have ex- panded scope of practice for chiropractors and other health care practitioners. But TBCE’s most recent proposed rules recognizing “chiro- practic neurology” as a specialty concerned Dr. Austin.
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