She worried that the use of the title by chiropractors could confuse patients who already have a difficult time discerning among health care professionals’ qualifications. A 2010 American Medical Association Truth in Advertising
survey that revealed that 68 percent of respondents thought a podiatrist is a medical doctor validates her concern. Fifty-four percent answered that optometrists are medical doctors, and 41 percent said psychologists are medical doctors. However, the board voted Aug. 16 not to adopt the rules in the face of opposition from organized medicine and legislators. TMA asked TBCE to withdraw them because they “mislead, confuse, and even defraud the public.” TMA President Michael E. Speer, MD, outlined two pri- mary concerns in a letter to Ms. Yarbrough:
“First, ‘neurology’ connotes the practice of medicine,” he wrote. “If TBCE recognizes ‘chiropractic neurology’ as a specialty, it will confuse, deceive, and potentially injure the public. Second, neurology is beyond the law- ful scope of practice of chiropractic in Texas, so a ‘chiropractic neurology’ specialty is inap- propriate.” Rep. John Zerwas, MD (R-Simonton), Sen. Jane Nelson (R-Flower Mound), Sen. Bob Deuell, MD (R-Greenville), and Rep. Charles Schwertner, MD (R-Georgetown), all wrote letters asking TBCE to withdraw inappropri- ate scope expansion rules and to obtain prop- er stakeholder input when proposing rules in the future.
TMA wasn’t the only organization to op- pose the board’s proposed rules. American Association of Neuromuscular & Electrodi- agnostic Medicine Executive Director Shirlyn Adkins and American Academy of Neurology President Bruce Sigsbee, MD, wrote to TBCE to contest the proposed rules. Like TMA, they say chiropractors’ use of the term “chiroprac- tic neurologist” could confuse and mislead patients as to practitioners’ qualifications. David Bragg, TMA’s attorney in its liti- gation against the chiropractic board, says TBCE continues to “push the envelope” by expanding scope of practice through rule- making.
“Each time the board proposes scope rules,
chiropractors tread further into the practice of medicine,” he said.
TMA has persuaded the chiropractic board to withdraw disputed scope-of-practice rules in the past. Earlier this year, TBCE attempted to redefine chiropractors’ practice rules to in- clude the peripheral nervous system. That would have allowed chiropractors to perform needle EMG or other nerve testing, which the courts already rejected.
The law limits chiropractors to treating the biomechani- cal condition of the spine and musculoskeletal system. The proposed rules also would have permitted chiropractors to perform video fluoroscopy and “dry needle” treatment. The chiropractic board withdrew the rules in February after facing stiff opposition from TMA. TMA and the chiropractic board have a history of litiga-
tion. TMA prevailed in its lawsuit over TBCE rules that allowed vestibular-ocular-nystagmus (VON) testing by chiropractors. TMA sued the board in early 2011 and emphasized to the court that allowing some chiropractors to perform the VON testing puts Texans’ health in danger and that the diagnostic test is outside chiropractors’ scope because “the eyes and ears
Study group looks at NPP delegation
At the request of the Texas Academy of Family Physicians (TAFP), TMA convened a study group to examine alternatives to rules governing physician delegation of nonphysician practi- tioner (NPP) duties. Gary Floyd, MD, a Fort Worth pediatrician, is a member of
the study group and a consultant to the TMA Council on Leg- islation. He says the rules related to site-based delegation vary among NPPs. The study group will look at possibly modifying the rules for consistency and effectiveness. For instance, state law requires supervising physicians to
randomly review 10 percent of charts for NPPs who practice at alternate sites. Dr. Floyd says the study group may consider whether there is a better method of chart review. “As an example, it might be more effective to have the NPP
screen the charts and then have the physician and NPP com- pare them to the practice’s protocol. If deviations from the protocol exist, maybe the physician can focus on changing the protocol or working with the NPP to meet the guideline,” he said.
He stresses physicians will always remain the “captains of the health care team,” serving in an essential supervisory role. For additional guidance on site-specific prescriptive delega-
tion, consult the Texas Medical Board website,
http://bit.ly/ P7Qo2y. The study group met for the first time in August. Dr. Floyd
says the group’s findings may lead to legislation related to site- based physician delegation of NPPs. “That will depend on the group’s recommendations and TMA’s guidance,” he said.
October 2012 TEXAS MEDICINE 19
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