are not part of the spine or musculoskeletal system of the hu- man body.”
The trial court sided with TMA, but TBCE appealed the
decision. In July, TMA asked the Third Court of Appeals to uphold the trial court ruling, saying in part that:
• The vestibular system isn’t part of the spine or musculoskel- etal system;
• The vestibular testing rules unlawfully authorize chiroprac- tors to practice medicine; and
Ms. Yarbrough declined to comment because the case is
on appeal. She did say her goal as TBCE executive director is reducing the scope-of-practice litigation “by not only ensur- ing that all board actions are in compliance with the Texas Occupations Code and other statutes but also by encouraging more communication between the chiropractic and allopathic communities.”
“I believe that some of the concepts in- NPPs are part of the team
As health system reform evolves, physicians may have to use nonphysician practitioners (NPPs) more frequently as their patient volumes rise. “With the doctor shortage, the health system could feel
increased pressure to allow unqualified health professionals to treat patients. That could be tragic,” said David Bragg, TMA’s attorney in some of the association’s scope-of-practice litigation. David Teuscher, MD, a Beaumont orthopedic surgeon and a member of the TMA Board of Trustees, and many physicians recognize while TMA has had differences with some nonphysi- cian practitioner groups, NPPs are an integral part of the medi- cal care team. “Physicians will increasingly work with NPPs as health system
reform is implemented. They’re a valuable part of a physician- led team,” Dr. Teuscher said. TMA has tools to help physicians properly manage nonphysi-
cian practitioners. The white paper titled “Delegation of Duties by a Physician to a Nonphysician” contains information on delegation of medi- cal acts and prescriptive authority, standing delegation orders, physician supervision, and other topics. Access it on the TMA website,
www.texmed.org/Template.aspx?id=2095, or contact the TMA Knowledge Center at (800) 880-7955 or knowledge@
texmed.org to request a copy. Nonphysician Practitioners is available for sale from TMA.
The publication covers prescriptive authority, physician liability, NPP scope of practice, physician supervision, standing orders, documentation requirements, hiring NPPs, billing, credentialing with government and private payers, and more. Call the TMA Knowledge Center at (800) 880-7955 to order the publication. The cost is $99 for TMA members and $149 for nonmembers.
20 TEXAS MEDICINE October 2012
volved in chiropractic have not historically been accepted or understood in the allopath- ic community, leading to misunderstandings about the board’s actions regarding scope of practice. There has also been a lack of ac- ceptance regarding the ability of doctors of chiropractic to diagnose, even within the chiropractic scope of practice, leading to pro- longed litigation,” she said.
Scope litigation nothing new Besides chiropractors, TMA has taken podia- trists and marriage counselors to court. Dr. Teuscher describes the association’s ongo- ing scope-of-practice litigation as a game of Whac-A-Mole. “Just when you think you’ve addressed one
agency that’s trying to expand scope for its li- censees, another one pops up doing the same thing,” he said. TMA’s lawsuit with the Texas State Board of Examiners of Marriage and Family Thera- pists (TSBMFT) began in 2008 when the board attempted to allow therapists to diag- nose medical conditions. TMA’s lawsuit contends that “because
marriage and family therapists are neither li- censed nor trained to practice medicine,” giv- ing them the ability to diagnose mental and physical conditions would diminish the qual- ity and standards of the practice of medicine. TMA asked a Travis County District Court judge to declare the board’s rule invalid and to prohibit the board from enforcing it. TSBMFT, joined by the Texas Association for Marriage and Family Therapists, claims the board’s rules authorizing marriage and family therapists to diagnose “are reasonable and consistent with the statutory scope of practice.” They contend that therapists “have been exercising the authority to diagnose in this state for at least 18 years with no known complaints.” According to the board, “Law, public policy,
• The Chiropractic Act doesn’t allow chiropractors to make a “differential diagnosis” of a patient’s medical condition.
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