and common sense all dictate that MFTs should be allowed to continue doing so.” Mr. Bragg anticipates the trial court judge will hear argu- ments in the case in early October. TMA also has clashed previously in the courts with the Tex- as State Board of Podiatric Medical Examiners and the Texas Podiatric Medical Association (TPMA) over the scope of prac- tice of podiatrists.
In 2010, TMA and the Texas Orthopaedic Association (TOA) won their eight-year legal battle with podiatrists stemming from their definition of the foot. (See “Foot Fight,” October 2010 Texas Medicine, pages 20–24.) Throughout the case, TMA maintained that expanding the scope of podiatry requires amending the Podiatry Act, the state law governing the podiat- ric medical treatment and diagnosis of diseases and disorders of the human foot. Dr. Teuscher says the ruling in TMA’s lawsuit against the podiatrists sent a message that state agencies need legislative authority to expand scope. “Unfortunately, the court decision hasn’t deterred other agencies from trying to expand scope through the back door via rulemaking. Agreed-to legislation formulated with input from TMA is essential if NPP organizations want to succeed in lawfully and safely expanding their scope of practice,” Dr. Teuscher said.
Shortcuts not allowed NPPs were busy filing legislation to expand their scope of prac- tice in 2011. Rep. Kelly Hancock (R-North Richland Hills) filed House
Bill 708, which allowed advanced practice registered nurses, nurse practitioners, nurse anesthetists, and clinical nurse spe- cialists to prescribe, diagnose, and order therapeutic care with- out physician supervision. The bill stipulated that an advanced practice registered nurse could prescribe, procure, administer, and dispense dan- gerous drugs and controlled substances under the supervision of the Texas Board of Nursing. Similarly, House Bill 915 by Rep. Wayne Christian (R-Na- cogdoches) would have granted advanced practice registered nurses the authority to make medical diagnoses and to pre- scribe and order prescription drugs and devices. (Mr. Chris- tian will not be returning to the legislature next year; he was defeated in the Republican primary in part because organized medicine fought his reelection.) Rep. Craig Eiland (D-Galveston) filed House Bill 637, which
authorized physical therapists to treat patients without a phy- sician referral.
TMA opposed all three bills, which died in the House Com- mittee on Public Health when the legislative session ended. TMA has met with NPP organizations to draft agreed-upon legislation with mixed results. “What we’ve found in some instances is people want to take shortcuts in regard to certification and education or don’t want to meet the same standard of patient safety required of physi- cians,” Dr. Teuscher said.
During the 2011 session, TMA attempted, to no avail, to draft scope-of-practice legislation with input from TPMA to take to lawmakers. In the end, Dr. Teuscher says, the podiatry association was unwilling to consider anatomic expansion of scope of practice for a select group of podiatrists based on objective criteria, such as the level of their residency training and the higher level of time-limited board certification. “There is a wide range in the level of training, certification, and qualifications of podiatrists in Texas. They [TPMA] in- sisted that all Texas podiatrists — regardless of qualifications —who managed to gain privileges beyond the foot retain those. The podiatry association adopted the slogan ‘no podiatrist left behind,’ creating an unhealthy environment after a year of mediation,” he said.
On the other hand, TMA supported House Bill 2098 by Rep. John Davis (R-Houston), which authorizes physicians and phy- sician assistants (PAs) to form corporations for certain pur- poses. Under the legislation, which Gov. Rick Perry signed last June, physicians can allow a PA to invest in a practice as long as the PA has minority ownership and doesn’t exert control over a physician’s practice of medicine. The bill provides regulatory authority under TMB and the
Texas Physician Assistant Board over their respective license holders and establishes recordkeeping requirements. “NPP groups can be most effective at the legislature if they work with us rather than working solely in their personal best interests,” Dr. Teuscher said. “TMA has a great relationship with the PAs, and that collaboration can serve as a model for other groups. The PAs try to augment the physician, not serve as a substitute for the physician.”
Pay attention in 2013 Dr. Teuscher urges physicians to support TMA in thwarting NPPs’ efforts to expand their scope of practice through rule- making. He suggests physicians talk to their legislators about the risks to patient safety when health professionals attempt to practice medicine without going to medical school and com- pleting a residency. Dr. Austin doesn’t foresee scope expansion attempts by chi-
ropractors and other practitioners going away anytime soon. She expects NPP groups to file legislation to that end next session.
“Physicians have a wide range of scope, and other practi- tioners don’t. There’s a natural push-pull between the groups. Others want to expand their scope to generate more business,” Dr. Austin said.
She encourages her physician colleagues to stay abreast of
scope-of-practice efforts during the 2013 legislative session. “I know all physicians are busy running their medical prac- tices day to day, but we have to pay attention to the legislature. We have to ensure physicians remain the leader of the health care team and utilize NPPs effectively and in a way that en- hances safe patient care,” she said. (See “Study Group Looks at NPP Delegation,” page 19.) TCBE’s Ms. Yarbrough says she’s not aware of any scope
October 2012 TEXAS MEDICINE 21
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