BILL ANALYSIS C.S.S.B. 718 By: Moncrief Health and Human Services 04-18-95 Committee Report (Substituted) BACKGROUND In 1992, the Sunset Commission reviewed the Texas Board of Chiropractic Examiners, and reported on problems the board had with certain provisions, especially the review and readoption of rules. In 1995, at a joint hearing on the board's progress toward addressing issues raised by the Sunset Commission in 1992, board members and the attorney general's office testified that legislative intent regarding scope of practice was unclear. Other testimony indicated problems with enforcement and the extent of the board's authority. PURPOSE As proposed, C.S.S.B. 718 requires a person regarded as practicing chiropractic to use non-surgical, non-invasive procedures to improve the subluxation complex and biomechanical condition of the spine and appendicular skeleton and the muscles of the spine and appendicular skeleton; creates an advisory commission to the Texas Board of Chiropractic Examiners (board); limits the membership of the enforcement committee appointed by the board; and requires the board to keep an information file for complaints filed with the board and referred to the enforcement committee. RULEMAKING AUTHORITY It is the committee's opinion that rulemaking authority is granted to the Texas Board of Chiropractic Examiners under SECTION 7 (Section 14.c.1., Article 4512b, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 1, Article 4512b, V.T.C.S., as follows: Sec. 1. (a) Requires a person to be regarded as practicing chiropractic if the person: (1) analyzes, examines, or evaluates the subluxation complex and biomechanical condition of the spine and appendicular skeleton and muscles of the spine and appendicular skeleton; or (2) performs non-surgical, non-invasive procedures, rather than uses adjustment, manipulation, to improve the subluxation complex and biomechanical condition of the spine and appendicular skeleton and the muscles of the spine and appendicular skeleton. (b) Prohibits the practice of chiropractic from being construed to include invasive or surgical procedures, prescribing of controlled substances or dangerous drugs. (c) Defines "invasive procedure." SECTION 2. Amends Section 4(c), Article 4512b, V.T.C.S., to require the Texas Board of Chiropractic Examiners (board) to adopt guidelines for educational preparation and acceptable practices which are within the scope of chiropractic practice as defined in Section 1 of this Act. SECTION 3. Amends Section 5a, Article 4512b, V.T.C.S., by adding Subsection (c), to provide that a person in violation of this section commits an offense classified as a Class A misdemeanor, or, if the person was previously convicted under this section, a felony of the third degree. Provides that each day of violation constitutes a separate offense. SECTION 4. Amends Article 4512b, V.T.C.S., by adding Section 12b, as follows: Sec. 12b. (a) Creates the advisory commission (commission) to the board. (b) Sets forth the composition of the commission. (c) Provides that each member serves at the pleasure of the authority that appointed the member. (d) Requires the president of the board to appoint the chair of the commission. (e) Prohibits members from being compensated for their services, but entitles members to reimbursement for expenses incurred in service to the commission. (f) Considers all expenses of the commission to be expenses necessary to the administration of this Act and requires them to be defrayed under Section 2. (g) Requires the commission to meet at least once each year at the call of the chair. (h) Provides that the commission serves to review new and experimental procedures, therapies, and tests which would be within the scope of the practice of chiropractic to determine the safety and efficacy of such procedures, therapies, and tests. SECTION 5. Amends Article 4512b, V.T.C.S., by adding Section 13b, as follows: Sec. 13b. (a) Requires the board to adopt a process to certify chiropractors to perform manipulation under anesthesia. Requires the process to include a requirement that the chiropractor demonstrate competence by submitting proof of successful completion of a postgraduate course in manipulation under anesthesia offered by a chiropractic college accredited by the Council on Chiropractic Education. (b) Requires a chiropractor certified by the board to perform manipulation under anesthesia to perform the procedure in a setting which provides immediate access to emergency medical care in the event of adverse reaction of the patient to the anesthesia. Requires anesthesia to be administered only by a medical or osteopathic doctor licensed by the Texas State Board of Medical Examiners to administer anesthesia and who shall be present throughout the chiropractic procedure. SECTION 6. Amends Section 14a, Article 4512b, V.T.C.S., to authorize the board to refuse to admit for examination and to cancel, revoke, suspend, or place on probation licensees for advertising or representing in the use of a professional name or title the term "physician," "chiropractic physician," or any combination or derivation of the term "physician." SECTION 7. Amends Section 14b, Article 4512b, V.T.C.S., to require the board to implement any federal and state law requirements relating to radiologic training of a chiropractor's employees. Makes nonsubstantive changes. SECTION 8. Amends Section 14c, Article 4512b, V.T.C.S., as follows: Sec. 14c. (a) Requires the enforcement committee appointed by the board to be composed of three board members, two of whom are doctors of chiropractic and one of whom is a representative of the general public. Deletes from membership the executive director of the board and a representative of the attorney general's office. (b) Authorizes the board to contract with a private attorney to advise the enforcement committee concerning complaints and other enforcement matters, if funds are available. Sec. 14c.1. (a) Created from existing text. (b) and (c) Redesignate existing Subsections (c) and (d). SECTION 9. Amends Section 19, Article 4512b, V.T.C.S., to make a conforming change. SECTION 10. Sets forth requirements for term limits under the Texas Board of Chiropractic Examiners. SECTION 11. (a) Requires any rule adopted or proposed by the Texas Board of Chiropractic Examiners on or after September 1, 1994, to be reviewed and amended in conformance with this Act, except for a rule relating to procedures for the conduct of a contested case under Chapter 2001, Government Code, or internal operating procedures. (b) Requires the board, not later than December 1, 1996, to submit a report to the governor, lieutenant governor, and speaker of the house of representatives on the results of the review and rulemaking actions under Subsection (a) of this section. SECTION 12. Requires the comptroller to review and analyze the effectiveness and efficiency of the policy, management, fiscal affairs, and operation of the Texas Board of Chiropractic Examiners. Requires the report to be made before January 10, 1997. SECTION 13. Emergency clause. Effective date: upon passage.