By: Moncrief, Armbrister S.B. No. 718
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the regulation of the practice of chiropractic;
1-2 providing a penalty.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 1, Chapter 94, Acts of the 51st
1-5 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
1-6 Civil Statutes), is amended to read as follows:
1-7 Sec. 1. (a) A person shall be regarded as practicing
1-8 chiropractic within the meaning of this Act if the person:
1-9 (1) uses objective or subjective means to analyze,
1-10 examine, or evaluate the biomechanical condition of the spine and
1-11 musculoskeletal system of the human body;
1-12 (2) performs nonsurgical, nonincisive <uses
1-13 adjustment, manipulation, or other> procedures, including
1-14 adjustment and manipulation, in order to improve the subluxation
1-15 complex or the biomechanics of the musculoskeletal system; or
1-16 (3) holds himself out to the public as a chiropractor
1-17 or uses the term "chiropractor," "chiropractic," "doctor of
1-18 chiropractic," "D.C.," or any derivative of those terms in
1-19 connection with his name. The term "chiropractic physician" may be
1-20 used for the express purpose of filing a claim for necessary
1-21 services within the definition of chiropractic under this Act when
1-22 the billing for such services has universally applied,
1-23 predetermined coding or description requirements that are a
2-1 prerequisite to appropriate reimbursement. A chiropractor may not
2-2 advertise using the term "physician," "chiropractic physician," or
2-3 any combination or derivation of the term "physician."
2-4 (b) The practice of chiropractic shall not be construed to
2-5 include incisive or surgical procedures or the prescribing of
2-6 controlled substances or dangerous drugs.
2-7 (c) In this Act, "incisive procedure" includes entry into
2-8 any tissue, cavity, or organ by any person or implement. It does
2-9 not include examination of the ear, nose, and throat, drawing blood
2-10 for the purposes of diagnostic testing, or acupuncture or needle
2-11 EMG if the chiropractor is certified to perform acupuncture or
2-12 needle EMG under Section 13b(d) of this Act.
2-13 SECTION 2. Subsection (h), Section 3, Chapter 94, Acts of
2-14 the 51st Legislature, Regular Session, 1949 (Article 4512b,
2-15 Vernon's Texas Civil Statutes), is amended to read as follows:
2-16 (h) The members of the Texas Board of Chiropractic Examiners
2-17 shall be divided into three (3) classes, one, two and three, and
2-18 are appointed for staggered six-year terms, with three members'
2-19 terms expiring on February 1 of each odd-numbered year. No person
2-20 may be appointed to serve more than two terms. The president of
2-21 the Board shall be a licensed doctor of chiropractic. Members hold
2-22 office for their terms and until their successors are duly
2-23 appointed and qualified. In case of death or resignation of a
2-24 member of the Board, the Governor shall appoint another to take his
2-25 place for the unexpired term only.
3-1 SECTION 3. Subsection (c), Section 4, Chapter 94, Acts of
3-2 the 51st Legislature, Regular Session, 1949 (Article 4512b,
3-3 Vernon's Texas Civil Statutes), is amended to read as follows:
3-4 (c) The Board shall adopt rules <guidelines> for regulation
3-5 and enforcement of this Act <educational preparation for all
3-6 aspects of the practice of chiropractic. The Board may not adopt a
3-7 rule relating to the meaning of the practice of chiropractic under
3-8 this Act except for:>
3-9 <(1) a rule relating to an adjustment, manipulation,
3-10 or other procedure directly related to improving the subluxation of
3-11 the spine or of the musculoskeletal system as it directly relates
3-12 to improving the subluxation of the spine; or>
3-13 <(2) a rule that defines an unacceptable practice of
3-14 chiropractic and provides for a penalty or sanction under this
3-15 Act>. The Board shall issue all opinions based on a vote of a
3-16 majority of the Board at a regular or called meeting. The issuance
3-17 of a disciplinary action or disciplinary order of the Board is not
3-18 limited by this subsection.
3-19 SECTION 4. Section 5a, Chapter 94, Acts of the 51st
3-20 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
3-21 Civil Statutes), is amended by adding Subsection (c) to read as
3-22 follows:
3-23 (c) A person who violates this section commits an offense.
3-24 An offense under this section is a Class A misdemeanor. If it is
3-25 shown at a trial of an offense under this section that the
4-1 defendant has previously been convicted under this section, the
4-2 offense is a felony of the third degree. Each day of violation
4-3 constitutes a separate offense.
4-4 SECTION 5. Chapter 94, Acts of the 51st Legislature, Regular
4-5 Session, 1949 (Article 4512b, Vernon's Texas Civil Statutes), is
4-6 amended by adding Section 12b to read as follows:
4-7 Sec. 12b. (a) The advisory commission to the Texas Board of
4-8 Chiropractic Examiners is created. The advisory commission shall
4-9 advise the Board on scientific and technical matters regarding new
4-10 and experimental diagnostic and treatment practices, procedures, or
4-11 instruments that are within the definition of chiropractic as set
4-12 out in Section 1 of this Act.
4-13 (b) The advisory commission shall be composed of:
4-14 (1) three persons who are licensees of the Board and
4-15 who are appointed by the Board;
4-16 (2) two licensees from chiropractic colleges in this
4-17 state appointed by the Board from a list submitted by the president
4-18 or governing body of each college;
4-19 (3) two licensees of the Texas State Board of Medical
4-20 Examiners who are designated by that board;
4-21 (4) one licensee of the Board of Nurse Examiners who
4-22 is designated by that board; and
4-23 (5) one licensee of the State Board of Pharmacy who is
4-24 designated by that board.
4-25 (c) Each member of the advisory commission serves at the
5-1 pleasure of the authority that appointed the member to the advisory
5-2 commission.
5-3 (d) The chair of the advisory commission shall be selected
5-4 from among the three members of the Board who are licensed doctors
5-5 of chiropractic.
5-6 (e) The members of the advisory commission shall serve
5-7 without compensation but are entitled to reimbursement for actual
5-8 expenses incurred in carrying out official duties, subject to the
5-9 approval of the chair of the advisory commission.
5-10 SECTION 6. Chapter 94, Acts of the 51st Legislature, Regular
5-11 Session, 1949 (Article 4512b, Vernon's Texas Civil Statutes), is
5-12 amended by adding Section 13b to read as follows:
5-13 Sec. 13b. (a) Notwithstanding any other provision in this
5-14 Act, the Board shall adopt a process to certify chiropractors to
5-15 perform manipulation under anesthesia. The process shall include,
5-16 but not be limited to, a requirement that the chiropractor
5-17 demonstrate competence by submitting proof of successful completion
5-18 of a postgraduate course in manipulation under anesthesia offered
5-19 by a chiropractic college accredited by the Council on Chiropractic
5-20 Education.
5-21 (b) A chiropractor certified by the Board to perform
5-22 manipulation under anesthesia shall perform the procedure in a
5-23 setting which provides immediate access to emergency medical care.
5-24 Anesthesia shall only be administered by a medical or osteopathic
5-25 doctor licensed by the Texas State Board of Medical Examiners to
6-1 administer anesthesia, who shall be present throughout the
6-2 chiropractic procedure.
6-3 (c) The Board shall adopt rules for the use of manipulation
6-4 under anesthesia by a chiropractor, including the indications and
6-5 contraindications for its use. In adopting these rules, the Board
6-6 shall consult with the advisory commission.
6-7 (d) The Board shall adopt a process to certify chiropractors
6-8 to perform acupuncture and needle EMG. The process shall include,
6-9 but not be limited to, a requirement that the chiropractor
6-10 demonstrate competence by submitting proof of successful completion
6-11 of a postgraduate course in acupuncture or needle EMG offered by a
6-12 chiropractic college accredited by the Council on Chiropractic
6-13 Education. The Board shall adopt rules for the use of acupuncture
6-14 and needle EMG by a chiropractor, including the indications and
6-15 contraindications for use. In adopting these rules, the Board
6-16 shall consult with the advisory commission.
6-17 SECTION 7. Section 14b, Chapter 94, Acts of the 51st
6-18 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
6-19 Civil Statutes), is amended to read as follows:
6-20 Sec. 14b. (a) The Board may require evidence of proper
6-21 training, precaution, and safety in the use of analytical and
6-22 diagnostic x-ray in conformity with the provisions of Chapter 401,
6-23 Health and Safety Code, and in conformity with all rules and
6-24 regulations of the Texas Radiation Control Agency and the Texas
6-25 State Department of Health. Nothing in this section <herein> shall
7-1 be deemed to alter, modify, or amend the provisions of Section 1 of
7-2 this Act<, Chapter 94, Acts of the 51st Legislature, 1949, as
7-3 amended (Article 4512b, Vernon's Texas Civil Statutes),> or to
7-4 enlarge in any manner the scope of the practice of chiropractic or
7-5 the acts which a chiropractor is authorized to perform; and,
7-6 provided further, that nothing in this section <herein> shall be
7-7 deemed to alter, modify, or amend the provisions of Article 4510,
7-8 Revised Civil Statutes of Texas, 1925, as amended. The Board shall
7-9 implement any federal law and state law requirements relating to
7-10 radiologic training of the employees of a chiropractor.
7-11 (b) The Board may, insofar as no conflict with other law
7-12 exists, adopt a certification process to differentiate chiropractic
7-13 licensees who have successfully completed advanced, postgraduate
7-14 training at a chiropractic college accredited by the Council on
7-15 Chiropractic Education or who have obtained certification through a
7-16 national chiropractic board.
7-17 SECTION 8. Section 14c, Chapter 94, Acts of the 51st
7-18 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
7-19 Civil Statutes), is amended to read as follows:
7-20 Sec. 14c. (a) The Board shall appoint an enforcement
7-21 committee to oversee and conduct the investigation of complaints
7-22 filed with the Board under this Act and to perform other duties
7-23 related to enforcement as directed by the Board. The enforcement
7-24 committee is composed of three<:>
7-25 <(1) two or more> Board members, two <at least one> of
8-1 whom are doctors <is a doctor> of chiropractic and <at least> one
8-2 of whom is a representative of the general public<;>
8-3 <(2) the executive director; and>
8-4 <(3) a representative of the attorney general's
8-5 office>.
8-6 (b) The attorney general shall provide legal counsel to the
8-7 enforcement committee concerning the investigation and disposition
8-8 of complaints and other enforcement matters.
8-9 Sec. 14c.1. (a) The Board shall keep an information file
8-10 about each complaint filed with the Board and referred to the
8-11 enforcement committee. The Board's information file shall contain
8-12 a record for each complaint of:
8-13 (1) all persons contacted in relation to the
8-14 complaints;
8-15 (2) a summary of findings made at each step of the
8-16 complaint process;
8-17 (3) an explanation of the reason for a complaint that
8-18 is dismissed; and
8-19 (4) other relevant information.
8-20 (b) If a written complaint is received by the Board that the
8-21 Board has authority to resolve, the Board, at least as frequently
8-22 as semiannually and until final disposition of the complaint, shall
8-23 notify the parties to the complaint of the status of the complaint
8-24 unless the notice would jeopardize an undercover investigation.
8-25 (c) The Board by rule shall adopt a form to standardize
9-1 information concerning complaints made to the Board. The Board by
9-2 rule shall prescribe information to be provided to a person when
9-3 the person files a complaint received by the Board.
9-4 (d) The Board shall provide reasonable assistance to a
9-5 person who wishes to file a complaint.
9-6 (e) The Board by rule shall adopt procedures concerning the
9-7 retention of information files on licensees and the expunction of
9-8 files on licensees including complaints, adverse reports, and other
9-9 investigative information on licensees.
9-10 Sec. 14c.2. (a) The Board shall adopt rules concerning the
9-11 investigation of complaints <a complaint> filed with the Board.
9-12 The rules adopted under this subsection shall:
9-13 (1) distinguish between categories of complaints;
9-14 (2) ensure that complaints are not dismissed without
9-15 appropriate consideration;
9-16 (3) require that the Board be advised of a complaint
9-17 that is dismissed and that a letter be sent to the person who filed
9-18 the complaint explaining the action taken on the dismissed
9-19 complaint;
9-20 (4) ensure that the person who filed the complaint has
9-21 the <an> opportunity to explain the allegations made in the
9-22 complaint; and
9-23 (5) prescribe guidelines concerning the categories of
9-24 complaints that require the use of a private investigator and the
9-25 procedures for the Board to obtain the services of a private
10-1 investigator.
10-2 (b) <(c)> The Board shall dispose of all complaints in a
10-3 timely manner. The Board shall establish a time line for
10-4 conducting each phase of a complaint that is under the control of
10-5 the Board not later than the 30th day after the date the complaint
10-6 is received by the Board. The time line shall be kept in the
10-7 information file for the complaint and all parties shall be
10-8 notified of the projected time requirements for pursuing the
10-9 complaint. A change in the time line must be noted in the
10-10 complaint information file and all parties to the complaint must be
10-11 notified not later than the seventh day after the date the change
10-12 is made.
10-13 (c) <(d)> The executive director of the Board shall notify
10-14 the Board of a complaint that extends beyond the time prescribed by
10-15 the Board for resolving the complaint so that the Board may take
10-16 necessary action on the complaint.
10-17 SECTION 9. Section 19, Chapter 94, Acts of the 51st
10-18 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
10-19 Civil Statutes), is amended to read as follows:
10-20 Sec. 19. Except as provided by Section 5a of this Act, a
10-21 person who <Whoever> violates any provision of this Act shall be
10-22 guilty of a misdemeanor, and upon conviction shall be punished by a
10-23 fine of not less than Fifty Dollars ($50) nor more than Five
10-24 Hundred Dollars ($500), or by imprisonment in the county jail for
10-25 not more than thirty (30) days.
11-1 SECTION 10. (a) Any rule adopted or proposed for adoption
11-2 by the Texas Board of Chiropractic Examiners on or after
11-3 September 1, 1994, must be reviewed and amended in conformance with
11-4 this Act except for a rule relating to:
11-5 (1) procedures for the conduct of a contested case
11-6 held under Chapter 2001, Government Code (Administrative Procedure
11-7 Act); or
11-8 (2) internal operating procedures.
11-9 (b) Not later than December 1, 1996, the Texas Board of
11-10 Chiropractic Examiners shall submit a report to the governor,
11-11 lieutenant governor, and speaker of the house of representatives on
11-12 the results of the review and rulemaking actions under Subsection
11-13 (a) of this section.
11-14 SECTION 11. The comptroller, under the authority of Section
11-15 403.022, Government Code, shall perform a review and shall analyze
11-16 the effectiveness and efficiency of the policy, management, fiscal
11-17 affairs, and operation of the Texas Board of Chiropractic
11-18 Examiners. The report shall be made before January 10, 1997.
11-19 SECTION 12. The importance of this legislation and the
11-20 crowded condition of the calendars in both houses create an
11-21 emergency and an imperative public necessity that the
11-22 constitutional rule requiring bills to be read on three several
11-23 days in each house be suspended, and this rule is hereby suspended,
11-24 and that this Act take effect and be in force from and after its
11-25 passage, and it is so enacted.