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
1-24 prerequisite to appropriate reimbursement. A chiropractor may not
2-1 advertise using the term "physician," "chiropractic physician," or
2-2 any combination or derivation of the term "physician."
2-3 (b) The practice of chiropractic shall not be construed to
2-4 include incisive or surgical procedures or the prescribing of
2-5 controlled substances or dangerous drugs.
2-6 (c) In this Act, "incisive procedure" includes entry into
2-7 any tissue, cavity, or organ by any person or implement. It does
2-8 not include examination of the ear, nose, and throat, drawing blood
2-9 for the purposes of diagnostic testing, or acupuncture or needle
2-10 EMG if the chiropractor is certified to perform acupuncture or
2-11 needle EMG under Section 13b(d) of this Act.
2-12 SECTION 2. Subsection (h), Section 3, Chapter 94, Acts of
2-13 the 51st Legislature, Regular Session, 1949 (Article 4512b,
2-14 Vernon's Texas Civil Statutes), is amended to read as follows:
2-15 (h) The members of the Texas Board of Chiropractic Examiners
2-16 shall be divided into three (3) classes, one, two and three, and
2-17 are appointed for staggered six-year terms, with three members'
2-18 terms expiring on February 1 of each odd-numbered year. No person
2-19 may be appointed to serve more than two terms. The president of
2-20 the Board shall be a licensed doctor of chiropractic. Members hold
2-21 office for their terms and until their successors are duly
2-22 appointed and qualified. In case of death or resignation of a
2-23 member of the Board, the Governor shall appoint another to take his
2-24 place for the unexpired term only.
2-25 SECTION 3. Subsection (c), Section 4, Chapter 94, Acts of
2-26 the 51st Legislature, Regular Session, 1949 (Article 4512b,
2-27 Vernon's Texas Civil Statutes), is amended to read as follows:
3-1 (c) The Board shall adopt rules <guidelines> for regulation
3-2 and enforcement of this Act <educational preparation for all
3-3 aspects of the practice of chiropractic. The Board may not adopt a
3-4 rule relating to the meaning of the practice of chiropractic under
3-5 this Act except for:>
3-6 <(1) a rule relating to an adjustment, manipulation,
3-7 or other procedure directly related to improving the subluxation of
3-8 the spine or of the musculoskeletal system as it directly relates
3-9 to improving the subluxation of the spine; or>
3-10 <(2) a rule that defines an unacceptable practice of
3-11 chiropractic and provides for a penalty or sanction under this
3-12 Act>. The Board shall issue all opinions based on a vote of a
3-13 majority of the Board at a regular or called meeting. The issuance
3-14 of a disciplinary action or disciplinary order of the Board is not
3-15 limited by this subsection.
3-16 SECTION 4. Section 5a, Chapter 94, Acts of the 51st
3-17 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
3-18 Civil Statutes), is amended by adding Subsection (c) to read as
3-19 follows:
3-20 (c) A person who violates this section commits an offense.
3-21 An offense under this section is a Class A misdemeanor. If it is
3-22 shown at a trial of an offense under this section that the
3-23 defendant has previously been convicted under this section, the
3-24 offense is a felony of the third degree. Each day of violation
3-25 constitutes a separate offense.
3-26 SECTION 5. Chapter 94, Acts of the 51st Legislature, Regular
3-27 Session, 1949 (Article 4512b, Vernon's Texas Civil Statutes), is
4-1 amended by adding Section 12b to read as follows:
4-2 Sec. 12b. (a) The advisory commission to the Texas Board of
4-3 Chiropractic Examiners is created. The advisory commission shall
4-4 advise the Board on scientific and technical matters regarding new
4-5 and experimental diagnostic and treatment practices, procedures, or
4-6 instruments that are within the definition of chiropractic as set
4-7 out in Section 1 of this Act.
4-8 (b) The advisory commission shall be composed of:
4-9 (1) three persons who are licensees of the Board and
4-10 who are appointed by the Board;
4-11 (2) two licensees from chiropractic colleges in this
4-12 state appointed by the Board from a list submitted by the president
4-13 or governing body of each college;
4-14 (3) two licensees of the Texas State Board of Medical
4-15 Examiners who are designated by that board;
4-16 (4) one licensee of the Board of Nurse Examiners who
4-17 is designated by that board; and
4-18 (5) one licensee of the State Board of Pharmacy who is
4-19 designated by that board.
4-20 (c) Each member of the advisory commission serves at the
4-21 pleasure of the authority that appointed the member to the advisory
4-22 commission.
4-23 (d) The chair of the advisory commission shall be selected
4-24 from among the three members of the Board who are licensed doctors
4-25 of chiropractic.
4-26 (e) The members of the advisory commission shall serve
4-27 without compensation but are entitled to reimbursement for actual
5-1 expenses incurred in carrying out official duties, subject to the
5-2 approval of the chair of the advisory commission.
5-3 SECTION 6. Chapter 94, Acts of the 51st Legislature, Regular
5-4 Session, 1949 (Article 4512b, Vernon's Texas Civil Statutes), is
5-5 amended by adding Section 13b to read as follows:
5-6 Sec. 13b. (a) Notwithstanding any other provision in this
5-7 Act, the Board shall adopt a process to certify chiropractors to
5-8 perform manipulation under anesthesia. The process shall include,
5-9 but not be limited to, a requirement that the chiropractor
5-10 demonstrate competence by submitting proof of successful completion
5-11 of a postgraduate course in manipulation under anesthesia offered
5-12 by a chiropractic college accredited by the Council on Chiropractic
5-13 Education.
5-14 (b) A chiropractor certified by the Board to perform
5-15 manipulation under anesthesia shall perform the procedure in a
5-16 setting which provides immediate access to emergency medical care.
5-17 Anesthesia shall only be administered by a medical or osteopathic
5-18 doctor licensed by the Texas State Board of Medical Examiners to
5-19 administer anesthesia, who shall be present throughout the
5-20 chiropractic procedure.
5-21 (c) The Board shall adopt rules for the use of manipulation
5-22 under anesthesia by a chiropractor, including the indications and
5-23 contraindications for its use. In adopting these rules, the Board
5-24 shall consult with the advisory commission.
5-25 (d) The Board shall adopt a process to certify chiropractors
5-26 to perform acupuncture and needle EMG. The process shall include,
5-27 but not be limited to, a requirement that the chiropractor
6-1 demonstrate competence by submitting proof of successful completion
6-2 of a postgraduate course in acupuncture or needle EMG offered by a
6-3 chiropractic college accredited by the Council on Chiropractic
6-4 Education. The Board shall adopt rules for the use of acupuncture
6-5 and needle EMG by a chiropractor, including the indications and
6-6 contraindications for use. In adopting these rules, the Board
6-7 shall consult with the advisory commission.
6-8 SECTION 7. Section 14b, Chapter 94, Acts of the 51st
6-9 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
6-10 Civil Statutes), is amended to read as follows:
6-11 Sec. 14b. (a) The Board may require evidence of proper
6-12 training, precaution, and safety in the use of analytical and
6-13 diagnostic x-ray in conformity with the provisions of Chapter 401,
6-14 Health and Safety Code, and in conformity with all rules and
6-15 regulations of the Texas Radiation Control Agency and the Texas
6-16 State Department of Health. Nothing in this section <herein> shall
6-17 be deemed to alter, modify, or amend the provisions of Section 1 of
6-18 this Act<, Chapter 94, Acts of the 51st Legislature, 1949, as
6-19 amended (Article 4512b, Vernon's Texas Civil Statutes),> or to
6-20 enlarge in any manner the scope of the practice of chiropractic or
6-21 the acts which a chiropractor is authorized to perform; and,
6-22 provided further, that nothing in this section <herein> shall be
6-23 deemed to alter, modify, or amend the provisions of Article 4510,
6-24 Revised Civil Statutes of Texas, 1925, as amended. The Board shall
6-25 implement any federal law and state law requirements relating to
6-26 radiologic training of the employees of a chiropractor.
6-27 (b) The Board may, insofar as no conflict with other law
7-1 exists, adopt a certification process to differentiate chiropractic
7-2 licensees who have successfully completed advanced, postgraduate
7-3 training at a chiropractic college accredited by the Council on
7-4 Chiropractic Education or who have obtained certification through a
7-5 national chiropractic board.
7-6 SECTION 8. Section 14c, Chapter 94, Acts of the 51st
7-7 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
7-8 Civil Statutes), is amended to read as follows:
7-9 Sec. 14c. (a) The Board shall appoint an enforcement
7-10 committee to oversee and conduct the investigation of complaints
7-11 filed with the Board under this Act and to perform other duties
7-12 related to enforcement as directed by the Board. The enforcement
7-13 committee is composed of three<:>
7-14 <(1) two or more> Board members, two <at least one> of
7-15 whom are doctors <is a doctor> of chiropractic and <at least> one
7-16 of whom is a representative of the general public<;>
7-17 <(2) the executive director; and>
7-18 <(3) a representative of the attorney general's
7-19 office>.
7-20 (b) The attorney general shall provide legal counsel to the
7-21 enforcement committee concerning the investigation and disposition
7-22 of complaints and other enforcement matters.
7-23 Sec. 14c.1. (a) The Board shall keep an information file
7-24 about each complaint filed with the Board and referred to the
7-25 enforcement committee. The Board's information file shall contain
7-26 a record for each complaint of:
7-27 (1) all persons contacted in relation to the
8-1 complaints;
8-2 (2) a summary of findings made at each step of the
8-3 complaint process;
8-4 (3) an explanation of the reason for a complaint that
8-5 is dismissed; and
8-6 (4) other relevant information.
8-7 (b) If a written complaint is received by the Board that the
8-8 Board has authority to resolve, the Board, at least as frequently
8-9 as semiannually and until final disposition of the complaint, shall
8-10 notify the parties to the complaint of the status of the complaint
8-11 unless the notice would jeopardize an undercover investigation.
8-12 (c) The Board by rule shall adopt a form to standardize
8-13 information concerning complaints made to the Board. The Board by
8-14 rule shall prescribe information to be provided to a person when
8-15 the person files a complaint received by the Board.
8-16 (d) The Board shall provide reasonable assistance to a
8-17 person who wishes to file a complaint.
8-18 (e) The Board by rule shall adopt procedures concerning the
8-19 retention of information files on licensees and the expunction of
8-20 files on licensees including complaints, adverse reports, and other
8-21 investigative information on licensees.
8-22 Sec. 14c.2. (a) The Board shall adopt rules concerning the
8-23 investigation of complaints <a complaint> filed with the Board.
8-24 The rules adopted under this subsection shall:
8-25 (1) distinguish between categories of complaints;
8-26 (2) ensure that complaints are not dismissed without
8-27 appropriate consideration;
9-1 (3) require that the Board be advised of a complaint
9-2 that is dismissed and that a letter be sent to the person who filed
9-3 the complaint explaining the action taken on the dismissed
9-4 complaint;
9-5 (4) ensure that the person who filed the complaint has
9-6 the <an> opportunity to explain the allegations made in the
9-7 complaint; and
9-8 (5) prescribe guidelines concerning the categories of
9-9 complaints that require the use of a private investigator and the
9-10 procedures for the Board to obtain the services of a private
9-11 investigator.
9-12 (b) <(c)> The Board shall dispose of all complaints in a
9-13 timely manner. The Board shall establish a time line for
9-14 conducting each phase of a complaint that is under the control of
9-15 the Board not later than the 30th day after the date the complaint
9-16 is received by the Board. The time line shall be kept in the
9-17 information file for the complaint and all parties shall be
9-18 notified of the projected time requirements for pursuing the
9-19 complaint. A change in the time line must be noted in the
9-20 complaint information file and all parties to the complaint must be
9-21 notified not later than the seventh day after the date the change
9-22 is made.
9-23 (c) <(d)> The executive director of the Board shall notify
9-24 the Board of a complaint that extends beyond the time prescribed by
9-25 the Board for resolving the complaint so that the Board may take
9-26 necessary action on the complaint.
9-27 SECTION 9. Section 19, Chapter 94, Acts of the 51st
10-1 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
10-2 Civil Statutes), is amended to read as follows:
10-3 Sec. 19. Except as provided by Section 5a of this Act, a
10-4 person who <Whoever> violates any provision of this Act shall be
10-5 guilty of a misdemeanor, and upon conviction shall be punished by a
10-6 fine of not less than Fifty Dollars ($50) nor more than Five
10-7 Hundred Dollars ($500), or by imprisonment in the county jail for
10-8 not more than thirty (30) days.
10-9 SECTION 10. (a) Any rule adopted or proposed for adoption
10-10 by the Texas Board of Chiropractic Examiners on or after
10-11 September 1, 1994, must be reviewed and amended in conformance with
10-12 this Act except for a rule relating to:
10-13 (1) procedures for the conduct of a contested case
10-14 held under Chapter 2001, Government Code (Administrative Procedure
10-15 Act); or
10-16 (2) internal operating procedures.
10-17 (b) Not later than December 1, 1996, the Texas Board of
10-18 Chiropractic Examiners shall submit a report to the governor,
10-19 lieutenant governor, and speaker of the house of representatives on
10-20 the results of the review and rulemaking actions under Subsection
10-21 (a) of this section.
10-22 SECTION 11. The comptroller, under the authority of Section
10-23 403.022, Government Code, shall perform a review and shall analyze
10-24 the effectiveness and efficiency of the policy, management, fiscal
10-25 affairs, and operation of the Texas Board of Chiropractic
10-26 Examiners. The report shall be made before January 10, 1997.
10-27 SECTION 12. The importance of this legislation and the
11-1 crowded condition of the calendars in both houses create an
11-2 emergency and an imperative public necessity that the
11-3 constitutional rule requiring bills to be read on three several
11-4 days in each house be suspended, and this rule is hereby suspended,
11-5 and that this Act take effect and be in force from and after its
11-6 passage, and it is so enacted.
11-7 COMMITTEE AMENDMENT NO. 1
11-8 Amend C.S.S.B. 718 as follows:
11-9 (1) Amend S.B. 718 by striking lines 4 through 12, page 2.
11-10 (2) Amend S.B. 718 on page 1, at the end of line 13, after
11-11 the word "including" by inserting the words "but not limited to".
11-12 (3) Amend S.B. 718 by inserting the following new SECTION 6
11-13 and renumbering subsequent sections accordingly:
11-14 SECTION 6. Section 13a., Chapter 94, Acts of the 51st
11-15 Legislature, Regular Session, 1949 (Article 5412b), Vernon's Texas
11-16 Civil Statutes), is amended to read as follows:
11-17 Sec. 13a. (a) The practice of chiropractic shall not be
11-18 construed to include:
11-19 (1) incisive or surgical procedures;
11-20 (2) the prescribing of controlled substances or
11-21 dangerous drugs or any drug that requires a prescription; or
11-22 (3) the use of x-ray therapy, or therapy that exposes
11-23 the body to radioactive materials.
11-24 (b) In this act, "incisive or surgical procedure" means
11-25 making an incision into any tissue, cavity or organ by any person
11-26 or implement. It does not include the use of a needle for the
11-27 purposes of drawing blood for diagnostic testing. <A chiropractor
12-1 may not use in the chiropractors's practice surgery, drugs that
12-2 require a prescription to be dispensed, x-ray therapy, or therapy
12-3 that exposes the body to radioactive materials.>
12-4 Glaze
12-5 COMMITTEE AMENDMENT NO. 2
12-6 Amend S.B. No. 718 as follows:
12-7 (1) In SECTION 1 of the bill, in amended Section 1, Chapter
12-8 94, Acts of the 51st Legislature, Regular Session, 1949 (Article
12-9 4512b, Vernon's Texas Civil Statutes), strike Subsection (c) (page
12-10 2, lines 7-12, senate engrossment).
12-11 (2) In SECTION 6 of the bill, in added Section 13b, Chapter
12-12 94, Acts of the 51st Legislature, Regular Session, 1949 (Article
12-13 4512b, Vernon's Texas Civil Statutes), strike Subsection (d) (page
12-14 6, lines 7-16, senate engrossment).
12-15 (3) In SECTION 7 of the bill, in amended Section 14b,
12-16 Chapter 94, Acts of the 51st Legislature, Regular Session, 1949
12-17 (Article 4512b, Vernon's Texas Civil Statutes), strike "(a)" (page
12-18 6, line 20, senate engrossment).
12-19 (4) In SECTION 7 of the bill, in amended Section 14b,
12-20 Chapter 94, Acts of the 51st Legislature, Regular Session, 1949
12-21 (Article 4512b, Vernon's Texas Civil Statutes), strike Subsection
12-22 (b) (page 7, lines 11-16, senate engrossment).
12-23 Glaze
12-24 COMMITTEE AMENDMENT NO. 3
12-25 Amend SB 718, SECTION 6, Sec. 13b. as follows:
12-26 1) on page 5, line 14, between "to" and "certify", by adding
12-27 the word "annually";
13-1 2) on page 5, line 20, between "Education" and the period,
13-2 by adding "and passing an examination prepared by the Board to
13-3 assess the chiropractor's clinical ability to perform manipulation
13-4 under anesthesia";
13-5 Janek