1-1 By: Moncrief, Armbrister S.B. No. 718
1-2 (In the Senate - Filed February 22, 1995; February 23, 1995,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; April 18, 1995, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 8, Nays 0;
1-6 April 18, 1995, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 718 By: Moncrief
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the regulation of the practice of chiropractic;
1-11 providing a penalty.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Section 1, Chapter 94, Acts of the 51st
1-14 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
1-15 Civil Statutes), is amended to read as follows:
1-16 Sec. 1. (a) A person shall be regarded as practicing
1-17 chiropractic within the meaning of this Act if the person:
1-18 (1) uses objective or subjective means to analyze,
1-19 examine, or evaluate the subluxation complex and biomechanical
1-20 condition of the spine and appendicular skeleton and muscles of the
1-21 spine and appendicular skeleton <musculoskeletal system of the
1-22 human body>;
1-23 (2) performs non-surgical, non-invasive <uses
1-24 adjustment, manipulation, or other> procedures, including but not
1-25 limited to adjustment and manipulation, in order to improve the
1-26 subluxation complex and biomechanical condition of the spine and
1-27 appendicular skeleton and the muscles of the spine and appendicular
1-28 skeleton <or the biomechanics of the musculoskeletal system>; or
1-29 (3) holds himself out to the public as a chiropractor
1-30 or uses the term "chiropractor," "chiropractic," "doctor of
1-31 chiropractic," "D.C.," or any derivative of those terms in
1-32 connection with his name.
1-33 (b) The practice of chiropractic shall not be construed to
1-34 include invasive or surgical procedures or the prescribing of
1-35 controlled substances or dangerous drugs.
1-36 (c) In this Act, "invasive procedure" includes entry into
1-37 any tissue, cavity, or organ by any person or implement. It does
1-38 not include examination of the ear, nose, and throat or drawing
1-39 blood for the purposes of diagnostic testing.
1-40 SECTION 2. Subsection (c), Section 4, Chapter 94, Acts of
1-41 the 51st Legislature, Regular Session, 1949 (Article 4512b,
1-42 Vernon's Texas Civil Statutes), is amended to read as follows:
1-43 (c) The Board shall adopt guidelines for educational
1-44 preparation and acceptable practices which are within the scope of
1-45 chiropractic practice as defined in Section 1 of this Act <for all
1-46 aspects of the practice of chiropractic. The Board may not adopt a
1-47 rule relating to the meaning of the practice of chiropractic under
1-48 this Act except for:>
1-49 <(1) a rule relating to an adjustment, manipulation,
1-50 or other procedure directly related to improving the subluxation of
1-51 the spine or of the musculoskeletal system as it directly relates
1-52 to improving the subluxation of the spine; or>
1-53 <(2) a rule that defines an unacceptable practice of
1-54 chiropractic and provides for a penalty or sanction under this
1-55 Act>.
1-56 SECTION 3. Section 5a, Chapter 94, Acts of the 51st
1-57 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
1-58 Civil Statutes), is amended by adding Subsection (c) to read as
1-59 follows:
1-60 (c) A person who violates this section commits an offense.
1-61 An offense under this section is a Class A misdemeanor. If it is
1-62 shown at a trial of an offense under this section that the
1-63 defendant has previously been convicted under this section, the
1-64 offense is a felony of the third degree. Each day of violation
1-65 constitutes a separate offense.
1-66 SECTION 4. Chapter 94, Acts of the 51st Legislature, Regular
1-67 Session, 1949 (Article 4512b, Vernon's Texas Civil Statutes), is
1-68 amended by adding Section 12b to read as follows:
2-1 Sec. 12b. (a) The advisory commission to the Texas Board of
2-2 Chiropractic Examiners is created.
2-3 (b) The advisory commission is composed of:
2-4 (1) three persons who are licensees of the Board and
2-5 who are appointed by the Board;
2-6 (2) two representatives from chiropractic colleges in
2-7 this state appointed by the president of the Board from a list
2-8 submitted by the president or governing body of each college;
2-9 (3) two members of the Texas State Board of Medical
2-10 Examiners who are designated by that board;
2-11 (4) one member of the Board of Nurse Examiners who is
2-12 designated by that board; and
2-13 (5) one member of the State Board of Pharmacy who is
2-14 designated by that board.
2-15 (c) Each member of the advisory commission serves at the
2-16 pleasure of the authority that appointed the member to the advisory
2-17 commission.
2-18 (d) The president of the Board shall appoint the chair of
2-19 the advisory commission.
2-20 (e) The members of the advisory commission are not entitled
2-21 to compensation for their services, but each member is entitled to
2-22 reimbursement for any necessary expense incurred in the performance
2-23 of the member's duties on the advisory committee including
2-24 necessary travel expenses.
2-25 (f) All expenses of the advisory commission shall be
2-26 considered expenses necessary to the administration of this Act and
2-27 shall be defrayed as provided in Section 2 of this Act.
2-28 (g) The advisory commission shall meet at least once each
2-29 year at the call of the chair.
2-30 (h) The advisory commission serves to review new and
2-31 experimental procedures, therapies, and tests which would be within
2-32 the scope of the practice of chiropractic as defined in this Act to
2-33 determine the safety and efficacy of such procedures, therapies,
2-34 and tests.
2-35 SECTION 5. Chapter 94, Acts of the 51st Legislature, Regular
2-36 Session, 1949 (Article 4512b, Vernon's Texas Civil Statutes), is
2-37 amended by adding Section 13b to read as follows:
2-38 Sec. 13b. (a) Notwithstanding any other provision in this
2-39 Act, the Board shall adopt a process to certify chiropractors to
2-40 perform manipulation under anesthesia. The process shall include,
2-41 but not be limited to, a requirement that the chiropractor
2-42 demonstrate competence by submitting proof of successful completion
2-43 of a postgraduate course in manipulation under anesthesia offered
2-44 by a chiropractic college accredited by the Council on Chiropractic
2-45 Education.
2-46 (b) A chiropractor certified by the Board to perform
2-47 manipulation under anesthesia shall perform the procedure in a
2-48 setting which provides immediate access to emergency medical care
2-49 in the event of adverse reaction of the patient to the anesthesia.
2-50 Anesthesia shall only be administered by a medical or osteopathic
2-51 doctor licensed by the Texas State Board of Medical Examiners to
2-52 administer anesthesia, who shall be present throughout the
2-53 chiropractic procedure.
2-54 SECTION 6. Section 14a, Chapter 94, Acts of the 51st
2-55 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
2-56 Civil Statutes), is amended to read as follows:
2-57 Sec. 14a. The Texas Board of Chiropractic Examiners may
2-58 refuse to admit persons to its examinations and may cancel, revoke
2-59 or suspend licenses or place licensees upon probation for such
2-60 length of time as may be deemed proper by the Board for any one or
2-61 more of the following causes:
2-62 1. For failure to comply with, or the violation of,
2-63 any of the provisions of this Act or of a rule adopted under this
2-64 Act;
2-65 2. If it is found that said person or persons are in
2-66 any way guilty of deception or fraud in the practice of
2-67 chiropractic;
2-68 3. The presentation to the Board or use of any
2-69 license, certificate or diploma, which was illegally or
2-70 fraudulently obtained, or the presentation to the Board of any
3-1 untrue statement or any document or testimony which was illegally
3-2 practiced in passing the examination;
3-3 4. Conviction of a crime of the grade of a felony, or
3-4 one which involves moral turpitude, or the procuring or assisting
3-5 in the procuring of an abortion;
3-6 5. Grossly unprofessional conduct or dishonorable
3-7 conduct of a character likely to deceive or defraud the public,
3-8 habits of intemperance or drug addiction, or other habits
3-9 calculated in the opinion of the Board to endanger the lives of
3-10 patients;
3-11 6. The use of any advertising statement of a character
3-12 to mislead or deceive the public;
3-13 7. Employing or associating with, directly or
3-14 indirectly, any person who, during the period of such employment,
3-15 commits any act constituting the practice of chiropractic when such
3-16 person is not licensed to do so;
3-17 8. The advertising of professional superiority, or the
3-18 advertising of the performance of professional services in a
3-19 superior manner;
3-20 9. The purchase, sale, barter, use, or any offer to
3-21 purchase, sell, barter or use, any chiropractic degree, license,
3-22 certificate, or diploma, or transcript of license, certificate, or
3-23 diploma in or incident to an application to the Board of
3-24 Chiropractic Examiners for license to practice chiropractic;
3-25 10. Altering with fraudulent intent any chiropractic
3-26 license, certificate or diploma, or transcript of chiropractic
3-27 license, certificate or diploma;
3-28 11. The impersonation of, or acting as proxy for,
3-29 another in any examination required by this Act for a chiropractic
3-30 license;
3-31 12. The impersonation of a licensed practitioner, or
3-32 the permitting or allowing another to use his license or
3-33 certificate to practice chiropractic as defined by statute by a
3-34 licensed practitioner;
3-35 13. Proof of insanity of the holder of a certificate,
3-36 as adjudged by the regularly constituted authorities;
3-37 14. Failure to use proper diligence in the practice of
3-38 chiropractic by the holder of a certificate, or grossly inefficient
3-39 practice of chiropractic;
3-40 15. Failing to clearly differentiate a chiropractic
3-41 office or clinic from any other business or enterprise;
3-42 16. Personally soliciting patients, or causing
3-43 patients to be solicited, by the use of case histories of patients
3-44 of other chiropractors;
3-45 17. Using an accident report prepared by a peace
3-46 officer in a manner prohibited by Section 38.12, Penal Code, for
3-47 the purpose of soliciting patients; <or>
3-48 18. If, when uninvited, a licensee or person
3-49 designated, contracted or paid by licensee directly canvasses,
3-50 drums, secures or solicits by phone, mail or in person patients or
3-51 potential patients who, because of their particular circumstances,
3-52 are vulnerable to undue influence. Circumstances in which patients
3-53 or potential patients may be considered to be vulnerable to undue
3-54 influence include but are not limited to:
3-55 a. when a person is known to the licensee to
3-56 have recently been involved in a motor vehicle accident;
3-57 b. when a person is known to the licensee to
3-58 have recently been involved in a work-related accident; or
3-59 c. when a person is known to the licensee to
3-60 have recently been injured by another person or as a result of
3-61 another person's actions; or
3-62 19. Advertising or representing in the use of a
3-63 professional name or title the term "physician," "chiropractic
3-64 physician," or any combination or derivation of the term
3-65 "physician."<.>
3-66 SECTION 7. Section 14b, Chapter 94, Acts of the 51st
3-67 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
3-68 Civil Statutes), is amended to read as follows:
3-69 Sec. 14b. The Board may require evidence of proper training,
3-70 precaution, and safety in the use of analytical and diagnostic
4-1 x-ray in conformity with the provisions of Chapter 401, Health and
4-2 Safety Code, and in conformity with all rules and regulations of
4-3 the Texas Radiation Control Agency and the Texas State Department
4-4 of Health. Nothing in this section <herein> shall be deemed to
4-5 alter, modify, or amend the provisions of Section 1 of this Act<,
4-6 Chapter 94, Acts of the 51st Legislature, 1949, as amended (Article
4-7 4512b, Vernon's Texas Civil Statutes),> or to enlarge in any manner
4-8 the scope of the practice of chiropractic or the acts which a
4-9 chiropractor is authorized to perform; and, provided further, that
4-10 nothing in this section <herein> shall be deemed to alter, modify,
4-11 or amend the provisions of Article 4510, Revised Civil Statutes of
4-12 Texas, 1925, as amended. The Board shall implement any federal law
4-13 and state law requirements relating to radiologic training of the
4-14 employees of a chiropractor.
4-15 SECTION 8. Section 14c, Chapter 94, Acts of the 51st
4-16 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
4-17 Civil Statutes), is amended to read as follows:
4-18 Sec. 14c. (a) The Board shall appoint an enforcement
4-19 committee to oversee and conduct the investigation of complaints
4-20 filed with the Board under this Act and to perform other duties
4-21 related to enforcement as directed by the Board. The enforcement
4-22 committee is composed of three<:>
4-23 <(1) two or more> Board members, two <at least one> of
4-24 whom are doctors <is a doctor> of chiropractic and <at least> one
4-25 of whom is a representative of the general public<;>
4-26 <(2) the executive director; and>
4-27 <(3) a representative of the attorney general's
4-28 office>.
4-29 (b) If sufficient funds are available, the Board may
4-30 contract with a private attorney to advise the enforcement
4-31 committee concerning complaints and other enforcement matters and
4-32 the investigation and disposition of complaints and other
4-33 enforcement matters.
4-34 Sec. 14c.1. (a) The Board shall adopt rules concerning the
4-35 investigation of a complaint filed with the Board. The rules
4-36 adopted under this subsection shall:
4-37 (1) distinguish between categories of complaints;
4-38 (2) ensure that complaints are not dismissed without
4-39 appropriate consideration;
4-40 (3) require that the Board be advised of a complaint
4-41 that is dismissed and that a letter be sent to the person who filed
4-42 the complaint explaining the action taken on the dismissed
4-43 complaint;
4-44 (4) ensure that the person who filed the complaint has
4-45 an opportunity to explain the allegations made in the complaint;
4-46 and
4-47 (5) prescribe guidelines concerning the categories of
4-48 complaints that require the use of a private investigator and the
4-49 procedures for the Board to obtain the services of a private
4-50 investigator.
4-51 (b) <(c)> The Board shall dispose of all complaints in a
4-52 timely manner. The Board shall establish a time line for
4-53 conducting each phase of a complaint that is under the control of
4-54 the Board not later than the 30th day after the date the complaint
4-55 is received by the Board. The time line shall be kept in the
4-56 information file for the complaint and all parties shall be
4-57 notified of the projected time requirements for pursuing the
4-58 complaint. A change in the time line must be noted in the
4-59 complaint information file and all parties to the complaint must be
4-60 notified not later than the seventh day after the date the change
4-61 is made.
4-62 (c) <(d)> The executive director of the Board shall notify
4-63 the Board of a complaint that extends beyond the time prescribed by
4-64 the Board for resolving the complaint so that the Board may take
4-65 necessary action on the complaint.
4-66 SECTION 9. Section 19, Chapter 94, Acts of the 51st
4-67 Legislature, Regular Session, 1949 (Article 4512b, Vernon's Texas
4-68 Civil Statutes), is amended to read as follows:
4-69 Sec. 19. Except as provided by Section 5a of this Act, a
4-70 person who <Whoever> violates any provision of this Act shall be
5-1 guilty of a misdemeanor, and upon conviction shall be punished by a
5-2 fine of not less than Fifty Dollars ($50) nor more than Five
5-3 Hundred Dollars ($500), or by imprisonment in the county jail for
5-4 not more than thirty (30) days.
5-5 SECTION 10. (a) Any rule adopted or proposed for adoption
5-6 by the Texas Board of Chiropractic Examiners on or after
5-7 September 1, 1994, must be reviewed and amended in conformance with
5-8 this Act except for a rule relating to:
5-9 (1) procedures for the conduct of a contested case
5-10 held under Chapter 2001, Government Code (Administrative Procedure
5-11 Act); or
5-12 (2) internal operating procedures.
5-13 (b) Not later than December 1, 1996, the Texas Board of
5-14 Chiropractic Examiners shall submit a report to the governor,
5-15 lieutenant governor, and speaker of the house of representatives on
5-16 the results of the review and rulemaking actions under Subsection
5-17 (a) of this section.
5-18 SECTION 11. The comptroller, under the authority of Section
5-19 403.022, Government Code, shall perform a review and shall analyze
5-20 the effectiveness and efficiency of the policy, management, fiscal
5-21 affairs, and operation of the Texas Board of Chiropractic
5-22 Examiners. The report shall be made before January 10, 1997.
5-23 SECTION 12. The importance of this legislation and the
5-24 crowded condition of the calendars in both houses create an
5-25 emergency and an imperative public necessity that the
5-26 constitutional rule requiring bills to be read on three several
5-27 days in each house be suspended, and this rule is hereby suspended,
5-28 and that this Act take effect and be in force from and after its
5-29 passage, and it is so enacted.
5-30 * * * * *