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Texas Performance Review
Realigning Chiropractic Oversight


Appendices
Appendix 1
TBCE Compliance with S.B. 673 Changes
Appendix 2
Texas Board of Chiropractic Examiners Disciplinary Actions - 1993-96


Appendix 1

TBCE Compliance with S.B. 673 Changes

Summary of Change in Law
(Citation in V.T.C.A., Article 4512b)
Implementation
Status
Scope of Practice: Adds language specifying that chiropractic practice involves non-surgical, nonincisive procedures, including but not limited to adjustment and manipulation to improve the subluxation complex. (Section 1)
The board had no rules regarding the scope of practice when these changes went into effect. Since then, the board has not adopted any new rules to give guidance to practitioners to ensure compliance with the law changes limiting the scope to "nonsurgical, nonincisive procedures."
Use of Needles: Specifically excludes incisive or surgical procedures from the practice of chiropractic. Defines "incisive or surgical procedure" as including but not limited to making an incision into any tissue, cavity, or organ by any person or implement. Specifies that this does not include the use of a needle for the purpose of drawing blood for diagnostic testing. (Section 13a)
Again, no rules have been developed to ensure compliance with these changes. In fact, the board does not interpret these provisions as restricting the use of needles by chiropractors.

For example, when considering the appropriateness of chiropractors injecting vitamin supplements, the board was concerned that this practice was potentially in conflict with restrictions on controlled substances, but was not concerned that it was in conflict with the provisions prohibiting "incisive" procedures.

Manipulation Under Anesthesia: Prohibits board from adopting a process to certify chiropractors to perform manipulation under anesthesia (MUA). (Section 13b)
The board states that this language only prohibits the board from certifying chiropractors to perform MUAs, but does not prohibit chiropractors from performing them. Therefore, the board is not restricting chiropractors from this practice.
Board Opinions: Requires the board to issue all opinions based on a vote of a majority of the board at a regular or called meeting. (Section 4(c))
The board is complying with this provision.
Advisory Commission: Creates a nine-member, multi-disciplinary advisory commission to advise the board on scientific and technical matters regarding new and experimental diagnostic and treatment practices, procedures, or instruments that are within the definition of chiropractic. Membership includes five chiropractors, two medical doctors, one nurse, and one pharmacist. (Section 12b)
Members were appointed in 1995 and met for the first time on July 11, 1996. The board seems unclear about the need for or use of this advisory commission. Issues related to the scope of practice continue to be referred to the Technical Standards Committee of the board.
Chiropractic Physician: Prohibits chiropractors from advertising using the term "physician," "chiropractic physician," or any combination or derivation of the term "physician." Authorizes use of the term "chiropractic physician" expressly for the purposes of filing a claim for necessary services within the definition of chiropractic under the act when the billing for such services has universally applied, predetermined coding or description requirements that are a prerequisite to appropriate reimbursement. (Section 14a.19)
The board notified chiropractors of this change but many had already submitted telephone book advertisements that could not be modified. Several complaints were received and the board is working with these chiropractors to ensure compliance.
Board Terms: Limits board members to two terms. (Section 3(h))
No action required.
Board President: Requires the board president be a doctor of chiropractic. (Section 3(h))
The current board president, a licensed doctor of chiropractic, was appointed by the governor in August 1995.
Rulemaking Authority: Requires the board to adopt rules, rather than guidelines, for the regulation and enforcement of the Act. Deletes provisions setting forth specific rules the chiropractic board is or is not allowed to make. (Section 4(c))
General rulemaking authority -- no specific action required.
Sanctions: Makes practice without a license a Class A Misdemeanor, each day separate offense. (Section 5a(c))
No action required.
Enforcement Committee: Changes the composition of the board's enforcement committee to two chiropractors and one public member. Deletes the executive director and attorney general representative from the committee. Requires the attorney general representative to provide legal counsel to the committee on enforcement matters. (Section 14c)
These changes are in place.
Information Files: Requires the board to keep an information file on each complaint listing all persons contacted; summarizes findings at each step; and listing a reason if the complaint is dismissed. (Section 14c.1(a))
These procedures are in place for all complaints. This language duplicates existing language in Section 14f.
Complaints: Requires semiannual notice to parties of status of complaint until resolved. (Section 14c.1(b))
Notice procedures are in place. This language is similar to existing language in Section 14(g), but it modified the time frame for notification from quarterly to semi-annually.
Requires the board to develop rules to standardize complaint information. Requires the board to provide reasonable assistance to a person filing a complaint. (Section 14c.1(c-d))
Rules governing the standardization of complaint information are covered in Section 75.9 of the TBCE rules. The board provides reasonable assistance to complainants.
Requires the board to develop rules regarding the retention of information files and expunction of files. (Section 14c.1(e))
The board has policies regarding the retention of information files, but they have not been adopted as rules. The board is working on rules on the expunction of files.
Rules: Requires any rule proposed or adopted after September 1, 1994 to be reviewed and amended in conformance with this Act, with limited exceptions. Requires the board to report to governor, lieutenant governor and speaker of the House of Representatives on the results of the review and rulemaking actions by December 1, 1996. (Instructional provision of S.B. 673)
The board readopted all of these rules by May 1996, with minor changes, to ensure compliance with this requirement. The board began a more substantive review of its rules in June 1996. The board will report to the Legislature on all of these changes before December 1, 1996.
Comptroller Review: Requires the Comptroller's office to perform a review and analyze the effectiveness and efficiency of the policy, management, fiscal affairs, and operations of TBCE, with a report by January 10, 1997. (Instructional provision of S.B. 673)
This report is the comptroller's response to this requirement.


Appendix 2

Texas Board of Chiropractic Examiners Disciplinary Actions - 1993-96
(By Type of Action and Type of Violation)

TYPE OF VIOLATION TYPE OF ACTION
  No Violation No Jurisdiction Pending Letter Warning Closed: Compliance Withdrawn Refer to AG Reprimand Agreed Order Non-renewal Suspension Revocation Total Percent of Total
Unprofessional Conduct 207 48 27 26 19 1 7 7 0 2 1 0 345 35.9%
Fee Dispute 93 60 13 11 3 14 1 1 0 0 0 0 196 20.4%
Advertising 91 13 12 30 13 1 0 1 1 0 0 0 162 16.9%
Radiation 75 1 4 1 2 3 0 0 0 1 0 0 87 9.1%
Sexual Misconduct 26 4 8 0 0 0 0 0 2 0 0 1 41 4.3%
Billing Irregularity 22 7 7 0 1 0 0 0 0 0 0 0 37 3.9%
Solicitation 19 9 3 1 0 0 0 0 0 0 0 0 32 3.3%
Practice w/o License 10 6 8 0 2 2 3 0 0 0 0 0 31 3.2%
Release of Records 12 7 2 1 0 0 0 0 0 0 0 0 22 2.3%
Utilization Review 2 1 1 0 0 0 0 0 0 0 0 0 4 0.4%
Testimonial 1 0 0 1 0 0 0 0 0 0 0 0 2 0.2%
Facility Registration 1 0 0 0 0 0 0 0 0 0 0 0 1 0.1%
Total 559 156 85 71 40 21 11 9 3 3 1 1 960 100.0%
Percent of Total 58.2% 16.3% 8.9% 7.4% 4.2% 2.2% 1.1% 0.9% 0.3% 0.3% 0.1% 0.1% 100.0%

Source: Texas Board of Chiropractic Examiners, Disciplinary Actions, 1993-96


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