Introduction

The case of TEXAS BOARD OF CHIROPRACTIC EXAMINERS; PATRICK FORTNER, IN HIS OFFICIAL CAPACITY AS THE BOARD'S EXECUTIVE DIRECTOR; AND TEXAS CHIROPRACTIC ASSOCIATION v. TEXAS MEDICAL ASSOCIATION (616 S.W.3d 558) presents a critical examination of the boundaries of chiropractic practice as defined by Texas law. Petitioner entities, including the Texas Board of Chiropractic Examiners and the Texas Chiropractic Association, challenged rules established by the Chiropractic Board that expanded chiropractors' scope of practice to include eye examinations for diagnosing neurological conditions unrelated to the spine or musculoskeletal system. The respondent, the Texas Medical Association, argued that these rules exceeded the legislative authority granted to the Chiropractic Board.

Summary of the Judgment

Justice Jane N. Bland, joined by Justice Boyd, delivered a dissenting opinion in this case. The dissent argues that the Texas Board of Chiropractic Examiners overstepped its authority by permitting chiropractors to perform vestibular-ocular-nystagmus testing—an eye examination used to diagnose neurological conditions unrelated to the musculoskeletal system. The dissenting justices maintain that the Texas Legislature has explicitly limited chiropractors to practices strictly related to the spine and musculoskeletal system, as outlined in the Chiropractic Act. By authorizing tests beyond this scope, the Chiropractic Board violated the statutory limitations set by the Legislature.

Analysis

Precedents Cited

The dissent references several key precedents to bolster its argument:

• Tex. State Bd. of Exam'rs of Marriage & Family Therapists v. Tex. Med. Ass'n (511 S.W.3d 28, 33) emphasizes the importance of adhering to statutory language over agency interpretations.
• Univ. of Tex. v. Garner (595 S.W.3d 645, 651) underscores the principle that the Legislature's intent must guide statutory interpretation.
• Tex. Orthopaedic Ass'n v. Tex. State Bd. of Podiatric Medical Exam'rs (254 S.W.3d 714, 717) illustrates the judiciary's stance against agencies expanding professional scopes beyond legislative grants.

These precedents collectively reinforce the notion that administrative agencies, like the Chiropractic Board, cannot independently expand professional scopes without explicit legislative authorization.

Legal Reasoning

The dissent hinges on the strict interpretation of the Chiropractic Act, which confines chiropractors to diagnosing and treating conditions of the spine and musculoskeletal system. The Act explicitly states that chiropractors "must engage strictly in the practice of chiropractic as defined by law." The Chiropractic Board's authorization for chiropractors to perform neurological examinations falls outside this defined scope.

Furthermore, the dissent argues that expanding the scope of practice in this manner undermines the statutory framework that distinguishes non-physician healthcare providers. By allowing chiropractors to conduct tests related to the sensory nervous system and inner ear, the Board effectively erodes the Legislature's intention to limit chiropractic practices, thereby encroaching on roles traditionally reserved for medical doctors.

The dissent also contends that the Board's actions represent an overreach of its regulatory authority, as the Legislature is the sole body empowered to delineate professional scopes of practice. This interpretation aligns with the principle that courts should not substitute their policy preferences for those of the elected Legislature.

Impact

If the dissenting opinion were to become the prevailing viewpoint, it would reinforce stringent boundaries on non-physician healthcare providers, ensuring that professions like chiropractic care remain specialized and confined to their intended domains. This would prevent potential overlaps and conflicts between different healthcare disciplines, safeguarding patient safety by ensuring that diagnoses and treatments are conducted by appropriately qualified professionals.

Additionally, upholding the dissent's stance would limit the administrative agencies' abilities to expand professional scopes without legislative backing, thereby maintaining a clear separation of powers and respecting the Legislature's authority in defining healthcare roles.

Complex Concepts Simplified

Conclusion

The dissenting opinion in TEXAS BOARD OF CHIROPRACTIC EXAMINERS v. TEXAS MEDICAL ASSOCIATION serves as a robust defense of legislative authority in defining professional scopes of practice. By emphasizing the limits imposed by the Chiropractic Act, the dissent underscores the necessity of maintaining clear boundaries to ensure specialized and safe healthcare delivery. This judgment highlights the essential role of the Legislature in regulating healthcare professions and cautions against administrative overreach that could blur professional distinctions and potentially compromise patient care.