Attorney Keith Pendleton, JD, in a ProvideLaw e-mail announcement on 4:00 p.m. ET, Monday, April 26, 2010, reports: "Chiropractors, if you care about your right to diagnose, then you should DEFINITELY read this brief message...."

"Last week, at the request of several ProviderLAW members in Texas, I took a look at a case that some of you may have heard about, but doesn't seem like it has hit the national press yet. I have to tell you, as a chiropractic patient myself, what I discovered was something of a shock."

"The Texas Medical Association - a founding member of an AMA-led nationwide consortium called the Scope of Practice Partnership (SOPP) - sued the Texas Board of Medical Examiners to remove the ability of chiropractors to diagnose. The TMA isn't just suing the TBCE on any old grounds either. It is challenging the ability of chiropractors to diagnose based on State constitutional grounds."

"If you have heard that this case is about Needle EMG or Manipulation Under Anesthesia, then you need to look a little closer. The TMA is challenging the ability of the chiropractors to diagnose and they're doing it based on State constitutional grounds...."

"Now, forget for a moment the fact that state statutes in Texas on their face seem to support the ability of chiropractors to diagnose in Texas. If DCs in Texas lose the ability to diagnose based on State constitutional grounds, do you realize the implications this could have for DCs nationwide? More importantly, do you realize the implications this could have for chiropractic patients -- and also parents with kids -- nationwide?"

"Let me put it another way: You may have the right in your State (currently) to diagnose....Then consider a few facts. Consider the fact that DCs have been diagnosing in Texas for decades. Consider the fact that State statutes in Texas on their face seem to provide that right. Consider the fact that Texas chiropractors have been reimbursed for years by insurance to diagnose (e.g., state worker's comp). Consider the fact that statutes like these are being challenged as unconstitutional. Consider the fact that they are being challenged by one of the founding members of a national consortium that is systematically challenging scope of practice nationwide and even publishes a chart of its current actions."

"Am I the first one to discover SOPP and Resolution 814? [see below] Absolutely not. Chiropractic organizations and thought leaders have known about SOPP for quite some time. What's different about it right now, as we speak, is that a tropical storm in Texas - a storm which in the public's eye has been about "Needle EMG" and "MUA" - has now upgraded into something much bigger -- the right to diagnose."

"Chiropractic organizations, leaders, and individuals - I have a suggestion for you....Make a contribution towards the ability of DCs to diagnose, even if it's a small one. When the TBCE was originally sued, the TCA voluntarily joined the lawsuit as a defendant and has been slugging it out ever since. Do you realize how much this costs? It could use everyone's help. Now. Trial date is set for August 16th."

"I personally am making this suggestion - and commitment -- because as a patient, parent, heck, even as a citizen, what I feel is really at stake with this case goes deeper than just the ability of DCs to diagnose."

"Make the call and make a small contribution towards your ability to diagnose. You can reach the TCA at 512-477-9292. I'm doing the same."

The text of Resolution 814 is:

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution: 814
Introduced by: Texas Delegation
Subject: Limited Licensure Health Care Provider Training and Certification Standards

Whereas, The physicians of America voluntarily perform a vital role through initial and subsequent credentialing and privileging of limited licensure health care providers at health care facilities and through peer review of the quality of care provided by these providers at these facilities; and

Whereas, In comparison to the uniform national standards of undergraduate and graduate medical education and board certification for physicians, the education and certification standards for limited licensure health care providers may not be uniform nor well defined nor generally understood by physicians and the public; and

Whereas, The American public and health care facilities’ governing boards properly rely upon physicians to be well-informed about the education, training, and certification standards of all health care professionals when performing voluntary credentialing, privileging, and peer-review; and

Whereas, State legislatures, courts, and regulatory agencies frequently call upon the opinions and/or testimony of informed physicians when they consider the public’s safety and qualifications in relation to the statutory limitations of practice of limited licensure health care providers; and

Whereas, While our American Medical Association has well defined the training and certification of allied health professionals in its 33rd edition of Health Professions Career and Education Directory, 2005-2006, there is no similar source of information on such limited licensure health care providers as chiropractors, optometrists, nurse anesthetists, advanced practice nurses, podiatrists, or psychologists; and

Whereas, The standards for admission, graduate education, postgraduate training, education, testing, graduation, board certification, board governance, ethics, professional discipline, and licensing of limited licensure health care providers are neither well-defined nor generally known by physicians or public members who voluntarily evaluate and recommend them, grant them privileges, and conduct peer review of the quality of care they provide; and

Whereas, The uniformity of training, autonomy of accrediting organizations, independence of peer review, and the role played by the professions’ trade associations of limited licensure health care providers are neither well defined nor generally known by physicians or public members who voluntarily evaluate and recommend them, grant them privileges, and conduct peer review of the quality of care they provide; therefore be it

RESOLVED, That our American Medical Association study the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of the limited licensure health care providers, including but not limited to, chiropractors, optometrists, nurse anesthetists, advanced practice nurses, podiatrists, and psychologists, and report back at the 2006 Annual Meeting. (Directive to Take Action)

Fiscal Note: Estimated cost of $171,975 includes two half-time employees for one year and input of legal counsel, and cost to publish the results of the study.

E-3.03 Allied Health Professionals
Physicians often practice in concert with allied health professionals such as, but not limited to, optometrists, nurse anesthetists, nurse midwives, and physician assistants in the course of delivering appropriate medical care to their patients. In doing so, physicians should be guided by the following principles:

(1) It is ethical for a physician to work in consultation with or employ allied health professionals, as long as they are appropriately trained and duly licensed to perform the activities being requested.

(2) Physicians have an ethical obligation to the patients for whom they are responsible to ensure that medical and surgical conditions are appropriately evaluated and treated.

(3) Physicians may teach in recognized schools for the allied health professionals for the purpose of improving the quality of their education. The scope of teaching may embrace subjects which are within the legitimate scope of the allied health profession and which are designed to prepare students to engage in the practice of the profession within the limits prescribed by law.

(4) It is inappropriate to substitute the services of an allied health professional for those of a physician when the allied health professional is not appropriately trained and duly licensed to provide the medical services being requested. (I, V, VII) Issued December 1997.

H-35.985 AMA Role in Allied Health Education and Accreditation The AMA reaffirms its commitment to promoting quality in allied health education. (CME Rep. E, I-86; Amended by Sunset Report, I-96)

H-35.996 Status and Utilization of New or Expanding Health Professionals in Hospitals

(1) The services of certain new health professionals, as well as those professionals assuming an expanded medical service role, may be made available for patient care within the limits of their skills and the scope of their authorized practice. The occupations concerned are those whose patient care activities involve medical diagnosis and treatment to such an extent that they meet the three criteria specified below:

(a) As authorized by the medical staff, they function in a newly expanded medical support role to the physician in the provision of patient care.

(b) They participate in the management of patients under the direct supervision or direction of a member of the medical staff who is responsible for the patient's care.

(c) They make entries on patients' records, including progress notes, only to the extent established by the medical staff. Thus this statement covers regulation of such categories as the new physician-support occupations generically termed physician's assistants, and those allied health professionals and nurses functioning in an expanded medical support role. It is not intended to cover regulation of nurses and allied health professionals performing their regular and customary roles, nor nurse practitioners functioning within the legal definition of nursing.

(2) The hospital governing authority should depend primarily on the medical staff to recommend the extent of functions which may be delegated to, and services which may be provided by, members of these emerging or expanding health professions. To carry out this obligation, the following procedures should be established in medical staff bylaws:

(a) Application for use of such professionals by medical staff members must be processed through the credentials committee or other medical staff channels in the same manner as applications for medical staff membership and privileges.

(b) The functions delegated to and the services provided by such personnel should be considered and specified by the medical staff in each instance, and should be based upon the individual's professional training, experience, and demonstrated competency, and upon the physician's capability and competence to supervise such an assistant.

(c) In those cases involving use by the physician of established health professionals functioning in an expanded medical support role, the organized medical staff should work closely with members of the appropriate discipline now employed in an administrative capacity by the hospital (for example, the director of nursing services) in delineating such functions.