The Ft. Worth Star-Telegram REPORTS HERE in a story about the TMA v. TBCE Lawsuit, and reported on June 12, reports that a "chiropractor, often suspects that a herniated disc is to blame when patients complain of back pain shooting down their legs. But it could also be a fatty cyst or even bone cancer. To try to find out [they] run tests and order an MRI.  But do White and other chiropractors have the training or legal authority to diagnose such medical conditions?"
 
"That question is at the heart of a lawsuit by the Texas Medical Association, which represents [medical] physicians. The organization is challenging chiropractors' qualifications to diagnose anything beyond skeletal problems."

"The suit, scheduled to be heard by an Austin state district judge in August, says chiropractors have overstepped their scope of practice, saying misdiagnosis can mean delayed or inappropriate treatment. Diagnosing medical conditions undermines the purpose of the Texas Medical Practice Act, said David Bragg, an attorney for the [medical] association."

"Allowing chiropractors to diagnose a medical condition is beyond their training, scope and expertise," he said. "I do a lot of nursing home neglect cases, and I know a lot about bedsores, but I am by no means qualified to diagnose bed ulcers because I've never been to medical school."

"Such scope-of-practice lawsuits are common in Texas and nationwide," said Ronald Scott, a research professor at the University of Houston Law Center Health Law and Policy Institute. "It's the classic argument of just how much...is reserved for someone with a medical degree....The criteria should be whether or not the profession is safely and appropriately able to perform the procedure or diagnostic test," he said.

Chiropractors say a victory for the association's suit would be a fatal blow to their profession....patients would be left with fewer choices regarding the type of healthcare they receive....'If chiropractors can't diagnose, how are they going to know what to treat the patient for?' asked Kevin Kanz, former president of the Texas Chiropractic Association. 'A doctor of chiropractic must diagnose,' he said."

In 1995, the Legislature prohibited chiropractors from performing surgical procedures or making incisions into any organ, body cavity or tissue. But the Texas Board of Chiropractic Examiners issued an opinion saying needle electromyography is allowed, though it involves inserting needles under the skin. The procedure is used to assess the health of muscles and diagnose conditions....The 1995 law also prohibited the chiropractic board from certifying chiropractors to perform spinal manipulation under anesthesia. However, the board took the stance that while the law prohibited it from certifying chiropractors to perform the procedure, it did not prohibit chiropractors from performing it."

"In 1998, the attorney general weighed in, saying using a needle for any purpose other than drawing blood was outside the scope of practice for chiropractors."

"In 2006, the Texas Medical Association and Texas Medical Board sued to block the chiropractic board's rules.  In November, a judge issued a partial summary judgment, effectively preventing chiropractors from performing the two procedures.  A third issue, that of diagnosing medical conditions, was left undecided. The chiropractic association has asked for a jury trial."

Professor Scott said he sees the chiropractors' point: "If they can't say what is wrong based on their training, then how can they appropriately refer patients?"

"At the same time, physicians are saying that patients should go to them in the first place for diagnosis."

"At the heart of the lawsuit has been what the medical association sees as chiropractors' ever-expanding scope of practice...'If chiropractors are allowed to do one thing, they'll keep trying to expand their scope until the line that separates the two professions is completely blurred,' Bragg said. 'It's already happened in other allied health fields,' he said."

"The TMA says Texas law stipulates that chiropractors may analyze, examine or evaluate the biomechanical condition of the spine and musculoskeletal system but that they are prohibited from diagnosing physical diseases, disorders, deformities or injuries."

"'The state decides who should practice medicine, including diagnosing medical conditions based on the person's education and training,' according to Brent Annear, spokesman for the TMA. 'And the state has decided that to diagnose medical conditions in Texas, a medical degree is required.'"

Dale White, a past president of the state chiropractors association, said "the TMA attacks podiatrists, psychologists, optometrists and just about anyone who he says competes with physicians."

"That's one of the things that bothers chiropractors and other allied health professionals the most," Professor Scott said. "From their perspective, medical doctors get to decide what they [chiropractic physicians] do and don't do," he said. "They feel like their voices are not heard."

"The medical association says it isn't worried about competition from chiropractors ...'it's concerned that chiropractors will go from treating problems related to the spine and musculoskeletal system, which they are trained to do, to much more than their education safely warrants,' Bragg said. 'Using the kind of broad language in their rules, it's not such a big leap from working on the spine to the brain,' he said."

"Chiropractors were once characterized as 'bone poppers'...But in recent years some have been treating more than back problems.  Some are using lasers...others are providing nutritional advice to address diabetes and the obesity epidemic, an area that had fallen to physicians. Others tout chiropractic as effective for ear infections, infertility and developmental delays in children."