Art. 4512b. Practice of chiropractic
Acts Constituting Practice of Chiropractic
(a) A person shall be regarded as practicing chiropractic within the meaning of this Act if the person:
- uses objective or subjective means to analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system of the human body;
- performs nonsurgical, nonincisive procedures, including but not limited to adjustment and manipulation, in order to improve the subluxation complex or the biomechanics of the musculoskeletal system; or
- holds himself out to the public as a chiropractor of the human body or uses the term "chiropractor," "chiropractic," "doctor of chiropractic," "D.C.," or any derivative of those terms in connection with his name.
Patient Information, Communications and Records; Confidentiality; Evidentiary
(a) Communications between one licensed to practice chiropractic, relative to or in connection with any professional services as a chiropractor to a patient, are confidential and privileged and may not be disclosed except as provided in this section.
(b) Records of the identity, diagnosis, evaluation, or treatment of a patient by a chiropractor that are created or maintained by a chiropractor are confidential and privileged and may not be disclosed except as provided in this section.
(c) Any person who receives information from confidential communications or records as described in this section other than the persons listed in Subsection (h) of this section who are acting on the patient's behalf may not disclose the information except to the extent that disclosure is consistent with the authorized purposes for which the information was first obtained.
(d) The prohibitions of this section continue to apply to confidential communications or records concerning any patient irrespective of when the patient received the services of a chiropractor.
(e) The privilege of confidentiality may be claimed by the patient or chiropractor acting on the patient's behalf.
(f) The chiropractor may claim the privilege of confidentiality, but only on behalf of the patient. The authority to do so is presumed in the absence of evidence to the contrary.
(g) Exceptions to confidentiality or privilege in court or administrative proceedings exist:
- when the proceedings are brought by the patient against a chiropractor, including but not limited to malpractice proceedings, and any criminal or license revocation proceeding in which the patient is a complaining witness and in which disclosure is relevant to the claims or defense of a chiropractor;
- when the patient or someone authorized to act on the patient's behalf submits a written consent to the release of any confidential information, as provided in Subsection (j) of this section;
- when the purpose of the proceedings is to substantiate and collect on a claim for chiropractic services rendered to the patient;
- in any civil litigation or administrative proceeding, if relevant, brought by the patient or someone on his behalf if the patient is attempting to recover monetary damages for any physical or mental condition including death of the patient; any information is discoverable in any court or administrative proceeding in this state if the court or administrative body has jurisdiction over the subject matter, pursuant to rules of procedure specified for the matters;
- in any disciplinary investigation or proceeding of a chiropractor conducted under or pursuant to this Act, provided that the Board shall protect the identity of any patient whose chiropractic records are examined, except for those patients covered under Subdivision (1) of this subsection or those patients who have submitted written consent to the release of their chiropractic records as provided by Subsection (j) of this section;
- in any criminal investigation of a chiropractor in which the Board is participating or assisting in the investigation or proceeding by providing certain records obtained from the chiropractor, provided that the Board shall protect the identity of any patient whose records are provided in the investigation or proceeding, except for those patients covered under Subdivision (1) of this subsection or those patients who have submitted written consent to the release of their chiropractic records as provided by Subsection (j) of this section; this subsection does not authorize the release of any confidential information for the purpose of instigating or substantiating criminal charges against a patient; and
- in any criminal prosecution where the patient is a victim, witness, or defendant; records are not discoverable until the court in which the prosecution is pending makes an in camera determination as to the relevancy of the records or communications or any portion thereof; such determination shall not constitute a determination as to the admissibility of such records or communications or any portion thereof.
(h) Exceptions to the privilege of confidentiality, in other than court or administrative proceedings, allowing disclosure of confidential information by a chiropractor, exist only for the following:
- governmental agencies if the disclosures are required or permitted by law, provided that the agency shall protect the identity of any patient whose chiropractic records are examined;
- medical or law enforcement personnel if the chiropractor determines that there is a probability of imminent physical injury to the patient, to himself, or to others or if there is a probability of immediate mental or emotional injury to the patient;
- qualified personnel for the purpose of management audits, financial audits, program evaluations, or research, but the personnel may not identify, directly or indirectly, a patient in any report of the research, audit, or evaluation or otherwise disclose identity in any manner;
- those parts of the records reflecting charges and specific services rendered when necessary in the collection of fees for services provided by a chiropractor or chiropractors or professional associations or other entities qualified to render or arrange for services;
- any person who bears a written consent of the patient or other person authorized to act on the patient's behalf for the release of confidential information, as provided by Subsection (j) of this section;
- individuals, corporations, or governmental agencies involved in the payment or collection of fees for services rendered by a chiropractor;
- other chiropractors and personnel under the direction of the chiropractor who are participating in the diagnosis, evaluation, or treatment of the patient; or
- in any official legislative inquiry regarding state hospitals or state schools, provided that no information or records which identify a patient or client shall be released for any purpose unless proper consent to the release is given by the patient, and only records created by the state hospital or school or its employees shall be included under this subsection.
(i) Exceptions to the confidentiality privilege in this Act are not affected by any statute enacted before the effective date of this Act.
(j)(1) Consent for the release of confidential information must be in writing and signed by the patient; a parent or legal guardian if the patient is a minor; a legal guardian if the patient has been adjudicated incompetent to manage his personal affairs; an attorney ad litem appointed for the patient, as authorized by the Texas Mental Health Code (Subtitle C, Title 7, Health and Safety Code) ; [FN1] the Persons with Mental Retardation Act (Subtitle D, Title 7, Health and Safety Code) ; [FN2] Subtitle B, Title 6, Health and Safety Code ; [FN3] Subtitle E, Title 7, Health and Safety Code ; [FN4] Chapter 5, Texas Probate Code; and Chapter 11, Family Code; or other applicable provision or a personal representative if the patient is deceased, provided that the written consent specifies the following:
- the information records to be covered by the release;
- the reasons or purposes for the release; and
- the person to whom the information is to be released.
(j)(2) The patient or other person authorized to consent has the right to withdraw his consent to the release of any information. Withdrawal of consent does not affect any information disclosed prior to the written notice of the withdrawal.
(j)(3) Any person who receives information made confidential by this Act may disclose the information to others only to the extent consistent with the authorized purposes for which consent to release the information was obtained.
(k) A chiropractor shall furnish copies of chiropractic records requested or a summary or narrative of the records pursuant to a written consent for release of the information as provided by Subsection (j) of this section, except if the chiropractor determines that access to the information would be harmful to the physical, mental, or emotional health of the patient, and the chiropractor may delete confidential information about another person who has not consented to the release. The information shall be furnished by the chiropractor within a reasonable period of time, and reasonable fees for furnishing the information shall be paid by the patient or someone on the patient's behalf. In this subsection, "chiropractic records" means any records pertaining to the history, diagnosis, treatment, or prognosis of the patient.
(l) "Patient" for the purposes of this section means any person who consults or is seen by a person licensed to practice chiropractic to receive chiropractic care.
(a) The Texas Board of Chiropractic Examiners hereinafter provided for shall defray all expenses under this Act from fees provided in this Act, and no appropriation shall ever be made from the State Treasury for any expenditures made necessary by this Act.
(b) The financial transactions of the board are subject to audit by the state auditor in accordance with Chapter 321, Government Code.
Texas Board of Chiropractic Examiners Created; Personnel and Terms;
Application of Sunset Act
(a) A Board to be known as "The Texas Board of Chiropractic Examiners" is hereby created. No member of said Board shall be a member of the faculty or Board of Trustees of any chiropractic school; and all appointments to said Board shall be subject to the confirmation of the Senate. The Texas Board of Chiropractic Examiners, which hereinafter may be referred to as "The Board," shall be composed of nine (9) members, appointed by the Governor, whose duty it shall be to carry out the purposes and enforce the provisions of this Act. Appointments to the Board shall be made without regard to the race, color, disability, sex, religion, age, or national origin of the appointees.
(b) Six (6) members must be reputable practicing chiropractors who have resided in this State for a period of five (5) years preceding their appointment. Three (3) members must be representatives of the general public. A person is not eligible for appointment as a public member of the Board if the person or the person's spouse:
- is registered, certified, or licensed by an occupational regulatory agency in the field of health care;
- is employed by or participates in the management of a business entity or other organization regulated by the Board or receiving funds from the Board; or
- owns or controls, directly or indirectly, more than a 10 percent interest in a business entity or other organization regulated by the Board or receiving funds from the Board; or
- uses or receives a substantial amount of tangible goods, services, or funds from the Board, other than compensation or reimbursement authorized by law for Board membership, attendance, or expenses.
(c) Five (5) members of the Board shall constitute a quorum. No member of said Board shall be a stockholder, or have any financial interest whatsoever in any chiropractic school or college.
(d) An officer, employee, or paid consultant of a professional or trade association in the field of health care may not be a member or employee of the Board who is exempt from the state's position classification plan or is compensated at or above the amount prescribed by the General Appropriations Act for step 1, salary group 17, of the position classification salary schedule.
(e) A person who is the spouse of, or who is related within the first degree by affinity or within the first degree by consanguinity to, an officer, manager, or paid consultant of a professional or trade association in the field of health care may not be a Board member and may not be an employee of the Board who is exempt from the state's position classification plan or is compensated at or above the amount prescribed by the General Appropriations Act for step 1, salary group 17, of the position classification salary schedule.
(f) For the purposes of Subsections (d) and (e) of this section, a professional or trade association is a nonprofit, cooperative, and voluntarily joined association of business or professional competitors in this state designed to assist its members and its industry or profession in dealing with mutual business or professional problems and in promoting their common interest.
(g) A person may not serve as a member of the Board or act as the general counsel to the Board if the person is required to register as a lobbyist under Chapter 305, Government Code, because of the person's activities for compensation on behalf of a profession related to the operation of the Board.
(h) The members of the Texas Board of Chiropractic Examiners shall be divided into three (3) classes, one, two and three, and are appointed for staggered six-year terms, with three members' terms expiring on February 1 of each odd- numbered year. No person may be appointed to serve more than two terms. The president of the Board shall be a licensed doctor of chiropractic. Members hold office for their terms and until their successors are duly appointed and qualified. In case of death or resignation of a member of the Board, the Governor shall appoint another to take his place for the unexpired term only.
(i) The Texas Board of Chiropractic Examiners is subject to Chapter 325, Government Code (Texas Sunset Act). Unless continued in existence as provided by that chapter, the board is abolished and this Act expires September 1, 2005.
Information of Consumer Interest; Informational Sign in Licensee's Place of Business
(a) The Board shall prepare information of public interest describing the functions of the Board and the Board's procedures by which complaints are filed with and resolved by the Board. The Board shall make the information available to the public and appropriate state agencies.
(b) The Board by rule shall establish methods by which consumers and service recipients are notified of the name, mailing address, and telephone number of the Board for the purpose of directing complaints to the Board. The Board may provide for that notification:
- on each registration form, application, or written contract for services of an individual or entity regulated by the Board; or
- on a sign prominently displayed in the place of business of each individual or entity regulated by the Board.
(c) The Board shall list along with its regular telephone number the toll-free telephone number that may be called to present a complaint about a health professional if the toll-free number is established under other state law.
Grounds for Removal From Board; Validity of Actions
(a) It is a ground for removal from the Board if a member:
- does not have at the time of appointment the qualifications required by Subsection (b) of Section 3 of this Act;
- does not maintain during service on the Board the qualifications required by Subsection (b) of Section 3 of this Act;
- violates a prohibition established by Subsection (d), (e), or (g) of Section 3 of this Act;
- cannot discharge the member's duties for a substantial part of the term for which the member is appointed because of illness or disability; or
- is absent from more than half of the regularly scheduled Board meetings that the member is eligible to attend during a calendar year unless the absence is excused by majority vote of the Board.
(b) The validity of an action of the Board is not affected by the fact that it was taken when a ground for removal of a Board member exists.
(c) If the executive director has knowledge that a potential ground for removal exists, the executive director shall notify the governor and the attorney general that a potential ground for removal exists.