616 S.W.3d 558
Tex.2021Background
- Longstanding conflict between chiropractors and the medical community over the legal boundary between chiropractic and the practice of medicine.
- Texas Chiropractic Act (Tex. Occ. Code §201.002(b)) authorizes chiropractors to "diagnose, analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system" and to perform nonsurgical procedures to improve the subluxation complex.
- In 2006–2010 the Texas Board of Chiropractic Examiners adopted Rule 78.1: it defined "musculoskeletal system" to include associated nerves and defined "subluxation complex" to include neuromusculoskeletal and neurophysiological elements; in 2010 it authorized certain chiropractors to perform vestibular-ocular-nystagmus testing (VONT) after specialized training.
- The Texas Medical Association (TMA) sued under the Administrative Procedure Act (Tex. Gov’t Code §2001.038(a)), arguing the rules exceed the Act by authorizing diagnosis/neurology reserved to physicians; lower courts invalidated the rules in part.
- The Texas Supreme Court granted review, held TMA had standing, applied de novo legal review with a presumption of validity for agency rules, and reversed the court of appeals, upholding the challenged provisions as within the statute’s scope.
Issues
| Issue | Plaintiff's Argument (TMA) | Defendant's Argument (Board/TCA) | Held |
|---|---|---|---|
| Standing to bring §2001.038(a) challenge | Rules diminish physicians' licensed- practice privilege and economic value of licenses | No concrete injury shown; no evidence chiropractors are practicing neurology or failing to refer | TMA has constitutional and statutory standing; alleged economic injury is traceable and redressable |
| Definitions including "nerves" and "neuromusculoskeletal" | References to nerves authorize chiropractors to diagnose neurological conditions beyond chiropractic scope (i.e., practice of medicine) | Definitions reasonably reflect a functional evaluation of musculoskeletal conditions and only include "associated" nerves relevant to biomechanical assessment; other Board rules require referral and limit practice | Definitions are valid; challenger failed to show they contravene the Act’s text or objectives |
| Authorization to perform VONT | VONT is a neurological diagnostic test (brain/inner ear/eye) and therefore exceeds chiropractic scope | VONT can be used for differential diagnosis to rule out non-musculoskeletal causes or to guide musculoskeletal treatment; limited to specially trained licensees; Board explained appropriate, limited uses | VONT authorization valid on its face; statute does not forbid its limited use and the rule is a permissible exercise of Board authority |
| Standard of review/deference | Trial-court factual findings and expert testimony support invalidation | Agency rules are presumptively valid; challenger must show rule contravenes statute or its objectives; courts should not substitute their policy judgment | Court applied de novo legal review with presumption of validity; lower courts erred by treating the issue as primarily factual |
Key Cases Cited
- Tex. State Bd. of Exam’rs of Marriage & Family Therapists v. Tex. Med. Ass’n, 511 S.W.3d 28 (Tex. 2017) (agency rule authorizing diagnostic assessment interpreted in statutory context; physicians’ overlap not dispositive)
- Pike v. EMC Mgmt., LLC, 610 S.W.3d 763 (Tex. 2020) (statutory standing distinguished from constitutional subject-matter jurisdiction)
- Fin. Comm’n of Tex. v. Norwood, 418 S.W.3d 566 (Tex. 2013) (treatment of §2001.038(a) as an expression of standing requirements)
- Heckman v. Williamson Cty., 369 S.W.3d 137 (Tex. 2012) (constitutional standing requirements under Texas law)
- Lujan v. Defenders of Wildlife, 504 U.S. 555 (U.S. 1992) (federal standing principles for concrete, traceable, redressable injury)
- Edgewood Indep. Sch. Dist. v. Meno, 917 S.W.2d 717 (Tex. 1995) (agency-rule challenges and presumption of validity)