Texas State Board of Examiners v. Texas Medical Ass'n
511 S.W.3d 28
Tex.2017Background
- Texas Licensed Marriage and Family Therapists Act (Therapists Act) authorizes MFTs to provide professional therapy services including the “evaluation and remediation of cognitive, affective, behavioral, or relational dysfunction in the context of marriage or family systems.”
- Therapists Board adopted rule 22 Tex. Admin. Code § 801.42(13) permitting MFTs to provide “diagnostic assessment” using the DSM to help clients identify emotional, mental, and behavioral problems.
- Texas Medical Association sued, arguing the rule is invalid because the Texas Medical Practice Act reserves diagnosis (and thus practicing medicine) to licensed physicians, and the Therapists Act authorizes only evaluations, not diagnoses.
- Trial court and court of appeals invalidated the rule; the Therapists Board defended it as necessary and within their statutory authority and limited by competency and referral rules.
- Supreme Court framed the question as statutory construction: whether the Therapists Act authorizes DSM-based diagnostic assessments by MFTs and whether the Medical Practice Act precludes that authority.
Issues
| Issue | Plaintiff's Argument (Medical Assn.) | Defendant's Argument (Therapists Board) | Held |
|---|---|---|---|
| Whether the Therapists Act authorizes "diagnostic assessments" using the DSM | "Diagnostic" means identifying a disease/disorder; Act authorizes only "evaluations," not diagnoses | "Evaluate"/"assess" reasonably includes making determinations/diagnoses necessary to remediate dysfunctions in therapy | Court held "evaluate" reasonably encompasses diagnostic assessments as used in rule; rule is within Act's authority |
| Whether identifying DSM mental disorders necessarily constitutes the practice of medicine | DSM diagnoses are diagnoses of diseases/disorders; diagnosis is reserved to licensed physicians under Medical Practice Act | Many DSM diagnoses involve nonmedical dysfunctions; Act limits MFTs to family-systems context and professional competency, with referral obligations | Court held not all DSM diagnoses equate to practicing medicine; the Therapists Act authorizes limited diagnostic assessments and does not conflict with Medical Practice Act |
| Whether the Board exceeded its rulemaking authority by issuing §801.42(13) | Rule conflicts with statute and imposes duties beyond Act; any exception to Medical Practice Act would be explicit if intended | Board's rule implements Act; statutory context and other Code provisions show "evaluate" can include diagnosis; rule is limited by competency and referral provisions | Court held presumption of agency rule validity met; Board acted within authority and rule is valid |
| Whether construction canons (later/specific statute, deference to agency) control if conflict exists | Medical Assn.: statutes must be harmonized; repeal by implication disfavored so Medical Practice Act governs | Board: Therapists Act is later and more specific; agency interpretation merits deference | Court found statutory language unambiguous in context and did not need to invoke canons; result upheld Board rule |
Key Cases Cited
- Public, Util. Comm’n of Tex. v. City Pub. Serv. Bd., 53 S.W.3d 310 (Tex. 2001) (agencies have only powers granted by statute and implied powers necessary to carry out duties)
- R.R. Com’n of Tex. v. Lone Star Gas Co., 844 S.W.2d 679 (Tex. 1992) (agency may adopt only rules authorized by statute)
- Edgewood Indep. Sch. Dist. v. Meno, 917 S.W.2d 717 (Tex. 1995) (rule invalidity measured by harmony with general objectives of the statute)
- TGS-NOPEC Geophysical Co. v. Combs, 340 S.W.3d 432 (Tex. 2011) (courts defer to agency interpretations only when statutory language is ambiguous)
- Jaster v. Comet II Const., Inc., 438 S.W.3d 556 (Tex. 2014) (context required to expand a term’s meaning beyond its ordinary sense)