Part 10.
TEXAS FUNERAL SERVICE COMMISSION
Chapter 201.
LICENSING AND ENFORCEMENT--PRACTICE AND PROCEDURE
22 TAC §201.19
The Texas Funeral Service Commission adopts new §201.19
Correspondence without changes to the proposed text as published in the January
12, 2001, issue of the
Texas Register
(26
TexReg 273).
The Texas Funeral Service Commission adopts a new section to establish
the requirement that all correspondence to an establishment or to the funeral
director in charge shall be sent to the street address of the establishment
as reflected on the license application.
No comments were received.
The new section is adopted under Section 651.152 of the Texas
Occupation Code, as amended by Section 18 of House Bill 3516, 76th Legislature
which authorizes the Commission to issue such rules and regulations as may
be necessary to effect the intent of the provisions of this Section.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on March 7, 2001.
TRD-200101384
O.C. "Chet" Robbins
Executive Director
Texas Funeral Service Commission
Effective date: March 27, 2001
Proposal publication date: January 12, 2001
For further information, please call: (512) 936-2474
Chapter 375.
RULES GOVERNING CONDUCT
22 TAC §375.1
The Texas State Board of Podiatric Medical Examiners adopts
an amendment to §375.1 concerning definitions defining the term "foot"
with changes to the proposed text that was published in the December 1, 2000,
issue of the
Texas Register
(25 TexReg 11840).
The rule was initially published in an earlier issue of the
Texas Register
.
The changes that were made change where it says "tibia, fibula in articulation"
to "tibia and fibula in their articulation".
The definition of "podiatry" provided by the podiatry practice act, Tex.
Occup. Code §202.001(4), addresses the scope of practice of podiatry
in broad, general terms. The board has determined that there exists uncertainty
among various groups resulting from the lack of a definition of the term "foot"
in the podiatric practices act. Podiatrists aren't entirely sure of the limits
of their practice; insurance companies aren't sure for what procedures podiatrists
may charge; hospitals aren't entirely sure about the scope of practice for
podiatrists; and the public has no guidance to determine whether a podiatrist
is practicing within the scope of practice. The board has determined that
the definition of the "foot" should be clarified for purposes of the practice
of podiatry. It also has determined that the definition should reflect the
long-standing practice of podiatry in the State of Texas. The definition the
board has adopted is based on a common sense approach to the treatment of
patients that is medically sound and protects the patient's interests. The
board has applied its expertise in identifying those injuries or other conditions
that affect that ability of the foot to function. The rule was arrived at
after considering the public welfare and safety, its effect on the consumer,
and various definitions that exist for foot. This definition best describes
the foot as it functions in the human body.
What commonly is referred to in layman's terms as the "ankle" is included
in the definition of "foot" because injury to the ankle causes a failure in
the foot's ability to function properly. A procedure on the ankle would be
within the podiatrist's scope of practice to the extent that the injury to
the ankle causes the inability of any part of the rest of the foot to function
properly. While a surgical procedure is being performed on the part of the
foot below the ankle, it frequently occurs that the tendon or ligament being
repaired is one which is attached to the lower part of the foot on one end
and is attached to a higher part of the foot, on the other end. The podiatrist
is in the best position to repair the damage on the higher end of that tissue
at the same time as the damage to the tissue is being repaired a few centimeters
below that spot. Although some of these tissues may be attached at the foot
on one end and as high as the knee at the other end, the board, by this rule,
limits the scope of podiatric practice to that area that is no higher up the
human body than the area at the level at which the structures affect the function
of the foot.
In other instances, after the podiatrist begins surgery, damage to the
ankle is noted for the first time. The podiatrist is in the best position
to repair the damage during the surgery rather than subjecting the patient
to a separate surgical procedure on another day along with the exposure to
anesthesia, the discomfort, and other medical risks, costs, and inconveniences
that arise from having to return on another day to perform a second procedure
that could have been performed during the first surgery. One alternative would
be for the podiatrist to obtain another surgeon while the patient is still
anesthetized, to complete the repair, assuming another surgeon can be found
on short notice. The other option would be to close the patient, leaving the
injury as is, until another appointment can be made for another surgery, risking
additional injury to the patient in the meantime. Both of those options are
not acceptable, when the podiatrist is trained to perform the procedure to
repair the damage to the ankle. Of course, a podiatrist that is not trained
to perform surgery of the ankle or of the tissues that attach to a location
above the lower foot, would not be authorized to perform the procedure, not
because the definition does not allow it, but because the proper practice
of podiatric medicine consistent with the public health and welfare would
require an unqualified podiatrist to refrain from attempting procedures that
are not within the podiatrist's capability. The podiatric practice act already
protects against such an occurrence by making it a violation of the act for
a podiatrist to practice podiatry in a manner inconsistent with the public
health and welfare.
Numerous comments were received in response to the proposed rule. The comments
and the board's response to the comments follow below:
Comment #1: There seemed to be a generalized concern by many commentators
about the word "tibula".
Commentators: There were ten individuals who presented this comment.
TSBPME Response: There was a typographical error in which "tibula" should
have been printed tibia. The rule was republished in the December 1, 2000
issue of the
Texas Register
25 TexReg 11840,
showing the correct spelling.
Comment #2: Most of the commentators were very concerned with the proposed
definition of the word "foot" and cited many other sources, as will as their
own definitions that they felt were more applicable to the word "foot".
These definitions included:
Dorland's Illustrated Medical Dictionary, 29th Edition; W.B. Saunders Company,
Copyright 2000: "1. The distal portion of the Primate leg, upon which an individual
stands and walks. It consists, in man, of the tarsus, metatarsus, and phalanges
and the tissues encompassing them."
Stedman's Medical Dictionary, 27th Edition: Lippincott, Williams, Wilkins,
Copyright 2000; "1. The lower, pedal, podalic extremity of the leg."
Webster's Ninth New Collegiate Dictionary; Merriam-Webster, Inc., Copyright
1984. "1. The terminal part of the vertebrate leg upon which an individual
stands."
International Dictionary of Medicine and Biology; John Wiley and Sons,
Inc., copyright 1986. "The distal end of the lower limb."
Black's Medical Dictionary, 37th Edition; A.C. Black (Publishers) Limited,
Copyright 1992; "Foot is that portion of the lower limb situated below the
ankle joint."
Taber's Encyclopedic Medical Dictionary, Edition 18; F.A. Davis company,
Copyright 1997; "Foot-determinate portion of the lower extremity. The bones
of the foot include the tarsus, metatarsus and phalanges."
Single standard definition of the foot used in all anatomical text books,
including 1. Gray's Anatomy, 35th Edition; Warwick and Williams, Copyright
1973, W.B. Saunders Company. 2. Cunningham's Textbook Anatomy, Ninth Edition;
Copyright 1951, Oxford University Press. 3. Anatomy for Surgeons, Volume III,
First Edition; Copyright 1958, Heber-Harper. 4. Clinically Oriented Anatomy,
Second Edition; Copyright 1985, Williams and Wilkins. 5. Grants Method of
Anatomy, Eleventh Edition; Copyright 1989, Williams and Wilkins. 6. Clinical
Anatomy for Medical Students, Fifth Edition; Copyright 1995, Little Brown
and Co. "The foot has 3 bony anatomical components: 1. the tarsus, (in which
there are seven bones; talus, calcaneum, navicular cuboid, lateral cuneiform,
intermediate cuneiform, and medial cuneiform); 2. the metatarsus, (in which
there are five metatarsal bones); 3. the phalanges, (in which there are 5
bony units, the first digit has a proximal and distal phalanx, the 2nd, 3rd
, 4th & 5th digits each have a proximal, intermediate and distal phalanx).
Soft tissues, including muscle, fascia, tendons, which attach to these bones,
as well as nerves and vessels complete the structure of the foot."
One commentator felt that the Achilles muscle was not part of the foot,
but he felt the attachment of the tendon to the calcaneus would be considered
a portion of the foot, but the tendon that is proximal to the foot is not
part of the foot.
Another commentator felt "I think it is common medical knowledge that the
foot includes the phalanges, metatarsals and encompassing soft tissues. This
does not include the ankle joint, which includes the distal tibia and fibula."
Another commentator defined the foot as "The talus is the transitional
bone. The upper surface of the talus belongs to the ankle and the lower surface
of the talus belongs to the foot. The foot is coimposed of the hindfoot, midfoot
and forefoot. The hindfoot ends in the center of the talus and everything
from the point distally is considered the foot. Once you reach the most superior
proximal aspect of the talus you are in the ankle."
The commentators were the President of Texas Orthopedic Association; Senior
Associate Dean, Baylor College of Medicine; Chairman of Podiatry Issues Committee,
Texas Orthopedic Association, and 24 individuals.
TSBPME response: The board disagrees with the commentators' conclusions.
The definition of the foot, even among many different references, varies.
Some definitions even discuss the weight bearing portion of the extremity,
which includes those structures outlined by the TSBPME board's definition.
Therefore, these weight bearing structures and any structures that affect
their function are included within our definition. In addition, even Stedman's,
International, and Webster's Medical Dictionaries cited by the commentators
define the foot by addressing the function of the foot, and the function described
in the definitions includes the function performed by the ankle. Therefore,
the ankle is included in the definition of the foot provided by those three
dictionaries.
Comment #3: Commentators felt that the training for podiatrists was not
as good as orthopedists and that the podiatrist did not have the training
that would cover procedures within the proposed definition of foot. One commentator
felt podiatrists have no training in some of the areas that might be covered
by the proposed definition. Another commentator stated podiatric training
is limited to the anatomy of injuries and disuse of the foot, therefore, to
permit the podiatric community to treat a portion of the body for which they
do not have specific training would be a detriment to public health.
The commentators were President of Texas Orthopedic Association and eight
individuals.
TSBPME response: The TSBPME does not agree, the review of course work in
the schools' curriculum and of podiatric students' transcripts filed with
the Board, show that podiatric education covers all areas of the body, as
well as the particular areas concerned with the above proposed definition.
Comment #4: Commentators felt that there was a movement to redefine the
foot to annex the ankle and leg into the scope of practice for podiatry and
therefore, there was a potential danger to the public health and safety. One
commentator was concerned that the proposed definition could extend privileges
to the knee.
The commentators were President, Texas Orthopedic Association; Chairman
of Podiatry Issues Committee, Texas Orthopedic Association and four individuals.
TSBPME Response: The proposed definition would not result in extension
of the existing privileges for podiatric physicians and certainly was not
meant to construe any representation of coverage around the knee. Podiatric
physicians in the State are currently treating conditions that are covered
in the proposed definition that include treatment of sprained ankles, treatment
of posterior tibialis tendonitis, lateral ankle stabilization, primary ankle
ligament repair, tarsal tunnel syndrome, tendo-Achilles lengthening, gastroc
recession as pertained to treatment of flatfoot, distal tibia fractures and
fibular fractures. All the above procedures are procedures for podiatrists,
which receive credentialing from hospitals to perform after showing they are
capable to perform those procedures in the State of Texas. There are existing
checks and balances for the quality of care that is performed by any podiatric
surgeon that performs those types of procedures. Regardless of how broadly
the scope of practice defined in the law permits a surgeon to practice podiatric
medicine, every surgeon, including a podiatrist, must demonstrate the ability
to perform specific procedures before a hospital will issue credentials, Although
this definition clarifies the extent to which a podiatrist may practice podiatry,
no podiatrist will be permitted to perform a procedure unless the podiatrist
has demonstrated to the hospital the specific ability to perform the procedure.
As for procedures provided in the podiatrist's office, the Board's disciplinary
process provides adequate checks and balances to protect the public. If a
podiatrist places the public at risk by performing a procedure for which the
podiatrist is not adequately trained, whether it is performed in a hospital
or in an office suite, that podiatrist would be subject to disciplinary action
by the Board. The board has not received consumer complaints regarding these
types of procedures of any greater or abnormal proportion as compared to any
other type of complaint. The TSBPME has a mechanism of handling complaints
concerning the quality and care for the citizens of Texas. Many hospitals
have professional activities committees. Many State associations have peer
review committees, and the credentialing departments of hospitals have stringent
requirements on all requested procedures and especially those that may require
further experience and education. Historically, podiatrists have performed
these procedures throughout the State of Texas, and the appropriate checks
and balances are in place to protect the people as consumers of the State
of Texas.
Comment #5: One commentator felt that there was an added cost to the State
in allowing the proposed definition to pass and the types of procedures that
would now be covered under that definition. He also felt like "An orthopedic
surgeon who is highly qualified to treat maladies of the foot and ankle, does
not require the work of an additional physician and many of the injuries of
the ankle or above require some hospitalization."
Commentator: Chairman of Podiatry Issues Committee, Texas Orthopedic Association.
TSBPME response: For many hospitals there is a co-admission requirement
for podiatric physicians or a medical clearance for a co-admitting admission
in the hospital. Most insurance companies or reimbursement issues will allow
one medical history and physical charge and would not allow two charges. Therefore,
the podiatric admission would not create any type of charge to the State,
as the co-admitting physician or anesthesiologist, and not the podiatrist,
would be billing for that particular function. In some respects there may
be less of a charge when a podiatrist is involved because an orthopedic surgeon
has already charged the admitting fee prior to the surgical intervention,
resulting in two fees - one by the orthopedic surgeon and one by the consulting
physician.
Comment #6: Commentators felt there were different standards of care for
foot problems, that the orthopedist who cares for the foot and ankle problems
in this state is held to a different legal standard than the podiatric community,
and that the podiatric community actively tries to distance itself from medical
physicians' standard of care.
The commentators were the Chairman of Podiatry Issues Committee, Texas
Orthopedic Association and one individual.
TSBPME response: The board is not aware of different standards of care
in the podiatric and medical community. Many states have legislation that
does not allow practitioners of different specialties to testify against one
another. This would apply for an orthopedist testifying against a podiatrist,
as well as a podiatrist testifying against an orthopedist. This rule does
not create any different standard of care. Podiatric physicians, as well as
medical doctors follow the allopathic branch of medicine in their educational
process and are therefore, the same as far as standards of care.
Comment #7: Commentators felt that the recognition and initial treatment
for diseases, such as chronic heart failure, liver disease, or communicable
infections can be vital to the care of the patient and that most of this is
not included in the training of the podiatrist.
The commentators were the Chairman of Podiatry Issues Committee, Texas
Orthopedic Association and one individual.
TSBPME response: The above noted conditions are addressed in the curriculum
for the training of the podiatric physicians. The addition of this rule has
no effect on the need for podiatrists to be aware of the recognition or treatment
of such diseases.
Comment #8: Commentators felt that the CPT codes, which are the codes utilized
in billing for certain procedures is evidence of a separation between leg
and foot. The commentator proposed that in the CPT code book there is a separate
section entitled leg, tibia and fibula and ankle joint, which was separate
from the section entitled foot and toes.
Commentator: There was one individual who submitted this comment.
TSBPME response: CPT codes are a method of separating procedures in the
reimbursement process for third party payment. There are so many codes that
sit under foot and toes it makes administrative sense to have a separate division.
This is not to say that CPT codes in the Neurology section would not be applicable
to both orthopedic surgeons and podiatric physicians in their treatment of
the foot.
Comment #9: Commentators felt that the purpose of the proposed definition
of the foot was to expand the scope of surgical services and treatment provided
by the podiatrist. One commentator felt "there is a significant medical concern
that the inclusion of the ankle by the podiatric board would allow surgical
intervention of the ankle, inclusive of total ankle replacement, fusions and
trauma." There is concern raised that a podiatrist in the U.S. does not have
sufficient training to perform these or other complicated procedures.
The commentators were Chairman, Podiatry Issues Committee, Texas Orthopedic
Association and 16 individuals.
TSBPME response: The podiatry practice act does not contain a definition
for "foot". The proposed definition of the foot accurately reflects the present
treatment and procedures for the ailments of the foot, which are currently
being performed in the State of Texas by podiatric physicians. The proposed
definition of the foot allows those procedures which research conducted by
the board indicates podiatric physicians are properly trained and presently
credentialed to perform in the State of Texas. While the board is only concerned
about protecting the consumers of the State of Texas, it should be noted that
the laws of other states include the ankle, and that the training throughout
the United States does include ankle replacement, fusions and trauma.
Comment #10: Commentators felt that the efforts of the board to redefine
the foot confuses the credentialing process.
Commentators: One individual.
TSBPME response: While the board appreciates the above noted comment, the
credentialing process throughout the State of Texas has been very successful
in identifying and credentialing those particular procedures that need additional
competence and training. The credentialing process at all hospitals should
continue as it has by requiring documentation of competency and experience
for any procedures in treating the ailments of the foot. A podiatrist would
not be any more likely, as a result of the addition of this definition, to
perform procedures that require credentials, unless the podiatrist demonstrated
the competence to do them.
Comment #11: Commentators felt that the foot and ankle are functionally
interdependent and they felt that the definition of orthopedic surgery and
classical anatomy of medical science that the foot and ankle are separate
structures.
Commentator: Two individuals.
TSBPME response: While the above comment fits along the line of one definition
of foot, it offers a slightly different approach from the other comments.
However, the board feels the proposed definition of the foot allows those
procedures which podiatric physicians are properly trained and presently credentialed
to perform in the State of Texas.
Comment #12: The commentators felt that alteration of the definition of
foot could leave loopholes, such as injuries suffered to the tibia or fibula
that would not be included within the definition.
Commentator: One individual.
TSBPME response: The board feels that the proposed rule does not alter
the definition of the foot and does not permit the podiatric physician to
perform any new procedures that are not presently credentialed and available
to perform currently. Any of these types of procedures that are clearly above
the tibia/fibular articulation and does not affect the function of the foot
would be deemed by this board to be outside the scope of the practice of podiatry.
Comment #13: Commentators felt the only reason for the definition proposal
was one of remuneration. The commentators felt that there was no medical definition
of the foot of which they were aware of, which included the ankle or tibia
and fibula.
Commentators: Two individuals.
TSBPME response: The proposed definition is one of clarification and does
not propose any medical or surgical treatment of the foot other than those
currently being performed by podiatric physicians in the State of Texas. The
definition provides guidance to podiatrists, clarifying the boundaries of
the scope of practice. The public is better protected when the podiatrist
has been notified of the boundaries of podiatric practice. The orthopedic
community may have a vested financial interest in trying to limit who treats
those structures that we have defined. However, it is this Board that is charged
by the legislature with regulating the practice of podiatry.
Comment #14: Commentators were concerned that the proposed definition was
done without any formal or informal consultation with the Texas Medical Association
or Texas Orthopedic Association and wants a committee including them to research
and discuss the proposed definition.
The commentators were President, Texas Medical Association and President,
Texas Orthopedic Association.
TSBPME response: By examination of the comments that have been made and
the understanding of the podiatric physicians curriculum, education and training
it seems that this board of which some members are podiatrists, licensed and
currently practicing in Texas, is the best to understand what the podiatric
physician has been trained to perform. In addition, the board feels that the
licensing board does not have an obligation to receive permission from the
Texas Medical Association or the Texas Orthopedic Association in regulating
the practice of podiatric medicine on behalf of the consumers of the State
of Texas. The TSBPME rightfully was created by the Texas Legislature to regulate
the practice of podiatric medicine. However, the Board is always open for
any comments or suggestions and encourages the Texas Medical Association and
the Texas Orthopedic Association to meet with other podiatrists or groups
of podiatrists or associations and to put forth independently or jointly their
own resultant thoughts, conclusions, suggestions to this Board.
Comment #15: Commentators felt that the definition of foot adequately clarifies
the training of many podiatric surgeons. The commentators especially felt
that the new practitioner with additional extensive postgraduate training
in trauma and reconstruction of the ankle, the ability to clearly market what
the podiatrist does.
Commentator: One individual.
TSBPME response: The board agrees. To the extent that a podiatrist has
received the necessary training, that podiatrist is qualified to perform procedures
to those structures included in the definition of "foot", as proposed.
Comment #16: Some commentators felt that podiatrists were the best group
to define what the structure of the foot was. He felt that podiatrists are
named as "foot specialists" and, therefore, they as a group are most qualified
to define what the structure of "foot" is.
Commentator: One individual.
TSBPME response: The board agrees.
Comment #17: Commentator felt that there might be confusion on exactly
what the education of a Doctor of Podiatric Medicine is. The commentator described
the education as the typical DPM completes a four-year undergraduate degree
and has entrance prerequisites, similar, if not identical to those who attend
medical school, osteopathic, medical or dental school. This is followed by
four years of podiatric medical school. The first two years of podiatric medical
school education has the same basic sciences as all other allopathic/osteopathic
medical schools. There is sometimes a misconception that somehow podiatry
students take only foot basic sciences. The basic sciences are the same as
the other schools of medicine and often have the same instructors. These are
comprehensive courses and not limited. For example, podiatry students complete
the anatomical dissection of the entire human cadaver, learn the physiology
of all organ systems and study the pathological basis of diseases that affect
the entire body. The podiatric student's transcripts mirror those of other
physicians. The last two years include instruction and rotation through many
of the same clinical specialties as general medicine. Additionally, during
the last two years the podiatry student begins to concentrate on foot, ankle
and leg, much as a dental student focuses on the head and neck. Following
graduation most DPMs then perform postgraduate residencies in hospitals. Although
these are diverse, surgical residencies are one to three years in duration.
Commentator: One individual.
TSBPME response: The board agrees.
Comment #18: One commentator was concerned that to have an invisible line
as the definition of foot may cause harm to consumers.
One of the commentators felt that it would be harmful to the State residences
to prevent podiatrists from treating their patients functionally and that
it would not make sense to stop repairing a ruptured tendon or ligament that
attaches to the foot when it reaches some mystical line. In addition, he felt
that many procedures are used in combination when addressing many foot deformities.
He used an example that many flatfeet are caused by or created by a contracted
Achilles tendon (equines deformity of the foot) and that not lengthening the
structure when surgically repairing a symptomatic flatfoot would not only
be harmful to the patient, but may be considered malpractice. He felt that
even the orthopedist recognized the functional foot concept. He related that
their subspecialty group is named the American Association of Orthopedic foot
and ankle surgeons, not just foot surgeons. He felt that they understand,
as podiatrists do, the close interdependency of the foot and ankle.
Another commentator commented that in nearly twenty years of practice he
has successfully treated hundreds, perhaps thousands of patients with rearfoot
and ankle pathology. He had repaired and set ankle fractures and sprains.
He has also repaired flatfoot and cavus foot, as well as lengthened the Achilles
and transferred ankle tendons. He related that patients continue to come to
him for these problems and were referred by satisfied friends and family physicians.
He relates he has never had a complaint lodged against him regarding those
treatments. He related that in podiatric medical school he was taught the
foot and leg as a functional unit and throughout his training he was taught
to treat the entire weight bearing portion of the lower extremity. He also
relates that like all physicians he has had to update his skills often to
reflect the current state of podiatric medical knowledge. These have included
the use of lasers, reading MRI's, performing various internal fixation implant
procedures, as well as utilizing arthroscopes, endoscopes and many other techniques.
Commentators: Two individuals.
TSBPME response: The board agrees.
Comment #19: One commentator felt that the credentials committees in the
hospitals do an excellent job in protecting the consumers.
One of the commentators through his experience of sitting on the credentials
committee in his hospital felt that everyone understands the true scope of
practice by all doctors within the hospitals not defined by the state law,
but by the training, expertise, ability and their credentials. For example,
he related that many cardiologists are not allowed to do invasive cardiac
procedures in his hospital without the documentation of adequate expertise.
He also felt that the proposed definition to include all those podiatric physicians
that are capable of performing procedures does not allow every podiatrist
to do those more advanced procedures. He felt the limiting factor in the marketplace
for all doctors (medical, orthopedic and podiatrists) is the credentialing
that is performed at the hospital or surgical center.
Another commentator felt that this is not a license for a podiatrist to
practice outside the scope of their competence. It is merely a clear definition
of the foot and its governing structures in the State of Texas and other states
throughout the U.S. Physicians are licensed to treat all physical conditions,
anatomical regions and disease. In other words, all licensed M.D.'s have a
license to perform foot surgery, heart surgery, deliver babies, medically
manage diabetes, treat mental illness, such as schizophrenia and perform cataract
surgery. However, no one physician has the capability of doing all of these.
Physicians, with the desire to first do no harm, limit the conditions they
treat and procedures they perform based on their level of competence. In addition,
hospitals limit the privileges to the competence of the individual physician.
This is based on training and experience and not their medical license. This
is also true for podiatrists.
Commentators: Two individuals.
TSBPME response: The board agrees.
Comment #20: One commentator felt that the practice act for a podiatrist
presently covers more than treating the foot. The commentator described his
observation as Practice Act does not state that DPM's may treat the foot,
instead the Act states that DPM's may treat any "disease, disorder, physical
injury, deformity or ailment" of the human foot. Such disorders include the
failure of the foot to function properly. In order to remedy the problem so
that the foot does function properly it is often necessary to treat other
parts of the body (in other words, tendons that attach to the foot, the ankle,
etc.). Therefore, you may want to consider addressing a scope of practice
issue via rule, which would read something like this: "A Texas licensed Podiatrist
may utilize any system or method to treat any disease, disorder, physical
injury, deformity or ailment of the human foot. Such disorders include the
failure of the foot to function properly, as the lower extremity of the leg,
which may be caused by trauma to the soft tissues, (muscles, nerves, vascular
structure, tendons, ligaments, or any other anatomical structures) which insert
into or attach to the foot or other anatomical structures in articulation
with the talus. Appropriate procedures, when medically necessary to treat
any disease of the foot and/or its function, include the use of a prescription
and nonprescription drugs; surgical or nonsurgical treatments of anatomical
structures that affect the function of the foot, such as the ankle and soft
tissue, which insert into the foot; the surgical removal of skin, soft tissue
and bone from parts of the body other than the foot; medical histories and
physicals; and hyperbaric oxygen therapy".
Commentator: Legal counsel, Texas Podiatric Medical Association.
TSBPME response: While the board realizes there are different ways to describe
the present function and present existence of the podiatric physician in their
care and treatment of the people of the State of Texas, we felt defining the
foot, which had not been done previously in regard to the present practice
of podiatry was in the best interest of the citizens of Texas.
Changes to the proposed rule are that in both places where the language
appears, "tibia, fibula in articulation with the talus" is changed to read
"tibia and fibula in their articulation with the talus."
Changes to the proposed rule reflect non-substantive variations from the
proposed amendments. The board's legal counsel has advised that the changes
to the proposed rule affect no new persons, entities, or subjects other than
those given notice and that compliance with the adopted sections will be less
burdensome than under the proposed sections and that the changes to the published
proposed rule clarify the intent of the proposed rule. Accordingly, republication
of the adopted sections as proposed amendments is not required.
The amendment is adopted under the Tex. Occup. Code §202.151,
which provides the Texas State Board of Podiatric Medical Examiners with the
authority to adopt reasonable or necessary rules and bylaws consistent with
the law regulating the practice of podiatry, the law of this state, and the
law of the United States to govern its proceedings and activities, the regulation
of the practice of podiatry and the enforcement of the law regulating the
practice of podiatry.
The adopted amendment implements Texas Occupations Code, §202.151.
§375.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context indicates otherwise:
(1)
Board--The Texas State Board of Podiatric Medical Examiners.
(2)
Foot--The foot is the tibia and fibula in their articulation
with the talus, and all bones to the toes, inclusive of all soft tissues (muscles,
nerves, vascular structures, tendons, ligaments and any other anatomical structures)
that insert into the tibia and fibula in their articulation with the talus
and all bones to the toes.
(3)
Medical Records--Any records, reports, notes, charts, x-rays,
or statements pertaining to the history, diagnosis, evaluation, treatment
or prognosis of the patient including copes of medical records of other health
care practitioners contained in the records of the podiatric physician to
whom a request for release of records has been made.
(4)
Office--In the singular, includes the plural.
(5)
Public communication--Any written, printed, visual, or
oral statement or other communication made or distributed, or intended for
distribution, to a member of the general public or the general public at large.
(6)
Solicitation--A private communication to a person concerning
the performance of a podiatric service for such person.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of
the Secretary of State on March 12, 2001.
TRD-200101453
Janie Alonzo
Staff Services Officer I
Texas State Board of Podiatric Medical Examiners
Effective date: April 1, 2001
Proposal publication date: December 1, 2000
For further information, please call: (512) 305-7000
22 TAC §§377.1 - 377.3, 377.5 - 377.7, 377.10, 377.14, 377.15, 377.20 - 377.22, 377.24, 377.27, 377.31 - 377.38, 377.41, 377.45
The Texas State Board of Podiatric Medical Examiners adopts
amendments to §§377.1-377.3, 377.5-377.7, 377.10, 377.14-377.15,
377.20-377.22, 377.24, 377.27, 377.31-377.38, 377.41 and 377.45 concerning
Procedures Governing Grievances, Hearings, and Appeals without changes to
the proposed text as published in the September 22, 2000, issue of the
The amendments are being adopted in accordance with the Texas Government
Code §2001.039 regarding agency review of rules (formerly 1997 General
Appropriations Act, Article IX, Section 167), requiring all agencies to review
their rules. These amendments clarify the rules, change terminology to conform
with the statutes and with usual practice, and replace references to hearing
officer with ALJ; 377.15 changes the filing deadline for amendments from 3
to 7 days to comply with SOAH rules. The rules are amended throughout to comply
with or defer to the APA or the SOAH rules for consistency and to avoid cumbersome
hearings plagued by conflicting procedures. The rule regarding the taking
of certain discovery tools addressed in 377.34 is amended to avoid the use
of litigation tools for proceedings in which such tools would only serve to
create undue delay and cost to the parties.
No comments were received regarding the proposed amendments.
The amendments are adopted under the Occupations Code, §202.151,
which provides the Texas State Board of Podiatric Medical Examiners with the
authority to adopt reasonable or necessary rules and bylaws consistent with
the law regulating the practice of podiatry, the law of this state, and the
law of the United States to govern its proceedings and activities, the regulation
of the practice of podiatry and the enforcement of the law regulating the
practice of podiatry.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on March 12, 2001.
TRD-200101455
Janie Alonzo
Staff Services Officer I
Texas State Board of Podiatric Medical Examiners
Effective date: April 1, 2001
Proposal publication date: September 22, 2000
For further information, please call: (512) 305-7000
22 TAC §§377.4, 377.13, 377.17, 377.18, 377.23, 377.25, 377.26, 377.28 - 377.30, 377.39, 377.40, 377.42 - 377.44, 377.46, 377.47
The Texas State Board of Podiatric Medical Examiners adopts
the repeal of §§377.4, 377.13, 377.17-377.18, 377.23, 377.25-377.26,
377.28-377.30, 377.39-377.40, 377.42-377.44 and 377.46-377.47 concerning Procedures
Governing Grievances, Hearings, and Appeals without changes to the proposal
as published in the September 22, 2000, issue of the
Texas Register
(25 TexReg 9354). The text will not be republished.
The repeal is being adopted in accordance with the Texas Government Code §2001.039
regarding review of rules (formerly 1997 General Appropriations Act, Article
IX, Section 167), requiring all agencies to review their rules. The rules
refer to "hearing officers," whereas the Administrative Procedure Act refers
to Administrative Law Judge. Therefore some of the rules are obsolete. Some
rules merely restate statutory law, sometimes inaccurately, or conflict with
SOAH rules. Other rules depart from the usual practice in contested case hearings.
Therefore, the purpose for which these rules originally were adopted no longer
exists.
No comments were received regarding the repeal of these rules.
The repeals are adopted under the Occupations Code §202.151,
which provides the Texas State Board of Podiatric Medical Examiners with the
authority to adopt reasonable or necessary rules and bylaws consistent with
the law regulating the practice of podiatry, the law of this state, and the
law of the United States to govern its proceedings and activities, the regulation
of the practice of podiatry and the enforcement of the law regulating the
practice of podiatry.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on March 12, 2001.
TRD-200101454
Janie Alonzo
Staff Services Officer I
Texas State Board of Podiatric Medical Examiners
Effective date: April 1, 2001
Proposal publication date: September 22, 2000
For further information, please call: (512) 305-7000
Part 18.
TEXAS STATE BOARD OF PODIATRIC MEDICAL EXAMINERS
Chapter 377.
PROCEDURES GOVERNING GRIEVANCES, HEARINGS, AND APPEALS
Chapter 378.
CONTINUING EDUCATION