In their own words – Sunset Commission Votes to Recommend that Chiropractors be Removed from Performing School Physicals
Friday, August 22, 2014 04:00 PM
By: Chris Dalrymple 
 

At the Wednesday, August 13, 2014, hearing of the Sunset Commission a vote on a “modification” resulted in a vote of seven to five – the Sunset Commission voting to remove chiropractors from the list of providers authorized to conduct pre-participation UIL Athletic physicals.  In the coming weeks I will provide you with my analysis of what was said at this hearing, but first let’s hear it “straight from the horses' mouth.”   The video from which these transcripts come was posted at THIS LINK.

There was, apparently, a standing room only crowd at the hearing, which did not allow public comments, for Senator Jane Nelson, Chair of the Sunset Commission, stated "E 102.8 across the hall is an overflow room and you are welcomed  to use that so you can have a seat.”  Senator Nelson then sweetly extended "very warm welcome to our newest member, Senator Campbell; welcome.  We really look forward to working with you and having the benefit of your medical knowledge and expertise,”  and noted "we’ve got three doctors down there, and with the issues that are before us today, that is really awesome.  Senator Campbell is a Medical Doctor and the "three doctors" referred to are medical physicians.

When it came time on the agenda for Representative Price’s “modification” he stated “this new issue would require the pre-participation evaluation form required for each student participating in a UIL athletic activity to be signed by a licensed physician, physician assistant, or advanced nurse practitioner, as well as the student and the student’s parent or guardian and direct the UIL to amend its contest rules accordingly.”   He also noted "In addition to screening for musculoskeletal conditions and injuries, the pre-participation exam also looks for cardiovascular, neurological and other conditions that can best be identified by a physician who has been trained to exam and diagnose every system within the body.  A physician is in a good role in that regard and is really the only health care provider licensed with the education and training required to diagnose every part of the human body.”  

Further, Representative Price stated on the record:  “this modification is proposed to be some accommodation, a middle ground having licensed physicians, advanced practice nurses, registered nurse practitioners and PAs, who are all under the delegation of standing written orders by a licensed physician to do their job, to perform these physicals.  What that does is it eliminates chiropractors, a group that is conducting those physicals right now, and while I am absolutely not anti-chiropractor, that is the effect of this modification.  

Among other reasons given by Representative Price was the statement I think that the folks best medically trained to do wellness checks for pre certification physicals are licensed physicians, and the licensed advance nurse practitioners, and the advanced practice nurses.  Again, they are under the written orders of a physician and that’s why I think that that group is best served to operate and do these exams.

Confusion among the members regarding this “new item” brought by vice-chair Price seemed evident. Representative Larry Gonzales at one point questioned “I've got a … question ....  So we are now saying that modifications to a modification is going to be allowable today; a modification that we have not … vetted or talked about.  As we go down this modifying modifications route I just want to make certain that we as we proceed through the rest of our day with all of these modifications on our entire list, we’re now saying that all of these are now eligible to be modified?”  

This led to an exchange between Representative Gonzales the the Chair, Senator Jane Nelson: 

Sen Jane Nelson:  As chair do you want me to answer the question? [yes]  If it’s a newly discussed issue I probably will not allow it, but this is something we’ve talked about.  I don’t want to surprise any members and this is an issue that we’ve discussed.

Rep Larry Gonzales:  “I think that I am surprised by Senator Birdwell’s comments today [regarding requiring some form of additional training to become “certified” to perform UIL pre-participation physicals].  That is something that I hadn’t heard before, this is a brand new kind of middle ground … but as a matter of procedure, this did catch me off guard, I hadn’t heard that yet, and I just want to know if modifications on modifications or unannounced, undiscussed topics are going to be allowed today.” 

Sen Jane Nelson: “As determined by the chair.  How’s that?” 

Representative Price stated:  "What I’d like to do is to bring back up the modification and take a vote on the modification with the commitment that I will, certainly if it passes, work with Senator Schwertner, Senator Birdwell to craft language as we go forward in the bill, if its accepted, to address those concerns to the best of our ability.”  

When asked by Representative Richard Raymond “Representative Price, can you guarantee us that Senator Birdwell’s Constituent will be able to conduct these physicals when you’re done with your amendments, or whatever you work out with Senator Schwertner?  Representative Price’s response was:  “Absolutely not.

The resulting vote, as noted in this report, was seven in favor of removing chiropractors from perfoming the services they are currently providing and five opposed to such removal.  

There you have it in their own words.  In coming editorials I will provide my perspective of the comments of the Sunset Commission.