Chiropractic Regulations & Complaints: A Conversation with the Texas Board of Chiropractic Examiners
February 25, 2025 • 23 mins
Are you a chiropractor looking to protect your professional license? In our latest episode, we sit down with Joseph McLaughlin, General Counsel for the Texas Board of Chiropractic Examiners (TBCE), to discuss the complaint process and what every practitioner needs to know. Complaints can arise from various issues, including billing violations, standard of care concerns, and patient record disputes. While the prospect of facing a complaint may seem daunting, most cases are resolved with minimal or no disciplinary action and are often dismissed. Joseph shares valuable insights on best practices, emphasizing the importance of thorough record-keeping and proactive communication with the TBCE to help safeguard your practice.
This episode provides a comprehensive overview of the investigation process, giving chiropractors a clearer understanding of what to expect should a complaint arise. Gain key insights into typical complaint outcomes, including letters of warning, required practitioner responses, and the potential consequences of disciplinary actions on future licensing. We also explore the legal options available to chiropractors under investigation.
Stay proactive, informed, and connected to safeguard your future in chiropractic care. Subscribe now and stay informed and ahead of any challenges you may face!
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Joseph McLaughlin currently serves as the general counsel for the Texas Board of Chiropractic Examiners. He began his career with the Board in August of 2018 as a staff attorney handling enforcement matters. He has since also practiced in several different areas of administrative law in his time with the TBCE, including public information requests, Open Meeting Act compliance, rulemaking, and providing general legal advice to the Board, chiropractors, and the public. His main goal in helping to create and enforce standards of chiropractic practice in Texas is to promote, preserve, and protect the health, safety, and welfare of the people of Texas. When not at work, Joseph enjoys spending time with his girlfriend, pets, and family.
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Visit the Texas Board of Chiropractic Examiners website: https://www.tbce.state.tx.us/
Get more information, details and resources on Know Your Regulator - https://www.belolaw.com/know-your-regulator
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to Know yourRegulator, the podcast that
inspires you to engage.
I am your host, simone Murphy,and co-hosting with me today is
(00:23):
MJ Hooper.
Hey, mj, hey, ms Simone.
In our last episode, we focusedon licensing with the Texas
Board of Chiropractic Examiners,or TBCE.
We learned what it takes toobtain and renew your license,
but what does it take tomaintain your license?
We have General Counsel JosephMcLaughlin with us today.
(00:44):
Joseph, as General Counsel andformer Director of Enforcement
for TBCE, can you tell us someof the things that can trigger
an investigation?
Speaker 2 (01:07):
investigations report .
Our three most commoncomplaints are billing
violations, standard of careviolations and patient records
violations.
Now, each of these three broadcategories includes multiple
different types of violations.
Billing violations can includeinsurance fraud, charging
clearly excessive amounts,billing for services not
rendered or just submitting abill for treatment that the
(01:30):
provider should reasonably knowis improper or unreasonable or
medically unnecessary.
Standard of care violationsreally kind of run the gamut,
but they ultimately boiled downto the same issue, and for our
agency that would be that thechiropractor in question failed
to meet the standard of carethat is expected of a doctor of
(01:53):
average skill and experience.
So this is typically whereyou're going to see allegations
of injuries to a patient duringtreatment, failures to properly
evaluate patients or justineffective or non-therapeutic
treatment.
And then, finally, patientrecord violations are typically
going to fall into one of twocategories it's either going to
(02:14):
be that the doctor failed toproperly document a
doctor-patient encounter, orthat they're failing to provide
records after a proper requestfrom a patient or somebody else
that has the authority to makethat request.
Speaker 1 (02:28):
Interesting and, joe, would you say, most of the
complaints are filed by otherpatients or staff or other
professionals.
Speaker 2 (02:38):
Most of the complaints we receive are going
to be filed by patients.
We are what you'll sometimeshear referred to as a
complaint-driven agency.
So what that means is thatreally we're only going to be
looking into a doctor or takingaction against someone because
we received a complaint.
We're not the type of agencythat goes out there and is kind
of hunting for stuff.
(02:59):
We don't do random inspectionson chiropractic clinics or
facilities.
We can do inspections, butthose have to be tied to some
complaint that we've alreadyreceived and the doctor has to
have notice of that complaint.
(03:22):
So the one exception to that,where you are going to see
complaints from somebody besidesthe patient, is typically going
to be those patient recordscomplaints.
A lot of chiropractors treatauto accident injury victims and
so a lot of times thatpatient's attorney is going to
be requesting the records ontheir behalf.
Sometimes disputes will arisebetween the chiropractor and the
attorney and so sometimes theattorney will be filing that
complaint, and I guess actuallyone other exception I would say
(03:46):
is we'll get advertisingcomplaints and sometimes those
are actually filed by otherchiropractors or just some
person who sees theadvertisement, especially if
it's like a scope of practiceissue, which is kind of a big
hot button topic forchiropractors in Texas kind of a
big hot button topic forchiropractors in Texas.
(04:06):
You'll see, like I said, otherchiropractors are just random
people who saw the advertisementand see something that they
think is outside of scope orsomething that's wrong or
misleading and they'll file thecomplaint.
Speaker 1 (04:15):
Interesting.
Yeah, that is interesting andreally, again, really good
information to know, so thatthose chiropractors can have
their heads, you know, on aswivel and kind of be very
mindful about the way that theypractice and especially keeping
the records, keeping those dogsin a row and making sure that
they're organized.
Can you walk us through atypical complaint process and
(04:40):
tell us kind of what a licenseholder may expect if they do
receive a complaint againsttheir license?
Speaker 2 (04:47):
Sure.
So our doctors will always benotified of a complaint by a
letter that they're going toreceive in the mail.
That kind of shows theimportance right there of
keeping your contact informationup to date with us, because if
we have an old, out-of-datemailing address on file, you're
not going to get the notice ofcomplaint and then you're not
(05:09):
going to be able to respond,which means you can't defend
yourself and potentially get thecomplaint dismissed.
So that's critical.
We always mail two copies ofthe notice of complaint.
We send one by regular mail andone by certified mail.
We do not provide the doctor acopy of the complaint or
directly identify the person whofiled the complaint, but we do
summarize the allegations andlist the specific statutes or
(05:33):
rules that we think might havebeen violated.
So the first step for us whenwe receive a complaint is the
investigator is going to analyzeit, maybe ask some follow up
questions of the person whofiled the complaint, and then
they're going to draft thatnotice of complaint letter.
In the notice of complaint wewill request a written response
to the allegations, as well asany relevant patient records or
(05:56):
other documents that we need.
If we're talking about anadvertising issue, we might ask
for a copy of the advertisementor something along those lines.
If you have malpracticeinsurance for all the
practitioners that are out therelistening, this is where you
would contact your carrier sothey can assign you an attorney
to help defend you At this point.
This is where the investigatormight need to, you know,
interview the chiropractor orany other witnesses, and they
(06:20):
also might need to request astandard of care review report.
So you know, earlier Imentioned that standard of care
complaints are, you know, a bigpart of our complaint load, and
so we have actually an in-housededicated expert reviewer who's
been licensed as a chiropractorwith an impeccable record for a
(06:41):
long time.
That is who would prepare thatreport, you know, after
reviewing records, making surethat the chiropractor actually
met the standard of care, andthen, once the investigation is
completed, the investigator'sreport is going to be reviewed
by the TBCE's EnforcementCommittee.
So that's, you know, our boardof examiners is nine members,
(07:02):
and three of them are theenforcement committee, and the
enforcement committee are theones that make the initial
determination of whether there'sbeen any violations that have
occurred, and then they alsorecommend a penalty, and so at
this stage, the enforcementcommittee might choose to
dismiss the case.
The case might have beendismissed at some point in the
(07:25):
investigative process forvarious reasons, but if the
enforcement committee does finda violation, then it will be
assigned to legal for some sortof resolution, which in this
case is me.
So you know legal resolutions.
There's a wide variety ofpotential outcomes.
It might be as simple as aletter of warning or a letter of
education.
These would be, you know,privateands, essentially that
would not go on a doctor'srecord.
(07:46):
We also utilize what we callnon-reportable administrative
citations.
You can kind of think of theselike a speeding ticket.
You would have to pay us a fine.
These can only be used forviolations that don't really
involve patient care in any way,and so those don't need to be
reported to national databases.
And so we basically just do aprivate fine for those cases.
(08:10):
But if you're talking aboutsomething that does involve
patient care and is going to goon the doctor's permanent record
, then that has to be resolvedusing some type of a formal
board order.
Disciplinary orders can beagreed to between the parties.
So you might've heard ofsomething called an agreed order
or an agreed final board order.
That's what that is.
It's just basically a.
(08:33):
That's like a settlementagreement in a civil suit or
maybe like a plea bargain in acriminal case.
But if the parties can't reachan agreement, then you have to
have an administrative hearing,and so in Texas that's going to
be with a government agencycalled the State Office of
Administrative Hearings, and soan administrative law judge
(08:53):
would be assigned to the caseand then you would basically
have a trial, very similar towhat you would see in district
court and civil district courtin Texas Same rules of evidence,
same rules of civil procedure,and then after that hearing, the
judge is going to make writtenfindings of facts and
conclusions of law in a documentthat's called the proposal for
(09:13):
decision.
And then that proposal fordecision is what will then
determine whether the board canactually discipline the doctor.
So in order for the board'sfinal formal disciplinary order
to be able to, you know, forexample, suspend the doctor's
license or put them on probationor, of course, in the worst
(09:34):
case scenario, revoke theirlicense, that proposal for
decision from the administrativelaw judge has to have findings
of fact and conclusions of lawthat support the disciplinary
action the board is taking, andof course that is actually
appealable.
So that's kind of the finalstep in the process is those
orders can be appealed todistrict court in Travis County.
(09:54):
At that point the cases areactually taken over by the
attorney general's office, andso that's who you'd be dealing
with.
Speaker 1 (10:02):
You wouldn't be really dealing with me anymore
at that point, so yeah, and thenI know I was about to say it's
a long process.
It sounds like, and it soundslike there's, you know, a good,
good opportunity for the licenseholder to have their day in
court and, you know, be able tostate their case and and defend
their license.
(10:22):
Yeah, and I also wanted topoint out that you know, with
those standard of care issues,that it's not just an executive
who is reviewing this right andmaking those decisions.
It's someone who is a licensedchiropractor that is reviewing
that and I think it's reallyimportant that license holders
(10:43):
know that that there is, youknow, the person who's reviewing
the standard of care is someonewho has been in you know your
exact job role before.
So that's, you know, veryimportant.
Speaker 2 (10:56):
Yeah, and you know, if I could add to that, I would
just say, you know that thisconcept of like due process, of
what you're talking about, abouthaving your day in court, that
say, you know that this conceptof like due process, of what
you're talking about abouthaving your day in court, that's
, you know, fundamental to theAmerican justice system really
is the easiest way to put it andthat's something that our
agency takes very seriously.
(11:17):
And you know, you wouldn't justeven have the standard of care
reviewer reviewing your case.
There's also two members of theenforcement committee that are
chiropractors.
And again, these are, you know,experienced professionals that
have been there before.
They know what to look for whenyou're dealing with an
allegation of oh, my doctor hurtme.
(11:39):
You know there's a whole litanyof steps and best practices and
standards of care that thedoctors are supposed to follow,
and so that's who you know whenyou're, when you're talking
about reviewing a case, that'swho's making those
determinations.
And then again, if it does haveto go to administrative hearing,
all of that has to be put on asexpert evidence, right, that
(12:03):
has to all be explained to theadministrative law judge.
So they're making not only anindependent decision, that's,
you know, free of any influencefrom the board or anything like
that, but also an informeddecision on the case, that they
actually know what thesestandards of care are and that
they actually know what the lawssay and require of the doctors.
So, you know, I might be alittle biased, but I think that
(12:27):
our process is extremely fairand gives doctors every
opportunity to to get their caseheard and to get it resolved in
a way that's fair to them.
And and you know you mentioneda few minutes ago that it's a,
it's a and it can be.
Certainly, if you go all theway to an administrative hearing
, I mean that could potentiallytake years, months, yeah, months
(12:51):
, just to get docketed.
But there's so many steps beforethat where the case can be
dismissed, you know, I mean,we've literally intaked cases
and then immediately dismissedthem because it was clear from
from the surface of thecomplaint that it was a
meritless complaint or therejust wasn't anything about it
(13:12):
that was under our jurisdiction.
But even in cases where we doinvestigate, our investigators
move very fast.
Speaker 1 (13:19):
We take that very seriously and they get cases
closed fast if they find thatthe doctor didn't do anything
wrong, well, good, yeah, and itdoes sound like that from what
you've described in yourprocesses that it's a very fair
process that y'all's agencytakes really serious.
This is a great segue into mynext question, which is how are
(13:42):
these cases most commonlyresolved?
Do you guys see a lot ofdismissals?
It sounds like not a lot ofstate office of administrative
hearings.
You know happen too often.
Speaker 2 (13:55):
Yeah, you know, like I said, that's really kind of
the weapon of last resort, ifyou will.
The majority of cases ofcomplaints that we receive don't
result in any disciplinaryaction at all, right Like a
majority of them are dismissedor closed by the enforcement
committee with a finding of noviolation, and I would say that
that's well over 50 percent ofcases.
(14:16):
And then even then, if anydisciplinary action is actually
taken, it's most likely going tobe a letter of warning or a
letter of education or anadministrative citation.
You know, I would certainly sayI don't have a hard number for
you off the top of my head, butI would certainly say a minority
of cases are closed with anysort of actual permanent
(14:37):
disciplinary action.
That goes on a doctor's record,and that's what the doctors are
most concerned about.
A lot of times it's not evenreally about the fine or maybe
being suspended for a few weeksor something.
It's the fact that this goes ontheir record and then that
causes all kinds of problemsdown the road.
When you're trying to getcredentialed in an insurance
(14:58):
network, when you're trying toget on with a new and up and
coming practice, you knowdisciplinary actions can come up
.
They can come up if you'retrying to get licensed in
another state or even if you'retrying to get an entirely
different type of license.
You might decide you want to gobecome a real estate agent,
that you're tired of being adoctor.
Background check for the TexasReal Estate Commission is going
(15:18):
to pull up that you had adisciplinary action with us.
So it's important to rememberthat all the different state
agencies communicate with oneanother, and so there's a lot of
information sharing.
That goes on.
Speaker 1 (15:33):
Yeah, I'm glad you, I'm glad you've said that,
because it is it's veryimportant for license holders to
know that, yes, if you, youknow, violate the standards of
care and you get your licenserevoked, you can't just pick up
and go to a different stateagency and, you know,
immediately obtain a license ina different industry.
They, they also are protectingthe public and they would, you
know, immediately obtain alicense in a different industry.
(15:55):
They also are protecting thepublic and they, would you know,
want to make sure that they'renot going to hand a bad apple a
license.
Speaker 2 (16:01):
Or often just move to another part of the country,
right, exactly that's somethingwe see a lot of.
Speaker 1 (16:06):
Yeah, but what you know, from what it sounds like
though it sounds likechiropractors in Texas generally
pretty well-behaved group ofpeople it sounds like there
common issues that you see comeup, and what recommendations do
(16:35):
you have to avoid those issues?
Speaker 2 (16:38):
So not keeping proper patient records is a major
problem.
So anytime we have to review apatient's records which is
really, you know, typically amajority of the complaints we
receive we're going to checkthem for compliance with our
record keeping rule, regardlessof whether or not that's what
(16:58):
the patient's alleging is anissue.
And so if we're reviewingrecords and we see there's notes
that are just not beingincluded entirely or it's
obvious that you're dealing withlike cookie cutter type notes
for the patient records, that'sgoing to be a violation of our
patient record keeping rule andeven if the chiropractor
(17:20):
otherwise did nothing wrong,we're going to have to, you know
, potentially take disciplinaryaction on that.
Another issue that we commonlysee, you know I kind of touched
on this a little bit earlier isthe issue with advertising for
services that are outside thescope for chiropractors.
You know this is mainly goingto consist of offers to treat
conditions that aren't relatedto the musculoskeletal system at
(17:44):
all.
Speaker 1 (17:45):
In.
Speaker 2 (17:45):
Texas, the.
You know, the scope of practicefor chiropractors is restricted
to the musculoskeletal systemof the human body, and that's
actually kind of anotherimportant point.
I don't know if you all knowthis at all, but animal
chiropractic is a real thing andit's.
Speaker 1 (18:01):
I have not heard of that.
That's crazy.
Speaker 2 (18:04):
It's important in Texas too.
I'm not just talking about dogsand cats, I'm talking about
livestock, you know, largeanimals.
Speaker 1 (18:10):
Okay about dogs and cats.
Speaker 2 (18:11):
I'm talking about livestock, you know, large
animals, and so in Texas, anytype of care provided to an
animal is strictly thejurisdiction of the
veterinarians.
And so in order for achiropractor to provide animal
chiropractic in Texas, that theyhave to basically receive a
referral from a veterinarian.
But as far as humans go, it'sstrictly going to be the
(18:34):
musculoskeletal system and thenthe nerves that are related to
the musculoskeletal system, andso you know we'll see
advertisements for chiropractorswho say that, you know, regular
adjustments can help with ADHD,or they can help with GI issues
or ear infections, all thesekinds of things, and those
that's those are advertisingservices that are outside the
(18:55):
scope.
It's it's not the actualadjustments that are outside the
scope, but it's what you'resaying, that the services that
you can provide can do.
You know how they can help andtreat a person, and just kind of
the way that the statute thatestablishes the scope in Texas
is written, that's going to beconsidered advertising outside
scope.
So that's something that's veryimportant for our licensees to
(19:18):
be to keep in mind, particularlywhen you know they're wanting
to advertise for their clinic.
You know social mediaadvertising is all the rage
these days, and so make surethat what you're putting out
there on your practices socialsis going to be within scope and
it's going to be above board forthe TBCE.
Speaker 1 (19:40):
Yeah, that's a good one, and thanks for providing
those examples so that you knowour listeners can go.
Oh, I'm going to pull down myadvertisement that says this
adjustment can help with, youknow, like you said, gut issues
or something like that.
Do you have any other finaladvice that may be beneficial to
our viewers, Any special orunique tips that they may be
(20:03):
able to utilize?
Speaker 2 (20:06):
Yeah, absolutely.
You know, one of the big thingsand I think I maybe touched on
this a little bit at the verybeginning is making sure that
you have up-to-date contact infowith us, because, again, if we
get a complaint and we can'tactually notify you of the
complaint, that's going to be adefault, which most of the time,
actually results in a licenserevocation, results in a license
(20:32):
revocation, and, unfortunately,I have actually revoked
someone's license before havingnothing to do with the complaint
, just the fact that theyweren't able to respond to the
complaint at all, and that's allwe can really do in a situation
like that, right?
Something else that I think isimportant to stress is, in Texas
, ownership of chiropracticclinics is not restricted to
(20:54):
chiropractors, and so we've hadkind of an increasing issue with
folks that have an ownershipinterest in a clinic, or own it
entirely, who are basicallyinstructing their doctors and
staff to do things that areillegal, whether you're talking
about billing fraud oradvertising services that are
(21:14):
outside the scope.
They're basically trying toargue that they're outside of
our jurisdiction, and so thepeople that end up having to
take the blame for anyviolations are the doctors.
Those are the only people thatactually have a license with us
that we can really enforce.
So it's important to be mindfulof what your ownership or your
(21:36):
management is saying and tellingyou, and if they're telling you
to do something illegal even ifit's, you know might
potentially cost you your jobyou have to get out of there
because otherwise you're talkingabout your license.
You know that's yourprofessional reputation that's
on the line.
That's something to be verymindful of.
And then the last thing I wantto just tell anybody who's
(21:57):
listening is if you ever haveany questions, please contact us
.
You can ask us anything, and wewould always rather be able to
answer a question and tell youno, that's not really legal,
then to find out after the factin a complaint that we're having
to investigate.
You can always pick up thephone and call us.
We are a small agency.
(22:19):
We don't have a very big staff,but we actually really try and
prioritize customer service, andso if the person that you talk
to isn't able to answer yourquestion, they'll get a hold of
somebody who can, or they'lltransfer you, and we're always
going to follow up on avoicemail or an email too.
So just don't be afraid to ask.
(22:40):
That's really probably thesingle most important piece of
advice I can give anyonelistening.
Speaker 1 (22:46):
Yes, and we support that.
We want you to reach out toyour regulatory agency and ask
them the questions.
We want you to reach out toyour regulatory agency and ask
them the questions you know.
We want you to get engaged andstay informed.
Well, thank you again, joe, somuch for joining us this
afternoon and taking the time toshare your knowledge with us
Again.
For more information on thistopic, you can visit the TBCE
(23:07):
website linked in thedescription below.
And until next time, stayinformed and continue engaging
with your regulatory agency.
Know your Regulator the podcastthat inspires you to engage.
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to Know yourRegulator, the podcast that
inspires you to engage.
I am your host, simone Murphy,and co-hosting with me today is
(00:23):
MJ Hooper.
Hey, mj, hey, ms Simone.
In our last episode, we focusedon licensing with the Texas
Board of Chiropractic Examiners,or TBCE.
We learned what it takes toobtain and renew your license,
but what does it take tomaintain your license?
We have General Counsel JosephMcLaughlin with us today.
(00:44):
Joseph, as General Counsel andformer Director of Enforcement
for TBCE, can you tell us someof the things that can trigger
an investigation?
Speaker 2 (01:07):
investigations report .
Our three most commoncomplaints are billing
violations, standard of careviolations and patient records
violations.
Now, each of these three broadcategories includes multiple
different types of violations.
Billing violations can includeinsurance fraud, charging
clearly excessive amounts,billing for services not
rendered or just submitting abill for treatment that the
(01:30):
provider should reasonably knowis improper or unreasonable or
medically unnecessary.
Standard of care violationsreally kind of run the gamut,
but they ultimately boiled downto the same issue, and for our
agency that would be that thechiropractor in question failed
to meet the standard of carethat is expected of a doctor of
(01:53):
average skill and experience.
So this is typically whereyou're going to see allegations
of injuries to a patient duringtreatment, failures to properly
evaluate patients or justineffective or non-therapeutic
treatment.
And then, finally, patientrecord violations are typically
going to fall into one of twocategories it's either going to
(02:14):
be that the doctor failed toproperly document a
doctor-patient encounter, orthat they're failing to provide
records after a proper requestfrom a patient or somebody else
that has the authority to makethat request.
Speaker 1 (02:28):
Interesting and, joe, would you say, most of the
complaints are filed by otherpatients or staff or other
professionals.
Speaker 2 (02:38):
Most of the complaints we receive are going
to be filed by patients.
We are what you'll sometimeshear referred to as a
complaint-driven agency.
So what that means is thatreally we're only going to be
looking into a doctor or takingaction against someone because
we received a complaint.
We're not the type of agencythat goes out there and is kind
of hunting for stuff.
(02:59):
We don't do random inspectionson chiropractic clinics or
facilities.
We can do inspections, butthose have to be tied to some
complaint that we've alreadyreceived and the doctor has to
have notice of that complaint.
(03:22):
So the one exception to that,where you are going to see
complaints from somebody besidesthe patient, is typically going
to be those patient recordscomplaints.
A lot of chiropractors treatauto accident injury victims and
so a lot of times thatpatient's attorney is going to
be requesting the records ontheir behalf.
Sometimes disputes will arisebetween the chiropractor and the
attorney and so sometimes theattorney will be filing that
complaint, and I guess actuallyone other exception I would say
(03:46):
is we'll get advertisingcomplaints and sometimes those
are actually filed by otherchiropractors or just some
person who sees theadvertisement, especially if
it's like a scope of practiceissue, which is kind of a big
hot button topic forchiropractors in Texas kind of a
big hot button topic forchiropractors in Texas.
(04:06):
You'll see, like I said, otherchiropractors are just random
people who saw the advertisementand see something that they
think is outside of scope orsomething that's wrong or
misleading and they'll file thecomplaint.
Speaker 1 (04:15):
Interesting.
Yeah, that is interesting andreally, again, really good
information to know, so thatthose chiropractors can have
their heads, you know, on aswivel and kind of be very
mindful about the way that theypractice and especially keeping
the records, keeping those dogsin a row and making sure that
they're organized.
Can you walk us through atypical complaint process and
(04:40):
tell us kind of what a licenseholder may expect if they do
receive a complaint againsttheir license?
Speaker 2 (04:47):
Sure.
So our doctors will always benotified of a complaint by a
letter that they're going toreceive in the mail.
That kind of shows theimportance right there of
keeping your contact informationup to date with us, because if
we have an old, out-of-datemailing address on file, you're
not going to get the notice ofcomplaint and then you're not
(05:09):
going to be able to respond,which means you can't defend
yourself and potentially get thecomplaint dismissed.
So that's critical.
We always mail two copies ofthe notice of complaint.
We send one by regular mail andone by certified mail.
We do not provide the doctor acopy of the complaint or
directly identify the person whofiled the complaint, but we do
summarize the allegations andlist the specific statutes or
(05:33):
rules that we think might havebeen violated.
So the first step for us whenwe receive a complaint is the
investigator is going to analyzeit, maybe ask some follow up
questions of the person whofiled the complaint, and then
they're going to draft thatnotice of complaint letter.
In the notice of complaint wewill request a written response
to the allegations, as well asany relevant patient records or
(05:56):
other documents that we need.
If we're talking about anadvertising issue, we might ask
for a copy of the advertisementor something along those lines.
If you have malpracticeinsurance for all the
practitioners that are out therelistening, this is where you
would contact your carrier sothey can assign you an attorney
to help defend you At this point.
This is where the investigatormight need to, you know,
interview the chiropractor orany other witnesses, and they
(06:20):
also might need to request astandard of care review report.
So you know, earlier Imentioned that standard of care
complaints are, you know, a bigpart of our complaint load, and
so we have actually an in-housededicated expert reviewer who's
been licensed as a chiropractorwith an impeccable record for a
(06:41):
long time.
That is who would prepare thatreport, you know, after
reviewing records, making surethat the chiropractor actually
met the standard of care, andthen, once the investigation is
completed, the investigator'sreport is going to be reviewed
by the TBCE's EnforcementCommittee.
So that's, you know, our boardof examiners is nine members,
(07:02):
and three of them are theenforcement committee, and the
enforcement committee are theones that make the initial
determination of whether there'sbeen any violations that have
occurred, and then they alsorecommend a penalty, and so at
this stage, the enforcementcommittee might choose to
dismiss the case.
The case might have beendismissed at some point in the
(07:25):
investigative process forvarious reasons, but if the
enforcement committee does finda violation, then it will be
assigned to legal for some sortof resolution, which in this
case is me.
So you know legal resolutions.
There's a wide variety ofpotential outcomes.
It might be as simple as aletter of warning or a letter of
education.
These would be, you know,privateands, essentially that
would not go on a doctor'srecord.
(07:46):
We also utilize what we callnon-reportable administrative
citations.
You can kind of think of theselike a speeding ticket.
You would have to pay us a fine.
These can only be used forviolations that don't really
involve patient care in any way,and so those don't need to be
reported to national databases.
And so we basically just do aprivate fine for those cases.
(08:10):
But if you're talking aboutsomething that does involve
patient care and is going to goon the doctor's permanent record
, then that has to be resolvedusing some type of a formal
board order.
Disciplinary orders can beagreed to between the parties.
So you might've heard ofsomething called an agreed order
or an agreed final board order.
That's what that is.
It's just basically a.
(08:33):
That's like a settlementagreement in a civil suit or
maybe like a plea bargain in acriminal case.
But if the parties can't reachan agreement, then you have to
have an administrative hearing,and so in Texas that's going to
be with a government agencycalled the State Office of
Administrative Hearings, and soan administrative law judge
(08:53):
would be assigned to the caseand then you would basically
have a trial, very similar towhat you would see in district
court and civil district courtin Texas Same rules of evidence,
same rules of civil procedure,and then after that hearing, the
judge is going to make writtenfindings of facts and
conclusions of law in a documentthat's called the proposal for
(09:13):
decision.
And then that proposal fordecision is what will then
determine whether the board canactually discipline the doctor.
So in order for the board'sfinal formal disciplinary order
to be able to, you know, forexample, suspend the doctor's
license or put them on probationor, of course, in the worst
(09:34):
case scenario, revoke theirlicense, that proposal for
decision from the administrativelaw judge has to have findings
of fact and conclusions of lawthat support the disciplinary
action the board is taking, andof course that is actually
appealable.
So that's kind of the finalstep in the process is those
orders can be appealed todistrict court in Travis County.
(09:54):
At that point the cases areactually taken over by the
attorney general's office, andso that's who you'd be dealing
with.
Speaker 1 (10:02):
You wouldn't be really dealing with me anymore
at that point, so yeah, and thenI know I was about to say it's
a long process.
It sounds like, and it soundslike there's, you know, a good,
good opportunity for the licenseholder to have their day in
court and, you know, be able tostate their case and and defend
their license.
(10:22):
Yeah, and I also wanted topoint out that you know, with
those standard of care issues,that it's not just an executive
who is reviewing this right andmaking those decisions.
It's someone who is a licensedchiropractor that is reviewing
that and I think it's reallyimportant that license holders
(10:43):
know that that there is, youknow, the person who's reviewing
the standard of care is someonewho has been in you know your
exact job role before.
So that's, you know, veryimportant.
Speaker 2 (10:56):
Yeah, and you know, if I could add to that, I would
just say, you know that thisconcept of like due process, of
what you're talking about, abouthaving your day in court, that
say, you know that this conceptof like due process, of what
you're talking about abouthaving your day in court, that's
, you know, fundamental to theAmerican justice system really
is the easiest way to put it andthat's something that our
agency takes very seriously.
(11:17):
And you know, you wouldn't justeven have the standard of care
reviewer reviewing your case.
There's also two members of theenforcement committee that are
chiropractors.
And again, these are, you know,experienced professionals that
have been there before.
They know what to look for whenyou're dealing with an
allegation of oh, my doctor hurtme.
(11:39):
You know there's a whole litanyof steps and best practices and
standards of care that thedoctors are supposed to follow,
and so that's who you know whenyou're, when you're talking
about reviewing a case, that'swho's making those
determinations.
And then again, if it does haveto go to administrative hearing,
all of that has to be put on asexpert evidence, right, that
(12:03):
has to all be explained to theadministrative law judge.
So they're making not only anindependent decision, that's,
you know, free of any influencefrom the board or anything like
that, but also an informeddecision on the case, that they
actually know what thesestandards of care are and that
they actually know what the lawssay and require of the doctors.
So, you know, I might be alittle biased, but I think that
(12:27):
our process is extremely fairand gives doctors every
opportunity to to get their caseheard and to get it resolved in
a way that's fair to them.
And and you know you mentioneda few minutes ago that it's a,
it's a and it can be.
Certainly, if you go all theway to an administrative hearing
, I mean that could potentiallytake years, months, yeah, months
(12:51):
, just to get docketed.
But there's so many steps beforethat where the case can be
dismissed, you know, I mean,we've literally intaked cases
and then immediately dismissedthem because it was clear from
from the surface of thecomplaint that it was a
meritless complaint or therejust wasn't anything about it
(13:12):
that was under our jurisdiction.
But even in cases where we doinvestigate, our investigators
move very fast.
Speaker 1 (13:19):
We take that very seriously and they get cases
closed fast if they find thatthe doctor didn't do anything
wrong, well, good, yeah, and itdoes sound like that from what
you've described in yourprocesses that it's a very fair
process that y'all's agencytakes really serious.
This is a great segue into mynext question, which is how are
(13:42):
these cases most commonlyresolved?
Do you guys see a lot ofdismissals?
It sounds like not a lot ofstate office of administrative
hearings.
You know happen too often.
Speaker 2 (13:55):
Yeah, you know, like I said, that's really kind of
the weapon of last resort, ifyou will.
The majority of cases ofcomplaints that we receive don't
result in any disciplinaryaction at all, right Like a
majority of them are dismissedor closed by the enforcement
committee with a finding of noviolation, and I would say that
that's well over 50 percent ofcases.
(14:16):
And then even then, if anydisciplinary action is actually
taken, it's most likely going tobe a letter of warning or a
letter of education or anadministrative citation.
You know, I would certainly sayI don't have a hard number for
you off the top of my head, butI would certainly say a minority
of cases are closed with anysort of actual permanent
(14:37):
disciplinary action.
That goes on a doctor's record,and that's what the doctors are
most concerned about.
A lot of times it's not evenreally about the fine or maybe
being suspended for a few weeksor something.
It's the fact that this goes ontheir record and then that
causes all kinds of problemsdown the road.
When you're trying to getcredentialed in an insurance
(14:58):
network, when you're trying toget on with a new and up and
coming practice, you knowdisciplinary actions can come up
.
They can come up if you'retrying to get licensed in
another state or even if you'retrying to get an entirely
different type of license.
You might decide you want to gobecome a real estate agent,
that you're tired of being adoctor.
Background check for the TexasReal Estate Commission is going
(15:18):
to pull up that you had adisciplinary action with us.
So it's important to rememberthat all the different state
agencies communicate with oneanother, and so there's a lot of
information sharing.
That goes on.
Speaker 1 (15:33):
Yeah, I'm glad you, I'm glad you've said that,
because it is it's veryimportant for license holders to
know that, yes, if you, youknow, violate the standards of
care and you get your licenserevoked, you can't just pick up
and go to a different stateagency and, you know,
immediately obtain a license ina different industry.
They, they also are protectingthe public and they would, you
know, immediately obtain alicense in a different industry.
(15:55):
They also are protecting thepublic and they, would you know,
want to make sure that they'renot going to hand a bad apple a
license.
Speaker 2 (16:01):
Or often just move to another part of the country,
right, exactly that's somethingwe see a lot of.
Speaker 1 (16:06):
Yeah, but what you know, from what it sounds like
though it sounds likechiropractors in Texas generally
pretty well-behaved group ofpeople it sounds like there
common issues that you see comeup, and what recommendations do
(16:35):
you have to avoid those issues?
Speaker 2 (16:38):
So not keeping proper patient records is a major
problem.
So anytime we have to review apatient's records which is
really, you know, typically amajority of the complaints we
receive we're going to checkthem for compliance with our
record keeping rule, regardlessof whether or not that's what
(16:58):
the patient's alleging is anissue.
And so if we're reviewingrecords and we see there's notes
that are just not beingincluded entirely or it's
obvious that you're dealing withlike cookie cutter type notes
for the patient records, that'sgoing to be a violation of our
patient record keeping rule andeven if the chiropractor
(17:20):
otherwise did nothing wrong,we're going to have to, you know
, potentially take disciplinaryaction on that.
Another issue that we commonlysee, you know I kind of touched
on this a little bit earlier isthe issue with advertising for
services that are outside thescope for chiropractors.
You know this is mainly goingto consist of offers to treat
conditions that aren't relatedto the musculoskeletal system at
(17:44):
all.
Speaker 1 (17:45):
In.
Speaker 2 (17:45):
Texas, the.
You know, the scope of practicefor chiropractors is restricted
to the musculoskeletal systemof the human body, and that's
actually kind of anotherimportant point.
I don't know if you all knowthis at all, but animal
chiropractic is a real thing andit's.
Speaker 1 (18:01):
I have not heard of that.
That's crazy.
Speaker 2 (18:04):
It's important in Texas too.
I'm not just talking about dogsand cats, I'm talking about
livestock, you know, largeanimals.
Speaker 1 (18:10):
Okay about dogs and cats.
Speaker 2 (18:11):
I'm talking about livestock, you know, large
animals, and so in Texas, anytype of care provided to an
animal is strictly thejurisdiction of the
veterinarians.
And so in order for achiropractor to provide animal
chiropractic in Texas, that theyhave to basically receive a
referral from a veterinarian.
But as far as humans go, it'sstrictly going to be the
(18:34):
musculoskeletal system and thenthe nerves that are related to
the musculoskeletal system, andso you know we'll see
advertisements for chiropractorswho say that, you know, regular
adjustments can help with ADHD,or they can help with GI issues
or ear infections, all thesekinds of things, and those
that's those are advertisingservices that are outside the
(18:55):
scope.
It's it's not the actualadjustments that are outside the
scope, but it's what you'resaying, that the services that
you can provide can do.
You know how they can help andtreat a person, and just kind of
the way that the statute thatestablishes the scope in Texas
is written, that's going to beconsidered advertising outside
scope.
So that's something that's veryimportant for our licensees to
(19:18):
be to keep in mind, particularlywhen you know they're wanting
to advertise for their clinic.
You know social mediaadvertising is all the rage
these days, and so make surethat what you're putting out
there on your practices socialsis going to be within scope and
it's going to be above board forthe TBCE.
Speaker 1 (19:40):
Yeah, that's a good one, and thanks for providing
those examples so that you knowour listeners can go.
Oh, I'm going to pull down myadvertisement that says this
adjustment can help with, youknow, like you said, gut issues
or something like that.
Do you have any other finaladvice that may be beneficial to
our viewers, Any special orunique tips that they may be
(20:03):
able to utilize?
Speaker 2 (20:06):
Yeah, absolutely.
You know, one of the big thingsand I think I maybe touched on
this a little bit at the verybeginning is making sure that
you have up-to-date contact infowith us, because, again, if we
get a complaint and we can'tactually notify you of the
complaint, that's going to be adefault, which most of the time,
actually results in a licenserevocation, results in a license
(20:32):
revocation, and, unfortunately,I have actually revoked
someone's license before havingnothing to do with the complaint
, just the fact that theyweren't able to respond to the
complaint at all, and that's allwe can really do in a situation
like that, right?
Something else that I think isimportant to stress is, in Texas
, ownership of chiropracticclinics is not restricted to
(20:54):
chiropractors, and so we've hadkind of an increasing issue with
folks that have an ownershipinterest in a clinic, or own it
entirely, who are basicallyinstructing their doctors and
staff to do things that areillegal, whether you're talking
about billing fraud oradvertising services that are
(21:14):
outside the scope.
They're basically trying toargue that they're outside of
our jurisdiction, and so thepeople that end up having to
take the blame for anyviolations are the doctors.
Those are the only people thatactually have a license with us
that we can really enforce.
So it's important to be mindfulof what your ownership or your
(21:36):
management is saying and tellingyou, and if they're telling you
to do something illegal even ifit's, you know might
potentially cost you your jobyou have to get out of there
because otherwise you're talkingabout your license.
You know that's yourprofessional reputation that's
on the line.
That's something to be verymindful of.
And then the last thing I wantto just tell anybody who's
(21:57):
listening is if you ever haveany questions, please contact us
.
You can ask us anything, and wewould always rather be able to
answer a question and tell youno, that's not really legal,
then to find out after the factin a complaint that we're having
to investigate.
You can always pick up thephone and call us.
We are a small agency.
(22:19):
We don't have a very big staff,but we actually really try and
prioritize customer service, andso if the person that you talk
to isn't able to answer yourquestion, they'll get a hold of
somebody who can, or they'lltransfer you, and we're always
going to follow up on avoicemail or an email too.
So just don't be afraid to ask.
(22:40):
That's really probably thesingle most important piece of
advice I can give anyonelistening.
Speaker 1 (22:46):
Yes, and we support that.
We want you to reach out toyour regulatory agency and ask
them the questions.
We want you to reach out toyour regulatory agency and ask
them the questions you know.
We want you to get engaged andstay informed.
Well, thank you again, joe, somuch for joining us this
afternoon and taking the time toshare your knowledge with us
Again.
For more information on thistopic, you can visit the TBCE
(23:07):
website linked in thedescription below.
And until next time, stayinformed and continue engaging
with your regulatory agency.
Know your Regulator the podcastthat inspires you to engage.
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