1 

Honorable Jeffrey D. Kyle

Clerk, Third Court of Appeals

209 W 14th Street, Room 101 

Austin, TX 78701

Re: Texas Association of Acupuncture and Oriental Medicine v. Texas Board of 

Chiropractic Examiners and Yvette Yarborough, Executive Director in Her Official 

Capacity, No. 3-15-00262-CV 

To the Honorable Members of the Third Court of Appeals:

Please accept this amicus curiae letter on behalf of the Accreditation 

Commission for Acupuncture and Oriental Medicine (ACAOM) in the abovereferenced matter. ACAOM is the national accrediting agency recognized by the 

U.S. Department of Education for the accreditation and pre-accreditation 

(“Candidacy”) throughout the United States of first professional master’s degree and 

professional master’s level certificate and diploma programs in acupuncture and 

Oriental medicine, and professional post-graduate doctoral programs in acupuncture 

and in Oriental medicine (DAOM), as well as freestanding institutions and colleges 

of acupuncture and Oriental medicine that offer such programs. ACAOM provides 

both institutional and programmatic accreditation.

1 It is the opinion of ACAOM that 

the Texas Board of Chiropractic Examiners (Chiropractic Board) has promulgated 

 

1 The Accreditation Commission for Acupuncture and Oriental Medicine, About Us, available at 

http://acaom.org/about/.

ACCEPTED

03-15-00262-CV

7943947

THIRD COURT OF APPEALS

AUSTIN, TEXAS

11/23/2015 11:14:11 AM

JEFFREY D. KYLE

CLERK

 RECEIVED IN 3rd COURT OF APPEALS AUSTIN, TEXAS 11/23/2015 11:14:11 AM JEFFREY D. KYLE Clerk
2

rules that significantly undermine historically accepted standards of acupuncture 

education and professional practice in Texas. As such, ACAOM respectfully asks 

that the Third Court of Appeals reverse the decision by the 201st District Court and 

render judgement in favor of the Texas Association of Acupuncture and Oriental 

Medicine. 

The goal of accreditation is to ensure that education provided by institutions 

of higher education meets acceptable levels of quality. In the most practical terms, 

accreditation also serves to recognize that an institution maintains standards requisite 

for its graduates to achieve credentials for professional practice. 2 The rule to 

“certify” chiropractors to practice acupuncture designed by the Chiropractic Board 

appears to have significantly lower standards of education that are not subject to the 

oversight accreditation provides.

3

 2 U.S. Dept. of Education, FAQs about Accreditation, available at 

http://ope.ed.gov/accreditation/FAQAccr.aspx

3 Despite a requirement to take a certification examination, it is unclear by what authority, or 

indeed if, chiropractors are certified to practice acupuncture. See National Board of Chiropractic 

Examiners, Does the NBCE License Chiropractors?, available at 

http://mynbce.org/score/licensing-certification/ (“NBCE does not certify / license chiropractors” 

and “examinees who successfully complete NBCE Parts I, II, III and IV are awarded an NBCE 

Certificate of Attainment”). There is no mention of a “certificate of attainment” in acupuncture. 

See also CR 249, Admission No. 14 (stating that the Chiropractic Board does not certify 

chiropractors in acupuncture.)
3

It is our understanding that current Chiropractic Board rules provide two 

different pathways for chiropractors to practice acupuncture.4 One option requires a 

chiropractor to pass the same national certification examination that acupuncturists 

must take as part of their requirements to become licensed in Texas, a test which at 

a minimum requires nearly 1,500 hours of ACAOM accredited curriculum5

. 

Alternatively, the Chiropractic Board allows a far less rigorous second option, the

certification examination administered by the National Board of Chiropractic 

Examiners (NBCE), which requires 100 hours of acupuncture education with no 

clinical training requirement.6

To help clarify, there are two distinct types of accreditation: "institutional" 

accreditation, which typically applies to an entire institution, indicating that each of 

its parts are contributing to the achievement of the institution's objectives; and 

"specialized" or "programmatic" accreditation, which applies to the evaluation of 

specific programs of study.7 NBCE policy articulates certain accreditation

 4

 22 TEX. ADMIN. CODE §78.14.

5 See National Certification Commission for Acupuncture and Oriental Medicine, NCCAOM 

Certification Handbook 2015, available at http://www.nccaom.org/wpcontent/uploads/pdf/Certification%20Handbook.pdf. Licensed Acupuncturists in Texas must 

receive full certification in Oriental Medicine (page.22, Table 2: ACAOM Graduation Hour 

Requirements, Oriental Medicine Program, minimum of 2625 hours). The lowest possible number 

of hours allowed to sit for the NCCAOM Acupuncture with Point Location exam is 1490 hours 

(page 23, Table 3: Pre-graduation Hour Requirements for Taking Examinations).

6 22 Tex. Admin. Code § 78.14.

7 See Note 2 supra.
4

requirements which must be met for a candidate to sit for the NBCE acupuncture 

exam,8 but these requirements do not appear to be related or relevant to acupuncture

education:

• The Council on Chiropractic Education (CCE) is the specialized chiropractic 

accrediting body, with purview over doctoral level chiropractic programs.9

Acupuncture is not included as part of the programmatic curriculum nor is it 

listed as a competency for the doctoral programs at chiropractic schools in 

CCE accreditation standards. Some chiropractic institutions offer elective

training of limited duration in acupuncture through non-credit bearing “postgraduate” continuing education programs. Continuing education programs 

are not normally reviewed by accrediting commissions as the education is 

non-credit bearing. In this instance CCE does not have specific standards for 

acupuncture and therefore the content of acupuncture training programs does 

not fall within their regulatory purview.

• Absent acupuncture-specific programmatic accreditation, the case has been 

made that oversight of acupuncture education at chiropractic colleges is 

 8 See National Board of Chiropractic Examiners, Acupuncture Brochure (page 3, Applicant 

Eligibility), available at http://nbce.wpengine.com/wp-content/uploads/acu_brochure.pdf. See 

also NBCE Eligibility Policy, available at http://mynbce.org/apply/eligibilityrequirements/eligibility-policy/.

9 Council on Chiropractic Education website, available at http://www.cce-usa.org/.
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provided via a school’s institutional accreditor.10 In Texas, that entity is the 

Southern Association of Colleges and Schools (SACS). However, as 

previously noted, the role of an institutional accrediting body is to assess the 

broader organizational effectiveness of an institution, not to establish or assess 

specialized curriculum. SACS thus offers no specific oversight of acupuncture 

education, whether taught at a chiropractic college or elsewhere.

• Other than the general requirement that a school’s continuing education 

program overall must be in alignment with the stated mission of the 

institution, continuing education is generally outside the scope of the 

accreditation process.11

Thus, acupuncture education as taught by chiropractic colleges does not 

include the oversight of accreditation. Without accreditation in the area being tested, 

there is no assurance that verifiable standards of education and training have been 

 10 Dr. Kenneth Thomas, V.P. of Academic Affairs at Parker University at a 2012 Chiropractic 

Board meeting stated, “I want to make that point very clear that those programs do have scrutiny 

over them outside the university via SACS.” And, “They do accredit that...they look at faculty 

rosters, faculty credentials, student learning outcomes, our benchmarks...” Chiropractic Board 

July 11, 2012 ad hoc meeting, at 1:54:22 - 1:55:40, available at 

https://www.tbce.state.tx.us/Hearings/Acupuncture20120711.MP3.

11 See Southern Association of Colleges and Schools, Commission on Colleges ‘The Principles of 

Accreditation: Foundations of Quality Enhancement’ (Section 3.3.1.5, and 3.4.2, Continuing 

Education), available at http://www.sacscoc.org/pdf/2012PrinciplesOfAcreditation.pdf. 
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met. Consequently, an individual may graduate from a chiropractic college, become 

a licensed chiropractor, and practice acupuncture without any actual clinical training 

or demonstrated clinical competencies in acupuncture,12 as would be required in an 

accredited acupuncture program. The Chiropractic Board claims to only approve 

acupuncture courses which include a clinical component, but it appears this may not 

be the case.13ACAOM considers clinical training in acupuncture to be fundamental 

and central to acupuncture education.14

 The Chiropractic Board’s area of expertise is chiropractic medicine not 

acupuncture. The Chiropractic Board’s rule sidesteps the important role of 

accreditation in setting specific standards of quality for acupuncture programs that 

relate to safe and legal practice and we trust that the information provided in this 

amicus curiae letter will assist the Court in reversing the decision by the 201st District 

Court and rendering judgement in favor of the Texas Association of Acupuncture 

and Oriental Medicine.

Respectfully submitted,

 12 Id. at 2:04:49

13 See Parker University Continuing Education, Texas State Board Approvals, available at 

http://ce.parker.edu/state-board-approvals/texas/. And, Dr. Kenneth Thomas, V.P. of Academic 

Affairs at Parker University at a 2012 Chiropractic Board meeting confirmed, “Yes, there’s no 

clinical requirement [in acupuncture]...at our university” (discussed further below). Chiropractic 

Board July 11, 2012 ad hoc meeting, at 2:06:27 – 2:06:47, available at 

https://www.tbce.state.tx.us/Hearings/Acupuncture20120711.MP3. 14 ACAOM Accreditation Manual, Criterion 8.7 Clinical Training, available at 

http://acaom.org/documents/accreditation_manual_712.pdf.
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/s/ Mark S. McKenzie

Mark S. McKenzie, PhD, MsOM, LAc

Executive Director

Accreditation Commission for Acupuncture and Oriental Medicine

8941 Aztec Drive

Eden Prairie, MN 55347

Phone: (952)212-2434

mark.mckenzie@acaom.org

Certificate of Amicus

Pursuant to Rule 11 of the Texas Rules of Appellate Procedure, this will 

confirm that ACAOM has not incurred any legal fees related to the drafting of this 

letter. The undersigned is an employee and the Executive Director of ACAOM and 

neither ACAOM nor the undersigned have received or will receive any direct 

compensation for the drafting or submission of this amicus letter. 

/s/ Mark S. McKenzie

Mark S. McKenzie

Certificate of Compliance

I certify on behalf of Amicus Curiae, that this Amicus letter contains 1231

words in the text of the document and 397 words in the foot notes according to the 

word count feature of the software used to prepare this amicus letter.

/s/ Mark S. McKenzie

Mark S. McKenzie
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Certificate of Service

I hereby certify that a true and correct copy of the above and foregoing

Amicus letter has been served to all attorneys of record as listed below on November 

23, 2015.

Joe H. Thrash

Assistant Attorney General

Administrative Law Division

P.O. Box 12548

Austin, Texas 78711

Joe.Thrash@texasattorneygeneral.gov

Craig T. Enoch

Enoch Kever, PLLC.

600 Congress Avenue, Suite 2800

Austin, Texas 78701

cenoch@enochkever.com

/s/ Mark S. McKenzie

Mark S. McKenzie