### TEXA S C OU R T OF A PPEAL S, THIR D DIST R ICT , AT AU STIN

NO. 03-0 5 -00 620 -CV

Texas Orthopaedic Association, Texas Medical Association and An drew M. Kant, M .D. , Appellan ts

v. Te xa s St at e Boa r d of P odi at r ic M e dic al E xa m ine r s; Te xa s P odi at r ic M e dic al A sso c iat ion ; and B ruce A . Scudd ay, D.P .M. , Appellees

F ROM THE DISTRICT CO URT OF TRAVIS COUNTY , 345TH JUDICIAL DISTRICT NO. GN20402 2 , HO NORAB LE DARLENE B Y RNE , JUDGE PRESIDI NG

O P I N I O N

Var ious statutes ov er

t h e y ea rs h av e d es cr i b edt h e p ra ct i ce o f p o d i at ry as t h e t re at ment of the foot, but the ter

m “foot” ha s never

been statutorily

define d. See, e .g. , T ex. Occ. Code Ann. § 202.001(a )(4) (West 2004). I n 2001, the Texas State Boa rd of Podiatric Medica l Ex aminers (t h e “B oard” ) promulg ated a rule de fining the word “ foot.” See T e x. O c c . Co d e A n n . § 2 02.151 (West 2004) (author izi ng Boa rd to adopt rules go v er n i n g prac tice of podiatry ); 22 Tex. Admin. Code § 375.1(2) (2 007) (de fining foot) (the “Rule”) . The Rule included in its definition, among other thing s, portions of what in lay man’s ter ms is called the ankle. In response , the Texas Orthopae dic Association, the Te x as Medica l Association, and Andr ew M. K a n t, M

. D . (“a

ppellants”) soug ht a decla

ration that the Rule impermissibly expanded the scope of podiatry . The district cour t2

conclude d that the Rule was valid and did not exceed the Boa rd’s authority

. The appellants a ppeal the jud g me nt o f t

he dis tr ic t c ourt . We wi ll r e ve rs e the dis tr ic t c ourt ’s jud g me nt.

BACK GR OUND I n g ener al, the statutory

provisions g overning the medical treatment and diag nosis of dis e a se s and

dis or de rs of

the human b od

y a nd the ind ivi du a ls a

uth or ize d to e ngage i n th os e prac tices ar e found in the Me dical Prac tice Ac t. See Tex. Occ. Code Ann. §§ 151.001- 165.160 (West 2004 & Supp. 2007). Althoug h the Act re quires complianc e with its provisions to practice medicine, see id. § 155.001 (West 2004), the Ac t exem p t s ce rt ain individuals from compliance , id. § 151.052 (West 2004). The ex emption rele vant i n this case is found in subsec tion 151.052(a)( 5) and exempts “a lice nsed p o d i at ri s t eng ag ed str ic tly in the prac tice of podiatry as def ined by law.” Id. § 151.052(a) (5) ( emphasis adde d). By providing the exemption, the leg islature ac knowledg ed that there is some deg ree of over lap betwe en podiatrists’ and phy sicians’ scope s of pra ctice.

The pra ctice of

podiatry in Texas has been g overne d by statute since 1923. At that tim e , p od ia tr ist s w e re referr e d to a s c hir op od ist s, and c hir op od y wa s d e fi ne d a s “ the dia g no sis , medical a nd surg ical tre atment of a ilments of the human foot.” A ct o f M ar ch 6, 1923, 38th L eg ., R.S., ch. 169, § 1, 1923 Tex. Gen. L aws 357, 357-60. In 1951, the statute wa s amende d and def ined

c h i r o p o dy, i n r e l e v a n tp a rt , a s t h e t r e a t m e n to f “ a n y d i s e a s e o r

d i s o r d e r , p h ys i c a l i n

j u r y o r d e f o r m i t y, or ailment of the huma

n foot, by any sy stem or method.” See Act of April 18, 1951, 52nd L eg ., R.S., ch. 132, § 1, 1951 Te x . Gen. L aws 219, 219. In 1 9 6 7 , the leg islature re named c hiropodists as podiatrists. See Act of A pril 12, 1967, 60th L eg ., R.S., ch. 96, §§ 1, 2, 1967 Tex. Gen. L aws 181, 181-82. The c urre nt statute provides, i n rele vant part, that podiatry “mea ns the treatment of or off

er3

to treat a ny disease, disorde r, phy sical injury , defor mity , or ailment of the human f oot by any sy stem

or me tho d. Th e te rm

inc lu des po diatr ic me dic ine .” Te x. Oc c . Co de Ann. § 2 02 .0 01 (a )( 4) ; see Senate Comm. on Hea lth & Human Service s, Bill Analy sis, Tex. S.B. 673, 74t h L eg ., R.S. (1995) (stating that chang es we re ma de to statute g overningpodiatry b ec ause former statutes contained “antiquate d and limiting lang uag e”)

.

Pursuant to statutory authority , the Board announced in 2000 that it intended to adopt an administrative r

ule def ining the te rm “foot.” See Tex. Occ. Code Ann. § 202.151(2) ( “The board shall adopt rea sonable or ne cessa ry rules and by

laws consistent with the law r eg ulating the prac tice of podiatry , the law of this state, and the law of the United States to gove rn: . . . (2) the regulation of the pr a c tic e of

po diatr y ” ); see also id. § 202.051 (West Supp. 2007) (detailing r equire ments for Boa rd member ship). I n descr ibing the ne ed for t h e def inition, t he B oard state d that there was “un cert ainty a mon g va

ri ou s g ro up s re su lti ng fr om the la c k of a de fi nit ion ” a nd that, wi tho ut a definition, podiatrists, insurance c ompanies, and hospitals we re unc erta in as to the limit of the p ra ctice of

podiatry

. See 26 Te x. Re g . 2 38 5, 23 85 (M a rc h 2 3, 20 01 ). Af te r r e c e ivi ngc omm e nts reg ardingthe proposed de finition, including objec tions from the Texas Orthopae dic Association and the Texas Medica l Association, the B oard a dopted the Rule in 2001. S e e 2 2 T ex . Admin. Code § 3 75 .1 (2 ); 26 Te x. Re g . at 23 90 . T he Rul e pr ov ide s a s f oll ow s:

The foot is the tibia and f

ibula in their articulation with the talus, and all bones to the toe s, inc lus ive of

a ll s of t ti ssu e s ( mus c le s, ne rv e s, vas cula r s tr uc tur e s, te nd on s, lig a me nts a nd a ny oth e r a natom ic a l str uc tur e s) that ins e rt

int o th e tib ia

a nd fi bu la in their ar ticulation with the talus and all bones to the toes.Be fore addre ssing the merits of the c ase, w e will addre ss a jurisdictional argument made 1 by the B oard. O n appea l, the Boa rd conte nds that the appe llants did not have standing to seek the decla rations re g ardingthe proprie ty of the Rule. In a pre vious opinion, we addre ss ed the issue of the appe llants’ standing

. See State B d. of Podiatric Med. Exam iners v. Texas O rthopaedic Ass’n , No. 03-04-00253- CV, 2004 Tex. App. L EXI S 10031 (Tex. A pp.—Austin N ov. 12, 2004, no pet.). 4 The tibia is “the shin bone” or “the inner a nd larg er bone of the leg b el ow the knee .” Dorland’s Illustrated Medical Dic tionary 1911 (30th ed. 2003). The fibula is “the outer and smaller of the two bone s of the leg .” Id. at 698. The ta lus is “the highe st of the t arsa l bones and the one that articulates with the tibia and fibula to for m the ankle joint” and is also called the ankle. Id. at 1853; see also id. at 1855 (ex p l ai n i n g t hat tarsus is “the r eg ion of the ar ticulation betwee n the foot and the le g ”).

I n response to c oncer

ns reg arding the validity of the Rule, the attorne y g ener al issued

an o p in io n s tati n g th a t th e Ru le w a s in v a li d b e c a u s e it im p e r mi s s ib ly e xp a n d e d th e p r a c tic e of podiatry to the extent that it allowed podiatrists t o treat the tibia and fibula. See Tex. Att’y Gen. Op. No. J C-441 (2001). The attorney g ener al re asoned that the tibia and fibula a re leg bones, not bones of t he foot, and, therefor e, outs ide t he scope of podiatry

. See id. Shortly afte r the attorney

g ener al op ini on wa s r e le a se d, the a

pp e lla nts fi le d a dec lara

tor y jud g me nt a c tio n, a sk ingthe dis tr ic t c ourt to deter mine the validity

of the Rule. See Tex. G o v’t Code Ann. § 2001.038 (West 2000) (a llowing plaintiff to seek de clar ation reg ardingvalidity of rule) ; Tex. C iv. Prac. & Rem. Code Ann. § 37.001- .011 (West 1997 & Supp. 2007) (Unifor m D ecla ratory J udg ment Act). The Texas Podiatric Medical Association and B ruce A. Scudday (cumulatively

“the Assoc iation”) interve ned. The district cour

t declar ed that the Rule wa s valid and d id not ex cee d the B oard’ s statut or y a uth or ity . T he a

pp e lla nts a pp e a l th e jud g me nt o f t

he dis tr ic t c ourt

. 1I n that case , the B oard f iled a plea

to the jurisdiction asserting that the a p p el lants did not have sta nd ingto b ri ngthi s su it, bu t w e ult imate ly c on c lud e d th a t th e a

pp e lla nts did hav e st and in g to co ntest the Rule. Id. a t *1 1; see also South Tex. W ater Auth. v. Lomas , 223 S.W .3d 304, 307-08 (Tex. 2007) (providing g ener al and a ssociational standing require ments). I n this appeal, the B oard raises si mi la

r c o n c e r n s r e g a r d in g th e a

p p e ll a n ts ’ s ta

n d in g . I n p a rti c u la

r , it c o n te n d s th a t t

he appellants do not have s t an d i ng beca use, duringthe trial, the a ppellants offe red no e vidence that would satisfy

traditional stand i n g re qu i re m en t s an d b ec au s e t h e ap p el l an t s p re s en t edn o ev i d en ce that subsection 2001.038(a ) of the g overnme nt code ha d been c omplied with. We dis a g re e wi th the B oa rd

. We pr e vio us ly c on c lud e d tha t th e a pp e lla nts ha d s uf

fi c ie ntl y demonstrated that they had standing to ma intain this suit a nd that they compl i ed wi t h t ra ditional standing and associational standing require ments, se e Sta te Bd . of P od iat ric Me d. Ex am ine rs , 2004 Te x. Ap p. L EX I S 10 03 1, a nd a ll the re a so ns a rt ic ulate d in our pr e vio us op ini on a g a in co mpe l us to conclude that the appellants had standing to seek the de clar ations sought. The fac t that the Boa rd alleg es that no additional evide nce r elating to standing w as introduce d at t rial would not divest the district court of jurisdiction at the e nd of the trial. Th e a pp e lla nts a lso a sk

us to i ssu e a decl arat ion that “ the lawf

ul p ra c tic e of

po diatr y in 2 Texas is confined to treatment of the foot.” Given our resolution of this case , it is unnecessar y and wo uld be a dv iso ry

fo r u s to op ine a s to the e nti re sc op e of the pr a c tic e of

po diatr y in T e xas. 5 STA ND AR

D O F RE VI EW On appea l, the appellants argue that the Boa rd’s promulg ation of the Rule excee ded i t s r u l e - m a k i n g a

u t h o r i t y. As an a g ency , the B oard is a c rea t i o n o f t he leg islature and, the ref ore, 2 “has no inhere nt authority .” See Public Util. Comm’n v. City Pub. Serv. Bd. , 53 S.W .3d 310, 316 (Tex. 2001). For this re ason, the B oard posse sses only those power s “expressly

confe rre d upon it.” See id. Howeve r, whe n confe rring a powe r upon an age ncy , the l eg islature also “impliedly intends that the ag ency

have w hateve r powe rs ar e re asonab l y n ec es s ar y to fulfill its express functions or duties,” see id. , a

nd the le g isl a tur e is n ot r e qu ir e d to inc lud e e ve ry sp e c if ic det ail o r a

nti c ipate a ll unfore seen c ircumstance s when e nacting an ag ency ’s authorizing statute, Sta te v. Pu bl ic U til

. Comm’n , 131 S.W .3d 314, 321 (Tex. App.—Austin 2004, pet. denied).6 An a g e nc y ’s c on str

uc tio n of a sta

tut e that it is c ha

rg e d wi th e nf

or c ing is e nti tle d “ to serious consider at i o n b y

revie wing courts, so long as that construc tion is reasonable and does not

co n t ra d i ct the plain languag e of the statute.” Employe es Ret. Sy s. v. Jone s , 5 8 S. W. 3 d 1 4 8 , 151 (T e x. Ap p. —A us tin 20 01 , no pe t.)

. I n othe r w or ds , w he n d e te rm ini ngwh e the r a n a g e nc y ’s ru le is valid, we must asce rtain whether the rule is c ontrary to the rele vant g overningstatutes, Pu bli c Ut il. C omm’n , 1 3 1 S. W. 3 d a t 3 2 1 , o r w h e th e r th e r u le is in h a r

mo n y w it h th e g e n e r a l objectives of the statutes involved, see L i berty Mut. I ns. Co. v. Griesing , 150 S.W .3d 640, 648 (Tex. App.—Austin 2004, pet. dism’d w.o.j.). I f a pr omul gat ed ru le has no supportingstatutory authority , the rule is void. Office of Pub. Util. Counsel. v. Public Util. Comm’n , 104 S.W .3d 225, 232 (Tex. App.—Austin 2003, no pet.).

To pr op e rl y

pe rf or m th is f un c tio n, we mus t a scer tai n the l e g isl a tur e ’s int e nt i n

enac ting the r eleva

nt gove rning statutes. See Tex as W orkers’ Comp. Comm’n v. P atient Advocate s of Tex. , 136 S.W .3d 643, 652 (Tex. 2004). Although the leg islature has spe cified othe r tools to guide us when d et er m i n ing the ir intent, see Tex. Gov’t Code Ann. § 311.023 (West 2005), our deter mination beg ins with the plain lang uag e of the statutes involved, Bragg v. Edwards Aquifer Auth. , 71 S.W .3d 729, 734 (Tex. 2002). See Fireman’s Fund County Mut. Ins. Co. v. Hidi , 13 S.W. 3d

76 7, 76 8- 69 (T e x. 20 00 ) ( provi di ng that to de te rm ine le g isl a tiv e int e nt, c ourt s sh ou ld loo k to pla in m e a nin g of

wo rd s u se d in re le va

nt statut or

y pr ov isi on s) . I n p e rf

or min g our a

na ly sis , we r eview the entire statute, not isolated por tions, Co n ti n e n ta l Ca s . I n s . Co

. v . Functional Re sto ra tio n A sso c s. , 19 S.W .3d 393, 398 (T ex. 2000), and we must pre sume that eve ry word wa s deliberately

chosen a nd that excluded words wer e lef t out purposely , USA W

aste Servs. of Houston,7

In c . v . S tra y ho rn , 150 S.W .3d 491, 494 (Tex. A pp.—Austin 2004, pet. denied)

. We should not adopt

a c on str uc tio n o f a

statut e that w ill re nd e r t he statut e me a nin g less or lea d to a bs ur d r e su lts

. Fleming Foods of Tex., Inc . v. Ry lander , 6 S.W. 3d 27 8, 28 4 ( Te x. 19 99 ); W

atts v. City of Houston , 126 S.W .3d 97, 100 (Tex. App.—Houston [1s t Dist.] 2003, no pet.).

DI SCU SSIO N On appeal, t he appellants contend that the di strict court erre d when it conclude d that the Board’ s enac tment of the Rule was a valid exercise of

the ag ency ’s rule- making authority . On the contra ry , appellants a ssert that the Rule impermissibly expands the prac tice of podiatry bey ond the treatment of the foot.

I n r e sp on se , th e As so c ia tio n c on te nd s th a t in mak in g the ir c la ims , th e a

pp e lla nts improperly

focus on the phr ase “foot” found in the statutory definition of podiatry

rathe r than re ading and g iving meaning to e very word found in the definition. See Tex. Occ. Code Ann. § 202.001( a)( 4). I n p a rt i c u l a r , t h e A s s o c i a t i o n c o n t e n d s t h a t t h e d e f i n i t i o n d o e s n o t s t a t e t h a t p o d i a t r i s t s m a y on ly treat the foot; on the contrary , it emphasizes that the provision allows podiatrists to t reat the foot “by any sy stem or method” and that “podiatry ” includes e very thing c onstitut ing “ podiatric medic ine.” Id. Th e B oa

rd make s sim ila

r a rgume nts

. I n p a rt ic ula

r, it a sse rt s th a t by

inc lud ingthe te rm

“ po diatr ic medicine” in its definition, t he leg isl ature incorporated into the definition of podiatry all of the proce dures podiatr ists were a ctually perf orming at the time the statute wa s enac ted. I n support of this interpr e ta tion of the statutory

structure , the B oard introduc ed during trial evidenc e demonstrating that f or seve ral de cade s, podiatrists have been treating the ankle. For example, severa l podiatrists testified that the y wer e trained to pe rfor m both surg ical and nonsurg icalWe note that some medica l definitions of the “foot” exclude the ankle. See, e .g. , Black’ s 3 Me dic al D ic tio na ry 211 (39th ed. 1999) (def ining foot as “that portion of the lower limb s ituated bel ow t he ankle joi nt” ); Am e ric an He rit ag e Ste dm an ’s Me dic al D ic tio na ry 312 (2002) ( defining foot as “The lower e x tremity

of the ve rtebrate leg that is in direct contac t w ith the gr ound in standing or walking ”). 8 proce dures on the a

n k l e d u ri ng their re sidencies, a nd the B oard pr esente d evidenc e that var ious p o d i a t r y b o o k s w r i t t e n o v e r

t h e p a s t8 0 y e a r s h a v e i n c l u d e d s e c t i o n s o n t r e a t i n g t h e a n k l e . In

a dd iti on , s e ve ra l po diatr ist s tes tif ie d tha t the y

have be e n g ra

nte d p ri vil e g e s b y

va ri ou s h os pit a ls t o perf orm ankle sur g erie s and that whe n they perf ormed ankle pr ocedur es, they wer e re imbursed by insurance companies, Medica re, and Medica id. Fur

ther, sever al podiatrists te stified that the pra ctice of podiatry

has alwa y s included treatment of the ankle and that the Board’ s definition is consistent with that prac tice and did not incr ease or dec rea se the scope of the pra ctice.

I n addition, the Association contends that the Rule is consiste nt with the medical definition of the ter

m “foot,” w hich it asserts includes the ankle. S ee Tex. Gov’t Code Ann. 3 § 311.011 (West 2005) (re quiring cou rt s t o construe “ [w] ords and phr ases that have ac quired a te c hn ic a l or

pa rt ic ula r m e a nin g ” in a c c or da

nc e wi th t hat me a nin g ); Llo

y d F ry Ro ofi ng Co. v . S

tat e , 541 S.W .2d 639, 642-43 (Tex. Civ. App.—Dallas 1976, writ ref ’d n.r.e.) (explaining th at when statutory term has technica l me aning , court will look to particular art, scie nce, or

trade from which it was taken to a scer

tain its meaning ). Fur

thermore , the Association argues t hat by promulg ating the Rul e , t he B oa

rd wa s f oll ow ingthe statut or

y dir e c tiv e to util ize its e xpe rt ise and pr omu lg a te

re as o n able and nece ssary rules to g overn the prac tice of podiatry

. See T e x. O c c . Code Ann. § 202.151(2). I n ad dition, it insists that an interpr etation limiti ng the scope of pra ctice of9

podiatry to the are a below the ankle bone s and joint would lead t o ab s u rd results, including prohibiting podiatrists from tre ating a spra ined ankle.

We disag ree with the Board and the Association. All of t heir arg uments are couche d on the pre mise that the Rule mere ly authorizes podiatrists to treat the foot and the a nkle and that the R u l e i s , t h er ef

o re , co n s i s t en t wi t h t h e sc o p e of p o d i at ri c me d i ci n e. Ho we v er , t h er e is n o l an gu age i n t h e R u l e l i m i t i n g t h e f

o o tt o t h a t p o rt i o n o f

t h e b o dy t h a t

i s a to r b e l o w t h e an k l e . O n t h e c o n t r a r y, the terms of the Rule authorize podiatrists to treat par ts of the body that are well above the ankle. The Rule states that the “ foot” includ es “a l l soft tissues (muscles, ner ves, vasc ular str uc tur e s, te nd on s, lig a me nts a nd a ny oth e r a natom ic a l stru c tur e s) that in se r t in to t he tib ia and fi bu la in their articulation with the talus.” 22 Tex. Admin. Code § 375.1(2). Howe ver, ma ny of the soft tissues included in this definition are not par t of the foot or e ven t h e an k le. For example, various

nerve s ending in the foot—including the t i b i al ner ve, the pe ronea l nerve , and the sura l

nerve —run alongsignific ant portions of the legbefor e re achinga termination point in the foot. See Fr ank H. Netter, N.D., Atlas of Human Anatomy4 8 2 , 4 8 3 , 4 8 5 , 5 0 4 ( 2 n d e d

. 1 9 9 7 )

. S i m i l a r l y,

se ve ra l ve ins a nd a rt e ri e s— inc lud ing the sa ph e no us ve in a nd the tib ia l a rt e ry a nd ve in— a lso e nd in the foot af ter having tr aver sed sig nificant portions of the le g . Id. at 477, 482, 483, 508. I n fac t, one of the ne rves a

nd one of the veins previously mentioned run a long the entire le ng th of the leg

. Be cause there is no lang uag e limiting the per missibl e area of treatment for these soft tissues, the Rule authorizes p o d i at ri s t s to treat these anatomica l features whe reve r they may be loca te d in th e b o dy a n d to tr e a t “ a n y d is e a s e , d is o r d e r , p h y s ic a l in ju r y , d e f o r mi ty , o r ailment” of t h es e fe at ures be cause they have be en def

ined as be ing pa

rt of the f

oot. See Tex. Occ. Code Ann. § 202.001(a )(4)

. Moreove r, beca use the occupations c ode allows podiatrists to tre at the footAlthough the re w as extensive testimony and evidenc e prese nted during trial showing that 4 treating the a

nkle was within the scope of podiatry , no evidenc e wa s introduced showingthat treating s t r u c tu r e s f o u n d w i t h i n t h e l e g w e r e w i t h i n t h e s c o p e o f p o d i a t r y. I t is worth not ing that althoug h on one hand the Rule impermissibly expands the prac tice 5 of podiatry , the Rule also see ms to truncate the sc ope as w ell. The Rule def ines the foot as inc luding cer tain bones and the s o ft tissues “that insert into the tibia and fibula in their a rticulation with the ta lus a nd a ll b on e s to the toe s. ” 22 Te x. Ad min . Co de § 3 75 .1 (2 ) ( 20 07 ). Th is d e fi nit ion se e ms t o exclude soft tissues that a

re found exclusively within the foot and, conseque ntly , that are not pa rt of the ar ticulation betwee n the talus and the tibia a nd fibula. On appea l, the Association also argues that beca use the appellants stated in their brief that 6 the y a re no t c on te sti ng“ the re a so na ble ne ss o f t

he B oa rd ’s Rul e,” th e a

pp e lla nts have e sse nti a lly conce d ed t h at t h ey

lose their appe al. I n making this arg ument, the Association re lies on Bullock v . Hewlett-Pac kard Co. , 628 S.W .2d 754, 756 (Tex

. 1 9 8 2 ). That case involved a deter mination of the validity

of a f ranc hise tax rule. Id. at 756. I n its analy s i s , t h e supre me cour t stated that “[c]ourts must uphol d ‘leg islative’ administrative rule s if they are rea sonable. . . . S uch ru le s n e e d only be ba se d on some le g iti ma te po sit ion by the a dmi nis tr a tiv e a g e nc y inv olv e d. ” Th e se state me nts we re no t pa ir e d w iththe us ua l qu a lif ie rs that th e rul e mus t no t c on tr a dic t th e pla in lang uag e of the statutes that the rule interpre ts or that the rule must be in ha rmony with the rele vant 10 “by any sy st em o r m ethod,” the Rule effe ctively authorizes podiatrists to treat these f eatur es by

u t i l i z i n g p ro ce d

u re s th at ar e o u t s i d e t h e s co p e o f t h ei r t ra i n i n g. See id. § 2 02 .0 01 (a )( 4) ; see also id. 4 § 202.254 (spec ify ing that to obta in lice nse to pr actice podiatry , applicant m u s t p as s ex amination

cover ing a ilments of the foot ) (e mphasis added) . As a re sult, the Rule authorizes podiatrists to treat parts of the body

outside the traditional scope of podiatry without satisfy ing the require ments of the Medica l Practice Act. See id. §§ 15 5. 00 1- .1 52 (d e ta ili ngre qu ir e me nts fo r o bta in ing lic e ns e to pr a c tic e me dic ine ). Th is a uth or iza tio n e xce e ds the lim ite d e xemp tio n g ive n to po diatr ist s and wo uld constitute the unauthorized pra ctice of medicine. See id. §§ 151.052(a) (5), 155.001. 5 For all these reasons, we conclude that the Rule is not in harmony with the g ener al objectives of the various statutes involved and that the Boa rd ex ce ed ed i ts authority by promulg ating the Rule. 6statutory o b j ec t i v es . Compare id. , with Employees Re t. Sys. v. J ones , 58 S.W .3d 148, 151 (Tex. App.—Austin 2001, no pet.), and Liberty Mut. Ins. C o . v. Griesing , 150 S.W .3d 640, 648 (Tex. App.—Austin 2004, pet. dism’d w.o.j.). I n light of this absence , the Association conte nds that the a pp e lla nts ’ s ta te me nt i s an a dmi ssi on that th e Rul e is r e a so na

ble , a nd the re fo re , th e a na ly sis is conclude d. We d is a g r e e w it

h th e A s s o c iati o n ’ s a s s e r ti o n a n d b e li e v e th a t it s r e liance on B u llock is mis pla c e d. Al tho ug h the su pr e me c ourt did no t sta te e xplic itl y that a rule mus t not be c on tr a ry to the re levant g overningstatut es, t he cour t perfor med a de tailed ana ly sis of why the rule w as “not inconsistent” with r eleva

nt statutory

provisions. Bullock , 628 S.W .2d at 756-58. Moreove r, whe n the appe llants wrote the state ment at issue in this case, they wer e simply

stating tha

t the leg islature has the ultimate a

uthority for de termining whether podiatrists may

medically

treat parts of the body other than the foot and not conc eding that the Rule was, in fa ct, re asonable

. 11 As an a lternative ba sis to support the dist rict cour t’s judgme nt, the Asso ci at ion contends that the judg ment should be aff irmed bec ause the appellants “fa iled to me et their burde n of proof ” reg arding the Rule’s alleg ed invalidity

. I n making this a ssertion, it notes that ag ency rules

a re pr e su me d to be val id and th at the c ha lle ng ingpa rt y ha s th e burd e n o f p ro vin g that th e ru le is invalid. TXU Gene ration Co. v. Public Util. Comm’n , 1 65 S.W. 3d 82 1, 82 9 (Tex . App .— Au sti n 20 05 , n o p e t.) . In li g ht of thi s p ro po sit ion , th e As so c ia tio n c on te nd s th a t th e a pp e lla nts fa ile d to meet this burden be cause they failed to disput e the basis for the Rule set out in the Boa rd’s re asoned justification. See Tex. Gov’t Code Ann. §§ 20 0 1

. 0 3 3 (West 2000) (mandating that a g ency order adopting rule must contain “a rea soned justification for the rule as adopte d”), .035( b) (de tailing twoy e a r d e a dli ne fo r atta c kin g ru le ); see also id. § 20 01 .0 35 (a ) (We st 20 00 ) (s ta tin g that a g e nc y ru le is

vo ida ble if a g e nc y a do pts ru le wi tho ut s ub sta nti a lly c omp lyingwi th v a ri ou s st a tut or y re qu ir e me nts including ne ed for

rea soned justification). Stated diffe rently , the Association a r g u e s th at by

detailing

a re a so ne d ju sti fi c a tio n fo r a ru le , a n a g e nc y e sta bli sh e s a pr e su mpt ion

that th e ru le is v a lid

a nd in harmony with the rele vant statutory require ments and that a pa rty dissatisfied with the rule ha s the12

burden of a tt a c k in g th e ju s ti f ic a ti o n a n d

r e b u tt in g th e p r e s u mp ti o n w it h in tw o y e a r s o f

th e r u le ’s promulg ation. Fur

ther, the A ssociation contends that the pr esumption o f validi ty extends to t he fac tual basis found i n an age ncy ’s reasoned just ification and that this presumption m ust be rebutted for a ny challeng e to a r

ule to be succ essful. More over, it ar g ues that the val i d i t y of the re asoned justificat i o n m ay

only be over come if the challeng ing pa rty shows and convinc es a c ourt that the j ustification is “illogica l, arbitrar y or demonstrates an improper interpre tation of the scope of [the ag ency ’s] statutory

authority .” We disag ree with these contentions. I t is true that the gover nment code doe s specify

cer tain require ments that an ag ency mu s t co m p l y with when promulg ating a rule , including the require ment that an orde r conta in a re asoned justification for the rule

. See Tex. Gov’t Code Ann. §§ 20 01 .0 23 -. 03 4 ( Wes t 20 00 ). I t is a lso tr ue tha t th e g ov e rn me nt c od e a llo ws a pe rs on to c on te st a rule on the g round that the a g ency promulg ating the rule did not comply with those proce dural require ments. Id. § 2001.035.

Ho we ve r, the g ov e rn me nt c od e a lso a uth or ize s a par

ty to co nte st e ith e r t

he va lid ity or applica bility of a r ule by filing a decla ratory judgme nt action. Id. § 2001.038. This provision allows a pa

rty to contest the rule if the party alleg es t hat t he rule “impairs, or thre atens to interf ere with or impair, a leg al rig ht or privileg e” of the par ty

. Id. The provision imposes no requireme nt that a pa rt y mus t c on te st the fa c tual bas is of an a g e nc y ’s re a so ne d ju sti fi c a tio n a s a c on dit ion

to disputing the va lidity

of the rul e, and we see no r eason to impose this ty pe of r equire ment on our own. Althoug h consideration of th e re as o n ed justification may be re levant in ce rtain dec laratory actions, a de termination of whe ther the f actua l basis suppor

ting the justification is proper will not13

nece ssarily

addre ss whether

the ag ency ’s rul e is consistent with releva nt statutory

lang uag e or whether the ag ency

had the a uthority to issue the rule. Finally , the B oard and the Association contend that the leg islature has r atified or adopted the B oard’ s definition of the term f oot throug h subsequent actions. First, the Boar d and the Association contend that the leg islature has a dopted the B oard’ s definition and that, there fore , the Rule is c onsistent with the occupations code . The doc trine of leg islative acc eptanc e provide s that if “an amb igu o u s s tatute th a t h a s b e e n . . . g iv e n a lo n g s ta n d in g c o n s tr

u c ti o n b y a p roper administrative offic er is re -ena cted without substantial chang e, the L eg islature is presumed to have been f amiliar with t hat interpre tation and to have a dopted it.” Texas De p’t of Protective & Regulatory Serv

s. v. Me ga Child C

are, Inc

. , 145 S.W. 3d

17 0, 17 6 ( Te x. 20 04 ). I n ma kin g the ir claim that the leg islativ e ac ceptance doc trine applies, the B oard a nd the Association note that althoug h two differ ent amendme nts to the relev a n t p r o v isions of the occupations code we re pr oposed in the leg islature, neither of these pr oposals left the c ommi t t ee , and ther efor e, the leg islature has acquie sced to the B oard’ s interpre tation.

Second, althoug h acknow ledg ingth a t t h e ir a r g u me n t d if f e r s f r o m a ty p ic a l r a tif ication argument, the B oard note s that after the Rule was pr omulgated and af ter a ppellants first expressed dis sa tis fa c tio n w iththe Rul e , th e le g isl a tur e c on tin ue d to c omp e ns a te po diatr ist s th ro ug h M e dic a id pay ments for proc edure s perf ormed on the a

nkle. We disag ree . First, we do not be lieve that the leg islative acc eptanc e doctr ine applies

un de r t he c ir c ums tanc e s o f t

his c a se . Th e le g isl a tur e did no t re e na c t se c tio n 20 2. 00 1 a ft e r t he Rul e was promulg ated—a

prer equisite to p r o p e r

uti li za ti o n o f the doc trine. More over, w hat little evidenceThe statutory authority curr ently in pla ce limit s podiatrists to the treatment of “the f oot.” 7 Whil e it may be dif

fi c ult to de fi ne that te rm fo r purp os e s of tr e a tme nt, wh a te ve r the te rm me a ns , it is c le a r t hat “ the fo ot” do e s n ot i nc lud e the fu ll po rt ion of the bo dy inc lud e d w ith in t

he de fi nit ion

in the Rul e . Com

pe lli ng a rgume nts mig ht be ma de a s to wh e the r— fr om a me dic a l st a nd

po int —it is rea sonable to allow a

prac titioner treating the foot to consider a nd treat other anatomical sy stems that interac t with and aff

ect the f oot. This is a debate to be had at the le g islature.

14 there is reg ardingthe leg islature’s belief about the scope of podiatry undermines the B oard a nd the Association’s sug g estion that the leg islature has a dopted the construc tion found in the Rule or that th e l i m i t s of the scope are well settled. Afte r the Rule wa s promulgated, two contra dictory amendments to the statutory definition of podiatry

wer e propose d. The fir st proposed ame ndment was made in 2003 and was dire ctly contra ry to the Rule beca

use it would have limit ed t h e term “foot” to th e part of the body found below the ankle. Te x . S.B. 1395, 78th L eg ., R.S. (2003). Ho we ve r, the se c on d p ro po sa l, w hic h w a s ma de in 200 5, wo uld have inc lud e d tr e a tme nt o f t he a nk le within the definition of podi atry

. Tex. S.B. 460, 79th L eg ., R.S. (2005). Further more, the le g islative

a c c e pta nc e do c tr ine c a nn ot b e uti lize d a s su pp or t f or the c on str

uc tio n of a statut e that is c on tr a ry to the lang uag e of the g overningstatutes, see Fle ming Foods of Tex., Inc . v. Ry lander , 6 S.W .3d 278, 282 (Tex. 1999), and we have a lrea dy conclude d that the Rule is inconsistent with the occupations

co d e in th a t it a ll o w s p o d iatr is ts to p e r f o r m tr e a tm e n t o u ts id e th e ir s c o p e o f p r a c ti ce—it allows po diatr ist s to tr e a t are a s o f t he bo dy oth e r t ha n th e fo ot. 7 Second, whe ther t h e leg islature continued to c ompensate podiatrists through the Me dic a id p ro g ra

m f or tr e a tme nts pe rf

or me d o n th e a nk le a ft e r the Rul e wa s p ro mul g a te d s e e ms t o have no be aringon our ul timate conclusion. As discussed pre viously , the Rule authorizes treatment of body features that ar e above the ankle.15 F or a ll the re a so ns g ive n, we c on c lud e that th e B oa rd e xce e de d it s a

uth or ity wh e n it pr omul gated th e Rul e a nd that th e Rul e is i nv a lid . T he re fo re , w e su sta in t he a pp e lla nts ’ issue on appea l.

CO NC LU SION

Hav i n g s u stained appe llants’ sole issue on appe al, we r ever se the judg ment of the district court and r emand the c ase to the district c ourt for procee dings consistent with thi s opinion.

David Pury ear , J ustice Be fore J ustices B . A. Smith, P ury ear and Waldrop J ustice B . A. Smith Not P articipating Reverse d and Remande d Filed: Mar ch 14, 2008