See Tex. Ci v. Prac. & Rem. Code Ann. § 51.014(a )(8) (West 2008). 1 

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

444 444 444 444 444 444 444 444 444 ON MOTION F OR REHEARING

444 444 444 444 444 444 444 444 444 NO. 03-0 8 -00 058 -CV

Texas Board of

Chiropractic Exam iners and Glenn Par ker, Exec utive Dire ctor , Appellan ts

v. Texas Medical Associat ion an d Texas Medical Board, App ellees

F ROM THE DISTRICT CO URT OF TRAVIS COUNTY , 250TH JUDICIAL DISTRICT N O. D -1 -G N -0 6- 00 34 51 , HON OR A BL E S T E PHE N YE L E N OS KY , JUDGE PRESIDI NG

O P I N I O N

We w ith dr aw our op ini on date d Au g us t 15 , 20 08 , a nd su bs tit ute the fo llo wi ngin i ts place . The Court has ove rruled the motion for rehe aringen banc filed b y t h e Tex as B oard of Chiroprac tic Ex aminers a nd its ex ecutive dir ector
. The Texas B oard of Chiroprac tic Ex aminers and Glenn Par ker, its executive dire ctor (collec tively , the “Chiropra ctic Boa rd”) , appea l f

rom a district c ourt order denying their plea to the jurisdiction in a suit brought by the Texas Me dical Association (TMA) and the Texas Me dical B oard (“Me dical B oard” ). For

the re asons explained below, we will affirm the district c ourt’s orde r. 1See , e.g. , O’ Ne al v. T

exas B d. of C

hir op ra c tic Ex am ’r

s , No. 03-03-00270- CV, 2004 2 Tex. App. L EXI S 8254, at *2-10 (T ex. App.—Austin S ept. 10, 2004, no pet.) ( mem. op.) (r eg arding whether needle elec tromy og raphy —“ n e e d le E M G ”—is within the scope of prac tice of c hiroprac tic); Con tin e nta l Cas. Co. v . Tex as Bd . of Ch iro prac tic Ex am ’r

s , No. 03-00-00513- CV, 2001 Tex. App. L EXI S 2336, at *1-8 (Tex. A pp.—Austin A

pr. 12, 2001, no pet.) (not desig nated for p ublication) (re g ardingwhether

needle EMG and manipulatio n u nder a nesthesia ( MUA) a

re w ithin scope of prac tice of c hiroprac tic); Op. Tex. Att’y Gen. No. JC-0379 (2001) (whe ther “ spinal manipulation” is w ith in s c op e of

pr a c tic e of

a c up un c tur e ); Op

. Te x. Att’ y . Ge n. No . D M- 47 2 ( 19 98 ) ( wh e the r u se of inj e c ta ble su bs tanc e s is wi thi n sc op e of pr a c tic e of c hir op ra c tic ); Op

. Te x. Att’ y Ge n. No . D M415 (1996) ( whether acupunc ture was within sc ope of pr actice of chiropr actic)

. Se e als o Te x as Mu t. Ins. Co. v. Stelzer , No. 03-06-00675- CV (Tex. App.—Austin, notice of appe al filed Nov. 2, 2006), which pre sents issues reg ardingwhether needle EMG is within the scope of pr actice of chiropr actic. 2 Ag ainst the bac kdrop of the long standing scope- of-pr actice d i s p u t es involving

c hir op ra c tor s, ph y sic ians , and oth e r h e a lthc are pr ov ide rs , the Se ve nty -N int h T e xas L e g isl a tur e , in 2 its 2005 S unset Bill for the Texas Boa rd of Chiroprac tic Ex aminers, amended c hapter 201 of the occupations code to expressly exclude from the sc ope of pr actice of chiropr actic “ surg ical proce dures” define d as p ro ce d u re s “desc ribed in the surg ery section of the c ommon procedur e coding sy stem as adopted by the C en t ers f

or Medica

re a nd Medica id Services of the United States Depa

rtment of He alth and Human Ser vices.” Act of May 27, 2005, 79th L eg ., R.S., ch. 1020, § 1, sec. 201.002(a) , 2005 Tex. Ge n. L aws 3464, 3465 (c urre nt version at Te x . Occ . Code Ann. § 2 01 .0 02 (a )( 4) (We st Supp . 2 00 7) ) ( a dd ingde fi nit ion of “ surg ic a l pr oc e dure s” ); see Tex. Occ. Code Ann. § 201.002(c )( 1 ) (W es t Supp. 2007) (pree x isting exclusion of “incisive or sur g ical proce dures” from the sc ope of chiropra ctic practice ). I n the same bill, the leg islature also mandated that the Chiroprac tic Boa rd:

. . . shal l a d o p t r

u le s c la r if y in g w h a t a c ti v it ie s ar e in c lu d e d w it h in th e s c o p e of pr a c tic e of

c hir op ra c tic and

wh a t a c tiv iti e s a

re ou tsi de of

that sc op e . T he ru le s:See O ’Neal , 2004 Tex. App. L EXI S 8254, at *2 (noting Chiropra ctic B oard’ s prac tice of 3 issuing “stateme nts” or “me moranda ” rather than r ules to addre ss issues reg ardingscope of prac tice for c hiroprac tors). 3 (1 ) mus t c le arl y

sp e c if y the pr oc e dure s th a t c hir op ra c tor s ma y pe rf or m; (2 ) mus t c le arl y

sp e c if y any e qu ipm e nt a

nd th e us e of

that e qu ipm e nt t

hat is prohibited; and ( 3 ) may r e qu i r e a l i c e n s e h o l d e r t o o b t a i n a d d i t i o n a l t r a i n i n g o r c e rt i f i c a t ion to pe rf or m c e rt a in p ro c e dure s o r u se c e rt a in e qu ipm e nt.

Act of Ma y 27, 2005, 79th L eg ., R.S., ch. 1020, § 8, sec. 201.1525, 2005 Te x . Gen. L aws 3464, 3466 (c ur re nt v e rs ion

a t T e x. Oc c . Co de Ann. § 2 01 .1 52 5 ( Wes t Su pp . 20 07 )) . Wh e n f

or mul a tin g the se

r u le s , th e le g is latu

r e a ls o r e qu ir e d

th a t t h e Ch ir o p r a c ti c B o ar d

“ e s ta b li s h me th o d s u n d e r

w h ic h [i t] , to the extent appropriate, w ill see k input e arly in the rule development pr ocess f rom the public and from per sons who will be most affe cted” by the proposed r

ule t hroug h methods that “must include identifying pe rsons who will be most affe cted a nd soliciting, at a minimum , the advice and opinions of those per sons,” and “ may include n eg otiated rulemaking, inf ormal conf

ere nces, a dvisory

com m i t t ees, a

nd any other a ppropriate method.” Ac t of May 27, 2005, 79th L eg ., R.S., ch. 1020, § 8, sec. 201. 1 5 2 6 , 2 0 0 5 Tex. Gen. L aws 3464, 3466 (c urre nt version at Te x . Occ . Code Ann. § 201.1526 (West Supp. 2007)).

Sections 201.1525 and 201.1526 im plemented Sunset Advisory Commi ssion

re c omm e nd a tio ns a ime d at r e qu ir ing“ the B oa rd to c e a se its pr a c tic e of

iss uin g B oa

rd op ini on s” to addre ss scope-of

-pra ctice issues a nd

ins te a d “ fo llo w t

he State ’s ru le makin g pr oc e ss” so a s to 3

“ c le arl y de fi ne the pr a c tic e s and te c hn olo g y that c hir op ra c tor s c an a nd c ann ot u se to t

re a t patie nts4

by rul e, u sing the input of stakeholder s ear ly in the rulemakingproce ss.” Sunset Advisory Commi ssion, Su ns e t Co mm iss ion De c isi on s: Te x as Bo ar d o f Ch iro prac tic Ex am ine rs (May

2004), at 3. As the Sunset Commiss ion observed, one imp l i ca t i o n of this require ment was that the Chi ro pr a c tic B oa

rd wo uld e ff e c tiv e ly be “ re qu ir e [d] to su

bmi t a ll o f i ts p re vio us op ini on s to thi s rulemakingproce ss.” Id.

The legislature g ave the Chiroprac tic Boa rd unt il J anuar

y 1, 2006, to adopt the rule s require d u n d er s ection 201.1525. Act of May 27, 2005, 79th L eg ., R.S., ch. 1020, § 38, 2005 Te x. Ge n. L aws 34 64 , 34 74

. Th e Chi ro pr a c tic B oa rd pu bli sh e d a pr op os e d s c op e -o f- pr a c tic e ru le i n the Texas Register fo r pu b l i c co m m en t o n De ce mb er 1 6 , 2 0 0 5

. 3 0 T ex . R eg. 8 3 8 3 ( 2 0 0 5 )

. It ultimately adopted a final rule, which was published in the Texas Register o nJu n e 2 , 2 0 0 6

. 3 1 T e x. Reg . 4613 (2006) ( codified at 22 Tex. Admi n. Code § 75.17 (2008)) . The rule addre ssed a number of proc edure s that had gene rate d controve rsy . At issue in this appeal is the Chiroprac tic Boa rd’s action in re g ard to one of those proc edure s, manipulation under ane sthesia, or “ MUA.” In the prea mble to its rule, the Chiroprac tic Boa rd stated:

Manip ulatio n und e r an e the sia (M UA ) ha s b e e n p art of the pr a c tic e of

c hir op ra c tic in Texas for more than 25 y ear s. The B oard ha s not rece ived any complaints reg arding the pra ctice of

MUA and the principal malpra ctice insurance car rier f or chiropr actor s in Texas has likewise not rec eived a ny cl ai ms. Howeve r, MUA is listed under the surg ical codes of the CPT Codebook. Consequently , the Boa rd is still re v i ew ing sever al issues reg arding M UA am d whether it is wit hin the scope of prac tice of chiropra ctic in T exas a s descr ibed under the Chiroprac tic Act. I n the abse nce of any evidenc e of a

risk to the public health, the B oard ha s elec ted to not disturb the status quo until it has reache d a final conclusion on whether MUA remains within the scope of pra ctice in Te x as.The TMA a lso alleg ed that the r ule con fl icted with sec tion 201.154 of the Act, whic h 4 pr ov ide s, “ No tw ith sta

nd ing any oth e r pr ov isi on of thi s c ha pte r, the bo ard

may no t a do pt a

pr oc e ss to cer tify chiropra ctors to per form manipulation under anesthe sia.” Tex. Occ . Code Ann. § 201.154 (West 2004). 5 31 Te x. Re g . a t 46 15

. As no te d a bo ve , the le g isl a tur e in the 20 05 a me ndme nts had expre ssl y excluded from the sc ope of pr actice of chiropr actic “ surg ical proced u re s ” defined as pr ocedur es “desc ribed in the surg ery

section of the c ommon proce dure coding sy stem as adopte d by the Centers for M edica

re a nd Medica id Services of the United States De partment of H ealth and H uman Service s.” See Tex. Oc c. Code Ann. § 201.002(a) (4). Acc ording to its statement r eg ardingMUA in the pr e a mbl e , the Chi ro pr a c tic B oa rd wa s e le c tin g to “ no t di sturb the status qu o” wi th i ts r ule s, which wa s—as the stateme nt had pre viously rec ited—that chiropra ctors per form MUAs. The new rule d id n o t e xp r e s s ly a d dr e s s M U A s n o r d id it p r o h ib it th e p r a c ti c e . T h e o n ly g u id an c e that the Boa r d g a v e o n th e s u

b je c t w a s to e xp r e s s th e v ie w in th e p r e a mb le to th e r u le that it was not disturbing the “ status quo.”

The TMA f

iled suit challe n g in g

s e v e r a l provisions of the Chiroprac tic Boa rd’s scope

of-pr actice rule. With respec t to MUA, t he TMA alleg ed that the rule, by purporting to maintain a “status quo” in which c hiroprac tors wer e being p ermitted to perf orm MUA, conf

licted with the leg is l at u re ’s rulemaking ma ndate in sec tion 201.1525 and chapte r 201’s e x plicit ex clusion of

“ surg ic a l pr oc e dure s, ” a s n owde fi ne d in the 20 05 a me ndment s, fro m th e sc op e of c hir op ra c tic prac tice. Id

. § § 2 0 1

. 1 5 2 5 , . 0 0 2 ( a ) ( 4 ), .002(c )(1)

. The TMA r equeste d a dec laration under the 4 Uniform Dec laratory J udg ments Act that the scope -of- prac tice rule conflicte d with these statutory mandates. See Tex. Ci v. Prac. & Rem. Code Ann. §§ 37.001-.011 (West 2008). TMA also sought6

a decl ar at i o n u n d er section 2001.038 of the g overnme nt code that its order adopting the rule a

nd prea mble failed to pr ovide an adequa tely rea soned justification be cause it “fails to explain why the B oa rd ’s fa ilure to i nc lud e [MU A] a s o uts ide the sc op e of pr a c tic e of c hir op ra c tic ” do e s n ot v iol a te statutory mandates. See Tex. Gov’t Code Ann. § 2001.038 (Wes t 2 0 0 0). TMA a lso asserted a n alternative constitutional challeng e re g arding chapte r 201’s scope- of-pr actice limit ations, as we ll as a cla im for injunctive re lief ag ainst implementation of the rule.

TM A j oin e d th e Me dic a l B oard in the s uit . T he Chi ro pr a c tic B oa rd fi le d a ple a to the jur isd ic tio n c on te nd ingtha t th e TM A l a c ke d s tand ingand that “ the is sues re la tin g to manipulation under a

nesthesia” wer e not ripe. I n support, it attache d a copy of i ts final rule. The district court denie d the plea, a nd the Chiroprac tic Boa

rd there afte r appe aled this order

. Th e Chi ro pr a c tic B oa

rd br ing s a sin g le iss ue c on te nd ingthat ap pell e e s’ c la ims relating to MUA a

re not ripe for a djudication beca use the boa

rd “ha s not made a f

inal decision on this iss ue.” It emphasizes the statement in the rule’ s preamble t h at “the Boar d is stil l review ing

sev eral is su es r e g ard ingMU A a nd wh e the r i t is wi thi n th e sc op e of pr a c tic e of

c hir op ra c tic in Texas.” Unless and until it “promulg ates a rul e that fina lly

conclude s whether

MUA is or is not within the scope of pr actice ,” ac cordingto the Chiroprac t i c Bo ard, “[j] udicial re view of the Ap pe lle e ’s a lle g atio ns re la tin g to M UAwi ll n ot b e ri pe ,” a s the y are “ hy po the tic a l” and

“ c on tin g e nt” up on the fu rt he r a c tio n o f t

he bo ard . T he se a sse rt ion s a re wi tho ut m e ri t.

“ Ri p e n e s s , li k e s ta

n d in g , is a

thr e s h o ld

is s u e th a t i mp li c a te s s u b je c t ma tter ju r is d ic ti o n . ” P a t t er

s on v. Planned Pare nthood , 9 71 S.W. 2d 43 9, 44 2 ( Te x. 19 98 ). Rip e ne ss

conce rns whethe r, at the time a lawsuit is f iled, the fac ts ha

ve develope d sufficie ntly such “that an7

injury has occurre d or i s likely

to occur , rathe r than be ing c ontinge nt or remote.” Id . A ca se is not ripe when its re solution depe nds upon conting ent or hy pothetical fa cts, or upon eve nts that have not y et come to pa ss. W

aco Inde p. Sch. Dist. v. Gibson , 22 S.W .3d 849, 852 (Tex. 2000). L ike other justic ia

b il it y d o c trin e s , r ip e n e s s d e r ive s from the c onstitut ional prohibition ag ainst adviso ry o p i n i ons, which in turn stems from sepa ration-of -powe rs principe s. Patterson , 97 1 S. W.2 d at 44 2. Th e ri pe ne ss do ctr in e al so ha s a “ pr a g ma tic , p ru de nti a l a sp e c t” that a ims to

c on se rv e “ ‘j ud ic ia l ti me and re so ur c e s f

or re a l and c ur re nt c on tr ov e rs ie s, rather th an a bs tr a c t, hy pothetical, or r emote disputes.’” Id

. at 4 4 3 (q u o t i n g Ma y he w v . To wn o

f Su nn y v ale , 964 S.W .2d 922, 928 (Tex. 1998)). Moreover , in the administrative law c ontext , avoiding premature litigation

over a dminist rative d eter minations “preve nts courts from ‘e ntang ling themse lves in abstrac t disag ree ments over administ rative policies’ while at the s ame tim e ser ving to ‘ protec t the ag encie s fr om j ud ic ia l in te rf

e re nc e un til an a dmi nis tr a tiv e de c isi on ha s b e e n fo rm a lize d a

nd its e ff e c ts f e lt i n

a concr ete way by the challeng ing pa rties.’” Id. (q u o t i n g City

of E l P as o v . M

ad e ro De v . &Con str

. Co. , 803 S.W .2d 396, 389-99 (Te x . App.—El Paso 1991, writ denied) ).

Ho we ve r, the re is n oth ing “ hy po the tic a l” or “ a

bs tr a c t” a bo ut the a pp e lle e s’ c la ims

. As all parties a cknowledg e, the Chiropra ctic B oard a ctually promulg ated a

final scope -of- prac tice rule ostensibly

in compliance w ith the leg islature’s mandates in its 2005 S unset Bi l l . Appellee s alleg e that the rule adopted by the C hiroprac tic Boa rd di d not comply

with these leg islative mandates
or t he APA. Appellee s pled t hat chiropractor s have been eng ag ing in MUA, also attachingevidenc eSee Texas De p’t of Parks & W

ildlif e v. M iranda , 1 33 S.W. 3d

21 7, 22 6 ( Te x. 20 04 ) ( un le ss 5 a pled jurisdictional fa ct is challeng ed and c onclusively neg ated, it must be taken a s true for purposes of dete rmining subjec t-matter jurisdiction). Se e Te x as Or tho pa e dic As so c . v. Te

x as Sta te Bd

. of Pod iat ric Me d. Ex am ’r

s , 254 S.W .3d 6 71 4, 71 8 n. 1 (T e x. Ap p. —A us tin 20 08 , no pe t. h. ) (o p. on re h’ g ) (c iti ngwi th a pp ro va l Te

x as Sta te Bd. of P odiatric M

ed. Exam’ rs v . Texas Orthopaedic Assoc. , 2004 Tex. App. L EXI S 10031, at *9-10 (T e x. Ap p. —A us tin

20 04 , n o p e t.) (r e c og nizi ngthat phy sic ians and TM A h a d s tand ingto c omp la in of podiatrist board’ s rule that alleg edly infring ed on pra ctice of

medicine) ). Although the Chiroprac tic Boa rd had not ra ised the issue, amicus c uri ae , P ro fe s s or Ron 7 B e a l of Ba

y lor L aw Sch oo l, sug g e sts that the dis tr ic t c ourt wo uld la c k ju ri sd ic tio n o ve r a

pp e lle e s’ challeng e to any rule to the extent they asser ted it under the U DJ A and not APA sec tion 2001.038. Appellee s can r emedy

any jurisdictional defe ct in this re g ard by amendingtheir plea dings. See , e.g ., Texas De p’t of Parks & W

ildlif e v. M iranda , 1 3 3 S

. W

. 3 d

2 1 7 , 2 2 6 -2 7 (T ex . 2 0 0 4 ) ( I f t h e p l ea d i n gs do not contain suffic ient fac ts to aff irmatively demonstrate the trial court’s jurisdiction but do not aff irmatively demonstrate incura ble defe cts in jur isdiction, the issue is one of pleadingsufficie ncy and the plaintiffs should be a ffor ded the oppor tunity to amend). 8 to that e ff e c t, and the Chi ro pr a c tic B oa

rd do e s n ot d isp ute thi s f

a c t. I n fac t, the board acknow ledg ed 5 in the rule’s pr eamble that Texas chiroprac tors had bee n conductingMUA for y ear s. I n this factual context, the Chi ropra ctic B oard e x pressly “ele cted not to disturb” this “status quo” in it s rule, ther eby allowing the pra ctice to c ontinue. Appellee s alleg e that by all o wi n g chiropra ctors to continue perf orming MUA, the rule violate s chapte r 201’s e x plicit ex clusion of “surg ical proc edure s,” as define d in the 2005 amendments, fr om the scope of chiropra ctic prac tice, there by intruding upon the p r a c t i c e o f m e d i c i n e an d c a u s i n g t h e m i n

j u r y. Appellee s further

alleg e that the Chiropra ctic B oard 6 fa ile d to pr ov ide a

re a so ne d ju sti fi cat io n for c ra ft ingits ru le in t

his mann e r. Th e re is nothing hy

pothetical or c ontinge nt about these disputes re g ardingthe rule the Chiroprac tic Boa rd has adopte d. 7 We further note the long standing principle that “[a]n administrative body cannot, by

rese rving for itself the power to chang e a ruling , deprive the cour ts of jurisdiction to the detriment9

of the pa rties injured by

the ruling .” Glen Oaks Utils., Inc. v. City of Houston , 340 S.W .2d 783, 786 (Tex. 1960) . As appe llees sug g est, the Chiroprac tic Boa rd’s position is essentially that “no par

ty or

c ourt ha s th e a uth or ity to c ha lle ng e wh a t it ha s don e ” in its ru le “ so lon g a s [the bo ard ] say s th a t it is stil l study ing the issue” and mig ht later c hang e the r ule. We reje ct that view. The Chiropra ctic B oard a lso urg es that the leg isl ature vested in it “exclusive jurisdiction” to define the scope of prac tice of chiropra ctic. I t acknow ledg es, however, that it “does
not contend that it has authority or jurisdiction to decide the Appellee s’ claims.” See Subaru of Am., I n c . v . D a v id M

c D a v id Ni s s a n, Inc. , 8 4 S .W.3d 212, 221 (Tex. 2002) (expl aining that exclusive jurisdiction ex ists when the leg islature has deleg ated to a n ag ency the sole power

to make an initial deter mination in a dispute). I nstead, it “ claims only the authority and jurisdiction to make a de cision on chiropra ctic MUA be fore the Appellee s may challeng e the va lidity o f t he dec ision under the Adm in is tr a ti v e Pr o c e d u r e s A c t. ” T h is a s s e rti o nis u lt im a te ly a r e s tate me n t o f

the Chiroprac tic Boa

rd’s fla wed r ipeness ar g uments. We overrule the Chiroprac tic Boa rd ’s i ssue and a ffirm the district c ourt’s orde r denyin g i t s p l ea to the jurisdiction. W e intend no opinion reg ardingthe ultimate merits of appellee s’ claims.

____________________________________________ Bob Pembe rton, J ustice Be fore Chief J ustice L aw, Justi ces Pembe rton and Waldrop Affir med on Motion for Rehea ring Filed: Nove mber 26, 2008