JIM MATTOX Attorney General

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# The Attorney General of Texas

January 15, 1986

Honorable James S. McGrath CriminalDistrictAttorney P. 0. Box 2553 Beaumont,Texas 77704 OpinionNo.JM-421
Re: Whether a public agencymay offer physical therapy services without employing a licensed therapist if such services are offered by or under the supervision of a licensedphysician
DearMr. McGrath:
You have ask&l the followingquestion:

To what extent can a public agency offer physica:. therapy services without employing a licensed therapist, so long as such services are offered through a licensed physician, through direct t'reatmentor by direction to his nursing support staff to give such treatments? The physic&t therapy licensing act contains the following definitionof "phy~~ical therapy": 'Physicitl.

therapy' means the examination, treatment, or instruction of human beings to detect, assess, prevent, correct, and alleviate physical d1sabW.t.y and pain from injury, disease, disorders, or physical deformities and includes the adminisi:ration and evaluation of tests and measurements of bodily functionsand structuresin aid of diagnosis or treatment; the planning, adminislxation, evaluation, and modification of treatment:and instruction, including the use of physica:.measures, activities, and devices for preventl.veand therapeutic purposes on the basis of approved test findings and the provision of consultirt:ive,

educational, and advisory services for the purpose of reducing the incidence and severity of physical Physica! therap; - disabilitv and nain.

shallalso includethe delegation of selegtive forms of treatment to supportive personnc?.

with assumption of the responsibilities

p. 1919Honorable James S.McGrath -- Page 2 W-421)

for the care Of the patient and continuing direction and supervision of the supportive personnel. The ;lse of roentgen rays and radium for diagnostic z,ndtherapeutic purposes, and the use of electrkity for surgical purposes, includlng cauterization, are not authorized under the term 'physical therapy' as used herein, and a license issued Hereunder shall not authorize the diagnosis of dieeisses or the practice of medicine as definedby lnr.. (Emphasisadded).
V.T.C.S. art. 4512e. 51(l)I The physical therapy 1Lcensingact sets out certainprohibitions on the practice of physica:L therapy: (a) A persor.may not practice or represent himself as able to practice physical therapy, or act or represent himself as being a physical therapistunlesshe is licensedunder thisAct. (b) A person may not act or representhimself as being a physical therapist assistantunless he is licensedundr: thisAct. Id. 97. - The act, and thosla prohibitions,however, do not apply to

a licensee of another state agency performing health-care serr!:ceswithin the scope of the applicable licnlsing act, an occupational therapist who confines his practice to occupational therapy, a certified corrective therapist who confines hi:;practice to corrective therapy, and a speech pz.thologistor an audiologist who confines his prsctice to the treatment of communication disorders.
. . . Id. 56(l). - The definition of "practicingmedicine" in the Medical Practice Act clearly subsumesthe p'ractice of "physical therapy." (8) 'Practictngmedicine.' A person shall be considered to be!practicing medicine within this Act: (A) who shall publicly profess to be a physician or sur::eon and shalldiagnose, treat, or offer to treat any disease or disorder,mental or physical, or any physical deformity or injury byRonorable James S.McGrat,h, - Page 3 (m-421)

any system or method or to effect cures thereof; or (B) who shz13.1 diagnose, treat, or offer to treatany disease or disorder,mental or physical, or any physical deformityor injury by any system or method and l:ceffect cures thereof and charge therefor, direct:Lyor indirectly,money or other compeasation.
V.T.C.S. art. 4495b, §1.3:3(8). Thus, a doctor who is licensed to practicemedicine in Texar; can perform all the functionsof a physical therapistwithin the scope: of his medical license. Also, a doctor can delegate certainmedical acts to 3 qualified person: (1) a pers~1 licensed to practice medicine

shall have the authority to delegate to any qualified and p:roperlytrained person or persons acting under the physiciaa's supervision any medical act which a reasonable and prudent physicianwould ftnd is within the scope of sound medical judgmeat to delegate if, in the opinion of the delegatingphysician, the act can be properly and safely performed by the person to whom the medical act is dKLegated and the act is performed in its customary manner, not in violation of any other statute, and the person does not hold himself out to the public as being authorized to practicemediciar:.The delegatingphysician shall remain responsible for the medical acts of the personperforming the delegatedmedical acts. The board may determine whether or not an act constitutes the prxtice of medicine, not inconsistent with thi:; Act, aad may determine whether any medical act may or may not be properly or safely delegated byphysicians.
. . . V.T.C.S. 4495b, 93.06(d)(l). The physical therapy licensing act is not applicable to "a licensee of another state agency performing health-care services within the scope of the z.pplicablelicensing act." V.T.C.S. art. 4512e, 96(l). Although a person acting under the supervision of a physicianwould probablynot himselfbe a "licensee"under theMedical Practice Act, we think acts delegated by a licensed physician come within the scope of the exxption to the physical therapy licensing act. Obviously, the purposl!of the exception for health careworkers licensed under other acts :.E! to make clear that health care workers

p. 1921Honorable James S.McGrath -. Page 4 (J'M-421)

who perform acts that comewithin the definitionof "physical therapy" are aot violating the law 8:~ long as their acts are authorizedby the licensing act applicable to them. As long as the requirements of article 4495b, section 3.116(d)(l)are met, any person performing medical acts under the supervision of a doctor is acting within the scope of the Medical Practice Act. Therefore, a person performing medical acts thathappen to constitute "physical therapy"would not be subject to the physical thln:apy licensingact as long as such acts are authorizedby theMedical I?ractice Act. Article 4495b, sectioi 3.06(d)(l), sets out a number of requirements thatmust be met in order for a doctor to delegatemedical acts. Consequently, the propriexy of any specific instance of delegation would involve fact questions thatwe cannotanswer. SUMMARY
A doctor may perform medical acts that come within the defia:Ltionof "physical therapy" in article 4512e. section L(1). If the requirements of article 4495(>'),section 3.06(d)(l) are met, a person who is abt a licensed physical therapist but who is actingunder a doctor's supervisionmay perform medical wts that come within the definition of "physical therapy" in article 4512e, section l(L).

Very trulyyour , 

# J b

A JIM MATTOX Attorney General of Texas JACK HIGHTOWBR FirstAssistantAttorney Ga!neral
MARY KELLER ExecutiveAssistantAttornl!y General
ROBERT GRAY SpecialAssistantAttorney General RICK GILPIN Chairman,Opinion Committea! Preparedby SarahWoelk AssistantAttorney General

p. 1922