Did manipulation or adjustment by a South Carolina physical therapist count as practicing medicine?

Plain-English summary

A legislator asked whether a licensed physical therapist's “adjustment” or “manipulation” amounted to practicing medicine under South Carolina law. The Attorney General declined to classify the procedures. The letter quoted the statutes defining physical therapy and medicine, along with a provision saying the physical-therapy chapter did not authorize a therapist to practice medicine or restrict chiropractic practice.

The office explained that the label attached to a procedure did not decide its legal classification. The answer required facts about what the therapist actually did, and determining those facts lay outside the opinion process. The letter therefore gave no yes-or-no answer for a particular treatment.

Currency note

This opinion was issued in 2009. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

Q: Did the AG say every physical-therapy manipulation was practicing medicine? A: No. The office did not decide the classification of the procedures described generally in the request.

Q: Did the AG say all adjustments were within a therapist's license? A: No. The letter quoted the statutory limits but declined to apply them without facts about the actual conduct.

Q: Why did the opinion stop short of an answer?
A: It said the legal classification depended on facts, and the Attorney General's opinion process could not investigate or determine those facts.

Background and statutory framework

The opinion quoted S.C. Code Ann. § 40-45-20(9)'s physical-therapy definition, § 40-45-310's limits on construing that chapter, and § 40-47-20(36)'s definition of practicing medicine. It also discussed a case emphasizing factual conduct over a procedure's name. It made no factual finding about the requested techniques.

Citations and references

Statutes: S.C. Code Ann. § 40-45-20(9); S.C. Code Ann. § 40-45-310; S.C. Code Ann. § 40-47-20(36).

Source

• Landing page: https://www.scag.gov/opinions/opinions-archive/april-30-2009-1/
• Original PDF: https://www.scag.gov/wp-content/uploads/2011/03/harrison-j-h-os-8771-4-30-09-sc-physical-therapy-practice-act.pdf

Original opinion text

H ENRY M CMASTER
AITORNEY G ENERAL

April 3 0, 2009

The Honorable James H. Harrison
Member, House of Representatives
P. 0. Box 11867
Columbia, South Carolina 29211
Dear Representative Harrison:

In a letter to this office you questioned whether or not the practices of "adjustment" and "manipulation" as performed by a licensed physical therapist, is the practice of medicine pursuant to the South Carolina Physical Therapy Practice Act. The term "physical therapist" is defined by S.C. Code Ann. § 40-45-20(4) as " ... a person who has met all the conditions of this chapter and is licensed in this State to practice physical therapy." S.C. Code Ann. § 40-45-20(9) defines "the practice of physical therapy" as
... the evaluation and treatment of human beings to detect, assess, prevent, correct, alleviate, and limit physical disability, bodily malfunction, and pain from injury, disease, and any other bodily or mental condition and includes the administration, interpretation, documentation, and evaluation of physical therapy tests and measurements ofbodily functions and structures; the establishment, administration, evaluation, and modification of a physical therapy treatment plan which includes the use of physical, chemical, or mechanical agents, activities, instruction, and devices for prevention and therapeutic purposes; and the provision of consultation and educational and other advisory services for the purpose of preventing or reducing the incidence and severity of physical disability, bodily malfunction, and pain. The use of roentgen rays and radium for diagnostic or therapeutic purposes and the use of electricity for surgical purposes, including cauterization and colonic irrigations, are not authorized under the term "physical therapy" as used in this chapter, and nothing in this chapter shall be construed to authorize a physical therapist to prescribe medications or order laboratory or other medical tests. Additionally, S.C. Code Ann. § 40-45-310 notes the distinction between physical therapist and other health professionals in providing that

REMBERT C. D ENNIS B UILDING •

Posr OFFICE Box 11549 •

COLUMBI A, SC 29211- 1549

•

TaEPHONE 803-734-3970

•

FACSIMILE 803-253-6283

The Honorable James H. Harrison
Page2
April 30, 2009

[n]othing in this chapter may be construed as authorizing a licensed physical therapist or any other person to practice medicine, surgery, osteopathy, homeopathy, chiropractic, naturopathy, magnetic healing, or any other form, branch, or method of healing as authorized by the laws of this State. Nothing in this chapter shall be construed to restrict, inhibit, or limit the practice of chiropractic as now practiced in this State and as taught by accredited schools or colleges of chiropractic. Nothing in this chapter shall be construed to restrict, inhibit, or limit the practice of licensed nurse practitioners, licensed physicians assistants, certified athletic trainers, licensed massage therapists, exercise physiologists, or personal trainers. Moreover, nothing in this chapter shall be construed to restrict, inhibit, or limit in any way the practice of dentistry pursuant to Chapter 15 of Title 40 or the practice of medicine pursuant to Chapter 47 of Title 40. The practice of medicine is defined by S.C. Code Ann. § 40-47-20(36) as: (a) advertising, holding out to the public or representing in any manner that one is authorized to practice medicine in this State; (b) offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of any other person; (c) offering or undertaking to prevent or to diagnose, correct or treat in any manner, or by any means, methods, or devices, disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or mental condition of a person, including the management or pregnancy and parturition; (d) offering or undertaking to perform any surgical operation upon a person; (e) rendeting a written or otherwise documented medical opinion concerning the diagnosis or treatment of a patient or the actual rendering of treatment to a patient within this State by a physician located outside the State as a result of transmission of individual patient data by electronic or other means from within a state to such physician or his or her agent; (f) rendering a determination of medical necessity or a decision affecting the diagnosis and/or treatment of a patient is the practice of medicine subject to all of the powers provided to the Board of Medical Examiners, except as provided in Section 38-59-25; (g) using the designation Doctor, Doctor of Medicine, Doctor of Osteopathic Medicine, Physician, Surgeon, Physician and Surgeon, Dr., M.D., D.O., or any combination of these in the conduct of any occupation or profession pertaining to the prevention, diagnosis, or treatment of human disease or condition unless such a designation additionally contains the description of another branch ofthe healing arts for which one holds a valid license in this State that is applicable to the clinical setting; and (h) testifying as a physician in an administrative, civil, or criminal proceeding in this State by expressing an expert medical opinion.

The Honorable James H. Harrison
Page3
April 30, 2009

The State Supreme Court in Sloan v. SouthCarolinaBoardofPhysical Therapy Examiners, 370 S.C. 452, 636 S.E.2d 598 (2006) determined that physical therapists are generally prohibited from providing therapy to a patient without an order from a physician or a dentist. An opinion of this office dated October 3, 1986 referring to the decision of the State Supreme Court in Dantzler v. Callison, 230 S.C. 75, 94 S.E.2d 177, 187 (1956) noted that the Court " ... has held that the right to practice medicine is a qualified one which is subordinate to the State's duty to protect the public health and the exercise of its police powers." While the statutes referenced above define the various practices, an opinion of the Washington Court of Appeals in Washington State Department of Health Unlicensed Practice Program v. Yow, 2008 WL 4561437 (2008) stated that "[w]hether actions constitute the practice of medicine is dependent upon the facts and not the name of the procedure, its origins, or legislative lack of clairvoyance." Therefore, a response to your inquiry is dependent upon a review of facts in rendering any opinion. However, this office has repeatedly stated that an opinion of this office cannot determine facts noting that the determination of facts is beyond the scope of an opinion of this office. See: Ops. dated November 12, 2008; March 19, 2008; October 8, 2007. Therefore, this office is not in a position to provide a response to your inquiry inasmuch as any response would necessitate a review of facts. We regret that we cannot be of assistance at this time. Very truly yours, Henry McMaster Attorney General

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By:

REVIEWED AND APPROVED BY:

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Robert D. Cook
Deputy Attorney General

Charles H. Richardson
Senior Assistant Attorney General