Does 'physician' in the Texas Occupational Therapy Title Act include chiropractors?

Plain-English summary

The Texas Advisory Board of Occupational Therapy asked who counts as a "physician" under the law that governs occupational therapists. The Occupational Therapy Title Act used that word in two places. One exempted people working "under a physician's supervision" under a provision of the Medical Practice Act. The other said that direct occupational therapy "shall be based on a referral from a physician licensed to practice in the State of Texas." The Board wanted to know whether "physician" covered only medical doctors licensed by the State Board of Medical Examiners, or also chiropractors licensed by the Board of Chiropractic Examiners.

The Attorney General concluded it meant only the former. Because the first reference tied "physician" directly to a provision of the Medical Practice Act, the word in that spot plainly meant a person licensed under that Act, not a practitioner licensed under some other statute. Applying the rule that the same word used in different parts of one statute carries the same meaning, the opinion read "physician" in the referral provision the same way. So a referral for direct occupational therapy had to come from a State Board of Medical Examiners licensee, and a chiropractor did not qualify.

Currency note

This opinion was issued in 1992. 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. The Occupational Therapy Title Act (article 8851) and the Medical Practice Act (article 4495b) cited here have since been recodified into the Texas Occupations Code, and the licensing structure for occupational therapy and chiropractic has changed since 1992.

Background and statutory framework

The Occupational Therapy Title Act, V.T.C.S. article 8851, regulated who could call themselves an occupational therapist and how occupational therapy services were delivered. Two of its provisions used the term "physician."

Section 15(b)(6) carved out an exception. The Act did not apply to "any qualified and properly trained person or persons acting under a physician's supervision pursuant to Subdivision (1) of Subsection (d) of Section 3.06 of the Medical Practice Act (Article 4495b, Vernon's Texas Civil Statutes)." Because this clause pointed straight at the Medical Practice Act, the opinion treated "physician" here as unambiguously meaning a person licensed under that Act.

Section 27 governed referrals: "Implementation of direct occupational therapy to individuals for their specific medical conditions shall be based on a referral from a physician licensed to practice in the State of Texas." The word "physician" there was not tied to a particular statute, which is what created the question.

The Board itself had adopted a rule, 40 T.A.C. § 383.1, reading "physician" to mean only persons licensed to practice medicine. The Attorney General agreed with that reading. The opinion leaned on the canon of statutory construction that a word given a clear meaning in one part of a statute keeps that meaning elsewhere in the same statute, citing Boriack v. Boriack, 541 S.W.2d 237, 240 (Tex. Civ. App.-Corpus Christi 1976, writ dism'd). It also pointed to Attorney General Opinion DM-21 (1991), which had read "physician" in the athletic-trainer statute to mean State Board of Medical Examiners licensees. A separate 1990 opinion, JM-1279, had addressed when a chiropractor may call himself a "chiropractic physician," but that title question did not change the meaning of "physician" inside article 8851.

Common questions

Could a chiropractor write a referral for direct occupational therapy under this opinion?
No. The opinion read section 27's "physician licensed to practice in the State of Texas" to mean a person licensed by the State Board of Medical Examiners under the Medical Practice Act. A chiropractor, licensed under article 4512b, was not a "physician" for that purpose.

Why did the Attorney General read the two sections the same way?
Section 15(b)(6) tied "physician" directly to the Medical Practice Act, so its meaning there was clear. Texas courts presume that a word used in different parts of the same statute carries the same meaning throughout. The opinion applied that presumption and gave "physician" in section 27 the same scope it had in section 15(b)(6).

Did this opinion say a chiropractor is not a real physician?
No, and it did not need to. The question was narrow: what "physician" meant inside one licensing statute, the Occupational Therapy Title Act. A separate opinion, JM-1279 (1990), addressed the distinct question of when a chiropractor may use the title "chiropractic physician."

Citations

• Occupational Therapy Title Act, V.T.C.S. art. 8851, §§ 15(b)(6), 27
• Medical Practice Act, V.T.C.S. art. 4495b (incl. § 3.06(d)(1))
• V.T.C.S. art. 4512b (Board of Chiropractic Examiners)
• 40 T.A.C. § 383.1
• Boriack v. Boriack, 541 S.W.2d 237, 240 (Tex. Civ. App.-Corpus Christi 1976, writ dism'd)
• Tex. Att'y Gen. Op. DM-21 (1991)
• Tex. Att'y Gen. Op. JM-1279 (1990)

Source

• Landing page: https://www.texasattorneygeneral.gov/opinions/dan-morales/dm-0091
• Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1992/dm0091.pdf

Original opinion text

Best-effort transcription from a scanned PDF. Minor errors may remain — the linked PDF is authoritative.

Office of the Attorney General
State of Texas

DAN MORALES
ATTORNEY GENERAL

February 18, 1992

Ms. Linda Vaclavik
Executive Director
Texas Advisory Board of
Occupational Therapy
4900 North Lamar
Austin, Texas 78751-2316

Opinion No. DM-91

Re: Whether the term "physician" in the Occupational Therapy Title Act, article 8851, V.T.C.S., includes chiropractors (RQ-246)

Dear Ms. Vaclavik:

You ask about the meaning of the term "physician" in two provisions of the Occupational Therapy Title Act, V.T.C.S. art. 8851, §§ 15(b)(6), 27. Specifically, you ask whether the term refers only to persons licensed to practice medicine by the State Board of Medical Examiners under the Medical Practice Act, V.T.C.S. art. 4495b, or whether it also refers to persons licensed by the Board of Chiropractic Examiners under article 4512b, V.T.C.S. See Attorney General Opinion JM-1279 (1990) (holding that chiropractor may identify himself as "chiropractic physician" if he also uses one of the following terms: chiropractor; doctor, D.C.; or doctor of chiropractic, D.C.). You state that your board has adopted a rule stating that the term refers only to persons licensed to practice medicine. 40 T.A.C. § 383.1.

One of the provisions at issue provides that the provisions of article 8851 do not apply to

any qualified and properly trained person or persons acting under a physician's supervision pursuant to Subdivision (1) of Subsection (d) of Section 3.06 of the Medical Practice Act (Article 4495b, Vernon's Texas Civil Statutes).

V.T.C.S. art. 8851, § 15(b)(6). Since section 15(b)(6) refers to a person acting under a physician's supervision in accordance with a provision of the Medical Practice Act, it is clear that "physician" in that context means a person licensed under the Medical Practice Act, not a health-care professional licensed under some other act.

The other provision at issue is section 27, which provides:

An occupational therapist may enter a case for the purposes of providing consultation and monitored services and evaluating an individual for the need of services. Implementation of direct occupational therapy to individuals for their specific medical conditions shall be based on a referral from a physician licensed to practice in the State of Texas.

V.T.C.S. art. 8851, § 27. When a word or phrase is used in different parts of a statute, a clear meaning appearing in one instance will be attached to the same word or phrase used elsewhere. Boriack v. Boriack, 541 S.W.2d 237, 240 (Tex. Civ. App.-Corpus Christi 1976, writ dism'd). Applying the principle of statutory construction set forth in Boriack, we conclude that the term "physician" in section 27, as in section 15(b)(6), refers to a person licensed by the State Board of Medical Examiners, not to other health-care practitioners. See Attorney General Opinion DM-21 (1991) (term "physician" in athletic trainer statute refers to persons licensed by the State Board of Medical Examiners).

SUMMARY

The term "physician" in section 15(b)(6) and section 27 of article 8851, V.T.C.S., the Occupational Therapy Title Act, refers to persons licensed by the State Board of Medical Examiners under article 4495b, V.T.C.S., not to health-care practitioners licensed under other statutes.

Very truly yours,

DAN MORALES
Attorney General of Texas

WILL PRYOR
First Assistant Attorney General

MARY KELLER
Deputy Assistant Attorney General

JUDGE ZOLLIE STEAKLEY (Ret.)
Special Assistant Attorney General

RENEA HICKS
Special Assistant Attorney General

MADELEINE B. JOHNSON
Chair, Opinion Committee

Prepared by Sarah Woelk
Assistant Attorney General