Can a Texas public agency provide physical therapy without hiring a licensed physical therapist, if a doctor supervises?
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This page answers the general question as of 1986. Ezel answers yours: what it means for your facts, under current Texas law, with citations.
Texas AG Opinion JM-421: Physical Therapy Licensing
Plain-English summary
A criminal district attorney asked how far a public agency could go in offering physical therapy without employing a licensed physical therapist, so long as the services ran through a licensed physician. JM-421 answered that a doctor can do this two ways. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
First, a licensed physician can personally perform any act that falls within the statutory definition of physical therapy, because the Medical Practice Act's definition of practicing medicine already covers that ground. Second, the physician can delegate those acts to other trained people, such as nursing support staff, who work under the physician's supervision. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
The catch is the delegation rules. Article 4495b, section 3.06(d)(1) sets out conditions a physician must satisfy to delegate a medical act, including that a reasonable and prudent physician would find the act within sound medical judgment to delegate and that the person can safely perform it. The opinion stressed that whether any particular delegation is proper turns on the facts, so it could not bless every arrangement in advance. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
The physical therapy licensing act carves out an exception for people already licensed by another state agency and performing health-care services within that license. The opinion read acts properly delegated by a physician as falling within that exception, so staff performing delegated physical-therapy acts are not practicing physical therapy without a license. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Currency note
This opinion was issued in 1986. 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
Does every provider of physical therapy have to be a licensed physical therapist?
No. JM-421 explained that a licensed physician can perform acts that meet the definition of physical therapy under the physician's own medical license, without a separate physical therapy license. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Can the doctor hand the actual treatments to support staff?
Yes, if the delegation rules are met. Article 4495b, section 3.06(d)(1) lets a physician delegate a medical act to a qualified, properly trained person acting under supervision, and the physician stays responsible for the delegated acts. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Would that supervised staff member be practicing physical therapy without a license?
No. The opinion treated properly delegated acts as authorized by the Medical Practice Act and within the physical therapy act's exception for health-care workers licensed under other acts, so the delegated care does not violate the physical therapy licensing law. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Does the opinion approve any specific staffing arrangement?
No. It said the propriety of any particular delegation involves fact questions the opinion could not answer, so each arrangement has to be measured against the section 3.06(d)(1) requirements. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Background and statutory framework
The physical therapy licensing act, article 4512e, defines physical therapy broadly in section 1(1), covering examination, treatment, and instruction to detect and alleviate physical disability and pain, and it prohibits practicing or holding oneself out as a physical therapist without a license in section 7. Section 6(1) makes those prohibitions inapplicable to a licensee of another state agency performing health-care services within the scope of that license. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
The Medical Practice Act, article 4495b, defines practicing medicine in section 1.03(8) in terms broad enough to include physical therapy, which is why a physician can perform those acts directly. Section 3.06(d)(1) supplies the delegation authority and its conditions, and it keeps the delegating physician responsible for the delegated acts. Reading these two acts together, the opinion concluded that a physician, or supervised staff acting on properly delegated authority, can provide physical-therapy services without a physical therapy license. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Citations and references
- V.T.C.S. art. 4512e, §1(1)
- V.T.C.S. art. 4512e, §6(1)
- V.T.C.S. art. 4512e, §7
- V.T.C.S. art. 4495b, §1.03(8)
- V.T.C.S. art. 4495b, §3.06(d)(1)
Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Source
- Landing page: https://www.texasattorneygeneral.gov/opinions/jim-mattox/jm-0421
- Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0421.pdf
Original opinion text
Best-effort transcription from a scanned PDF via OCR. Minor errors may remain; the linked PDF is authoritative.
The Attorney General of Texas
JIM MATTOX
Attorney General
January 15, 1986
Honorable James S. McGrath
Criminal District Attorney
P. O. Box 2553
Beaumont, Texas 77704
Opinion No. JM-421
Re: Whether a public agency may offer physical therapy services without employing a licensed therapist if such services are offered by or under the supervision of a licensed physician
Dear Mr. McGrath:
You have asked the following question:
To what extent can a public agency offer physical therapy services without employing a licensed therapist, so long as such services are offered through a licensed physician, through direct treatment or by direction to his nursing support staff to give such treatments?
The physical therapy licensing act contains the following definition of "physical therapy":
'Physical therapy' means the examination, treatment, or instruction of human beings to detect, assess, prevent, correct, and alleviate physical disability and pain from injury, disease, disorders, or physical deformities and includes the administration and evaluation of tests and measurements of bodily functions and structures in aid of diagnosis or treatment; the planning, administration, evaluation, and modification of treatment and instruction, including the use of physical measures, activities, and devices for preventive and therapeutic purposes on the basis of approved test findings and the provision of consultative, educational, and advisory services for the purpose of reducing the incidence and severity of physical disability and pain. Physical therapy shall also include the delegation of selective forms of treatment to supportive personnel with assumption of the responsibilities for the care of the patient and continuing direction and supervision of the supportive personnel. The use of roentgen rays and radium for diagnostic and therapeutic purposes, and the use of electricity for surgical purposes, including cauterization, are not authorized under the term 'physical therapy' as used herein, and a license issued hereunder shall not authorize the diagnosis of diseases or the practice of medicine as defined by law. (Emphasis added).
V.T.C.S. art. 4512e, §1(1).
The physical therapy licensing act sets out certain prohibitions on the practice of physical therapy:
(a) A person may not practice or represent himself as able to practice physical therapy, or act or represent himself as being a physical therapist unless he is licensed under this Act.
(b) A person may not act or represent himself as being a physical therapist assistant unless he is licensed under this Act.
Id. §7. The act, and those prohibitions, however, do not apply to
a licensee of another state agency performing health-care services within the scope of the applicable licensing act, an occupational therapist who confines his practice to occupational therapy, a certified corrective therapist who confines his practice to corrective therapy, and a speech pathologist or an audiologist who confines his practice to the treatment of communication disorders. . . .
Id. §6(1).
The definition of "practicing medicine" in the Medical Practice Act clearly subsumes the practice of "physical therapy."
(8) 'Practicing medicine.' A person shall be considered to be practicing medicine within this Act:
(A) who shall publicly profess to be a physician or surgeon and shall diagnose, treat, or offer to treat any disease or disorder, mental or physical, or any physical deformity or injury by any system or method or to effect cures thereof; or
(B) who shall diagnose, treat, or offer to treat any disease or disorder, mental or physical, or any physical deformity or injury by any system or method and to effect cures thereof and charge therefor, directly or indirectly, money or other compensation.
V.T.C.S. art. 4495b, §1.03(8). Thus, a doctor who is licensed to practice medicine in Texas can perform all the functions of a physical therapist within the scope of his medical license.
Also, a doctor can delegate certain medical acts to any qualified person:
(1) a person licensed to practice medicine shall have the authority to delegate to any qualified and properly trained person or persons acting under the physician's supervision any medical act which a reasonable and prudent physician would find is within the scope of sound medical judgment to delegate if, in the opinion of the delegating physician, the act can be properly and safely performed by the person to whom the medical act is delegated 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 practice medicine. The delegating physician shall remain responsible for the medical acts of the person performing the delegated medical acts. The board may determine whether or not an act constitutes the practice of medicine, not inconsistent with this Act, and may determine whether any medical act may or may not be properly or safely delegated by physicians. . . .
V.T.C.S. art. 4495b, §3.06(d)(1).
The physical therapy licensing act is not applicable to "a licensee of another state agency performing health-care services within the scope of the applicable licensing act." V.T.C.S. art. 4512e, §6(1). Although a person acting under the supervision of a physician would probably not himself be a "licensee" under the Medical Practice Act, we think acts delegated by a licensed physician come within the scope of the exception to the physical therapy licensing act. Obviously, the purpose of the exception for health care workers licensed under other acts is to make clear that health care workers who perform acts that come within the definition of "physical therapy" are not violating the law as long as their acts are authorized by the licensing act applicable to them. As long as the requirements of article 4495b, section 3.06(d)(1) 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 that happen to constitute "physical therapy" would not be subject to the physical therapy licensing act as long as such acts are authorized by the Medical Practice Act.
Article 4495b, section 3.06(d)(1), sets out a number of requirements that must be met in order for a doctor to delegate medical acts. Consequently, the propriety of any specific instance of delegation would involve fact questions that we cannot answer.
SUMMARY
A doctor may perform medical acts that come within the definition of "physical therapy" in article 4512e, section 1(1). If the requirements of article 4495b, section 3.06(d)(1) are met, a person who is not a licensed physical therapist but who is acting under a doctor's supervision may perform medical acts that come within the definition of "physical therapy" in article 4512e, section 1(1).
Very truly yours,
JIM MATTOX
Attorney General of Texas
JACK HIGHTOWER
First Assistant Attorney General
MARY KELLER
Executive Assistant Attorney General
ROBERT GRAY
Special Assistant Attorney General
RICK GILPIN
Chairman, Opinion Committee
Prepared by Sarah Woelk
Assistant Attorney General
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