The opinion
ACCEPTED
03-13-00077-CV
4288823
THIRD COURT OF APPEALS
AUSTIN, TEXAS
2/26/2015 4:38:03 AM
JEFFREY D. KYLE
CLERK
No. 03-13-00077-CV
IN THE COURT OF APPEALS RECEIVED IN
3rd COURT OF APPEALS
FOR THE THIRD JUDICIAL DISTRICT AUSTIN, TEXAS
AUSTIN, TEXAS 2/26/2015 4:38:03 AM
JEFFREY D. KYLE
Clerk
TEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY
THERAPISTS; CHARLES HORTON IN HIS CAPACITY AS EXECUTIVE
DIRECTOR; SANDRA DESOBE IN HER CAPACITY AS PRESIDING
OFFICER; TEXAS ASSOCIATION FOR MARRIAGE AND FAMILY THERAPY,
Appellants/Cross-Appellees,
v.
TEXAS MEDICAL ASSOCIATION,
Appellee/Cross-Appellant.
On Appeal from the 53rd Judicial District
Travis County Texas
AMICUS BRIEF OF
THE ASSOCIATION OF MARITAL
AND FAMILY THERAPY REGULATORY BOARDS
STEVEN T. PELUSO
THE LAW OFFICE OF
STEVEN T. PELUSO, ESQ.
The St. James Building
1133 Broadway, Suite 304
New York, New York 10010
Tel.: 646.448.4319
steven.peluso@spelusolawoffice.com
TABLE OF CONTENTS
Table of Contents ii
Index of Authorities iv
Statement of Interest 1
Statement of Facts 3
Summary of the Arguments 4
Arguments 7
A. Licensed Marriage and Family Therapists are fully qualified
to perform diagnostic assessments as part of their
therapeutic role in the therapeutic settings in which they
practice. 7
B. Licensed Marriage and Family Therapists are specifically
trained to perform diagnostic assessments as part of their
therapeutic role in the therapeutic settings in which they
practice. 9
C. Licensed Marriage and Family Therapists are specifically
tested on their competency to perform diagnostic
assessments as part of their therapeutic role in the
therapeutic settings in which they practice. 14
D. Diagnosis standing alone does not meet the statutory
definition of practicing medicine under the Texas Medical
Practice Act. 16
E. There is no lawful mechanism by which a Licensed Marriage
and Family Therapist may receive a diagnosis from a
physician. 19
ii
F. The Texas legislature has specifically set forth in the
Medical Practice Act those instances in which a physician
must supervise a non-physician practitioner when
performing a medical act. 20
G. The structure of the Occupations Code supports that
Marriage and Family Therapy is not the practice of medicine
and therefore a diagnostic assessment is not practicing
medicine. 22
H. Holding that a diagnostic assessment is practicing medicine
violates the intent of the Code Construction Act. 24
I. Dr. Priscilla Ray the Texas Medical Association’s expert
should have been disqualified. 25
Conclusion 27
Certificates of Compliance 29
Certificate of Service 30
Appendix A 31
Appendix B 36
Appendix C 38
iii
INDEX OF AUTHORITIES
STATUTES
Title 3 of the Occupations Code 23
TEX. OCC. CODE § 1.001 22
TEX. OCC. CODE § 1.001(b) 22
TEX. OCC. CODE § 151.2(a)(13) 16, 17
TEX. OCC. CODE § 157.001 et. seq. 20,21
TEX. OCC. CODE § 502.002(4) 18
TEX. GOV. CODE § 311.021 24
TEX. GOV. CODE § 311.021(5) 25
RULES
22 TEX. ADMIN CODE §801.2 12
22 TEX. ADMIN CODE §801.42 8, 9
22 TEX. ADMIN CODE §801.42(13) 3, 4, 5, 6, 7, 8, 9, 25, 27
22 TEX. ADMIN CODE §801.112 11,12
22 TEX. ADMIN CODE §801.113 11
22 TEX. ADMIN CODE §801.114 13
iv
STATEMENT OF INTEREST
The Association of Marital and Family Therapy Regulatory
Boards (the “AMFTRB”) is a nonprofit organization whose
members are statutorily constituted regulatory boards, including
administrative agencies, legally responsible for the regulation of
Marital and Family Therapists.1 It is organized to: facilitate
communication among its member boards concerning the
regulation of Marital and Family Therapists; to sponsor
collaboration among the member boards in developing compatible
standards and Family Therapy services to other Marital and
Family Therapy organizations, to legislative, judicial, regulatory,
and executive governmental bodies, and to other groups or
associations whose areas of interest may coincide with those of its
membership; to aid its member boards in fulfilling statutory,
professional, public, and ethical obligations; and to engage in and
encourage research on matters related to the legal regulation of
Marital and Family Therapists. AMFTRB’s membership includes
1
In Texas the term Licensed Marriage and Family Therapist is
used to describe a licensed practitioner. When relating specifically
to practitioners in the state of Texas, the Texas convention will be
used.
the regulatory agencies of all fifty-(50) states, the District of
Columbia, and the Territory of Guam. The Texas State Board of
Examiners of Marriage and Family Therapists (the “Texas MFT
Board”) is a member in good standing of the AMFTRB
The AMFTRB develops, sponsors, and administers National
Marital and Family Therapy Examination (the “MFT
Examination”). Currently, fifty-one (51) AMFTRB member
jurisdictions use the MFT Examination as part of the licensure
process for Marital and Family Therapists. The Texas MFT Board
utilizes the MFT Examination to test candidates for licensure as
Licensed Marriage and Family Therapists in the State of Texas.
Given the above set forth, AMFTRB respectively submits
that it is an interested party to this litigation, and furthermore,
requests that the Court consider this Amicus Brief in its
deliberations. Attached as Appendix A, and incorporated herein,
is the affidavit of the Executive Director of the AMFTRB Lois Paff
Bergen, Ph.D. that was executed in support of this Amicus Brief.
2
TO THE HONORABLE THIRD COURT OF APPEALS
Amicus, the Association of Marital and Family Therapy
Regulatory Boards, respectfully urges that the Court grant the
Appellants’ motion for en banc reconsideration and reverse the
panel’s upholding of the District Court’s finding that 22 TEX.
ADMIN CODE §801.42(13) is invalid and void. AMFTRB
respectfully submits that not to do so frustrates the Texas
legislature’s intent in enacting the Licensed Marriage and Family
Therapist Act, deprives the people of Texas the services of
Licensed Marriage and Family Therapists, and violates the Texas
Code Construction Act in that the ruling favors a private interest
over that of the public.
STATEMENT OF FACTS
The Texas Medical Association (the “TMA”) filed suit
challenging inter alia a rule promulgated by the Texas MFT Board
that permits Licensed Marriage and Family Therapists to perform
diagnostic assessments. 22 TEX. ADMIN. CODE § 801.42(13). The
TMA claimed, and the District Court and a three (3) judge panel of
this Court agreed, that performing a diagnostic assessment as set
3
forth in the rule, or any diagnosis for that matter, falls within the
definition of “practicing medicine” as set forth in the Texas
Medical Practice Act. As Licensed Marriage and Family
Therapists are not licensed as physicians in the state, it was
therefore reasoned that performing a diagnostic assessment or a
diagnosis is the unlicensed practice of medicine. As such 22 TEX.
ADMIN. CODE § 801.42(13) was declared to be invalid and void.
SUMMARY OF THE ARGUMENTS
The TMA has managed to have the language of the Texas
Licensed Marriage and Family Therapist Act contorted in such a
way as to ensure that Licensed Marriage and Family Therapists
in the State of Texas are effectively prohibited from professional
practice. In an exercise of semantic gymnastics, the TMA has
effectively had the marriage and family therapy profession gutted
in the state of Texas.
On its face, this case would appear to be about the rule
making authority of the MFT Board, and the statutory limits of
that authority. It is not. This case is about market protectionism,
and the medical profession’s effort to prevent another profession
4
from rendering professional services. If a Licensed Marriage and
Family Therapist cannot provide a diagnostic assessment, she
cannot bill an insurance company for her services. If a Licensed
Marriage and Family Therapist cannot bill an insurance company
for her services, she cannot afford to practice. As a result, if
Licensed Marriage and Family Therapists cannot perform
diagnostic assessments as set forth in 22 TEX. ADMIN. CODE §
801.42(13), then the people of the State of Texas will be denied
access to the mental health services of Licensed Marriage and
Family Therapists; mental health services to which the Texas
legislature decided they were entitled when it enacted the Texas
Licensed Marriage and Family Therapist Act.
The AMFTRB has reviewed the Appellants’ motion for en
banc reconsideration and finds it to be compelling. Furthermore,
the AMFTRB feels that the arguments set forth in the motion are
such that the Appellants’ motion for en banc reconsideration of the
panel’s decision should be granted by the Court and the panel’s
decision upholding of the District Court’s finding that 22 TEX.
ADMIN CODE §801.42(13) as invalid and void should be reversed.
5
Therefore, the AMFTB hereby adopts the arguments set forth by
the Appellants’ in the motion.
The AMFTRB would like to bring to the Court’s attention
arguments in addition to those that are set forth in the Appellants’
motion. The AMFTRB feels that these arguments lend additional
support to the Appellants’ motion for en banc reconsideration by
the Court and that the panel’s decision upholding of the District
Court’s finding that 22 TEX. ADMIN CODE §801.42(13) as invalid
and void should be reversed. The arguments are summarized as
follows:
A. Licensed Marriage and Family Therapists are fully qualified
to perform diagnostic assessments as part of their
therapeutic role in the therapeutic settings in which they
practice.
B. Licensed Marriage and Family Therapists are specifically
trained to perform diagnostic assessments as part of their
therapeutic role in the therapeutic settings in which they
practice.
C. Licensed Marriage and Family Therapists are specifically
tested on their competency to perform diagnostic
assessments as part of their therapeutic role in the
therapeutic settings in which they practice.
D. Diagnosis standing alone does not meet the statutory
definition of practicing medicine under the Texas Medical
Practice Act.
6
E. There is no lawful mechanism by which a Licensed Marriage
and Family Therapist may receive a diagnosis from a
physician.
F. The Texas legislature has specifically set forth in the
Medical Practice Act those instances in which a physician
must supervise a non-physician practitioner when
performing a medical act.
G. The structure of the Occupations Code supports that
Marriage and Family Therapy is not the practice of medicine
and therefore a diagnostic assessment is not practicing
medicine.
H. Holding that a diagnostic assessment is practicing medicine
violates the intent of the Code Construction Act.
I. Dr. Priscilla Ray the Texas Medical Association’s expert
should have been disqualified.
ARGUMENTS
A. Licensed Marriage and Family Therapists are fully
qualified to perform diagnostic assessments as part of
their therapeutic role in the therapeutic settings in
which they practice.
The Texas Medical Association selectively cites section 22
TEX. ADMIN. CODE § 801.42(13) of the Texas Administrative Code
and surmises that the Texas MFT Board is authorizing Licensed
Marriage and Family Therapists to diagnosis any and all of the
mental disorders set forth in the nine hundred plus (900+) pages
7
of the Diagnostic and Statistical Manual of Mental Disorders
(DSM). Furthermore, based upon this ridiculously expansive
reading of § 801.42(13), and given the context in which it appears,
the TMA asserts that the Texas MFT Board is explicitly
sanctioning Licensed Marriage and Family Therapists to practice
outside their area of expertise and beyond their level of training,
to include the practice of medicine. This is not the case.
22 TEX. ADMIN. CODE § 801.42(13) reads as follows:
The following are professional therapeutic services which
may be provided by a Licensed Marriage and Family
Therapist or a Licensed Marriage and Family Therapist
Associate.
…
(13) Diagnostic assessment which utilizes the knowledge
organized in the Diagnostic and Statistical Manual of
Mental Disorders (DSM) as well as the International
Classification of Diseases (ICD) as part of their therapeutic
role to help individuals identify their emotional, mental, and
behavioral problems when necessary.
22 TEX. ADMIN. CODE § 801.42(13)
Citing the above section selectively, however, the TMA
removes it from the larger context in which it appears. 22 TEX.
ADMIN. CODE § 801.42 contains a total of twenty-two (22) sections,
twenty (20) of which specify in great detail the professional
8
therapeutic services that may be provided by a Licensed Marriage
and Family Therapist. Far from granting carte blanche for a
Licensed Marriage and Family Therapist to practice in any
therapeutic setting, 22 TEX. ADMIN. CODE § 801.42 acts as a
limitation on the scope of practice.
As such, the logical reading of 22 TEX. ADMIN. CODE §
801.42(13) is that it confines Licensed Marriage and Family
Therapists to conducting diagnostic assessments related to those
professional therapeutic services specifically set forth in its twenty
(20) other sections. Licensed Marriage and Family Therapists are
specially trained in and specifically tested on conducting
diagnostic assessments related to those professional therapeutic
services.
B. Licensed Marriage and Family Therapists are
specifically trained to perform diagnostic assessments as
part of their therapeutic role in the therapeutic settings in
which they practice.
Under the AMFTRB’s Test Policy, only individuals who have
successfully completed a master or doctorate degree in marital
and family therapy (or its equivalent as established by the
jurisdiction) from a university program that has been accredited
9
by a nationally or regionally recognized accreditation body, and
who have undertaken and/or completed post degree supervised
practical experience as outlined by the jurisdiction in which the
candidate is seeking licensure, may be approved by the
jurisdiction to sit for the MFT Examination. As set forth in Dr.
Paff Bergen’s affidavit, to the best of AMFTRB’s knowledge, in
order for a program to be accredited by a nationally or regionally
recognized accreditation body its curriculum includes assessment
and diagnosis of patients in the marital and family therapy
practice setting.
For example, the Commission on Accreditation for
Marriage and Family Therapy (COAMFTE) accredits master's
degree, doctoral degree, and post-graduate degree clinical training
programs in marriage and family therapy throughout the United
States and Canada. COAMFTE is the accrediting arm of the
American Association for Marriage and Family Therapy (AAMFT)
and is recognized by the Council for Higher Education
Accreditation. In order to meet COAFMTE’s Accreditation
10
Standards, a program’s curriculum must include coursework in
systemic/relational assessment and mental health diagnosis.
The Texas MFT Board has adopted by rule the accreditation
scheme described above. 22 TEX. ADMIN. CODE § 801.113 reads in
relevant part as follows:
(b) Persons applying for licensure as a marriage and family
therapist or a marriage and family therapist associate must
have a master's or doctorate degree in marriage and family
therapy or a master's or doctorate degree in a related mental
health field with course work and training determined by
the board to be substantially equivalent to a graduate degree
in marriage and family therapy from a regionally accredited
institution of higher education or an institution of higher
education approved by the board.
(c) A degree or course work in a master's or doctorate in
marriage and family therapy or a related mental health field
must include at least 45 semester hours which the applicant
completed at a regionally accredited school, except that those
applicants starting August 1, 2017, must have 60 semester
hours.
22 TEX. ADMIN. CODE § 801.113.
The Texas MFT Board defines the accreditation bodies that
meet the accreditation requirement in two (2) places. First, in 22
TEX. ADMIN. CODE § 801.112, which recognizes COAFMTE
accreditation and reads in relevant part:
(a) The board shall accept the following as meeting academic
11
requirements for licensure as a marriage and family
therapist associate:
(1) a master's degree or doctorate degree in marriage
and family therapy from a program accredited by the
Commission on Accreditation for Marriage and Family
Therapy Education (COAMFTE);
(2) a master's degree or doctorate degree in marriage
and family therapy from an accredited institution or
program as defined in §801.2 of this title (relating to
Definitions), but the program is not accredited by
COAMFTE, provided that the practicum is at least 9
credit hours or 12 months.
22 TEX. ADMIN. CODE § 801.112
The Texas MFT Board will also accept non-COAFMTE
accreditation, provided, that, the accreditation body is recognized
by the Council for Higher Education Accreditation (CHEA). As set
forth in the relevant part of 22 TEX. ADMIN. CODE § 801.2:
The following words and terms when used in this chapter,
shall have the following meanings unless the context
indicates otherwise.
(1) Accredited institutions or programs--An institution
or program which holds accreditation or candidacy
status from an accreditation organization recognized
by the Council for Higher Education Accreditation
(CHEA).
22 TEX. ADMIN. CODE § 801.2
12
In addition, an applicant for licensure must have taken a
prescribed number of course hours in the area of assessment as
set forth in 22 TEX. ADMIN. CODE § 801.114, which reads in
relevant part:
An applicant who holds a graduate degree in a mental
health-related field must have course work in each of the
following areas (one course is equal to three semester hours):
(2) assessment and treatment in marriage and family
therapy--four courses;
22 TEX. ADMIN. CODE § 801.114
As the Texas MFT Board utilizes the MFT Examination, and
therefore must bide by the AMFTRB’s Test Policy, all Texas
applicants for licensure as a Licensed Marriage and Family
Therapist must graduate from an accredited institution. As set
forth in the Texas Administrative Code, the Texas MFT Board has
adopted rules consistent with this requirement. As such,
licensure applicants would have had to demonstrate mastery of
assessment and diagnosis of patients in a marital and family
therapy practice setting during their education. Therefore, before
they can even sit for the MFT Examination, every applicant for
licensure as a Licensed Marriage and Family Therapist in the
13
state of Texas will have received training in and demonstrated
mastery of, in the educational setting, diagnostic assessment and
diagnosis in the therapeutic settings in which they will practice.
In short, Licensed Marriage and Family Therapist in Texas must
have demonstrated sufficient training to competently perform
diagnostic assessments and diagnoses in the therapeutic settings
in which they practice, otherwise they would not be eligible for
licensure by the state.
C. Licensed Marriage and Family Therapists are
specifically tested on their competency to perform
diagnostic assessments as part of their therapeutic
role in the therapeutic settings in which they practice.
The MFT Examination is an objective competency based
national licensure examination that tests candidates on six (6)
practice domains. The MFT Examination is based upon a role
delineation study. The purpose of the role delineation study is to
develop practice-relevant test specifications for the MFT
Examination. The role delineation is updated every five (5) to
seven (7) years to ensure it remains current. The last such update
for the MFT Examination was in 2013.
14
The process works as follows: First, an Examination
Advisory Committee (the “EAC”) is convened to define the
performance domains, tasks, and knowledge required for entry-
level practice in marital and family therapy. Members of the EAC
are appointed by the AMFTRB and include representatives from
various practice settings. The draft of role delineation is then
constructed. Next, the draft role delineation undergoes a
validation study by a representative sample of licensed Marital
and Family Therapists nationwide. Once validated, the task
statements are rated for frequency of performance and relation to
clinical competence; knowledge statements are rated and weighted
for contribution to public protection and appropriateness for entry-
level practice. Based upon these ratings, test specifications are
developed. Perhaps most importantly to this litigation is Domain
2 of the test specifications
Domain 2 of the test specifications of the MFT Examination
is entitled: Assessing, Hypothesizing, and Diagnosing. It tests
candidates’ knowledge with respect to each of those tasks.
Domain 2 of the MFT Examination is based upon the most current
15
version of the DSM. In the event that the DSM changes in
between role delineation updates, all questions on the MFT
Examination related to the DSM are updated to the new version.
By requiring candidates to pass the MFT Examination as
part of the licensure process, the Texas MFT Board ensures all
Texas licensure candidates are tested on diagnostic assessment.
Furthermore, in being required to pass the MFT Examination as
part of the licensure process, all Licensed Marriage and Family
Therapists in Texas have objectively demonstrated competency in
performing diagnostic assessments and diagnoses in the
therapeutic settings in which they practice.
D. Diagnosis standing alone does not meet the statutory
definition of practicing medicine under the Texas
Medical Practice Act.
TEX. OCC. CODE § 151.2(a)(13) reads as follows:
DEFINITIONS. (a) In this subtitle:
…
(13) "Practicing medicine" means the diagnosis, treatment,
or offer to treat a mental or physical disease or disorder or a
physical deformity or injury by any system or method, or the
attempt to effect cures of those conditions, by a person who:
(A) publicly professes to be a physician or surgeon; or
16
(B) directly or indirectly charges money or other
compensation for those services.
TEX. OCC. CODE § 151.2(a)(13)
Diagnosis standing alone does not meet the statutory
definition of practicing medicine. In order to meet the statutory
definition of practicing medicine, a diagnosis must be coupled with
either a: “treatment, or an offer to treat a mental or physical
disease or disorder or a physical deformity or injury [.]” TEX. OCC.
CODE § 151.2(a)(13). Such a reading is consistent with the
practice of medicine. Diagnosis absent a treatment, or an offer to
treat, is an empty act. Similarly, treatment, or an offer to treat,
cannot be made absent a diagnosis. Diagnosis and treatment are
inextricably intertwined in the practice of medicine and should be
interpreted as such by this court.
Given that a diagnosis must be coupled with treatment, or
an offer to treat, to meet the statutory definition of practicing
medicine, it logically follows that the diagnosis must be related to
a type of treatment offered by a physician. The therapeutic role
Licensed Marriage and Family Therapists perform and the
therapeutic settings in which they practice are not the same as
17
those of physicians. In this instance, to define diagnosis so
broadly as to include the therapeutic role and therapeutic settings
in which physicians do not practice as practicing medicine is to de
facto render the Licensed Marriage and Family Therapist Act null
and void. Surely, the Texas legislature never intended such a
counterintuitive result.
In addition, the Texas Licensed Marriage and Family
Therapist Act defines a Licensed Marriage and Family Therapist
as:
DEFINITIONS. In this chapter:
…
(4) “Licensed marriage and family therapist" means a person
who offers marriage and family therapy for compensation.
TEX. OCC. CODE § 502.002(4).
The Licensed Marriage and Family Therapy Act only
permits the practitioner the to use the title Licensed Marriage and
Family Therapist. As the use of additional titles such as
"physician” or “surgeon" are not permitted, the public will not
mistakenly believe that a Licensed Marriage and Family
Therapist is practicing medicine.
18
E. There is no lawful mechanism by which a Licensed
Marriage and Family Therapist may receive a
diagnosis from a physician.
If as the TMA asserts, performing a diagnostic assessment is
practicing medicine and as such may only be done by a physician,
then from where will the diagnosis for a Licensed Marriage and
Family Therapist originate? Nowhere in the Licensed Marriage
and Family Therapist Act or the Medical Practice Act is a
physician authorized to provide a diagnosis to a Licensed
Marriage and Family Therapist. Absent such authorization, only
two (2) conclusions can follow. Either, the Texas legislature
intended physicians to aid and abet the unlicensed practice of
medicine by Licensed Marriage and Family Therapists; or in
enacting the Licensed Marriage and Family Therapist Act the
Texas legislature created a licensed profession with what amounts
to no authority to practice. Neither conclusion makes any sense.
The only logical conclusion is that in enacting the Licensed
Marriage and Family Therapist Act the legislature intended
marriage and family therapy to be a stand-alone profession,
including conducting the diagnostic assessment upon which
19
treatment would be based. Further analysis as set forth in the
next two (2) arguments supports this view.
F. The Texas legislature has specifically set forth in the
Medical Practice Act those instances in which a
physician must supervise a non-physician
practitioner when performing a medical act.
The Texas legislature has specifically set forth in the
Medical Practice Act those instances in which a physician must
supervise a non-physician practitioner when performing a medical
act. By not requiring that Licensed Marriage and Family
Therapists receive such supervision, the legislature made a
determination that marriage and family therapy is a stand-alone
profession. Therefore, a diagnostic assessment by a Licensed
Marriage and Family Therapist in the context of the practice of
that profession cannot be the practice of medicine.
Chapter 157 of the Medical Practice Act, Authority of
Physician to Delegate Certain Medical Acts, sets forth the
circumstances under which a physician may delegate medical acts
to certain licensed persons. TEX. OCC. CODE § 157.001 et. seq. If a
proper delegation is made, that person is not considered to be
practicing medicine without a license in performing the medical
20
act. Chapter 157 covers, for example, Advanced Practice
Registered Nurses, Physician Assistants, and Pharmacists.
Licensed Marriage and Family Therapists are not listed in
Chapter 157.
The omission of Licensed Marriage and Family Therapists in
Chapter 157 was not an accident. If the legislature determined
that marriage and family therapy was the practice of medicine
and as such must be delegated by a physician, Licensed Marriage
and Family Therapists would have been listed in the chapter as
well. Similarly, if in the context of marriage and family therapy a
diagnostic assessment was a medical act and as such the practice
of medicine that required a diagnosis be made by a physician, the
legislature would have stated such and included Licensed
Marriage and Family Therapists as part of Chapter 157.
Similarly, there is no mention in the Texas Licensed
Marriage and Family Therapist Act of a Licensed Marriage and
Family Therapist requiring a diagnosis. Had a Licensed Marriage
and Family Therapist required a diagnosis or a referral from a
physician, the Texas Licensed Marriage and Family Therapist Act
21
would have required such.
G. The structure of the Occupations Code supports that
Marriage and Family Therapy is not the practice of
medicine and therefore a diagnostic assessment is not
practicing medicine.
In setting forth the purpose of the Texas Occupations Code,
and the revisions thereto, TEX. OCC. CODE § 1.001 states in
relevant part:
Sec. 1.001. PURPOSE OF CODE. (a) This code is enacted
as a part of the state's continuing statutory revision program,
begun by the Texas Legislative Council in 1963 as directed
by the legislature in the law codified as Section 323.007,
Government Code. The program contemplates a topic-by-
topic revision of the state's general and permanent statute
law without substantive change.
(b) Consistent with the objectives of the statutory revision
program, the purpose of this code is to make the law
encompassed by this code more accessible and
understandable by:
(1) rearranging the statutes into a more logical order;
…
TEX. OCC. CODE § 1.001(b)
Given the above expressed purposes the legislature was
seeking to accomplish when revising the Occupations Code, its
structure and the placement of sections are instructive of
legislative intent.
22
More specifically, Title 3 of the Occupations Code is entitled:
Health Professions. Within Title 3 there are thirteen (13)
Subtitles A through M. Subtitle B concerns physicians. Subtitle
C is entitled: Other Professions Performing Medical Procedures.
Within Subtitle C are: Chiropractors, Podiatrists, Midwives,
Physician Assistants, Acupuncturists, and Surgical Assistants.
The Licensed Marriage and Family Therapist Act is set forth
in Subtitle I entitled: Regulation of Psychology and Counseling.
Also listed therein are Psychologists, Licensed Professional
Counselors, Chemical Dependency Counselors, and Social
Workers. Had the legislator intended that marriage and family
therapy be an extension of the medical profession, as a finding
that a diagnostic assessment is practicing medicine suggests, the
Licensed Marriage and Family Therapist Act would appear either
in Subtitle B or Subtitle C of Title 3 of the Occupations Code, not
in Subtitle I where it currently appears along with the other
recognized mental health counseling professions.
23
H. Holding that a diagnostic assessment is practicing
medicine violates the intent of the Code Construction
Act.
The Code Construction Act, TEX. GOV. CODE § 311.021 states in
relevant part:
Sec. 311.021. INTENTION IN ENACTMENT OF
STATUTES. In enacting a statute, it is presumed that:
(1) compliance with the constitutions of this state and
the United States is intended;
(2) the entire statute is intended to be effective;
(3) a just and reasonable result is intended;
(4) a result feasible of execution is intended; and
(5) public interest is favored over any private interest.
TEX. GOV. CODE § 311.021
Holding that a diagnostic assessment is practicing medicine
violates Subsections (2) through (5) of Subchapter C of the Code
Construction Act as set forth above. Specifically, the holding
violates Subsections (2) through (4) because: it renders the
statute ineffective in that it severely restricts or eliminates a
Licensed Marriage and Family Therapist’s ability to practice; is
not just and reasonable in that it severely restricts or eliminates a
Licensed Marriage and Family Therapist’s ability to practice; and
it does not result in feasible execution of the statute as intended,
i.e., that Licensed Marriage and Family Therapist will be able to
24
practice. Perhaps most importantly, however, such a holding
violates TEX. GOV. CODE § 311.021(5) in that it favors a private
interest over the public interest.
As the Appellants point out in their motion, a holding that
diagnostic assessment is practicing medicine will result in an
acute shortage of mental health professionals within the State of
Texas. As the TMA points out in its Original and Amended
petitions, it is seeking to protect its members’ rights to practice
and the integrity of their licenses. This places the private
interests of the TMA’s members before the public’s interest in a
fully functioning mental health system. A holding that a Licensed
Marriage and Family Therapist cannot perform a diagnostic
assessment as set forth in 22 TEX. ADMIN. CODE § 801.42(13) will
deny the people of the State of Texas certain mental health
services to which the legislature decided they were entitled when
it enacted the Texas Licensed Marriage and Family Therapist Act.
I. Dr. Priscilla Ray the Texas Medical Association’s
expert should have been disqualified.
In both its Original Petition and Second Amended Original
Petition, the TMA relies on the affidavit of Priscilla Ray, MD as its
25
expert. A search of Dr. Ray’s physician profile as maintained by
the Texas Medical Board, and accessed through the board’s
website, reveals that Dr. Ray has been the subject of two (2)
separate and distinct administrative proceedings, both of which
involved ethics lapses, and both of which resulted in action by the
Texas Medical Board.
In October 2008, the Texas Medical Board imposed a two
thousand dollar ($2,000) administrative penalty on Dr. Ray. This
penalty was the result of Dr. Ray ignoring two (2) separate audit
letters issued by the Texas Medical Board requesting information
about her continuing medical education. Attached hereto and
incorporated herein as Appendix B is a copy of the Texas Medical
Board’s Order Imposing Administrative Action on Dr. Ray dated
October 8, 2008.
In February 2013, Dr. Ray entered into a Remedial Plan
with the Texas Medical Board requiring that she take continuing
medical education credits in the topic of ethics. The Remedial
Plan was the result of Dr. Ray continuing to write prescriptions
following the expiration of her Texas Controlled Substance
26
Registration on August 31, 2010 and its renewal on September 20,
2010. Attached hereto and incorporated herein as Appendix C is
a copy of the Texas Medical Board’s Order Remedial Plan for Dr.
Ray dated February 8, 2013.
Given the above ethical lapses on the part of Dr. Ray, both of
which resulted in administrative action by the Texas State
Medical Board, Dr. Ray should be disqualified as an expert in this
matter. To the extent that either the District Court or the three
(3) judge panel of this Court relied upon her affidavit, such
reliance in and of itself should be the basis of a reversible error.
At a minimum, it calls for reconsideration of this matter by this
Court.
CONCLUSION
For the reasons both set forth in the Appellants’ motion and
this amicus brief, the AMFTRB respectfully submits that
Appellants’ motion for en banc reconsideration of the panel’s
decision should be granted by the Court and the panel’s decision
upholding of the District Court’s finding that 22 TEX. ADMIN CODE
§801.41(13) as invalid and void should be reversed. Not to do so
27
frustrates the legislative intent behind the Texas Licensed
Marriage and Family Therapist Act. Perhaps more importantly,
however, is that it deprives the people of the State of Texas access
to the mental health services that Licensed Marriage and Family
Therapists provide.
Dated: February 25, 2015
Respectfully submitted,
By: /s/ Steven T. Peluso
STEVEN T. PELUSO, ESQ.
THE LAW OFFICE OF
STEVEN T. PELUSO, ESQ.
The St. James Building
1133 Broadway, Suite 304
New York, New York 10010
Tel.: 646.448.4319
steven.peluso@spelusolawoffice.com
ATTORNEY FOR AMICUS THE ASSOCIATION OF MARITAL
AND FAMILY THERAPY REGULATORY BOARDS
28
CERTIFICATE OF COMPLIANCE
In accordance with Rule 11(c) of the Texas Rules of Appellate
Procedure, the Association of Marital and Family Therapy
Regulatory Boards has paid all fees and costs in connection with
preparing this Amicus Curie Brief.
/s/ Steven T. Peluso
STEVEN T. PELUSO
CERTIFICATE OF COMPLIANCE
In compliance with 9.4(e) of the Texas Rules of Appellate
Procedure, this Amicus Curie Brief has been prepared using a size
14 Century Schoolbook Font. In compliance with 9.4(i)(2) of the
Texas Rules of Appellate Procedure this Amicus Curie Brief
contains 4,899 words, excluding those portions exempted under
Rule 9.4(i)(1).
/s/ Steven T. Peluso
STEVEN T. PELUSO
29
CERTIFICATE OF SERVICE
I Steven T. Peluso hereby certify that I have served a copy of
this amicus brief of the Association of Marital and Family Therapy
Regulatory Boards on all Counsel of record by United States
Postal Service Express Mail Service on February 25, 2015 as listed
below:
BAKER BOTTS L.L.P. COUNSEL FOR
APPELLANTS/CROSS-
MATT C. WOOD APPELLEES TEXAS STATE
BOARD OF EXAMINERS OF
98 San Jacinto Blvd., MARRIAGE AND FAMILY
Suite 1500 THERAPISTS, CHARLES
Austin, Texas 78701-4039 HORTON, AND SANDRA
DESOBE
COUNSEL FOR
APPELLANT/CROSS-APPELLEE LAW OFFICES OF DAVID F.
TEXAS ASSOC. FOR MARRIAGE BRAGG, P.C.
AND FAMILY THERAPY D AVID F. BRAGG
OFFICE OF THE ATTORNEY P. O. Box 2047
GENERAL Bastrop, Texas 78602-2047
DUSTIN M. HOWELL C OUNSEL FOR
Assistant Attorney A PPELLEE /C ROSS -
General, Solicitor A PPELLANT
General Division T EXAS M EDICAL
A SSOCIATION
P.O. Box 12548 (MC-
059) Austin, Texas / S / Steven T. Peluso
78711-2548 STEVEN T. PELUSO
30
APPENDIX A
31
32
33
IO)The MFT Examination is an objective competency based national
licensure examination that tests candidates on six (6) practice domains.
The MFT Examination is based upon a role delineation study. The
purpose of the role delineation study is to develop practice-relevant
test specifications for the examination. The role delineation is updated
every five (5) to seven (7) years to ensure it remains current. The last
such update was in 2013.
ll)The process works as follows: First, an Examination Advisory
Committee (the "EAC") is convened to define the performance domains,
tasks, and knowledge required for entry-level practice in marital and
family therapy. Members of the EAC are appointed by the AMFTRB
and include representatives from various practice settings. The draft
of role delineation is then constructed. Next, the draft role delineation
undergoes a validation study by a representative sample of licensed
Marital and Family Therapists nationwide. Once validated, the task
statements are rated for frequency of performance and relation to
clinical competence; knowledge statements are rated and weighted for
contribution to public protection and appropriateness for entry-level
practice. Based upon these ratings, test specifications are developed.
Perhaps most importantly to this litigation is Domain 2 of the test
specifications
12)Domain 2 of the test specifications of the MFT Examination is entitled:
Assessing, Hypothesizing, and Diagnosing. It tests candidates'
knowledge with respect to each of those tasks. Domain 2 of the MFT
Examination is based upon the most current version of the DSM. In
the event that the DSM changes in between role delineation updates,
all questions on the MFT Examination related to the DSM are updated
to the new version.
[Text continues on Page 4.]
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APPENDIX B
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APPENDIX C
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39
40
41
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SIGNED AND ENTERED by the presiding officer of the Texas Medical Board on this
J_dayof ~~ ,201.3.
Page 5 of5
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