Licensed physical therapists (PTs) and assistants (PTAs) play a vital role in the Texas healthcare industry for patients coping with pain and recovering from injuries. Whether working in a busy medical center in Dallas, Houston, or San Antonio, a community clinic in rural West Texas, or a private practice in the Panhandle, they deliver essential care, restoring patients and clients throughout the state.
Although PTs and PTAs are focused on the therapeutic and rehabilitative functions of their duties, they must always maintain a high degree of professionalism and ethical behavior. State agencies can investigate any complaint that comes their way and can immediately cease a practitioner's ability to work. That means failing to document condition changes, forgetting to supervise an aide or slightly misleading forms for insurance reimbursements can lead to sanctions, such as:
- Probationary measure that limits the ability to practice
- Administrative penalties that cause financial stress
- License suspension or revocation that ends a career
When allegations arise naming Texas PTs and PTAs as the subject of complaints, they deserve an experienced legal team to protect their careers. They require a dedicated outlet to respond to state agencies, collect evidence, and build a defense strategy to challenge charges.
The Lento Law Firm stands prepared to marshal our extensive experience to keep PTs and PTAs aligned with their careers. Whether addressing investigators, managing disciplinary hearings, or pursuing appeals, our Professional License Defense Team will provide the assistance licensees need. Call us at 888-535-3686 now or fill out our confidential consultation form, and we will reach out to you.
Physical Therapist Licensing With ECPTOTE
The Texas Executive Council of Physical Therapy and Occupational Therapy Examiners (ECPTOTE) is charged with protecting the public's health, safety, and welfare by supporting two agencies: the Board of PT Examiners (Board) and the Board of OT Examiners. From its headquarters in Austin, the Board uses the Texas Physical Therapy Practice Act to govern the practice, including enforcing established minimum standards.
Licensed PTs are responsible for conducting patient evaluations, interpreting referrals from physicians, and making decisions to create and support patient care plans. PTAs implement treatment components that have been delegated by the supervising PT.
One of the most significant parts of licensing for PTs and PTAs is displaying their credentials correctly. ECPTOTE's guidelines include three main provisions:
- Individuals must display their original license in their principal place of business.
- Licensees must provide patient information about the Board's online verification system when conducting services through telehealth, home visits, and other non-traditional settings.
- Reproduction (including displays) is unauthorized unless for institutional filing purposes.
Direct access to physical therapy services is permitted in Texas, allowing patients to seek rehabilitation without a physician's referral. However, PTs must have at least one year of experience and licensing with ECPTOTE, have the minimum amount of professional liability insurance coverage from the Board, and must provide patients with a disclosure form and obtain a signature. Critically, PTs are no substitute for physicians as they may not diagnose illnesses or diseases.
Professional Standards for PTs and PTAs
Licensees must remain knowledgeable of modern therapy techniques, practice advancements, and others that serve patients, yet they must also be beholden to professional and ethical standards.
Failure to abide by these standards can lead to disciplinary measures, including fines, probation, or even license revocation. Conduct subject to adverse action includes the following:
- Providing care outside the scope of practice
- Use of drugs or intoxicating liquors to an extent that it affects professional competence
- Felony convictions or pleas of "no contest" in felony cases
- Practicing physical therapy in a grossly negligent manner
- Court findings of mental incompetency
- Practicing physical therapy in a manner detrimental to the public
- License suspension or revocation in other jurisdictions
- Treating a patient other than under supervision and direction from a PT (PTAs only)
In addition to professionalism standards, licensees are required to adhere to the Board's guidelines on delegation and supervision of physical therapy services. The dichotomy of PTs and PTAs is centered on tasks carried out under strict rules, wherein PTs are ultimately responsible. PTs may delegate interventions that are within the PTA's competence and scope of practice—as long as the intervention does not require advanced clinical judgment.
PTAs may not carry out the following independently:
- Patient evaluations
- Interpretation of referrals
- Creating or modifying care plans
- Making final discharge decisions
Delegation requires supervision, which includes clear directives to the PTA, such as patient treatment goals, specific therapeutic or rehabilitative interventions, and any parameters for adjusting treatment. PTs must be accessible for consultation, either on-site or via telecommunication, but the level of required supervision can depend on factors like the PTA's experience level, patient alertness, and overall complexity. PTs must periodically reevaluate goals or treatment strategies as needed, but their frequency depends on specific facility policies.
Regarding unlicensed support personnel, such as aides, only PTs may delegate certain tasks that do not require clinical decision-making, such as patient transport or equipment setup for sessions. For any patient-related tasks, the PT must be immediately available on-premises and able to intervene at any point. Support personnel may not perform any documentation for billing purposes or provide skilled therapeutic interventions that require credentialing. They can, however, record selected data as directed by the PT—such as vital signs or height and weight—and assist in routine patient care tasks.
Investigation Process for Texas PTs and PTAs
The grievance process for licensed PTs and PTAs can begin whenever an alleged violation reaches ECPTOTE. Normally, it occurs through the state agency's complaint portal, with a petition received in written or electronic form. Anyone—patients, their family members, colleagues, supervisors—can lodge complaints, which can include objections to care services given in a facility to incidents in the public space that call the fitness of a licensee into question.
ECPTOTE's Executive Council takes charge of investigating the complaint. First, it determines whether the alleged violation is related to the Texas Physical Therapy Practice Act. Upon establishing jurisdiction, investigators gather evidence, including interviewing witnesses, analyzing records and the licensee's notes, insurance claims, and anything else needed to substantiate their findings.
Investigations can take a long time to conduct. ECPTOTE has a rule that those accused must be given notice of the status of the case after 180 days have passed without a hearing scheduled (unless it would jeopardize an undercover investigation). However, those accused must first contact the Board within 30 days of the filed complaint.
Even if the Board dismisses a complaint, it may keep a file about the information collected by the Executive Council (but is not public record), which includes the following:
- Each person contacted in relation to the complaint
- A summary of findings made at each step of the complaint process
- An explanation of the legal basis and reason for the complaint's dismissal
After reviewing the investigation results, the Board may offer the licensee (respondent) the opportunity for an informal conference or negotiation to attempt a resolution without proceeding to a formal hearing. Respondents who agree to proposed sanctions or remedial action can avoid a contested hearing. However, it can come at the cost of full due process and being absolved of wrongdoing going forward.
Informal Settlement Conference
At any point after the filing of a complaint, the Board may schedule an informal settlement conference to resolve the case. Licensees may also request one, but the authority lies with the Executive Director of the Executive Council's Investigation Committee. A notice to the respondent is sent no less than 10 days before the conference and includes the following information:
- The nature of the alleged violation
- Notice of the right to legal counsel
- Notice of the right to have witnesses present for testimony
During the conference, each party—respondents, their representation, Investigation Committee members, and Board staff—may question witnesses and present arguments in a relatively informal manner. No formal recordings are made, and at the conference's conclusion, Board members propose an informal disposition, which includes disciplinary action, but typically only that which is probationary in nature. If parties do not strike an Agreed Order to end proceedings, the Board can vote to file formal charges, leading to a contested case hearing.
Texas Contested Case Hearings
The State Office of Administrative Hearings (SOAH) holds contested case hearings, with an Administrative Law Judge (ALJ) assigned to each case. The ALJ may hold a pre-hearing conference to address scheduling and discovery and as another means to resolve the matter before formal proceedings.
Although not as formal as a courtroom trial, both sides can present evidence, call and cross-examine witnesses, and make arguments to the ALJ. As the prosecuting party, the Board bears the burden of proof—but a very low bar to hurdle—with the SOAH working off the "preponderance of the evidence" standard.
After the hearing concludes, the ALJ issues a Proposal for Decision (PFD) detailing findings of fact, conclusions of law, and recommended sanctions (if any). The Board will review the PFD and may accept, modify, or reject the ALJ's recommendations but must provide justification if it significantly deviates from the PFD. It then files a Final Order, which becomes legally binding on the licensee.
If a licensee disputes the Board's Final Order, they appeal to a Texas district court within 30 days. However, appeals and judicial review are not a re-litigation of the matter but a review of the case for legal or procedural errors.
Board Sanctions for Texas Physical Therapists
The Board has a wide variety of punishments it can levy on licensees. Yet, it can take into account far more than the substantiated charges when determining appropriate discipline. It will take into account the following:
- The seriousness of the violation, including its nature, circumstances, extent, and gravity
- Hazard or harm (potential or actual) created to the public health, safety, confidence, or economic welfare
- History of previous violations and whether the conduct was intentional
- The extent of penalties necessary to deter future violations
- The licensee's efforts to correct the violation
The Board can impose written reprimands regarding minor misconduct, generally in conjunction with mandatory continuing education. Administrative fines can be added for the Board to recoup the costs of disciplinary proceedings and if damage occurred or restitution for victim harm.
The Board can order licensees to complete remedial plans with targeted stipulations to address charges. However, remedial plans may not restrict the authority to practice or contain administrative penalties. The Board cannot agree to remedial plans where the substantiated misconduct was felonious, involved sexual behavior or a patient's death, or if the licensee entered into a plan in the past five years.
Suspensions typically last for a minimum of one year, and to regain the ability to practice, licensees must complete requirements imposed by the Board before reissuance. Revocations can also last for one year but are sometimes indefinite. However, individuals can apply for reinstatement in most cases, but not before the first anniversary of the date on which the revocation was issued or became final.
Protect Your Texas Physical Therapist License
At the Lento Law Firm, we provide Texas PTs and PTAs with the strong legal support they need to continue rendering much-needed physical therapy services to the public. Some may hesitate to engage an attorney for fear of appearing overly confrontational to the Board, but our Professional License Defense Team has a deep understanding of the regulatory framework governing licensees.
Critically, licensees working in multiple states through reciprocity can be punished multiple times. Under Board rules, home states may take adverse action based on the investigative information of a remote state. Moreover, license discipline can further cascade by ruining the reputation built by years of competent physical therapy service.
Our team knows the priorities of ECPTOTE and the Board when addressing alleged violations, and we understand how to advocate effectively on your behalf, from the initial investigation to contested cases at the SOAH through appeals and judicial review. With the Lento Law Firm's help, Texas PTs and PTAs can respond to allegations, successfully address formal charges, and continue pursuing their careers. Call our Professional License Defense Team at 888-535-3686 today or fill out our confidential consultation form, and we will contact you.
