Recently, the Veterans Administration (VA) announced its appointments to the VA Advisory Committee, established by statute to implement chiropractic into the VA health care system. The 11-member committee includes five health care providers who aren't chiropractic doctors (including two medical doctors, a physical therapist, an osteopath, and a physician's assistant) and one provider who represents the National Association of Chiropractic Medicine (NACM), which has strong positions contrary to mainstream chiropractic. Five DCs were also appointed. On its face, the majority of the committee is made up of providers that, at a minimum, have little knowledge about chiropractic, and at worst, a possible anti-chiropractic bias or views that are contrary to the majority of the profession.
We are disappointed by the actions of the VA, but not completely surprised, given its history with this profession. The bureaucrats have for years attempted to stifle any chiropractic input into their health care system. It first became obvious in 1999 when the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) passed legislation requiring the department to establish a policy on the implementation of chiropractic care in the VA health system, with the specific requirement that it seek input from chiropractic organizations. With normal legislation of this kind, the implementing agency consults with the groups that were the sponsors of the bill. It certainly made sense this time that the ACA and ACC would be the organizations consulted, since we represented chiropractic education and the profession, and were the only groups that actively lobbied for the passage of the legislation.
However, as a sign of things to come, the VA decided instead to invite every chiropractic group in the profession, including the NACM, to participate in the development of the chiropractic policy. The VA had discovered the profession's Achilles' heel: Include "fringe" with mainstream chiropractic - and chaos will prevail. They were not disappointed, for when the group convened, the mainstream chiropractic groups fought with the fringes.
We went to Congress for support and forced the VA to convene another meeting. This time the VA decided to include not only the fringe, but also other health care groups, including the American Physical Therapy Association, the American Osteopathic Association and other physician groups. What did these groups have in common? They had previously testified in opposition to appropriate implementation of chiropractic into the VA. By this time, however, the World Chiropractic Alliance (WCA) and the International Chiropractors Association (ICA) joined with the ACA and ACC and boycotted the meeting.
Frustrated by the VA's attitude and with the encouragement of Congress, we introduced more comprehensive legislation. The VA thought it would be able to stop it, counting again on the profession going different directions in the legislation. It was mistaken. The ACA, ACC, ICA and WCA made an agreement to work together, pushing for a comprehensive package. Included was the commitment to support for appointment the same doctors who served on the DOD Oversight Committee, plus Dr. Carl Cleveland III.
So what happened with this commitment?
Once President Bush signed the legislation, the agreement was broken by the ICA and the WCA. It is our understanding that they didn't even support the appointment of Dr. Cleveland, whose presence on this committee should have satisfied all the factions in the profession. How much of this disunity encouraged the VA to appoint a committee, which appears to have a majority bias against chiropractic, is difficult to document.
Obviously, it would never acknowledge a problem. But I believe, given its previous action, the VA saw this sign of disunity as an opportunity to reverse what the Congress and the president had done.
My experience with the federal government, including working two years at the Department of Health and Human Services (specifically on secretarial and presidential appointments to advisory committees), taught me that well-entrenched bureaucrats will always find a way to slow down or derail the implementation of legislation, particularly if they detect disunity within the special interest groups that pushed for the proposal. They had found our Achilles' heel and felt they could get away with it.
It is too bad that our proposal to appoint the same DoD members to the VA committee wasn't included in the legislation signed by the president. If it had been, we wouldn't be as concerned about the appointments that were just announced.
Making the VA committee identical to the DoD committee made a lot of sense from a practical standpoint. It meant we would have a group of doctors who understood how the medical bureaucracy worked.
This action by the ICA and the WCA has left a bad taste in our mouths regarding future cooperation and coalition building with them. In particular, it is impossible to work with the current leadership of the ICA, which has shown its inability to follow through on its commitment. Perhaps with what is occurring on the educational level, changes will be made in the political organizations.
We don't oppose the idea of coalitions, but coalitions must be based on mutual respect and trust.
This profession has survived in the past, in spite of its numerous splits. And we will go back to Congress and show it once again that the VA cannot be trusted to do the right thing.
But what is troublesome is my strong opinion that none of this had to happen. The VA has decided to make pawns of our fringe groups, and the unfortunate result may be a delay in implementing the chiropractic provision in the VA system. Had the ICA and WCA just kept their written commitments, this would not have happened!
Garrett Cuneo HCD(hc),FICC(hc), Executive Vice President, American Chiropractic Association Arlington, Virginia
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