"What allows a professional guidelines panel to expel members that may bring up a controversial topic?"
I was a little shocked at the tone of the response by Chris Kent,DC (see "Simply not re-elected" in the August 13, 2001 "We Get Letters," or on line at www.chiroweb.com/archives/19/17/20.html). I was amazed to hear that when my usefulness was completed, I was dismissed before the guideline was published, or I suppose I should correctly state, "I was not re-elected." Can you imagine my shock when the CCP Guidelines were published and I was not recognized for my efforts?
On the re-election matter, I contacted two members of the CCP panel. I called Dr. Stephen Renner,DC, in Spokane, WA on August 27, and Dr. John Gerhardt,MD, in Portland, OR on August 29. I asked if they ever voted on my membership or dismissal from the CCP panel. They both clearly stated that they never voted on any membership continuation on the CCP panel. I further pressed the matter and asked them if they were every informed that a vote on the panel was scheduled; they both confirmed that they were never informed.
I flew down to Phoenix, Arizona on several occasions for the formation meetings at my own personal expense, just like everyone else. Packets and packets of scientific research material were forwarded to my office for review on inclusion for the CCP Guidelines. On many evenings and during many lunches, my partner was the research I had been assigned to review. In addition to research review, I contacted local chiropractic organizations in Washington state and presented information to chiropractors on the development of the CCP Guidelines. My area of expertise to the CCP was evidenced based practice. I had been using outcome assessments in my private practice for years and had lectured internationally on their effectiveness in determining that treatment was therapeutically necessary.
Dr. Kent may be sorry that I didn't get a 'Thank you' for my efforts, however his tone is not sincere. This situation was not handled professionally by any standard. Never being notified that a vote on my membership was scheduled, never notifying other members of the CCP panel of any membership vote, and then after being the only original member of the panel to be voted out on an unannounced vote. What allows a professional guidelines panel to expel members who may bring up a controversial topic?
I remember the last meeting I attended in Phoenix. I made a several comments on the wording and topics of the CCP Guidelines. I questioned the nonspecificity of the language, and stated that this type of language would not help the chiropractor in private practice to receive reimbursement from third-party carriers. I stated that the language needed to be specific concerning treatment being therapeutically necessary. This was also during the time that Don Harrison,DC, was questioning the credentials of Jay Holder,DC,MD. I asked about documentation concerning the credentialing of Dr. Holder, since if what Dr. Harrison said was true, it would diminish the efforts and effectiveness of the work of the CCP. After that meeting, I no longer received any notification of meetings and my phone calls were not returned from Dr. Rondberg's office.
During the discussion of the guidelines, it is true, as Dr. Kent stated, we never discussed a guideline for malpractice coverage. However, it doesn't take a rocket scientist to figure it out after the fact. Frequently, the Chiropractic Journal will feature articles that have basically the same tone: "CCP Guidelines defeat Mercy Guidelines in Malpractice Case" in bold type. Then there is the picture of the Rondberg family as the only chiropractic owned malpractice insurance carrier.
If I was to go to court in a malpractice case, I certainly would prefer the CCP Guidelines as the yardstick of measure, it gives a great amount of latitude in its interpretation of chiropractic practice. It is more of an ethical guideline. However, if I want to rebut an insurance carrier or an independent examiner, and get reimbursed for my services, I use the Mercy Guidelines every time with success. The Mercy Guidelines are designed to determine what is reasonable and effective care in a chiropractic practice. It is important that the chiropractic profession realize that these two guidelines have different target audiences. You cannot compare the two directly; each is more effective in its own arena. I would be happy if I never received another e-mail or read another newspaper headline that states; "CCP defeats Mercy." What's the point?
However, the actions of the officers of the CCP in this matter were not professional, and perhaps creates an ethical problem for the developers of the CCP.
Mark van Hemert,DC,DACS
Montesano, Washington
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