Report from Ms. Darcy McKinstry, executive director, Colorado Chiropractic Association
A measure to add limited prescription rights to the scope of chiropractic practice died a quick death following its first hearing in the Colorado legislature. Committee members killed the bill on a 5-6 vote following testimony by several medical organizations, the Colorado Chiropractic Association, Western States Chiropractic College, and two chiropractors who had been instrumental in drafting the legislation.
The issue of limited prescription rights surfaced in Colorado in 1993 when the association leadership at the time put the issue to a vote of the membership. CCA members voted 2-1 to "maintain the existing scope of practice," which did not include prescription rights of any kind. A survey of both members and nonmembers conducted earlier that year bore out the 2-1 ratio of support for the "no drugs" stance of the association.
In 1995, the same small group of chiropractors again asked the membership to reverse their previous stance. On a vote of 98-2, the members elected not to hear the issue again. The two DCs who voted "yes" subsequently dropped their membership in the CCA and, together with four of the CCA's past-presidents, went on to form a splinter organization whose main purpose was to integrate limited prescription rights into the practice of chiropractic in Colorado.
Following a 36-hour continuing education course on prescription NSAIDs, anti-inflammatories, pain-killers and muscle relaxants, which was co-sponsored by Western States College of Chiropractic (WSCC), the legislation was introduced.
The measure would have allowed chiropractors to obtain limited prescriptive authority after being in practice for at least five years on a full-time basis, and attaining the 36 hours of specialized training. As the bill was written, prescriptive authority would have included "legend drugs" (non-narcotic) and injectable nutrients.
Proponents of the bill argued that prescription rights are absolutely necessary to maintain chiropractic's position in the changing health care delivery system, however the issue was presented to the legislature strictly as a cost savings and patient convenience measure.
The Colorado Medical Society, the Colorado Society of Osteopathic Medicine, and at least two other medical specialty societies violently opposed the bill, citing concerns for patient safety because of lack of clinical training in drug interactions and potential drug reactions. The Colorado Chiropractic Association also provided testimony in opposition to the bill, based on the published policies of the ACA, ICA, Congress of Chiropractic State Associations, and the Association of Chiropractic Colleges, all of which have explicitly stated that chiropractic is a drugless profession.
Dr. Lester Lamb of WSCC testified for the bill's proponents, reading a letter from WSCC President Dr. William Dallas. "This letter is to affirm our support of the pending legislation concerning the drafting of authority to doctors of chiropractic in your state to prescribe certain pharmaceutical agents in the conduct of their practices." According to the letter, "There is a serious deficit in statutory authority regarding the use of pharmaceuticals in treatment protocols used by most chiropractic physicians. ...The need to refer to other physicians for prescribing imposes an unnecessary burden on the patient, the financial system and the treating chiropractic physician."
When asked, "Are you aware that not all chiropractors are endorsing the idea of limited prescription rights and can you address that?" Dr. Lamb responded, somewhat tongue-in-cheek, "Well, you have certainly asked a very important question that I know deserves an answer, and if you have another hundred years...."
Dr. Ken Spresser, board member of the Colorado Chiropractic Association and Colorado ACA delegate, presented the written position and policy statements of all of the major national chiropractic organizations. "Chiropractic has been a drug free profession since its inception 102 years ago, and we'd like to keep it that way," he emphasized. He underscored the comparative inadequacy of the bill's proposed educational requirements for prescription certification.
In arriving at its decision to actively oppose the expansion of Colorado's practice act, the CCA contacted the network development specialists of four leading managed care companies, including Blue Cross and Blue Shield of Colorado and Kaiser Permanente. They were asked to respond to two questions:
1) "If chiropractors had prescription rights, how would it affect chiropractic inclusion in your network?"
Replies to the first question ranged from a benign, "It wouldn't make any difference if DCs had prescription rights; that's not why they are in our network," to a more ominous, "You had better consider that decision very carefully. We already have providers who can write prescriptions. The reason we have chiropractors is because of the unique service they provide."
2) "If individual chiropractors had prescription rights, would it increase or decrease their desirability as a provider in your network?"
Without exception, the answer to the second question was it would decrease their desirability. Again, the reason cited was that DCs are included in managed care networks because of the unique service they provide.
Darcy McKinstry
Executive Director
Colorado Chiropractic Assoc.
