In response to the recent article by Darcy McKinstry, executive director for the Colorado Chiropractic Association ("Bid For Prescription Rights Killed in Colorado Legislature," DC, 4/7/97), there are, as in most cases, two sides to every story. House Bill 1017 was sponsored by the Colorado Chiropractic Society (CCS). The CCS was established in 1994 to promulgate and advance the science and art of chiropractic, improve the quality of chiropractic patient care, and improve the chiropractors' access to patients, most notably in the fields of lifestyle, preventive and alternative medicine.
The board of the CCS is made up of five past presidents of the Colorado Chiropractic Assoc. These doctors have observed the dramatic changes in chiropractic practice over the last four decades. Their desire is to support chiropractors with tools to have active successful practices.
House Bill 1017, "Chiropractic Limited Prescriptive Authority," was drafted to enhance the scope of the chiropractors' ability to effectively treat neuromuscular conditions, and to empower the chiropractor to use effective alternative nutritional therapies in the treatment of chronic diseases. This would require that chiropractors have prescriptive authority, including nutritional therapies and certain legend drugs.
Testifying in favor of chiropractic prescriptive authority on January 27, 1997 in Denver, Colorado were Lester Lamm, DC, postgraduate director from Western States Chiropractic College; David Ornes, RPh, postgraduate director from the University of Colorado Health Science Center School of Pharmacy; Paul Neal, DO, private osteopathic practitioner; Larry Morries, DC, DACAN, chiropractic researcher and board member of the Colorado Chiropractic Society;and Reiner Kremer, DC, from the board of the Colorado Chiropractic Society.
Qualifications for prescriptive authority included 6,000 hours of postlicensure clinical practice, including at least 50 hours of rounds in a prescriptive family practice, and a competency-based clinical examination. Didactic training includes 120 contact hours of pharmacokinetics, pharmacology, pharmacodynamics and pharmacotherapy, and the injectable administration of nutritional therapies. The program was modeled after the curriculum that is obtained by doctors of medicine at the University of Colorado Health Science Center School of Medicine (UCHSC) to obtain an MD degree. At UCHSC, 126 total contact hours of pharmacology is the entire medical student curriculum. The chiropractic pharmacology training was broad-based and comprehensive, focusing on key areas of pharmacology, including drug interactions specific to the chiropractic and alternative medicine practice. The program was taught at the University of Colorado Health Science Center School of Pharmacy and Western States Chiropractic College. Both postgraduate program directors felt that this curriculum was more than adequate for the increased scope of practice that chiropractors were pursuing.
Limited prescriptive authority was born in early 1994 after a statewide survey of all 1,014 practicing Colorado chiropractors revealed the majority of responding chiropractors desired practice expansion. The survey asked a very simple question: "Do you support the expansion of practice to include limited prescriptive authority, neuromuscular medications and nutritional therapies?" Of the 653 respondents, 59% were in favor; 34% were against, and 6% were undecided. Survey results were authenticated by a certified public accountant. The survey results demonstrated that the prevailing view of the Colorado Chiropractic Association (executive director, et al.) was not representing the concerns and needs of practicing field doctors who clearly indicated their support of optional limited prescriptive authority (LPR) for those who are qualified and have the appropriate training. Support for LPR was strong and diverse, including members of the Colorado State Board of Chiropractic Examiners, and thousands of patients.
Testifying in opposition to House Bill 1017 were the Colorado Chiropractic Association, the Colorado Medical Society and the Colorado Society of Osteopathic Medicine. No "violent" testimony took place as reported in Ms. McKinstry's article. That article epitomizes how far philosphy-based chiropractors will go to sell out their science-based brothers. It was a case of medical doctors not wanting their turf to be eroded by chiropractors; of philosophy-based chiropractors testifying against chiropractors who are patient-care oriented, whose desire is to give their patients all the conservative options possible for the treatment and recovery of their subluxations and chronic diseases.
The Colorado ACA delegate who testified against HB 1017 did not have the permission, as he alleged, then misstating the policy and positions of the ICA, the Congress of Chiropractic State Associations, and the Association of Chiropractic Colleges. Each organization was asked if he had obtained permission, and each responded that he did not.
Unfortunately, as in most political ventures, opponents use misrepresentation and innuendos to distort and misrepresent facts. Fact: The largest Colorado managed care organization with significant chiropractic participation stated in writing that they were supportive of chiropractors obtaining limited prescriptive authority. Limited prescriptive authority also is supportive of chiropractors being primary care providers.
The goal of House Bill 1017 was for chiropractors to broaden their scope of practice by obtaining limited prescriptive authority appropriate to the skills and training of the chiropractor.
House Bill 1017 has received support from doctors and state organizations in Alaska, Arizona, Florida, Idaho, Kansas, Missouri, Nebraska, New Jersey, New York, North Dakota, Oklahoma, Oregon, and Washington. The common theme is that chiropractic as a profession needs to move forward into the 21 century.
A Colorado LPR Task Force has been formed. The issue of prescriptive authority requires additional and ongoing discussion. The LPR issue centers on individual rights and the freedom of choice of both the doctor and the patient. Is it in the best interest of the chiropractic patient to limit the scope of chiropractic practice? Does a trained chiropractor have the right to practice what he has learned? Let's never forget our chiropractic roots and our mentors: mine was Dr. Joseph Janse.
We should never forget lessons learned from history, for they will help us formulate the vision for the future. The vertebral subluxation complex is the foundation, but not the ceiling of chiropractic health care. Chiropractic should have the maturity that is broad enough to encompass a wide variety of thinking, philosophy, practice styles, and treatment options.
News flash from the April 1997 Rocky Mountain Health Care Observer:
"Alternative Medicine" Bill Expected to Pass
Advocates for integrating allopathic and alternative health care are celebrating an important political victory that most never expected them to win. House Bill 1183's passage directs the Colorado Board of Medical Examiners not to discipline a physician solely on the grounds that he or she uses alternative methods as part of a sound allopathic practice. Under current law any time a physician performs or prescribes a therapy that is not within traditionally accepted standards of care, such as acupuncture or herbal medicines, he or she is technically in violation of the law and exposed to the possibility of discipline by the Board of Medical Examiners."
Philosophy-based chiropractors did not support medical doctors in their quest for alternative medicine to be clarified. Philosophy-based chiropractors did not support chiropractic LPR. What do philosophy-based chiropractors envision chiropractic should be as we approach the 21st century?
Reiner G. Kremer, DC,
Vice President, Colorado Chiropractic Society
Editor, Colorado Chiropractic Journal
E-mail: rgk7601@aol.com or cchiros@aol.com
Website: www.chiropractors.org
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