As we celebrate our 25th anniversary as the definitive news and information source for the chiropractic profession, we look back at the important events as reported in DC since 1983, while also looking forward to the future. Throughout 2008, we will feature a review of the top headlines in chiropractic for a given year, along with an article on the future of chiropractic authored by an influential member of the profession.
April 1985: Chiropractors Win Landmark Pact in Illinois
Illinois chiropractors say that they have achieved a "historic breakthrough" in an out-of-court agreement that could lead nationally to their long-sought equality with medical doctors. The agreement, which declares that there shall be no professional barrier between medical doctors and chiropractors, was reached between the Illinois State Medical Society and five chiropractors.
In their 90-year history, chiropractors have not achieved the popular status of doctors or many of their privileges, such as hospital rights. The "Chicago Five" chiropractors sued the society and several other medical organizations in 1976, charging violation of antitrust laws. The Illinois society is the first major medical group to come to terms with chiropractors, said attorney George McAndrews, who represented the chiropractors. The suit still is pending against seven national health organizations, including the American Medical Association, McAndrews said. The AMA said Tuesday that the agreement had no bearing on its status in the case.
According to the settlement, filed Monday in federal court, the state medical society agreed that "there are and should be no ethical ... impediments to full professional association and cooperation between doctors of chiropractic and medical physicians."
The agreement is a "historic breakthrough," said Lawrence Levin, chairman of the board of Illinois Chiropractic Society, which was not involved in the suit. "This is the first time any medical organization in this country has come out with a policy dropping its objection" to professional associations between medical doctors and chiropractors, he said. Levin also said most Illinois hospitals have not allowed chiropractors to admit patients in hospitals or become staff members, and that he hopes the agreement will set a national trend with other medical societies.
However, Dr. Robert Hamilton, president of the state medical society, said the agreement isn't as significant as it once might have been because in recent years there has been growing cooperation between physicians and chiropractors. He said his organization - the only non-national group involved in the litigation - withdrew from the suit for financial reasons.
The suit charged that the AMA and 10 other medical organizations conspired to isolate and eliminate chiropractic practice in the country. It also alleged that those organizations barred their members from referring patients to chiropractors, consulting with them or having professional relationships, McAndrews said.
The agreement allows doctors and chiropractors to engage in patient referrals, group practices and consultations, McAndrews said. The medical society also will pay the plaintiff $35,000 as part of the agreement, he added.
June 1985: Newly Elected ICA Officers Announced at ICA Convention in Kansas City
Editor's note: At the Convention of the International Chiropractic Association (ICA), held this year in Kansas City, May 17-19, the election of three new ICA officers was announced. Michael D. Pedigo, DC, of San Leandro, California was elected president of the ICA; Virgil Strang, DC, of Davenport, Iowa, was chosen as vice president; and Frank Bemis, DC, of Alton, Illinois, was elected central regional director.
The following is a list of thoughts in the recent ICA election and goals for the future of the chiropractic profession as submitted to Dynamic Chiropractic by Dr. Michael Pedigo, president of the ICA. The staff of the Motion Palpation Institute and Dynamic Chiropractic wishes to extend our heartiest congratulations to Drs. Pedigo, Strang and Bemis on their recent election, and would like to offer our support in their future ICA endeavors.
I would like to begin by saying that Drs. Strang, Bemis and I are extremely pleased with the outcome of the recent election. It is the first time in the history of the ICA that the membership-at-large has elected a president through the mail ballot. The interest in this campaign was extremely high. About 70% of the ICA membership voted in this election, and our margin of victory was more than 2 to 1. While we are excited about our margin of victory, we do not feel our victory was a rejection to our opponents, but rather a mandate from the membership showing support for the programs and platform that we ran our campaign on.
The chiropractic profession is an exciting profession to be a member of at this time in history. So many things are taking place in the health care system in this country today. In fact the entire health care system in undergoing explosive and unparalleled changes. There are many factors causing this change; anti-trust lawsuits, competition, malpractice claims, the high cost of health care, government deficits, medicare, PPOs, HMOs, and hospital shake-up.
The fact is that the chiropractic profession is sitting on the threshold of becoming a part of the mainstream of health care in the American Society. As that happens, the public that we serve will be better served because of the improved health care they will receive at the hands of qualified, competent doctors of chiropractic.
Our #1 priority for the remainder of this decade must be to position our profession as a strong and viable health care provider in the marketplace. There are so many worthwhile projects and activities that our profession can and should be involved in, but due to a lack of funds and resources, we must set our priorities to accomplish the most important of these tasks.
In my opinion, it is time that as a profession we concentrate our efforts and goals on those areas where there is no conflict in the profession as much as possible, and that we put on hold those areas where there is disagreement within the profession. We have more pressing matters facing us than the continual inter-professional bickering and fighting that plagued our profession almost since its very beginning. We need to put these areas aside until our profession is firmly entrenched in the public's mind as the expert in conservative spinal health care matters. If we do not concentrate our energies in this positive avenue, there is a strong possibility that the medical profession will be able to steal our profession from right under our noses. Whether we like it or not, we are a new era of health care.
Today, at an ever-increasing rate, MDs, PTs and osteopaths are all competing for a share of the marketing of those patients who need spinal adjusting and manipulation health care services. We are entering into an era of inter- and intra-professional competition never before seen in the health care market, and those who will survive will be those the public perceives best-qualified to help them with their health care problems, and for the least dollars. Patients are concerned with three things: Can you help me? How much will it cost? How long will it take?
Perceive is a very important word. The public has long perceived the medical profession as the authority in health matters. We must change the public's perception of our profession. The number-one problem facing our profession today is "image." The only reason every chiropractor's office in this country is not busting at the seams with patients requesting to see the doctor of chiropractic is because of a negative image they have regarding our profession - an image that has been built and fostered and carefully cultivated by the AMA in an attempt to distort, and in fact eliminate, the chiropractic profession. As the image of our profession improves, all the other problems in our profession will become much easier to deal with.
Therefore, it is my opinion that there are three areas our profession must direct its attention and priorities towards:
We must have a nationwide, massive public relations program to improve the image of our profession in the minds of the public.
We must have a research program to validate the value and benefits of our services.
We must maintain our profession as a separate and distinct health care profession that is willing and capable of inter-professional cooperation to the benefit of the patients who we serve.
The real question is not do we need a public relations program or do we need research programs, but how do we go about accomplishing these needed programs? The bottom line, as so frequently is the case, is the almighty dollar. To develop this type of public relations program that we need to change the image of our profession, and as rapidly as we need to change that image, will cost a great deal of money. The ICA does not have that kind of money, nor does the ACA, and in fact, neither do the ICA and ACA combined. However, the chiropractic profession does. And since the profession will be the direct beneficiary, by way if increased patient load, from a positive public relations program, let's go directly to the profession and support such a campaign.
To make such a program work it must have credibility. Under ideal circumstances, such a program would have the endorsement of the national and state chiropractic associations and the chiropractic colleges. One of the first actions that I, as president of the ICA, will initiate will be to call a meeting of the heads of all these various organizations so that we may sit down, discuss and hopefully come up with a workable plan to raise the necessary funds for such a public relations program. My concept in calling such a meeting is not to have an ICA-sponsored program, but to have a chiropractic-sponsored program that has the united support of the profession.
One viable way I see of raising a significant amount of money would be to go to the profession with a program that has the endorsement of the previously mentioned associations and ask colleges, and as an example, ask members of the profession to contribute $100 a month for a year to start with. If we could find 10,000 chiropractors who would be willing to contribute $100 a month, that would equal $1 million a month or $12 million a year. While that kind of a budget is not on the scope of a public relations budget the AMA, General Motors or a lot of your major corporations have, it's certainly a much larger amount than the chiropractic profession is presently putting into a public relations program.
In my opinion, we not only need to do research, but research also needs to be channeled and directed in two specific areas. First of all we need to have research that demonstrates the neurological connection between the vertebral subluxation complex. Our profession is founded and based on the tenet that there is a neurological involvement in the subluxation complex. As our profession grows in acceptance, increased responsibility is placed upon the doctor of chiropractic to be able to back up the substantiate claims and implications relative to the services and benefits we provide. The second area of research that is of vital importance is that we have research that continues to keep the technical applications of our science and art.
Many things can be done to raise funds for research. But to start the ball rolling, I think we need to take a lesson from the medical profession and go directly to the public and ask them to help support our research efforts, go to the government and obtain grants, and also go to the private sector, foundations, etc., in pursuit of grant money from large foundations and corporations. As an example of going to the public, why not put a donation can in every chiropractor's office to involve our patients in contributing for special research? This would have a tendency to do two things: First, it would inform our patients that we are involved in and interested in research (that's public relations); and second, it would provide funds for research. How much it would provide, we don't know; it's never been tried. Then we need to sit down and brainstorm all the various avenues that we can for raising funds for research efforts in a productive manner.
These are just some of the important areas in which I feel a pressing need for the profession to devote its attention to. I realize that these programs are ambitious, and know that there are those who can give a dozen reasons why they won't work, but I believe that they can work and that we must do them, I believe we must look together for solutions rather than reasons why it can't work. I look forward to the ICA becoming known as the "Solution Association" and I look forward to working together with the entire profession in areas of common goals. I would ask that those who support the ideas and concepts that I have support by joining the ICA and helping us bring about these goals and objectives.
Michael D. Pedigo, DC San Leandro, California President, ICA
July 1985: Chiropractic Mourns the Loss of Dr. Ernest G. Napolitano
Dr. Ernest G. Napolitano, president of the New York Chiropractic College in Old Brookville, New York, passed away suddenly on Sunday, June 2, 1985. An internationally recognized educator, author, and lecturer, Dr. Napolitano was acknowledged as a pioneer in his beloved profession of chiropractic. He had served as president of NYCC for over 25 years, in addition to holding numerous positions with international, national and state chiropractic associations, professional societies and academies, as well as many civic organizations.
Dr. Napolitano received his doctorate from Palmer College of Chiropractic in Davenport, Iowa. He served with distinction in the United States Army and was awarded the Purple Heart and Bronze Star. Following his discharge from the service, he resumed his practice of chiropractic in New York City, which he continued until early 1985. He presented over 300 seminars and lectures before professional and civic groups, and authored numerous articles and papers. A member of the United Nations Association of the U.S., he also served on the Speakers Research Committee on the U.N. and on the Communications Coordination Committee for that organization.
Dr. Napolitano served as chairman of the advisory board, Columbia Association of Nassau County, Civil Service Employees, Inc., 1967-72; president of the Chiropractic Press Guild, 1969-74; and president, Council on Chiropractic Education, 1982-84. His honors included 13 honorary degrees, 11 fellowships in learned societies, and more than 50 educational, professional, military, religious and civic awards, including Purple Heart, Knight of Malta, Pontifical Lateran Cross, Distinguished Service Cross (awarded by Gov. Rockefeller of New York State), and Distinguished Service Awards from the International Chiropractic Association, the American Chiropractic Association, the Council on Chiropractic Education, the New York State Chiropractic Association, the New Jersey Chiropractic Society, and various chiropractic institutions. He was honored as Man of the Year in 1982 by the Nassau Civic Club.
He is survived by his sister, Josephine Bruno, his daughter, Catherine Burton, and three grandchildren. In honor and in memory, of Dr. Ernest G. Napolitano, his sister Josephine has established a memorial scholarship fund, which will be perpetual. Donations to the fund may be sent to the Dr. Ernest G. Napolitano Memorial Scholarship Fund, c/o New York Chiropractic College.
August 1985: Activator Methods Approved for Federal Research Grant
Dr. Arlan W. Fuhr, president and co-founder, announced that Activator Methods, Inc., has been awarded a federal research grant from the United States Department of Health & Human Services National Institutes of Health (NIH). Activator Methods is likely the first chiropractic technique to receive a research grant from the NIH. The research project is designated to measure forces applied to the spine and the acceleration response of the spine during manipulation.
The NIH recommended that the research project, titled "Safety & Efficacy Instrument for Spinal Manipulation," be approved for funding. The National Neurological and Communicative Disorders and Stroke Council made the final determination of the grant application and will administer the funding as it is allocated.
The study is intended to characterize typical forces and displacements during manipulation to establish safe limits, particularly in the patient over age 65, who may be susceptible to stroke. From the data, it will be possible to determine the most effective physical manipulative procedures in the treatment and research of spinal musculoskeletal problems.
Dennis Smith, PhD, the research director for Activator Methods Laboratory, is the principal investigator. Lawrence Carlson, DEng., associate professor of Mechanical Engineering at the University of Colorado and Barry Davis, PhD., former professor and research director at Logan College, will serve as consultants to the project.
October 1985: Michigan Federal Court Trial could Trigger Chiropractic "Dark Ages"
Article written by Dr. Arlene Karian
While celebrating the bold victory of our anti-trust suit against the medical profession's monopolistic practices, the chiropractic profession could lose far more than it has gained in a new, more serious legal suit. We are now engaged in a dangerous new legal war that is a product of an internal battle from within against ourselves. This new war is being conducted right now in a Michigan federal court trial.
In 1978, the Michigan legislature became the frustrated victims of chiropractic's eternal "straight" versus "mixer" controversy. Since an ultra "straight" chiropractic law would also be supported by the medical profession, such as a law was drawn and enacted. Now, in 1985, the ultra "straight" chiropractic law is not only ready to "backfire" against both the "straight" and the "mixers" of Michigan, but also is ready to disastrously threaten the status of the entire chiropractic profession.
"How could a Michigan law effect an entire profession?" you might ask. It is simple: The Michigan ultra "straight" chiropractic law licenses chiropractors to practice while, at the same time, legally destroying their rights and privileges to conduct their practices. Unknowingly, this law even eliminates the doctors' rights to practice "straight" chiropractic. The law (paraphrased) merely states that the practice of chiropractic involves the analysis and adjustment of vertebral subluxations for the removal of nerve interference. In addition, it states that the doctor of chiropractic cannot perform "differential diagnosis."
To the "straight" chiropractic movement, I am sure this law is claimed as a major victory. I am also sure the medical profession would be most eager to support such a limiting law in the wake of their anti-trust suit losses. The chiropractic "victors" were short sighted, however, and did not consider the long-range implications, nor the potentially "lethal effect" of this Michigan law.
Soon after passage of the Michigan law, Blue Cross and Blue Shield decided that they did not like their own new law which forced them into paying chiropractic claims. They immediately recognized that the newly enacted ultra "straight" chiropractic law gave them everything they needed to do battle, once again denying the payment of chiropractic claims. In Michigan, this means 70 percent of the insured persons.
The key aspect of the law which they were able to take advantage of was the part that made differential diagnosis an illegal practice. "Whoopee," you might say, "Blue Cross and Blue Shield agree with us that chiropractors can't differentially diagnose; now we can practice "straight" chiropractic!" Sorry, it did not work that way, it boomeranged! All the "Blues" had to do was find the most successful doctor who was doing some of the best and most complete work: this doctor was also getting the most claims money paid. Then they used the fact that this chiropractor had hired both medical and osteopathic doctors in his clinic who confirmed not only the need for chiropractic care but made their own "differential diagnoses". Regardless of the use of MDs and DOs, Dr. Demido's approach was still considered to be illegal as far as the "Blues" were concerned. So, they turned the problem over to the U.S. Mail Service and complained of mail fraud. Thereby, the "Blues" allowed the federal government to conduct the investigation, bear the costs and try the case.
Isn't it ironic that chiropractors who now pay their federal taxes are supporting this case against themselves? Now, the Federal Bureau of Investigation (FBI) and the U.S. Department of Justice became involved. They are obligated to investigate anyone who reportedly and/or apparently is using the mail for illegal purposes. Again, the feds must interpret state law literally. Therefore, any appearance of a DC attempting to "tell one condition from another" is a "differential diagnosis," which is illegal in Michigan.
After some 10 months of the FBI investigating Dr. Demido's chiropractic clinic, a lying FBI "plant" was instrumental bringing a suit to be filed in federal court: United States Justice Department v James A Demido, J.D., D.C., et al. Of course, we all must say at this point, "Now, how can the FBI and U.S. Justice Department do this to chiropractors? We are not medical doctors. We don't have to diagnose. We are chiropractors." In chiropractic, we often live in our own private little world and operate under our own peculiar "philosophy" or belief system of the chiropractic college in which we were trained. We frequently also mistakenly believe the world sees everything like we see it and that they will conform to our ways if we "educate" them to our philosophies. Sorry, it didn't happen that way.
Federal court operates quite differently than boards and civil or state courts. Federal investigators, prosecutors and judges interpret the state laws in a literal way without license or privilege. What the law actually says is what it means. They do not have the right to interpret or expand state law. Naturally, when it comes to defining "differential diagnosis," the federal court is taking the lay interpretation for the "sake of the jury." In lay terms, "differential diagnosis" simply means "being able to tell one condition from another."
The Michigan Chiropractic Law, according to the way it is being tried in federal court, would make it illegal for a chiropractor to distinguish a pimple from a broken arm, a lordosis from a kyphosis or (now get this one) a "subluxation" from a normal vertebra. Because of my background in courtroom testimony and in stressology research, I was asked to be an expert witness in this case. I could confirm the American Chiropractic Association's recommended procedures, defending six cervical X-rays, two thoracic and four lumbosacral views by way of the singular unit integral systems approach. I am the only (non-involved) chiropractor testifying in this case. Little did I know what I was getting into at the same time.
The prosecutor at first seemed quite naïve in his questions, perhaps even a little dumb. "Now, doctor, why would you as a chiropractor have to take a case history? Why would you have to do an examination? Would take some spine X-rays? Why would you palpate the spine? Would you have to tell the difference between a subluxation and a normal vertebra before you adjusted the subluxation?" Dumb questions? No. Naïve? No. Brilliant? Definitely. Anyone who has had any extensive court room experience very easily recognizes the direction that the questions are leading them into and the traps that are being set up. These traps, because of Michigan's law banning chiropractors from using "differential diagnosis," were unavailable. The only way I could have done better was to answer most every question with the word "subluxation". But, I would have come across rather incompetent, wouldn't I?
Doctor, in layman's terms, what is a differential diagnosis? If you had a patient report of a headache, would you look for a subluxation? What's the difference between a headache and a subluxation? Is a headache a subluxation? Is a headache or a back pain different than a subluxation? As a chiropractor, would you have to know the difference between a headache and a subluxation to treat or adjust the patient?"
"Doctor, are you aware of the fact that in Michigan, it is against the law for a chiropractor to diagnose or tell one condition from another? Tell me, doctor, how many patients have come into your office and reported to you that they had only a "subluxation"? Do most chiropractic patients report a 'subluxation' on their case history? What percentage of your patients coming into your office complain of a subluxation? Do most of them report things other than a 'subluxation'? Would you treat or adjust anyone who did not report having a subluxation? Would you be likely to do any tests or examinations other than analyzing the spine for subluxations? Why would you do those tests - to tell if there was some other condition involved?"
"Tell me, doctor, would you accept a patient from a medical doctor who had diagnosed back pain? Would you refer a patient to a medical doctor who had a ruptured disc? Would you have to tell the difference in these conditions, one from another, to do your work?"
In testifying in hundreds of cases such as civil, malpractice, personal injury, workers' compensation, medical and chiropractic boards, depositions, arbitrations, etc., I have never felt so inadequate and helpless! Most every question I was asked pounded another coffin nail into the case. Being able to "tell one condition from another" or to "differentially diagnose" is the very essence of being a doctor of chiropractic, whether "straight" or "mixer." Without this privilege, we cannot exist as health professionals. The chiropractic argument against differential diagnosis is being destroyed in this case.
The prosecutor in this case is fortifying the position that taking a case history, doing an examination, taking X-rays, doing laboratory work, accepting a patient, referring a patient or even adjusting a "subluxation" establishes the fact that WE ARE ATTEMPTING TO TELL ONE CONDITION FROM ANOTHER AND THEREBY WE ARE CONDUCTING AN ILLEGAL PRACTICE BY "DIFFERENTIALLY DIAGNOSING." Therefore, if Michigan doctors do any of these things and send a bill through the mail, they are probably guilty of committing mail fraud, which is a felony punishable for up to 20 years in prison.
Dr. Demido's clinic records (the clinic includes three other DCs) were thorough, complete and impeccable. His procedures reflected the state of the art in American Chiropractic Association procedural standards compliance. Few chiropractors whose records I've seen could even compare. Before this indictment, Dr. Demido challenged the narrow Michigan law and had gotten an attorney general's opinion confirming the fact that he could not legally "differentially diagnose" and that he was obligated to send patients with any even-suspected condition other than a "subluxation" to a medical doctor or osteopath for differential diagnosis. Dr. Demido hired two MDs and one DO who also saw his patients. This still did not save him from the federal indictment.
"Doctor, would you say it was important to recognize a reverse cervical curve or a spondylolisthesis? Would that make a difference in whether you would adjust a subluxation? What is a subluxation?" At this point, I defined a subluxation as a generalized philosophical term which was associated with any mechanical biomechanical disorder, dysfunction or distortion of the spinal column - pelvic-meningeal unit, which is also measurable, documentable or otherwise known by another specific medical term such as a reversed curve, excessive lordosis, kyphosis, spondylolithesis, scoliosis, broken George's line or pelvic drop. It is my opinion that all chiropractic "subluxations" should be accompanied by their specific medical name and/or comparative normal, abnormal biomechanical measurements.
"Well, doctor, do you use the term subluxation because you cannot legally tell one real condition from another? Do you write down any other word or words to describe the patient's complaints on an insurance form? Under examination findings, do you report any other than a subluxation? How about for the diagnosis?" Isn't it strange after years of warning chiropractors against relying upon one philosophical word, I now found myself trying to rescue Dr. Demido and chiropractic by developing a defense for "subluxation" rather than having doctors of chiropractic appear that they are professionally incompetent in their ability to distinguish or tell one condition from another. And they are illegal if they do so.
It hurts to the bottom of your heart, after spending six years in chiropractic college and years in practice, when a prosecutor turn to the jury and screams, "WHO IN THEIR RIGHT MIND WOULD EVER GO SEE A CHIROPRACTOR WHO IS FORBIDDEN BY LAW TO TELL ONE CONDITION FROM ANOTHER? WHO WOULD DARE TRUST THEIR HEALTH OR LIVE TO SUCH INCOMPETENCY?"
This case has gone on for over three months. It will continue through November. The defendants are broke. They need your immediate financial support. They need to bring in various expert witnesses and support to their defense. On top of it all, the Michigan Supreme Court has just decided on the Beno case appeal, stating that supplements may be used only if they can be proven to effect the removal of subluxations. I now fear what will happen when this Michigan case gets into the "removal nerve interference" issue. That, again, will add to the differential diagnosis issue, which will contribute to this "so called" mail fraud case.
How does all of this affect you if you practice in another state? If this case goes down in federal court, the first cross-examination question all over the country could be, "Doctor, isn't it a fact that a federal court recently found that chiropractors who differentially diagnosed or distinguished one condition from another were guilty for fraud? Answer yes or no. Doctor - no further questions." This case also could be a springboard to set a precedent in denying the payment of insurance claims nationwide. The decision in this case could also affect every state that does not specifically provide for differential diagnosis in their law with the mere stroke of a bureaucratic pen. We could lose medicare and Medicaid and all federal insurance programs. The effect of this case may literally take years to overcome. We've worked too hard for that.
In Michigan, should the case go down, the insurance industry may have an immediate right to not only deny all chiropractic claims but also to demand repayment of all monies paid during the existence of this law. It is my understanding that Michigan DCs already have a new law in committee. This is not enough. The old law must be repealed, challenged retroactively to its inception or even declared unconstitutional. An immediate injunction should be ordered preventing any and all prosecution relative to that law.
The Demido case must not go down, regardless of costs involved, because of the disastrous effects and even short-lived precedent it may set nationwide. If Demido, et al., are to be tried, they must be tried on the merits of any wrongdoing - not because of a opportunistic law which is hazardous to all chiropractors.
To all chiropractors, may I suggest you rethink your process and merely begin taking responsibility for your professional opinions, including differential diagnosis, commensurate with the many years of education you have had. I am sure you were not aware of the long-range problems such a law could present for us. Let's not blame anyone. Instead, let's learn a valuable lesson in the need for mutual recognition and understanding among chiropractors. Let's unite on the science of the spine and get together enacting laws that are broad enough to provide freedom of choice in chiropractic practices which involve differential diagnosis specific to the area of chiropractic practice each doctor chooses.
Some of our legal concepts prevent us from helping ourselves and advancing our science. Too many legal limitations are destined to stifle our growth and prevent our scientific progress. Objective evidence and scientific progress demand a broader-scope base. If our laws are too straight, they will prevent us from doing what we must do to survive. Even disallowing anything that is not taught in CCE-approved chiropractic colleges is far too narrow and approaches belief control (cultism) policies. Traditionally colleges and universities are often 15-20 years behind the practicing professionals. This too can limit scientific development. Then before too long, between the "straights," the "mixers" and the CCE policies, we can destroy every tool we need to prove chiropractic scientifically and broaden our scientific scope of practice.
To all of our great doctors of chiropractic, it is time for us to release the tenants of our belief systems and turn our sights toward supporting our chiropractic scientists to establish normals, utilize documentable measuring systems, quantified biomechanical stress analysis, understanding process and growing into an era of chiropractic technology. By this means, chiropractic will have an ever-expanding, growing and productive philosophy, not one that is old, stubborn and a product of continuing brainwashing and stagnation.
As a private researcher and chiropractic entrepreneur, I believe we can unify this profession with scientific technology. In doing so, I believe we can have both the purest of the "straight" chiropractic "while earning the right" to an imaginatively broadened scope of structural healing practices. Once we know our normals, classify our abnormal biomechanical intensities and associate or type their related disease process, then we can document, objectively evaluate, establish and substantiate treatment response and cost effectiveness.
November 1985: Proposed Rule 302 - It's Time to Take a Stand
Submitted by Laura Flores, PhD, DC
The CCA (California Chiropractic Association) executive board is proposing that the state board of chiropractic examiners adopt their new definition of chiropractic to reflect that "chiropractic is medicine minus drugs and surgery." But somehow it misses the mark! It would have been a simple matter to state that a doctor of chiropractic could use any and all methods except drugs and surgery and have this included in the chiropractic board's regulations. Instead, we are given a selected list of "modalities" and a longer list of prohibitions. The basic rule in law is that you can go from the general to the particular but not the other way around. Consequently, items such as oxygen, herbs, salt for dietary use and electrotherapy except for ultrasound are automatically omitted and no provision is made for future developments.
From all appearances, the list of "modalities" conforms with the requirements of the insurance industry and peer review to confirm us as back specialists. In this proposal, the word "chiropractic" is used in this specific sense. There is no reference that we are primary care providers or that ours is an alternative approach to medicine, or that we are even holistic practitioners. One only has to look at the record to see that CCA efforts are being directed to reducing chiropractic to an ancillary practice, that of a para-professional, merely assisting a medical doctor.
The new hospital privileges being promoted by the CCA have doctors of chiropractic working under the direction of an MD. The new California state scoliosis law makes referrals by DCs to medical doctors for diagnosis and treatment of spinal condition MANDATORY. And the definition of chiropractic submitted by CCA to insurance companies and PPOs such as Blue Shield defines us as "spinal specialists." Obviously, CCA must level the profession to maintain its "clout."
Proposed Rule 302 states that we may "make use of" or "employ" vitamins. These terms are tantamount to "incidental" and "adjunctive" and make it easier for the attorney general to discipline a DC when they use modalities and fail to give a chiropractic adjustment. It also makes it easier for the insurance carrier not to pay your bill. "Make use of" is the terminology used in attorney general opinions and briefs regarding chiropractic practice to reduce a DC to a technician. If adopted as part of the board's regulations, it gives credence to attorney general opinions so that they may be introduced in a court of law where otherwise these opinions would not be admissible. The same applies to the reference to section 10b, which deals with violations, prohibitions and crimes such as fraud, moral turpitude and habitual intemperance. None of these should be a part of a definition of chiropractic proposed by any professional organization.
Perhaps the most serious mistake in the proposal is that it sets out to refute the Crees case and then goes on to adopt its reasoning by stating that "the scope of practice is defined by section 7 of the Act." It is well-known that the Crees case concluded that only the "straight" (hands only) practice of chiropractic is legal because only section 7 of the Act was considered. The attorney general is afraid of our Act. He knows if he has to try us on the whole Chiropractic Act, he will lose. If he can splinter it and use only one section, he can say it's ambiguous and twist its meaning.
The courts have held that when interpreting statute, every title and section of that statute must be given due consideration with reference to the entire statutory system of which it is a part. This means chiropractic laws are not different from those of nurses, acupuncturists, podiatrists or medical doctors. The courts have looked to the curriculum to determine the scope of practice with respect to health practitioners. Why should a professional organization propose a definition that denies its members this constitutional right?
The practice of clinical diagnosis and the use of X-ray can only be justified by section 5 (curriculum) of the Act. It is the clinical subjects mandated in section of 5 of the Act that set California chiropractic practitioners apart from other states in terms of vulnerability. To exclude these from a definition of scope of practice is to invite the problems of states such as Michigan, where a denial of differential diagnosis has become the grounds to challenge the right to practice "straight" chiropractic.
In this proposal, venipuncture appears as an awkward enticement considering that the CCA amicus brief in the Dr. Luly case states that venipuncture is surgery and that nothing was done by the CCA to defend those doctors currently disciplined by the Chiropractic Board for the practice of venipuncture. The references to pre- and postnatal care and to obstetrics seem out of place in a proposal dealing with methods of treatment and modalities. The art of chiropractic obstetrics during actual childbirth is no more than skillful use of the hands (manipulation). It needs no drugs or surgery. It needs no modalities. If the base premise of Rule 302 states we cannot use drugs and surgery, that should suffice. However, if we name one area or field of practice with regard to that premise, it opens the door to question our right to practice in other areas such as pediatrics, geriatrics or orthopedics.
The five cases cited as references do not deal with the chiropractic management of obstetrics nor with normal childbirth: People v. Rehman dealt with the illegal practices of an osteopathic hospital. People v. Bernhardt involved a charge of conspiracy to commit manslaughter that was reversed on appeal and Dr. Bernhardt was acquitted. People v. Magliagli involved a blood transfusion, People v. Fowler dealt with an abortion case and Crees v. Board of Medical Examiners dealt with the medical-surgical aspects of childbirth but involved no actual case.
No favorable cases which support the practice of chiropractic obstetrics were submitted by the CCA to its members. Some of these are as follows: People v. Chong, a Supreme Court decision that determined the cutting of the umbilical cord is an exception to surgery; Boland v. Santa Cruz Municipal Court, a Supreme Court decision dealing with three lay midwives with no formal training who had more vision than many professionals. The Supreme Court ruled that pregnancy is not a medical condition nor a disease, but a physical condition. However, the court observed that in order to treat a physical condition, a license was required; and People v. Cabral, a court of appeals decision that holds that chiropractic and medicine are two distinct approaches to health care. Although they treat the same conditions, chiropractors are limited by the methods they employ. The 1948 Ballot Argument to the Chiropractic Act would allow obstetrics by chiropractors if the amendment was adopted. And it was. In addition, the cases which support a holistic practice in California were totally ignored by the attorney who wrote the CCA's proposed Rule 302.
No, we cannot afford to take for granted the "good" judgment of those in charge when the CCA lawyer today differs radically in the interpretation of our law with those of a few years ago, who not only supported chiropractic as a full-scope practice, but also upheld specialty areas in obstetrics, proctology, pediatrics, etc. Are there no moral obligations here?
The legal archives show that only the scope of limited practitioners is specified. The art of general practitioners such as osteopaths, chiropractors, naturopaths and allopaths have never been defined in the statutes except to prohibit the use of drugs and surgery to those who are not physicians and surgeons. The California Legislature (Bus. & Prof. Code 1001) states "[A chiropractic license] in any manner authorizes the treatment of human beings for diseases, injuries, deformities or any other physical or mental conditions." THSE FEW SENTENCES INCLUDE MORE THAN THE PROPOSED RULE 302!
Proposed Rule 302 needs to be protested, and hopefully dropped altogether, before it is officially adopted by the chiropractic board. Facts should have been verified and not formulated on preconceived notions for ulterior motives. It is time to reason from facts, not from prejudice or the personal wishes of a select few. The People of the State of California voted for an alternative health profession distinct from medicine and free from its harassment. We as doctors of chiropractic have an obligation to provide this service. And when our organizations abandon us, we have a responsibility to protect that which is rightfully our - our license and our livelihood.
Alternative practitioners are "sprouting up like weeds in a well-tended garden" [Los Angeles Times, December 1982] adopting as their own philosophies and procedures that which were once our exclusively. And other professionals are expanding their scope, we are going backward. There is a concerted effort to eliminate us, but do our organizations have to be the ones to pull the trigger?
One merely has to look at the old college catalogues and review the insurance claims paid to doctors of chiropractic through the years to realize that the Chiropractic profession has endured heavy losses. In past years, claims were paid for all conditions. Payments for chiropractic obstetrics only ceased when the chiropractic board adopted a negative policy with regards to obstetrics in 1980. A compromise today may mean a complete surrender tomorrow. If we don't take a positive stand now, later it might be too late!
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
