The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
The first is "Resolution #2 – The Six Key Elements of a Modern Chiropractic Act." Resolution #2 includes two "elements" that call for "prescriptive authority." The second, "Resolution #12 – Establishment of College of Pharmacology & Toxicology" establishes the "College of Chiropractic Pharmacology and Toxicology of the American Chiropractic Association."
To better understand how these resolutions are viewed by ACA delegates – and perhaps the profession at large – we asked Michael Taylor, DC (Oklahoma delegate) and Edward McKenzie, DC (Kansas delegate) to give their opinions regarding the resolutions. (Dr. Taylor, an author on both resolutions, deferred to Tony Hamm, DC, newly re-elected ACA president, who is also an author on Resolution #12.)
Dynamic Chiropractic: The Six Key Elements of a Modern Chiropractic Act (Resolution #2) includes the following four elements: 1) "Chiropractic Physician" and "Chiropractic Medicine" as the Regulatory Terms of Licensure; 2) Scope of Practice Determined by Doctoral and Post-Doctoral Education, Training and Experience Obtained Through Appropriately Accredited Institutions; 3) Full Management, Referral and Prescription Authority for Patient Examination, Diagnosis, Differential Diagnosis and Health Assessment; and 4) Full Management, Referral and Prescription Authority for the Care and Treatment of Neuromusculoskeletal and Other Health Conditions or Issues. In your opinion, do these four elements suggest doctors of chiropractic should have the authority to prescribe drugs?
Dr. Hamm: No. The American Chiropractic Association supports the Summit statement: "The drug issue is a non-issue because no chiropractic organization in the Summit promotes the inclusion of prescription drug rights and all chiropractic organizations in the Summit support the drug-free approach to health care."
Dr. McKenzie: There is a saying in the Midwest: "If it looks like a pig, acts like a pig and smells like a pig ... it probably is a pig ... and no matter how much lipstick you put on it ... it is still a pig." In my opinion, it would be hard to draw any other conclusion than to suggest that these elements are there explicitly for the purpose of furthering the agenda towards acquiring prescription authority.
DC: The "Rational" for Resolution #2 states that "[t]he creation of this new ACA policy also creates a road map that will guide ACA leadership, staff, and committees when a state Chiropractic association requests ACA support and assistance for an initiative to modernize their state Chiropractic act." How do you see this resolution impacting how the ACA supports and assists state chiropractic associations?
Dr. Hamm: Through research, we have found that some existing state practice laws and regulations can limit the optimal health care workforce when they create a mismatch between legal scope of practice and professional competence. In fact, some state laws and regulations limit practice to standards below our education and tested competencies. In order to be inclusive in new and emerging health care delivery models, our profession should be allowed to practice in all states and territories uniformly.
Dr. McKenzie: There is little question as to the direction this "road map" leads. As past president of the Kansas Chiropractic Association and having served on its board of directors, I hate to see this kind of national intervention. When joining the ACA, I felt I could practice in accordance with the laws of Kansas and have a national association that would not dictate guidelines. This resolution is nothing more than a vehicle designed to pass the agenda of those proposing prescriptive rights on to the states.
DC: Why do you feel it was necessary for the ACA to create the "College of Chiropractic Pharmacology and Toxicology of the American Chiropractic Association"?
Dr. Hamm: First of all, the proposal is for the creation of the ACA College of Pharmacology and Toxicology. Pharmacology is the discipline concerned with the use, effects and modes of action of drugs. Pharmacotherapy, on the other hand, is medical treatment by use of drugs. Pharmacology and toxicology are subjects currently being taught in chiropractic institutions and tested for on the national boards.
Further, meaningful use in electronic health records mandates a working knowledge of drug-drug and drug-allergy dynamics. Many of us are National Registry-certified medical examiners, which also requires advanced training in pharmacology and toxicology to perform DOT physical examinations for the nation's truck drivers. The singular purpose of the College is to provide advanced training in this subject matter to those interested.
Dr. McKenzie: This resolution was not necessary and figures to be yet another divisive wedge to drive our profession further apart.
DC: The "Rational" for this Resolution #12 (that creates the College) states, "And the ACA Wellness Model Policy under Health Information Resource (Primary Prevention) whereby typical health promotion activities performed by a DC serving as a health information resource includes Drug Alerts, Immunization, and Drugs Used in Pain Relief;" Do you believe doctors of chiropractic should be equipped to be an "information resource" in "Drug Alerts, Immunization and Drugs Used in Pain Relief?"
Dr. Hamm: The ACA supports education of our profession in all matters related to public health.
Dr. McKenzie: No; other than being a resource for recommending places patients can go to attain this information, chiropractors do not need to be the experts in the above.
DC: Do these two resolutions have the potential of creating a level of expectation that could negatively impact non-participating DCs with payers and in malpractice litigation?
Dr. Hamm: I'm not sure what is meant by "non-participating DCs." All doctors of chiropractic in the U.S. have the same degree and are afforded the same privileges and opportunities to practice to the level of their individual training, competencies and professional interests. The ACA supports advanced training for those with special interests based on state scope-of-practice laws and regulations. Examples include pediatrics, orthopedics, neurology and of course, many more. I would defer the professional liability question to our legal counsel.
Dr. McKenzie: Any time one is cited as an authority and by that authority directs a patient's health, it must be construed as affecting their health. In light of that, I feel it would be reasonable to assume that malpractice rates would climb as well.
DC: Do you believe doctors of chiropractic should have the authority to prescribe drugs?
Dr. Hamm: No. The ACA adopted a policy in support of the Summit statement on drugs at its annual House of Delegates meeting in 2014. It is a non-issue. The ACA is focused on increased utilization, reimbursement parity and maintenance of clinical authority that will protect our ability to manage our patients as physician level providers.
Dr. McKenzie: Absolutely not ... period! Pharmacological intervention as a means to improve health is not working. It is now estimated that approximately 70% of all Americans are taking at least one prescriptive drug. Prescription drug use has climbed astronomically in the past several decades, and more and more people are looking for another way to become healthy. We need to be the wellness experts. We need to be the resource for healthy living, not just another iteration of "a better life through drugs."
In closing, my experience watching the passage of these two resolutions, the proceedings of this past ACA COD (Council of Delegates, comprised of only ACA state delegates, whereas the House of Delegates includes the members of the Board of Governors and the presidents of the specialty counsels) and HOD, as well as other activities of ACA leadership over the past two years, is why I am taking this opportunity to publicly announce my resignation as Kansas ACA delegate.
Do Resolution #2 and Resolution #12 deviate too far from the fundamental principles of chiropractic – or are they a necessary sign of the health care times that will help take the profession to the next level? What's your opinion? Send an email to editorial@mpamedia.com.
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