Colorado Chiropractic Association Accused of Illegal and Unethical Behavior
Chiropractic in Colorado has been in the news over the past few years as elements within the Colorado Chiropractic Association (CCA) and on the Regulatory Board have made repeated and embarassing attempts to expand the scope of practice including the use of prescription drugs.
Since that time there has been an effort to restore some sanity to the Chiropractic Board and to the leadership of the Colorado Chiropractic Association. One such effort was a meeting of the CCA on September 11, 2015 where they adopted the following position statements:
Whereas addressing subluxations and spinal adjustments are central to The Colorado chiropractic practice act. The Colorado Chiropractic Association considers it standard practice and an acceptable standard of care for practitioners to choose to deliver care solely for the location analysis and correction of spinal subluxations in child and adult patients, regardless of whether symptoms are present. Subluxations are in and of themselves a detriment to one’s health.
Whereas The Colorado Chiropractic Association is concerned with practitioners delivering quality chiropractic care, the CCA considers it standard practice and within the acceptable standard of care, as noted in recognized clinical practice guidelines, to take x-rays for the location and analysis of spinal subluxations when clinically indicated. Clinical indications include evidence of subluxation demonstrated by chiropractic examination, and is not limited to patients presenting with symptoms or a history of trauma.
Whereas the Colorado chiropractic Association considers patient safety a priority, the Colorado Chiropractic Association considers it an acceptable and standard practice for chiropractic practitioners to deliver chiropractic care solely for the location analysis and correction of spinal subluxation and for practitioners to choose to focus their scope of practice to that practice objective when an informed consent is obtained from the healthcare consumer.
The position statements adopted by the Colorado Chiropractic Association asserting that vertebral subluxation is an acceptable stand alone diagnosis warranting chiropractic care are not new.
Several other organizations including the Foundation for Vertebral Subluxation, the International Federation of Chiropractors and Organizations and the International Chiropractors Association have similar position statements and some of them go back decades.
Foundation for Vertebral Subluxation Position Statement
International Federation of Chiropractors & Organizations Position Statement
There is nothing – absolutely nothing – in these statements to suggest that chiropractors are not responsible to triage their patients, recognize deviations from the normal and then make appropriate case management decisions that are in the best interests of patients. In fact, all of them state exactly that.
But none of that means that a patient with an identified subluxation is not entitled to chiropractic care just because they have some other disease, disorder or syndrome. And none of that means that any chiropractor in any state should be forced to manage all disease manifesting in their patients to the fullest extent of the scope of practice.
That would be absurd and everyone knows it.
But as absurd as that sounds, in a rambling tirade published in the Dynamic Chiropractic newspaper, James Lehman points out that the Colorado Chiropractic Board of Examiners is appointed by the Governor to protect the public and he states:
“It is time for the Colorado Board of Chiropractic Examiners to denounce the CCA Standards of Care.”
Lehman is an Associate Professor of Clinical Sciences and Director of Health Sciences Post Graduate Education at the University of Bridgeport. The University of Bridgeport has a small chiropractic program there.
In his article in Dynamic Chiropractic, Lehman states that after reading the position statements he “. . . doubted a responsible chiropractic association such as the CCA could have approved such standards” and goes on to opine that:
“The new standards of care eliminate the need to make a diagnosis prior to chiropractic treatment.”
Of course there is NOTHING in the position statements to suggest such an absurdity. The position statements merely state that subluxation is acceptable as the sole rationale for care. In other words if someone comes in to see you and has no pain, no symptoms, no other current diseases and you examine them and find subluxations then they are entitled to chiropractic care to arrest, reduce or correct those subluxations.
This management, by the way, is consistent with the law governing the practice of chiropractic in Colorado.
(1.7) “Chiropractic” means that branch of the healing arts that is based on the premise that disease is attributable to the abnormal functioning of the human nervous system. It includes the diagnosing and analyzing of human ailments and seeks the elimination of the abnormal functioning of the human nervous system by the adjustment or manipulation, by hand or instrument, of the articulations and adjacent tissue of the human body, particularly the spinal column, and the use as indicated of procedures that facilitate the adjustment or manipulation and make it more effective and the use of sanitary, hygienic, nutritional, and physical remedial measures for the promotion, maintenance, and restoration of health, the prevention of disease, and the treatment of human ailments.
The plain language of the statute reads: “It includes . . .”
This means that chiropractors may diagnose human ailments. It does not mandate that the chiropractor must diagnose every human ailment. And when taken in context with the rest of the statute it becomes clear that the intention of the statute is that the chiropractor would address the cause of human ailments vis a vis the abnormally functioning nervous system.
What doesn’t Lehman understand?
There are only three possibilities:
- Lehman knows and understands that this is consistent with the law and is purposely attempting to confuse and mislead chiropractors, plaintiff’s attorneys, regulatory boards and legislatures into believing that chiropractors who choose to focus their practice on subluxation are a threat to the public health.
- Lehman understands this but is attempting to take the statute and re-interpret the plain language of the statute to mean that one must practice to the fullest extent of the scope in the state.
- Lehman does not understand this. If this is true it makes one wonder how he is allowed to teach differential diagnosis and management to anyone.
I am going to give him the benefit of the doubt and suggest that its number one and two that are in play here. This is not new.
During the chiro wars in the 80’s and 90’s there was a “Live and Let Live” strategy promoted by the broad scope practitioners who were pushing the profession into primary care and drugs.“We’ll let you do what you want as long as you let us do what we want” was their mantra.
The problem is that in one regulatory board action after another, chiropractors who chose to practice this way were attacked by these boards, sanctioned or had licenses revoked. This is because the majority of our state chiropractic regulatory boards are controlled by those who want an expanded scope - including drugs.
In addition, while out of one side of their mouths they said “live and let live” out of the other side they were changing accreditation standards to focus on primary care and sanctioning schools that did not adhere to this standard.
This is what Lehman actually represents and what he is arguing for.
If we take Lehman’s ridiculous interpretation of the law in Colorado seriously then every chiropractor in Colorado should be doing gynecological exams, poking prostates, testing for syphilis and practicing psychiatry, since Lehman states:
“The Colorado Chiropractic Practice Act requires chiropractic schools and colleges to teach chiropractic students to perform a diagnosis. In fact, the law states that training chiropractors to diagnose is a minimum educational requirement.”
Lehman then quotes the law:
The schedule of minimum educational requirements to enable any person to practice chiropractic in the state of Colorado is, except as otherwise provided, as follows: Diagnosis (to include, but not be limited to, physical, clinical, laboratory, and all other recognized diagnostic procedures), pediatrics, dermatology, syphilology, psychiatry, and X-ray.
The law goes on to include: Obstetrics and gynecology.
Readers are urged to join and support those chiropractic trade organizations that support your right to locate, analyze and correct vertebral subluxation as well as the public’s right to receive such care.
