In a recent article published by Dynamic Chiropractic, James Lehman DC, an Associate Professor at the University of Bridgeport College of Chiropractic and Member of the American Chiropractic Association claimed that chiropractors in Colorado must practice to the fullest extent of the scope in the state.

He accused chiropractors who choose to focus their practice on the location, analysis and correction of subluxation as engaging in illegal and unethical behavior following the adoption of new position statements protecting such rights by the Colorado Chiropractic Association.

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Lehman is an outspoken proponent of chiropractic scope expansion including drugs. In a previous article published in Dynamic Chiropractic Lehman stated:

“If the chiropractic profession is truly patient-centered, it will realize the need to develop laws that provide chiropractic physicians opportunities to be trained and credentialed to use prescription medications.” 

In addition to being a chiropractic drug pusher, Lehman is an avowed anti-subluxationist stating in the same DC article:

“If the chiropractic profession is concerned with the future of the profession, it will eliminate antiquated statutes based upon subluxation and create new laws with broad-scope practice parameters that enable chiropractic physicians to better serve patients and integrate the health care system as musculoskeletal providers and primary care providers with limited prescriptive authority.”

Lehman’s comments are seen as an attempt to portray the subluxation centered chiropractor as a threat to public health to plaintiff’s attorneys, regulatory boards and legislatures while at the same time supporting those individual trade organizations and chiropractic schools that are seeking primary care status and drug rights.

The Press Release by the International Federation of Chiropractors and Organizations (IFCO) made the following points to correct the misinformation provided by Lehman:     

A licensed practitioner may choose to limit their practice, and it is prudent to do so. The notion that one must practice to the entire scope of their license is absurd. Is a gynecologist compelled to perform neurosurgery? Are orthodontists compelled to perform root canals? Of course not. We are unaware of any plenary licensee (MD or DO) who claims to offer the service of operationalizing all 69,823 diagnosis codes in ICD-10 code sets. (3) The issue is whether they are performing to the standard of care for their selected subset of permissible procedures.

The ability of a doctor of chiropractic to limit the scope of their care has been recognized by law in several states. For example, under New Jersey Statutes, subluxation may be the sole basis for chiropractic care:

Nothing in this act shall be deemed to prohibit a chiropractor from caring for chiropractic subluxation. Chiropractic analysis which identifies the existence of a chiropractic subluxation may be the basis for chiropractic care even in the absence of a subjective complaint or other objective findings. In Kerkman v. Hintz The Wisconsin Supreme Court clearly defined the extent of a chiropractor's duty to diagnose:

In summary, we hold that a chiropractor has a duty to:

(1) determine whether the patient presents a problem which is treatable through chiropractic means;

(2) refrain from further chiropractic treatment when a reasonable chiropractor should be aware that the patient's condition will not be responsive to further treatment; and

(3) if the ailment presented is outside the scope of chiropractic care, inform the patient that the ailment is not treatable through chiropractic means.

The IFCO Press Release went on to explain:

It should also be recognized that in clinical practice, medical or chiropractic, there are situations where no medical diagnosis is rendered. DOT physicals, "Well baby" checkups, Lifestyle advice, athletic performance enhancement strategies, checking for vertebral subluxation, etc.

This is acknowledged in the portion of the Colorado statute which includes “measures for the promotion, maintenance, and restoration of health, the prevention of disease, and the treatment of human ailments.”

Finally, let us address the issue of ethics. The Principle of Beneficence states that one should do only that which benefits the patient, and to hold the patient’s welfare as the first consideration. Excessive and inappropriate diagnostic testing leads to patient harm, including iatrogenic effects and excessive costs.

Diagnostic testing that is not relevant to the clinical objectives of analysis of vertebral subluxations and determining the safety and appropriateness of chiropractic care may be unethical, particularly if the examination procedures employed have not demonstrated acceptable levels of reliability and validity.

Doctors of chiropractic focusing on the analysis and correction of vertebral subluxations embrace a patient-centered, evidence informed, ethical, and cost-effective approach to health. Every chiropractor should be familiar with applicable state statutes, rules, and regulations. To state or infer that a subluxation-centered approach is illegal and unethical is wrong stated the IFCO. 

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