In the complex world of chiropractic governance we are finding that many of those who hold leadership positions are potentially conflicted because of various roles and position they hold.
Case in point is Laurence Adams DC. Appointed to the California Board of Chiropractic Examiners (BCE) by Governor Gavin Newsom in October 2020, Dr. Adams claims to bring a wealth of experience from a dedicated career in chiropractic care. However, his concurrent roles raise critical questions about conflict of interest and the integrity of chiropractic regulation.
This investigation draws on information from the Board of Chiropractic Examiners (Board) meeting on October 19-20, 2023, at the Southern California University of Health Sciences, and Dr. Laurence Adams' interview on the *Staying Aligned: The Steel & Eisner Podcast* by Steel & Eisner, LLP, dated September 22, 2022.
Background of Laurence Adams DC
Dr. Laurence Adams, DC, DACNB, earned his Doctor of Chiropractic degree from Life Chiropractic College-West in 1996 and his Post-Doctorate degree in Chiropractic Neurology in 1999. His service to the chiropractic community includes positions such as Senior Examiner for the American Chiropractic Neurology Board (ACNB), Vice President and President of his local North Bay California Chiropractic Association (CCA), and Region 7 Director on the Cal-Chiro Board. Today, Dr. Adams practices privately in Sonoma, California, while serving on the BCE.
A Dual Role: California Board and FCLB's RCSP
One of the more controversial aspects of Dr. Adams' roles is his simultaneous service on the California Board of Chiropractic Examiners and the Federation of Chiropractic Licensing Boards' (FCLB) Recognized Chiropractic Specialty Program (RCSP). The RCSP is a new FCLB initiative which they claim is designed to establish criteria and procedures for multijurisdictional recognition of chiropractic specialty program providers.
Many in chiropractic simply view this as another land grab by the FCLB and its partners to gain more control over the profession.
Adam's dual role is particularly concerning due to the potential conflicts of interest it presents. Dr. Adams' influence on both a state regulatory board and a private corporation aiming to standardize specialty programs creates a situation where decisions in one role could unduly benefit the other. Such overlapping responsibilities could compromise the objectivity required to serve the public interest effectively.
Regulatory Control Over Chiropractic Education
During the October 2023 Board meeting and his interview on the *Staying Aligned* podcast, Dr. Adams elaborated on the BCE's regulatory authority over chiropractic colleges in California. He highlighted the board's power to approve colleges, curricula, and the number of hours required for various programs. He claims this level of control ensures that educational standards align with the board's objectives and regulatory requirements. Of course no evidence to support these contentions was provided and these assertions are used routinely by the FCLB, NBCE and others to justify their monopolies within chiropractic.
Dr. Adams also revealed plans to modernize these regulations, acknowledging that some existing rules are "arcane" and "don’t really make sense today" though he did not reveal what exactly was arcane or what he was going to change. While modernization efforts are necessary, they must be conducted transparently and without undue influence from private corporations like the FCLB.
Monopolies and The Chiropractic Cartel
The Council on Chiropractic Education (CCE) and the National Board of Chiropractic Examiners (NBCE)are both private corporations that are actually named in the statutes, rules, and regulations governing chiropractic in California. The FCLB, in which Dr. Adams plays a significant role, receives the majority of its funding from the NBCE (which is funded by student loan money), in addition to contributions from California tax dollars sent to the FCLB by the Board as dues payments.
The inclusion of these organizations in regulatory frameworks presents potential legal and ethical problems. Their dominant positions have created monopolistic practices that limit competition and innovation within the chiropractic profession. The financial interdependencies among these bodies raise questions about impartiality and the potential for regulatory capture, where private interests could unduly influence public regulatory agencies.
The ACA Connection and Potential Conflicts
Of the three members of the California Board of Chiropractic Examiners who are chiropractors, two are members of the American Chiropractic Association (ACA). Dr. Laurence Adams practices with a relative, who is also an ACA member. Moreover, Dr. Adams is a diplomate of the American Chiropractic Neurology Board (ACNB), the sole specialty board in neurology recognized by the ACA through the ACA Council on Neurology.
Board Chair David Paris is another key figure, heavily involved in Independent Medical Examinations (IME) and utilization review for third-party payors. Paris, an ACA member, also serves on the Council on Chiropractic Education Site Team Academy and the Chiropractic Clinical Guidelines and Practice Parameters Board (CCGPP). Known as MERCY II, the CCGPP has a controversial reputation within the profession. Paris, who served as Vice President of the California Chiropractic Association in 2015, completed the Primary Spine Practitioner Certification program at the University of Pittsburgh and is board-certified with the American Chiropractic Rehabilitation Board.
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Pamela Daniels, the third chiropractor on the California Board, is also an ACA member and a diplomate of the American Chiropractic Neurology Board.
The ACA strongly supports the Council on Chiropractic Education, NBCE, and FCLB. It is currently involved in a nationwide campaign to expand the scope of practice in Medicare to state scopes, including the use of drugs. The ACA is also a member of the Chiropractic Summit Group.
According to propaganda distributed by the Summit, this secret gathering plays a significant role in the chiropractic profession, bringing together self-selected key stakeholders within the Cartel to discuss industry developments and goals. These types of meetings are key attributes of Cartels that attempt to restrain trade.
Attempts to find out who the members of the Summit are and what the requirements are for membership have gone unanswered. Lisa Love-Smith, the Executive Director of the Chiropractic Summit, has refused to respond to email and fax requests for this information despite her assertion that the Summit has over 30 members.
Love-Smith is also the Executive Director of the Michigan Association of Chiropractors (MAC), a Related Organization to the American Chiropractic Association (ACA). The MAC website does not list who the leadership of MAC is. The International Chiropractors Association (ICA) is also a member of this secretive Summit group, and discovery documents in the Vanterpool lawsuit show that the FCLB is a "Partner" of the Chiropractic Summit. It is also known that ChiroCongress is part of the Summit. ChiroCongress is an organization made up of all the ACA Related and Affiliated state organizations. Despite its claim to represent all chiropractors, not all state associations are members of ChiroCongress.
Ethical and Regulatory Concerns
Dr. Adams and the other Board Members' roles in the BCE, the FCLB and ACA raise several ethical and regulatory concerns:
1. Conflict of Interest: Thier roles may lead to decisions that benefit the FCLB, CCE, or NBCE at the expense of state regulatory impartiality. Their influence over educational standards and specialty recognition could disproportionately favor initiatives from these organizations.
2. Use of Public Funds: The California Board of Chiropractic Examiners is funded by state tax dollars. The board's financial commitment to the FCLB, a private organization, necessitates scrutiny to ensure that public funds are used appropriately.
3. Monopolistic Practices: The dominant positions of the FCLB, CCE, and NBCE in chiropractic regulation and education may stifle competition and innovation within the profession. Their involvement with these entities could further entrench these monopolistic practices.
4. Regulatory Capture: The financial ties between the NBCE and the FCLB, combined with their significant influence on regulatory standards, suggest a risk of regulatory capture. This situation could compromise the BCE's ability to act in the best interests of the public and the chiropractic profession as a whole.
Moving Forward
The chiropractic community and public stakeholders must remain vigilant about the potential conflicts of interest inherent in board members' dual roles. Ensuring transparency and accountability in the BCE's actions is crucial for maintaining public trust and advancing the chiropractic profession without undue influence from monopolistic entities.
As regulatory bodies continue to evolve and modernize, it is imperative that they do so with a clear focus on protecting the public interest and promoting fair competition within the profession. Dr. Adams' case serves as a poignant reminder of the delicate balance between governance and professional advancement in the world of chiropractic care.
