Colorado Chiropractic Association Supports Scope Expansion
The Foundation had specifically requested the following:
o Confidential Memorandum from the Attorney General’s Office
o Missouri injectable memo August 22, 2012
o Medical Board memo to Board
o Colorado Medical Society letters to Board
o Minutes of the 11/15/12 Board meeting
o Any and all other communications, emails, letters, correspondence, faxes, memos etc between or to the board and its members regarding this issue.
In all, approximaltely 70 pages of documents were turned over including letters, e-mails, memos and other documents. They included letters from the Colorado Medical Board and the Colorado Medical Society who were both opposed to adoption. Others in opposition included the Citizens for Patient Safety and a practicing chiropractor. All other correspondence from chiropractors, including the Colorado Chiropractic Association and American Chiropractic Association Members were in support of the rule.
Colorado Medical Board
In a Memorandum from Marschall Smith, Program Director of the Colorado Medical Board (CMB), Smith states that the “CMB also expresses concern that the public could be harmed by such practice.”
Smith further states:
“The subcutaneous injection of such ambiguous substances present unnecessary risk to the health of prospective recipients, and could cause unnecessary harm requiring physician rescue or response. The CMB believes that such a rule exceeds your board’s statutory authority because it authorizes injections of substances that are non-FDA approved or undefined. Moreover, the CMB believes that these subjects fall within the CMB’s legal responsibility to protect the public against the unauthorized, unqualified, and improper practice of the healing arts in this state.”
Colorado Medical Society
In a Memorandum from Susan Koontz, General Counsel of the Colorado Medical Society (CMS), the CMS stated such practices extend into the practice of medicine and objected to the adoption of Rule 7 C for the following reasons:
- The proposed rule exceeds the statutory authority of the Colorado Board of Chiropractic Examiners
- House Bill 10-1416 in 2010 sought to allow chiropractors in Colorado to administer drugs by injection did not pass the General Assembly.
- Allowing chiropractors to administer drugs would jeopardize patient safety.
The CMS went on to compare the training of a medical doctor to that of a chiropractor pointing out the one year of pharmacology training as well as ongoing training in pharmacology in the third and fourth year of clinical rotations that amount to 8000 clinical hours. An additional 15,000 hours in residencies.
She contrasted this with chiropractic training which has no requirements in pharmacology, no residency requirements and only 4200 hours of combined classroom, laboratory and clinical experience.
In a 6 page follow-up letter dated August 22, 2012, Koontz provides statutory, regulatory and legal evidence for her argument that a chiropractor’s scope of practice in Colorado is limited by statute, “to adjustment or manipulation, by hand or instrument” and does not include invasive procedures.
Two other letters from the Colorado Medical Society expressed concerns regarding allergic and anaphylactic and cardiovascular reactions to such injections.
Submissions in Support of Rule 7 C
Also included in the documents retrieved from the Colorado Board was a 2009 Memorandum from Kevin Heupel, an attorney representing Bob Nelson, a Colorado chiropractor who considers himself an “Advanced Practice Chiropractor” having completed the New Mexico Advanced Practice Certification Course and after examination was conferred certification as an "Advanced Practice Chiropractic Physician" from the ACPCC.
The Heupel memo was written to Diana Protopapa, Director of Legislative affairs for the Colorado Medical Society and argued for the adoption of Amendments to the Chiropractic Practice Act to include the administration and prescription of such things as homeopathics, botanicals, NSAIDS and aspirin. Heupel included the Council on Chiropractic Education Accreditation Standards in his evidence that chiropractors were adequately trained to use “supplements” considered legend drugs.
The documents submitted to the Colorado Board in support of the expanded scope also included a copy of Resolution # 10 on Scope of Practice from the American Chiropractic Association.
This Resolution also pointed to the Council on Chiropractic Education stating that the:
“ACA recognizes the duties of these institutions are to educate and train our chiropractic student doctors to the level of providing conservative primary care services to the health consumers of our country.”
The ACA Resolution goes on to state that it is the ACA’s position that the “…scope of practice of chiropractic physicians should be determined by the education and training provided within CCE accredited institutions . . .”
The ACA Resolution also calls for the “states to establish uniform scopes of practice commensurate with contemporary education and training.”
Consistent with the ACA’s resolution was written testimony submitted to the Board in support of the adoption of injectables into the scope by Nelson Vetanze DC, President of the Colorado Chiropractic Association and member of the American Chiropractic Association and the American Academy of Chiropractic Physicians.
Despite the above arguments against the scope expansion, the Foundation has learned that on November 15, 2012 the Board of Chiropractic in Colorado passed the rule allowing the use of injectables. It is our understanding that the Rule still needs to go to the Attorney General and then Legislative Counsel. The Foundation had previously provided a review of the legal arguments against such expansion.
Interestingly, other than a single practicing chiropractor, no other chiropractors or chiropractic organizations submitted written testimony against the adoption of injectables.
Whether or not the rule is enacted, Colorado has joined several other states including Missouri, Arizona, and New Mexico where expansion of the scope of chiropractic practice is being sought under marketplace conditions that lead chiropractors to believe that decreasing market share, and their related financial challenges, can be solved through the provision of primary care and an expanded scope.
