Washington State Association Seeks Scope Expansion

AMA & Other Medical Groups Say Chiropractors Not Qualified

The Washington State Chiropractic Association proposed a bill during the 2013 legislative session that they stated would clarify the scope of practice for chiropractors specific to pre-participation and Department of Transportation examinations. 

While WSCA stated that the current scope of practice currently requires chiropractors to perform an examination on all patients specific to the purpose of their visit. And while WSCA believes that the two examinations are something that chiropractors should already be allowed to perform, they initiated these efforts to make it clear.

The bill did not pass the legislature, but the House Health Care Committee Chair, Rep. Eileen Cody, sent the bill for a Department of Health Sunrise Review.  The Sunrise hearing took place on August 6, 2013 and WSCA’s case was made to an independent panel. There were ten days to provide rebuttal comments from the hearing and according to WSCA that letter was delivered August 16, 2013.

The panel will make a preliminary recommendation in September and an additional opportunity for public comment will occur and a final recommendation goes to the Legislature in December which WSCA states will decide their direction for possible legislation in 2014.

At a hearing in February, and in submitted comments obtained by the Foundation for Vertebral Subluxation - opponents , including the American Medical Association, athletic trainers, pediatricians, osteopaths, nurses and others, stated that chiropractors do not have the necessary training to perform these physical exams safely and effectively.  

CLICK HERE TO WATCH VIDEO OF HEARING – 39 Minutes into Meeting.

Much of the submitted testimony centers on concerns that chiropractors do not have the necessary training and therefore the skills to conduct visceral examinations, address medication issues and perform other functions consistent with a primary care physician.

In a letter, the American Medical Association stated that:

". . . chiropractors are wholly unprepared to perform comprehensive examinations of school athletes and commercial truck drivers. While chiropractors do complete four years of chiropractic school, which includes education in the basic sciences, the focus of chiropractic school is largely the treatment of the musculoskeletal system - the body's bones, muscles, cartilage, tendons, ligaments, joints and other connective tissues. Chiropractors lack the range of exposure to and depth of knowledge about all organ systems necessary to perform a comprehensive and complete examination. Chiropractors also lack education and training in pharmacology and prescription medicines, and as such, are not prepared to evaluate an applicant for a commercial driver's license who might be on multiple medications"  

Similar testimony was received from a host of medical, physical therapy, athletic trainers, nurses and other providers and organizations.

At least two chiropractic college Presidents (Palmer & Western States) also submitted testimony in support of the notion that chiropractors are fully qualified to conduct full body physical examinations, render full body diagnosis and determine necessary treatment or management.     

Dr. Joseph Brimhall, President of the University of Western States argued:

"For example, the discovery of stage 1 or 2 hypertension, visual acuity deficits or uncontrolled diabetes would be expected of a competent chiropractic physician under any clinical situation, not just a DOT physical."

He went on to defend chiropractors' expertise in diagnosing heart problems such as cardiac bruits, inguinal hernias, metastatic bone lesions, traumatic brain injuries and concussions.

Brimhall's evidence of this training included the Council on Chiropractic Education's (CCE) Accreditation Standards and the testing of these skills on the related parts of the National Board of Chiropractic Examiners (NBCE) tests.   

Testimony in support of expanding the scope to include these physicals was also submitted by Palmer's Chancellor Dr. Dennis Marchiori. Stating he was the President of the largest chiropractic college, Marchiori lamented that there was a great deal of misinformation regarding this issue.

Marchiori stated:

"Chiropractors in general and Palmer graduates specifically are highly trained in providing comprehensive health evaluations."   

He went on to cite the number of hours in the chiropractic program, accreditation by the CCE and related licensure as evidence of these qualifications.

Palmer, under the leadership of Marchiori recently adopted a new mission centered around chiropractors as primary care physicians for the spine. Brimhall and Marchiori's testimony is consistent with the general push within chiropractic education and regulation to position chiropractors as another provider of primary care.  Several states are pursuing the expansion of the chiropractic scope of practice in order to include primary care and drugs.

In their testimony, both Presidents ignored the obvious flaws in their arguments which were highlighted by the AMA and the other medical groups in regards to the extent of the training chiropractors receive in such areas as cardiopulmonary diagnosis and management. The Presidents failed to consider that the chiropractor would be solely responsible for detecting abnormalities in these body systems in young children or in commercial drivers. Instead, they maintain that chiropractic college graduates are trained well enough in these areas.       

In fact, WSCA itself acknowledges that chiropractors lack the appropriate training to conduct these physical exams in their Applicant Cover Sheet and Outline to the Department of Health on their request for Sunrise Review.

WSCA itself calls for “. . . additional training requirements for those doctors of chiropractic who would be eligible to perform pre-participation physical examinations . . .”

WSCA goes on to state:

“The current regulatory scope of practice does not reflect recent advances in the education of the chiropractic profession including specialty and recent trends in voluntary training to demonstrate additional competencies. This proposal recognizes doctors of chiropractic with specialty training or additional voluntary training specific to these areas of practice provide an important quality assurance measure. This proposal will protect public health and safety through education and training.”

This statement by WSCA acknowledges that in order to protect the public health, chiropractors need additional training to perform these examinations – which is a direct contradiction to what Brimhall and Marchiori claim.

The WSCA proposal to add additional training requirements for those chiropractors interested in providing pre-participation physicals and DOT exams amounts to nothing more than tiering of the chiropractic profession in the state of Washington. Chiropractors are either already trained to provide these exams or they are not. Two chiropractic college Presidents assert chiropractors are already trained experts at whole body diagnosis and management by virtue of their graduation from a CCE accredited institution.  WSCA appears to believe they are not.

Such confusion on the part of the chiropractic profession itself should be enough to give the legislature and citizens of Washington State a reason to pause on this issue. 

ADDITIONAL LINKS ON THIS TOPIC BELOW:   

OVERVIEW OF THE INITIATIVE

HEARING VIDEO

REQUEST FOR SUNRISE REVIEW

WSCA RATIONALE FOR INITIATIVE

AMERICAN MEDICAL ASSOCIATION LETTER

WASHINGTON STATE MEDICAL ASSOCIATION LETTER

WASHINGTON STATE OSTEOPATHIC ASSOCIATION LETTER

WASHINGTON STATE ACADEMY OF PEDIATRICS LETTER

PALMER LETTER FROM DR. MARCHIORI

WESTERN STATES LETTER - DR. BRIMHALL

SURVEY ON STATE SCOPE RELATED TO PRE-PARTICIPATION EXAMS