April 2006, Vol. 16, No. 2
Table of Contents
CCE Recognition by USDE Set to Expire • CCE Response Spurs Follow-up Complaint • Differentiating Neuromuscular from Musculoligamentous Subluxation • Chiropractic Pioneer Passes Away • Early Life Infections Improve the Function of the Immune System • European Spine Journal Publishes PosturePrint® Study • ICA Defending Chiropractic from PT's • Immunization • Letters to the Editor • Life University Teaches CBP® as an Elective • The Ineffectiveness of Over Accommodating • Parker College and Seminars Begin Celebration Preparations • PosturePrint® Used to Determine Stability of Upright Posture • CBP® Hits 91 Publications • Thanks for Helping Your Local HMO Grow! • The Perfect Chiropractic Storm • Three Keys to Practice Success • Building Wealth Securely: Maintenance, Not Pain Relief •
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ICA Working to Defend the Frontiers of Chiropractic in the Face of PT's Aggressive Expansion Efforts
by John K. Maltby, DC
ICA President
The health care marketplace is facing a swirling series of changes and realignments as consumers, governments and the health professions alike seek to grapple with rapidly rising costs, emerging technologies and new centers of competition, provider shortages and confusing marketing and insurance climates. One thing is certain, however, regarding the validity and viability of chiropractic procedures; and that is that there are plenty of former critics who are moving heaven and earth in the legislatures of the US states to try and get in on what has historically been a unique chiropractic preserve. I am speaking, of course, of the physical therapy profession.
From Vermont to Hawaii, the physical therapy organizations are pushing legislation to significantly increase their scope of practice, in some instances including “manipulation” and “chiropractic-like” procedures. ICA continues to be very active in the states to combat this aggressive wave of initiatives to attain direct patient access and, in some cases, doctor level status, with no additional education or testing. ICA’s activities include testimony before the various state legislatures as well as activity in the court system. ICA has responded to legislative initiatives in more than a dozen states, where physical therapists are seeking major scope expansions and even doctor-level rights, with no additional education or testing.
The tactics being employed by the PTs include the submission of extensive documents concerning proposed “doctor of physical therapy” programs, and telling legislators what the PT profession is “going” to do to better qualify their practitioners. On the basis of these goals and aspirations, legislators are being asked to pass on extensive scope expansion initiatives, in a move that ICA strongly believes is just plain bad public policy because it puts the public at risk.
Could the chiropractic profession ever get away with asking for massive scope enhancements on the basis of what we might do in the future? Of course not! I might add that I cannot even imagine that the chiropractic profession would presume to use such a bait and switch tactic, because we know that we would not deserve any such consideration on the basis of anything less than hard proof that our practitioners are fully skilled and equipped BEFORE ASKING FOR NEW AUTHORITIES. As a member of ICA’s legislative team told one Vermont legislator, “Sure, I’m going to dance more like Fred Astaire, I’m going to look like more Robert Redford and I’m going to sing more like Frank Sinatra, someday. Does this mean you should put me in your movie now?” Again, the inherent bait and switch being applied here is lost on no one, nor is ICA hesitant to highlight the dangerous leap of faith PTs are asking policy makers to take.
Alone among national chiropractic organizations, ICA has been involved in on-going cooperative efforts with numerous state associations to meet this challenge head on. ICA has prepared a lengthy public safety policy document, which has been successfully adapted to meet the specifics of many state PT initiatives. This ICA “PT White Paper” has been very useful in defeating what can only be characterized as an unwarranted and dangerous expansion of PT scope in many states. ICA is ready and willing to assist any state chiropractic organization dealing with the current wave of PT legislation.
ICA’s efforts have not been limited to the legislatures or the regulatory process, but have extended to the courts. In a case that has major national implications for maintaining and enforcing the boundaries between chiropractic and physical therapy, the US Supreme Court has declined to hear the appeal by the physical therapists in the case of Michael Teston vs. Arkansas Board of Chiropractic Examiners. In this case, a physical therapist in Arkansas was found to be performing “spinal manipulations,” for which only chiropractors are licensed. After rigorous review by the Arkansas Board of Chiropractic Examiners, the defendant was found to be in violation of the Chiropractic Practice Act. The Arkansas Chiropractic Board levied a “civil penalty” of $10,000 following the determination that the chiropractic code had been violated.
The PT appealed the decision to the Arkansas Supreme Court, and the International Chiropractors Association (ICA) stepped forward to assist by filing a detailed and compelling Amicus Curiae brief in support of the Chiropractic Board’s decision. After the state appeal was rejected, the PTs appealed to the federal courts, but in a letter to the Arkansas Attorney General dated October 17, 2005, William K. Suter, Clerk of the Supreme Court of the United States announced that the “petition for a writ of certiorari is denied” and thus the previous rulings upholding the actions of the Arkansas State Board of Chiropractic Examiners stand. The text of ICA’s amicus brief is available on ICA’s website http://www.chiropractic.org/ pdf/ Arkansas.PDF .
“This is an historic and important case since the professional boundaries between PT and chiropractic are being challenged by physical therapy in an extra-legislative and sophisticated manner,” said Dr. Henry Rubinstein, who was hired expressly to take on this vitally important case because of his unique background. “The ICA wants chiropractors who have endured decades of harassment to achieve and maintain the recognition they deserve for the benefits that they bestow upon the public that the physical therapists now want to claim as their own.”
ICA was invited to submit a brief in the case by the Arkansas Attorney General, who is defending the Chiropractic Board, and ICA’s efforts were coordinated with the chiropractic community in the state to provide for maximum effectiveness. National physical therapy groups had intervened on behalf of the PT, and briefs were filed in the case with the Arkansas Supreme Court by the American Physical Therapy Association and the Federation of State Boards of Physical Therapy. Those groups, along with contributions from a number of individual PTs also funded the appeals through the federal court system. “The Arkansas State Board appreciates the ICA for its efforts in this important matter and feels this information will be invaluable on chiropractic’s behalf in this important legal contest,” said Dr. Beverly J. Foster, President of the Arkansas State Board of Chiropractic Examiners.
ICA will be studying each development in this vitally important arena as part of its ongoing effort to protect the boundaries and integrity of the chiropractic profession. ICA feels an obligation to be active on this issue as a means of protecting the public from less than fully trained professionals, and to preserve the unique chiropractic adjustment. ICA understands that doctors of chiropractic know the level of skill and training necessary to safely and effectively apply physical manipulation procedures, including chiropractic adjustments, and the public is entitled to no less.
