TEXAS CHIROPRACTIC ASSOCIATION

It’s an EMERGENCY—our profession is under attack and your help is needed.

The Texas Medical Association (TMA) has filed a lawsuit attacking Chiropractors’ ability to practice. TMA’s suit alleges that Diagnosis is the practice of medicine and not within the scope of chiropractic practice.

The Judge has issued a letter of intent to rule in favor of TMA but give Chiropractors the ability to Diagnose patients on a limited basis subject to revision of the Board of Chiropractic Examiners rule. The next attack will come in the Legislative session which begins in January.

This shallow victory also makes it possible for TMA to file more lawsuits and continue the attack on the profession. If TMA is able to legislatively limit the scope of practice, it will set a precedent for other states.

Any limit of a Chiropractor’s Scope of Practice is a loss for doctors of Chiropractic nationwide which the AMA orchestrated for the TMA. As one of the nation’s largest healthcare provider states, Texas was specifically targeted by the AMA. If TMA/AMA prevails legislatively Chiropractors will NO LONGER be able to: • File insurance claims • Practice on a cash basis • Practice UNLESS we have a referral from an M.D. or D.O. who has made a diagnosis for each patient.

The actions of the TMA/AMA are yet another attempt to eliminate the chiropractic profession. Texas is the beginning of an assault nationwide. If we don’t stop them here, we won’t be able to stop them.

YOU CAN TAKE ACTION TO STOP TMA/AMA IN ITS TRACKS.

The Texas Chiropractic Association (TCA) has launched a VIGOROUS CHIROPRACTIC DEFENSE and needs your FINACIAL HELP to continue fighting this lawsuit. We have established a Chiropractic Defense Fund , and you can contribute directly several ways:

• Visit www.chirotexas.org and click on the contribute directly to the Litigation Fund link • Reply to this email to pledge your financial support • Email us at [email protected] with your contact information for us to contact you • Call us at 512.477.9292 to let us know you want to fight back, too

JOIN the Texas Chiropractic Association in FIGHTING BACK to protect Chiropractors’ right to diagnose and practice to the fullest extent of our education and training. Please DONATE to the Chiropractic Defense Fund TODAY.

1122 Colorado St., Ste 307, Austin, TX 78701 * 512/477-9292 * FAX 512/477-9296 www.chirotexas.org

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Dynamic Chiropractic – September 23, 2010, Vol. 28, Issue 20

Texas DCs Fighting a Modern-Day Goliath

Texas chiropractors defend their right to diagnose as the powerful Texas Medical Association backs them into a corner.

By Peter W. Crownfield, Executive Editor

With their ability to perform needle electromyography and manipulation under anesthesia already in severe jeopardy courtesy of a November 2009 summary judgment by Judge Stephen Yelenosky, the 4,800-plus practicing chiropractors in Texas now face an even more ominous threat to their scope of practice - the right to diagnose - that could set a dangerous precedent for the profession nationwide.

While Yelenosky tabled the diagnosis issue when making his ruling regarding needle EMG and MUA late last year, the Texas Medical Association (TMA) is still pushing with its substantial political clout - and millions in PAC funds - for diagnosis to be declared completely outside chiropractic scope of practice. In his summary judgment, Yelenosky stated that he was reserving judgment on whether diagnosis constitutes the practice of medicine because "expert testimony is pertinent to that question."

However, on Aug. 17, 2010, Yelenosky issued a letter of intent announcing his intended ruling regarding the issue of diagnosis. While it is unknown as of press time when he will issue his ruling and how the TMA will react in the interim, the letter strongly suggests that diagnosis will be permitted in chiropractic practice - but that its application will be severely limited.

After reviewing the Yelenosky letter of intent, the Texas Chiropractic Association (TCA), a voluntary defendant in the TMA's suit against the Texas Chiropractic Board of Examiners, said it "believes TMA will likely appeal the ruling, when issued, because it does not completely eliminate chiropractors' ability to diagnose. The AMA and TMA have published on their websites the [medical] profession's intent to decrease the scope of practice of all complementary and alternative health care providers. Their list begins with chiropractors."

Fighting for Professional Livelihood

The Texas Medical Association filed suit against the Texas Board of Chiropractic Examiners in May 2006, alleging that needle EMG and MUA are surgical procedures and that diagnosis is a medical act by definition. Within months, the Texas Board of Medical Examiners joined the suit while the TCA, the state's sole chiropractic membership association and one of the largest in the country, joined the chiropractic board voluntarily as a defendant.

In an exclusive interview with Dr. Carter, Dr. Kevin Raef, TCA coordinator of governmental affairs, and TCA Executive Director Patte Kent, Dr. Carter noted that the current chiropractic practice act uses the definition of diagnosis, but not the term. It is the TMA's contention that the term diagnosis is

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synonymous with the practice of medicine and thus is reserved for MDs and DOs. In his letter of intent, Yelenosky explains that the medical dictionary definition of diagnosis does not limit its application tomedical doctors only. How the TMA will respond to this conclusion is unknown at this time.

The TCA is hoping to introduce legislation that would revise the state's 1989 chiropractic practice act to ensure diagnosis is clearly included in chiropractic scope in its most expansive form. According to Drs. Carter and Raef, legislation to revise the act would use language from other states' practice acts to create a more universal statute that would not only help Texas DCs, but also assist other states whose practice acts may require modification down the road.

Political, Not Personal?

Dr. Carter said that in his opinion, most medical doctors are not aware of the current suit, and Texas chiropractors generally have good working relationships with MDs, DOs and orthopedic surgeons throughout the state. He believes a select few within the TMA are responsible for pushing the suit forward and are motivated by "greed, diminishing health care dollars and a desire to monopolize the health care marketplace."

According to Dr. Carter, medical doctors in Texas (as in many areas of the country) are facing patient Recent/Ongoing Advocacy Efforts overload and doctor shortages in underserved by the TCA areas. With that said, he questions why the average

medical doctor would want to limit or altogether  Hired Anthony Phillips, a former Texas eliminate the referral relationship between MDs and Supreme Court justice, as an appeals DCs. He also emphasized that the TCA's ongoing attorney public-relations activities are not designed to  In the process of hiring several state polarize the medical and chiropractic professions in lobbyists to help introduce legislation to the eyes of the consumer, but rather to focus change the practice act to include a clear squarely on how removing or even restricting DCs' definition of diagnosis applicable to right to diagnose would impact patient choice and chiropractic access to chiropractic care.  Raised approximately $85,000 from various sources including the American Texas Medical Association vs. Chiropractic: Not Chiropractic Association, Parker College of the First Time Chiropractic and Texas Chiropractic College DC readers will recall that in May 2006 at the  Hired a PR firm to help develop multiple American Medical Association's interim meeting in media messages, including newspaper Dallas, the TMA delegation introduced Resolution articles, radio spots, etc., to reinforce the 814, Limited Licensure Health Care Provider chiropractor's right to diagnose and their Training and Certification Standards. The resolution overall value in patient care was designed specifically to study the qualifications,  Nearing completion of a patient advocacy education and academic requirements of "limited Web site that will be similar to the ACA's licensure health care providers and limited ChiroVoice.org in its ability to allow independent practitioners," including doctors of patients to contact their state legislators chiropractic. The resolution called for the TMA to allocate $171,975 to help fund and publish the study, and to provide a report of findings at the AMA's annual meeting later that year.

While it is not clear what the results of that study were or how any results may have played a role in the TMA's latest actions, what is clear is that the TMA is not afraid to flex its muscle when it comes to protecting its interests at the expense of non-MD/DO professions.

Defending Chiropractic: A Call for Profession-Wide Support

The TCA has filed 21 motions to dismiss the lawsuit and recently filed a motion for jury trial (which it has been requesting for the past year). In response, the TMA submitted its latest motion questioning TCA's standing to even be a party in the lawsuit and contending that Texas chiropractors have no legal

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interest in what the TMA constitutes as the unauthorized practice of medicine. As of press time, the TCA has been allowed to move forward with its defense of the scope-of-practice issue and remains a co-defendant, while a decision has not been made regarding a jury trial. If his lengthy and detailed letter of intent is any indication, Yelenosky plans on issuing a ruling regarding diagnosis in the near future, which would make the possibility of a jury trial that much more unlikely.

When legislation to revise the state's existing chiropractic scope of practice is introduced, the TCA said it plans on recruiting chiropractic organizations including the ACA, ICA and others to help get the act changed. The Association of Chiropractic Colleges and its member institutions will also be contacted for financial assistance, as well as for documentation of accreditation standards and curriculum that support chiropractors' qualifications and right to diagnose.

In an official statement, Dr. Rick McMichael, ACA president, emphasized the significance of the TBCE/TCA fight against organized medicine in Texas and offered the association's complete support going forward:

"The American Chiropractic Association stands with the Texas Chiropractic Association and the Texas Board of Chiropractic Examiners in their fight against the Texas Medical Association. This attempt by the TMA to remove Texas DCs' right to diagnose their patients' condition(s) is an outright attack on DCs as doctors and as physician-level health care providers.

"Doctors of chiropractic have long been educated and trained to examine, diagnose and assume responsibility for patient care. Assuming responsibility for patient care (and for referral when needed) requires diagnosis of patients' presenting conditions. The AMA has made it clear through its approved policies and its legislative efforts that it wants to remove the right of non-MD/DO providers to diagnose or to identify themselves as 'doctors' or 'physicians.' TMA and AMA realize that the responsibility to diagnose is central to the rights and privileges of a portal-of-entry, first-contact, primary health care provider (a doctor or physician). AMA has also made it clear that it would prefer current discriminatory policies in health care to continue by repealing recent health care reform language that seeks to end such discrimination.

"ACA has offered its full legal resources, including the services of its General Counsel and funding from the National Chiropractic Legal Action Fund (NCLAF). ACA will continue to support our Texas chiropractic leaders in this effort and we encourage all doctors of chiropractic to support the battle for DCs' diagnostic privileges in Texas."

For additional information regarding this significant lawsuit, visit www.tbce.state.tx.us and www.chirotexas.org. Further developments including Judge Yelenosky's ruling and the Texas Medical Board's response will be reported in the our next (Oct. 7) print issue and posted in advance on DynamicChiropractic.com.

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http://www.chiroeco.com/chiropractic/news/10099/52/nuhs-prepares-chiropractors-for-limited-prescription- powers-in-nm/

NUHS prepares chiropractors for limited prescription powers in N.M.

August 31, 2010 — The United States is experiencing a shortage of primary care family doctors. That’s why more than the last eight to 10 years, chiropractic associations in states with severe shortages of primary care physicians have sought to expand the scope of practice for chiropractic physicians.

They seek new laws and regulations that would allow chiropractic physicians to prescribe a limited range of medications in order to help their patients in a more comprehensive manner. These include medications that are common to conditions frequently seen by chiropractic physicians, such as anti-inflammatory drugs and drugs that treat ailments such as osteoporosis and arthritis.

By granting them the ability to prescribe select medications, specially trained and licensed DCs can help a significant number of patients who would otherwise be forced to seek simultaneous care from an already overburdened and limited pool of MDs in general practice.

To this end, several individual state chiropractic associations contacted experts at National University of Health Sciences (NUHS) in Lombard, Ill. and asked them to assess what additional training would be required to prepare chiropractic physicians to have a license to prescribe from a limited formulary of drugs.

Top NUHS faculty in pharmacology and chiropractic medicine examined and compared curricula from allopathic medical schools in addition to a wide range of medical specialty schools, such as: osteopathic medical schools, schools of podiatry, dentistry, psychology and those training nurse practitioners.

Each of these professions has also recently been granted authority to prescribe medications from a limited formulary.

NUHS determined that chiropractic physicians would need 90 hours of pharmacology in addition to the prerequisite physiology and biochemistry courses already required by accredited chiropractic education programs. (The DC program at NUHS already provides students with these 90 hours in pharmacology, but such requirements are not representative of all chiropractic institutions.)

At the same time that it was compiling its review, NUHS also launched an accredited masters of science degree program in advanced clinical practice. In anticipation that an expanded scope of chiropractic care would be part of the future, the MSACP program incorporated the 90 hours of advanced pharmacology coursework as part of its degree requirements as well.

One state, New Mexico, has already passed new regulations allowing chiropractic physicians with the right licensure and training to prescribe drugs from a limited formulary. The New Mexico Chiropractic Association asked NUHS if it would be willing to offer post-graduate coursework in Albuquerque delivering a 90-hour program in pharmacology to chiropractic physicians wanting to practice under the new expanded scope of care.

Teaching the New Mexico program is Dr. Daniel Richardson, assistant dean at NUHS, who holds a PhD in Pharmacology and Pharmocognosy from Loyola University, Stritch School of Medicine. “At the end of each module, the physicians must pass an examination,” Richardson says. “At the conclusion of the course, they must also pass a comprehensive examination given by the state association in order to be eligible to apply for a license and a DEA number.”

The physicians in the New Mexico program also receive training in injectable nutrients and drugs from Dr. Michael Taylor, a chiropractic physician who also holds a diplomate from the American Board of Chiropractic Internists.

More states are thinking about expanding the scope of practice for chiropractic physicians. In fact, several physicians attending the New Mexico program come from other states, in hope that they will be prepared for the future. Because of this growing interest, NUHS is also thinking about offering its MSACP in New Mexico as well, and is strategizing how to deliver similar programs in other states in the future.

“Chiropractic physicians are already licensed as primary care doctors in most states,” says Dr. James Winterstein, president of NUHS. “As health care policy-makers wrestle with the scarcity of general practice physicians, expanding the scope of chiropractic care to qualified chiropractic physicians makes good economic and strategic sense. New Mexico’s citizens will undoubtedly benefit from broadening health care delivery by chiropractic physicians, and we anticipate that more states will see the wisdom in this as well.”

Source: National Health Sciences University, www.nuhs.edu