SUBSTITUTE HOUSE BILL 1629







                        52nd Legislature

                      1991 Regular Session



Passed by the House March 12, 1991

  Yeas 75   Nays 21




Speaker of the

       House of Representatives


Passed by the Senate April 16, 1991

  Yeas 44   Nays 3




President of the Senate












Governor of the State of Washington



I, Alan Thompson, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is SUBSTITUTE HOUSE BILL 1629 as passed by the House of Representatives and the Senate on the dates hereon set forth.




                                      Chief Clerk











                        Secretary of State   

                       State of Washington  




                            SUBSTITUTE HOUSE BILL 1629



                             AS AMENDED BY THE SENATE


                     Passed Legislature - 1991 Regular Session



State of Washington              52nd Legislature             1991 Regular Session


By House Committee on Health Care (originally sponsored by Representatives Prentice, Wood, R. Meyers, Franklin, Day, Miller, Ludwig, Morris, Pruitt, Brough, Braddock, Anderson, Betrozoff, Cooper, Fuhrman, R. King, McLean, Cantwell, Leonard, Kremen, Nealey, Phillips, P. Johnson, Wynne and Dorn).


Read first time February 28, 1991.  Redefining the practice of chiropractic.

     AN ACT Relating to chiropractic; amending RCW 18.25.040 and 18.25.090; adding a new section to chapter 18.25 RCW; adding new sections to chapter 18.26 RCW; and creating a new section.




     NEW SECTION.  Sec. 1.      Unless the context clearly requires otherwise, the definitions in this section apply throughout sections 2 through 7 of this act.

     (1) "Accepted standards" means those standards of practice, skill, and treatment that are recognized by a reasonably prudent chiropractor as being acceptable under similar conditions and circumstances.

     (2) "Appropriate chiropractic treatment" means treatment and other services performed or ordered, in connection with a substantiated and properly documented condition, which would appear to a reasonably prudent chiropractor to be consistent with the diagnosis or analysis presented.

     (3) "Excessive" fees or costs means charges above the usual and customary charges in that service area as paid by public and private third-party payors.

     (4) "Patient" means an individual who receives chiropractic evaluation or treatment, or both.

     (5) "Peer review committee" means the committee established under section 2 of this act.

     (6) "Peer review proceeding" or "peer review" means an evaluation, based on accepted standards, by the peer review committee, of the appropriateness, quality, utilization, and cost of health services provided to a patient.  Peer review does not include matters related to the licensing, discipline, or scope of practice of any health care profession.

     (7) "Properly utilized services" means appropriate services rendered or ordered, including the frequency and duration of such services, which are documented as being necessary and reasonable by clinical records and reports or by other facts, presentations, or evidence reviewed by the peer review committee.

     (8) "Services rendered" means all services provided to a patient.


     NEW SECTION.  Sec. 2.      (1) The board shall appoint the peer review committee, which shall be constituted as follows:  The chair of the peer review committee shall be a member of the board and shall not vote except to break a tie; one chiropractor from each congressional district; one independent member representative of the health insurance industry; and one representative from the department of labor and industries.  The term of appointment of peer review committee members shall be one year, and no member shall serve more than four consecutive terms.  The board may appoint additional pro tem members as necessary.  Chiropractor members shall have at least five years of active practice in this state.  The board shall adopt rules establishing other qualifications for appointment of the chiropractic members to the peer review committee, including rules to avoid conflict of interest or the appearance of conflict of interest.

     (2) The peer review committee may be compensated in accordance with RCW 43.03.240 and may be paid travel expenses while engaged in the business of the committee in accordance with RCW 43.03.050 and 43.03.060.


     NEW SECTION.  Sec. 3.      (1) A patient, a patient's representative, an insurer, an agency of the state of Washington, or a chiropractor may request a peer review proceeding by submitting an inquiry about services rendered to a patient by a chiropractor.  The board shall, in its discretion, determine whether the inquiry should be reviewed as a peer review proceeding, as a matter for possible voluntary mediation, or as a disciplinary proceeding.  Peer review shall not be used to replace the independent medical/chiropractic examination.

     (2) Request for peer review constitutes consent to submission by the requesting party of all necessary records and other information concerning the chiropractic services rendered.  Chiropractors licensed under this chapter who are a party to the peer review are required to submit all necessary records and other information concerning services rendered by the chiropractor.

     (3) All costs associated with conducting peer review under this chapter shall be borne by the chiropractic profession as part of the licensing fees.  Notwithstanding, the board shall assess a fee to cover the costs of the review when the requesting party is a chiropractor or a third-party payor.


     NEW SECTION.  Sec. 4.      (1) The peer review committee may review matters regarding the appropriateness, quality, utilization, or cost of chiropractic services rendered.  The peer review committee on each review shall include in its findings a determination whether appropriate chiropractic treatment was rendered, whether the services rendered were properly utilized services, whether treatment or services rendered or ordered were appropriate in accordance with accepted standards, and whether the fees charged were excessive or not.

     (2) The committee may appoint subcommittees to assist it in conducting peer review.  All activities of the subcommittees shall be reviewed and approved or disapproved by the committee.

     (3) The peer review committee shall submit to all parties and to the board a decision setting forth the committee's findings and recommendations.

     (4) Any party may appeal the decision to the board.  The board, on the record of the peer review committee, may return the proceeding with recommendations to the committee for reconsideration, may initiate disciplinary proceedings, or may approve the decision of the peer review committee, or may take any combination of the above actions.


     NEW SECTION.  Sec. 5.      The peer review committee shall file with the board a complaint against a chiropractor if the committee determines that reasonable cause exists to believe the chiropractor has committed unprofessional conduct.  The peer review committee shall transmit all information pertinent to the complaint to the board.  Such information shall be confidential and shall be used solely for disciplinary purposes.


     NEW SECTION.  Sec. 6.      The board shall prepare a biennial report summarizing its peer review decisions and shall include such report as part of the board's report requirements under RCW 18.130.310.  The published summary of peer review decisions shall not be used and shall not serve as the basis for establishing appropriate fee schedules or treatment regimes for the profession.


     NEW SECTION.  Sec. 7.      No findings or decisions of the peer review committee shall have any effect on or be admissible in any court proceeding or administrative proceedings conducted under another chapter of the Revised Code of Washington.


     Sec. 8.  RCW 18.25.040 and 1991 c 3 s 39 are each amended to read as follows:

     Persons licensed to practice chiropractic under the laws of any other state, territory of the United States, the District of Columbia, Puerto Rico, or province of Canada, having ((equal requirements of)) qualifications substantially equivalent to those required by this chapter, may, in the discretion of the board of chiropractic examiners, and after such examination ((by the board in principles of chiropractic, x-ray, and adjusting, as taught by chiropractic schools and colleges)) as may be required by rule of the board, be issued a license to practice in this state without further examination, upon payment of a fee determined by the secretary as provided in RCW 43.70.250.


     Sec. 9.  RCW 18.25.090 and 1989 c 258 s 6 are each amended to read as follows:

     On all cards, books, papers, signs or other written or printed means of giving information to the public, used by those licensed by this chapter to practice chiropractic, the practitioner shall use after or below his or her name the term chiropractor, chiropractic physician, D.C., or D.C.Ph.C., designating his or her line of drugless practice, and shall not use the letters M.D. or D.O.:  PROVIDED, That the word doctor or "Dr." or physician may be used only in conjunction with the word "chiropractic" or "chiropractor".  Nothing in this chapter shall be held to apply to or to regulate any kind of treatment by prayer.


     NEW SECTION.  Sec. 10.  A new section is added to chapter 18.25 RCW to read as follows:

     Nothing in this chapter shall be construed to prohibit:

     (1) The temporary practice in this state of chiropractic by any chiropractor licensed by another state, territory, or country in which he or she resides.  However, the chiropractor shall not establish a practice open to the general public and shall not engage in temporary practice under this section for a period longer than thirty days.  The chiropractor shall register his or her intention to engage in the temporary practice of chiropractic in this state with the board of chiropractic examiners before engaging in the practice of chiropractic, and shall agree to be bound by such conditions as may be prescribed by rule by the board.

     (2) The practice of chiropractic, except the administration of a chiropractic adjustment, by a person who is a regular senior student in an accredited school of chiropractic approved by the board if the practice is part of a regular course of instruction offered by the school and the student is under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board.

     (3) The practice of chiropractic by a person serving a period of postgraduate chiropractic training in a program of clinical chiropractic training sponsored by a school of chiropractic accredited in this state if the practice is part of his or her duties as a clinical postgraduate trainee and the trainee is under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board.

     (4) The practice of chiropractic by a person who is eligible and has applied to take the next available examination for licensing offered by the board of chiropractic examiners, except that the unlicensed chiropractor must provide all services under the direct control and supervision of a licensed chiropractor approved by the board.  The unlicensed chiropractor may continue to practice as provided by this subsection until the results of the next available examination are published, but in no case for a period longer than six months.  The board shall adopt rules necessary to effectuate the intent of this subsection.

     Any provision of chiropractic services by any individual under subsection (1), (2), (3), or (4) of this section shall be subject to the jurisdiction of the chiropractic disciplinary board as provided in chapters 18.26 and 18.130 RCW.


     NEW SECTION.  Sec. 11.     The board may adopt rules necessary and appropriate to implement sections 1 through 7 of this act.


     NEW SECTION.  Sec. 12.     Sections 1 through 7 of this act are each added to chapter 18.26 RCW.