H-3333.1  _______________________________________________

                          HOUSE BILL 2591

          _______________________________________________

State of Washington      53rd Legislature     1994 Regular Session

By Representatives Appelwick, Fuhrman, Dorn, Anderson, Kessler, Schoesler, Brough, Chandler, Edmondson, Cooke, Long, Talcott, Stevens, B. Thomas, R. Meyers, Ogden, Scott, Jones, Moak, Kremen, Roland and King

Read first time 01/19/94.  Referred to Committee on Health Care.

Including chiropractors as primary care providers.

    AN ACT Relating to chiropractic; amending RCW 18.25.005; and adding a new section to chapter 18.25 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

    Sec. 1.  RCW 18.25.005 and 1992 c 241 s 2 are each amended to read as follows:

    (1) Chiropractic is the practice of health care that deals with the diagnosis or analysis and care or treatment of the vertebral subluxation complex and its effects, articular dysfunction, and musculoskeletal disorders, all for the restoration and maintenance of health and recognizing the recuperative powers of the body.

    (2) Chiropractic treatment or care includes the use of procedures involving spinal adjustments, and extremity manipulation insofar as any such procedure is complementary or preparatory to a chiropractic spinal adjustment.  Chiropractic treatment also includes the use of heat, cold, water, exercise, massage, trigger point therapy, dietary advice and recommendation of nutritional supplementation ((except for medicines of herbal, animal, or botanical origin)), the normal regimen and rehabilitation of the patient, first aid, and counseling on hygiene, sanitation, and preventive measures.  Chiropractic care also includes such physiological therapeutic procedures as traction and light, but does not include procedures involving the application of sound, diathermy, or electricity.

    (3) As part of a chiropractic differential diagnosis, a chiropractor shall perform a physical examination, which may include diagnostic x-rays, to determine the appropriateness of chiropractic care or the need for referral to other health care providers.  The chiropractic disciplinary board shall provide by rule for the type and use of diagnostic and analytical devices and procedures consistent with this chapter.

    (4) Chiropractic care shall not include the prescription or dispensing of any medicine or drug, the practice of obstetrics or surgery, the use of x-rays or any other form of radiation for therapeutic purposes, colonic irrigation, or any form of venipuncture.

    (5) Nothing in this chapter prohibits or restricts any other practitioner of a "health profession" defined in RCW 18.120.020(4) from performing any functions or procedures the practitioner is licensed or permitted to perform, and the term "chiropractic" as defined in this chapter shall not prohibit a practitioner licensed under chapter 18.71 RCW from performing medical procedures, except such procedures shall not include the adjustment by hand of any articulation of the spine.

NEW SECTION. Sec. 2.  A new section is added to chapter 18.25 RCW to read as follows:

    (1) A chiropractor is a primary care provider.  As a primary care provider, a chiropractor:

    (a) Is a point of entry into the health care system for patients who seek health care without being referred by another health care provider and regardless of the nature of the health care problem; and

    (b) Is responsible for evaluation of a patient's health by conducting physical examinations and performing such tests as are necessary, within the chiropractic scope of practice, to determine the need for chiropractic treatment or referral to other health care providers; and

    (c) Coordinates or manages the health care of the patient by appropriate chiropractic treatment, referral to other appropriate providers, and provision of quality assurance of care; and

    (d) Provides comprehensive and continuous preventive and therapeutic care within the chiropractic scope of practice.

    (2) Chiropractors shall be recognized to be primary care providers so that an enrollee in a certified health plan under RCW 43.72.100 may utilize the health care services of a chiropractor as the enrollee's point of entry to health services in this state.

    (3) In consultation with the health services commission, the chiropractic disciplinary board shall provide rules to carry out the intent of this section.

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