HOUSE BILL REPORT

                     SHB 1629

                           As Passed Legislature

Title:  An act relating to chiropractic.

Brief Description:  Redefining the practice of chiropractic.

Sponsor(s):  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).

Brief History:

   Reported by House Committee on:

Health Care, February 27, 1991, DPS;

Passed House, March 12, 1991, 75-21;

Amended by Senate;

House concurred;

Passed Legislature, 94-0.

HOUSE COMMITTEE ON

HEALTH CARE

Majority Report: That Substitute House Bill No. 1629 be substituted therefor, and the substitute bill do pass.  Signed by 10 members:  Representatives Braddock, Chair; Day, Vice Chair; Moyer, Ranking Minority Member; Casada, Assistant Ranking Minority Member; Cantwell; Edmondson; Franklin; Morris; Paris; and Prentice.

Minority Report: Without recommendation.  Signed by 1 member:  Representative Sprenkle.

Staff:  John Welsh (786-7133).

Background:  The practice of chiropractic is regulated by the state, and chiropractors must be licensed in order to practice.  Chiropractic involves primarily the detection and correction of neuronal disturbances of the spine by adjustment and manipulation of the vertebral column and its immediate articulations.

There is no peer review process established by law for evaluating the quality, utilization and cost of chiropractic services provided to the public.

Chiropractors may identify themselves as "chiropractors," "D.C.," "D.C.Ph.C.," or "Dr." in conjunction with the word chiropractic or chiropractor.  The use of the title "chiropractic physician" is not presently authorized.  However, the use of the title of "physician" is not prohibited by law so long as it is employed in connection with a description of another branch of the healing arts.

Chiropractors licensed in other states may be granted a license to practice in this state, if their states of origin have equal standards, and they complete examinations in chiropractic, x-ray and adjustment.

There is no exemption from the requirement of licensure provided for students, clinical postgraduate trainees, or eligible applicants for the examination practicing chiropractic in this state.

Summary of Bill:  A peer review committee is established, composed of eight chiropractors, a member of the Chiropractic Disciplinary Board serving as chair, a representative of the insurance industry, and a member representing the state Department of Labor and Industries.

Peer review may be initiated by a patient, a state agency or a chiropractor.  Peer review includes an evaluation of appropriate quality, utilization and the cost of chiropractic services provided to a patient.  It excludes issues associated with licensure, scope of practice and discipline.  The Chiropractic Disciplinary Board determines each request for review as appropriate for either review by the Peer Review Committee, voluntary mediation or discipline.  The costs associated with peer review proceedings are to be borne by the chiropractic profession as general regulatory costs, except that the board must assess a fee if the requesting party is a chiropractor or third party.

Findings and recommendations of the Peer Review Committee are to be submitted to the board for approval, and are appealable to the board.  The committee is to file complaints with the board in those cases involving any alleged unprofessional conduct.

The board is required to report to the Legislature on a biennial basis summarizing its peer review activities.

Chiropractors may refer to themselves as "chiropractic physicians" in addition to other titles.

Chiropractors licensed in US territories, the District of Columbia, Puerto Rico, and Canada, as well as in other states, may be granted a license to practice, if those jurisdictions have substantially equivalent qualifications and applicants complete any examinations required by the board.

Exemptions from licensure are provided for chiropractors from other jurisdictions practicing temporarily in this state; for regular senior students enrolled in accredited chiropractic schools; for clinical postgraduate trainees; and for eligible applicants for the licensing examination who practice under the direct supervision of a licensed chiropractor.  Persons exempted from licensure are subject to disciplinary procedures provided by law.

Fiscal Note:  Requested February 7, 1991.

Effective Date:  Ninety days after adjournment of session in which bill is passed.

Testimony For:  The expansion of the scope of practice to include nonspinal procedures, such as the manipulation of extremities, complementary to a spinal adjustment, is standard chiropractic practice done in the other 49 states. It is taught in the schools as a normal part of the curriculum.  Chiropractic practice should be up‑dated in this State to reflect current notions in the healing arts and new terminology.  The use of the title chiropractic physician is already authorized and used by the profession.

Testimony Against:  There is concern over the expansions of chiropractic practice beyond the spinal manipulation. There is an absence of practice standards for nonspinal chiropractic conditions.

Witnesses:  Margaret Stanley, Health Care Authority (con); Steve Wehrly and Kelli Pearson, Washington Chiropractic Association (pro); Thomas Campbell, Washington Chiropractic Trust (pro); Peter McGough, Washington State Medical Association (con); Frank Morrison, Washington State Podiatric Medicine Association (con); Jeff Larsen, Washington Association of Naturopathic Physicians (con); Mel Sorensen, Washington Physicians Service and Blue Cross (con); and Enid Layes, Association of Washington Business (con).