HOUSE BILL REPORT

                      HB 1629

                     As Reported By House Committee on:

                                Health Care

Title:  An act relating to chiropractic.

Brief Description:  Redefining the practice of chiropractic.

Sponsor(s):  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.

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:  Chiropractic is a health care profession directly accessible by the public, and chiropractors must be licensed by the State in order to practice their services.  The chiropractic scope of practice involves primarily the detection and correction of neuronal disturbances of the spine by adjustment and manipulation of the vertebral column and its immediate articulations, as well as the normal regimen and rehabilitation of the patient.

Chiropractic does not presently include nonspinal procedures, such as the manipulation of extremities.

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 Substitute Bill:  Chiropractic is defined as an alternative health care practice providing a point of entry into the health care system for the treatment or referral of patients.

The chiropractic scope of practice is expanded to include nonspinal procedures, including manipulation of extremities complementary to or preparatory to a chiropractic spinal adjustment. 

Practitioners may refer to themselves as "chiropractic physicians" in addition to their 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.

Substitute Bill Compared to Original Bill:  The provisions for diagnosis, nutritional supplementation, counseling and first aid are deleted, as well as references to management of the vertebral subluxation complex, articular dysfunction, and neuromusculoskeletal disorders.  The emergency clause is also deleted.

Fiscal Note:  Requested February 7, 1991.

Effective Date of Substitute Bill:  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).