HOUSE BILL REPORT

                      HB 2329

                     As Reported By House Committee on:

                                Health Care

Title:  An act relating to chiropractic.

Brief Description:  Modifying the chiropractic practice act.

Sponsor(s):  Representatives Ebersole, Miller, Morris, McLean, Prentice, Nelson, Dorn, Wilson, Chandler, H. Myers, Scott, Fuhrman, Cantwell, Day, Cooper, Franklin, Jacobsen, Nealey, Jones, Edmondson, Heavey, Paris, Wineberry, G. Cole, Ludwig, Bray, Mitchell, Brekke, Spanel, Sheldon, Leonard, Pruitt, P. Johnson and Appelwick.

Brief History:

   Reported by House Committee on:

Health Care, February 6, 1992, DPS.

HOUSE COMMITTEE ON

HEALTH CARE

Majority Report: The substitute bill be substituted therefor and the substitute bill do pass.  Signed by 7 members:  Representatives Braddock, Chair; Day, Vice Chair; Casada, Assistant Ranking Minority Member; Cantwell; Edmondson; Morris; and Prentice.

Minority Report: Do not pass.  Signed by 3 members:  Representatives Moyer, Ranking Minority Member; Paris; and Sprenkle.

Staff:  John Welsh (786-7104).

Background:  Chiropractic is a health care practice that is licensed by the state. 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, and physical examination to determine the necessity for chiropractic care. It includes the use of x-ray and analytical instruments, and the rendering of dietary advice. It does not include the dispensing of medicine or drugs nor the practice of obstetrics or surgery, nor x-ray for therapeutic purposes.

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

Summary of Substitute Bill:  The practice of chiropractic deals with the diagnosis or analysis, and care and treatment of the vertebral subluxation complex, articular dysfunction and musculoskeletal disorders. Definitions of vertebral subluxation complex, articular dysfunction, and musculoskeletal disorders are specified.

Chiropractic procedures include spinal adjustments, extremity manipulation, heat, cold, water, exercise, massage, trigger point therapy, dietary advice, normal regimen and rehabilitation of the patient, first aid, counseling on hygiene, and prevention measures.  Physiological therapeutic procedures are included, except for the application of sound, diathermy or electricity.

Definitions of chiropractic adjustment and extremity manipulation are provided. Extremity manipulation is a corrective thrust applied to a joint of the appendicular skeleton that is complementary to and preparatory to a chiropractic spinal adjustment, and no separate or additional billing for this procedure is permissible.

A chiropractic differential diagnosis, as defined, includes a physical examination, diagnostic x-rays, and such other procedures and devices as determined by the Chiropractic Disciplinary Board.

Chiropractic care does not include the prescription and dispensing of drugs, the practice of obstetrics or surgery, the use of x-rays for therapeutic purposes, colonic irrigation or venipuncture.

The practice of the regulated health professions within their respective scopes of practice are not affected.

Substitute Bill Compared to Original Bill:  An amendment was added that declared that extremity manipulation was a part of a spinal adjustment, and no separate or additional billing for it was permissible.

Fiscal Note:  Requested January 29, 1992.

Effective Date of Substitute Bill:  The bill contains an emergency clause and takes effect immediately.

Testimony For:  The purpose of this legislation is principally to expand the chiropractic scope of practice to include the manipulation of extremity joints, complementary to a spinal adjustment. In addition, the practice act is clarified in a number of regards, such as the use of the term "diagnosis" to determine the need for chiropractic care. Extremity adjustment is permissible in 47 states. This bill will bring the practice act up to date with other practice acts and permit chiropractors to practice in accordance with their education and training.

Testimony Against:  This bill broadly expands the chiropractic scope of practice beyond what chiropractors can do consistent with their training. The bill would permit them to treat all extremities, as well as problems of the muscle structure and skeleton, including primary care and neurologic conditions. Some 25 percent of reimbursement under workers' compensation goes toward chiropractic care. It will rise to 50 percent if this bill passes.

Witnesses:  Karl Nelson, Washington State Medical Association (con); Dr. Ken Martin, Washington State Medical Association; and Courtney Nevitt, Department of Labor and Industries (con).