AN ACT
Relating to chiropractic; amending RCW 18.25.005 and 18.25.006; adding a new
section to chapter 18.25 RCW; creating a new section; and declaring an
emergency.
BE IT ENACTED BY THE LEGISLATURE
OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. This
act is intended to expand the scope of practice of chiropractic only with
regard to adjustment of extremities in connection with a spinal adjustment.
Sec.
2. RCW
18.25.005 and 1974 ex.s. c 97 s 7 are each amended to read as follows:
((For
the purpose of chapters 18.25 and 18.26 RCW, the term "chiropractic"
shall mean and include that practice of health care which deals with the
detection of subluxations, which shall be defined as any alteration of the
biomechanical and physiological dynamics of contiguous spinal structures which
can cause neuronal disturbances, the chiropractic procedure preparatory to, and
complementary to the correction thereof, by adjustment or manipulation of the
articulations of the vertebral column and its immediate articulations for the
restoration and maintenance of health; it includes the normal regimen and
rehabilitation of the patient, physical examination to determine the necessity
for chiropractic care, the use of x-ray and other analytical instruments
generally used in the practice of chiropractic: PROVIDED, That no chiropractor
shall prescribe or dispense any medicine or drug nor practice obstetrics or
surgery nor use x-rays for therapeutic purposes: PROVIDED, HOWEVER, That the
term "chiropractic" as defined in this act shall not prohibit a
practitioner licensed under chapter 18.71 RCW from performing accepted medical
procedures, except such procedures shall not include the adjustment by hand of
any articulation of the spine: AND PROVIDED FURTHER, That nothing herein shall
be construed to prohibit the rendering of dietary advice.))
(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.
Sec.
3. RCW
18.25.006 and 1991 c 3 s 36 are each amended to read as follows:
Unless
the context clearly requires otherwise, the definitions in this section apply
throughout this chapter.
(1)
"Department" means the department of health.
(2)
"Secretary" means the secretary of the department of health or the
secretary's designee.
(3)
"Chiropractor" means an individual licensed under this chapter.
(4)
"Board" means the Washington state board of chiropractic examiners.
(5)
"Vertebral subluxation complex" means a functional defect or
alteration of the biomechanical and physiological dynamics in a joint that may
cause neuronal disturbances, with or without displacement detectable by x-ray.
The effects of the vertebral subluxation complex may include, but are not
limited to, any of the following: Fixation, hypomobility, hypermobility,
periarticular muscle spasm, edema, or inflammation.
(6)
"Articular dysfunction" means an alteration of the biomechanical and
physiological dynamics of a joint of the axial or appendicular skeleton.
(7)
"Musculoskeletal disorders" means abnormalities of the muscles,
bones, and connective tissue.
(8)
"Chiropractic differential diagnosis" means a diagnosis to determine
the existence of a vertebral subluxation complex, articular dysfunction, or
musculoskeletal disorder, and the appropriateness of chiropractic care or the
need for referral to other health care providers.
(9)
"Chiropractic adjustment" means chiropractic care of a vertebral
subluxation complex, articular dysfunction, or musculoskeletal disorder. Such
care includes manual or mechanical adjustment of any vertebral articulation and
contiguous articulations beyond the normal passive physiological range of
motion.
(10)
"Extremity manipulation" means a corrective thrust or maneuver
applied to a joint of the appendicular skeleton. The use of extremity
manipulation shall be complementary and preparatory to a chiropractic spinal
adjustment to support correction of a vertebral subluxation complex and is
considered a part of a spinal adjustment and shall not be billed separately from
or in addition to a spinal adjustment.
NEW
SECTION. Sec. 4. A new
section is added to chapter 18.25 RCW to read as follows:
All
state health care purchasers shall have the authority to set service and fee
limitations on chiropractic costs. The health care authority shall establish
pilot projects in defined geographic regions of the state to contract with
organizations of chiropractors for a prepaid capitated amount.The text of the following section has been vetoed by the
Governor. It is noted in bold italic.
*
NEW SECTION. Sec. 5. This
act is necessary for the immediate preservation of the public peace, health, or
safety, or support of the state government and its existing public
institutions, and shall take effect immediately.
*Sec. 5
was vetoed, see message at end of chapter.
Passed the Senate March 8, 1992.
Passed the House March 6, 1992.
Approved by the Governor April 3,
1992, with the exception of certain items which were vetoed.
Filed in Office of Secretary of State April 3, 1992.
Note: Governor's explanation of partial veto is as follows:
"I
am returning herewith, without my approval as to section 5, Engrossed Senate
Bill No. 6054 entitled:
"AN ACT Relating to
Chiropractic."
Section
5 of Engrossed Senate Bill No. 6054 implements this bill immediately. The
language in the bill is ambiguous concerning the ability of chiropractors to
treat problems originating in the extremities. The proponents of the bill
assure me that the expansion in the scope of practice does not include disorders
that originate in the extremities. I have asked the Chiropractic Disciplinary
Board to clarify this issue in rule.
For
these reasons, I have vetoed section 5 of Engrossed Senate Bill No. 6054.
With the
exception of section 5, Engrossed Senate Bill No. 6054 is approved."
