HOUSE BILL REPORT

HB 1492

BYRepresentatives Ebersole, D. Sommers, Vekich, Cantwell, Chandler, Jones, Morris, Day, May, R. Meyers, Anderson, P. King and Phillips

Defining chiropractic care.

House Committe on Health Care

Majority Report:  The substitute bill be substituted therefor and the substitute bill do pass.  (7)

      Signed by Representatives Braddock, Chair; Day, Vice Chair; Cantwell, Chandler, Morris, D. Sommers and Vekich.

Minority Report:  Do not pass.  (3)

      Signed by Representatives Brooks, Ranking Republican Member; Prentice and Sprenkle.

House Staff:John Welsh (786-7133)

AS REPORTED BY COMMITTEE ON HEALTH CARE JANUARY 31, 1990

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.  It includes physical examinations to determine the necessity for chiropractic care and the use of analytical instruments, such as x-ray.

Chiropractic does not presently include nonspinal procedures, such as the manipulation of extremities, or diagnosis.  There are no specific references to vertical subluxation complex, articular dysfunction, and neoromusculoskeletal disorders.  There are also no specific references to nutritional supplementation, first aid and counseling.

Chiropractors are prohibited from dispensing any medicine or drugs, practicing obstetrics or surgery or using x-rays for therapeutic purposes, although dietary advice may be rendered.

There is no prohibition against the use of diathermy or electricity, nor performing colonic irrigations and venipuncture.

Chiropractors may identify themselves as "chiropractors","D.C.", "D.C.Ph.C.", or "Dr." in conjunction with the word chiropractic or chiropractor.

There is no exemption from licensure provided for persons practicing chiropractic in this state.

SUMMARY:

SUBSTITUTE BILL:  Chiropractic is defined as an alternative health care practice providing a point of entry into the health care system for 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.  The scope is also expanded to include differential diagnosis for determining the nature and appropriateness of chiropractic treatment or for referral.

Chiropractic services are clarified to include the care and management of the vertical subluxation complex, articular dysfunction, and neuromusculoskeletal disorders, as determined by the board, through manipulation, heat, cold, exercise and physiological procedures.

Chiropractic also includes recommendation of nutritional supplementation; the normal rehabilitation of the patient; first aid; and counseling on hygiene and preventive measures.

The use of diathermy or electricity is prohibited. Chiropractors are also prohibited from performing colonic irrigations and venipuncture.

Practitioners may refer to themselves as chiropractors or chiropractic physicians in addition to their other titles.

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.

The bill contains an emergency clause.

SUBSTITUTE BILL COMPARED TO ORIGINAL:  The substitute made the following changes:  Chiropractic is described as an alternative, rather than as a primary, health care practice.  Existing language was restored prohibiting physicians from adjusting spinal articulations by hand, and permitting chiropractic practitioners from using the title "chiropractor." References to somatic dysfunction were deleted.  The bill sections were reorganized.

Fiscal Note:      Available.

Effective Date:The bill takes effect immediately.

House Committee ‑ Testified For:    Steve Wehrly, Washington Chiropractic Association, United Chiropractors of Washington and Chiropractic Society of Washington; Dan Hansen.

House Committee - Testified Against:      Len Eddinger and Dr. Alan Roser, Washington State Medical Association Jeff Larsen, Washington Osteopathic Medical Association; Dr. Dan Labriola, Washington Association of Naturopathic Physicians; Ken Bertrand, Group Health Cooperative; Basil Badley, Health Insurance Association of America and American Insurance Association;

House Committee - 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.

House Committee - Testimony Against:      Chiropractors are not qualified to recommend nutritional supplementation in the area of botanical substances.  There is concern over the expansions of chiropractic practice beyond the spinal manipulation.  There is an absence of practice standards for nonspinal chiropractic conditions. There are no training requirements or the proper use of new diagnostic procedures.