AN ACT Relating to chiropractic; amending RCW 18.25.005 and 18.25.090; adding new sections to chapter 18.25 RCW; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. Section 7, chapter 97, Laws of 1974 ex. sess. and RCW 18.25.005 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.))

The term "chiropractic" shall include the adjustment by hand of any articulation of the spine.

NEW SECTION. Sec. 2. A new section is added to chapter 18.25 RCW to read as follows:

(1)(a) "Chiropractic" means the alternative health care practice that detects, cares for, and manages the vertebral subluxation complex, articular dysfunction, and neuromusculoskeletal disorders, all for the restoration and maintenance of health, as determined by rules of the chiropractic disciplinary board. As a healing arts profession, chiropractic is a science, art, and philosophy that deals with health and disease in persons who choose to be treated by chiropractors, whether as the initial health care provider or as the result of referral from other health care providers.

(b) As an "alternative health care practice," chiropractic provides a point of entry into the health care system and a coordinating and referral point to other providers, as appropriate.

(c) "Vertebral subluxation complex" is a functional defect or an alteration of the biomechanical and physiological dynamics in a joint, with or without displacement detectable by x-ray, which may include, but is not limited to, any of the following: Fixation, hypomobility, hypermobility, periarticular muscle spasm, edema, or inflammation and the defect or alteration may cause neuronal disturbances.

(d) "Articular dysfunction" is an alteration of the biomechanical and physiological dynamics of the joints of the axial or appendicular skeleton.

(e) "Chiropractic adjustment" is chiropractic care of a vertebral subluxation complex, articular dysfunction, or neuromusculoskeletal disorder. Such care includes manual or mechanical adjustment of any vertebral articulation beyond the normal passive physiological range of motion.

(2)(a) Chiropractic care includes consultation, examination, analysis, diagnosis, and treatment.

(b) A "chiropractic differential diagnosis" is a diagnosis to determine the nature of a vertebral subluxation complex, articular dysfunction, or neuromusculoskeletal disorder and the appropriateness of chiropractic care, or to recognize the need for referral to other health care providers, or both.

(c) "Examination, analysis, and diagnosis" may include the use of physical, clinical, thermal, laboratory, x-ray, or other generally accepted diagnostic analytical methods and devices. The extent and necessity of analytical and diagnostic tests shall be based upon objective findings, progress of the patient, and the professional judgment of the chiropractor.

(d) Chiropractic care incorporates the use of chiropractic adjustment and other manipulative procedures to manage vertebral subluxations and relieve aberrations of the neuromusculoskeletal system that may cause neuronal disturbances. Chiropractic care may include the manipulation or mobilization of extremities only insofar as any such nonspinal procedure is used in a manner complementary or preparatory to a chiropractic spinal adjustment.

(e) Chiropractic care also includes the use of procedures involving manipulation and mobilization, heat, cold, water, and exercise, and includes such physiological therapeutic procedures and instruments as traction and light, but does not include procedures involving the application of sound, diathermy, or electricity.

(f) Chiropractic care may include the provision of dietary advice and recommendation of nutritional supplementation, which is defined as vitamins, minerals, foods, food concentrates, or food extracts, for the restoration and maintenance of health. Such care may also include the normal regimen and rehabilitation of the patient, first aid, and counseling on hygiene, sanitation, and preventive measures.

(3) 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.

(4) Nothing in this chapter prohibits or restricts any other practitioner of a "health profession" defined in RCW 18.120.020(4) from performing any health care functions or procedures the practitioner is licensed or permitted to perform under this title, and the term chiropractic as defined in this section 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.

Sec. 3. Section 15, chapter 5, Laws of 1919 as last amended by section 6, chapter 258, Laws of 1989 and RCW 18.25.090 are each amended to read as follows:

On all cards, books, papers, signs or other written or printed means of giving information to the public, used by those licensed by this chapter to practice chiropractic, the practitioner shall use after or below his or her name the term chiropractor, chiropractic physician, D.C., or D.C.Ph.C., designating his or her line of drugless practice, and shall not use the letters M.D. or D.O.: PROVIDED, That the word doctor or "Dr." or physician may be used only in conjunction with the word "chiropractic" or "chiropractor". Nothing in this chapter shall be held to apply to or to regulate any kind of treatment by prayer.

NEW SECTION. Sec. 4. A new section is added to chapter 18.25 RCW to read as follows:

Nothing in this chapter shall be construed to prohibit:

(1) The temporary practice in this state of chiropractic by any chiropractor licensed by another state, territory, or country in which he or she resides: PROVIDED, That such chiropractor shall register his or her intention to engage in the temporary practice of chiropractic in this state with the board of chiropractic examiners before engaging in the practice of chiropractic in this state and shall agree to be bound by such reasonable and necessary conditions as may be prescribed by rule by the board of chiropractic examiners;

(2) The practice of chiropractic, except the administration of a chiropractic adjustment, by a person who is a regular senior student in an accredited school of chiropractic approved by the board of chiropractic examiners: PROVIDED, That the performance of such services shall be pursuant to a regular course of instruction in the student's school of chiropractic and that such services shall be performed only under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board of chiropractic examiners;

(3) The practice of chiropractic by a person serving a period of postgraduate chiropractic training in a program of clinical chiropractic training sponsored by a school of chiropractic accredited in this state: PROVIDED, That the performance of such services shall only be pursuant to his or her duties as a clinical postgraduate trainee and that such services shall be performed only under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board of chiropractic examiners;

(4) The practice of chiropractic by a person who is eligible and has applied to take the next available examination for licensing offered by the board of chiropractic examiners: PROVIDED, That the unlicensed chiropractor must perform all services under the direct control and supervision of a licensed chiropractor approved by the board of chiropractic examiners. The unlicensed chiropractor may continue to practice as provided by this subsection until the results of the next available examination are published, but in no case for a period longer than six months. The board of chiropractic examiners shall adopt rules necessary to effectuate the intent of this subsection.

(5) Any provision of chiropractic services by any individual under subsection (1), (2), (3), or (4) of this section shall be subject to the jurisdiction of the chiropractic disciplinary board as provided in chapters 18.26 and 18.130 RCW and rules adopted thereunder.

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.