S-455                 _______________________________________________

                                                   SENATE BILL NO. 5358

                        _______________________________________________

State of Washington                               51st Legislature                              1989 Regular Session

By Senators Smith, Kreidler, Johnson, Niemi, Vognild and Amondson

Read first time 1/23/89 and referred to Committee on Health Care & Corrections.

AN ACT Relating to practice rights for chiropractors; amending RCW 18.25.005; and adding a new section to chapter 18.25 RCW.

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

NEW SECTION. Sec. 1.  A new section is added to chapter 18.25 RCW to read as follows:

          The legislature finds that the purpose of this chapter is to ensure that every chiropractic physician practicing in this state meets minimum requirements for safe practice, in order to promote the public safety and welfare, to protect the public from being misled by unauthorized persons, and to assure the highest degree of professional conduct.

        Sec. 2.  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" as a philosophy, science, and portal of entry healing arts profession that deals with health and disease shall mean and include that practice of health care which ((deals with)) concerns 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)), care, and management of the vertebral subluxation complex, articular dysfunction, and neuromusculoskeletal disorders for the restoration and maintenance of health, as approved by the board.

"Vertebral subluxation complex" is defined as a functional defect, alteration of the biomechanical and physiological dynamics, in a joint, with or without displacement detectable on x-ray, which may include but not be limited to any of the following:  Fixation, hypomobility, hypermobility, periarticular muscle spasm, edema, and inflammation; and which can cause neuronal disturbances, somatic dysfunction, and direct or reflex functional changes in remote tissues.

Chiropractic care includes examination, analysis, and diagnosis.  A chiropractic differential diagnosis is a diagnosis to the extent necessary to determine the nature and appropriateness of chiropractic treatment, or to recognize the need for referral to other health care professionals, or both.  Examination, analysis, and diagnosis may include the use of physical, clinical, thermal, laboratory, x-ray, or other generally accepted diagnostic analytical methods and devices.  Patient records shall justify the extent of the analytical and diagnostic tests prior to further testing or referral.

Chiropractic care incorporates the use of adjustive and/or manipulative procedures to manage vertebral subluxations and relieve aberrations of the neuromusculoskeletal system which may cause neuronal disturbances.

Nonspinal procedures shall be utilized in a manner complementary or preparatory to a chiropractic spinal adjustment, and not solely as a treatment for a specific condition or dysfunction.

Chiropractic care further includes the use of procedures such as heat, cold, water, exercise; and physiological therapeutic procedures and instruments as approved by the board, such as traction and light, but not including sound, diathermy, or electricity.

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

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)), perform colonic irrigation, venipuncture, or conduct examinations of the breast, vagina, or rectum.  The term "chiropractic" as defined in this ((act)) chapter 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)) or a practitioner licensed under chapter 18.74 RCW from performing accepted physical therapy procedures which shall include skeletal mobilization procedures, except such procedures shall not include manual or mechanical adjustment or manipulation or mobilization of any vertebral articulation beyond the normal passive physiological range of motion.  Practitioners licensed under chapter 18.71 and 18.74  RCW shall not advertise that they perform adjustments, spinal manipulation, or manipulative mobilization of the spine.  A violation of this section is unprofessional conduct under this chapter and chapter 18.130 RCW.