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Federation of Chiropractic Licensing Boards 901 54th Ave., #101, Greeley, CO 80634 (970) 356-3500 FAX (970) 356-3599 Protecting the public and serving our member boards by promoting excellence in chiropractic regulation. |
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The FCLB asked its member boards to describe three of the most interesting and / or important events/achievements/changes their Chiropractic Regulatory Board has accomplished in the past year.
We also asked what difficult challenges they will face in within the next year or future.
Reports have been received (as of 5/11/99) from the following boards: Alabama, Arkansas (added 5/11/99), Colorado, Florida, Kansas, Minnesota, Missouri, New York, Nevada, Ohio, Oregon, Tennessee, Texas, Washington, and Virginia.
1. Alabama was successful in getting legislation passed to increase the maximum amount the Board can charge for renewal to $300.00. The renewal amount for 99-2000 will be $150.00 Alabama has legislation pending to regain the authority to administer a specialty certification program for licensed doctors of chiropractic. (Alabama lost this authority in its sunset audit in 1996.)
2. The board obtained an independent legal counsel and an investigator to help handle consumer complaints. The backlog of complaints is decreasing and new complaints are being processed in a more timely fashion.
3. The states' two largest professional associations combined in January 1999. The Board is holding a seminar with Alabama's professional trade organization (ASCA) to educate members of the profession on Alabama's laws and rules and common violations of these. The Board hopes that by educating the doctors to reduce the number of complaints received. The four hours the Board is giving are free of charge and will count as continuing education credit. The Board hopes the seminar becomes an annual event and that interest increases with each seminar held.
Difficult challenges:
The most difficult challenge for Alabama continues to be complaints by consumer and professionals. However, the Board feels it is finally making adequate efforts to handle the complaints as outlined in number two and three above.
1) January 1998 the ASBCE adopted additions to the Rules & Regulations the utilization of acupuncture in chiropractic practice. Prior to engaging in the practice of acupuncture/meridian therapy, said physician is to submit to the Board of Examiners a certificate of completion of one hundred (100) hour's instruction in acupuncture/meridian therapy from a college accredited by the Council on Chiropractic Education.
2) March 10, 1998 in the Chancery Court of Pulaski County Second Division the Arkansas State Board of Chiropractic Examiners entered a motion for ex parte temporary restraining order against the University of St. Augustine for Health Sciences Institute of Physical Therapy; Baptist Rehabilitation Institution and Ken Olson. The Board sought a temporary injunction to block seminar instructors from performing the unlawful practice of chiropractic, specifically spinal manipulation, by person not trained, examined, regulated and licensed, which threatened the public health, safety and welfare of the people of the State of Arkansas. Chancellor Collins Kilgore denied the request, citing due-process concerns arising from failure to properly serve the defendants in time for a hearing. The Board of Examiners may have lost this round, but they will continue to vigorously pursue all available legal options to prevent any further efforts to instruct physical therapists in the techniques of "manipulation" and "adjustment" as defined by Ark. Chiropractic Statutes.
3) Revision of the Arkansas Chiropractic Statutes, which has been presented in Bill, format to the 82nd General Assembly.
Difficult Challenges:
- Professional Licensing - Revision of examination test manuals. Updating the test questions will ensure the quality of the examinations. The Board has the ultimate responsibility for ensuring a valid, reliable and legally defensible examination.
- The continued debate over whether chiropractors can perform physical examinations of public school students to participate in school athletic activities. The AG's opinion has been that the school boards have the discretion in formulating the policies that govern the details of the operation of their school systems. Therefore, they are authorized to determine what type of physical examination will be required in their school district as a prerequisite to participation in athletics. Whether chiropractors could perform the physical exam would depend on the schools requirement of such physical exams. There is nothing in Arkansas laws, which would prohibit chiropractors from conducting physical examinations to students for extra-curricular activities. But for now, it appears that whether chiropractors can perform physicals for students depend on parameters of each individual schools' requirements.
1. Relative to conducting utilization reviews as that term is defined in 10-4-115, C.R.S., it is the policy of the State Board of Chiropractic Examiners that in the course of doing business a third party is entitled to seek a utilization review and that a third party is entitled to advise the insured of policy coverage. However, when an insured is provided with an interpretation of charts or radiographs, diagnosis, opinion on treatment or treatment plan, then the third party as well as the person conducting the review is deemed to be practicing chiropractic. These interpretations can only be provided to the patient or guardian by a practitioner licensed to practice chiropractic in the state of Colorado. Doing so without an appropriate license is a violation of the Chiropractic Practice Act of Colorado. Those persons who provide such interpretations, diagnostic opinions, or treatment plans are held to the same standard of care as any Colorado licensed Chiropractor who performs patient examination, diagnosis, and treatment planning.
2. The Program Administrator is granted the authority to suspend and reinstate the licenses of practitioners who are in violation and subsequently in compliance of the Child Support Enforcement Act as notified by the Colorado Department of Human Services.
3. The FCLB has helped us achieve our goals by the implementation and use of CIN-BAD.
Difficult challenges:
Lay persons who have started LLC's and are employing chiropractors for financial gain.
1. Renaming of the Board of Chiropractic Medicine. During the past year, the Florida Board of Chiropractic Medicine has been involved in numerous important issues which have affected our practitioners greatly. These alterations include the renaming of our Board by the legislature from the "Board of Chiropractic" to the "Board of Chiropractic Medicine". This makes all physician Board uniform, to include the term "medicine".
Additionally, as some political organizations had recommended that the State Legislatures adopt legislation prohibiting the use of the term "physician" by anyone other than an M.D. or D.O. The majority of the Florida chiropractic profession has taken a pro-active stance to insure that the "chiropractor" "doctor of chiropractic" and "chiropractic physician" would not be excluded from third party payment, as insurance companies take the position that a "physician" only includes allopathic providers. This semantic charge has strengthened the premise that chiropractors are able to render "expert medical opinions" and that care is reimbursable under the Automobile No-Fault law and Worker's Compensation Practice Act.
2. Minimal Recordkeeping Standards. While our Board several years ago established minimal recordkeeping standards, these have been further enhanced as a means of protection for the consumer.
3. Registered Chiropractic Assistants. We have also established the "Registered Chiropractic Assistant" to complement the Certified Chiropractic Physician's Assistant. The "RCA" has been designated as a professional multi-skilled person dedicated to assisting in all aspects of chiropractic medical practice under the direct supervision and responsibility of a chiropractic physician. A Registered Chiropractic Assistant assists with patient care management, executes administrative and clinical procedures, and often performs managerial and supervisory functions.
4. FSU Endowed Chair. The endowed chiropractic and biomechanical research chair at the Florida State University has been fully funded at $1 million, and the legislature approved a $250,000 appropriation for the second year in a row to fund research relative to chiropractic.
5. Statutory ability to access investigative costs from those who violate the laws and rules.
6. Board created an additional Probable Cause Panel which improves the turn around time of the discipline matters.
The Federation of Chiropractic Licensing Boards has been a significant partner in our ability to access and retrieve data regarding licensees throughout the United States through its CIN-BAD program. Additionally, the FCLB has provided excellent reference material in regards to issues affecting our profession and allowing us to act on a pro-active basis.
Difficult challenges:
Standardized Physician Credentialing. In an effort to avoid duplicative applications for managed health care companies, the Board of Chiropractic Medicine, under the supervision of the Department of Health, is working in concert with all other physician Boards to establish one standardized core credentialing form which would be accessed by managed care organizations.
a) Chiropractic profiling - maintain accurate and workable data.
b) Maintain the quality and standards of the chiropractic profession through continual education with the constant changes in the health care industry.
1. Adoption of rules and regulations pertaining to patient records.
For many years, Kansas law has required that licensees in one of the three branches of the healing arts (D.C., M.D., and D.O.) transfer patient records to another licensee when requested to do so by the subject patient or by such patient's legally designated representative. Another long standing requirement has been to keep written records which accurately describe the services rendered to the patient, including patient histories, pertinent findings, examination and test results. The Board has been faced with a number of consumer complaints about the inability of patients to receive copies of their own records. Also, a number of doctors have inquired about the adequacy of maintaining records electronically rather than keep the physical paper in files. On October 29, the Board met and formally adopted three regulations which address these issues. K.A.R. 100-22-1 requires that each licensee furnish a copy of the patient record to the patient upon receipt of an appropriate release. The licensee may withhold the record from the patient and furnish it to another licensee if the information within the patient record is determined to be detrimental to the mental or physical health of the patient.
While the licensees may charge reasonable costs to retrieve or reproduce a patient record, prepayment of these costs cannot be made a condition of furnishing the patient record to another licensee. K.A.R. 100-24-1 was also amended and specifies the requirements each patient record must meet to be adequate. This regulation was also amended to provide that records may be maintained electronically if they cannot be altered and if each entry in the electronic record is authenticated by the licensee. K.A.R. 100-24-2 was newly adopted and provides that records must be maintained for 10 years. However, this regulation enables the patient records to be stored by an electronic data system or by photographic means and the originals destroyed. The changes made by these regulations insure that the patients have access to their records and that such records are sufficient to insure continuity of care in the event there is a change in providers. Further, the licensee doctors are benefited by being specifically allowed to use the latest in technology to maintain and store their patients' records.
2. Continuing education credits for attendance at Federation Annual Meeting.
On October 17, 1998, the Board adopted a resolution which grants six hours of continuing education credits each day in attendance at the Federation's annual meeting. By approving continuing education for attendance at the annual meeting, the Board acknowledged the value of the Federation's programs in assisting Board members to improve the regulation of the chiropractic profession. Being able to obtain CEU for attendance at the Federation's annual educational conference provides a further basis for the chiropractic members of each state's board to attend the conference and benefit from the ideas and innovations presented.
3. Resolution for more frequent administration of SPEC.
On October 17, 1998, the Board adopted a resolution requesting the NBCE to administer the SPEC on at least a monthly basis and to release the results as soon after administration as possible. In adopting this resolution, the Board noted that it occasionally utilizes SPEC when considering applicants for licensure by endorsement or reinstatement following lapse or revocation of license or when considering licensees whose current professional competency has been brought into question. The Board also noted that NBCE currently administers SPEC twice each year in March and September and the results are not made available to licensing boards for approximately eight weeks after administration. This infrequency in administration creates problems when Boards must act upon applications for a license or for reinstatement of a license in a timely manner and must immediately satisfy itself of an applicant's professional competency when that has been brought into question.
We appreciate the FCLB for the information and overview of the proposed HIP Data Bank rules has been extremely helpful to the Board in understanding its potential obligations under the this new data bank. Although our Board has for years been reporting to the National Practitioner Data Bank created by PL99-660, it was important to receive the overview of the regulations prepared by FCLB. Posting the proposed rules on the Federation's home page and adding an "easy search" index was also very helpful. These efforts were much appreciated by the Board staff who will be responsible for preparing and submitting the reports required by the proposed rules.
Difficult challenges:
Health care regulatory boards are facing many difficult challenges. Three of the most critical issues facing the Kansas Board are as follows:
A. Sale of products by licensees of the Healing Arts Board.
The Board has appointed a committee to study the issue of sale of products by licensees, both health and non-health care related, and the issue of multi-level marketing approaches by licensees. The Committee has had two meetings as of this date. No formal position has been developed for recommendation to the Board as a whole. Generally, as to the sale of non-health related goods and products, the Committee is in general agreement that the sale or offer to sell these goods or products or the recruitment of the patient to participate in a marketing or sales organization involved in such sales from a licensee's office or other treatment setting should constitute unprofessional conduct. An exception should exist for sale of non-health related goods or products from a licensee's office or other treatment settings for community, charitable, non-profit or similar organizations provided the licensee does not profit from such sales. As far as health-related goods and products, the Committee is studying how these can be accomplished without amounting to unprofessional conduct. On the one hand, the Committee wants to ensure that there will be no unreasonable restraint of trade by adopting a statute or rule and regulation regulating this practice and that licensees will be able to offer goods or products incidental to the normal and customary practice of the licensee and which will be beneficial to the patient. However, the Committee is also concerned that no advantage is taken of any patient by use of pressure or conditioning continuation of care on the purchase of the goods or the participation by the patient in a marketing or sales organization.
B. Use of the internet by non-state licensed individuals to provide health care services.
During the past year, there has been an explosion in the use of the internet as a means to provide various forms of health care. In 1998, Kansas was one of the first states to obtain an injunction against an unlicensed physician who was offering Viagra over the internet. However, as soon as one person has been enjoined, many other appear offering the same type of services. It is extremely difficult to even identify the people who are offering these services as one can assume any identity they wish on the internet. The Board will be working with other state boards and attorneys general to see what can be done to address this difficult and growing problem.
C. A Legislative Committee recommended that health care boards be reorganized under one administrative division.
Bills were introduced in both the House and the Senate that ostensibly would have grouped all health-related state boards and their health-related professionals under one administrative division to eliminate overlapping, duplication of effort and use of resources more efficiently. The stated purpose of the bills was to transfer only ministerial functions to the new administrative division and to keep the other powers and duties under the individual boards. However, the effect of these two bills was just the opposite and transferred almost all powers and duties to the new division. A concerted effort by all health care boards caused the defeat of these two bills for this session. However, this issue will surely arise in the future.
1. Although not yet complete, we seem to have a reciprocity bill moving through the legislature at high speed. It is a distinct probability that it will pass this session. Additionally, Dr. LeRoy Otto continues to work with many other state in the country to facilitate reciprocity/endorsement provisions and standards.
2. Our web site is up and running (www.mn-chiroboard.state.mn.us)
3. We completed the Board Legislative Audit with good results, and with no recommendations.
FCLB Assistance with Board goals: Updates through power polls & ALLDoCS program
Difficult challenges:
Still dealing with the Independent Examiners Litigation; currently in judges hands for summary procedure.
We have a new governor (Jesse Ventura) so with legislature of two different parties and Governor of a third party, we are unsure how appointments or legislative issues are going to go.
The medical profession continues to attempt to diminish the ability of chiropractors to perform physical examinations. They have a bill before the legislature this year, but it appears to be dead this session (however ...)
1. Complaints involving sexual misconduct decreased in our last fiscal year by 20%. The Board contributes this significant decrease by a recently implemented rule requiring all chiropractic physicians to earn at least four (4) hours of continuing education in either boundary training or emergency procedures. We have not yet measured the number of licensees who choose to earn the additional four-hour continuing education requirement in boundary training. However, the significant decrease in the number of sexual misconduct complaints received by the Board in our last fiscal year is a very good indication that this was something very much needed in Missouri.
2. In 1999, the Board wanted to achieve significant changes relative to the continuing education requirements for Missouri licensees. There was a duel purpose the Board intended to achieve in these changes. First, the Board wanted to implement a strategy to reduce the cost for chiropractic physicians to comply with Missouri regulations. Secondly, the Board wanted a more simplified method of monitoring compliance with the statutory continuing education requirements. These goals were met when the Board's amended rule on annual license renewal was implemented this year. The major changes include provisions in the amended rule that now authorizes a licensee to earn twelve of the twenty-four hour continuing education requirement through other continuing education experiences. This means that a licensee is eligible in 1999 to earn continuing education credits by attending a State Board open meeting or professional association meetings. Other continuing education experiences may include the publication of a book and/or article by the licensee in professional books, national or international journals, or periodicals. Presentations that include teaching an approved post graduate course is considered other continuing education experiences, along with many types of home study or self study. The Board has established restrictions on the number of hours a licensee can earn in some of these categories but the Board believes it has met the challenge of reducing licensee costs to comply with Missouri regulations in its adoption of the amended rule. The Board also believes that it has achieved its purpose to establish a more simplified method of monitoring compliance with the statutory continuing education requirements by eliminating the licensee's required filing of continuing education attendance certificates. We now have a form that the licensee will complete asking for the courses they attended in the continuing education reporting period and the number of hours earned in the various required categories of continuing education and other continuing education experiences. By signature of the licensee, the information on the form is attested to as accurate and complete. The licensee will, however, be required to maintain continuing education attendance certificates for a period of time following the renewal cycle. When the Board selects a licensee for an audit, the licensee will be required to produce the attendance certificates. Other than the certificates collected through an audit, the Board's staff is no longer handling and processing the thousands of attendance certificates that have been required from licensees in past years.
3. In 1998, new legislation was passed that creates the "Missouri Acupuncture Advisory Committee". This is a new licensure law for acupuncturists. The new committee will function in an advisory capacity to the Missouri State Board of Chiropractic Examiners in the issuance of new licenses for acupuncturists and in the enforcement of the acupuncture licensing laws and regulations. To be operational, the Governor must appoint the members of this new committee and the committee must adopt necessary rules and regulations to conduct its business. One of the members of the Missouri Acupuncture Advisory Committee must be a current Board member of the Missouri State Board of Chiropractic Examiners.
The FCLB is always a constant source of information to the Board. Decisions are made at almost every meeting based on statistics or information gathered by the FCLB. The Board also relies on CIN-BAD when seeking adverse information regarding reciprocity candidates. Perhaps a more appropriate question would be to name a goal that the Board has achieved that in some way was not linked to information or assistance obtained from the FCLB.
Difficult challenges:
The Board faces two difficult challenges this year. While we continually strive to reduce licensee costs to comply with Missouri regulations, the Board is now focusing its attention to finding ways to shorten the time span in the issuance of a new license. Because the Board conducts criminal history background checks on all its new applicants for licensure, we have no control over the length of time it takes for the Missouri State Highway Patrol and the FBI to process the fingerprinting cards of each applicant. The Board is considering ways to combat this problem and has not yet decided on the best way to proceed. The Board may consider new legislation that would authorize the issuance of temporary licenses. Secondly, the Board is researching the possibility of issuing the license before the criminal history reports are received and then implement disciplinary action against the licensee if a negative report comes back, or if the Board finds through the report that the licensee was not completely truthful on his/her application.
The Board is also considering travel-to-treat legislation. We will be seeking out information on what other states have done in this area in order to present a solid proposal to the legislature.
1. We successfully led the effort to engage all health professions in drafting generic guidelines for identifying and preventing sexual misconduct by licensees. The draft report of the Work Group currently is under review by all the Boards for the health professions in our agency.
2. Together with FCLB staff, we created an electronic link with CIN-BAD to provide secure input and access to the system. We have already identified an applicant with an undisclosed disciplinary action from another state.
3. We surpassed the 5,000 mark in number of currently registered licensees in the State.
We received numerous types of assistance from the FCLB this past year, but one of the most important and ongoing services is the Power Poll. This "quick and sometimes-not-so-dirty" survey mechanism has provided useful information in a short period. Important questions can be asked before a meeting so that the answers are available at the meeting. The mechanism enables large-scale benchmarking to occur, which helps drive certain policy calls. We hope the tool extends to e-mail.
Difficult Challenges:
By far, the most critical challenge has been, and still is, related to a legislative bill that would restrict provision of spinal manipulation/adjustment to licensees in the chiropractic and medical professions. The Board has been providing information to the Department regarding the rationale for supporting this bill. Meanwhile, the physical therapists are claiming to provide similar services within their lawful scope, i.e., grade 5 mobilizations, and are providing documentation of it. Outside the Department, the State chiropractic organizations are launching a concerted lobbying campaign to attract support for the restriction bill. As of this writing, the Department has not taken a position on the bill.
There are continuous challenges to define and interpret the lawful scope of chiropractic practice. Inquiries, sometimes adversarial, have been received questioning such practices as use of diagnostic ultrasound and various other electrodiagnostic instruments, vascular testing, allergy testing, physiotherapeutic modalities, extremity manipulation and care for primary peripheral sports injuries, such as shoulder adhesive capsulitis.
1. We finished, after 18 months of effort, a major re-write of our Nevada Administrative Code (rules and regs) which became effective this fall.
2. We also have the beginnings of our web page available - www.state.nv.us/chirobd. We have been challenged by being without support staff for our executive director so changes are slow until we get another staff person on board. However, there is a link to our new rules and regs available.
3. Highlights of admin. code:
* Chiropractic Assistant for Massage has been added for certification. After January 1, 2000, a CA for Massage must meet different requirements which includes passing the National Massage examination. This category does not assist in physiotherapy or x-ray unless they also pass a Nevada CA exam. Likewise a CA can not do massage without meeting the new requirements and being certified as a CA for Massage. If a massage therapist is truly an independent contractor (defined in rules and regs based on IRS definitions), they do not need to be certified.
* A new section was added defining minimum competence. A licensee shall maintain competence in: the application of chiropractic; the production and interpretation of x-rays; In determining whether a licensee has maintained competence , the board will consider whether the licensee: applies therapeutic modalities properly, including whether the licensee uses therapeutic modalities that are appropriate for the treatment of a patient as documented by the record of that patient; manages cases in such a manner that the services provided to a patient are supported by the record of the patient; Produces x-rays that are of diagnostic quality; uses appropriate techniques of shielding and collimation in the taking of x-rays; documents the interpretation of x-rays in writing and maintains those written interpretations as a part of the patient's record; ensures that the radiographic equipment with which x-rays are taken and produced meets the specifications of the manufacturer for the safety and use of that equipment; is maintained properly and is registered with and made available for inspection by the health division of the department of human resources as stated in the Nevada Statutes.
* Additional clarifications and definitions of sexual misconduct.
* Minimum health care records contents.
* Further clarifications of what a "doctor waiting for licensing," chiropractor assistant and chiropractor assistant for massage may and may not do: May not: diagnose a patient or establish a prognosis, prescribe a program of treatment or perform a chiropractic adjustment or perform any service, except at the direction and under the direct supervision of a licensee.
We appreciate the work that has come out of the various FCLB committees such as the disciplinary guidelines has been very valuable to us when re-writing our rules and regs. Being able to come back from the various meetings knowing what may be coming in the future has made us ready for change. It is very nice not to be working in a vacuum.
Difficult challenges:
No one thing stands out on this one. Just continuing to keep up with business.
1. Education of the Profession: In February 1999, in conjunction with the Chiropractic Association of Ohio and Palmer College, the Board co-sponsored a first of its kind license renewal seminar: "Contemporary Issues for the Ohio D.C." We planned the curriculum and presented speakers on topics including: child abuse and domestic violence recognition/reporting, chemical dependency and the D.C., documentation for the patient's benefit under managed care, applied ethics and professionalism, risk management, and legal compliance. This was a multi-disciplinary seminar including Board members, a medical doctor, a pediatric dentist, lawyers and a chemical dependency counselor. The course evaluations indicated that on average, the participants rated the seminar as an "8" on a scale of 1 to 10.
2. Impaired Physicians Program: Director Moran attended the Citizen Advocacy Center's Forums I & II in Washington, D.C. in March 1998 and March 1999 respectively. Forum I focused on the Regulatory Management of Chemically Dependent Health Care Practitioners and Forum II focused on Developing Standards for the Regulatory Management of Chemically Dependent Health Care Practitioners.
The Board's proposed House Bill 812 specifically requires the Board to establish an "Alternative Program for Impaired Chiropractors," which includes developing by administrative rule standards for approving treatment providers and standards for both inpatient and outpatient treatment of impaired chiropractic physicians. Attendance at this forum allowed Director Moran access to dozens of subject matter experts in the field. He gained first-hand knowledge about implementing the Board's legislation. In addition, the Board received over 500 pages of printed material relevant to regulation of chemically dependent health care practitioners and implementation of the Board's legislation.
3. Flawless State Audit: The Board recently was audited for fiscal years 1997 and 1998. This was our first "performance" based audit and the state auditor found no instances of legal non-compliance, internal control weaknesses or lack of defined outcomes.
4. Staff Education: Beginning in January 1999, the Board conducts "staff education." Individual Board members are chosen to conduct the education discussion in order to empower the staff with knowledge on chiropractic.
5. Administrative Innovations: For every Board meeting, a "meeting reference binder" is prepared for all Board members and staff who attend. The binder is tabbed to include copies of all materials/reports to be reviewed and the meeting agenda is indexed to each tab. Minutes of the meeting are taken on one of the Board's laptop computers. These measures ensure maximum efficiency in the Board's meetings.
6. Fighting Fraud: During Fiscal Year 1998, the Board was invited to serve on the United States Attorney's Health Care Fraud Task Force for the Northern District of Ohio. In Fiscal Year 1999, we were invited to serve on the U.S. Attorney's Health Care Fraud Task Force for the Southern District of Ohio. The Board was also accepted as a member of the National White Collar Crime Center and the Coalition Against Insurance Fraud.
7. Consumer Outreach: The Board is a proud sponsor of the 1999 Consumer Conference sponsored by the Joint Working Group of Health Care Regulatory Boards. This conference was held April 6, 1999 to educate Ohio citizens on the duties and responsibilities of Ohio's professional licensing boards. Director Moran routinely speaks to health care organizations about the Board and chiropractic investigations in order to educate the participants about the Board's functions.
8. Strategic Planning: Since 1997, we have held annual planning retreats with the Board members and senior staff. By developing and revising the mission/vision statement and our planning document, the Board updates its priorities in the areas of communications, legislation, administrative policies/procedures, media relations, education, crisis management, licensing and renewal, and enforcement. Each year's retreat and planning document set the agenda and tone for the Board and its staff every year.
9. Legal Externships: The Board is the only Ohio regulatory board to have volunteer legal externs from Capital University Law School working at its office. Their work provides thousands of dollars in free services to the Board and promotes understanding of chiropractic amongst future lawyers.
The FCLB is a great resource and facilitator of information for the Board. The information obtained from CIN-BAD, Power Polls, etc. is invaluable.
Difficult challenges:
Prosecuting the unlicensed practice of chiropractic.
Budgetary constraints.
Developing meaningful relationships with other health care regulatory boards.
1. We recently finalized our sexual misconduct rule and voted it into place at our meeting in March 1999. This provides improved definitions to help the Board address the growing number of complaints in this area. You can view a copy of this rule on our web site at www.obce.state.or.us
2. We received a recent ruling from our AAG (in response to a particular vendor issue) regarding our continuing education rule that has created quite a challenge for us. Our CE rule includes language that requires us to approve CE vendors as having met certain requirements before they can offer courses for CE credit in the state of Oregon. In March of 1999, we were informed that this approval was to be considered a form of "licensing" by the OBCE. (This rule has been in place since November of 1997 and was not previously interpreted this way). The change in interpretation means that all CE discussion must take place in Executive Session (it has always been in public session) and if we want to deny a vendor approved status, we must first issue a notice of our proposal to deny status. The vendor then has the right, as any licensee does, to a contested case hearing. We could find ourselves in a very lengthy process, all in our efforts to maintain some handle on who teaches CE courses. The course may very well be given well before the process in completed. We also approve courses given by these vendors and it appears that this ruling also applies to the courses. Needless to say once again we need to re-write our CE rule.
3. The OBCE continues its progress on developing Practice Guidelines. Our process is very inclusive and has brought about incredible cooperative efforts by very disparate groups of chiropractors. We are near completion of the chapter on the Chiropractic Paradigm, which has gone through two levels of consensus development. Some copies of this will be available at the FCLB meeting in April, along with a description of the process we are using to develop the document. You can also obtain copies of this working document by calling the Oregon Board at 503-378-5816. We continue to work hard on making the document one that will bring about quality improvement and also provide methodologies for the difficult issue of how to measure the outcome.
The FCLB has helped us with the following: the documents attained regarding sexual misconduct and the conversation on that topic at the FCLB meeting in San Diego were instrumental in getting our conversation started on the subject. The annual and regional meetings provide us with a vital link to other state boards.
Difficult challenges:
1. We will be re-writing our CE rule (see above) and intend to use this opportunity to try to make a clearer connection between CE and the quality of care delivered. This presents quite a challenge and will most likely require changes made over several years. One concept under consideration is a requirement that every doctor do a self-assessment as a guide to meeting his or her continuing education needs.
2. We have seen a rise in the number of boundaries violations cases and find this particularly distressing and challenging. We have issued a challenge to the profession to help us out, and we're proposing tougher sanctions in recognition of the damage this does to patients.
3. We are currently struggling with the issue of Quality Improvement and how to incorporate that into the work of the board. This is a very broad issue, tough to get a handle on and we view this as quite a challenge.
4. We are interested in finding ways to speed up the complaint process.
1. Held our first disciplinary hearing in the last nine years. Guilty, sexual misconduct- six months suspension, year probation.
2. Upgraded educational requirement for x-ray techs to 48 hours of classroom and 1050 hours of practical training.
3. Accepted Part 4 of the National Board in lieu of our state exam. Initiated utilization of SPEC for reciprocity.
4. Developed alternative dispute resolution (ADR) mechanism for handling complaints. Final rules in process.
The FCLB has helped us by allowing access to solutions used in other states which gives direction and encouragement to pursue options that will apply to our problems.
Difficult Challenges:
1. Gaining access to adequate staff to administer the board.
2. Cumbersome rulemaking process slows implementation. Usually takes two years to push rules through the system.
3. Difficulty in hearing complaints because of cumbersome and lengthy process.
1. The TBCE began construction on their web page in October of 1998. The web address is www.tbce.state.tx.us The site offers great potential for disseminating important agency information. The site is in a continuous state of maintenance and revision. Browsers of the web site will find informational and interesting items about the Texas Board of Chiropractic Examiners.
2. In May of 1998 the Board initiated an agency newsletter. The Texas Chiropractic Board News and Views is mailed quarterly to all doctors of chiropractic who are licensed in Texas. The newsletter is becoming a valuable informational resource for the licensees of the TBCE.
3. Because of staff limitations, the enforcement division of the TBCE has been primarily limited to being reactive to complaint and compliance matters. Beginning in FY2000, September 1, 1999, the agency will implement a more proactive approach in dealing with agency violations. Both houses of the Texas legislature have given preliminary approval for one additional full time staff employee. If approved, the new staff member will be used to assist in coping with an increasing number of enforcement violations.
Listing only "one way" the FCLB has helped our agency during this past year is really unfair to the FCLB staff. The staff team at the FCLB has assisted our agency on numerous occasions the past year. They helped us to update our CIN-BAD files and they also supplied additional information about the proposed federal rule change for the Healthcare Integrity and Protection Databank. These are only two examples, there were many more.
Difficult Challenges:
1. The TBCE staff has 13 databases of information on licensees, radiological technologist, facilities and other related agency information. These databases are no longer able to serve the needs of the agency adequately. An Informational Technologist has been retained to completely redesign all of the TBCE databases so our software will perform more efficiently.
2. The Board has recently repealed and has written a new rule regarding the expunction of some of the previous violations by licensees of agency rules, which the Board considers to be minor infractions. All of the agency chiropractic personnel files will have to be individually reviewed to ascertain if there have been enforcement violations in past years that have not been transferred to the current enforcement database. A review of all chiropractic personnel files in the TBCE will take several hundred hours of clerical labor. The agency is still in the process of deciding on the best method to accomplish this huge task.
1. Began administering the Jurisprudence examination open book and revised the practical examination.
2. Completed review of 75 Washington Administrative Codes (WAC's) (rules) for necessity and revisions.
3. Complete the review and continued approval of educational criteria for fourteen chiropractic colleges and approving one new college.
4. The Commission's most difficult challenge is finalizing the project regarding "Continued Quality Assessment".
The Federation staff and the CIN-BAD reporting system continues to assist the Commission daily in handling licensing and disciplinary issues.
Difficult Challenges:
Sometimes facing opportunity is like staring at the knees of a giraffe.
1. A motion was made to have a study to limit the board of medicine to MD's, DO's, physician assistants and nurse practitioners. In the discussion that followed there was no second to the motion. In a conversation with the executive director by telephone he said that he thought it would be fair to state that although individuals would oppose it he thought the board would not oppose the study.
Difficult Challenges:
The challenge to our board is the backlog of cases which number over 700.