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Re: Chiropractic madness!!!!!!!!!!!!
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Re: Chiropractic madness!!!!!!!!!!!! - November 18, 2001 10:09:00 AM
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doc4bax
Posts: 7
Joined: November 15, 2001
From: o'fallon, IL USA
Status: offline
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Mr. Ball, did I say something to offend you? Talk about being arrogant, misinformed, and unethical . Maybe it is you who should check your facts before you speak.
"Physician means a person licensed under the Medical Practice Act to practice medicine in all of its branches or a chiropractic physician licensed to treat human ailments without the use of drugs and without operative surgery"(Illinois). There is nothing under the Medical Practice Act or any Illinois statute that prohibits a chiropractor from advertising or administering physical therapy. (if your accusation is true then it’s news to me).
Since you say chiropractors aren’t "real doctors" then why don’t you define what a real doctor is? By the way when you make comments such as this your speaking to ALL CHIROPRACTORS!
"DC services prior to injury may rape the patient of their right to more medically appropriate reimbursement for services after injury?"
This is news to me. I suggest you blame the insurance companies and vent your hostility toward them. Why are you blaming chiropractors? Most chiropractors are unaware of this. If this was turned the other way I think we could all agree that YOU certainly wouldn’t disclose this information!
"How can you as a chiropractor possibly be serious about a RIGHT to be a PCP while offputting professionals with equal or more training, stealing resources that the patient may need after injury, and generally operating not as a professional, but as the slimy used car salesman of the healthcare industry?"
I don’t appreciate being called a "slimy used car salesman of the healthcare industry". Again when you make comments like this your addressing all chiropractors. How professional of you. As far as having the right to be a PCP, what professional with equal or more training are you referring to?
"As for DPT’s not being qualified to be PCphysicians, I agree. In comparison to you, however, I suppose they may be as they’ve had more extensive training than you. As I said before . . . you’re not qualified either. That said, I support the idea of DPT’s and DC’s as PCpractitioners ".
The only "extensive training" a DPT would have over a DC is in physical therapy. That would be provided the DC doesn’t have addition training such as a D.A.C.R.B (Diplomat of the American Chiropractic Rehabilitation Board). A diplomat of the American Board of Chiropractic Internists (DABCI) would certainly qualify as a PCP.
You act as though chiropractor’s are only trained in spinal manipulation. I think you need to do some more research on a DC’s education. Sure spinal manipulation is our stock of the trade but we don’t use it to treat every condition. Of course with every profession your going to have a few bad apples. Unfortunately we have a few bad apples that claim they can cure just about anything with chiropractic manipulation. I assure you this is not my way of thinking. Further, this is not the norm for our profession. We look down upon those individuals who preach this nonsense. They give us a bad name and their dangerous. We as doctors utilize every form of treatment to treat the patients condition except for drugs or surgery. (of course the treatment would have to be within the scope of practice in that particular state). It’s not that we don’t believe in drugs or surgery it that we our a natural approach to health care. Another thing is that most people say chiropractor’s can’t prescribe medication. The thing you need to understand is that this is not what were about. If you want to prescribe meds you go to MD or DO school. If that’s what I wanted to do I certainly wouldn’t be talking to you folks right know. Well maybe if I was a Physiatrist. Anyway those rights were available in the beginning when defining our profession. The chiropractic profession turned them down and made sure it wasn’t part of our profession. The question isn’t "we can’t" it’s should be "we chose not to".
doc4bax
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Re: Chiropractic madness!!!!!!!!!!!! - November 18, 2001 10:28:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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SJ,
I don’t mean to be patronizing, but welcome to the discussion. Sounds like you went back and read the previous postings in this thread about the differences between a PCpracitioner and a PCphysician. Your recent experiences certainly have given you the tools to now tell the difference. I dare say that we (the collective we) DC's and PT's on this forum belive that both DC's and DPT's are qualified to operate as PCP's, provided that means PCpracitioner and NOT PCphysician (under the definitions that follow).
With the exception of maybe one or two DC's, I think there is general consensus here.
Your statement, "If wellness is truly an issue, why not have physician assistants or nurse practitioners handle that kind of stuff?" Demonstrates an apparent revelation on your part, and one that I've been trying to get across for some time now. You seem to have articulated it better though. Anyway, role of the PA and NP's is exactly what the APTA has in mind for DPT's . . . within, of course, certain scopes of practice. This is what is meant by a PCpracitioner. This is NOT what is meant by PCphysician.
I have no problem with DPT's or DC's as PCpractitioners. Some DC's, however, don't seem to know the difference and are using PCP to describe both. When most DC's talk about a desire to be a PCP, they usually mean PCpracitioner . . . and we as PT's should support that. Their problem is that by not well defining what they mean by PCP, some of the more loopy of their ranks, (I'd assume the non-members of their professional association), are under the incorrect assumption that PCP for DC's means truly replacing MD's with DC's as PCphysicians. Even Dr. Peterson, who came on this forum fighting rather loudly for respect as a PCP . . . turned out to largely mean PCpracitioner.
There are a few, and I'd suggest that they tend to be ill-informed ones on the outskirts of thier profession, that actually mean for PCP to mean PCphysician. Dr. Peck, for example, is either one of these people, or didn't read and understand postings leading up to his regarding the difference between PCpracitioner and PCphysician.
For reasons described above, I don't think that most chiropractors actually mean PCphysician when using that terminology. The few that do, are quite obviously out of their minds. When the issue is debated professionally, I've found that most DC's agree that diagnostically trained DC's and DPT's alike are capable of operating as PCpractitioners (like OD's, Podiatrists, PA's, NP's, etc), and most don't mean --- nor want the responsibility of being --- a PCphysician.
As for your final comment, I’m not sure what your injury was, but I’ve got to side with the DC’s as being competent to act as a Pcphysican here. Why would a DC, working as a physician extender like a PA or NP, not be an appropriate person to see? Suppose you had just banged up your shoulder a bit. An appropriately trained DC could take an X-ray (or order one) and determine weather or not the injuries fell within his or her scope of practice. A DPT could do the same. Like a PA or NP, either DPT or DC would have to have their diagnosis and services reviewed and signed off on by a real PCP, a PCphysician, within 48 to 72 hours (depending on the state).
This was basically the model of PCpracitioner loosely overseen by a PCphysician. Worked well for you with a PA or NP in that role. Why not use a DC or DPT for issues that appear to be musculo-skeletal in nature?
What I can't understand is, DC's have done quite well operating on the fringe of the healthcare industry. They have escaped peer-review and evidence-based review of the effectiveness of their treatments beyond natural history or with relations to other treatment paradigms. Why subject the profession of Chiropractic to external review under which it (like physical therapy) can't withstand?
Furthermore, DC's already operate in a fairly autonomous manner. Why give that up in order to re-enter the healthcare enviroment as a PCpracitioner? It elevates thier respect within the healthcare environment by placing them on par with other professions emerging as PCpracitioners (OD's, Podiatristists, DPT's, etc.), but submits to a subordinate position just below the PCphysician --- the MD or DO.
DC's have been at feud with MD's for so long, that I've got to wonder if thier quest to be a PCpracitioner is really what they belive to be a stepping stone --- DC's as truly PCphysicians atop the Healthcare Pyramid.
I was snooping around on ChiroWeb this morning and couldn’t resist responding on thread where a DC basically suggested to the mother of a non-ambulatory 22 month old child who had a “stroke” in utero, that Chiropractic should be the treatment mode of choice for this “balance problem.” No suggestion of seeing a physical therapist for neurodevelopmental therapy and strengthening/control of lower trunk musculature, orthotic intervention, or perhaps PWB-TT. No suggestion that a neurological, genetic, or perhaps metabolic evaluations may be good ideas. Heck, no one even questioned what the child WAS doing developmentally. Nope, it’s all in the spinal subluxation apparently. How irresponsible.
It's not just lack of compotence in extra-subluxationar dignosis repeatedly demonstrated on the part of many DC's. Until DC's can address all of the primary healthcare needs of the patient, from birth to death, that's simply not realistic. It's the same reason why DPT's will never be PCphysicians either.
Andrew M. Ball, MS, MBA, PhD(c), PT
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Re: Chiropractic madness!!!!!!!!!!!! - November 18, 2001 11:24:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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Dr. Peck,
In answer to your question, yes, you did offend me with your arrogant and misinformed question, “When are physical therapists going to learn that they are therapists and not doctors? I certainly don't see the qualifications for a PT or DPT being a PCP (Primary Care Provider).” As for your assumption that I would turn the other way if the shoe was on the other foot, my personal ethics as Master of Business in Healthcare Management, and A.B.D. status with a Ph.D. in Healthcare Management do not allow me the luxury of such one-sided subjectivity. Friends and enemies alike may have much to say about my character, but no one, no one, could ever accuse me of acting in a manner that I believed to subvert the needs of the patient or healthcare industry as a whole. Many times (and I’d refer you to my work and proclamations that PWB-TT as a more effective alternative in achieving independent ambulation than traditional PT in working with patients with stroke, TBI, cerebral palsy, than traditional pediatric physical therapy), I’ve placed global ethics and patient needs above that of my own profession. I’ll assume, however, that you simply didn’t know who you were talking to, and drop it. I’d like to say that all of my colleagues would be as virtuous, but I’ll admit that I’ve seen a few “bad apples” in positions of power within my profession too.
As for questioning the education of DPT’s, that’s a fair question. We can get back to that issue if you like. It’s a great question that we should all discuss. In the meantime, I’m sure you’ll be surprised to hear about their 3 to 3 and a half years of post baccalaureate training that includes not only “physical therapy” coursework, but training in differential medical diagnosis, pharmacology, and radiographic imaging too. Generally speaking, DPT training is equivocal, and sometimes surpasses, that of a DC.
Beyond, that, I'll suspend with my defense of physical therapy and attack of some of your continued misinformation for few moments because it appears that we agree quite a bit on issues you raised in your last paragraph. In the spirit of this emerging positive relationship and understanding that seems to be brewing here on RehabEdge, I’ll back off and extend an “olive branch.” I will not disclose your name or location, nor how I was able to view your webpage, but upon viewing it and your recent comments, you're in hotter water than you realize, and I don't strike debate opponents when they are down. Especially when they don't realize that they're down. You're down.
Though ignorance of the law is not a defense, I don’t believe in turning in people for such issues without giving them an opportunity to correct the transgression.
According to Illinois state law, by representing yourself on your website as providing "physical therapy," and subsequently admitting to that fact in your last post. You are in direct violation of section 31 part b of your states physical therapy practice act. This is not be dismissed Dr. Peck. It's punishable under both civil and criminal codes.
In terms of crime, it's a Class A misdemeanor for a first offense, and a Class 4 felony for a second or subsequent offense. Civil penalties include fines of up to $5,000 per occurance in your state. I'm no lawyer, but I think that means once for your website, once for your yellow pages ad, once for each mailer . . . that could add up pal.
Anyway, allow me to introduce you to the Illinois Physical Therapy Practice Act. According to your recent statements, you are admitting violation of Section 31 section b
I've taken the liberty of reprinting the sections you'd be interested here in this posting:
[URL=http://www.legis.state.il.us/ilcs/ch225/ch225act90.htm]http://www.legis.state.il.us/ilcs/ch225/ch225act90.htm[/URL]
Illinois Compiled Statutes
Professions and Occupations
Illinois Physical Therapy Act
225 ILCS 90
(225 ILCS 90/31)
Sec. 31. Violations.
(a) Any person who is found to have violated any provision of this Act is guilty of a Class A misdemeanor for the first offense and a Class 4 felony for the second and any subsequent offense.
(b) Any person representing himself as a physical therapist or that the services he renders are physical therapy services, or uses any words, such as physical therapy, physical therapist, physiotherapy or physiotherapist, abbreviations, figures or letters with the intention of indicating practice as a licensed physical therapist, when he does not possess a currently valid license as defined herein, commits a Class A misdemeanor, for a first offense, and a Class 4 felony for a second or subsequent offense.
(c) Any person representing himself as a physical therapist assistant or that the services he renders are physical therapy services, or uses any words such as physical therapy or physical therapist assistant, or uses abbreviations, figures or letters with the intention of indicating practice as a physical therapist assistant, when he does not possess a currently valid license as defined herein, commits a Class
A misdemeanor for a first offense, and a Class 4 felony for a second or subsequent offense.
(Source: P.A. 85-342; 86-1396.)
Sec. 32. Civil Penalty.
a) Any person who practices, offers to practice, attempts to practice, or holds oneself out to practice physical therapy or as a physical therapist or a physical therapist assistant without being licensed under this Act shall, in addition to any other penalty provided by law, pay a civil penalty to the Department in an amount not to exceed $5,000 for each offense as determined by the Department. The civil penalty shall be assessed by the Department after a hearing is held in accordance with the provisions set forth in this Act regarding the provision of a hearing for the discipline of a licensee.
(b) The Department has the authority and power to investigate any
and all unlicensed activity.
(c) The civil penalty shall be paid within 60 days after the effective date of the order imposing the civil penalty. The order shall constitute a judgment and may be filed and execution had thereon in the same manner as any judgment from any court of record.
(Source: P.A. 89-387, eff. 1-1-96.)
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Re: Chiropractic madness!!!!!!!!!!!! - November 18, 2001 3:16:00 PM
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EWDC CSCS
Posts: 42
Joined: November 14, 2001
Status: offline
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Andrew,
I thought I'd accept the invitation that you posted on Chiroweb's discussion forum and give my 2 cents. I am in agreement with many of the posters here that chiropractors are in no way qualified to act as primary care physicians. However, there is an ever growing number of chiropractic graduates who are well trained in musculoskeletal diagnosis and red flag recognition. I am sure that DPTs are similarly trained. Therefore, it's my opinion that both disciplines have the skills necessary to function as competent and effective primary care practitioners.
-Bobcat,
That link that you posted certainly reflects poorly on our profession.
[This message has been edited by EWDC CSCS (edited November 18, 2001).]
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Re: Chiropractic madness!!!!!!!!!!!! - November 19, 2001 5:28:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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Dr. Peck,
In support of my statement that Chiropractors are not physicians, I offer the following legal foundation for that statement. So far, nothing has convinced me that a Doctor of Chiropractic is any more qualified than a Doctor of Physical Therapy, Doctor of Podiatry, Doctor of Dentistry, Doctor of Optomotrey, or Doctor of Psychology to be be a physician. A primary care pracitioner, perhaps . . . but why do so many DC's believe that the term, "Doctor" makes them any more qualified than clinical doctorates of other disciplines?
Thankfully, state law of most states agrees with this position . . .
Under Colorado State Law, Chiropractors are not considered physicians (this question was resolved 30 years ago). Accrding to Title 12 Article 33 of Colorado Statute:
Term "physician" as used in statutes relating to healing arts relates solely to doctors of medicine and doctors of osteopathy, so that statute requiring notification of coroner where death occurs without medical attention was properly construed to mean that death occurred without "medical attention" where one dies while under care of chiropractor. Colorado Chiropractic Ass'n v. State, 1970, 467 P.2d 795, 171 Colo. 395.
Under Kentuky State Law (TITLE XXVI. OCCUPATIONS AND PROFESSIONS
CHAPTER 312. CHIROPRACTORS),Chiropractors are not considered physicians as evidenced by the statement, "OAG 74-758. A chiropractor is not a physician and, therefore, cannot exempt a child from immunization for school under KRS 214.036."
In Virginia, GRAY v. GRAVES MOUNTAIN LODGE, INC., et al. Overturned a lower court's decision resulting in Virginia common law, as of JANUARY 20, 1998, being of the opinion that, a chiropractor is not a "physician" for purposes of designation to a panel of physicians pursuant to Code § 65.2603(A)(1) of the Workers' Compensation Act."
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - November 19, 2001 7:53:00 AM
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EWDC CSCS
Posts: 42
Joined: November 14, 2001
Status: offline
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SJBird5,
[QUOTE]Isn't the geriatric population generally more complicated than just a simple musculoskeletal problem?[/QUOTE]
-Yes
With increasing age comes an increasingly larger differential diagnosis list. Patients seeking the services of a primary care Practitioner typically have a specific complaint ie. an ache or a pain. It is the responsibility of the Practitioner to take a thorough history, perform a physical exam, and order the appropriate imaging studies if necessary. Most chiropractors are capable of identifying mechanical versus organic pain and I would assume that this is true of DPTs. In cases of organic pain, I see no reason why a DC or DPT would not be capable of making a prompt and appropriate referral.
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Re: Chiropractic madness!!!!!!!!!!!! - November 19, 2001 7:56:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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Agreed. Well said.
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - November 20, 2001 2:55:00 AM
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Hirsch
Posts: 43
Joined: October 16, 2000
From: Germany
Status: offline
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Drew, great discussion going on here. Why arent there any DC-PT programs, or are there any? I bet that would be an awesome mix. My own experience is that even MD's who are also trained as PT's (I know 3 here in Germany, so it's an extremely biased sample) are no better as PT's than PT's without an MD degree...
I think it's sad that PT's and DC's can't discuss the issues with less emotion. But I guess its normal for professions which often harbor professionals who are not truely interdisciplinary. In medicine it's horrible. Many MD's I work with have the attitude : "this is MY patient, hands off". I have made positive experiences in PM&R where there is alot of interdisciplinary work. Oh well, as long as DC's and PT's get all offended by each other no effective communication is possible. Good points on the law Drew, you really know your stuff. Mark Hirsch
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Re: Chiropractic madness!!!!!!!!!!!! - November 20, 2001 9:09:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Hirsch:
I agree that there should be a more rational discourse and some more cooperation. But some of these issues reflect professional realities.
Currently there are Chiropractors who bill for physical therapy with no physical therapist on staff. This is a sticking point with us. Also, there are several bills pending that would prevent the use of manipulation by anyone other that a DC. Manipulation has been used and refined by PTs for a very long time. And....even if I don't use them, I have colleagues who are more than qualified and skilled.
Soo.......Cooperation would be good but some turf wars seem to be inevitable.....
Respectfully,
mcap
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Re: Chiropractic madness!!!!!!!!!!!! - November 20, 2001 10:53:00 AM
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Wisecracker
Posts: 70
Joined: November 15, 2001
Status: offline
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To all,
Greetings from the beautiful North Coast of California. I've been reading this board for the past week, and am a first time poster.
I don't know that I can add anything terribly insightful, but I have a tendency to share my $.02 regardless [IMG]http://www.rehabedge.com/forums/wink.gif[/IMG]
First, I think this has been one of the more rational discourses on this subject that I've seen. Bird, mcap, and Mr. (soon to be Dr.) Ball have all added insight and thought provoking issues to the discussion. I also would like to commend Dr. Peterson for his reasoned and tactful approach.
Second, I have only met 2 DPTs. Both in academic settings (one was one of five jurors at my thesis defense). Both expressed significant doubt concerning legislative changes in order to allow them to practice to their full abilities/training. Is that a viable concern?
Third, is the general consensus amongst PTs that DCs bill PT codes without actually performing PT services? Or that DCs are not qualified by either training or knowledge to utilize PT? I utilize C-spine traction, US, EMS, etc. as part of patient care when appropriate. I also bill for these services, as is my right and obligation in this state. I have MDs who refer to my office for this passive care, because they don't think the patients can tolerate the local PT's active care. I still utilize PTs, as they do a fantastic job (IMO) of active rehab, functional capacity testing, etc. Is it just my local area where passive treatment has fallen out of favor by the local PTs? Thus making my experience unique, or is this more of a national trend?
Fourth, there exists NO evidence that continuing trials of passive care have any efficacy. This is especially true for the "wellness" care model of DCs who utilize SMT biweekly, monthly on asymptomatic patient populations. It is simply non-sensical. However, should a patient desire a monthly "wellness adjustment" (and no I don't know what that means) it is their right to pay out of pocket for such.
Fifth, I agree that DC/PT combined treatment is the best of both worlds and should be what is strived for. After all in a perfect world it is about getting the best possible outcome for the patient.
Sixth, most DCs (IMHO) are not trained to be PCchiros. Portal of Entry providers (POE) maybe. For musculoskeletal complaints, yes. But by and large we as profession have not had the exposure necessary to refer COPD patients, or a multi-infarcted parietal lobe dementia patients, or a diverticulitis patient to the appropriate specialist and order the appropriate tests to send along to the secondary treater.
And finally, does there exist a profession that is pure, good, ethical and above reproach? I don't know of one, all professions have problems. But we should not judge others or ourselves by the lowest common denominator, but rather by the majority.
Thanks, I'm done now. And again, have enjoyed the discourse.
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Re: Chiropractic madness!!!!!!!!!!!! - November 20, 2001 11:28:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Wisecracker:
Welcome to the board. We appreciate your comments and I agree with your points.
Yes....for newly minted DPTs, full utilization of their skills is an issue. Most of them are dissapointed when they encounter the clincal realities. However, the DPT is built upon a model of the future, not necessarily the current clincal picture.
I would agree that both PTs and Chiropractors are qualified for direct access for musculoskeletal complaints. But I don't feel either are qualified to handle issues of internal medicine.
I also agree that if someone wants to pay out of pocket for weekly/monthly adjustments then that is there perogative. (Although I think long term passive care is not only fruitless, it may be harmful in the long run both biomehancially and psychologically).
There are some central questions that need to be restated....
1. Does the bill as written, intend to allow chiropractors to serve as primary care for all conditions or just uncomplicated musculoskeletal conditions.
2. Is it the position that most chiropractors feel themselves to handle other issues?
3. What effect will authorization of VA chiropractic (which may include monthly adjustments) have on the money available for PT?
These are important questions that I don't think have been answered.
Respectfully,
mcap
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Re: Chiropractic madness!!!!!!!!!!!! - November 20, 2001 11:35:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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It appears that they are asking for PC physician status, not just direct access. Here is info from the AMA website....
The IOM defines primary care as "integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health needs, especially as a first point of contact for undiagnosed symptoms." The IOM considers family physicians, general internists and general pediatricians to be primary care providers.
Dr. McAndrews calls the IOM definition "self-serving" and contends that chiropractors have equivalent training to family physicians or internists. He said a primary care provider should be defined as those practitioners "qualified to treat the patient or make an intelligent referral."
So....it appears as if they are asking to be the PCP even in internal medicine cases. Where do the rest of the chiropractors stand on this issue??
mcap
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Re: Chiropractic madness!!!!!!!!!!!! - November 21, 2001 9:23:00 AM
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Wisecracker
Posts: 70
Joined: November 15, 2001
Status: offline
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Howdy mcap,
I would have to say that I don't have the foggiest idea what the general populace of DCs think. Though I'm inclined to believe that most would accept my position of POE, not PCP.
Of course Dr. McAndrews is a political animal, which is a different horse altogether. And one (political, that is) that I have never understood or trusted. So, I don't know the answers to your queries, but would agree that these are questions that need to be answered.
Have a happy thanksgiving.
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Re: Chiropractic madness!!!!!!!!!!!! - November 21, 2001 7:28:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Wisecracker:
You too. Happy holiday!
mcap
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Re: Chiropractic madness!!!!!!!!!!!! - November 21, 2001 8:23:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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Dr. Peck,
My offer to not to report your advertising violation to the Illinois Board of Physical Therapy Examiners on the condition that you would rectify the problem has gone unanswered for several days now. In the spirit of the holidays, I'll assume that you're simply out of the office for the Thanksgiving holiday and are unable to respond.
Be aware that I've been checking your website daily, and if you contine to ignore my warnings, and the problem is not corrected by 8:00 am November 30, 2001, you will leave me no choice but to report your violation to the proper authorities. Two and a half weeks should be more than enough time to take down or remedy your intertek webpage, or at least return my e-mail explaining that you have the intention to do so, but lack the web-building skills necessary to avoid an actionable situtation. You silence, however, suggests that you have no intention of doing anything at all.
By the way, given the ACA's hard lobbying for thier eventual defeat on this issue in Pennsylvania Supreme Court, I find it hard to belive that you've never checked your State Practice Act, and that all of this is, truly "news" to you . . . as your previous posting alleges. The following is taken directly from an ACA website:
Boch Case Affirmed by 4- 2 vote, D.C',s cannot advertise "Physical Therapy", but can "Adjunctive Procedure Therapy
BOCH CASE DECISION 4-2 IN FAVOR OF PHYSICAL THERAPY PROFESSION, rules against a D.C. advertising such services so as not to mislead general public, hopefully avoiding confusion for both professions.
The Commonwealth of Pennsylvania's Highest ruling, State Supreme Court issued their opinion in the long awaited case affirming that it would be illegal for a Doctor of Chiropractic to advertise they perform "Physical Therapy."
The long awaited decision came at 4:30 PM, Tuesday April 20th, ironically PCA was at The Capital conducting their Legislative Lobby Day when the news was published.
The Chief Justice wrote in his majority decision, that this ruling in no way restricts or limits the right of a Doctor of Chiropractic from performing services they have under their Licensure act of 1986. The Judge further wrote that, " Doctors' of Chiropractic, right to advertise therapies that they are licensed to perform has in no way been restricted by this decision."
Furthermore, given the Conneticut Attorney General's opinion regarding Chiropractors billing for physical therapy, I'd contact the insurance comissioner to find out if billing for "physical therapy" constitutes insurance fraud on your part:
Attorney General's Opinion
Attorney General, Richard Blumenthal
June 26, 1992
William M. Hardy
Chairman
Connecticut State Board of
Examiners for Physical Therapists
1251 South Main Street Extension
Middletown, Connecticut 06457
Dear Chairman Hardy:
This is in response to your request for our opinion on whether it is a violation of Chapter 376 of the Connecticut General Statutes for a chiropractor to bill patients and/or seek insurance reimbursement for "physical therapy" services, as opposed to chiropractic services, provided to patients. For the reasons discussed below, by denominating services rendered as 'physical therapy" for billing purposes, rather than as "chiropractic' services, the chiropractor is 'holding himself out" as a licensed physical therapist in violation of Chapter 376.
Connecticut has defined 'physical therapy" as 'a separate and distinct paramedical field rather than a general term for the use of physical measures in the evaluation and treatment of human ailments.' 82 Conn. Op. Atty. Gen. (10-5-82).
Conn. Gen. Stat.. § 20-66(2) provides:
"Physical therapy" means the evaluation and treatment of any person by the employment of the effective properties of physical measures, the performance of tests and measurements as an aid to evaluation of function and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting or alleviating a physical or mental disability. Physical therapy includes the establishment and modification of physical therapy programs, treatment planning, instruction and consultative , services. The term 'physical therapy' does not include the use of cauterization or the use of Roentgen rays or radium for diagnostic or therapeutic purposes;....
The "practice of chiropractic" as defined by Conn. Gen. Stat. § 20-24(a) means:
The practice of that branch of the healing arts consisting of the science of adjustment, manipulation and treatment of the human body in which vertebral subluxations and other malpositioned articulations and structures that may interfere with the normal generation, transmission and expression of nerve impulse between the brain, organs, and tissue cells of the body, which may be a cause of disease, are adjusted, manipulated or treated.
It is evident from their statutory definitions that these two disciplines may render to patients procedures which may be very similar in appearance but involve the application of different and separate disciplines.
Chapter 376 provides two sections that delineate the extent to which other medical fields may perform treatments that fall within the definition of '"physical therapy". Conn. Gen. Stat.. § 20-73 states that no one who is not licensed by the State as a physical therapist:
... shall practice or hold himself out as authorized to practice physical therapy, or represent himself as being so registered or licensed or use in connection with his name the term "Registered Physical Therapist", "Licensed Physical Therapist" or "Physical Therapist" or the letters "R.P.T.", "L.P.T." or any other letters, words or insignia indicating or implying that he is a licensed physical therapist in this state.
Recognizing the inevitable overlap between the treatments provided by various medical disciplines, Conn. Gen. Stat.. § 20-74 provides that:
[No provision of this chapter] shall prohibit persons registered under the provisions of Chapter 371 (osteopathy), 372 (chiropractic), 373 (natureopathy), 375 (podiatry) or 378 (nursing) from administering care to patients ... provided such persons shall not otherwise engage in the practice of physical therapy within the meaning of this chapter.
In an earlier opinion to the Board regarding whether chiropractors, podiatrists, physicians or others who are not registered or licensed therapists might practice physical therapy, we said that Conn. Gen. Stat.. § 20-74 does not accord to any person, other than a licensed physical therapist, the right to practice physical therapy. While this section recognizes the overlapping of modalities of treatment of these professions, -we said 'such procedures are included within the practice of those other professions and do not constitute the practice of physical therapy as it is defined in § 20-66." 82 Conn. Op. Atty. Gen. (10-15-82).
Read together, these statutory sections authorize a chiropractor or any professional indicated in § 20-74 to perform treatments which in their application appear to fall within the statutory definition of "physical therapy", but they may not hold themselves out in any way that would indicate or imply that they are authorized to practice physical therapy. See R.W. Beverungen, Jr. v. Briele, 25 Md. App.. 233, 242, 333 A.2d 664, 669 (1975) (chiropractor was holding himself out as a physician by use of "chiropractic physician" because such usage of "physician" implies to the public, that he is licensed to practice medicine). See also Ritt v. Ritt, 98 N.J. Super. 590, 592, 238 A.2d 196, 198 (1967), rev'd on other grounds, 244 A.2d 497 (1968) (members of other professional groups doing work of a psychological nature are not prevented from doing such work, but may not hold themselves out to the public by any title or description or implication that they are psychologists).
It is our opinion, that by denominating services as "physical therapy" rather than chiropractic services to third parties or to the patient, the chiropractor is holding him/herself out to the public as authorized to practice 'physical therapy' in violation of Conn. Gen. Stat.. § 20-73. A patient or third party receiving a bill for 'physical therapy" from a chiropractor might reasonably conclude that the chiropractor is licensed as a physical therapist, which is not true. A chiropractor is not prevented from performing services that may overlap with those provided by physical therapists, but he or she must make clear chiropractic services are being rendered. There is nothing to prevent a chiropractor from becoming a licensed physical therapist if he or she meets the qualifications and requirements. Nevertheless, the person would have to bill under the license he was actually using at the time.
In reaching this result it is necessary to clarify an opinion issued to the Department of Consumer Protection, with regard to whether the use of 'physical therapy" or "physiotherapy" in chiropractic advertisements is commercial speech protected under the First Amendment of the United States Constitution. 86 Conn. Op. Atty. Gen. (07-15-86). This opinion indicates that in the use of such terms, a State may regulate commercial speech by prohibiting or restricting the speech if it is false, deceptive or misleading, or that, even when the speech is not misleading, the State nevertheless may regulate the speech if such regulation serves and directly advances a substantial governmental interest.
Commercial speech is protected by the First Amendment only if it concerns lawful activity and is not misleading. Virginia Board of Pharmacy v. Virginia Citizens Consumers Council, 425 U.S. 748, 96 S.Ct. 1817, 48 L.Ed.2d 346 (1976); see also, Burns v. Barrett, 212 Conn. 176, 182, 561 A.2d 1378, cert denied, _ U.S. _, 110 S.Ct. 563, 107 L.Ed.2d 558 (1989); Caldor, Inc. v. Heslin, 577 A.2d 1009, 1015, 215 Conn. 590, 600 (1990). The Court in Virginia Pharmacy noted the enhanced possibility for confusion and deception of the public in advertising by doctors and lawyers because of the lack of standardization of professional services rendered by these professions, and that they could be subject to regulation not applicable to other professions. Id. 425 U.S. at 774, n.25, 96 S.Ct. at 1831, n.25.
The court has also stated repeatedly, that even when commercial speech is potentially misleading, the state may require "that the information be presented in a way that is not deceptive". In re: R.M.J., 455 U.S. 191, 203, 102 S.Ct. 929, 937, 71 L.Ed.2d 64 (1982) (state may require a disclaimer to clarify the advertised material); Posadas de Puerto Rico Assocs.. v. Tourism Co., 478 U.S. 328, 340, 106 S.Ct. 2968, 2976, 92 L.Ed.2d 266 (1986); Peel v. Attorney Reg. & Disciplinary Comn., 496 U.S. _, 110 S.Ct. 2281, 2292-93, 110 L.Ed.2d 83 (1990). (If the state believes. that statements of private certification might be potentially misleading, the state could require a disclaimer about the certifying organization or the standards of a specialty without disclaimer.) The use of the words "physical therapy" without a disclaimer by a chiropractor could mislead a patient into thinking that the chiropractor was authorized to practice physical therapy.
Our opinion is that use of the term physical therapy in this fashion by a chiropractor may potentially mislead the public and constitutes the chiropractor holding her/himself out as a physical therapist. The State through the Board may at a minimum require that a chiropractor performing chiropractic services which include those aspects of physical' therapy that come within the definition of chiropractic services make clear that the services are not "physical therapy" services and are not rendered by a licensed physical therapist.1
In a related case, the Sixth Circuit found the use of the terms "orthodontics" and "brackets" by a dentist might be classified as potentially misleading. The Court advised the state that its concerns could be adequately addressed by requiring a disclaimer in the dentist's advertisements. Parker v. Com. of Kentucky, Board of Dentistry, 818 F.2d. 504, 511 (6th Cir. 1987). Cf. Accountant's Society of Virginia v. Bowman, 860 F.2d 602, 605 (4th Cir. 1988) (use of the title "public accountant" by a non-CPA in advertisement was misleading because it is possible that "some members of the public would believe the title has the state's imprimatur.")
Very truly yours,
RICHARD BLUMENTHAL
ATTORNEY GENERAL
Richard J. Lynch
Assistant Attorney General
[This message has been edited by Andrew M. Ball MS MBA PT (edited November 22, 2001).]
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Re: Chiropractic madness!!!!!!!!!!!! - November 23, 2001 8:01:00 AM
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doc4bax
Posts: 7
Joined: November 15, 2001
From: o'fallon, IL USA
Status: offline
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Mr. Ball,
I see you have nothing better to do but police the Internet looking for physical therapy practice act violations LOL. First of all I don’t claim or market myself as a physical therapist. My website just say’s "physical therapy" under "services offered". The language under the Illinois Physical Therapy Act says "with the intention of indicating practice as a licensed physical therapist". This is not my intention. Physical therapy is a broad term, i.e. the CPT codes. Chiropractors do manual therapy by our very nature. Most chiropractors perform physical therapy everyday. If your argument is that chiropractors are not licensed to perform such treatments in Illinois, I assure you your wrong. Not only is it LEGAL for a chiropractor physician to engage in the practice of physical therapy but also LEGAL for those chiropractic physicians to delegate unlicensed individuals to perform the service. I do not have the time as you do to research every little detail in Illinois law regarding this matter. I have forwarded my webpage to The Illinois Department of Professional Regulation. If they find that having the word "physical therapy" under "services offered" is a violation of the Illinois Physical Therapy Act I will change it. That is I will ask them what the appropriate language is and change it to that. I will be sure to let everyone know what they say. Remember I practice in Illinois not North Carolina or any of the states you quote your information from. This information has little interest to me. Post some information regarding cases in Illinois.
Dr. Peck.
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Re: Chiropractic madness!!!!!!!!!!!! - November 23, 2001 11:38:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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Dr. Peck,
I find it ironic, comical, and pathetic, that you find the defense of one's own profession a poor use of time. Given your previous posts however, I suppose that you feel that chastising other equivocal professional disciplines while somehow trying to defend the right of Chiropractors to act as primary care physicians is a better use of time? I think I speak for all RehabEdge members, DC's and DPT's alike, in asking you to, "Get over yourself."
I appreciate you having taken your website down while the Board of Chiropractic Examiners reviews this matter. As long at the website remains down, or modified to compliance, I see no reason to take the matter any further, and look forward to re-engaging in a more professional discussion regarding comparison and contrast of DC and DPT education. Should your website reappear without revision, however, the following complaint will be filed with the Board of Physical Therapy Examiners, with foundations in Illinois state law, Federal law, and case law used to resolve similar situations in other states:
Dear Board,
This letter serves as a formal complaint against Anthony W. Peck, DC of the Back and Neck Pain Center, located 1115 Frontage Road, Suite A, O'Fallon • Illinois. Dr. Peck maintains a website (http://www.intertek.net/~doc4bax) advertising “physical therapy” as one of the services he provides.
According to the Illinois Compiled Statues Professions and Occupations Illinois Physical Therapy Act (225 ILCS 90/31) Section 31, “An Any person representing himself as a physical therapist or that the services he renders are physical therapy services, or uses any words, such as physical therapy, physical therapist, physiotherapy or physiotherapist, abbreviations, figures or letters with the intention of indicating practice as a licensed physical therapist, when he does not possess a currently valid license as defined herein, commits a Class A misdemeanor, for a first offense, and a Class 4 felony for a second or subsequent offense.”
Upon being alerted of this on November 17th Dr. Peck replied on November 18th, "Physician means a person licensed under the Medical Practice Act to practice medicine in all of its branches or a chiropractic physician licensed to treat human ailments without the use of drugs and without operative surgery"(Illinois). There is nothing under the Medical Practice Act or any Illinois statute that prohibits a chiropractor from advertising or administering physical therapy. (if your accusation is true then it’s news to me).”
A more detailed follow-up response, outlining my complaint, and possible criminal and civil penalties, yielded no reply. In the sprit of the holidays, I once again e-mailed Dr. Peck the following week with information regarding the Pennsylvania Supreme Court’s resolution of a similar conflict in that state affirming in the 4-2 Boch Case that, Chiropractors cannot advertise “Physical therapy.” Furthermore, I suggested to Dr. Peck, that if he was in fact billing for “Physical Therapy” without a physical therapy license, that some states may frown upon this practice, interpreting it as fraud, citing the 1992 letter to then Connecticut Attorney General Richard Blumenthal, to Willaim Hardy, the Chairman of the Connecticut State Board of Examiners for Physical Therapists at the time. It was the opinion of Mr. Blumenthal that, “by denominating services rendered as 'physical therapy’ for billing purposes, rather than as ‘chiropractic' services,’ the chiropractor is 'holding himself out" as a licensed physical therapist in violation of Chapter 376. . . . Connecticut [like, I assume, Illinois] has defined 'physical therapy" as 'a separate and distinct paramedical field rather than a general term for the use of physical measures in the evaluation and treatment of human ailments.' 82 Conn. Op. Atty. Gen. (10-5-82).” Dr. Peck maintains that the Medical Practice Act [which, in most states, applies to Medical Physicians, not Chiropractors] allows him free reign to advertise and practice as he wishes.
Based upon the Practice Acts of most other states, I don’t believe this to be a correct interpretation. Connecticut Chapter 376, for example, provides two sections that delineate the extent to which other medical fields may perform treatments that fall within the definition of '"physical therapy". Conn. Gen. Stat.. § 20-73 states that, "no one who is not licensed by the State as a physical therapist, “shall practice or hold himself out as authorized to practice physical therapy.” Note the word 'or' and not 'and.'
Furthermore, In an earlier opinion to the Board regarding whether chiropractors, podiatrists, physicians or others who are not registered or licensed therapists might practice physical therapy, stated in Conn. Gen. Stat.. § 20-74 the use of the term "physical thearpy" does not accord to any person, other than a licensed physical therapist, the right to practice physical therapy. While the recognized the overlapping of modalities of treatment of these professions, 'such procedures are included within the practice of those other professions and do not constitute the practice of physical therapy as it is defined in § 20-66." 82 Conn. Op. Atty. Gen. (10-15-82).
The resolution was that as all statutes were read together, these statutory sections authorized a chiropractor or any professional indicated in § 20-74 to perform treatments which in their application appear to fall within the statutory definition of "physical therapy", but they may not hold themselves out in any way that would indicate or imply that they are authorized to practice physical therapy. See R.W. Beverungen, Jr. v. Briele, 25 Md. App.. 233, 242, 333 A.2d 664, 669 (1975) (chiropractor was holding himself out as a physician by use of "chiropractic physician" because such usage of "physician" implies to the public, that he is licensed to practice medicine). See also Ritt v. Ritt, 98 N.J. Super. 590, 592, 238 A.2d 196, 198 (1967), rev'd on other grounds, 244 A.2d 497 (1968) (members of other professional groups doing work of a psychological nature are not prevented from doing such work, but may not hold themselves out to the public by any title or description or implication that they are psychologists).
It my concern and opinion, that by advertising and denominating services as "physical therapy" rather than chiropractic services to both the pubic and [I assume] third parties or to the patient, Dr. Peck is holding him/herself out to the public as authorized to practice 'physical therapy' in violation of Compiled Statues Professions and Occupations Illinois Physical Therapy Act (225 ILCS 90/31) Section 31. A patient or third party receiving a bill for 'physical therapy" from Dr. Peck might reasonably conclude that the chiropractor is licensed as a physical therapist, which is not true. It is not my position that he should not be prevented from performing services that may overlap with those provided by physical therapists, but he or she must make clear chiropractic, and not physical therapy services are being rendered, especially in advertising materials. Regardless, I would think that Dr. Peck would have to bill under the license he was actually using at the time.
I again refer to the Conn. Attny General's opinion in urging you to reach a similar conclusion in this case:
“In reaching this result,” Mr. Blumental stated, “it is necessary to clarify an opinion issued to the Department of Consumer Protection, with regard to whether the use of 'physical therapy" or "physiotherapy" in chiropractic advertisements is commercial speech protected under the First Amendment of the United States Constitution. 86 Conn. Op. Atty. Gen. (07-15-86). This opinion indicates that in the use of such terms, a State may regulate commercial speech by prohibiting or restricting the speech if it is false, deceptive or misleading, or that, even when the speech is not misleading, the State nevertheless may regulate the speech if such regulation serves and directly advances a substantial governmental interest.”
Furthermore, Mr. Blumental continued that, “Commercial speech is protected by the First Amendment only if it concerns lawful activity and is not misleading. Virginia Board of Pharmacy v. Virginia Citizens Consumers Council, 425 U.S. 748, 96 S.Ct. 1817, 48 L.Ed.2d 346 (1976); see also, Burns v. Barrett, 212 Conn. 176, 182, 561 A.2d 1378, cert denied, _ U.S. _, 110 S.Ct. 563, 107 L.Ed.2d 558 (1989); Caldor, Inc. v. Heslin, 577 A.2d 1009, 1015, 215 Conn. 590, 600 (1990). The Court in Virginia Pharmacy noted the enhanced possibility for confusion and deception of the public in advertising by doctors and lawyers because of the lack of standardization of professional services rendered by these professions, and that they could be subject to regulation not applicable to other professions. Id. 425 U.S. at 774, n.25, 96 S.Ct. at 1831, n.25.”
Finally, in a related case, the Sixth Circuit (Fedearl Court) found the use of the terms "orthodontics" and "brackets" by a dentist might be classified as potentially misleading. The Court advised the state that its concerns could be adequately addressed by requiring a disclaimer in the dentist's advertisements. Parker v. Com. of Kentucky, Board of Dentistry, 818 F.2d. 504, 511 (6th Cir. 1987). Cf. Accountant's Society of Virginia v. Bowman, 860 F.2d 602, 605 (4th Cir. 1988). No such disclaimers exist on Dr. Peck’s website.
As I’ve expressed my concerns to Dr. Peck and received an extremely several unprofessional replies, I feel that Dr. Peck has left me no choice but to report this situation to you for review. If I can be of further assistance, please do not hesitate to contact me at Drewpt@yahoo.com.
Respectfully,
Andrew M. Ball, MS, MBA, PT
[This message has been edited by Andrew M. Ball MS MBA PT (edited November 23, 2001).]
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Re: Chiropractic madness!!!!!!!!!!!! - November 23, 2001 2:53:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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SJSJSJSJSJSJSJSJSJSJSJSJSJSJSJ,
I understand your confusion, but Illinois state and Federal Law is in now way open for interpretation on this matter, nor does your post in any way conflict with I've been saying. Again, not to be patronizing, but I don't think you fully understand the point. Frankly, I’m beginning to think that Dr. Peck does either, because changing his webpage to read “physical modalities,” “therapeutic ultrasound,” or “therapeutic electrical stimulation,” instead of the illegal, “physical therapy’” would make this all go away. He either doesn’t realize how easy it would be to make this all go away, or he’s uncomfortable being fed crow from a professional representing a discipline that he doesn’t respect as an equal. Perhaps it's my fault for not fully explaining it, and if you're confused, it's likely that other RehabEdge members are as well, so let me try once again:
The ability to provide a physical agent/physical modality to a patient does not constitute physical therapy. Chiropractors may advertise and execute physical agents/modalities, so this doesn't really affect practice. What they can't do (in most states - Illinois included), is advertise or bill for "physical therapy," unless they have a physical therapist on staff providing those services.
Michigan V Beno refers to the provision of a "physical agent," or "physical modality." Galvanic stimulation is NOT physical therapy, nor is therapeutic ultrasound. They are both, however, physical agents, or physical modalities that are used, quite legally, by physical therapists and chiropractors alike.
Once again, Dr. Peck would be completely in the clear if he simply changed his advertisement to read "physical agents/modalities," or "therapeutic electrical stimulation." For a Chiropractor to advertise, "physical therapy," however, breaks all kinds of laws. Were I a risk management consultant for Dr. Peck, I'd therefore simply advise him to end the discussion by modification of his webpage accordingly. Apparently, however, Dr. Peck has a problem with the realization that Chiropractors have limits to their own professional practices and advertising abilities, and it kills him to be told by a physical therapist that he's acting outside the scope of what the law deems appropriate. His first post, articulating an incorrect view that DPT’s are somehow subordinate to DC’s made that point quite clear. This discussion boils down to something quite simple, Dr. Peck doesn’t eat crow very well.
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited November 23, 2001).]
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