Hot Issues
In a lively roundtable meeting prior to the official opening session, board members identified the most pressing topics in chiropractic licensing regulation today.
- temporary license or registration for travel-to-treat, interjurisdictional mobility, and telepractice were among the most complex issues;
- federal and state pressure to reassess the clinical competency of practicing doctors, regulating experimental procedures and techniques, claims review, and the regulatory role in specialty council certification;
- the impact of the Internet and other emerging technology.
FCLB President Lawrence Gerstein asserted that chiropractic regulation is not only the "heart and soul of public protection, (but) ultimately determines the future of the profession."
He added: "When every decision is based on what's best for the patient, chiropractic rises to its full potential. When a small fraction of outlier doctors try to take advantage of the public, we all suffer."
Deputy Commissioner Speaks
Keynote speaker Johanna Duncan-Poitier, a deputy commissioner for the New York State Education Department, opened the program by outlining the challenges recently overcome by the regulated professions in her state. She has been powerfully effective in removing obstacles to progress for the professionals in the department of education, and at no cost to the people of New York.
She noted that a tremendous improvement has been made by state boards in improving the information and satisfaction level of licensees, the public, and those who staff the boards.
So ... What Else Is Hot?
The emerging impact of the Internet was clear in three of the Thursday morning presentations. The public can have good information at its fingertips, and it can also be endangered by improper advice or the wild and instant spread of misinformation.
Mark Speicher, chief executive officer of OptiMed (and until recently, executive director of the Arizona Board of Medical Examiners), spoke on both the regulatory impact of the Internet and a recently-concluded Arizona court case. In the latter, a medical director was found to be practicing medicine in determining which services were to be provided to patients, and therefore held accountable to the medical board. Attendees were surprised to hear there are already four cases in chiropractic dealing with similar issues.
Lawrence Buening, executive director of the Kansas Board of Healing Arts, presented a lively challenge to boards to understand the complexities of their practice acts as they relate to telepractice. It was clear that technology is evolving more quickly than the health care regulatory system's ability to protect the public. This is both an opportunity and a challenge for chiropractic.
Interjurisdictional Mobility Issues
Thursday concluded with a panel on interjurisdictional mobility presented by the FCLB Task Force and invited guests. Moderated by Dr. Larry Spicer, task force chair and executive director of the Minnesota board, the panel focused on tools like national exams which can standardize the credentials in a doctor's portfolio.
Not confined to U.S. borders, registrar Jerry Grod, DC, of the College of Chiropractors of Ontario presented a Canadian viewpoint. The tendencies of regulatory boards to act under the premise, "You can have my bad apples, but I don't want yours," was central to his comments. He also reviewed the impact of Canada's agreement on internal trade.
Dr. Paul Townsend from the National Board of Chiropractic Examiners described the Special Purposes Exam for Chiropractic (SPEC) as an appropriate assessment tool for the doctor out of school for several years, and the emerging supportive credentials role of Part IV in combination with I, II, and III.
"When do we begin to trust one another's original licensure decisions?" Dr. Spicer challenged the attendees. Dr. LeRoy Otto described the real-life consequences affecting patient care associated with the current limitations on professional mobility.
The role of accreditation was also explored, as was the specific development of the Utah board as presented by its president, Dr. Joseph Brimhall.
CIN-BAD Jumps to the Internet
The highlight of the afternoon was the unveiling of the Chiropractic Information Network/Board Action Databank's (CIN-BAD) new Internet-based access, scheduled for formal availability in several weeks. Peter Sawtell, system designer and administrator explained: "The board action database has now been combined with the Medicare exclusions provided by the Department of Health and Human Services. This has opened the door to the easy Internet interface for our member boards and commercial subscribers."
The session also focused on support for boards which are trying to expand their public and licensee services to Internet access.
Stump the Attorneys
Friday's session started early with a two-hour interactive forum on legal issues. Attorneys Vance Kinlaw, Michael Moran, Ray Padilla, and Karen Perrine were joined by professional administrative directors Gail Zimmerman and Randy Singer.
The audience posed such controversial topics as whether regulatory board members should serve as officers in their state or national professional associations (a resounding yes and no!).
Sexual Misconduct
DCs Michael Stahl and Stephen Foreman are the co-authors of the monograph published by NCMIC, Sexual Misconduct: Ethical, Clinical and Legal Ramifications and the Chiropractic Profession. Their joint presentation portrayed current court cases and literature as defining sexual misconduct without a clear understanding of the highly touch-oriented focus of chiropractic.
They were clear on one point: "There is no existing literature or legal precedent to support having a sexual relationship with a current patient."
Dr. Ferguson Delivers the Janse Lecture
The 8th Annual Joseph Janse Lecture was delivered by Dr. Peter Ferguson, Democratic nominee for the U.S. House of Representatives from the 16th District of Ohio. Dr. Ferguson's topic, "A Vision of National Service," focused on the need for good character as central to regulation. The composite traits of courage, integrity, leadership, curiosity, and compassion were underscored as central to good character.
Breakout discussions dealt with three diverse topics:
- How board and college administrators might work more effectively together (including streamlining transcript verification and why boards may be duplicating some of the CCE accreditation processes) -- moderated by Connie Glasgow, president of the Association of Chiropractic Board Administrators, and Glenn Fried, assistant provost for New York Chiropractic College.
- Does raising educational standards makes a better doctor. Should a bachelors degree be a pre-entrance requirement? Should the minimum GPA be higher? This session was moderated by Robert Vaughn, DC, FCLB immediate past president, Reed Phillips, DC, PhD, president of Los Angeles College of Chiropractic, and Gerard Clum, DC, president of Life Chiropractic College West.
- How do boards courageously assess their current performance and develop new cooperative partnerships in redesigning the service model. This discussion was moderated by Charles Simpson, DC (Oregon) and James Powell, DC (Ohio).
The National Board of Chiropractic Examiners also hosted its annual business meeting and luncheon in conjunction with the Federation conference.
An International View
Saturday took a turn around the world as Canadian accreditation, examination, and regulation hit the forefront. Don Nixdorf, DC, chair of CCE-Canada and Murray McEwen, DC, co-chair of the Canadian Chiropractic Examining Board, gave an overview of two important components which affect international mobility. The Canadian Federation of Chiropractic Regulatory Boards was well represented by its president, Daniel Saint-Germain, DC, and executive director Peter Waite.
It was clear that regulatory issues are common throughout the world. The president and executive director of New South Wales Board of Registration, Edwin Devereaux, DC, and Michael Walsh, gave an overview of the Aussie regulatory situation, including the growing international accreditation presence of the joint education commission.
The conference concluded with reactions by a learned panel to the breakouts sessions from the previous day. College presidents Dr. William Dallas (Western States Chiropractic College) and Dr. Carl Cleveland, III (Cleveland Chiropractic Colleges) were joined by NBCE president Dr. Frank Hideg Jr., and Dr. Jan Harbour, FCLB executive board chairman.
So What Did We Learn?
The "take-home" lessons of the conference varied according to the needs the attendees brought with them. Some were empowered to go home and energize their visions for change, knowing the broad directions that health care and chiropractic regulation are taking. Some were nervous to see that their practice acts may not yet be able to handle the rapid demands of telepractice and the Internet. And still others were pleased to see that chiropractic regulation is clearly in the mainstream with other health care professions -- and at the cutting edge of board action databanking. "It's nice to be at the head of the pack in this important consumer protection area," Dr. Gerstein observed.
Annual Business Meeting
Without opposition, the member boards voted to adopt the FCLB mission statement: "To protect the public and to serve our member boards by promoting excellence in chiropractic regulation," and to enact a bylaws change extending the period an individual can qualify as a Fellow from three to five years.
Re-elected to second one-year terms were Drs. Lawrence Gerstein (Missouri), president, and David Brown (Virginia), vice president. Dr. Wayne Wolfson (Florida) was elected to his first full two-year term; Dr. James Powell (Ohio) was seated for his first three-year term. Drs. Ray Smith (West Virginia) and William Swanson (North Dakota) were approved by the membership to serve on the 1998-99 nominating committee.
In related business, the FCLB Board of Directors agreed to:
- continue assessing the feasibility of developing an all names database through CIN-BAD to assist doctors in verifying their licensure credentials;
- develop an educational seminar to teach managed care providers about chiropractic credentialing;
- develop an informational handbook for prospective students.
Regional meetings take place the first week of October. Next year's annual conference is scheduled for April 14-18 in Philadelphia, Pennsylvania. For further information about the San Diego meeting, please contact the FCLB at (970) 356-3500 or by e-mail at fclb-fclb.org.
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