Richard Jaffe, a Houston health care attorney, is leading the judicial battle for Chiropractic America. "This case has national significance," Mr. Jaffe told the Houston Business Journal. "It will determine who makes treatment decisions: the doctor and the patient, or the state government and the insurance companies.
Mr. Jaffe successfully represented New Jersey chiropractors several years ago in a racketeering lawsuit against the Dept. of Insurance Fraud Division.
The Automobile Insurance Cost Reduction Act was signed into law on May 19, 1998 by Governor Christie Whitman. Under that mandate, people injured in auto accidents are in many cases not covered for chiropractic care, and severely restricted in the number of treatments by a chiropractor when the injury is deemed appropriate for chiropractic referral.
The auto-reform act directs "care paths" for automobile accident victims. The care paths were developed by Price, Waterhouse and Coopers (PWC), a large accounting firm which used a team of "three individuals with medical degrees, two nurses, and one MBA." There were no chiropractors on the PWC team.
The new act requires the state insurance dept. to use existing standards and practices and incorporate them into the regulation. The insurance dept. has, however, ignored the existing New Jersey Chiropractic Standards which were established by the state's three chiropractic state associations and the four regional societies in lieu of the PWC path ways.
The lawsuit details the six care paths that leave chiropractic out in the cold:
| "Three of six care paths (care path 2-cervical spine herniated disc/radiculopath; care path 4 -- thoracic spine herniated disc/radiculopathy; and care path 6 -- lumbar spine herniated disc/radiculopathy) completely eliminate chiropractic care, even though chiropractic treatment of patients with these injuries is within the scope of practice and within the standard of care in New Jersey, and (despite the) dozens of scientific articles establishing the benefit of chiropractic treatment of these conditions. "The remaining three care paths allow for up to four chiropractic visits during the first month of treatment (care path 1: cervical spine strain/sprain/contusion whiplash of the neck, care path 3: thoracic spine strain/sprain/contusion of the upper back; (care path 5: lumbar sacral spine strain/sprain/contusion)." |
Michael Freeman, DC, MPH, PhD, a leading expert on care-path algorithms, assessed the PWC's document:
"The document from PWC that I have reviewed is highly problematic, mixing arcane pedestrian algorithmic guidelines with some very bad and highly erroneous presumptions. While I find that the information on testing protocol and diagnostic testing is, for the most part, reasonable and literature-based, the recommendations of the panel on duration of disability and medical treatment are a work of fiction with no basis at all in science or medicine."
Scott Haldeman, DC, MD, PhD, a foremost expert on the treatment of back injuries, also critiqued the PWC document:
"...I believe that the authors of the care path algorithm have not demonstrated a high level of understanding of the current treatment of patients with back and neck injuries. They have not followed a formal consensus or guideline approach to develop these care paths, have been very selective in their review of the literature and discriminatory in their decisions regarding different health care professionals."These guidelines, in their current format, cannot be considered a valid approach to patients with back and neck injuries."
The New Jersey State Board of Chiropractic Examiners, and all major county and state chiropractic organizations, are opposing the use of these care paths by the insurance department. And virtually every medical organization, medical society and medical school in the state has publicly opposed the care paths promulgated by the DOB&I, and complain that they will harm patients, lead to unnecessary surgical procedures and cost much more than the present system.
The automobile reform act has of course been front page news in New Jersey. In the latest twist, one of the bill's co-sponsors, state Senator John Adler (D), is now questioning the fairness of the regulations and whether they accurately reflect the intent of the New Jersey lawmakers.
In a letter to Chiropractic America President Carrison Pomeroy, Senator Adler stated:
"As you know, I am strongly advocating that the Department of Banking and Insurance revisit its proposed regulations implementing the recently enacted Auto Insurance Rate Relief Act.
"Rest assured that I will continue to fight for fairness and a reasonable approach to dealing with this very important issue."
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