Thursday, March 12, 2009

Chiropractor Scope Of Practice - Proposed Regulations On Manipulation Under Anesthesia

The scope of practice of chiropractors is presently being addressed with respect to chiropractors performing manipulation under anesthesia (MUA). MUA is the manipulation of a patient who is sedated by the administration of anesthesia by a physician and surgeon or other health care provider who is legally authorized to administer anesthesia; and is performed by a licensed chiropractor.

The California Board of Chiropractic Examiners has taken the position that MUA is within the scope of practice of a chiropractor. However, as currently written, the boards regulations do not contain the standard of care or conditions under which MUA shall be performed. The Chiropractic Board has therefore proposed regulations because not all settings are appropriate for the safe performance of MUA. The board determined that facilities licensed or approved by the entities listed in this subdivision have the necessary safety equipment and standards in place to protect consumers undergoing MUA. The Board has assumed that chiropractors can perform MUA but simply wanted to regulate where it would be performed.

Therefore, the Chiropractic Board proposed that Section 318.1 be added to Title 16, Division 4, of the California Code of Regulations. This would establish the standard of care or procedures in which MUA may be performed. The Board's reasoning is that adoption of this proposal is necessary to better protect consumers by requiring that chiropractors adhere to specific standards when performing MUA and that without any standards in place, consumers are at risk for serious injury.

Not surprisingly perhaps, the California Medical Association (CMA is opposing this regulation and the entire idea of chiropractors performing MUA on the ground that they interpret this regulation as expanding the chiropractic scope of practice. CMA submitted objections to proposed regulations that would allow chiropractors to perform MUA. CMA contends that MUA raises important patient safety concerns and the regulations, as proposed by the Chiropractic Board, would allow chiropractors to perform a procedure that is not authorized under current law. It is also CMA’s contention that because the use of anesthesia is integral to the technique itself, MUA is not explicitly authorized under current law. CMA's position is that chiropractors’ scope of practice is limited by the Chiropractic Act (an initiative measure passed by California voters in 1922) and that the scope of chiropractic practice can only be expanded through the initiative process. Here is the CMA's letter opposing the regulation:
Commentary: There continues to be tension between licensed physicians and surgeons and other licensed health care providers who are non-physicians. CMA's position highlights the conflict and striking divergent viewpoints. As attorneys who represent both physicians and non-physicians in California, we see that there is support for both positions. However, non-traditional methods have gained wide acceptance in California and there is also a populist viewpoint that people should be able to choose their practitioner and their method of treatment.

Any questions or comments should be directed to: Tracy Green is a principal at Green and Associates. They focus their practice on the representation of professionals, particularly health care professionals including individual physicians, corporate providers and group practices.


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