Ralph Boone, D.C., former president of Southern California
College of Chiropractic, suggested that the guidelines would also be a way to inform the
public about the uniqueness of chiropractic.
John Gerhardt, M.D., who served as a consultant to the American Medical Association in
preparation of the Guides of the Evaluation of Permanent Impairment (4th edition), added
that he thought the guidelines developed by the group should objectify outcome assessments
and reports.
Steve Shochat, D.C., who was a member of the Steering Committee for the Wyndham
Conference on Straight Chiropractic Standards and Quality Assurance, stated that he hoped
the new document would "preserve the vitalistic principals upon which the practice of
chiropractic is based."
In the end, the statement of purpose was agreed upon and the Council on Chiropractic
Practice embarked on its mission to "develop evidenced-based guidelines, conduct
research and perform other functions that will enhance the practice of chiropractic for
the benefit of the consumer."
Despite a general feeling of accord, the discussions which took place during the
historic meeting on June 8, 1995, were frank and open. Pat Gentempo, D.C., voiced a
concern that the group might have a politically motivated agenda -- a consideration which
generated serious and thoughtful discussion.
Naturally, all participants recognized it would be impossible to avoid inevitable
comparisons to the Mercy Center Conference which produced the controversial Mercy
Guidelines, or to its successor, the Council on Chiropractic Guidelines and Practice
Parameters (CCGPP).
The announcement of the formation of the CCGPP -- which came just weeks before the CCP
group convened -- was met with skepticism and criticism. Since the composition of the new
group is nearly identical to the one which formulated the Mercy document, few observers
expressed optimism that the CCGPP will produce a significantly improved version of Mercy.
Serious flaws in that document -- including the composition of the conference panel
itself, the lack of field doctor input, and the conspicuous absence of most generally
accepted chiropractic principles -- have resulted in its widespread rejection.
CCP participants agreed that the Mercy Guidelines -- currently being widely distributed
to insurance companies and regulatory agencies -- not only fails to support
subluxation-based chiropractic but seriously damages it. Numerous reports of insurance
claim denials based on the Mercy document have been received throughout the country.
At its most extreme, the document is seen as a way to eliminate subluxation-based
practices. Brent Owens, D.C., past president of the Federation of Chiropractic Licensing
Boards, clearly envisioned using Mercy as a tool to "discipline" chiropractors
when he wrote to Eddy Cohen, D.C., on June 18, 1992. Dr. Owens noted, "We hope that
the various licensing jurisdictions will use this document (Mercy Guidelines) in
disciplinary cases involving professional incompetency so that those individuals are not
allowed to continue chiropractic practice."
The continued efforts by Mercy and CCGPP supporters (particularly the American
Chiropractic Association) to impose the standards on the profession have been called a
blatantly "political" power play. The formation of the CCGPP is likewise seen as
a way to silence criticism by reintroducing Mercy with cosmetic changes.
Even Christopher Kent, D.C., who will serve as a CCGPP board member, admitted to being
unconvinced about the sincerity of the CCGPP's effort. "Based on previous experience
and the failure of the first Mercy document, we have grave concerns about the new
CCGPP," he stated in an open letter to D.C.s around the country. "Will they
benefit the consumer? Will they protect the right of children to obtain chiropractic care?
Will their guidelines allow you to make a chiropractic assessment where vertebral
subluxation is an acceptable primary diagnosis?"
Kent also acknowledged that Mercy and CCGPP supporters will very likely say the actions
of the CCP are a duplication of efforts or an attempt at political grandstanding.
"With such an overwhelming imbalance from the first version of Mercy," Kent
explained, "we are extremely cautious. 'Trust me' is just not good enough. We must do
everything possible to safeguard subluxation-based chiropractic."
CCP participants were adamant that their efforts be a positive step toward protecting
and strengthening chiropractic -- not merely a counteraction against Mercy. That's why
attorney Greg Zorro advised that the workings of the CCP -- and the development of
practice guidelines -- should not be undertaken in an adversarial manner.
To overcome any possible perception of the CCP as a "political" entity, the
board members decided the board would not be representative of any specific group,
organization, or chiropractic school of thought. Among those serving on the board would be
field doctors, educators and researchers; D.C.s, M.D.s., Ph.D.s, attorneys and laypeople.
Additional decisions about the CCP strengthened its status as an apolitical group: it
will have no ties with any international, national, state or local organization and will
rely primarily on the support and input of field doctors rather than special interest
groups, associations, or companies. Most importantly, its first allegiance would be to the
patients and health care consumers.
The very composition of the executive board shows both the diversity of the group, and
its shared dedication to the principles of subluxation-based chiropractic. Christopher
Kent, D.C., a diplomate of the American Academy of Pain Management and the Academy of
Chiropractic Radiology, as well as the chairman of the College on Chiropractic Imaging of
the International Chiropractors Association, was elected President of the newly formed
group.
Joining him on the executive board is Dr. Ralph Boone as vice president and John Fisk,
M.D. -- a diplomate of the American College of Radiology and a member of the Washington
State Medical Society's Committee on Industrial Medicine and Rehabilitation -- as
Secretary. Harold McCoy, D.C., a Diplomate in Applied Chiropractic Sciences who served as
a chiropractic consultant to the University of Washington Intercollegiate Athletic
Department, was elected as treasurer.
Serving as a special consultant to the CCP is a former project director for the AHCPR,
who was recommended to the Council by that agency. In addition, the Council's committee
involved in literature review has established (is in the process of establishing??) a
close working relationship with officials at the University of California, Irvine and will
have access to the world's largest science library, located on its campus.
Throughout the day, the group discussed a wide range of issues -- from broad concerns
about the development of the guidelines to mundane technicalities involving time tables
and budgets. Yet, they kept going back again and again to the first question they had
struggled with: their purpose and mission.
At every step along the way, they reminded themselves of why they were there and what
they hoped to achieve. It was that constant reminder that guided them in their decision
making process.
"The most important thing we kept in mind," said CCP Board Member Veronica
Gutierrez, D.C., after the meeting adjourned, "was that we were sitting there as
representatives the vast majority of the profession -- those field doctors who were
ignored by Mercy and are discriminated against by insurance companies and government
agencies. We are accountable to them and to their patients."
To ensure that field doctors will be properly represented, and their input valued, the
CCP is taking the unprecedented action of opening the International Guidelines Conference
to be held Jan. 6 - 7, 1996, to all interested D.C.s. In addition, it is calling on
doctors to provide the financial support necessary to fund the monumental undertaking
faced by the CCP.
"This will not be another set of quasi-medical guidelines formulated by an elite
group of so-called 'leaders,' and funded by high-powered, politically motivated
organizations," stated Jay Holder, D.C., M.D., Ph.D. "We want this to be a
grass-roots efforts which will be supported by doctors of chiropractic and have their best
interests in mind throughout the process."
The board members agreed that the success of the CCP depends a great deal on the
support and input it receives from actual practitioners who will be affected by their
actions. "We are doing this for them," said Board Member Steve Renner. "And
frankly, we can't do it without them."
