Ever since they were first developed, the Mercy Guidelines have been soundly criticized and rejected. Almost every chiropractic organization in the world has refused to endorse them. Numerous doctors reported that the document was being used by insurance companies to justify non-payment of claims and plaintiff attorneys to claim malpractice.

Chiropractors felt firsthand the negative impact of the Mercy Guidelines, and fought them. The effect of this campaign was seen earlier this year in the removal of the document from the National Guideline Clearinghouse (NGC), a database of evidence-based clinical practice guidelines and related documents produced by the Agency for Healthcare Research and Quality (AHRQ), in partnership with the American Medical Association and the American Association of Health Plans.

D.C.s aren't the only ones to have taken an outspoken stand against the document, however. Patients, hurt by insurance company decisions based on Mercy, have joined the protest as well.

Yet, few have made it a crusade the way Max McGee has. An inoperable herniated disc located on top of his sacroiliac joint has caused the Pennsylvania man to endure years of pain. Regular chiropractic care helps relieve the pain and impede the progress of the condition. But his insurance company -- Capitol Blue Cross -- recently decided that his adjustments weren't "medically necessary" since they were merely "maintenance." His trips to the medical doctor were never questioned, however, even though his M.D. recommended continued chiropractic care.

After receiving a letter stating that the chiropractic visits would not be covered by his policy, he called the Blue Cross office and learned that his case had been reviewed by a nurse. "I asked what they were basing their decision on and they told me they used the Mercy Guidelines," he recalled.

"I was incensed and after speaking with my chiropractor, I called the Pennsylvania Chiropractic Association (PCA) and was put in touch with another chiropractor who was fighting similar claim denials by Capital Blue Cross," McGee explained to The Chiropractic Journal. "After talking to this chiropractor and others, I decided to fight this unbelievably outrageous conduct."

He filed simultaneous complaints with the Pennsylvania Insurance Department, The Bureau of Professional and Occupational Affairs, and the Attorney General's Office complaining that Capital Blue Cross was using nurses to practice chiropractic without a license and was discriminating against the use of chiropractic care.

In March 2001, McGee received a call from a Dr. Paul Hetrick, who had been hired by Capital as the independent chiropractic consultant for his case.

According to McGee, Hetrick suggested that McGee withdraw from chiropractic care for a period of time, despite the recommendations to the contrary from his medical doctor and other health providers.

"This was difficult for me to understand because my chiropractor was helping me," McGee says. "I pleaded with him to examine me personally so he could see all the things I was telling him were true. I told him I would go to any of his clinics he chose. Dr. Hetrick declined saying he was only going to do a paper review."

The consultant refused, and told McGee he would apply the "medical necessity criteria" to the case to determine if the claim was to be honored. Although McGee considered contacting the PCA again for advice, he decided against that strategy when he learned that Hetrick was a featured speaker at the 2001 PCA convention and his seminars were often sponsored by the PCA. He also learned that Dr. Louis Sportelli, one of the developers of the Mercy Guidelines, was referred to as "one of the greatest chiropractors who ever lived," during the convention.

Reluctantly, McGee took Hetrick's advice and withdrew totally from chiropractic care. "After one week my muscles started to spasm so bad that I could not walk upright," he explained. "The pain was so intense and the muscle spasms so severe in my upper back that I started to get esophageal spasms where food would lodge in my throat and not go either up or down. During one incident in the faculty-dining hall witnessed by vice presidents and other colleagues it happened and they were so concerned that they were ready to begin the Heimlich maneuver.

The pain became so intense that while driving, he passed out behind the wheel of his car, barely averting a serious accident.

He immediately set up an appointment with a new chiropractor and, after four visits, his pain began to decrease a little. McGee filed a claim with Capital Blue Cross, which immediately demanded a treatment plan. His chiropractor sent one and McGee was told that Blue Cross would pay for my visits until June 5, 2002 -- but no longer.

At this point, McGee began researching the Mercy Guidelines that were used by Capital Blue Cross to deny his care. "I was stunned to find out that they were normed on 20-something males (I am 49), that they were intended for uncomplicated back strains only, that not even workman's compensation would use them as treatment guidelines. I learned, too, that every chiropractic association in the country that attended the consensus conference at Mercy repudiated their use in my situation, and that the research they relied on was almost 10-years old."

"When he found they were still listed on the National Guidelines Clearinghouse as current, I started asking pointed questions," he stated. The NGC's policies state they do not list any guidelines which have not been developed or updated in the last five years.

McGee immediately e-mailed the top NGC administrator to ask why the Mercy Guidelines were listed on their website. She wrote back stating that the developers of Mercy had submitted a letter to her that stating that Mercy was updated in 1999. "I told her that was not true and that I had a letter from the president of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), the group that originally developed Mercy that no reaffirmation process had taken place and that there were no plans to do this in the future," McGee explained. "I then asked for the names of these people who assured her that Mercy was being updated. She refused to provide this information saying that it was privileged."

Not to be discouraged, McGee contacted Sen. Arlen Specter and the U.S. Attorney's office to lodge a complaint of fraud.

In January 2002, McGee learned that the Mercy Guidelines had been removed from the NGC as obsolete guidelines.

"Although my battle with Blue Cross continues, I would like to think that my persistence in exposing the fraud the Mercy Guidelines developers perpetrated on chiropractors and their patients by telling the NGC they had been updated when they haven't was convincing enough to have Mercy officially withdrawn and declared obsolete," he noted. "But there are still problems which need more effective avenues for relief if people are going to get the chiropractic care they deserve and need."