December 2003

Louisiana Insurance Commission may fine Board for memo against CBS

A "bulletin" written and distributed by Mark B. Kruse, D.C., President of the Louisiana Board of Chiropractic Examiners, is being reviewed by the Office of the Commissioner of Insurance and could result in a fine being levied for misrepresenting an official statement.

The memo contained a warning about Chiropractic Benefit Services (CBS) insurance policies and suggested that "doctors ... may be placing themselves in a precarious position" by choosing CBS. The bulletin item displayed a headline reading: "LA Department of Insurance ‑‑ Medical Malpractice Insurance Info," giving the deliberate impression that the information and the warning was issued by the Department of Insurance.

However, it was quickly ascertained that the headline was deceptive.

According to Paula P. Davis, Deputy Commissioner with the Office of the Commissioner of Insurance, "The Department of Insurance has not issued any statements, nor has the Department rendered any opinions about, the CBS Medical Malpractice Insurance policy."

Davis added that "The Department's legal division is currently reviewing the statement to assess if any fines are necessary," for the misleading memo, which was distributed to licensed doctors throughout the state. She noted that Dr. Kruse told her the heading of his statement was "written in error."

Dr. Kruse is the American Chiropractic Association's Alternate Delegate for the State of Louisiana and has certification in Chiropractic Sports Medicine, and from the American Board of Chiropractic Orthopedists and the American Board of Chiropractic Consultants.

"Most doctors are well aware that the ACA has tried hard to discredit me and do as much damage as they can to the World Chiropractic Alliance through me and my businesses," stated Terry A. Rondberg, D.C., president of the WCA and CEO of Chiropractic Benefit Services. "I have come to expect personal attacks, but it is a grave violation of professional ethics for a member of a state board to provide false information to the doctor just to attack me. If Dr. Kruse's error was a deliberate one, he should face more than a fine. He should be removed from the board so that he cannot abuse his power by taking similar actions against me or any other doctor of chiropractic."

The headline wasn't the only incorrect information in the memo, Dr. Rondberg said. "The entire memo was filled with such totally erroneous and misleading statements that it is difficult to believe it was not a deliberate and malicious effort to malign CBS," he added.

In a letter to Louisiana doctors, he noted that, "Dr. Kruse made a personal statement that amounted to rendering an insurance decision, even though he has no training or expertise to do so. He did not speak with CBS officials to obtain information on policy coverage, nor did he consult with insurance experts in the state Insurance Department. The result was a statement containing gross errors and misinterpretations."

Among the disputed statements was one claiming that, in CBS, "a Class 1 chiropractor stipulates that he/she neither renders diagnosis nor makes referrals to medical practitioners."

This is not true, explained Timothy Feuling, CBS President. "Class 1 chiropractors do diagnose, although they choose to limit their services to the diagnosis of vertebral subluxation complex. Louisiana state statute specifies that the chiropractic scope of practice includes 'the diagnosing of conditions associated with the functional integrity of the spine.' Vertebral subluxation is such a condition and is within the scope of practice," Feuling stressed.

"Nothing in any federal or state law mandates that a licensed health provider offer ALL services allowed in a scope of practice statute," the CBS letter explained. "That is, D.C.s and other providers are permitted to select which services they wish to offer, as long as those services are within the scope of practice."

This concept of limited scope is so important that some states expressly make a note of it. California, for instance, lists the various services D.C.s are licensed to provide, but states specifically that a duly licensed chiropractor "is not required to use all of the diagnostic and treatment modalities set forth in this section."

The same applies to all health care providers. Dentists may be permitted by their scope of practice law to perform extractions or root canal, but many choose not to do so in their office. General medical practitioners may exclude pregnancy care and childbirth services, even though permitted by law to offer those services.

CBS officials have also contacted the Louisiana State Attorney General's office about the Krause memo, and have asked for a ruling about limited scope of practice for chiropractors.