November 2003

N.J. judge says D.C.s not 'physicians'

In a case involving a chiropractor's ability to certify that injuries are permanent, New Jersey Superior Court Judge Isabel Stark declared that M.D.s and chiropractors are two distinct health care professions and that claiming to be able to make a medical judgment about injury permanency is equivalent to practicing medicine without a license.

While not asserting superiority of one provider over the other, the judge cited numerous provisions in state statutes and case law that distinguish the two professions and limit medical decisions such as injury permanence to medical practitioners.

In addition to referring to "Black's Law Dictionary," which defines a physician as a "practitioner of medicine, a person duly authorized to treat diseases" and a chiropractor as one who employs "... a method of detecting and correcting by manual or mechanical means structural imbalance, distortion and subluxations in the human body," the judge noted that "common law distinctions between chiropractors and physicians in terms of education, licensing and oversight are reflected in all statutes relating to human health care."

She pointed out that "Physicians and chiropractors are so completely distinct in all aspects of training and applied techniques that they require separate licensing boards and licenses in order to practice," and that "Chiropractors are also not permitted to perform the panoply of objective diagnostic tests that physicians are obliged to use and which the...statute requires before an opinion on permanency can be given."

She concluded that, "A chiropractor would be viewed in the same manner as would a lay person, as practicing medicine without a license were he/she to offer the type of opinions required to prove permanency... and thus could be subject to fraud claims."

The New Jersey Chiropractic Society (NJCS) criticized Judge Stark's finding, and said it will fight for the "right" of the chiropractor to be considered a "physician" along with M.D.s and D.O.s. "We cannot allow this decision to snow‑ball!," warned NJCS Board member Joseph Garolis, D.C., offering that one possible way to "correct this ... errant decision" would be for the insurance commissioner to propose and pass a regulation stating that chiropractors may sign certificates of permanency. "This, though, would not necessarily correct the question of physician status in her court," he added.

The World Chiropractic Alliance agreed with Judge Stark's decision.

"It is clear to Judge Stark, as it is to most doctors of chiropractic, that chiropractic education does not cover the full range of medical diagnosis topics needed to accurately determine the permanency of many injuries," said Terry A. Rondberg, D.C., WCA president.

He added that ‑‑ particularly since there is a bill being proposed that will require health and accident plans to reimburse chiropractors and physicians at the same rate ‑‑ "We see no benefit to adopting the 'physician' designation, which is associated with M.D.s and D.O.s. Doing so will only further confuse the public and obliterate the distinction that makes us unique in the health care marketplace. The public doesn't need more medical physicians. It needs more chiropractors willing to offer something different, something better."