October 2003

WCA argues for direct access in VA health system

The World Chiropractic Alliance (WCA) responded quickly when it learned that the Department of Veterans Affairs (VA) Chiropractic Advisory Committee report might include a recommendation for a medical gatekeeper for chiropractic care.

The Committee's draft report contained a provision that "Access to chiropractic care should require referral from the patient's primary care provider or another VA clinician who is treating the patient for the condition(s) for which chiropractic care is indicated." The report noted that the Committee was deeply divided on this issue, with six members favoring a referral‑only system and five preferring a more direct form of access. Although the report does not identify how individual members of the Committee votes on this issue, there are six D.C.s and five M.D.s. It is assumed that the issue was split down professional lines, with "chiropractic" member Charles DuVall, D.C., president of the National Association of Chiropractic Medicine, siding with the medical profession against chiropractic.

The Committee asked for public comments on the report and the World Chiropractic Alliance immediately submitted a letter arguing against the recommendation.

"We vehemently oppose the use of medical gatekeepers to control access to chiropractic services," Terry A. Rondberg, D.C., WCA president noted. "The American public has the freedom to choose chiropractors without referral by M.D.s; our veterans deserve that same right. As the committee correctly points out, anti‑chiropractic bias still exists among some M.D.s, and a patient's right to have access to D.C.s would ultimately be determined by the personal prejudices of his or her medical provider.

"Requiring a medical referral to a D.C. would also be inappropriate since M.D.s receive no training in the detection or correction of vertebral subluxation, which is specifically mentioned under the chiropractic Scope of Practice. It would be impracticable to give M.D.s the responsibility of determining the appropriateness of chiropractic care when they have no training or experience in analyzing the subluxation complex."

The WCA alerted the profession to the objectionable provision and asked doctors to contact the VA Committee to submit their own comments on the issue.

The World Chiropractic Alliance also objected to the Committee's failure to include surface electromyography and thermography to the list of chiropractic privileges, even though two members of the Committee wanted them added to the list. "These procedures are well accepted in the profession and constitute appropriate chiropractic procedures," Dr. Rondberg noted in his letter on behalf of the WCA.

The WCA did applaud several provisions of the recommendations report, including a provision that D.C.s be graduates of either "schools of chiropractic accredited by the Council on Chiropractic Education Commission on Accreditation or equivalent agency recognized by the U.S. Secretary of Education, or schools (including foreign schools) accepted by the licensing body of a State, Territory, Commonwealth, or the District of Columbia as qualifying for full or unrestricted licensure."

The Committee recommended a broader latitude for school accreditation since, "Limiting recognition to CCE accredited schools excludes from VA employment licensed doctors of chiropractic who graduated from SCASA accredited schools, those who graduated from chiropractic school prior to the creation of CCE, those who graduated from a school of chiropractic before it achieved full CCE accreditation status, and those who, in the future, might graduate from a school accredited by a new chiropractic accrediting organization recognized by the U.S. Secretary of Education."

The WCA also praised the Committee for its recommendations concerning the scope of chiropractic practice within the VA. The draft report notes that "Doctors of chiropractic shall provide patient evaluation and care for neuro‑musculoskeletal conditions including the subluxation complex  within the boundaries set by state licensure, VHA privileging and the doctor's ability to demonstrate educational training and clinical competency in the areas necessary to provide appropriate patient care."

It also noted that examples of neuromusculoskeletal conditions appropriate for chiropractic care include, but are not limited, to subluxation, back pain, neck pain, headache, and joint sprains and strains.

"The recognition of the detection and correction of vertebral subluxation as an integral part of the chiropractic purpose is of utmost importance," the WCA stated in its public comments. "As the only health care professionals trained and experienced in this unique practice objective, the inclusion of subluxation correction underscores the unique contribution of chiropractic, and ensures that D.C.s do not duplicate the medical services already provided by M.D.s and other practitioners in the VA system."

The recommendations report was the culmination of a series of meetings by the 11‑member Committee, which was formed in order to advise the Secretary of Veterans Affairs, on how to incorporate chiropractic into the VA health care system.

Secretary Anthony J. Principi appointed Committee members in August 2002. Leona Marie Fischer, D.C., a member of the World Chiropractic Alliance International Board of Governors (IBG), was named as a Committee member and staunchly argued for direct access to chiropractic.

After all public comments have been reviewed, the Committee will finalize its report and make its official recommendations to the Secretary.