September 2003

ACC blindsides profession

Coalition vehemently against wording of diagnosis statement

The Chiropractic Coalition has come out in strong opposition to a statement on diagnosis passed during an ACC Board retreat in July. The Coalition was founded by the International Chiropractors Association, Federation of Straight Chiropractors and Organizations and World Chiropractic Alliance (WCA), and now has more than a dozen affiliated organizations around the world.

In addition, several college presidents are reconsidering their position on the statement and one, Dr. Jerry Hardee of Sherman College of Straight Chiropractic, has withdrawn his endorsement.

The ACC statement completely negates the intent of its original chiropractic "paradigm" that won nearly universal support throughout the profession.

As signed by all college presidents, the statement reads:

A diagnosis is an expert opinion identifying the nature and cause of a patient's concern or complaint, and/or abnormal finding(s). It is essential to the ongoing process of reasoning used by the doctor of chiropractic in cooperation with the patient to direct, manage, and optimize the patient's health and well being.

The process of arriving at a diagnosis by a doctor of chiropractic includes obtaining pertinent patient history; conducting physical, neurological, orthopedic, and other appropriate examination procedures; ordering and interpreting specialized diagnostic imaging and/or laboratory tests as indicated by symptoms and/or clinical findings; and performing postural and functional biomechanical analysis to determine the presence of articular dysfunction and/or subluxation.

The new ACC declaration "will have a serious and far‑reaching negative impact on the profession and, in essence, may prohibit the practice of traditional, subluxation‑based chiropractic," the Coalition argued in a preliminary announcement still being revised at press time. It will make doctors who limit their practices to the detection and correction of vertebral subluxation vulnerable to accusations of malpractice, board complaints, and exclusion from managed health care programs.

"I am very concerned to see that any such statement provide sufficient latitude so that chiropractors can practice according to chiropractic's traditional principles and their own personal values, and not be adversely impacted by the addition of new and unnecessary practice demands," stated CJ Mertz, ICA President.

"Equally important," he added, "if any such statement is to have the full backing of the chiropractic profession, it must be subjected to a reasonable and objective comment period so that all chiropractic organizations as well as individual practitioners have the opportunity to offer insight and comment, and for that feedback to be objectively evaluated and acted upon."

By maintaining that "The process of arriving at a diagnosis by a doctor of chiropractic includes...conducting physical, neurological, orthopedic, and other appropriate examination procedures; ordering and interpreting specialized diagnostic imaging and/or laboratory tests as indicated by symptoms and/or clinical findings; and performing postural and functional biomechanical analysis to determine the presence of articular dysfunction and/or subluxation" (emphasis added) the statement could mandate such procedures as integral to every chiropractic program of care, according to the Coalition. "The implications for chiropractors providing wellness services as opposed to the treatment or diagnosis of disease is profound," noted the Coalition in its draft paper.

Gary S. Horwin, D.C., President of the FSCO, expressed his criticism of the statement. "Diagnosis by a chiropractor no longer includes spinal analysis or palpation of the spine," he stated, referring to the description in the ACC Statement. "It does include conducting physical and other appropriate examination procedures and/or laboratory tests. When I was examined by an M.D., he conducted a physical exam and other appropriate examination procedures and ordered laboratory tests as indicated by my symptoms. It seems the blurry line has now been crossed. Our uniqueness obliterated."

The Coalition also faulted the statement for characterizing subluxation as nothing more than a postural or biomechanical problem. Eliminating the neurological element jeopardizes doctors who use instrumentation to assess neurological function, and contradicts the ACC statement concerning organ system function and general health. Additionally, it does not address other neurological findings as components of, or associated with, the subluxation, the Coalition stated.

The problem could be easily corrected by inserting the word "may" in the phrase: "The process of arriving at a diagnosis by a doctor of chiropractic may include obtaining pertinent patient history..." This would give chiropractors the freedom to use their own judgment as to the type and number of tests needed to make a chiropractic diagnosis, the Coalition stressed.

It also recommended the statement be modified to read "...performing appropriate postural and functional biomechanical analysis, and/or using specialized procedures to determine the presence of articular dysfunction and/or subluxation and its resultant neurological dysfunction in accordance with the judgment of the attending doctor and the unique needs of each patient" (proposed changes in bold). This would restore the neurological component to the definition of subluxation, rather than categorize it in strictly mechanical terms.

One college president said he was fairly certain that the word "may" was included in the original wording and he was surprised to learn that the final statement omitted it. The final version of the text was presented to the presidents via a slide show in a darkened room, he noted.

"As a relatively new college president in the chiropractic profession, I recognized immediately that one of my goals would be to work toward bringing about a sense of collegiality and unity in the profession," Dr. Hardee noted. "The diagnosis statement approved by the Association of Chiropractic Colleges (ACC) is an example. When I returned from the meeting, I immediately sought a level of consensus on the statement to be sure that our decision would not adversely impact a large number of constituents."

Hardee continued, "To my chagrin, I noticed that the 'may' from the old statement was not transposed into the new statement. I subsequently tried to get my fellow presidents to correct (change) the definition to include the word 'may' rather than 'includes' in the wording. Several were willing to make the change since it was just a matter of asking David O'Bryon to edit the document. To date, we have not been able or willing to direct Mr. O'Bryon to change the document. So, until further notice, I am withdrawing my vote on the definition until such time that we can again have a vote on the matter. "

In a press release distributed by the ACC, President Jean Moss stated: "The statement of diagnosis is a further clarification of the position papers issued as part of the ACC Paradigm. The ACC will continue provide further statements and white papers on this and other subject areas." Moss is president of Canadian Memorial Chiropractic College in Toronto. In 1996, the ACC embarked on a process that will periodically result in comments from the chiropractic academic community on topics of interest to the field.

"The statements reflect what is being taught at chiropractic colleges and in line with accreditation guidelines," noted ACC Executive Director David O'Bryon.

The debate over the ACC statement touches on issues beyond the actual wording, however.

There is growing resentment toward groups such as the ACC, CCE, FCLB and others that use their power to make declarations as to the definition and practice of chiropractic, without any input from field doctors who must suffer the consequences of those pronouncements.

The trend toward chiropractic "closed room" politics was most evident during the Mercy Conference. Thirty‑five carefully chosen delegates created a set of guidelines, which, although ultimately rejected by nearly the entire profession, were used extensively by the insurance industry to slash claims. Only a concerted effort by field doctors and organizations such as the WCA helped minimize the effects of the medically oriented guidelines.

"Once again, a small and powerful cabal is trying to redefine chiropractic, disassociate it from the principles upon which the profession was built, and hamstring a large portion of the chiropractic community that doesn't fit its image of a chiropractic physician," stated WCA President Terry A. Rondberg, D.C.

The Coalition called upon all doctors of chiropractic to fight the ACC pronouncement by contacting chiropractic college presidents and urging them to renounce the statement. By withholding donations and referrals, it is possible to demonstrate to college leaders that the profession ‑‑ after years of work to establish its identity and worldwide acceptance ‑‑ will simply not stand by and be railroaded into the medical model.

In addition, the Coalition asked all doctors who are in leadership positions in their state or regional chiropractic organizations to have the association vote to reject the ACC statement on diagnosis and endorse the Chiropractic Coalition Position Paper repudiating it.