May 2004

WCA to push for direct access law

The World Chiropractic Alliance (WCA) has thrown its full support behind a bill introduced by California Rep. Bob Filner that may do what the Veterans Affairs Chiropractic Advisory Committee (CAC) failed to do: provide veterans with direct access to doctors of chiropractic.

The bill (HR 4051, "Better Access to Chiropractors To Keep Our Veterans Healthy Act) directs the Secretary of Veterans Affairs to permit eligible veterans to receive care "on a direct access basis at the election of the eligible veteran," and specifies that "The Secretary shall not discriminate among licensed health care providers in the determination of needed services." The bill also includes preventative health services among the services to be provided by chiropractors.

The CAC's final recommendations included a provision that allowed veterans to see a chiropractor only after a "consultation" with their primary medical provider. Only two members of the CAC voted for direct access, arguing that the long standing bias against chiropractors by medical doctors could make it nearly impossible for the veterans to see a DC. Dr. Leona Fischer of the WCA and Dr. Michael McLean of the International Chiropractors Association (ICA) voted for direct access.

Voting against direct access were the three doctors nominated by and/or aligned with the American Chiropractic Association (ACA): Dr. Rick McMichael, DC, the ACA's Ohio Delegate; Cynthia Vaughn, DC, president and executive director of the Texas Board of Chiropractic Examiners and partner in the Chiropractic & Spine Center of Austin with James D. Edwards, DC, former president of the ACA; and Reed C. Phillips, president of Los Angeles College of Chiropractic who served as a member of the Mercy Center Consensus.

Siding with the ACA supported committee members was Charles Duvall, Jr., DC, president of the National Association of Chiropractic Medicine. The ACA had originally opposed Duvall's appointment, yet all chiropractors other than the WCA and ICA members voted with him on this key issue.

"This has been the goal of the WCA ever since we started working on the issue," stated WCA President Terry A. Rondberg, DC. "We were proud of Dr. Fischer for holding strong to her convictions during the Committee vote, and we were shocked and dismayed by the actions of the majority of the Committee ‑‑ including DCs who were supposed to act in the best interest of the veterans and the profession."

In a letter to Rep. Filner, Dr. Rondberg stated, "This bill would provide an important benefit to American veterans, who deserve the best possible care and the freedom to choose which type of health care they receive." He pledged the support of the WCA in finding co sponsors for the bill and helping to ensure its passage through Congress.

The ICA also came out in support of the bill.

"ICA enthusiastically supports this initiative," said Dr. McLean. "There is no question that veterans should have the minimum amount of bureaucracy standing between them and the care they want, and that the current status of the chiropractic program within the VA, requiring primary care referral is unacceptable to the ICA, to the profession at large, and to the veteran beneficiary."

The Federation of Straight Chiropractors and Organizations, a member of the Chiropractic Coalition with the WCA and ICA, favored the bill as well. "HR4051 will go a long way to right an injustice to our veterans. Our veterans (of which I am one) should have the right and freedom to go to the healthcare provider they choose and not have to go through a gatekeeper. The FSCO firmly supports direct access for all American veterans to receive chiropractic care and will work to support Rep. Filner's Bill," said Richard Plummer, DC, FSCO Chairman of the Board.

Ironically, the ACA issued a statement in support of the bill as well, even though it had scrambled to justify the Committee members' votes against direct access by claiming that the gatekeeper provision was the only way to ensure chiropractic inclusion in the VA system.

In a report posted on the ACA website, Dr. McMichael explained that he and the other ACA aligned Committee members were persuaded to vote for the gatekeeper system by Michael O'Rourke, a physician's assistant who serves as the assistant director of Veterans Health Policy with the Veterans of Foreign Wars.

"... Michael O'Rourke strongly encouraged us to agree to work within the VA system in coordination with VA primary care physicians," McMichael explained. "He assured us that this was the best way to give this new service a real opportunity to work effectively for the veterans we were avowed to serve. He asked us to consider this a new day, leave the past behind and move toward the future. This is what the majority of the CAC chose to do."

In a press release distributed after it learned of Rep. Filner's bill, the ACA noted "This new bill (HR 4051) seeks to send a message to opponents of chiropractic ‑‑ inside and outside of the government ‑‑ that America's veterans will not be denied the chiropractic care they need and deserve."

Dr. Rondberg pointed out the incongruity of the statement.

"It's extremely odd that, when they had a chance to push for direct access within the Committee, the ACA members sided with the medical contingent to deny veterans that privilege," he stated. "Only after the profession reacted with fury at the ACA's betrayal did they suddenly become supporters of direct access. It's their way of trying to back pedal, but it's too little, too late."

The World Chiropractic Alliance will work with Rep. Filner's office to coordinate a campaign to show chiropractic support of the bill. Additional information will be available on the WCA website, www.worldchiropracticalliance.org.

Still think consultation doesn't mean referral?

American Chiropractic Association officials have attempted to convince chiropractors that the "consultation" required to see a DC isn't really a "referral."

"The term 'by consultation with' strongly infers that the providers will engage in a 'conference' regarding the patient and how the patient will be best served...including chiropractic care," stated Rick McMichael, DC in an ACA announcement.

That's not the way medical doctors are seeing it. In fact, the American Medical Association's newspaper, AMNews ("VA OKs chiropractic care but keeps primary care oversight," April 19, 2004) tells exactly who's in charge when it comes to letting patients see chiropractors:

"It's official. The Dept. of Veterans Affairs will include chiropractors in its network of health care professionals, and patients will have access to them through any of the VA's physicians and other health care professionals. But primary care physicians will retain ultimate oversight of patient care. This decision ends the debate on how patients will access chiropractic care at the VA." (emphasis added).