December 2007

Should Dr. Sportelli act as our moral arbiter?

by Dr. Terry A. Rondberg

We're nearing the New Year and it's traditional to review the past to assess our progress and set future goals. At least one chiropractic writer ‑‑ Louis Sportelli, DC ‑‑ took the opportunity recently in Dynamic Chiropractic to look back over the past 20 years and wonder "How Far Have We Really Come?"

After reprinting an article he wrote in 1984, in which he placed much of the blame for the problems facing chiropractic on rampant "avarice and greed" within chiropractic, he came to the conclusion that we, as a profession, haven't progressed very far. As he put it, "we are almost in the same situation today."

Throughout his original article, as well as his recent review, he points to "an element of this profession which is not only greedy, but is attempting to teach and promulgate its greed throughout the profession. I'm talking about the practice‑builders who tell you about the baits and lures for hooking patients, the easy‑money formulas, and the 'bring 'em in dead or alive' insurance schemes."

He also claims that "I am denouncing procedures and protocols that are less than ethical, push the envelope to the limit, border on exploiting the patient and the provider, cause irreparable harm to the global image of the profession, and forsake doctor‑patient trust for patient abuse."

Who would possibly disagree with him on those statements? Yes, there is an unsavory element in this profession, one that is motivated by greed (for money, power, acceptance, stature, etc.) and conducts and/or teaches unethical procedures.

There are also those DCs who are guilty of sexual misconduct with patients ... practice outside their scope ... over‑bill insurance companies for a variety of tests and treatments ... attempt to pass themselves off as medical doctors. These are all deplorable actions and should not be tolerated by our profession.

Saying that, however, is like saying we shouldn't tolerate graft by politicians, embezzlement by accountants, or brutality by police officers. Of course we shouldn't!

But many types of behavior aren't so black and white.

For instance, Dr. Sportelli refers to the controversial "money hum" made famous by Sid Williams, DC, at the Dynamic Essentials seminars. That practice may have been in questionable taste or even laughable, but unethical? No one seems to remember that participants also chanted "I feel healthy, I feel happy, I feel terrific." Sounds to me like good, positive "prosperity" thinking!

Dr. Sportelli also points to "hucksters" who teach doctors to "Get 'em on a 10‑month program." Personally, I think doctors should get all patients on a lifetime program, since the need for subluxation correction doesn't end after 10 months. Long‑term care is, for Dr. Sportelli, a bad thing to be stamped out by our profession. For me, it's an important goal for our profession and one that will help restore health to our entire population.

Among the other transgressions Dr. Sportelli cites are "testimonials which claimed cures from everything from AIDS to Zoacanthosis." If these were patient testimonials, he can hardly blame the doctors if their patients, grateful for the gift of health they received from their DCs, wrote in glowing, if inaccurate, terms. In my two and a half decades as a chiropractor, I literally cannot recall a single instance of a DC claiming to "cure" these conditions. What I have seen ‑‑ and unconditionally approve of ‑‑ are ads or patient education material explaining the devastating impact of subluxations and how subluxation correction helps restore the body's normal functioning, which can, in turn, address health issues as varied as AIDS to Zoacanthosis.

In many instances, the actions Dr. Sportelli deplores don't appear to be inherently bad or unethical. Promoting long‑term care, teaching about subluxation correction for wellness, striving to maximize income by providing high‑quality care to as many patients as possible, and even using creative and innovative marketing techniques are not unethical to me or to many (if not most) of my colleagues. Nor is it wrong for management consultants to teach these methods, or to encourage doctors to strive for prosperity.

The real question we have had to answer throughout our history is who gets to determine what's ethical? Whose opinion will regulate the profession? Or, put another way, who will be given the authority to act as official "censor" for chiropractic?

Censorship, in general, is a tricky issue. When it comes to the film industry, I have very strong views as to what kinds of movies are bad. Browse around your local video store and take a look at some of the films being released right now. I see the violent and (to me) pornographic images splashed across the DVD boxes and my first reaction is "they shouldn't allow such trash to be made."

Give me the authority and I'd probably outlaw those movies! Give others that power, and they'd probably outlaw other types of films they find objectionable but which I think are acceptable.

That's why we fight so hard against censorship by any single person or group. In a free society, we can't allow any one group to impose its set of values on all of us, particularly as it relates to the gray areas of conduct.

So, the bottom line is who should serve as moral arbiter for the chiropractic profession, as its "censor" so to speak?

Personally, although I'm sure he has many good qualities, I am not comfortable with allowing Dr. Sportelli to act in that role. His record of maligning and attacking subluxation‑based chiropractors simply for their adherence to their principles clearly makes him far too biased to act objectively. He views chiropractic (as we all do) through his own tinted glasses.

The NCMIC empire

As president of the NCMIC Group, which provides insurance to medical doctors, dentists, naturopaths, and lawyers, as well as chiropractors, Dr. Sportelli has been put in the awkward position of catering to professions that are at odds with chiropractors.

Several years ago, for instance, he spoke at an insurance industry meeting and painted a rather grim portrait of our profession. The Auto Insurance Report stated that "Sportelli is willing to tell his fellow practitioners that too many of them are crooks ... the business has become a haven for crooks ... professional boards are toothless wimps who can't enforce anything and at best can 'gum to death' practitioners who step out of line."

The article also revealed that Dr. Sportelli said insurers who paid out these chiropractic claims were "too lazy to do anything about the crooks, preferring just to pay the bills and pass along the costs to their customers."

After listening to him, I'm sure most of the people in the audience left thinking that chiropractic was filled with crooks and schemers who over‑treat their patients in order to bilk insurance companies of un‑deserved income. I'm not willing to allow someone with such a dismal view of our profession act as its censor.

It's ironic, too, that for someone who would never chant the money hum, Dr. Sportelli has managed to help create quite a nice financial empire. NCMIC Group not only sells insurance to five different professions, it has a subsidiary called NCMIC Finance Corporation which offers equipment leases and loans, credit cards and credit card processing. It also provides HIPAA training (for a fee), continuing ed seminars (for a fee), SBA loans (for a fee), books and publications (for a fee) and a myriad of other services (for a fee). Making a profit does not seem to be unethical in this context.

Triad

One of the entities spawned by NCMIC and founded by Dr. Sportelli, is Triad, a PPO‑type organization. I think Jeffrey Shay, DC, one of the most knowledgeable insurance experts in the profession, put it best when he said that "dealing with NCMIC is like reliving Greek mythology. Hercules was sent to destroy the Hydra, a huge snake with nine heads. Every time he cut one head off, two more grew in its place. This should help explain the existence of the ACA, NCMIC, Triad, FCER and several other organizations."

In the speech he gave to members of the insurance industry, Dr. Sportelli promoted Triad. The Auto Insurance Report article noted that "He (Dr. Sportelli) says that there is a need for protocols for treatment of soft tissue and skeletal injuries, and that Triad is the best way to get the job done. He hopes to add value by 'organizing' the way treatment is given and requiring chiropractors to track results. Triad, he claims, gives providers a common language, practice strategy, and a mandate to share information and data." The report also noted that, "unsaid in all this is that Triad... should prove to be a valuable way to reduce outright fraud and excessive treatment by chiropractors."

Triad has been criticized by many in the profession for imposing unfair standards on DCs, and using extortion‑like practices to pressure doctors into joining the network.

The last I heard, member doctors are required to pay a hefty fee for a "Self Assessment Program" (known as "SAP") developed by Dr. Sportelli. They are also required to take Triad's risk‑management seminar, at a cost of another few hundred dollars, and carry $1 million/$3 million limits of liability. Since most Triad members also have their malpractice insurance through NCMIC, these high limits translate into increased revenue for the insurance company.

There have been numerous reports of withheld payments, claims rejections and reductions, and administrative snafus. When Triad tried to gain a foothold in Pennsylvania, critics of Triad sent a letter to colleagues warning them that Triad was beginning a push to recruit members in their state. The letter noted: "Triad negotiates contracts with major insurers to manage (cut) chiropractic care. Their program has seriously hurt, and has financially ruined many chiropractors in other states."

The letter also warned doctors of the economic impact of Triad's presence in the state. "Triad's pattern of doing business is clear. They donate a lot of money to the state association. They sell a group of naive doctors at the state convention ... They explain that if they don't jump on the bandwagon, they will be left out, and other doctors will reap all the rewards. In reality, the doctors who sign up end up hurting financially. In other states, some doctors are still waiting to be paid for claims that have been withheld by Triad for 2 years or more."

An endorsement by the Pennsylvania Chiropractic Association (PCA) led some doctors to probe into possible financial ties between the Triad group and the organization. They found, as noted in the letter, that Triad "donated a lot of money to the PCA. At the upcoming PCA convention in August, 50% of the seminars are sponsored by NCMIC or Triad."

A flyer distributed by the PCA went so far as to say that one of the top reasons for attending the convention was to "attend any of the four programs sponsored by Dr. Lou Sportelli and NCMIC."

Prior to this, the former President of the Maine Chiropractic Association, Robert P. Lynch, Jr., DC, wrote to Triad officials stating: "It is a great concern to my colleagues and constituents, as well as myself, that if Triad enters the state of Maine, that we will suffer significantly financially as a result... This fee schedule as presented will only negatively impact NCMIC's subscribers' practices in the State of Maine." Lynch was serving on the Board of Governors of the American Chiropractic Association when he wrote to Triad officials.

Does the man who started, and continues to promote, this apparent scheme, deserve to tell the rest of us what is ethical when it comes to chiropractic practice?

The WFC

Dr. Sportelli's actions while he was president of the World Federation of Chiropractic (WFC) also disqualifies him from wielding the moral compass for chiropractic, as does the major role he played in the development of the Mercy guidelines.

The WFC has absolutely no official standing or authority, yet it has attempted in recent years to rule the practice of chiropractic ‑‑ and chiropractic education ‑‑ throughout the world with an iron fist.

The WFC's "Tokyo Charter," which it developed in 1997, while Dr. Sportelli was president set the goal of establishing "one minimum international standard in chiropractic education," and proclaimed the WFC the sole arbiter of that standard.

According to the Charter, educational programs could be conducted only with "prior consultation with and approval by the national association or other chiropractic organization recognized by the World Federation of Chiropractic as representing chiropractors in that country..."

In addition, only WFC member associations would be allowed to invite people to teach in their countries. If a nation had two or more organizations, those which were not "ordained" by the WFC would be barred from providing educational programs.

In keeping with the agenda of the WFC's leaders, the WFC did not affiliate with any subluxation‑based organizations and, in fact, took action to prevent such organizations from becoming established or exercising any influence on their national policy.

Although the Charter is filled with explanations as to how chiropractic colleges should do things, it includes the notation, "In this Charter, the word 'should' is used with the meaning 'must.'"

In truth, the WFC was founded, and is led by, the same people who developed and pushed the Mercy guidelines, men who have consistently voiced their opposition to subluxation‑centered chiropractic. In addition to Dr. Sportelli, Drs. Scott Haldeman, Reed Phillips, and John Triano have been associated with the WFC.

All were also associated with the Mercy guidelines. Not surprisingly, one of the goals of the WFC appears to be promoting Mercy and its successor, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) as the basis of practice and educational standards worldwide.

I needn't remind anyone that Mercy has done more harm to chiropractic than all the practice gurus put together. It has limited chiropractic in an attempt to "medicalize" the profession and has been used as the key tool by the insurance industry to cut claims and devalue chiropractic. Yet, despite widespread opposition to the document by the profession, Dr. Sportelli repeatedly tried to promote the guidelines.

Who gets to rule?

Unless you are a big fan of Mercy, CCGPP, Triad, NCMIC, and the WFC ‑‑ and share its rather distorted and limited view of chiropractic ‑‑ I think you'll agree that Dr. Sportelli is not in a position to be telling the profession what's ethical or unethical.

And if you think I want the job, you're wrong. I'm just as passionate about my vision of chiropractic as Dr. Sportelli is about his. I think the DCs who wear white lab coats with stethoscopes around their necks are the ones presenting the wrong image of chiropractic. Doctors whose ads include a laundry list of symptoms like headaches, back aches, whiplash, shoulder pain (with the ubiquitous lightning bolts coming out of the highlighted body part!) are doing a lot more damage than those who pass their business cards around town. Teaching DCs to do medical blood work or obstetrics is a far greater sign of "greed and avarice" than long‑term wellness programs.

I'd like to think that I would never go so far as to try to outlaw those activities and I stand by the "live and let live" philosophy upon which the World Chiropractic Alliance was founded. But I don't expect the profession to hand me the power to regulate chiropractic and mold it into my vision.

Nor can we, as a profession, hand over that power to anyone or any one group. Dr. Sportelli cannot sit in judgment on chiropractic and instruct us on removing the mote from our eye until he notices the beam in his own!