February 2008

The VA, the ACA, and the USA

by Dr. Jeffrey Shay

Some years ago, there was a wave of indignation in the chiropractic profession after the Veterans' Administration mistreated a chiropractic patient. The veteran's name was Charles Culbertson, and he was punished by the VA for seeking chiropractic treatment for pain that had been unsuccessfully treated by MDs. In spite of his weakened condition, he was forced to leave the hospital after being warned not to have any further chiropractic adjustments. For not following his instructions, he was denied further treatment and died shortly thereafter.

An angry group of 300 patients protested his treatment, demanding that veterans have access to chiropractic services. They even sent a petition to Congress and the President of the United States, all to no avail. Once again, the people of this country were ignored, and the AMA won out, even though they had virtually destroyed a man who asked for a choice of treatments.

The president was Calvin Coolidge, and the year was 1924.

The chiropractor was Dr. Leo Spears, who practiced in Colorado at the time, treating Mr. Culbertson for injuries incurred during the First World War. He suffered lung damage from gas at Chateau Thierry in 1918, and also had injuries to his neck and shoulder. After being evicted from the hospital, he died for lack of treatment for uremic poisoning, the incident being related in a sworn statement by his wife and two of his friends.

Dr. Spears, angered by the actions of the medical establishment, ran the statements in a full‑page advertisement in the Denver Times, resulting in a three‑year battle with the medical board in Colorado, which eventually suspended his license for making the story public. After serving his sentence, Dr. Spears eventually resumed his chiropractic practice in 1928, but never forgot the actions of the AMA, or what was then called the Veterans' Bureau.

Eighty years later, things haven't changed all that much.

Oh, yes, we passed a bill that provided for chiropractic adjustments for our veterans, but it was accompanied by a major concession by the American Chiropractic Association, which proposed that chiropractic treatment be subject to a medical referral. Note that the WCA opposed the need for medical permission.

At that time, I predicted the concession was a folly, and that the referral system was a sham, similar to asking a cable TV supplier for a satellite dish. I haven't seen any studies performed on the program to this time, so I only have my own experience on which to draw. Conclusion: It's a joke.

I practice about 40 miles from the veterans' facility in Iowa City, and have sought referral for several patients. In general, it didn't happen.

One patient was told that "no one needs chiropractic treatment."

Another was refused because, as the MD said, "there was no proof that chiropractic care would benefit his low back pain."

A third veteran was initially refused permission, as he had to be referred to a special department to get approval. After seeing three different doctors, he was finally given permission for 12 adjustments. Later, I was surprised to receive referral for another set of treatments over six more months.

Of course, getting referral and getting paid were two different things. I had to refile several times, and my claim was bounced from department to department until I was finally paid ‑‑ five months later.

Following some unsuccessful medical treatment, my patient was denied further chiropractic care, but was referred to another medical specialist to get a proper diagnosis and a badly‑needed rectal exam. After more "miracle drugs," he was sent to still another functionary, who was again given the request for chiropractic care, which he was informed was not available until it was determined to be necessary, and that there was concern that it might be a waste of taxpayer money. Medical treatment, of course, is never unnecessary, no matter how dead the patient becomes.

After another series of x‑rays, blood tests, an MRI, and a CT, it has taken five months to render a decision to refer, which, I am told, is still under consideration. It is to be hoped that doing several thousand dollars of medical examinations will save the administration from having to pay out $200 for a few adjustments.

A fourth patient was allowed one adjustment per month over a six month period. When he reported improvement in his neck and back pain, he was refused further permission for care. After complaining to an ombudsman, he was told that referrals were hard to obtain, but that he needed to keep trying.

Over a period of three years, I received an allowance for 36 treatments to be distributed between two patients. Conclusion: As in Animal House, it's "Thank you, sir, may I have another?"

At this time, the profession is trying to pass legislation to correct the problem. While the ACA would claim that this system got our foot in the door, it would seem worse to be part of a farce that was implemented only to make some of our fearless leaders look good. If the ACA is part of the new legislative program, further patients will need referrals from both the AMA and the local Welcome Wagon.

The moral of the story: If you're enjoying the VA system, thank the ACA.

(Dr. Jeffrey Shay, a graduate of Palmer College of Chiropractic and the WCA's 1996 "Chiropractor of the Year," is the World Chiropractic Alliance Director of Insurance Relations. He welcomes comments or questions regarding any insurance‑related subject appearing in this column. Dr. Shay is available to speak to your state or local organization. Contact him at 1501 Mulberry Ave., Muscatine, IA 52761, or the WCA offices, FAX 480‑732‑9313.)