AB356: Bill Text

LRB-2381/5

MDK&PJH:wlj:cph

2003 - 2004 LEGISLATURE

2003 Assembly BILL 356

May 22, 2003 - Introduced by Representatives Underheim, Ott, Kestell, Freese, Musser, Hines, Seratti, Bies, J. Lehman, Hundertmark, Gronemus, Berceau, Weber, Albers, Turner, Kreibich, Pettis, Loeffelholz, Kreuser, Hahn, Ladwig, Olsen, Nass, Staskunas, Travis and Plouff, cosponsored by Senators Schultz, Reynolds, Breske, Chvala, Carpenter and Hansen. Referred to Committee on Health.

AB356,3,2 An Act to repeal 16.009 (1) (h), 655.001 (10m) and 948.70 (1) (a); to renumber 146.31 (1), 146.815 (1), 185.983 (1) and 804.10 (1); to renumber and amend 148.01, 446.02 (7) (b) and 975.001; to consolidate, renumber and amend 948.70 (1) (intro.) and (b); to amend 15.165 (5) (a) 7., 15.197 (25) (a) 1., 15.405 (7m), 15.407 (1m), 15.915 (2) (b), 20.927 (1m), 29.193 (3) (a), 30.67 (6) (b), 36.25 (11) (b), 36.25 (13g) (b) 2., 39.16 (2) (d), 46.18 (10), 46.19 (4), 46.21 (2) (m), 46.21 (4m) (a), 46.245, 46.297 (2) (a), 46.298, 46.56 (3) (b) 3., 46.87 (5) (a) 1., 49.148 (1m) (b), 49.19 (11s) (b) 2., 49.26 (1) (g) 11., 49.43 (9), 50.09 (1) (a) (intro.), 50.36 (3g) (c), 50.90 (3), 55.043 (1) (b) (intro.), 59.53 (13) (a), 59.64 (1) (a), 60.23 (9), 66.0601 (1) (b), 70.11 (25), 94.70 (3) (b), 97.18 (5), 97.48 (2), 100.43 (3) (c), 102.565 (2), 106.50 (2r) (bm) 2., 115.53 (4) (a), 115.777 (1) (a), 118.135 (3), 118.29 (1) (e), 118.291 (1) (b), 146.0255 (2), 146.15, 146.17, 146.58 (1), 146.82 (2) (a) 5., 146.89 (1), 146.89 (2) (b), 150.85 (4) (c) 2., 155.05 (2), 157.05, 157.06 (1) (h), 165.765 (2) (a), 180.1903 (4), 231.01 (7) (a) 2., 233.04 (3b) (a) 2., 252.23 (1) (a), 302.10, 302.113 (9g) (c), 302.37 (2), 302.383 (1) (b), 302.40, 343.63 (4), 347.485 (2) (b), 350.155 (2), 440.08 (2) (a) 58., 441.001 (3) (a), 441.001 (4) (b), 445.14, 446.01 (2) (b), 446.02 (1) (b), 446.02 (2) (b), 446.02 (4), 446.02 (9) (a), 446.03 (intro.), 446.05 (1), 446.05 (2), 447.03 (3) (h), 449.01 (2), 449.02 (2), 450.01 (22), 454.02 (1), 459.035, 560.33 (1) (e), 609.22 (4m) (a), 632.76 (2) (b), 647.01 (6), 700.16 (4) (d), 765.03 (1), 804.10 (3) (a), 880.33 (1), 880.33 (4m) (b) 1., 891.09 (2), 891.40 (1), 891.40 (2), 895.48 (1), 895.48 (4) (b) 2., 938.48 (6), 939.615 (6) (e), 967.02 (2), 968.255 (3), 971.14 (2) (g), 971.14 (5) (am), 971.17 (3) (c) and 990.01 (28); and to create 46.27 (1) (bg), 48.02 (14k), 50.01 (4p), 50.49 (1) (d), 51.01 (13m), 69.01 (17m), 77.51 (10m), 95.21 (1) (dm), 101.01 (10m), 146.31 (1g), 146.55 (1) (fm), 146.815 (1g), 148.01 (2), 149.10 (7m), 154.01 (6), 155.01 (9m), 185.983 (1g), 301.45 (1d) (q), 343.045, 346.01 (3), 441.001 (2q), 444.01, 446.01 (1d), 446.01 (1k), 446.01 (1L), 446.01 (1m), 446.01 (1q), 446.01 (3), 446.02 (6m), 446.02 (7) (b) 2., 446.02 (7s), 446.025, 446.03 (8), 446.035, 446.04 (6), (7), (8), (9), (10) and (11), 446.05 (3), 449.01 (5), 450.01 (15m), 454.01 (14m), 600.03 (34m), 767.001 (5m), 804.10 (1g), 938.02 (14g), 940.001, 941.315 (1) (c), 948.01 (3o), 961.01 (17m), 975.001 (2), 979.001, 990.01 (25v) and 990.01 (40m) of the statutes; relating to: the definition of the practice of chiropractic; chiropractic evaluations, treatments, and referrals to physicians; unprofessional conduct by chiropractors; delegations by chiropractors to physician assistants and other employees; continuing education for chiropractors; nutritional guidance provided by chiropractors to patients; statutory references to physicians and chiropractors; and granting rule-making authority.

Analysis by the Legislative Reference Bureau

This bill makes changes to the regulation of chiropractors regarding all of the following: 1) the definition of the "practice of chiropractic"; 2) patient evaluations, treatments, and referrals; 3) unprofessional conduct by chiropractors; 4) delegations by chiropractors; 5) continuing education requirements; 6) nutritional guidance provided by chiropractors; and 7) statutory references to physicians and chiropractors. These changes are described below.

Definition of the "practice of chiropractic"

Under current law, the "practice of chiropractic" is defined, in part, as the employment or application of chiropractic adjustments and the principles or techniques of chiropractic science in the diagnosis, treatment, or prevention of conditions of human health or disease.

Under this bill, the "practice of chiropractic" has the same definition, except that the chiropractic adjustments and principles or techniques of chiropractic science must be those that are taught at a college or university approved by the Council on Chiropractic Education or any successor organization.

Patient evaluations, treatments, and referrals

This bill requires a chiropractor to evaluate a patient to determine whether the patient has a condition that is treatable by chiropractic means. The evaluation must be based on an examination that is appropriate to the patient. Also, a chiropractor must utilize chiropractic science, as defined by rule by the Chiropractic Examining Board, and the principles of education and training of the chiropractic profession.

Under the bill, a chiropractor must discontinue treatment if, at any time, the chiropractor determines, or reasonably should have determined, that the patient's condition will not respond to further chiropractic treatment. Also, if a chiropractor makes such a determination, the chiropractor must inform the patient and refer the patient to a physician. If the referral is in writing, the chiropractor must provide a copy to the patient and maintain a copy with the patient's records. If the referral is made orally, the chiropractor must notify the patient about the referral and make a written record of the referral, which must be maintained with the patient's records.

Finally, the bill creates one exception to the requirement to discontinue treatment under the circumstances described above. The exception is that the bill allows a chiropractor to provide supportive care to a patient being treated by another health care professional.

Unprofessional conduct

Under current law, the Chiropractic Examining Board may investigate allegations of misconduct against a chiropractor and, following a hearing, may revoke, limit, or suspend the chiropractor's license.

Under this bill, the Chiropractic Examining Board must establish a Peer Review Panel of qualified chiropractors to evaluate a claim that a chiropractor provided inappropriate care to a patient. Under the bill, a finding by the Peer Review Panel that the chiropractor has provided a certain number of inappropriate services to a patient constitutes misconduct for which his or her license may be suspended or revoked.

The bill also creates several new categories of misconduct for which a chiropractor may have his or her license suspended, including improper billing and falsifying an insurance claim. In addition, under the bill, the Chiropractic Examining Board must suspend the license of a chiropractor who commits a third misconduct violation, for no less than six months.

Finally, the bill prohibits sexual misconduct by chiropractors. Sexual misconduct is sexual contact, exposure, or gratification, sexually offensive communication, dating a patient under the chiropractor's professional care or treatment, or other sexual behavior with or in the presence of a patient under the chiropractor's professional care or treatment. Consent is not relevant. A chiropractor who commits sexual misconduct that does not involve physical contact with a patient shall have his or her license suspended for not less than 90 days. A chiropractor who commits a second act of sexual misconduct that does not involve physical contact or a first act of sexual misconduct that does involve physical contact shall have his or her license suspended for one year, and a chiropractor who commits a third act of sexual misconduct that does not involve physical contact or a second act of sexual misconduct that does involve physical contact shall have his or her license revoked.

Delegations by chiropractors

Under current law, a chiropractor licensed by the Chiropractic Examining Board is allowed to delegate services that are adjunctive to the practice of chiropractic to individuals who are not licensed by the Chiropractic Examining Board, but only if the services are performed under the direct, on-premises supervision of the chiropractor. In addition, current law prohibits a chiropractor from delegating to individuals not licensed by the Chiropractic Examining Board the making of a diagnosis, the performance of a chiropractic adjustment, the analysis of a diagnostic test or clinical information, or any practice or service that the Chiropractic Examining Board specifies in rules.

This bill creates an exception to the prohibition described above. Under the bill, a chiropractor may delegate to a physician assistant licensed by the Medical Examining Board the making of a diagnosis, the analysis of a diagnostic test or clinical information, or any practice or service that the Chiropractic Examining Board specifies in rules. However, a chiropractor may not delegate the performance of a chiropractic adjustment to a physician assistant. Also, a delegation may not exceed the chiropractor's scope of practice or the education, training, or experience of the physician assistant. A delegation to a physician assistant allowed under the bill does not have to be under the direct, on-premises supervision of a chiropractor.

The bill also requires a chiropractor who applies to renew his or her license to identify each employee to whom clinical work is delegated, except that the following do not have to be identified: nurses, physician assistants, physical therapists, and athletic trainers. In addition, if the Chiropractic Examining Board has promulgated rules that require an employee who is required to be identified to complete a training program or course of instruction to perform the delegated work, the chiropractor must also provide in his or her application for renewal the name, date, and sponsoring organization for the training program or course of instruction that the employee completed.

Finally, the bill changes the definitions of "practical nursing" and "professional nursing" to include actions taken under the supervision or direction of a chiropractor, in addition to actions taken under the supervision or direction of other health care professionals that are specified under current law.

Continuing education

Under current law, a chiropractor licensed by the Chiropractic Examining Board must complete any continuing education that the board requires in order to renew his or her license, which must be renewed every two years. This bill creates additional requirements regarding continuing education.

Under the bill, the Chiropractic Examining Board must establish the minimum number of hours of continuing education courses that must be completed during the two-year licensure period. As under current law, a chiropractor does not have to begin complying with continuing education requirements under the bill until the first two-year licensure period beginning after he or she initially receives his or her license.

Also under the bill, only courses that are approved by the Chiropractic Examining Board may be used to satisfy the minimum hours required. The Chiropractic Examining Board may only approve a course if the organization that sponsors the course (sponsoring organization) satisfies certain requirements. The sponsoring organization must be the Wisconsin, American, or International Chiropractic Association, or an approved chiropractic, medical, or osteopathic college or university. Also, the sponsoring organization must carry out specified duties, including selecting the course instructor, preparing course materials, evaluating the course, maintaining transcripts, performing financial administration, proctoring attendance, providing attendance vouchers, and supplying a list of attendees to the Chiropractic Examining Board. The sponsoring organization is also allowed to delegate these duties to another organization. The Chiropractic Examining Board must withdraw or withhold approval from a sponsoring organization for a two-year period if the sponsoring organization fails to carry out any of the duties, or if an organization to which a duty is delegated fails to carry out any of the duties.

The bill requires the Chiropractic Examining Board periodically to publish an updated list of approved courses. A chiropractor who applies to renew his or her license must identify the courses used to satisfy the minimum hour requirement on a form provided by the Department of Regulation and Licensing. The bill requires the Department of Regulation and Licensing to audit a percentage, as determined by the department, of the renewal applications received during each two-year licensure period to determine whether an applicant has attended the courses that he or she identifies on the form.

Finally, the bill allows the Chiropractic Examining Board to take disciplinary action against a licensed chiropractor who violates any state law or rule regulating chiropractors, including the continuing education requirements.

Nutritional guidance

This bill requires certain chiropractors licensed by the Chiropractic Examining Board to complete a postgraduate course of study in nutrition before they may provide counsel, guidance, direction, advice, or recommendations to patients regarding the health benefits of vitamins, herbs, or nutritional supplements. However, the requirement applies only to chiropractors who were granted licenses on or before January 1, 2003. In addition, the requirement does not apply to chiropractors who are also certified as dietitians by the Dietitians Affiliated Credentialing Board. The required course of study must consist of 48 hours and must be approved by the Chiropractic Examining Board.

Statutory references to physicians and chiropractors

Under current law, if the term "physician" is used in the statutes, it means a physician licensed by the Medical Examining Board, except if that meaning is inconsistent with the legislature's manifest intent. Also, under current law, if "chiropractor" is used in the statutes, it means a chiropractor licensed by the Chiropractic Examining Board, with the same exception regarding legislative intent.

Under this bill, if the term "physician" is used in the statutes, it means either a physician licensed by the Medical Examining Board or a chiropractor licensed by the Chiropractic Examining Board, with the same exception under current law regarding legislative intent. As a result, the following provisions that refer to a "physician" under current law are changed under the bill to refer to either a physician licensed by the Medical Examining Board or a chiropractor licensed by the Chiropractic Examining Board:

1. Certifications, reports, or other requirements regarding handicap, disability, illness, physical fitness, or other physical condition that are related to class B hunting permits, testimony by telephone at tax dispute hearings conducted by a board of review, releases of land from farmland preservation agreements, polygraph testing by employers, verification of illness of striking municipal workers, duty of hospitals to provide emergency treatment, notification of the Department of Transportation about a patient's ability to drive, and participation in a property tax loan program administered by the Wisconsin Housing and Economic Development Authority, and driver's instructor licenses.

2. Certifications, reports, or examinations regarding handicap, disability, or other physical condition required for participation in a program for state agencies to make procurements from work centers for the severely physically handicapped, disability annuities administered by the Employee Trust Funds Board, eligibility of veterans for public employment, and exemptions of unemployed persons from certain supervision fees otherwise required by the Department of Corrections.

3. Appointments to the Private Employer Health Coverage Board in the Department of Employee Trust Funds.

4. Privacy requirements for medical communications regarding residents of nursing homes and community-based residential facilities and for releases of information by the Department of Health and Family Services, and requirements regarding the release of employee medical records by employers.

5. Reports required for accidents involving all-terrain vehicles and snowmobiles and investigations of snowmobile accidents by the Department of Natural Resources.

6. Requirements for drawing blood for testing persons arrested for intoxicated operation of motor vehicles, all-terrain vehicles, snowmobiles, or boats.

7. Physical examinations required for civil service employees of first class cities, for participation in the Wisconsin service and conservation corps programs, and for certain school employees and statements about job applicants obtained by the Division of Merit Recruitment and Selection of the Department of Employment Relations.

8. Access to physical examinations and medical evidence in personal injury actions.

9. Requirements for participating in the Volunteer Health Care Provider program administered by the Department of Health and Family Services.

10. Eligibility of nonprofit hospitals for property tax exemption regarding certain health and fitness centers.

11. Reduced railroad rates allowed for physicians.

12. Exception to immunity from civil liability for emergency care that applies to care provided in a physician's office.

Finally, the bill specifies that other references to a "physician" under current law mean a physician licensed by the Medical Examining Board. As a result, the bill does not change the meaning of those references under current law.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.