SB275: Bill Text

LRB-3012/2

MDK:wlj:pg

2003 - 2004 LEGISLATURE

2003 Senate BILL 275

October 8, 2003 - Introduced by Senators Schultz, Breske, Carpenter, Plale and M. Meyer, cosponsored by Representatives Freese, Hines, Vrakas, LeMahieu, Kreibich, Kestell, Musser, Van Roy and Hahn. Referred to Committee on Health, Children, Families, Aging and Long Term Care.

SB275,1,10 An Act to renumber 446.07; to amend 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) and 446.05 (2); to repeal and recreate 446.07 (title); and to create 446.01 (1d), 446.01 (1k), 446.01 (1L), 446.01 (1m), 446.01 (3), 446.02 (6m), 446.02 (7s), 446.025, 446.03 (8), 446.035, 446.04 (6), (7), (8), (9), (10) and (11), 446.05 (3), 446.05 (4) and 446.07 (2) 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; continuing education for chiropractors; nutritional guidance provided by chiropractors to patients; granting rule-making authority, and providing penalties.

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; and 6) nutritional guidance provided by 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 provisions regarding the Peer Review Panel do not apply 30 months after the bill's effective date.

The bill 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. For a fourth misconduct violation, the bill requires license suspension for no less than two years. The bill also provides grounds for disciplining a chiropractor who is found to provide chiropractic care that is not necessary for treating a patient. In addition, if the Peer Review Panel makes certain findings, the bill requires the Chiropractic Examining Board to assess a forfeiture against a chiropractor who provides inappropriate, unnecessary, or substandard care in an amount equal to three times the amount billed for the care or $5,000, whichever is less.

Finally, the bill prohibits sexual misconduct by chiropractors. Sexual misconduct is sexual contact, exposure, or gratification, sexually offensive communication, dating a patient while the patient is under the chiropractor's professional care or treatment or within six months after discharge from 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.

The bill 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, 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 accredited 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 90-day 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 90-day 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.

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

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB275, s. 1 Section 1. 446.01 (1d) of the statutes is created to read:

SB275,5,4 446.01 (1d) "Generally accepted standards" means a level of diagnosis, care, skill, and treatment that is recognized by a reasonably prudent chiropractor as being appropriate under similar conditions and circumstances.

SB275, s. 2 Section 2. 446.01 (1k) of the statutes is created to read:

SB275,5,8 446.01 (1k) "Patient" means an individual who receives treatment or services from a chiropractor or who has received treatment or services under the supervision, direction, or delegation of a chiropractor.

SB275, s. 3 Section 3. 446.01 (1L) of the statutes is created to read:

SB275,5,10 446.01 (1L) "Pattern of conduct" means more than one occurrence.

SB275, s. 4 Section 4. 446.01 (1m) of the statutes is created to read:

SB275,5,15 446.01 (1m) "Peer review" means an evaluation based on generally accepted standards, by a peer review panel appointed under s. 446.035 (1), of the appropriateness, quality, and utilization of chiropractic health care provided to a patient or the conduct of a chiropractor alleged to have violated s. 446.04 (11).

SB275, s. 5 Section 5. 446.01 (2) (b) of the statutes is amended to read:

SB275,5,20 446.01 (2) (b) To employ or apply chiropractic adjustments, and the principles or techniques of chiropractic science, that are taught at a chiropractic college or university approved by the Council on Chiropractic Education or its successor, in the diagnosis, treatment or prevention of any of the conditions described in s. 448.01 (10).

SB275, s. 6 Section 6. 446.01 (3) of the statutes is created to read:

SB275,6,2 446.01 (3) "Utilization" means the treatment or services provided to a patient, including the frequency and duration of the treatment or services.

SB275, s. 7 Section 7. 446.02 (1) (b) of the statutes is amended to read:

SB275,6,12 446.02 (1) (b) Meets the requirements of continuing education for license renewal as the examining board may require under s. 446.025. During the time between initial licensure and commencement of a full 2-year licensure period new licensees shall not be required to meet continuing education requirements. Any person who has not engaged in the practice of chiropractic for 2 years or more, while holding a valid license under this chapter, and desiring to engage in such practice, shall be required by the examining board to complete a continuing education course at a school of chiropractic approved by the examining board or pass a practical examination administered by the examining board or both.

SB275, s. 8 Section 8. 446.02 (2) (b) of the statutes is amended to read: