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Will 'doctor isn't in' bill for chiropractors' assistants cause pain?


Two warring factions among Nevada chiropractors split over a bill that has passed both houses of the Legislature without any “no” votes, despite one faction’s concerns that this bill poses a danger to public safety.

One faction is headed by Dr. James Overland Sr., head of the Nevada Chiropractic Association. He wanted the law changed so licensed chiropractic assistants could perform therapy on patients even if the chiropractor wasn’t present.

The other faction, including Nevada Chiropractic Physicians Board members Dr. Benjamin Lurie and Dr. Annette Zaro and former board members Dr. Margaret Colucci and Dr. Stephanie Youngblood, contends that the bill creates dangers for patients.

After the bill was amended so that the licensing board could write regulations to define what assistants could and could not do, the board voted to take a neutral position on the bill, not a ringing endorsement.

To be a licensed chiropractic assistant you have to be 18, have a high school diploma or the equivalent, have six months on-the-job training and pass a written test. On the most recent test in March, 80 percent of students failed the first time they took the written test, and 57 percent failed the second time they took it.

Zaro, Lurie and Youngblood all told legislators that allowing unsupervised treatment by assistants wasn’t safe and pointed out potential dangers.

Overland and the association’s lobbyist Marlene Lockard said safety wasn’t an issue. “They’re not going to be doing a thing that they don’t already do,” she said.

The Federation of Chiropractic Licensing Board wrote that under its Model Practice Act a clinical assistant may not provide clinical services in the absence of a licensed chiropractor. Yet Tennessee has had a similar law since 2000 allowing assistants to treat patients unsupervised and hasn’t reported any problems.

When this reaches Gov. Brian Sandoval’s desk, he’ll have to ask himself: Would I want an assistant working on a member of my family without a chiropractor in the building? Put that way, he might feel the need to veto Senate Bill 198. Or he might have no concerns and be willing to trust the Legislature. Or he might want to ask around.

It’s rare that there are complications, but it does happen, and when it does, do you want your chiropractor out of town, but supposedly accessible by an electronic device, to deal with it long distance?

Sure, you can sue if things go wrong, but is that really the answer to every problem?

The bill was sponsored by state Sen. Joe Hardy, R-Boulder City, a medical doctor.

In Overland’s written testimony in favor of the bill during the March 6 hearing in the Senate Committee on Commerce, Labor and Energy, Overland wrote: “We have all had the unpleasant experience of patients waiting too long or leaving the office because the chiropractors could not be present due to unforeseen circumstances. In this case, the patient receives no therapy as well as incurring an unfortunate expense for travel time.”

But here’s his kicker: “The chiropractor is also denied the income the patient would have generated.”

It’s seems to be about the money, honey.

Youngblood is forceful in her opposition to the bill. In her letter to Assemblywoman Maggie Carlton, D-Las Vegas, Youngblood wrote, “If you want to play golf, having long lingering lunches or make money while you are on a vacation, get a cover doctor.”

Youngblood, said that in her 26 years as a chiropractor, she has experienced “gross mistakes” by chiropractic assistants even under direct supervision. “Thank goodness a doctor was on site to rectify any of the situations.”

The bill doesn’t go into effect until the licensing board develops regulations, so the board will have the last word on creating the regulations saying when and where the unsupervised treatment would be allowed. Carlton was emphatic that she didn’t want to see chiropractic mills where one doctor has offices all over the valley staffed by assistants.

The bill specifies that the assistants cannot do adjustments or interview new patients and make diagnoses.

It’s possible to burn patients from the inside using electric muscle stimulators. The bill assumes that each time a patient goes for treatment, the previous therapy is repeated and the patient’s medical condition has not changed.

Overland, a provider for Culinary union Local 226, dismissed all the safety issues as coming from “a few naysayers” and said he didn’t know their agenda. He said the low pass rate by assistants on written tests is not a valid argument and compared chiropractic assistants to lawyers who have to take the Bar exam several times.

But Overland, a sole practitioner, undercut his own logic when he said even with the bill, about half of his patients wouldn’t come if they knew he wasn’t in the office. “More than half would wait until I got back.”

He said the bill would be used for instances such as recently, when he was 20 minutes late from a lunch meeting and because the assistants couldn’t work without him in the building, five patients left.

Zaro informed Assembly Commerce and Labor Chairman David Bobzien, D-Reno, she opposed the bill. “In my opinion, and the opinion of many others, this (bill) poses a danger to the public.”

“This seems to be clearly a doctor-driven bill that is designed to allow the (chiropractor) to not be in the office but still collect money for treatment without regard to the safety of the patient,” she wrote the chairman.

She also testified about checking a regular patient after his therapy and discovering he was having a medical emergency. With this bill, he would have left without seeing her and might have had a long-term permanent disability because he didn’t see her.

Apparently, her concerns didn’t concern Bobzien.

Can’t help but wonder if they’ll concern Gov. Sandoval.

Jane Ann Morrison’s column appears Monday, Thursday and Saturday. Email her at Jane@reviewjournal.com or call her at 702-383-0275.