WRITTEN
TESTIMONY
PRESENTED
BY DR. RICK MCMICHAEL ON BEHALF OF THE AMERICAN CHIROPRACTIC
ASSOCIATION TO THE HOUSE VETERANS’ AFFAIR SUBCOMMITTEE
ON HEALTH OCTOBER
3, 2000
Good morning
Chairman Sterns and members of the subcommittee.
My name is Dr. Rick McMichael, I am a practicing doctor of
chiropractic with 26 years of experience.
I currently practice in Canton, Ohio, and serve as the Ohio
delegate to the American Chiropractic Association (ACA).
I served as a member of the Department of Defense
Chiropractic Health Care Demonstration Project Oversight Advisory
Committee (CHCDP OAC), representing the Congress of Chiropractic
State Associations. Currently, I serve as the president of the Ohio State
Chiropractic Licensing Board. This morning, I
would like to share with you the eye-opening experience I had as a
member of the DOD CHCDP Oversight Committee, and how this relates to
providing chiropractic services to our nation’s veterans.
Not only did a large number of military personnel
independently choose chiropractic services for care, but those who
sought chiropractic care also reported significantly higher
satisfaction and outcomes. There
were no significant difficulties in opening chiropractic clinics,
and doctors of chiropractic worked well with the other military
health care providers. I
believe that the CHCDP experience, the DOD’s final report on the
demonstration project, and the CHCDP minority report all show that
chiropractic is a valuable service, needed and desired by many
military personnel. The CHCDP and
accompanying reports showed that chiropractic care: reduced
disability; return to duty; saved approximately 199,000 work days
per year; improved patient satisfaction; decreased physical therapy
and related cost savings; and produced an inpatient cost savings.
I believe the benefits of chiropractic care will continue to
be proven with the addition of chiropractic services in the military
health care system. Our
military personnel deserve the ready availability of these
much-needed and much-desired services, and our nation’s veterans
deserve no less. As you are aware,
the Veterans Millennium Health Care Act included a provision
requiring the Department of Veteran’s Affairs to develop a policy
with regard to chiropractic care in the DVA health care system.
More specifically, Section 303 of the Act required that
within 120 days after enactment of the Act, the DVA Under Secretary
of Health, after consultation with chiropractors, would establish a
policy for VHA regarding the role of chiropractic care for veterans. In response to the
enactment of this provision, the ACA and Association of Chiropractic
Colleges (ACC) provided to the DVA a set of policy recommendations
to serve as the basis of the agency’s new policy on chiropractic.
The recommendations included, a full scope of practice and
hospital privileges for doctors of chiropractic, direct access for
patients, availability of chiropractic care at all DVA treatment
facilities, and other substantive pro-chiropractic recommendations.
A copy of this report is respectfully submitted for the
committee record. On February 24,
2000, I had the opportunity to join representatives of the ACA, ACC
and other chiropractic organizations for a meeting with officials of
the Veterans Health Administration to discuss implementation of
chiropractic care into the VHA.
The ACA/ACC representatives’ main objective was to seek
direct patient access to a full scope of chiropractic services.
Despite these efforts, the DVA ignored the input of the
chiropractic profession and Members of Congress and ultimately
developed a policy on chiropractic care that is totally inadequate.
This poorly developed policy states that: “It is the VHA
policy that VHA medical centers and clinics may offer chiropractic
spinal manipulative therapy for musculoskeletal problems of the
spine.” As you
are well aware, Mr. Chairman, the use of the word “may” in the
policy statement means that the DVA is not mandating individual
medical facilities provide chiropractic care to their patients. Despite the
exclusion of any recommendations put forth by the chiropractic
profession, we are now asked by the Department of Veterans Affairs (DVA)
to believe that the chiropractic policy they issued on May 5, 2000,
is adequate, and will ensure that eligible veterans in need of
chiropractic care will have access to it. Insofar as the ACA is
aware, however, there is no DVA program or organized effort, of any
type, that exists to ensure that chiropractic services are in fact
made available within the DVA health care system. It is clear that
the current DVA bureaucracy is quite satisfied with merely having
issued a so-called chiropractic “policy”-- and now that the
policy has been issued, they could care little whether the policy is
appropriate or ensures adequate access to chiropractic care.
Certainly, no substantive activity is currently taking place
within the DVA to encourage the use of chiropractic care.
The bureaucracy’s contentment with their chiropractic
policy most likely stems from the fact that they know, or suspect,
that their policy will probably prove both inconsequential and
ineffective -- and as such, will have no significant impact in the
way they conduct business today.
Clearly, they do not expect significant referrals to doctors
of chiropractic to occur as a result of this policy. This may mean that American veterans will be denied
fair access to care they want and deserve just like every other
American citizen. How do they expect the policy to work? Are they not aware of past, unlawful efforts on behalf of organized medicine to contain and destroy the chiropractic profession and the lingering effects this discrimination has had against doctors of chiropractic and their patients? Are they not aware that in some quarter’s biased attitudes towards the chiropractic profession still exists? Are they not aware that medical doctors receive no education or formal training of any sort regarding chiropractic care, nor are they trained or educated as to when a referral to doctor of chiropractic is warranted? So even when bias is not present, there may likely remain little knowledge on behalf of DVA medical doctors as to when it is appropriate to refer to a doctor of chiropractic. Are they unaware of their own indifference regarding chiropractic care and of the Agency’s failure -- over the past half century -- to initiate, of its’ own accord, any effort to encourage the use of chiropractic care within the DVA health delivery system? Not one pro-active step in five decades...! When
examining the DVA track record regarding chiropractic care in its’
totality, one is forced to conclude that the DVA bureaucracy today,
either remains biased against the chiropractic, is woefully ignorant
about the benefits of chiropractic care
-- or both. If
either of these is true, it reflects poorly on stewardship of the
DVA health care program. At a bare minimum, it must be said that the Agency has
engaged in a pattern of long-term neglect with respect to the
provisioning of chiropractic care. Because of the
well-documented record of prejudice and neglect towards
chiropractic, the ACA recommends that the House Committee on
Veterans Affairs move forward, at the first opportunity, to advance
legislation that would require the DVA at a minimum to make
available chiropractic care on a “direct access” basis and allow
doctors of chiropractic practicing within or furnishing services to
the DVA health care system to provide the full-scope of their
services as enacted under applicable state law.
As you may know, a similar chiropractic provision applicable
to the Department of Defense health care system was recently
included in the House-passed version of the FY2001 Defense
Authorization Act (H.R. 4205), which was voted on and approved by
the full U.S. House of Representatives. With respect to
direct access, I would like to clarify that an eligible veteran
could self-select to be examined and treated by a doctor of
chiropractic, without first having to receive a referral from a
medical doctor or other health care provider.
Ensuring direct access to doctors of chiropractic is
extremely important to the proper utilization of chiropractic care. Patients often experience difficulty accessing chiropractic
care when a referral from a medical doctor or nurse is required.
AHCPR recognized this problem in a report entitled
“Chiropractic in the United States: Training, Practice and
Research”. In this
report, AHCPR stated: “Given
that medical practitioners have little exposure to chiropractic
training or practice, a case can be made for not requiring medical
referral.” A direct
access system within the DVA would expand an eligible veteran’s
“choice” of care and “choice” of provider within the DVA
health care system, and it would go far towards ensuring that
artificial barriers would not be erected in an effort to discourage
access to chiropractic care. It
should be noted that doctors of chiropractic are licensed and
regulated in all fifty states as independently practicing health
care professionals. All
of these jurisdictions recognize chiropractors’ rights and
responsibilities to serve as first-contact, portal-of-entry
providers. As such,
doctors of chiropractic possess the diagnostic skills necessary to
differentiate health conditions that are amenable to their
management from those conditions that require referral or
co-management with another professional.
Doctors of chiropractic recognize the value of working in
cooperation with other health care practitioners and acknowledge
their responsibility to do so in the best interest of their
patients. An additional benefit
of direct access should also be noted.
Such a system within the DVA would encourage the use of
chiropractic care -- a low cost, non-surgical and non-pharmaceutical
form of care. This may
help avoid unnecessary surgeries and pharmacological interventions
within the DVA health care system -- and would help emphasize the
benefits of the chiropractic profession’s natural, “wellness”
approach to health care that includes advice on diet/nutrition and
exercise/rehabilitation. As
added benefit is, that to the extent that some surgical and
pharmacological interventions could be eliminated, the risk of
life-threatening medical mistakes and/or adverse drug reactions could
be lessened within the DVA health care system -- a laudable goal in
and of itself. The
other component of any viable chiropractic benefit within the DVA is a
doctor of chiropractic’s ability to provide the full scope of their
services (as determined by state law) to veterans seeking chiropractic
care. The practice
and procedures that may be employed by doctors of chiropractic are
based on the academic and clinical training received in and through
accredited chiropractic colleges.
These include, but are not limited to, the use of diagnostics
and therapeutics. Such
procedures include the adjustment and manipulation of the
articulations and adjacent tissues of the human body, particularly of
the spinal column. Included is the treatment of intersegmental disorders for
alleviation of related functional disorders.
Patient care is conducted with due regard for environmental,
nutritional, psychotherapeutic factors as well as first aid, hygiene,
sanitation, rehabilitation, and physiological therapeutic procedures
designed to assist in the restoration, and maintenance of neurological
integrity and homeostatic balance. We request that the
Committee ensure that the “direct access” and “full scope”
provisions comprise the core provisions of any legislative initiative
aimed at ensuring access to chiropractic care for our nation’s
eligible veterans. The ACA stands ready and willing to work with the Committee
to ensure the adoption of an appropriate legislative provision and is
anxious to assist in the development of specific legislative language
to address our concerns. The
American Chiropractic Association also stands willing and able to work
with the DVA to devise and implement an acceptable plan to provide for
chiropractic care, as envisioned by the statutory provisions we
propose. We
are confident that a detailed, workable plan can be developed and
implemented, provided the DVA is mandated to do so by Congress and
acts in good faith to accomplish the legislative requirements. Mr. Chairman, we have
before us an historic opportunity to take decisive steps to ensure
that our nation’s veterans are afforded access to the benefits of
chiropractic care by advancing legislation that would establish a
framework within the DVA that would ensure the delivery of
chiropractic services in an appropriate and effective manner.
Undoubtedly this will require the DVA to make some
modifications to the way they currently conduct business today.
Change, of course, can often be unsettling to any government
agency – however, in this case I am hopeful that DVA will not
further resist a better way of serving our nation’s veterans.
I believe we have much to offer to the DVA, and if its
representatives will work with the chiropractic profession in good
faith to enhance health care for our nation’s veterans, there is
much we can achieve together.
We wish to be clear,
however, that in our judgment it will be necessary for Congress to
firmly establish in statute, desired policy goals and objectives to
ensure that a full scope of chiropractic services are made available
to our eligible veterans on a direct-access basis, without the
imposition of unnecessary barriers to that care.
Once Congress establishes those firm statutory directives, the
chiropractic profession looks forward to working though our current
differences with the DVA and in good faith develop an effective
chiropractic policy that will benefit the health of our nation’s
veterans. Back to Witness List |