May-June 2011 Issue

Texas Chiropractic Association

Texas Journal of Chiropractic Volume XXV, Issue 3 May/June 2011

Proposed TCA Constitutional Amendment TCA Annual Convention Information Landmark Legislation Passes Senate Parker Chiropractic College now Parker University And much more...

May 30, 2011

Texas Chiropractic Association

Texas Journal of Chiropractic May/June 2011

Volume XXV, Issue 3

Texas Journal of Chiropractic

Inside

The Official Publication of The Texas Chiropractic Association

1122 Colorado, Suite 307 Austin, TX 78701 Phone: 512 477 9292 Fax: 512 477 9296 E-mail: info@chirotexas.org www.chirotexas.org Executive Officers President: Ed Fritsch D.C. President Elect: Jorge Garcia D.C. Secretary: Jack Albracht D.C.

TCA Staff Executive Director: Patte Kent Communications Director: Chris Dalrymple D.C. Legislative Director: Chip Kent

Board of Directors District 1!

District 2!

District 3!

District 4!

District 5!

District 6!

District 7!

District 8!

District 9!

District 10!

District 11!

District 12!

Dan Petrosky D.C. Jon Blackwell D.C. Jason Clemmons D.C. Mark Bronson D.C. Dr. John Quinlan D.C. Cody Chandler D.C. David King D.C. Robert Hoffman D.C. James Welch D.C. Shane Parker D.C. Max Vige D.C. Yvonne Landavazo D.C.

Policies Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for non members.

The print Texas Journal of Chiropractic is published up to four times per year by the Texas Chiropractic Association under the supervision of the TCA Publication Committee.

Opinions expressed are those of the contributors and do not necessarily reflect the policy of the Texas Chiropractic Association or the Texas Journal of Chiropractic.

TCA Annual Convention!

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Parker Chiropractic, Now Parker University!

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Landmark Legislation Passes TX Senate!

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United Health Care Class Action Lawsuit!!

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Medical Board Battles!

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Exploring Texas Chiropractic--Documentation! !

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Mexican University Names Library After Dr. Mancini!

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S.D. Lawmakers Override Anti-Chiropractic Veto!

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Supreme Court: “No” to Fast Tracking Health Reform!

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One-third of All Hospital Patients are Harmed! !

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Chiropractors Join Partnership for Patients!

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Proposed Constitutional Amendment!

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Hospital Outpatient Care More Expensive In-Office !

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Fed to Fight “Prescription Drug Abuse Epidemic”!

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Gov. Calls for Phase-out of Mercury Amalgam! !

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Gov. Plans Comprehensive Health Plan! !

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English are Healthier than Americans!

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Shedding Pounds Lowers BP!

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Diet, Exercise Sufficient to Reduce Triglycerides!

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Exploring Texas Chiropractic--Cascade of Negative Effects!

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And more. . .

Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association.

The association shall have the absolute right at any time to reject any advertising for any reason.

For advertising rates contact the TCA Office. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type.

Copyright 2011 All Rights Reserved: Texas Chiropractic Association

Texas Chiropractic Association Annual Convention

June 9-12, 2011 T h e A n n u a l Te x a s Chiropractic Association Convention is scheduled for June 9-11 with educational seminars scheduled for June 10-11.

The Convention will be held at the Sheraton Hotel Austin at 701 East 11th Street in Austin, Texas 78701.

Contact information for the hotel is (512)478-1111.

Featured Speakers and Topics for the convention will be Cynthia Vaughn, D.C. and Susan McClellan speaking on Medicare Made Simple covering the TBCE required Medicare Hours and Coding Made Clear which ncludes the TBCE required 4 hours of instruction.

Ken Murkowski, D.C. will be speaking on Acupuncture: A to Z providing 12 hours of education time, and A (Audit) C (Complications) vs. D (Doctor) C (Compliance).

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Other events at the TCA convention include receptions and banquets and presentation of the annual awards for excellent service.

Register now at www.chirotexas.org.

Registration is available at the door. ☆ ☆ ☆

TCA Board of Directors Proposes Constitutional Amendment T h e Te x a s C h i r o p r a c t i c Association Board of Directors has recommended that a constitutional amendment be proposed for consideration at the TCA Annual Convention.

Voting for the Constitutional Amendment is scheduled for consideration at the General Session of the TCA on Friday, June 10, 2011 at the Annual TCA Convention in Austin.

The TCA board of directors has passed the following resolution: Whereas, there is an annual turnover of the elected executive officers of the TCA resulting in the elected executive leadership serving 3

for only a three year period; and Whereas, the TCA executive o f fi c e r s c y c l e t h r o u g h annually, while there is a legislative session every other year resulting in "legislative leadership" and "nonlegislative leadership"; and Whereas, the State Director is elected for a two year term resulting in TCA board members often serving longer than the elected TCA executive officer leadership; and Whereas, it is desired that the executive leadership cycle correspond with that of the state director, and Whereas, it is desired that each TCA executive officer should serve as president during a Texas legislative session, and Whereas, it is desired that the executive officers elected in 2011 begin serving a two-year term of office; Therefore, be it resolved that: Article II, Section 2 of the TCA Constitution be amended by striking the words "one year” and replacing it with the words "two years" to read: The officers of the association shall be a president, president-elect, and a secretary. The president-elect shall succeed to the presidency of the association Texas Journal of Chiropractic

unless his office is vacated.

The president, presidentelect, and secretary shall be elected from the membership by ballot as prescribed, for a term of one year two years, or until their successors are elected and installed. The officers of the association shall constitute the executive committee of the association and shall have coordinate authority to act for the association subject to ratification of the board. The president shall act as chairperson of the executive committee.

Further it is resolved that this amendment shall take effect immediately and shall apply to the executive officers elected in 2011 so that they shall serve a twoyear term to expire in 2013. ☆ ☆ ☆

Parker Chiropractic College Now

Parker University

The Dallas-based school cites the name change as part of an expansion of current graduate degree offerings and programs with a focused longterm strategy of educating the worldʼs top health care and wellness practitioners.

"Statistics show a shift in the health care industry as costs rise and patients look to natural, holistic care as an alternative to high prescription and surgery costs. According to CDC National Health Statistics, approximately 38 percent of American adults and 12 percent of children use some form of Complementary and Alternative Medicine (CAM), which includes chiropractic, massage therapy and more," says the University.

Transition to the new name will occur on the schoolʼs website, materials and elsewhere during the next six to 12 months.

The University reports that "with just 27 students in its first graduating class in 1985, Parker has grown into a leading chiropractic and wellness institution with 270 employees and more than 1,000 students impacting the local economy, education and health care industries."

Parker College of Chiropractic has announced that it has achieved university status and will now be known as Parker University.

“Achieving university status and transitioning to Parker University is very exciting, and I know our founding father Dr. Jim Parker, would have been immensely proud of this,” said D r. F a b r i z i o M a n c i n i ,

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president of Parker University.

“We are all extremely proud of this class—the inaugural graduating class of Parker U n i v e r s i t y, C o l l e g e o f Chiropractic.”

The Parker University, College of Chiropractic, presented members of its 77th commencement of the inaugural graduating class of Parker University with their doctor of chiropractic degrees on April 16, 2011. Many of the graduates were also awarded bachelor of science degrees in anatomy and health and wellness. More than 5,600 graduates of Parker have received the doctor of chiropractic degree and practice worldwide.

Commencement speaker Dr. DelRae Messer, founder and owner of Practice Acceleration Systems, a consulting company for chiropractors, encouraged the graduates to make a positive impact on the lives and health of others. Dr. Messer is a regular contributor to ShopNBC with Suzanne Somers, Fit and Firm Magazine, Natural Muscle Magazine, Southwest Metro Magazine, and local and regional radio. ☆ ☆ ☆

Consider YOUR ad HERE. Over 340,000 page views in the past issue! www.chirotexas.org

Landmark Legislation Passes Texas Senate T h e Te x a s C h i r o p r a c t i c Association reports that on Thursday, April 14, 2011, the Texas Senate passed Senate Bill 1001.

" A C O L L A B O R AT I O N BETWEEN PHYSICIANS AND CHIROPRACTORS. a person licensed under Subtitle B, Title 3, and a person licensed under Chapter 201 are authorized to: (1) collaborate with each other in providing services to a client ...."

Title 3 is the Health Professions portion of the Occupations Code. Subtitle B relates to Physicians. Chapter 201 of Subtitle C relates to Chiropractors.

"ASSOCIATIONS.

Says the Texas Chiropractic Association: "This landmark legislation is significant for two reasons: It allows chiropractors to form professional associations with medical doctors, and it ensures that chiropractors will be treated fairly by insurance companies that decide to cover services that can legally be provided by chiropractors and other types of practitioners. ...We have been trying to pass this type of legislation for more than 20 years."

The Senate Journal reflects that "Senator Carona offered the following amendments to the bill": These amendments include:

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(a) a person licensed under Subtitle B, Title 3, and a person licensed under Chapter 201 of this code may form a partnership, professional association, or professional limited liability company according to the requirements of this section and any other applicable law. (b) When persons licensed under Chapter 201 of this code form a professional entity with persons licensed under Subtitle B, Title 3 of this code, as provided by this section, the authority of each practitioner is limited by that practitioner's scope of practice, and a practitioner may not exercise control over another practitioner's clinical authority granted by the other practitioner's license, either through agreements, bylaws, directives, financial incentives, or other arrangements that would assert control over 5

treatment decisions made by the practitioner. (c) The state agencies exercising regulatory control over professions to which this section applies continue to exercise regulatory authority over their respective licenses. (d) A person licensed under Subtitle B, Title 3 of this code, who forms a professional entity under this section shall report the formation of the entity and any material change in agreements, bylaws, directives, financial incentives, or other arrangements related to the operation of the entity to the Texas Medical Board no later than the 30th day after the entity is formed or the material change is made."

"If physical modalities and procedures are covered services under a health benefit plan and within the scope of the license of a chiropractor and one or more other type of practitioner, a health benefit issuer may not: (1) deny payment or reimbursement for physical modalities and procedures provided by a chiropractor if: (A) the chiropractor provides the modalities and procedures in strict compliance with laws and rules relating to a chiropractor's license; and (B) the health benefit plan issuer allows payment or reimbursement for the Texas Journal of Chiropractic

same physical modalities and procedures performed by another type of practitioner; (2) make payment or reimbursement for particular covered physical modalities and procedures within the scope of a chiropractor's practice contingent on treatment or examination by a practitioner that is not a chiropractor; or (3) establish other limitations on the provision of covered physical modalities and procedures that would prohibit a covered person from seeking the covered physical modalities and procedures from a chiropractor to the same extent that the covered person may obtain covered physical modalities and procedures from another type of practitioner."

The amendment was adopted, the Senate Journal reports, with "all members ... deemed to have voted 'Yea'" with the exception of one absent-excused Senator. The bill passed to the third reading by a vote of 30 yeas and 0 nays. On final reading the bill passed the Senate 30 to 0 with one senator excusedabsent. The text of the final SB 1001 may be found HERE. The TCA reports that "Dallas state Sen. John Carona deserves our thanks and praise for successfully guiding SB 1001 through the Senate. ... SB 1001 now goes Texas Journal of Chiropractic

to the Texas House, where it must also be approved." ☆ ☆ ☆

United Health Care Class Action Lawsuit On April 22, 2011, more healthcare providers, durable

medical equipment (DME), ambulatory surgical center (ASC), national and state chiropractic associations, joined and expanded the ERISA class-action against UnitedHealthcare.

The lawsuit was originally filed on January 24, 2011 by a group of chiropractors, for

Call for Keeler Award Nominations Established in 1934 by Dr. Clyde Keeler, The Texas Chiropractic Association’s award designating the Chiropractor of the year, The Keeler Plaque, is Texas Chiropractic’s most prestigious award.

Nominations for the Keeler Plaque should be sent to: Dr. Curtis McCubbin Secretary, Keeler Plaque Committee P. O. Box 272 Hunt, Tx 78024 All nominations will be held in strict confidence to assure that the recipient will be surprised when their name is announced.

A candidate shall be: A member in good standing in the TCA Of good moral character A promoter of chiropractic advancement in at least one of the three years immediately proceeding the year in which the award is to be presented. Such advancement may be in research, public relations, school participation, promotion or support.

The candidate’s main endeavor must be in the practice of chiropractic and must have promoted chiropractic throughout their career.

Civic, church or community involvement, individually or within organizations or groups, and holding offices in local, state or national chiropractic organizations, chiropractic boards, and chiropractic college boards may also be considered.

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alleged ERISA violations in its overpayment recoupment and pre-service claim denials in connection with managed care network practice by OptumHealth, a subsidiary of UnitedHealthcare.

The suit seeks to represent “a nationwide class of all health care providers who have been subjected to alleged overpayment demands by UnitedHealth Group to repay previously paid health care benefits for services provided to UnitedHealth Group subscribers, only to have such funds forcibly recouped by the withholding of future payments from unrelated claims in alleged violation of the Employee Retirement Income Security Act of 1974 ("ERISA"), the Federal law governing private employee benefit plans.”

"The plaintiffs alleged complete violation of ERISA claim regulation by UnitedHealthcare, especially with ERISA requirements for compliant EOB practice, right to appeal and a full and fair review for all overpayment recoupment demand as an E R I S A a d v e r s e b e n e fi t s determination, overpayment withholding/offsetting as an E R I S A a d v e r s e b e n e fi t determination, and preservice claim and concurrent service claim denials."

A copy of the initial Class Action Complaint is available a t w w w. e r i s a c l a i m . c o m / UHC_Complaint.pdf

Bolen states in the report cited above that much like the procedure used by the Texas Chiropractic Board of E x a m i n e r s , " t h e Te x a s Medical Board has relied on the Anonymous Complaint format to justify spurious attacks on doctors."

T h e Te x a s Tr i b u n e REPORTS HERE that "The House Public Health Committee put its stamp of approval ... on a … Texas Medical Board bill, a measure designed to protect doctors from unfounded complaints."

A copy of the First Amended Complaint is available at w w w. e r i s a c l a i m . c o m / UHC_Complaint2.pdf ☆ ☆ ☆

"Health-care overpayment recoupment market is estimated to be over hundreds of billions of dollars.

With little or no judicial guidance, most health plan's relentless and abusive recoupment practices are mixed with genuine but little fraud investigation….This UHC ERISA class-action, along with other overpayment ERISA class actions, will become a historical and unique part of U.S. healthcare history," said Dr. Jin Zhou, President of ERISAclaim.com, a National Expert on ERISA and PPACA Appeals and Compliance.

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Medical Board Battles

By Chris G. Dalrymple D.C., F.I.C.C.

We are all familiar with the woes dealt to our profession by the Texas Medical Board and their close relationship w i t h t h e Te x a s M e d i c a l Association, so it is no surprise to us when Tim Bolen, a "crisis management consultant for the health care industry", REPORTS HERE that "Texas is a major battle ground in the health wars.

Always has been. What is different now is that the pace has been stepped up."

"HB 1013 would ban all anonymous complaints other than those filed by patients, their guardians or their family and open up the process by which doctors are investigated. These measures would include setting statutes of limitations, providing doctors with details of the charges against them and giving them more time and legal remedies to respond or appeal."

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State Representative Fred "Brown said heʼs gotten tired of watching Texas doctors get pursued for minor infractions or crippled by long, drawn-out investigations based on anonymous complaints."

"The amended bill now effectively tackles the small percentage of Medical Board complaints currently listed as anonymous."

"Medical Board data shows that in 2009, 43 percent of annual complaints were filed by a patient, and another 27 percent were filed by friends or family of the patient. Just 2 percent of complaints were listed as anonymous, and 1 p e r c e n t w e r e fi l e d b y insurance companies." This leaves one to wonder who filed the other 27% of annual complaints Bolen REPORTS HERE on some of his strategies in effectively dealing with an "out of control medical board" in California. Says Bolen, "Any problem, large or small, can be handled with simple crisis management techniques: Identify Problems, Identify Possible Solutions, Make Plans, Execute Plans, Review Situation. First, of course, Goals and Objectives need to be set in place."

would have to be ripped from their influence positions. So we did that. It was easier than we first thought, to do that, for the [medical monopolists] played right into our hands.

Their arrogance was legendary, and it worked very well for us. Once we solved the first problem, legislation to protect our cutting-edge people was easy. There were many pieces of legislation carried, but two bills passed SB 1691 (2004) for licensed practitioners and SB 577 (2002) for unlicensed practitioners, that pretty much solved the issues. But, getting to the legislation, and making it sail through both houses and into the Governor's hands took a lot of set-up, using a lot of dedicated, team-playing, people."

"The first step was to quietly, and sometimes not-so-quietly, point out to California legislative, and otherwise, leadership just exactly how sleazy, and downright rottenat-the-core, the [medical monopolists] operation actually was (and is)."

"There were a lot of problems in California, but, in short, the [medical monopolists], literally, controlled health care thinking in the state. It was obvious that in order to get anywhere the [medical monopolists]

"Then the California group began to attend the California Medical Board meetings - en masse, and we brought the media. TV cameras, and newspaper reporters, climbing over each other - and we choreographed all of it - as our speakers, as many as 300 at one time, assailed the Board over their prosecution of cutting-edge practitioners.

The Board Staff was terrified and brought in bludgeon

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carrying cops to line the walls when we were there. More, we pointed out that REAL bad doctors were being ignored by the Board Staff, and two of the State's major newspapers were fed a constant stream of horror stories - which they printed."

In Texas, Bolen and the "alternative medicine" groups he works with state that they are using a combined strategy. Says Bolen, "The combined strategy started out in two prongs: (1) with attorneys working on defending cutting-edge practitioners combining strategies and tactics, and (2) activist groups carrying legislation and stopping bad legislation. The first group, the attorneys and their clients, formed into structures and compared notes. They found, of course, that the Texas Medical Board had an "Anonymous Complaint" system - meaning that the complainant would be hidden.

They also found out that there was a consistency in the complaints, and that those same complaints ended up on one [medical monopolist's] website LONG BEFORE the doctor got a copy of it. Local newspapers were notified immediately."

REGULARLY check the TCA Website at www.chirotexas.org and catch up on the latest news by clicking on the Online Journal link

"...the pattern was obvious," Bolen says, "so the American Association of Physicians and Surgeons (AAPS), with Andrew Schlafly at the legal helm, stepped in and began the lawsuit. And, as of this month, Discovery has resumed." "...the Texas Medical Board has relied on the Anonymous Complaint format to justify spurious attacks on doctors.

AAPS will simply demand two things for sure: (1) copies of every complaint filed against its members, and (2) copies of every complaint filed against EVERY MD in the State for the last five years. When this info is provided, I suspect, and the Court will demand it, several things will happen, one of which will be the convergence of the two Federal Court cases" that involve anonymous complaints against a couple of medical doctors.

There are those in health care who desire to practice a profession to the best of their ability and seek to help ailing people to heal to the best of their ability. There are those in health care who desire to "make a killing" and get out.

There are those who desire the broadest perspective possible. There are those who d e s i r e t h a t O N LY o n e perspective be deemed by the government to be "correct," and there are many more battles than these.

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Call for Nominations for Young Chiropractor of the Year Established over half a century ago, this award is for the purpose of recognizing doctors who have shown outstanding dedication and who have made long-lasting contributions to the profession and their community, and who are under 40 years of age at the time of the award’s receipt.

Send nominations to 2010 recipient: Dr. Jon D. Blackwell, D.C. 6109 Ridgewood Amarillo, Tx 79109 or via email at jon@nts-online.net

The medical battles in Texas are being fought on many fronts and by many organizations--even within the medical front itself. The objective that best serves the public is to see that there is CHOICE in health care and that a medical monopolistic attitude is not imposed upon those who do not desire it. ☆ ☆ ☆

Are You Practicing The Art? By: James Welch Jr.. D.C.

Before we can answer that question it might help to know the meaning of art. Art is defined in one dictionary as: 1. Activity of creating things that arouse the emotions through one or more senses.

2. Skill or profession. There are others but I choose these 9

for our purpose of evaluating our use of “the art”.

Is “the art” of chiropractic the way you practice? There are as many ways to practice as there are chiropractors. There are a number of management firms to teach you their “art”.

There are also a number of technique classes to teach you an “art”. You may use an instrument that sounds like a tapping nail gun or something you just click a couple of times and sounds like a stapler or, like me, use something that goes thump when the drop piece falls, or the snap, crackle, pop sound which may be the original sound of chiropractic. Is “the art” in the using of some kind of adjusting tool or manual adjusting? I think it may be more than that.

I have one p at i ent that describes chiropractic as only Texas Journal of Chiropractic

knocking down the high spots and letting the body heal itself. Not a bad description but still has to be more to what we do or how we treat patients than just knocking down the high spots. I believe we practice “the art” by how we practice, not by just practicing.

it. Most chiropractors still touch even when they use some type of adjusting instrument, but some, sadly enough, are losing this part of “the art” by just letting some computer wand or instrument do all the touching. This may be the most important aspect of “the art” that is being lost.

I believe “the art” of chiropractic starts when the patient comes in the door. A friendly caring atmosphere is just the beginning. We continue practicing “the art” by listening to the patient, although Iʼm not sure some doctors listen to patients much anymore. We not only listen to what they are saying but also pay attention to their demeanor. I once heard someone give an excellent speech partly on a patientʼs body language. The art of reading a patient is very helpful in discovering what is wrong and how to treat it. This is all part of “the art”.

Practicing “the art” is all about the patient, not how impressive we can be to that patient.

“The Art” is not just one procedure. It is a number of procedures put together making chiropractic such a successful unique type of health care. We all can knock down the high spots, but it is “the art” that makes us different. Using part of the first definition, letʼs create a healing emotion by practicing a better art.

Another part of “the art” is touching. We have all had patients, after going to their MD for some type of back pain, come in and say, “he never even touched the place that hurts”. We all know there is a healing effect by just touching the hurt. Donʼt you remember when you were just a kid and you fell and hurt something? Mother could make most if not all of that hurt go away by just touching Texas Journal of Chiropractic

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are some number of individuals who have not a clue about the rules and regulations of their profession.

This article will provide you with a summary of the regulations pertaining to the practice of chiropractic pertaining to documentation, it will quote you the portion of the law or rule illustrating it, AND it provides you a direct link to the actual law or rule so that you may read it in its entirety.

These articles are intended to share with you some of the aspects of the regulations regarding chiropractic, but they may not be "all inclusive" and are NOT intended to serve as legal advice. They are intended as instruction in what regulations apply.

What is it and why does the TBCE care about how chiropractic doctors document their cases?

There are various reasons, and this article does not touch upon all of them, but here is what the Chiropractic Act states regarding documentation:

Exploring Texas Chiropractic-Documentation By: Chris G. Dalrymple D.C., F.I.C.C.

In observing the goings on at t h e Te x a s B o a r d o f Chiropractic Examiners and the Enforcement Committee for quite some time now it becomes obvious that there 10

The TBCE is the agency charged with enforcing the Chiropractic act: "The board shall administer the purposes of and enforce this chapter."

--Texas Occupations Code; Title 3: Health Professions; Subtitle C: Other Professions Performing Medical Procedures; Chapter 201,

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Chiropractors; Subchapter D, Board Powers and Duties; Section 201.151

chiropractor to receive chiropractic care."

--Section 201.401

The TBCE may adopt rules and regulations to regulate the practice of chiropractic: "The board may adopt rules and bylaws ... necessary to ... re g u l a t e t h e p r a c t i c e o f chiropractic ... the board shall adopt rules for the enforcement of this chapter."

--Section 201.152

"The board shall adopt rules clarifying what activities are included within the scope of the practice of chiropractic and what activities are outside of that scope ...."

--Section 201.1525

One of the charges of the TBCE is fraud prevention and to determine the records required to be maintained: "The board shall strictly and vigorously enforce the provisions of this chapter prohibiting fraud.

The board shall adopt rules to prevent fraud in the practice of chiropractic, including rules relating to .... records required to be maintained in connection with the practice of chiropractic." -Section 201.1555

The Chiropractic Act defines who is a patient: "... patient means any person who consults or is seen by a www.chirotexas.org

TBCE Rule touches upon documentation both directly and indirectly; indirectly through the discussion of "Grossly Unprofessional Conduct" "Grossly unprofessional conduct when applied to a licensee or chiropractic, facility [sic] includes ... failing to use the word 'chiropractor', 'Doctor, D.C.,' or 'Doctor of Chiropractic, D.C.' in all advertising medium, including signs and letterheads .... exploiting patients through the fraudulent use of chiropractic services which result in financial gain for a licensee or a third party. The re n d e r i n g o f c h i ro p r a c t i c services becomes fraudulent when the services rendered or goods or appliances sold by a chiropractor to a patient are clearly excessive to the justified needs of the patient as determined by accepted standards of the chiropractic profession; submitting a claim for chiropractic services, goods or appliances to a patient or a third-party payer which contains charges for services not actually rendered or goods or appliances not actually sold; failing to disclose, upon request by a patient or his or her duly authorized representatives, the full amount charged for any service rendered or goods supplied."

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--Title 22; Part 3; Chapter 75; Rule 75.1

One would be best served by adequately documenting: • that their advertising and letterhead include the proper terminology, • that all sales and financial claims are clearly justified, and • that all appropriate requests for charges are properly disposed and documented.

Note that this section states that gross unprofessional conduct includes failing to disclose "the full amount charged." It does NOT necessarily state that CPT billing codes must be included, but merely the "full amount charged." We will also revisit this in other rules.

Proper diligence and efficient practice of chiropractic: "A lack of proper diligence in the practice of chiropractic or the gross inefficient practice of chiropractic when applied to a licensee or chiropractic facility includes but is not limited to ... failing to assess and evaluate a patient's status; performing or attempting to perform procedures in which the chiropractor is untrained by education or experience; delegating c h i ro p r a c t i c f u n c t i o n s o r responsibilities to an individual lacking the ability or knowledge to perform the function or responsibility in question ....

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abandoning patients without reasonable cause and without giving a patient adequate notice and the opportunity to obtain the services of another chiropractor and without providing for the orderly transfer of a patient's records."

-- Rule 75.2

A licensee SHALL: • cooperate with the board in investigating a complaint, • respond to the complaint and any request for information from the board,

• RESPOND WITHIN 15 DAYS; or

• the assessment of a patient's status,

• face a NEW disciplinary by the board with NEW penalties, NEW fines, and ADDITIONAL paperwork.

• the proper notification of changing doctors.

Perhaps one of the easiest, and apparently often neglected, documentation responsibilities is simply the Duty to Respond to Complaint: "An individual or facility regulated by the board shall cooperate with the board in its investigation of a complaint filed against the individual or facility.

Upon receipt of a notice of a complaint from the board, an individual or facility shall respond to the complaint and any re q u e s t b y t h e b o a rd f o r information .... The response shall be in writing, sent no later than the 15th day after receipt of the notice from the board .... Failure to timely respond to a complaint shall be an independent ground for disciplinary action by the board."

--Rule 75.6

Texas Journal of Chiropractic

--Rule 77.2

• RESPOND IN WRITING,

One should properly document:

• the training of those to whom one delegates procedures, and

public communication shall maintain a signed statement from that person or group to support any statements that may be used in any public communication for a minimum of two years from publication of the testimonial."

REMEMBER TO RESPOND IN WRITING, AND DOCUMENT YOUR RESPONSE WITHIN 15 DAYS, WHEN THE TBCE CONTACTS YOU REGARDING AN INVESTIGATION. There are numerous other instances of documentation requirements relating to complaints, and hearings.

Here is one example of directly required documentation: "A licensee or registered facility engaging in telemarketing, either directly or through an agent, shall keep a copy of each script used for calling and a log of all calls made that shall include the date, telephone number, and the name of each person called. Such scripts and logs shall be maintained for a minimum of two years. Licensees or registered facilities that intend to include a testimonial as part of any form of 12

and then there is: "A licensee shall on the date of providing goods or services to a patient, disclose to the patient in writing the full amount of the licensee's charges. Compliance with this rule may be in any w r i t t e n f o r m re a s o n a b l y calculated to notify the patient of the actual charges for the goods or services provided."

--Rule 77.3

and: "In delegating the performance of a specific task or procedure, a licensee shall verify that a person i s q u a l i f i e d a n d p ro p e r l y trained ... . has the requisite education, training, and skill to perform a specific task or procedure."

-- Rule 80.1

The TBCE has defined the meaning of "chiropractic records": "... Upon request a licensee shall furnish copies of chiropractic records or narrative of the records pursuant to a written consent for the release of the information or records. ... For www.chirotexas.org

p u r p o s e s o f t h i s c h a p t e r, 'chiropractic records' means any records pertaining to the history, diagnosis, treatment or prognosis of the patient including records of other health care practitioners contained in the records of the licensee to whom a request for release of records has been made."

--Rule 80.3

"Chiropractic records" are copies of your actual records OR A NARRATIVE REPORT OF THE RECORDS that i n c l u d e s t h e h i s t o r y, diagnosis, treatment, or prognosis and any of these that are provided by other health care practitioners that are included in the patient file.

Take note that proprietary billing codes are not required to be made part of the "chiropractic record", but "records supporting billing" shall be.

"The written consent shall contain the specific information or chiropractic records to be released under the consent; the reasons or purposes for the release; and the person to whom the information is to be released."

--Rule 80.3

"A copy of chiropractic records or a summary or narrative of the records requested ... shall be furnished by the licensee within a reasonable time, not to exceed 15 business days from the date of the request. If the licensee denies the request ... either in whole or in part, the licensee shall furnish the patient a written statement, www.chirotexas.org

signed and dated, stating the re a s o n f o r t h e d e n i a l . . . .

Chiropractic records ... may not be withheld based on a past due account for care or treatment previously rendered to the patient."

--Rule 80.3

The written request for records shall specified the information or records to be released and these records, or a written statement of denial setting forth the reason, shall be furnished within 15 days.

Finally, for the purposes of this article touching upon documentation, here was what the law states about Maintenance of Chiropractic Records: "An adequate chiropractic record, as described in this section, for each patient shall be maintained for a minimum of six years from the anniversary date of the date of last treatment. ... License shall maintain patient and billing records in a manner consistent with the protection and welfare of the patient. A licensee's patient records shall support all diagnoses, treatments, and billing.

Records shall be timely, dated, accurate, signed or initialed by the licensee or person providing treatment, and legible. Electronic signatures are acceptable.

-- Rule 80.5

An "adequate chiropractic record" shall: 13

• be maintained for at least 6 years; • maintain patient records in a manner consistent with the protection and welfare of the patient; • maintain billing records in a manner consistent with the protection and welfare of the patient; • support all diagnoses; • support all treatments; • support all billing; • be timely; • be dated; • be legible; • be accurate; • and be attested with signature or initials.

This article is intended to help you to better understand what the State of Texas expects from a chiropractic doctor in the performance of their profession. Hopefully this will serve to remind of some of the basic necessities required by law. I encourage you to read through the Chiropractic Act and the TBCE Rules. You can find them online for free, or you may contact the TBCE and purchase a copy.

Find them HERE on the TBCE website. ☆ ☆ ☆ Texas Journal of Chiropractic

Mexican Public University Names Library After Parker's Mancini A public university near Mexico C i t y, t h e Universidad Estatal Del Va l l e de Ecatepec (UNEVE), the first institution in the world to offer a Spanisht a u g h t chiropractic program, recently dedicated its new campus library to Dr. Fabrizio Mancini, president of Parker College of Chiropractic. The new building is the official library for the entire university and supports the education of fi v e d i s t i n c t i v e c a r e e r s including acupuncture, chiropractic, gerontology, humanities, and multimedia communication.

UNEVEʼs rector, Jose Angel Fernandez Garcia, along with the universityʼs board, students, faculty, and staff recognized Dr. Mancini for his generous contributions to the university.

“We are pleased to name our library after Dr. Mancini— someone who has been extremely devoted to extending opportunities for Texas Journal of Chiropractic

our students,” said Garcia.

“This is the first time in Mexicoʼs history, which weʼre aware of, that a building has been dedicated to a nonnational person or person while living. This new library is

crucial for our studentsʼ learning and will be a s i g n i fi c a n t p a r t o f o u r campus,” said Garcia.

In 2009, Dr. Mancini donated more than 1,200 books from his personal library to the university, saying, “books are meant to be shared, not stored.”

“Iʼve always been an avid reader, and for more than 20 years Iʼve saved the books that have impacted me most,” said Dr. Mancini. “When I saw that UNEVE did not have many books, I felt inspired to share all this wisdom with their students for generations to come.”

During the ceremony, Dr. Mancini and Parker executives presented UNEVE with more than 10 donated 14

computers, scanners, and other computer accessories, which will be housed in the library for studentsʼ use.

Dr. Mancini, a native of Colombia, has assisted in the growth of chiropractic in underserved countries in Latin America. He was also instrumental in helping establish UNEVEʼs chiropractic program—the first institution in the world to offer a Spanish-taught chiropractic program. Today, more than 180 doctors of chiropractic have graduated from the program since its inception in 2001.

Parker College is also active within the UNEVE community through a student exchange program that gives Parker students hands-on clinical experience in addition to Spanish classes and a total immersion experience in Mexican culture. In turn, UNEVE students who participate in the exchange program receive hands-on experience at Parker College. ☆ ☆ ☆

South Dakota Lawmakers Override Governor's AntiChiropractic Veto South Dakota lawmakers overrode Governor Dennis Daugaard's veto of a measure that limits the co-payments www.chirotexas.org

insurance companies may charge for visits to chiropractors.

The new law, which takes effect July 1, prevents insurance companies from offering policies that charge higher co-payments for visits to chiropractors than for visits to [other] primary care physicians.

Lawmakers expressed their belief that it is unfair for insurance companies to set different copayments for visits to different kinds of primary health care providers.

Some insurance companies make customers pay more out of their own pockets when visiting chiropractors.

Says the Associated Press " P r e v i o u s l y, d o c t o r s o f chiropractic were labeled as specialists, which resulted in higher co-pays for patients.”

“Governor Dennis Daugaard vetoed the measure upon passage. The veto was subsequently overridden in the House and Senate by 51 to 15 and 25 to 10 votes, respectively. HB 1146 will take effect on July 1, 2010." ☆ ☆ ☆ TCA… Professionals helping chiropractic professionals for

Nearly 100 years!

www.chirotexas.org

Supreme Court Refuses to Fast Track Health Reform Decision The Supreme Court has denied a request from Virginia Attorney General Ken Cuccinelli to expedite the state's case against the Affordable Care Act. The request was denied without comment, and none of the justices recused themselves from the decision.

The case is currently awaiting a mid-May hearing in the Fourth Circuit Court of Appeals. ☆ ☆ ☆

One-Third of All Hospital Patients are Harmed

The AMA reports that “the findings draw attention to the safety troubles that have lingered in U.S. Hospitals ….

The study cited research estimating that up to 98,000 patients die each year due to preventable medical errors.”

"This is one of the best studies that now gives us a sense of how much harm is happening to patients in American hospitals," said Robert Wachter, MD, chief of the medical service at the University of California, San Francisco Medical Center.

"There is a tremendous amount of harm befalling patients who are admitted to hospitals and humongous opportunities for improvement."

The American Medical Association REPORTS HERE that "One-third of hospital patients experience adverse events, and about 7% are harmed permanently or die as a result, according to a study that detected patient safety problems at a far higher rate than other methods."

The AMA also reports that "Nearly 60% of adults polled by the Consumer Reports National Research Center believe medical errors are common in hospitals, and nearly half said serious harm is common. Nearly 80% of patients said they feared contracting an infection in a hospital, 71% were worried about medication errors and 65% were scared of surgical mistakes."

"The study, in April's Health Affairs, echoes two reports issued in November 2010 that showed rates of adverse events hovering near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals."

"But patient safety improvement remains uneven, said Mark R. Chassin, MD, president of the Joint Commission, which accredits hospitals and other health care organizations. "What we have been doing for the last

15

Texas Journal of Chiropractic

10 or 15 years has produced some important progress, but it has not produced the kind of improvement that anybody wants to see," he said. "The progress is not broad enough across the different services that are delivered in health care, and it's not consistent within health care, whether at physician practices, hospitals or facilities of any sort. And it's not deep enough."

"David C. Classen, MD, lead author of the study and associate professor of medicine at the University of Utah School of Medicine in Salt Lake City .... detected 10 times as many adverse events as the Agency for Healthcare Research and Quality's Patient Safety Indicators, which use billing data to spot events such as decubitus ulcers and postoperative sepsis. And where the Trigger Tool i d e n t i fi e d 3 5 4 t o t a l instances of harm, physicians, nurses and other health professionals reported only four adverse events using their hospitals' voluntary reporting systems."

"The vast majority of the adverse events identified in the Health Affairs study -- 93% -- required medical intervention but did not permanently injure or kill the patient. Most were medication-related or nosocomial infections."

"The NEJM study said 63% of the adverse events that reviewers identified could Texas Journal of Chiropractic

Chiropractors Join Partnership for Patients

have been avoided. A November 2010 report from the Dept. of Health and Human Services' Office of Inspector General that used the Trigger Tool for Medicare patients estimated that 44% were preventable."

"On April 12, HHS Secretary Kathleen Sebelius announced the "Partnership for Patients" initiative aimed at preventing 60,000 health care-related deaths and avoiding $50 billion in Medicare costs over 10 years."

"The program will disburse $1 billion under the Patient Protection and Affordable Care Act to reduce hospital readmissions and cut hospital-acquired conditions such as pressure ulcers and catheter-related urinary tract infections."

"Also in April, the Centers for Medicare & Medicaid Services, over objections from the American Hospital Assn., began reporting individual hospital performance on hospital-acquired conditions at its Hospital Compare website." ☆ ☆ ☆ 16

Citing concerns for patient safety, the U.S. Department of Health and Human Services (HHS) has created a new initiative called Partnership for Patients that will seek to target and eliminate medical errors.

Partnership for Patients will unite HHS officials with health care providers, hospital leaders, employers, and patient advocates to collaborate on new ways to help improve patient safety.

To d e m o n s t r a t e A C A ʼ s support for improving patient safety in all healthcare settings, ACA has signed the Partnership for Patients Pledge.

To learn more about ACAʼs involvement in this program click here.

To l e a r n m o r e a b o u t Partnership for Patients, click here. ☆ ☆ ☆

Hospital Outpatient Care Costlier than Office Based Care Although hospital outpatient care makes up only 5% of all outpatient visits in the U.S., it accounts for more than onewww.chirotexas.org

fifth of outpatient costs, according to Agency for Healthcare Research and Quality researchers.

The average cost of an officebased visit was $199, compared with $922 for emergency department (ED) visits and $1,275 for hospital outpatient visits.

Expenses per visit were generally highest for the emergency department and lowest for office-based visits when outpatient based surgical procedures are excluded.

unused drugs in the home.

The joint-agency group is also calling for new laws to turn these recommendations into requirements."

"I don't use the word 'epidemic' lightly, but that's what this country is in the midst of now and the facts are devastating. We set a goal of reducing this abuse by 15% over the next 5 years. But the severity of this issue requires a sustained national effort," said Gil Kerlikowske, director of the ONDCP, during a press conference."

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Fed to Fight "Prescription Drug Abuse Epidemic" It is reported at Medscape.com that "White House officials from the Office of National Drug Control Policy (ONDCP), along with the Food and Drug Administration (FDA) and the Drug Enforcement A d m i n i s t r a t i o n ( D E A ) , announced [on April 19,2011] the release of the first national a c t i o n p l a n t o fi g h t a "prescription drug abuse epidemic."

"The collaborative [plan] urges prescriber education on opioid r i s k s a n d b e n e fi t s , recommends monitoring programs for all states, and suggests easier ways to dispose of unwanted or www.chirotexas.org

abuse. This plan will save lives and will substantially lessen the burden this epidemic takes on our families, communities, and workforce."

"Calling prescription drug abuse "our Nation's fastest growing drug problem," Mr. Kerlikowske reported that approximately 27,000 people died of unintentional drug overdoses in 2007, "driven to a large degree by prescription drug abuse." Deaths from unintentional prescription drug overdoses now exceed deaths from gunshot wounds."

"In addition, the Substance Abuse and Mental Health Services Administration reports that hospital emergency department visits involving prescription drug abuse have doubled just over the past 5 years."

The 4 key goals of the new action plan are to: Expand awareness and education to physicians, researchers, and the public;

"Today we are making an unprecedented commitment to combat the growing problem of prescription drug abuse," said Vice President Joe Biden in a release.

"The Government, as well as parents, patients, healthcare providers, and manufacturers all play a role in preventing 17

Expand efforts to monitor the prescribing of these drugs, including calling upon every state to set up a program; Make it easier to dispose of drugs; and Shut down "pill mills" and reduce doctor shopping.

"Too many Americans are not aware of how dangerous these drugs can Texas Journal of Chiropractic

be, particularly compared to illegal drugs, which get a lot of attention. That's why we need to raise awareness," said Mr. Kerlikowske.

"The abuse of prescription drugs is an alarming public health crisis that is suffocating our society. This new national plan offers tremendous promise of health and hope to our country. And it gives us a chance to celebrate a healthcare system that delivers prevention early instead of treatment too late."

regions with proper training to deal with spinal issues.

"The treatment you get is more dependent upon the doctor you see than any rational, evidence-based, generally accepted treatment approach," he said. "No one has really worked out a model [that] offers the best treatment approach to anybody who has pain ... where they would come in an get a proper assessment and their treatments [would be provided] according to scientific evidence."

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Bringing Primary Care Chiropractic to the World In the near future, doctors of chiropractic in developing countries will wear the hat of primary care provider for millions of people suffering from musculoskeletal conditions and spinal disorders. This is the goal of World Spine Care (WSC), a multinational, not-for-profit organization led by Scott Haldeman, DC, MD, PhD. Dr. Haldeman estimates that approximately 70 percent of the populations in developing countries today suffer from back pain and are often given limited treatment options, such as simple naproxen prescriptions for pain, without much follow-up. There are also limited specialists and clinics in many of these Texas Journal of Chiropractic

"The journey to achieve this goal has already begun in a remote rural African village in Shoshong, Botswana, a small country located in Southern Africa with just over 2 million people. Soon after launching World Spine Care in 2008, Dr. Haldeman was able to get several sponsors and grants from Palmer College and others to get his ideas for an efficient model of care started in the small rural village.”

"The grants were enough to jump-start a model clinic that will provide answers on the burden of disease and the 18

effectiveness of a new model o f c a r e b y a l l o w i n g D r.

Haldeman and his team to gather information for research."

Dr. Haldeman said he was drawn to Botswana because 25 to 40 percent of the local hospital's incoming patients were coming in due to back and neck problems. "'In developing countries, if you are making a living digging the field or bent over all the time or carrying wood on your head and you develop a complaint in your back or neck, which stops you from doing this, you can't make a living and you are likely to die,' said Dr. Haldeman, who also noted that after a person in a developing country suffers from a spinal cord i n j u r y, t h e y h a v e a l i f e expectancy of approximately 1.5 years if they don't receive appropriate care."

The clinical model to be tested in Botswana will involve an inter-professional, multidisciplinary approach to spinal disorders that incorporates the best available scientific evidence into the cultural, political, medical, and economic values, according to Dr. Haldeman. WSC will integrate its approach into existing local health care systems and take steps to ensure that the care provided to people with spinal disorders continues on a permanent basis.

www.chirotexas.org

For those patients who require secondary and tertiary care, they will be referred to medical specialists within the participating country, or to volunteer specialists (rheumatologists, spine surgeons, etc.) that World Spine Care will recruit for short-term visits to provide the required services.

"In each community, DCs working in the model clinic will provide community education on the prevention of spinal injuries and spine hygiene.

Local health care providers will also be recruited and scholarships will be provided to allow advanced training in spine care. This will enable the spine care centers to eventually be run by local practitioners."

Being part of a World Spine Care clinic will be presented to those who are interested in participating as a serious commitment that entails training in the model clinic in Botswana for a month to six weeks, then moving on to establish another clinic in another country or city and running the business full-time.

Dr. Haldeman said a typical day would entail a practitioner working in a primary clinic doing assessments, screening for serious disease and also teaching courses to the local community through schools and police stations on how to manage spinal problems. At this time, the organization is mainly focused on finding individuals who have the www.chirotexas.org

desire, time, energy and contacts to develop more fund-raising.

For more information about the World Spine Care model and how you can get involved, visit www.worldspinecare.org. ☆ ☆ ☆

HHS proposes ʻmystery shoppers' for docs HHS is proposing to use a “mystery shopper” program to gauge primary-care physicians' timeliness in accepting new patients, according to a notice in [the] Federal Register.

The plan calls for contacting 4,185 primary-care physicians —465 in each of nine as-yetunnamed states—twice, once by someone pretending to be a new patient who has private insurance and once by someone pretending to be a publicly insured patient.

Scenarios will involve patients with both urgent medical concerns and those requesting a routine medical exam. ☆ ☆ ☆

Consider YOUR ad HERE. Over 340,000 page views in the past issue!

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U.S. Government Calls for the Phase-out of Dental Mercury Amalgam The United States government has announced that it supports a “phase down, with the goal of eventual phase out by all Parties, of mercury amalgam.”

Here is the excerpt on amalgam: "The United States supports further consideration of dental amalgam by the INC such that the agreement is able to achieve the phase down, with the goal of eventual phase out by all Parties, of mercury amalgam upon the development and availability of affordable, viable alternatives." ☆ ☆ ☆

Government Plans Comprehensive Health Plan The Associated Press reports that "From cradle to grave, minority populations tend to suffer poorer health and get poorer health care than white Americans. In a first-of-itskind report, the government is recommending steps to reduce those disparities. The plan being released Friday runs the gamut from Texas Journal of Chiropractic

improving dental care for poor children to tapping "promotoras," savvy community health workers who can help guide their Spanish-speaking neighbors in seeking treatment."

"Recent years have brought some improvements in health disparities, although racial and ethnic minorities still lag in many areas — from higher infant mortality rates to lower overall life expectancy. In between, they're more likely to suffer from a host of illnesses such as diabetes, heart disease, kidney disease and asthma."

"Part of the problem is access to care: Minorities make up more than half of the 50 million people who are uninsured, the HHS report says.

Among the HHS plans: Working with states to increase by 10 percent the number of poor children who receive preventive dental care, including cavity-blocking sealants.

Hiring trusted local people to serve as community health workers who can help diabetics understand and stick to their doctor's care instructions. A Medicare pilot program has begun in Mississippi and Texas, and will spread to other areas.

Increasing use of trained promotoras, the Spanish term for those trusted locals. Head Texas Journal of Chiropractic

Start will use them to direct parents to health services.

Developing reimbursement incentives to improve the quality of care for minority populations, such as better prevention of heart disease and strokes.

New studies comparing which treatments work best for diabetes, asthma, arthritis and heart disease in minority populations.

Creating an online national r e g i s t r y o f c e r t i fi e d interpreters that doctors or hospitals can use for patients who don't speak English. ☆ ☆ ☆

show up with problems ranging from labored breathing and rapid heartbeats to extreme paranoia and delusions. The symptoms can persist for days."

"At least 2,700 people have f a l l e n i l l s i n c e J a n u a r y, compared with fewer than 3,200 cases in all of 2010.”

"The Drug Enforcement Administration recently used emergency powers to outlaw fi v e c h e m i c a l s f o u n d i n synthetic pot, placing them in the same category as heroin and cocaine.

But manufacturers are quick to adapt, often cranking out new formulas that are only a single molecule apart from the illegal ones."

Synthetic “Dangerous Drugs” are STILL DANGEROUS! The Associated Press reports that "Synthetic substances that mimic marijuana, cocaine and other illegal drugs are making users across the nation seriously ill, causing seizures and hallucinations and even killing some people.

The products are often packaged as incense or bath salts and can be obtained for as little as $10 at many head shops. As more people experiment with them, the results are becoming evident at hospitals: a sharp spike in the number of users who 20

"Besides being cheap and easily obtained, they do not show up in common drug tests.”

"So far in 2011, poison control centers have received nearly 1,300 calls about synthetic pot, compared with 2,874 calls for all of last year, according to the poison control center data."

www.chirotexas.org

"Poison calls for bath salts rose at an even greater rate.

The centers took 301 calls in all of 2010, but had more than 1,400 for the first three months of 2011. Most of the calls came from doctors and nurses reporting patients in emergency rooms."

7.5% of the sales price of the book which ever is greater.

"But authorities acknowledge the challenge of stopping the drugs' spread. DEA experts are evaluating as many as 50 new synthetics."

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Supporting the American Medical Association We have heard it said that the law demanding that the use of the CPT code is a benefit to a competing trade association.

We have all heard it said that the AMA makes millions of dollars annually from their CPT code books.

Have you ever wondered how much YOU pay to the AMA every time you purchase a CPT code book?

In order to distribute a CPT coding product one must obtain a license from the AMA for this copyrighted material. The AMA HERE reports that currently this cost is a $13.50 royalty per user per product licensed.

The print product royalty is $10 per distributed copy or www.chirotexas.org

So with every CPT product we buy we pay between $10 to 7.5% of the purchase price, and perhaps more, as a "tax" to the American Medical Association.

One Suggestion for Narcoterrorism Dear Editor; Now that Obama ended Osamaʼs reign of terror we can be reminded of Americaʼs perpetual resolve in challenging our enemies. I just hope that "when", not if, Narcoterrorism gravely disrupts our nation that our leaders will have the equivalent tenacity or our current and former President in being eternally vigilant in our defense. How about preemptive strikes?

El Paso exists in the shadow of mass murder and Narcoterrorism, that is depopulating our sister city, that is a portentous indication of what could occur anywhere in America. Does anybody in our nations capital hear the grenade explosions and automatic weapons fire next door or should we just laugh at the impotent Merida Initiative that is supposed to make us feel secure in the safest city in the universe?

21

Maybe we could give a few of our neighbors a free lunch with a large serving of our ʻbad to the boneʼ Navy Seals with a side order of our local SWAT teams.

Respectfully, William Leff 3130 Montana Ave El Paso, TX 79903 915 566-9671

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Gaps in Hospital Disaster Plans MedpageToday.com reports that "Although nearly all surveyed U.S. hospitals had plans for responding to masscasualty events such as earthquakes and chemical spills, gaps and omissions were common, a CDC analysis found."

"Many hospitals had no plans for certain types of disasters and the plans they did have frequently failed to address the particular needs of important subpopulations such as children ..."

"Only about 68% of hospitals had plans for dealing with all six types of events [epidemicpandemic disease outbreaks, bioterror attacks, chemical accidents and attacks, nuclear-radiological events, large explosions and fires, and major natural disasters], the researchers found. Most often omitted were plans for explosive-incendiary and nuclear-radiological events, Texas Journal of Chiropractic

each missing in roughly 20% of hospitals."

"Planning was also often deficient when it came to patient transfer arrangements with other hospitals in cases of large numbers of casualties. Although 88% of respondents indicated they had written agreements from other hospitals to accept adult patients during overload situations, just over half (56.2%) had similar arrangements regarding children."

"More than 40% of hospitals had no agreements with burn centers to take casualties from explosions and fires ....

In addition, about one-quarter of hospitals had made no plans to expand onsite capacity to cope with large numbers of casualties."

"Nearly 40% had no plan for expanding morgue capacity."

"Perhaps the most important shortcoming ... was a low rate of special planning for pediatric patients.”

"About half of hospitals also had not delineated how they would manage special-needs populations, such as people with limited mobility, pregnant women, the blind, and those with mental health problems." ☆ ☆ ☆ TCA… Professionals helping chiropractic professionals for

Nearly 100 years!

Texas Journal of Chiropractic

German Doctors Advised to Give More Placebos The Associated Press reports that "For German patients plagued with problems like chronic pain and mild depression, doctors may soon be trying something a little different: a placebo."

"After completing a major study on the use of placebos, the German Medical Association recently concluded the fake pills sometimes work better than real medicines and recommended that doctors give them out more often — even without explicitly telling their patients."

"That is in stark contrast to guidance from American and British authorities, who say using placebos without the patient's consent is unethical.

Placebo pills are often made from things like sugar, flour or dust, though doctors also use other things like vitamins, herbal supplements or drugs with very little active ingredient."

"According to the German group, placebos don't come with any nasty side effects and could be the last hope for patients with hard-to-treat ailments where no good medicines exist." "... placebos shouldn't be used for conditions where an effective therapy exists and 22

that doctors must tell patients they're getting something unusual." "... using more placebos might wean people off drugs that haven't proven to be very helpful and could also save health care systems millions of dollars."

"The amount of drugs people are taking to really only get a (minor) benefit is astronomical. A lot of doctors will say it's easier to write a prescription but we're not giving patients the best treatment possible when we rely on drugs."

"Previous surveys have found up to half of the doctors in Denmark, Britain and the U.S. regularly give their patients placebos without telling them. ☆ ☆ ☆

English are Healthier than Americans Medscape.com reports that "Americans have higher rates of chronic illness at almost every age than people in England, a new study shows."

"Researchers are baffled by the health disparities between England and the United States, they explain. The United States spends twice as much on healthcare as does the United Kingdom, yet "adults aged 50 years or older in the United States have www.chirotexas.org

significantly worse health status and lower life expectancy than those in England."

Previous studies, which focused on elderly people or infants, have shed little light on these differences, but little attention has been paid to people of other ages.

The role of body weight, which is on average much higher in the United States than the United Kingdom, also has not been fully explored.

"Whatever the reason for these differences in health, they appear to arise early in life, the authors write. "Our findings suggest that body weight is not the driving force behind the observed health d i ff e r e n c e s b e t w e e n t h e United States and England and that, if weight plays a role, it is a complicated one."

"Although Americans make up just 5% of the world's population, they represent more than half of every medical dollar expended on the planet."

"Life expectancy in the United States is amongst the lowest worldwide ... 'American adults live in poorer health than most Europeans,' they write." ☆ ☆ ☆ www.chirotexas.org

California Lawsuit Alleges Doctor Bribing The American Medical Association reports that "California's insurance commissioner is s u i n g pharmaceutical giant BristolMyers Squibb Co., accusing the drug company of b r i b i n g physicians using an assortment of kickbacks to prescribe the company's drugs."

"According to the lawsuit, physicians deemed 'high prescribers' by Bristol-Myers received trips to basketball camps, free concert tickets, autographed basketball merchandise, liquor, golf outings and other rewards to boost prescriptions. Lowprescribing doctors were warned by drug reps that they would not receive free samples or event invitations, the suit said."

"The suit was filed in 2007 by former Bristol-Myers employees in the Superior Court of the State of California for the County of Los Angeles.

The suit was sealed until early March of this year, when California Insurance Commissioner Dave Jones joined the complaint and 23

requested that it be made public."

"California insurance companies have spent more than $3.5 billion in covering drug costs stemming from Bristol-Myers' kickback scheme, Jones said. The lawsuit is the largest health insurance fraud case pursued by a California state agency."

"Bristol-Myers said in a statement that the lawsuit has no merit and that the company plans to defend itself against the allegations." ☆ ☆ ☆

Shedding Pounds Lowers BP Medpagetoday.com reports that "even modest weight loss helps reduce blood pressure in real-world practice, researchers affirmed in an observational study. Each 1 kg weight loss (2.2 pounds) was associated with a 0.39 mm Hg decrease in systolic and 0.26 mm Hg decrease in diastolic blood pressure ...

Every kilogram matters .... pointing to the continuous association with blood pressure."

"Small decreases in weight, like 5%, which everybody is capable of doing, can make a difference."

"Compared with weight maintenance over this period, loss of 1% of body weight was Texas Journal of Chiropractic

associated with the following effects: 0.24% decrease in systolic blood pressure 0.26% decrease in diastolic blood pressure 0.25% decrease in mean arterial blood pressure 0.20% decrease in pulse pressure These benefits over five years suggested reduced risk of hypertension and greater chance of normalizing blood pressure for those initially hypertensive, the researchers concluded." ☆ ☆ ☆

Frailty: Deadly at Any Age Medpagetoday.com reports that "Frailty -- known to be associated with a greater risk of death -- is not just a problem of older people .... people of any age who are frail -- defined as having more self-reported deficits such as health problems and difficulty with tasks like climbing stairs -- are more likely to die than those who are relatively more fit at the same age ...."

"And the proportion of those who are frail grows steadily as the population ages ...."

"The prevalence of frailty increased exponentially with age throughout the adult life Texas Journal of Chiropractic

span and not just after age 65, where the sharpest i n fl e c t i o n o f t h e c u r v e occurred." "...at all ages ... frailty predicted mortality."

"A Houston-area physician, Paul was the only contender to remain in the Republican race after Arizona Senator John McCain clinched the party's nomination." ☆ ☆ ☆

"That deficits accumulate with age is not surprising," the authors concluded. But the data "suggest that deficit accumulation is a fact of aging, not age, and that the antecedents of frailty in late life manifest at least by middle age." ☆ ☆ ☆

Ron Paul Considers Presidential Run Reuters news Service reports that "Representative Ron Paul, who ran for president in 2008, said on Monday he will form an exploratory committee to consider pursuing the 2012 Republican presidential nomination."

"The Texas congressman confirmed ... that he would formally announce his plans ... in Iowa."

"We're going to announce that I'm going to start an exploratory committee ... I'll stop by in Iowa on my way home…”

FDA Slaps Hand Sanitizers MedpageToday.com reports that "Four companies have been told to stop claiming their products prevent infection by methicillinresistant Staphylococcus aureus (MRSA)."

"The FDA told the four companies that claims made for the products ... violate federal law."

The agency "does not have sufficient evidence demonstrating that these products are safe and effective for these purposes," the FDA said in a statement.

"As well as the MRSA claims, some of the products are claimed to prevent infection from E. coli and/or the H1N1 influenza."

"The FDA cannot allow companies to mislead consumers by making unproven prevention claims," said Deborah Autor, director of the Office of Compliance in the agency's Center for Drug Evaluation and Research. ☆ ☆ ☆

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Drug Side Effects Can Befuddle Elderly Brains MedpageToday.com reports that "A range of drugs commonly prescribed to older patients have side effects that can lead to mild cognitive impairment and should be used cautiously, researchers here reported."

"Drugs with anti-cholinergic effects - including some b r o n c h o d i l a t o r s , antihistamines, analgesics, anti-hypertensives, antiparkinsonian agents, and corticosteroids, among others - can lead to 'significant d e fi c i t s i n c o g n i t i v e functioning' .... " "Such deficits mean older patients are 'highly likely to be classified as mildly cognitively impaired .... In unintentional irony, patients diagnosed as having mild cognitive impairment are likely to be given acetylcholinesterase inhibitors, the researchers noted …."

"People with mild cognitive impairment due to anticholinergic drugs could be in the absurd situation of receiving pro-cholinergic drugs to counteract the effects of anti-cholinergic agents..." ☆ ☆ ☆ TCA… Professionals helping chiropractic professionals for

Nearly 100 years!

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Clinical Nutrition Gains Popularity as Doubts Are Cast on Drug Treatment

levels. What they did not know is that the painkillers were never discontinued at all."

In the past few months, the results of published studies regarding the effectiveness of drugs call into question the validity of drugs as treatment.

As consumers become more aware of this kind of information, along with steady increases in degenerative diseases despite medical treatment, more people are turning to ... clinical nutrition and other treatment modalities that represent a more integrated and effective approach to health.

"The second study was conducted on 80 patients with irritable bowel syndrome (IBS). Before being divided into two groups, they were told about the 'placebo effect' and that one group would receive "placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes." In fact, there were no such clinical studies. To give the researchers' story more credibility, the patients were also told it was critical to take the placebos as directed."

Two recent studies turning consumers away from traditional, drug-oriented medicine highlight the fact that many of the apparently positive effects from drugs may be more mental than physical.

"Nearly 60% of the group receiving placebos showed improvement. In fact, the number of patients whose condition improved was higher than that seen in recent drug trials for the same condition."

For the first study, published in Science Translational Medicine, participants were put on an IV drip and then heat was applied to their legs - enough heat to cause pain.

At one point, participants were told that a powerful painkiller was now added to the drip.

They reported that their pain was significantly reduced in response. When later told that the painkillers had been discontinued, their pain returned to pre-painkiller

☆ ☆ ☆

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Diet, Exercise Sufficient to Reduce Triglycerides MepageToday.com reports that "While cholesterol control is often balanced between statins and lifestyle changes, reducing triglycerides can

Texas Journal of Chiropractic

usually be accomplished with diet and lifestyle changes alone, according to a new scientific statement from the American Heart Association." "... the researchers reaffirmed that triglycerides are not directly atherogenic but represent an important biomarker of cardiovascular disease risk."

"They suggested that clinicians should better understand the "metabolic pathways of triglyceride-rich particles and the consequences of hypertriglyceridemia," particularly in knowing the "characteristic lipid alterations in diabetes mellitus, lipodystrophic disorders including those seen with HIV, and chronic renal disease."

"For those outside the normal range of triglycerides [the study] recommend limiting: •

•

Added sugar to less than 5% to 10% of calories consumed -about 100 calories per day for women and 150 calories per day for men Fructose from both processed foods and naturally occurring foods -- less than 50 to 100 grams per day

Additionally, for persons with especially high triglyceride levels -- greater than 500 mg/ dL -- Miller et al. recommend abstaining from alcohol to guard against pancreatitis.

"The recommendations encourage all patients with triglyceride levels in the borderline to high range (150 to 199 mg/dL) or greater to incorporate physical activities of at least moderate intensity (such as brisk walking) for a total of at least 150 minutes per week, because these activities may contribute an additional 20% to 30% triglyceride-lowering effect."

"Overall, the treatment of elevated triglyceride levels focuses on intensive therapeutic lifestyle change," they wrote.

"For example, a 5% to 10% reduction in body weight anticipates a triglyceridelowering response of 20%.

Further offsets in carbohydrate calories by reducing added sugars and fructose while increasing unsaturated fat intake may contribute an additional 10% to 20% reduction in triglyceride levels."

•

Saturated fat to less than 7 percent of total calories

"Further reduction or elimination of trans fats and increased consumption of marine-based omega-3 products, along with aerobic exercise, will result in optimal lowering of triglycerides."

•

Trans fat to less than 1 percent of total calories

"Taken together, reductions of 50% or more in triglyceride

Texas Journal of Chiropractic

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levels may be attained through intensive therapeutic lifestyle change," they concluded.

"The statement also concludes that the use of medications to lower triglycerides 'is still lacking crucial clinical trial evidence.'

Except to prevent pancreatitis for those with triglyceride levels above 500 mg/dL, the recommendations are to avoid triglyceride-lowering medications but to review medication lists for drugs that might be raising triglycerides." " Tr i g l y c e r i d e t e s t i n g i s traditionally taken after a 12hour fast. The authors suggest using non-fasting triglyceride testing as an initial screen. Although the cutoff for elevated triglycerides remains at 150 mg/dL, a new optimal level of 100 mg/dL has now been set to acknowledge the protective benefit of lifestyle in metabolic health, the authors noted." ☆ ☆ ☆

Exploring Texas Chiropractic-Cascade of Negative Effects

By Chris G. Dalrymple D.C., F.IC.C.

I would call your attention to an occurrence that is more noticeable to me now than in previous times. I call it a cascade of negative effects.

While it is not specifically www.chirotexas.org

Consider YOUR ad HERE. Over 340,000 page views in the last issue! found in the Chiropractic Act, or in the Rules of the TBCE, it IS related to documentation that I reported on in the first article of this column. It is important enough that you should take away two things from this editorial: 1) read the law and set your practices up according to it--not what you "guess" it says, but what it actually says, and update your practices with every rule change; and 2) it would be WISE to include an attorney who knows the laws pertaining to chiropractic when you answer a complaint from the TBCE. What is "a cascade of negative effects?" It proceeds something like this: 1) A complaint is made against a licensee for some cause. The complaint may seem serious, or it may seem frivolous. The licensee will often respond without sufficient thought as to the consequences of the response. It seems that many www.chirotexas.org

times licensees merely make copies of their handwritten chart notes and trust the TBCE to reach their own conclusions. Rather than, as the rule allows, taking the time to thoughtfully respond with a narrative report addressing the complaint, MANY seem to take the "easy" way of "just send copies of the case notes and write a letter saying they are wrong and I am right."

Thus often begins a cascade of negative effects.

2) Investigation of the provided documentation can result in other findings and new complaints such a s a fi n d i n g o f p o o r documentation. Proper record keeping is a part of the licensee's responsibility. It seems that frequently the documentation provided as the result of the complaint process is, in the opinion of the TBCE, poor and does not seem to substantiate the licensees claims regarding the complaint. Worse, the TBCE may conclude that the documentation does not substantiate what the licensee has billed. This may result in a finding of improper billing, or even other violations of rule or law, and thus lead to new charges being levied in addition to the original complaint.

3) A finding of Improper billing may require the addition of other violations to the original complaint resulting in a process that started as a simple complaint ending up resulting in much 27

more significant violations being alleged. For example the finding of a pattern of improper billing could result in a finding of fraud.

4) A finding of fraud. This could result in a much more severe, costly, even criminal process than one originally bargained for in responding to a simple complaint Lest you think that this is fearfulness, it has been demonstrated that on more that one occasion that a simple billing complaint turned into an improper documentation complaint; this led to other negative complaints, and resulted in a grand battle with costly expense. Much like the Mother Goose rhyme about "The House that Jack Built," one thing ads to another until what started off as one simple statement becomes an entirely different story.

In the complaint process of the TBCE the conclusion at which you arrive will often depend upon the simple statement with which you start. Don't thoughtlessly respond to a complaint investigation from the TBCE. Don't just "throw the case notes at it." Seek assistance, and legal assistance would be a wise idea.

How you START your story in responding to the complaint process of the TBCE may determine the outcome of the process.

Texas Journal of Chiropractic

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