Board Notes. Vermont Board of Chiropractic Newsletter. Message from the Chair. Governor The Honorable James Douglas

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1 Page 1 September 2006 Vermont Board of Chiropractic Newsletter Board Notes Message from the Chair Governor The Honorable James Douglas Secretary of State Deborah L. Markowitz Office of Professional Regulation Christopher D. Winters, Esq., Director Members of the Board Denise Natale, D.C., Chair Sean Mahoney, D.C., Charles Foster, D.C. Anne Eckert Valliere, Public Member Vacancy, Public Member Board Staff Rita Knapp, Division Administrator Diane Lafaille, Board Administrator Larry S. Novins, Esq., Board Counsel ========================= Vermont Board of Chiropractic Office of Professional Regulation 26 Terrace Street Montpelier, VT Phone: Fax: dlafaill@sec.state.vt.us First, let me say that it has been an honor to serve Vermont as one of your Board of Chiropractic members for the past five years. It has been both a learning experience and a challenge. I look forward to the second half of my tenure as I begin my turn as Chair of your Board. Second, thank you, fellow chiropractors (both new and seasoned) for taking the time to read this newsletter. It is our sincere hope that this publication will provide a greater understanding of the role of the Board, the Statute and Rules that govern the practice of chiropractic in the state of Vermont. I would like to share my experience when I was appointed to the Board. It takes two years to begin to understand the workings of a board. Each meeting provides new insights into the statutes and rules, as well as the nature of human nature. Sitting in judgment of ones peers is a difficult position to be in. Rules and Statute guide the Board in those judgments, but each case is unique, and must be heard as such. The Statute and Rules for chiropractic are listed under Title 26 (Professions and Occupations), Chapter 10 (Chiropractic). As a new Board member, I had no idea that there was a difference between a Statute and a Rule. The duty of the Board is to protect the public health, safety and welfare. Items falling under that heading include a fair amount of educating. The Board provides information to applicants, explains complaint procedures as well as complaint appeal procedures, performs x-ray competency evaluations, hears

2 Page 2 September 2006 unprofessional conduct complaints to decide whether the public has been harmed, and adopts rules as necessary. Even stipulation and consent orders are designed to educate a doctor when disciplinary action becomes necessary. There is a wealth of information in this newsletter. We hope it is interesting enough to read from cover to cover. We welcome all of our new DC s to Vermont, and we welcome all DC s to our Board meetings. They are generally held the first Tuesday of the month and are open to the public. Go to our web page for the current meeting date and agenda. We welcome your questions, participation and input. Know your Board Denise Natale, D.C., Chair, graduated from New York Chiropractic College after a prestigious career in medical technology. An active member of numerous FCLB committees, she currently serves as Chair of the Vermont Board of Chiropractic. Dr. Natale has also lent her considerable expertise in the development of the NBCE's Acupuncture Examination as well as serving as a voting delegate and member of that organization. In addition to her professional commitments, Dr. Natale has been an active participant in her community, serving on the Cavendish Chamber of Commerce, guest speaking at numerous civic events, and acting as Director of the Phineas Gage 150th Anniversary Symposium. Sean P. Mahoney, D.C., graduated Cum Laude from Palmer College of Chiropractic, in Davenport, Iowa in 1986 and has been practicing in the Burlington, Vermont area ever since. Appointed to the Vermont Board of Chiropractic Examiners in 1999, he has served as Vice-chair and Chair of the Board. He holds an Advanced Proficiency rating in Activator Methods. A native of Newport, Vermont, Dr. Mahoney lives with his wife, Cindy, and their three daughters in Hinesburg, where he coaches track and field, and is an active instructor in children s ski programs. Charles Foster, D.C., a native of LaHarpe IL, graduated from LaHarpe High School in Attended Palmer College of Chiropractic, graduating in 1986 with a B.S. and D.C. In doing so, received the first B.S. degree conferred by Palmer. While there, he received a clinical excellence award and served as his class president during his entire academic tenure. Upon graduation, he was invited to participate in the intern program at the Gonstead Clinic in Mt. Horeb, WI. Dr. Foster moved to Brandon, Vermont in 1987 and established his present practice. In that time he has served on numerous boards and committees in the community. He has been Vice-President and President of the Brandon Area Chamber of Commerce. He has served on his local church board as well. During the winter he volunteers at Killington in the Ambassador program assisting mountain guests. He runs an after school athletic clinic at the local high school, often treating athletes a day. Professional accomplishments have included serving as the Vermont representative to the ICA, President of the Vermont chapter of the Palmer International Alumni Association, Liaison for the ACA to Blue Cross Blue Shield Health Plan. Dr. Foster also served the Vermont Chiropractic Association as VP, and President and Immediate Past President. He has served on committees representing the state association to Medicare and has testified numerous times before various House and Senate committees to improve chiropractic benefits for all Vermonters. In 2003, Dr. Foster was awarded the distinction of being named Vermont Chiropractor of the Year. Dr. Foster is most proud of the fact that it was during his tenure as VCA president that the chiropractic insurance equality legislation was passed and signed by then Governor Howard Dean. He also is proud that he had a hand in writing the pro-chiropractic position statements of presidential hopefuls, Dean, Gephardt, Kerry, Lieberman and Clark. In fact, Dr. Foster and Dr. Maurice Cyr helped to draft the statements of Dean, Gephardt and Kerry all in the same day on a trip to Iowa where they met with candidate Dean.

3 Page 3 September 2006 Dr. Foster has been married to wife, Johnna, for 25 years and has two beautiful daughters, Leah and Taryn. Leah is a sophomore at Plymouth State University in NH and Taryn is senior at Otter Valley Union High School with aspirations to play Division I college softball as a pitcher. Anne Eckert Valliere, Public Member was born in Gettysburg, Pennsylvania on May 19, She began her schooling at St. Joseph Elementary, Taneytown, Maryland, and graduated from St. Joseph High School, Emmitsburg, Maryland. She married and raised her family of two girls and one boy in Maryland. During this time she catered weddings and became known for her cake decorating and baking skills. She taught cake decorating at the North Carroll High School, in Hampstead, Maryland. Anne met her present husband and they established a family restaurant in New Freedom, Pennsylvania which they operated for ten years. She became a resident of Barre, Vermont in She went on to continue her studies at Woodbury College where she received her Associate Degree as a Paralegal. She also holds a Real Estate License. She is a Justice of the Peace and serves on the Board of Civil Authority in Barre. On the Board she has gained experience through the voting and election process, reassessment appeals, and water and tax appeals. She is a tour guide at the Montpelier Capital. She has been the Chair of the Barre City Republican Committee. She is active in many local organizations where she has served with distinction. At present, Anne is heavily into genealogy, having traced her family ancestry arriving in America back to 1634, and is presently in the process of being approved to join the DAR. The Complaint Process Disciplinary action against a licensed professional is usually the result of a long and careful investigative process. The process is the same for all 39 professions in Vermont licensed by their respective boards. The Chiropractic Board follows the Office procedure for all aspects of the complaint process. The chain of events starts when an individual files a complaint with the Office of Professional Regulation against the licensed professional. Violations of professional conduct are contained in the Laws and the Rules of the Board as well as Title 3, Chapter 5 which sets the unprofessional conduct standards for all professional and occupations. The law that protects the public to the greatest extent takes precedent. This is how the complaint process works: Complaint forms can be requested from the Office of Professional Regulation or downloaded from the Internet ( The last two pages contain a Alayperson=s version,@ which translates legal terms into everyday language. The Chiropractic Board=s administrator, Rita Knapp, reviews all complaints within a week to decide if an investigation will be opened. Occasionally the administrator contacts the person (if known) who filed the complaint to clarify or confirm an issue. It helps if the person who files the complaint lists dates, time and place of events, names and addresses of witnesses, names and addresses of other persons who have factual knowledge of the complaint, and documents and records that may support the complaint. The administrator may screen out the complaint within 15 days of receipt if the grievance a) concerns a profession that is not regulated through the office; b) contains accusations that, if true, would not constitute unprofessional conduct; c) concerns an issue which is not regulated by the profession. Once the decision is made to open an investigation, the administrator will send a letter acknowledging receipt of the complaint to the complainant and practicing Chiropractor (respondent). The Investigative Team When a complaint received by the Office of Professional Regulation (OPR) results in an investigation, an investigative team (I-Team) is appointed. The team always includes a licensing administrator, one or more board members/advisors, and an OPR investigator. The I-Team may also have the assistance of a special consultant or one of the prosecuting attorneys employed by OPR.

4 Page 4 September 2006 The I-Team reviews the complaint, identifies witnesses, documents and records pertinent to the complaint, makes contact with witnesses, the respondent, and where possible with the complainant. Investigations should usually be completed within six to nine months of receipt of assignment. If the I-Team recommends closing a case without disciplinary action, a Report of Concluded Investigation is prepared, signed by all members, and forwarded to the Board. Because the closing report becomes a public document, the name of the licensee and complainant are not included. This protects people from unjustified bad publicity. If the Board accepts the closing report, the complainant and respondent receive copies, and the case is closed. If the Board rejects the report or the recommendation, the case is returned to the I-Team. The team then resumes the investigation, or provides the Board additional information. It may request that an OPR prosecuting attorney review its recommendation. If the I-Team still believes the case should be closed, the closing report is revised and submitted to the Board. When the investigation results in a recommendation for disciplinary action, the administrator will provide the OPR prosecuting attorney with a draft summary of the team's findings. The attorney will send a draft of charges and stipulation for settlement to the respondent. If there is no response within 10 days, the attorney will file charges within the subsequent five-day period. If, however, the respondent agrees to and signs the stipulation, it is presented to the Board, which can accept or reject the terms. Should the Board not accept the stipulation, it advises the respondent and the prosecuting attorney. If an agreement cannot be reached that satisfies all parties and the Board, then a contested hearing is scheduled. Chiropractic Alphabet Soup NBCE, FCLB, CCE, BOC, OPR Chiropractic is famous for shortening long cumbersome names into their initials. What does it all mean to you? Every chiropractor took their national boards and sent their dollars to NBCE (National Board of Chiropractic Examiners). Who are they? What are they doing for you now that you are a licensed DC? NBCE developed tests for state boards to utilize with their licensees such as the acupuncture exam, the Ethics and Boundaries exam, and the SPEC (Special Purpose) exam. The acupuncture exam is used in states that require a DC to have passed an exam in order to practice acupuncture. It is an entry level competency exam designed to test the knowledge of an entry-level practitioner. The E & B exam is available for state boards to use whenever a DC has had a violation in the area of ethics or boundaries. The SPEC exam is available to state boards to use whenever a DC has been out of practice for a while, or has had a violation relating to the practice of chiropractic. The NBCE develops and administers all of the national tests required of chiropractors. Their headquarters are in Greeley Colorado. They are helping other countries develop their standards of testing for DC s as chiropractic licensing spreads throughout the world. FCLB stands for Federation of Chiropractic Licensing Boards. This agency provides education and support to all of the state licensing boards, Canada, Mexico, Puerto Rico, Virgin Islands and other countries in the world where chiropractic is licensed. They hold two meetings a year, one national, and one regional where current regulatory issues are presented. Each state board has a representative who can attend these symposiums, either as an attendee or as a speaker. Representatives offer presentations on an issue that is a problem in their state offering suggestions and education to aid other state delegates. Speakers from other professions offer presentations on such topics as sexual harassment, ethics, documentation, illegal chiropractic rings, legislation and other issues that state boards must deal with. The Council on Chiropractic Education (CCE) is the accreditation body recognized by the US Department of Education to oversee the formal education of DC s. CCE audits all chiropractic schools on a regular basis, making sure all US students of chiropractic are taught all subjects that are required. The

5 Page 5 September 2006 CCE Board of Directors includes chiropractic college administrators, private practitioners, and public members. They perform site visits to review the college curriculum, facilities, staff and administration. Accreditation is granted for a number of years to schools meeting the CCE standards, and then the school must go through the process again. The Vermont Board of Chiropractic (BOC) has a five member board (three DC s and two public members) which generally meets on the first Tuesday of the month at 1:30 in Montpelier. Meetings are open to the public. The BOC is one of the professions licensed by the Office of Professional Regulation (OPR) under the umbrella of the Secretary of State. All state boards are charged with protecting the public. Whenever a complaint is made against a licensed profession, it is investigated through the appropriate board. Some cases are simple and do not require much more than an investigation, and corrective action on the part of the DC through a Stipulation and Consent Order. The professional charged with unprofessional conduct always has the opportunity to come before the board and plead their case during a formal hearing. If you have read this far, congratulations! You have made it through this edition of alphabet soup. Thanks for reading your BOC newsletter. Tips for Avoiding Complaints What follows is a composite of some of the issues that may result in the filing of a complaint against a practitioner. Having a complaint filed against you can be extremely disruptive and upsetting. If a case alleges unprofessional conduct, as defined by the Board=s laws and rules, the Office will order an investigation. Although many complaints do not result in disciplinary action they are still investigated. Many of those complaints that are closed might have been avoided altogether if the practitioner had better communicated with the patient. Many insurance carriers, and many state=s now ask if you are, or have ever been the subject of an investigation. If a complaint is filed and the Investigating Team finds unprofessional conduct, the Board has the authority to take disciplinary action. We hope that you will read this carefully. It does not cover every possible scenario, but it may help you avoid common pitfalls that result in a complaint, and/or disciplinary action. Some of these items may seem to be unimportant, but every one of them has been based on an actual complaint. 1. Advertising - Whether it be via newspaper, radio ad, telephone directory, etc. advertising must be accurate. A chiropractor who stated that he/she had been awarded the chiropractor of the year by an association was found to have committed unprofessional conduct and was sanctioned by the Board. In advertising, if you make a claim that you have been awarded some honor you must also indicate what the award was, who awarded it to you, and the year the award was given. 2. Release of Patient Records - Failing to make available promptly a copy of a patient's medical records or radiographs to a patient, the patient=s representative, succeeding health care professionals or institutions, upon proper request may be grounds for discipline. Fees as outlined in Title 18, ' 9419 may be charged for copying and duplicating, but copies cannot be withheld for failure to pay fees (including duplicating charges) or as an incentive to secure payment for a balance on a patient bill. The Board interprets promptly to mean within thirty days of receipt of the request. 3. Termination of services - When a decision has been made to terminate a patient from your practice the Board strongly encourages the practitioner to do so, in writing. Termination should not occur during the course of treatment for a procedure that requires multiple visits. However, if it does the patient should also be provided with names of other practitioners that they can contact. 4. Informed Consent - Many times practitioners assume that their patients fully understand what they are doing, and what will happen. More often than not, this is not the case. Practitioners can save themselves a lot of hassle by being sure that patients know at each visit what is planned, and what it entails. This helps to avoid the possibility that the

6 Page 6 September 2006 patient expects one procedure, and you perform another. Be especially communicative when dealing with minor children, keep the parent(s) informed before proceeding. 5. Keeping Patient Records - The standard of care for chiropractic record keeping requires, among other things, (a) that the chiropractor and patient be identified on each record, (b) that patient demographics., including family, social, and occupational histories, be included in the record, (c) that the onset of injury be documented, (d) that a review of symptoms be included in the record, (e) that any patient self-care be documented, (f) that examination findings be included in the record, and (g) that any special studies undertaken be documented in the record. In addition, the chiropractor=s progress notes for the patient should contain the elements of a SOAP note: (a) the patient=s subjective complaints, (b) the chiropractor=s objective findings, (c) the chiropractor=s assessment of what is happening with the patient, and (d) the chiropractor=s plan of treatment for the patient.