State of Arizona Board of Chiropractic Examiners newsletter

              State of Arizona
Board of Chiropractic
Examiners
August 1998 Newsletter
Mission Statement: The
mission of the Board of
Chiropractic Examiners is to
protect the health, welfare and
safety of Arizona citizens who
seek and use chiropractic care.
Board of Chiropractic
Examiners
N. Edwin Weathersby, D.C.
Chairman
Craig Seitz, D.C.
Vice Chairman
Norma H. Steinbrenner
Public Member
Sandra Lynne Velotta
Public Member
James J. Badge
Professional Member
Board Meetings
September 17, 1998
October 15, 1998
November 12, 1998
December 10, 1998
Examinations
Jurisprudence – 1st Friday of month
State of Arizona, Board of Chiropractic
Examiners, 5060 N. 19th Ave., Suite 416,
Phoenix, AZ 85015-3210. Phone: (602) 255-
1444 fax: (602) 255-4289.
The Question of the Year: How do I meet my
12 hour continuing education requirement?
by Patrice Pritzl, Executive Director
It probably will not come as a great surprise to learn that some of the most frequently
asked questions received by the Board office this year have to do with the continuing
education requirements. Since the intention of continuing education is not to make
your lives more difficult, but rather to benefit both the consumer public and the
profession, we will do our best to continue to address those questions.
Licensees are required, by law, to complete 12 hours of continuing education for each
calendar year. The most important thing for you to remember is that the continuing
education course(s) you take must meet the requirements for the State of Arizona.
Continuing education that has been approved in other states or by associations may not
meet this state's requirements. In addition, a course that advertises Board approval
may not be referring to this Board. It pays to be selective, so read the fine print.
Course Criteria
The requirements that a course must meet in order to be accepted for continuing
education credit are defined in statute and rule. All licensees were sent a copy of the
Laws and Rules book in October of 1997, which definitely should have been given a
place of honor in your office. If the course you will take meets the requirements
spelled out in the law, it will not be presented to the Board for approval in that it
already qualified for credit by law.
You will note that the course needs to meet two criteria. The first is a topic criteria.
The second is an instructor/sponsor criteria. I apologize for beating this to death, but,
the course must meet both criteria in order to qualify for continuing education credit.
Please use the following outline for easy reference:
Criteria Number 1: Topic
Each credit hour of the course must be on one or more of the following topics ;
Anatomy
Physiology
Bacteriology
Symptomology
What is the State of Arizona, Board of
Chiropractic Examiners; What do we do
and Why?
by N. Edwin Weathersby, D.C.
Chairman
The Board of Chiropractic Examiners and its staff are responsible for carrying out the
stated mission. It is a difficult task and virtually impossible to please everyone,
especially when you consider the following:
1) We are a regulatory board with statutes the legislature mandates we enforce.
Our area of jurisdiction is also determined by the legislature, and does not cover every
aspect of practice that licensees and the public may like to see covered.
2.) The Board is allowed to set the rules (code); however, all rules promulgated
by the Board must be authorized by statute, within the Boards jurisdiction and in
compliance with current statute. In addition, rules approved by the Board must
consider input and concerns from both the licensee and consumer public. While there
are times the concerns of the licensee and consumer public are mutually supportive,
oftentimes they are in conflict. Finally, all rules must be approved by the Governor’s
Regularity Review Council, (GRRC). The final language of a rule created by the
Board may include language required by GRRC.
3.) The standard of care is dictated by professionals in Arizona. Determining a
standard of care may be difficult because the acceptable minimum standard is a gray
area, and is often defined through expert witnesses.
The Board is faced with assimilating all of the statute, rules, and investigative
materials that have some impact on Board operations and decision making in order to
reach conclusions and make final decisions. The Board members dedicate a
considerable amount of time and energy analyzing any issue which comes before them
prior to making any decision which will impact the profession as a whole or an
individual licensee.
To better understand the process that the Board goes through on a regular basis, I
invite you to attend a Board meeting and give us your input on how we are
accomplishing the mission.
Public Information: What is and what is not
available to the public concerning each
licensee.
by Patrice Pritzl, Executive Director
The Board of Chiropractic Examiners has implemented this
newsletter as a way to communicate with our licensees about
some of the questions that are frequently asked, and to provide
you with some information that we hope will be helpful to
you. We will do our best to provide you with information that
answers some of your questions and to provide information
that may impact on your livelihood and explain why the Board
and staff are required to do the things they do.
Some of our most frequently asked questions from both
licensees and the public are about public records information.
Periodically, we receive a call from an angry licensee who will
demand to know why certain pieces of information have been
provided to a caller. Oftentimes, these calls have to do with a
dismissed complaint or a pending investigation.
The truth is that all information available that is not
protected by the confidentiality laws is available over the
phone to anybody who calls and asks. The Legislature
believes that the public has the right to make an informed
decision when selecting a health care practitioner. Prior to
placing an angry call to the staff, please remember that
disclosure of public information is not at the option of the staff
or Board. If it is public information by law, we must disclose
it.
Public information includes the following:
· Information about a specific license; The institution
from which a licensee graduated; the year licensed in
Arizona, name licensed under, office locations and
telephone numbers, license number, certification for
acupuncture or physiotherapy and numbers, date of
license expiration, National Board scores, and
jurisprudence examination scores. If a licensee provides
the home address as the primary address, this is also
public information. All information that you provided on
your application is public except for your social security
number and home address and phone number if your
home address is not your primary address.
· Information on complaints filed against a licensee; and
of those complaints, the number dismissed with date and
the number upheld. If a complaint was dismissed, a broad
definition of the type of complaint may be provided and
the minutes from the meetings relating to the dismissed
complaint must be provided if requested.
· Information and explanation about sanctions imposed
on a licensee by the Board; If a sanction has been
imposed, the Complaint and Notice of Hearing, the
Findings of Fact, Conclusions of Law and Order, similar
documents which have been filed and the information
contained therein is available to the public.
· Information about pending complaints; A caller must
be informed that a complaint is being investigated or is
pending, however, the contents of the complaint file are
protected by law. The caller is only told that a complaint
is open and ongoing.
· Assistance and referral advice to help make a decision
in choosing a doctor of chiropractic; Our response is
that as a regulatory agency, the staff is unable to make
referrals or to advise them about whether to file a
complaint. Callers are referred to the Chiropractic
Association for individual referrals.
Nothing is ever purged from a licensee’s administrative file.
Social Security numbers and non-primary homes addresses
and phone numbers are not public information. However, all
Board Orders, renewals, continuing education affidavits, name
changes, and correspondence to the licensee from the Board
are filed in the administrative file and are available for public
inspection upon request.
Not everyone likes, appreciates or understands what the Board
is required to do by law. However, I do ask you to understand
that the Board and the staff must follow the law, and cannot
disregard the law in response to angry phone calls or letters. I
also ask you to remember that the person who answers the
phone when you call the Board office is generally not going to
be an individual who is in a position to make administrative or
legal decisions. In this regard I invite you to ask to speak with
me when you call our office rather than express your anger or
frustration to a staff member who will not be able to
accommodate you. If I am not able to accommodate your
concern, I will, at least, be able to explain the law or agency
policy so that you can understand why an action was taken.
Complaints: How can you avoid having a
complaint filed against you, and what will
happen if a complaint is filed?
By Law, every complaint filed with the Board must be
investigated and heard by the Board. You do not want to have
a complaint filed against you by a patient. Even if you did
everything correctly with the care and treatment of that
patient, and the complaint is dismissed, you will still incur
some negative consequences.
What are the consequences?
1) Time out of the office to attend Board meetings,
which translates to loss of revenue.
2) Review of records and other information associated
with the complaint that translates to unproductive time.
3) Emotional stress incurred as a result of having to
defend yourself translates into many intangible negatives –
probably the biggest loss of all.
4) Having a complaint filed with the Board becomes a
permanent record in your public file, which may translate to a
negative perception by the inquiring public.
How can you avoid having a complaint filed against you?
Easy answer!
1) Know and follow all of the statutes and rules that
govern the practice of chiropractic in the State of Arizona, and
know the Board published substantive policy statements. All
licensees have a copy of the current laws. The Board has
provided all established licensees with a current law book. All
new licensees received the law book with their application and
were required to pass the jurisprudence examination. DO
NOT THROW YOUR LAW BOOK AWAY. READ IT,
KNOW IT, USE IT. If you lose it, you can obtain another
from the office for five dollars.
2) Use common sense. Don’t assume anything,
including what a patient understands.
3) Set up good business practices.
· Solve the problem with a patient before he or she
files a complaint. Almost always someone in the
office hears about the problem from the patient
before he or she contacts the Board. Listen to
your staff when they tell you about the patient’s
complaint. Pick up the phone and talk to the
patient. Do it yourself instead of sending a staff
person. Remember that it’s your license and
your potential complaint, not your staff’s.
· Keep accurate legible records on every patient.
This includes necessary x-rays, an examination,
a written diagnosis and a written treatment plan.
· Inform every patient in advance of any treatment
to be done and the fee. Better yet, provide your
fee schedule in writing; provide the patient with
a copy of the treatment plan and fee schedule.
Document that treatment and fees were discussed
with the patient and provided to the patient in
writing.
· Before you turn a delinquent account over to a
collection agency, exhaust every opportunity to
collect the amount owed you. Turning a patient
over to collection frequently triggers a complaint
being filed against you with the Board.
· Treat your staff the same as you expect them to
treat your patients. If you don’t like and respect
your staff, solve the problem quickly, before
something is said to a patient that may trigger a
complaint.
· Evaluate the quality of your treatment frequently.
Your patients expect the highest quality from
you.
· When you have a difficult patient who presents
you with a problem you don’t know how to
solve, pick up the phone. Call someone you trust
and respect for advice.
· Be caring, professional and polite. Make certain
your staff is the same. Cleanliness of the office
and staff courtesy are often seen as factor
contributing to quality of care by patients.
Similarly, a rude staff person or a less than clean
environment can trigger a complaint.
· Explain each procedure you are using to the
patient. Don’t assume that an individual who
has received chiropractic care in the past will
understand the treatment you will be using.
· Be aware of personal boundary issues. If you are
using a procedure that the patient is not
comfortable with and does not clearly understand
the necessity for, the patient may file a sexual
misconduct complaint due to the
misunderstanding. This is particularly true if
you will touch or possibly view any area of the
body that the patient may consider private.
· If you will need the patient to remove any piece
of clothing or will be conducting a rectal, pelvic
or breast examination, or any related type of
procedure, have a third person who is the same
gender as the patient present in the room at all
times.
· If you will need to unhook a patient’s bra or ask
the patient to partially remove any part of their
clothing, follow the same advise as above. Make
sure the patient knows why their clothing is
effected and consider having a third party in the
room. The Board has received many complaints
alleging sexual misconduct because the
chiropractor has failed to follow these simple
steps.
· The most common sense means of avoiding a
complaint is simply to treat each patient as you
want to be treated when you are a patient.
What will happen if a complaint is filed against you?
All complaints that are filed with the Board must be
investigated and brought before the Board for action. The
same process is followed for each complaint received.
· When the complaint is received, it is assigned a complaint
number and a file is opened.
· A copy of the complaint is sent to the licensee against
whom the complaint has been filed with a request for a
response within ten days of receipt, and a subpoena
requiring the licensee to provide a copy of the patients
records, if applicable.
· When the licensee’s response has been received, a copy of
the response is sent to the complainant.
· The complaint is then scheduled for the next available
Board meeting.
· In most cases, the licensee and complainant will be
contacted by the Board investigator prior to the Board
meeting in order to clarify the complaint and response and
to fill in any additional information that may be lacking.
You are also welcome to call the Board office and speak
with the investigator or director.
· The Board will then review the file for the first time. It is
important for you to remember that at this time the Board
is merely looking at the facts presented in the complaint,
response and records. There is no assumption that a law
has or has not been violated. It is simply a review of facts
as presented, and each complaint is treated the same. You
will receive a notice that the complaint has been placed on
the Board agenda with the meeting date and location.
You are welcome and encouraged to attend. If you or
your representative is present, you will be provided with
an opportunity to address the Board on the matter. The
complainant will have the same opportunity.
· The Board will review the complaint to determine one of
the following:
1) Is the nature of the complaint under
the Boards jurisdiction? If not, the Board
will not have authority and will dismiss the
complaint.
2) Is there a basis on which to believe
a law may have been violated? If there is
not a substantive basis on which to proceed,
the complaint will be dismissed. If the
Board is either concerned that a law may
have been violated or the Board does not
have enough information to make a
determination, the complaint will be held
open for further investigation.
3) If the Board is concerned that there
is a substantive basis to believe a law has
been violated, they may vote the matter to
go to a formal hearing.
· If the complaint is dismissed or open for further
investigation, you will be noticed by letter. If an
investigation will take place, you will be contacted by the
Boards investigator and kept informed of when the matter
will be scheduled for the Boards agenda.
· If the matter is voted to hearing, you will be noticed
through a formal Complaint and Notice of Hearing. The
Complaint will identify the time and place for the hearing,
the factual allegations made against you, and the charges.
You will have the right to be represented by an attorney,
and you are encouraged to engage such representation. If
you receive a Complaint, do not contact the staff to
determine how you should proceed. The board staff
cannot provide you with legal advice or guidance.
Seventy five percent of complaints filed with the Board in
1997 were dismissed for insufficient basis or because they
were not under the Jurisdiction of the Board. If you receive a
notice of complaint from the Board, and you have not violated
any of the laws governing the practice of chiropractic, don’t
panic, and don’t get angry. By law, the Board will have to
process each complaint. To expedite the matter, provide your
response and the patient’s records promptly, and provide as
much detail in your response as possible. The more
information the Board has to work with, the more quickly they
can come to a determination. If you have questions regarding
the process, you can call the investigator or the director. We
cannot predict for you the Board’s decision or tell you if there
has been a violation of law. Only the Board is authorized to
make that determination. We can, however, tell you what to
expect in the process and will be happy to help you with those
questions.
VOLUNTEERS? VOLUNTEERS?
The Board and staff periodically need the assistance of
volunteers from the professional community to serve on
committees, help develop test questions or possibly assist in
an investigation through your expertise. If you are interested
in signing up to volunteer your knowledge and expertise to
assist the Board, your license is in good standing, you have no
disciplinary history with this or any other agency and you
have been practicing chiropractic for three or more years, you
may apply by contacting the Board’s executive director,
Patrice Pritzl, at (602) 255-1444. Yes, there will be a little bit
of paperwork. We are a bureaucracy after all! We will keep it
brief and to the point, re: your areas of expertise and record of
good standing. We will also use your time sparingly so as to
make the best use of your assistance without impeding, too
greatly, on your personal and professional time.
Other Board Services
Verification of Licensure in Good Standing - No charge
Mail lists – zip code order $25.00 – Labels
Mail lists – zip code order $10.00 – List only
Directory – alpha order $25.00
Newly Licensed Chiropractors (Calendar Year) $25.00
Board Minutes (Calendar Year) $25.00
License by Examination Packet $10.00
License by Reciprocity Packet $10.00
Duplicate Renewal Receipt $ 5.00
Duplicate Ornamental License $10.00
Duplicate Ornamental Certificate $10.00
Jurisprudence Booklet $ 5.00
Public Record Copies $ .25 per page
Board Programs
License Preparation
The application process for licensing is a detailed process that
requires specific documentation for eligibility. To avoid
undue delays in licensing applicants are encouraged to contact
the Board office for information and to begin planning well in
advance of the deadline dates.
The Board now requires that applicants for licensure have
NBCE Parts I – IV and pass a state level jurisprudence
examination. The Board no longer gives a practical licensing
examination, but applicants are required to submit the
appropriate documentation and meet deadlines. The deadline
for applications is 30 days prior to the jurisprudence
examination. With thoughtful planning an applicant can meet
the deadlines and become licensed as soon as possible.
· Application deadline is 30 days prior
· A complete and notarized application.
· A complete fingerprint card.
· Official transcript sent directly from the
chiropractic college or a letter stating the
anticipated date of graduation on or before the
jurisprudence examination.
· Official transcript sent directly from the
National Boards for NBCE Parts I-IV.
· Verifications of licensure in good standing from
other states.
Preceptorship Training
The Board of Chiropractic Examiners allows board approved
licensed doctors to act as preceptors to chiropractic students
and recent unlicensed graduates serving as externs. There are
rules that regulate the program and there are some restrictions.
Below is a summary of the rules that govern the program.
EXTERN
· The extern must wear a nametag that identifies
he/she as an extern; he/she cannot advertise or
identify themselves as “Doctor” or as practicing
chiropractic except as a student/extern.
· Any patient the extern adjusts must sign the
Board approved consent form prior to treatment.
· Externs are allowed to adjust only when the
preceptor doctor is in the room.
· Externs are not allowed to do, perform, assist or
order any physiotherapy or acupuncture
treatments.
· Externs cannot take any x-rays, unless he/she is a
student at a Chiropractic College during their
externship.
PRECEPTOR
· The preceptor is responsible for submitting
evaluation reports and patient consent forms
· Must have been practicing continuously for the
immediately preceding three years and at least
one year in Arizona.
· Have no disciplinary actions against his/her
license.
Continuing Education
The Board has received numerous inquires as to which
seminars are acceptable to meet the 12 hour continuing
education requirement. The course does not require approval
by the Board if the provision of the statute and rule are met. If
your course does not meet the provisions, you may submit the
resume of the instructor and a detailed syllabus for each
course with a request that the Board approve your course for
continuing education credits.
The provisions that must be met in order to qualify for
continuing education credit are:
· Each credit hour must be on one or more of the following
topics:
Anatomy
Physiology
Bacteriology
Symptomatology
Diagnosis, including physical, clinical, x-ray and
laboratory subjects
Chiropractic orthopedics
Principles of chiropractic and adjusting
Neurology
Chemistry including biochemistry and nutrition
Public health and hygiene
Chiropractic spinal analysis
Acupuncture and physiotherapy
(sexual misconduct and personal boundaries
training is considered to fit within the above
listed topics)
AND – one of the following
· The course is taught by a faculty member of an accredited
college or university in the United States.
· The course is taught at or sponsored by an accredited
college or university in the United States.
· The course has been approved by a vote of the State of
Arizona, Board of Chiropractic Examiners in an open
meeting and is on record in the meeting minutes as
approved.
· By teaching a post-graduate course on one of the topics
listed above as a faculty member of a Council in
Chiropractic Education accredited chiropractic college.
STATE of ARIZONA
BOARD of CHIROPRACTIC EXAMINERS
5060 North 19th Avenue, Suite 416
Phoenix, AZ 85015