H-0997

AN ACT Relating to chiropractic; amending RCW 18.25.005, 18.25.040, and 18.25.090; adding a new section to chapter 18.25 RCW; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. RCW 18.25.005 and 1974 ex.s. c 97 s 7 are each amended to read as follows:

((For the purpose of chapters 18.25 and 18.26 RCW, the term "chiropractic" shall mean and include that practice of health care which deals with the detection of subluxations, which shall be defined as any alteration of the biomechanical and physiological dynamics of contiguous spinal structures which can cause neuronal disturbances, the chiropractic procedure preparatory to, and complementary to the correction thereof, by adjustment or manipulation of the articulations of the vertebral column and its immediate articulations for the restoration and maintenance of health; it includes the normal regimen and rehabilitation of the patient, physical examination to determine the necessity for chiropractic care, the use of x-ray and other analytical instruments generally used in the practice of chiropractic: PROVIDED, That no chiropractor shall prescribe or dispense any medicine or drug nor practice obstetrics or surgery nor use x-rays for therapeutic purposes: PROVIDED, HOWEVER, That the term "chiropractic" as defined in this act shall not prohibit a practitioner licensed under chapter 18.71 RCW from performing accepted medical procedures, except such procedures shall not include the adjustment by hand of any articulation of the spine: AND PROVIDED FURTHER, That nothing herein shall be construed to prohibit the rendering of dietary advice.)) (1)(a) "Chiropractic" means an alternative primary health care practice that detects, cares for, and manages the vertebral subluxation complex, articular disfunction, and neuromusculoskeletal disorders for the restoration and maintenance of health. As a health profession, chiropractic is a science, art, and philosophy that deals with health and disease in persons who choose to be treated by chiropractors, whether as the initial health care provider or as the result of referral from other health care providers.

(b) An "alterative primary health care practice" means a point of entry into the health care system and a coordinating and referral point to other providers, as appropriate.

(c) "Vertebral subluxation complex" means a functional defect or an alteration of the biomechanical and physiological dynamics in a joint, with or without displacement detectable by x-ray, that may include, but is not limited to, any of the following: Fixation, hypomobility, hypermobility, periarticular muscle spasm, edema, or inflammation. The defect or alteration may cause neuronal disturbances, somatic dysfunction, and direct or reflex functional changes in remote tissues.

(d) "Articular dysfunction" is an alteration of the biomechanical and physiological dynamics of the joints of the axial or appendicular skeleton.

(2)(a) "Chiropractic care" means chiropractic adjustment and other manipulative procedures to manage a vertebral subluxation complex and relieve aberrations of the neuromusculoskeletal system that may cause neuronal disturbances. Such care may include the manipulation or mobilization of extremities insofar as any such procedure is complementary or preparatory to a chiropractic spinal adjustment. It includes consultation, examination, analysis, diagnosis, and treatment.

(b) A "chiropractic differential diagnosis" is a diagnosis to determine: The existence of a vertebral subluxation complex, articular dysfunction, or neuromusculoskeletal disorder; the appropriateness of chiropractic care; and the need for referral to other health care providers.

(c) "Examination, analysis, and diagnosis" includes the use of physical, clinical, thermal, laboratory, x-ray, or other generally accepted diagnostic analytical methods and devices. The extent and necessity of analytical and diagnostic tests must be based upon objective findings, progress of the patient, and the professional judgment of the chiropractor.

(d) A "chiropractic adjustment" means chiropractic care of a vertebral subluxation complex, articular dysfunction, or neuromusculoskeletal disorder. Such care includes manual or mechanical adjustment of any vertebral articulation beyond the normal passive physiological range of motion.

(e) "Chiropractic treatment" includes the use of procedures involving heat, cold, water, and exercise, and such physiological therapeutic procedures and instruments as traction and light, but does not include procedures involving the application of sound, diathermy, or electricity.

(3) Chiropractic care may include the provision of dietary advice and recommendation of nutritional supplementation for the restoration and maintenance of health. Such care may also include the normal regimen and rehabilitation of the patient, first aid, and counseling on hygiene, sanitation, and preventive measures.

(4) Chiropractic care shall not include the prescription or dispensing of any medicine or drug, the practice of obstetrics or surgery, the use of x-rays or any other form of radiation for therapeutic purposes, colonic irrigation, or any form of venipuncture.

(5) Nothing in this chapter prohibits or restricts any practitioner of a health profession defined in RCW 18.120.020(4) from performing a function or procedure the practitioner is licensed or permitted to perform under this title, and the term chiropractic as defined in this section shall not prohibit a practitioner licensed under chapter 18.71 RCW from performing accepted medical procedures, except such procedures shall not include the adjustment by hand of any articulation of the spine.

Sec. 2. RCW 18.25.040 and 1985 c 7 s 15 are each amended to read as follows:

Persons licensed to practice chiropractic under the laws of any other state, territory of the United States, the District of Columbia, Puerto Rico, or province of Canada, having ((~~equal requirements of~~)) qualifications substantially equivalent to those required by this chapter, may, in the discretion of the board of chiropractic examiners, and after such examination ((~~by the board in principles of chiropractic, x-ray, and adjusting, as taught by chiropractic schools and colleges~~)) as may be required by rule of the board, be issued a license to practice in this state without further examination, upon payment of a fee determined by the director as provided in RCW 43.24.086, provided that the state or territory from where the person came extends substantially reciprocal treatment to licensees of this state.

Sec. 3. RCW 18.25.090 and 1989 c 258 s 6 are each amended to read as follows:

On all cards, books, papers, signs or other written or printed means of giving information to the public, used by those licensed by this chapter to practice chiropractic, the practitioner shall use after or below his or her name the term chiropractor, chiropractic physician, D.C., or D.C.Ph.C., designating his or her line of drugless practice, and shall not use the letters M.D. or D.O.: PROVIDED, That the word doctor or "Dr." or physician may be used only in conjunction with the word "chiropractic" or "chiropractor". Nothing in this chapter shall be held to apply to or to regulate any kind of treatment by prayer.

NEW SECTION. Sec. 4. A new section is added to chapter 18.25 RCW to read as follows:

Nothing in this chapter shall be construed to prohibit:

(1) The temporary practice in this state of chiropractic by any chiropractor licensed by another state, territory, or country in which he or she resides. However, the chiropractor shall not establish a practice open to the general public and shall not engage in temporary practice under this section for a period longer than thirty days. The chiropractor shall register his or her intention to engage in the temporary practice of chiropractic in this state with the board of chiropractic examiners before engaging in the practice of chiropractic, and shall agree to be bound by such conditions as may be prescribed by rule by the board;

(2) The practice of chiropractic, except the administration of a chiropractic adjustment, by a person who is a regular senior student in an accredited school of chiropractic approved by the board if the practice is part of a regular course of instruction offered by the school and the student is under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board;

(3) The practice of chiropractic by a person serving a period of postgraduate chiropractic training in a program of clinical chiropractic training sponsored by a school of chiropractic accredited in this state if the practice is part of his or her duties as a clinical postgraduate trainee and the trainee is under the direct supervision and control of a chiropractor duly licensed pursuant to this chapter and approved by the board;

(4) The practice of chiropractic by a person who is eligible and has applied to take the next available examination for licensing offered by the board of chiropractic examiners, except that the unlicensed chiropractor must provide all services under the direct control and supervision of a licensed chiropractor approved by the board. The unlicensed chiropractor may continue to practice as provided by this subsection until the results of the next available examination are published, but in no case for a period longer than six months. The board shall adopt rules necessary to effectuate the intent of this subsection.

Any provision of chiropractic services by any individual under subsection (1), (2), (3), or (4) of this section shall be subject to the jurisdiction of the chiropractic disciplinary board as provided in chapters 18.26 and 18.130 RCW.

NEW SECTION. Sec. 5. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.