How is the Chiropractic Examining Board different from the WCA?

The Chiropractic Examining Board is part of the State of Wisconsin’s Department of Regulation and Licensing. The four chiropractors that serve on the examining board, along with the public members, are chosen by the Governor. The board has the responsibility to enforce the rules that govern the chiropractic profession and to change the rules as circumstances warrant.

The Wisconsin Chiropractic Association is a trade association that works on issues that impact its members. As a private organization, the WCA also seeks to change laws and rules that harm the profession in some manner. While the examining board has the inherent authority to propose rule changes, the WCA must approach the legislature, or the examining board, if it wants a change in the law.

What may be confusing is the fact that the examining board and the WCA do not always take the same position on issues that affect the profession. The examining board sees problems from the state’s point of view; the WCA, from our members point of view. Occasionally, the WCA and the examining board differ on the problems that need to be resolved within the profession or the methods used to solve those problems. While a satisfactory solution is found for most disagreements, some are so significant that the legislature must make the final decision.

Should I get an attorney if a complaint is filed against me?

There are several advantages to hiring an attorney if a complaint is filed against you. While you will be understandably emotional, attorneys are trained to focus on facts. Their objectivity can be an asset when reviewing the allegations made against you. Attorneys can speak with department personnel to determine the seriousness of the allegations. If necessary, they can determine the best way of defending your conduct.

On the other hand, attorneys can be expensive and not always necessary. Many complaints are considered minor violations of the statutes or rules. Often these minor violations concern advertising or billing concerns. If that is the case, you may want to carefully review the complaint and call the Department of Enforcement to ask if the department considers this a serious problem and to define the potential consequences, if you are found to have violated a statute or rule. If the department intends to close its investigation by issuing a cautionary letter, it may not be necessary to go through the expense of an attorney.

Two important things to remember. The first is to immediately hire an attorney if a serious allegation is made against you. It is better to do so before you respond to the complaint with the department. The second is to spend some time researching the attorney before you hire him or her. Make sure the attorney you hire has prior experience working with the Department of Regulation & Licensing. The department has its own culture and you can help yourself immensely by hiring someone who knows the department’s style and operating methods.

The state requires 40 hours of continuing education each licensure period. Does it track my hours for me?

The state no longer tracks the continuing education hours earned by a chiropractor during each biennium. A chiropractor is required to keep track of their own hours. When a chiropractor renews their license, every two years, they must state whether or not they have completed their 40 hours of continuing education (CE). If not, they are required to stop practicing until the hours are obtained.

The WCA offers a CE database service for all chiropractors in the state that track the CE hours that they have earned. In order to participate, it is necessary for the doctor to send the WCA a copy of the education voucher they receive from all non-WCA CE programs (WCA programs are tracked automatically). An additional advantage of using the WCA’s CE database is that we check each course against the state’s list of approved CE programs. This is especially important because each year there are a number of programs from reputable colleges in which CE credit was “applied for” but never obtained. The WCA immediately notifies a doctor when they have submitted a course that has not been approved by the state. Those doctors that attend WCA courses, or submit vouchers for non-WCA courses, have no reason to be concerned when the state audits their CE records. A simple phone call to the WCA will yield copies of all of the doctor’s vouchers for the biennium being audited.

What is the scope of practice for a Wisconsin chiropractor?

The following definition of the chiropractic scope of practice defines the work of chiropractors:

“The practice of chiropractic is the application of chiropractic science in the adjustment of the spinal column, skeletal articulations and adjacent tissue which includes diagnosis and analysis to determine the existence of spinal subluxations and associated nerve energy expression and the use of procedures and instruments preparatory and complementary to treatment of the spinal column, skeletal articulations and adjacent tissue. Diagnosis and analysis may include physical examination, specimen analysis, drawing blood, blood-analysis and the use of x-ray and other instruments.”

What process does the Chiropractic Examining Board use to investigate a complaint that is made against me?

When a complaint is received, it is automatically referred to the Division of Enforcement for filing, screening and, if necessary, investigation. Screening is a preliminary review of the complaint and is important because it is the process used to determine whether an investigation is necessary. If the division concludes that the matter is trivial, the complaint is dismissed. Personnel and attorneys of the Division of Enforcement investigate serious complaints. On rare occasions, law enforcement personnel may also be involved if the allegations concern potential criminal activity.

X-ray is an important diagnostic tool used by chiropractors. However, there are several important restrictions/requirements on its use.

• X-ray may be used only for diagnostic or analytical purposes

• A chiropractor must comply with all safety guidelines required by their particular piece of equipment.

• You may not use x-ray procedures that require the introduction of drugs, clinical dyes or radioactive substances.

• You may not use therapeutic x-ray.

• You must take all of your x-rays unless your staff has been trained in a 48-hour course approved by the examining board. Even if your staff has passed this course, they may only work under your direct, on premise supervision.

Prohibited Practice.

A chiropractor’s scope of practice is limited. The following is a list of prohibited practices. It is very important to note that if you wish to do something that is not described in the scope of practice and is not on the prohibited practice list, you should obtain written permission from the chiropractic examining board before performing the technique or service.

• You may adjust a patient during pregnancy but you may not practice obstetrics or perform abortions

• You may not perform surgery.

• You may not administer substances subcutaneously. This includes TB testing.

• You may not practice acupuncture by needle insertion or laser application;

• You may not perform colonic irrigation.

• You may only sell vitamins, herbs, or nutritional supplements for the general health of the patient. You may not prescribe, dispense, deliver or administer any drug. The sale of a vitamin, herb, or nutritional supplement for the specific treatment, cure, or amelioration of a patient’s condition means that you have prescribed a drug as defined in the statutes (see index for drug statute).

Prohibited Techniques

The statute specifically prohibits the following techniques. This prohibition includes a prohibition against a technique with a different name that is similar to the prohibited technique. Once again, if there is any question as to whether a technique is allowed, you should obtain written permission from the chiropractic examining board before you use it in your practice.

• Aculips

• Pfeiffer technique or the application of magnets to the surface or near vicinity of the human body.

• Hair analysis if it is used as the only determinant for recommending chiropractic treatment or nutritional supplementation.

• Therapeutic ultrasound and galvanic therapy unless you have completed the physiologic therapeutics portion of the national board or completed a course approved by the board.

• Any of the following electro-diagnostic devices: EAV, Vegatest, Biotron 1000, Accupath 1000, Vi Tel 618, Interro System, Pro-Phyle, or substantially similar counterparts of any of these devices.

• Any practice system, analysis, method, or protocol which does not include the competent assessment, evaluation or diagnosis of the condition to be treated before beginning treatment of the patient.

• Any practice system, analysis, method, or protocol which relies upon diagnostic methods that are not generally recognized or accepted within the profession or which do not have scientific validity.

• Any practice system, analysis, method, or protocol which is represented as a means of attaining spiritual growth, comfort or well being.

What are the Department of Regulation & Licensing and the Chiropractic Examining Board?

Both the Department of Regulation & licensing and the Chiropractic Examining Board of these organizations were created by the state to regulate many aspects of your license to practice. The Department of Regulation & Licensing is responsible for many of the administrative aspects that affect your licensure as well as enforcing the decisions of the chiropractic examining board. The Chiropractic Examining Board, created by the Department of Regulation & Licensing, is comprised of four chiropractors and two members of the public that make and enforce the rules that govern the profession.

The following are the key duties and powers of the Department of Regulation & Licensing:

• They decide on the procedures for investigating complaints, commencing disciplinary proceedings and for conducting hearings.

• They develop the exam that must be passed by a chiropractor in order to receive a Wisconsin license.

• They investigate complaints that may be brought against you. They may issue subpoenas for witnesses or for the production of documents (such as your clinical records) as part of disciplinary action.

• They issue credentials and have the right to investigate whether or not you have an arrest or conviction record.

• They are required to cooperate with the departments of justice and health and family services in developing and maintaining a computer linkup to provide access to information regarding the current status of your license including whether your license has been restricted in any way.

• They decide the terms under which you may renew your license.

The Chiropractic Examining Board’s primary functions are to:

• Make rules related to the practice of chiropractic

• Participate in the investigation process when complaints are brought against chiropractors

• Conduct exams for those applying for a chiropractic license

What is the best way to respond if a complaint is brought against me?

The Department of Regulation & Licensing and/or the Chiropractic Examining Board have the power to make your life truly miserable if a complaint is brought against you. Because you will see thousands of patients over the course of your career, all of which will have different expectations and personalities, it should not surprise you if one of them files a complaint against you.

A complaint does not mean that you have done anything wrong. As a matter of fact, many complaints each year are routinely closed because the chiropractor has not committed any infraction. On the other hand, chiropractors have been known to get themselves into trouble because they do not take a complaint seriously. They ignore requests from the department or examining board for information and, as a result, make the process a lot worse than it needs to be.

If you receive notice of complaint, it is better to address the department’s concerns quickly, rather than delay. If, for whatever reason, you believe the complaint has merit, you are entitled to have an attorney represent you in any disciplinary hearing. If you are going to ask an attorney to represent you, it is better to hire him or her sooner rather than later. Please remember that whether a chiropractor is innocent or not, it tends to take a long time for a complaint to be resolved.

Another reason for taking a disciplinary proceeding seriously is that the standard of proof required for a conviction is that of “preponderance of the evidence.” This is the equivalent of saying “is it more likely than not that the doctor committed this offense”. Because the standard of proof is so much lower for disciplinary cases, it is imperative that you bring all of the facts to the department investigator as quickly as possible.

Can disciplinary action be taken against a chiropractor that does not pay his/her income taxes or child support payments?

The state legislature wants to insure that all Wisconsin citizens pay their state income taxes and make all of the support payments that are due as a result of a divorce. To assure that these payments are made, the Department of Revenue now has access to Department of Regulation & Licensing records. If an individual is shown as being delinquent in either of these areas, the department will not renew the individual’s license to practice.

It is against the law for a chiropractor to practice or attempt to practice when unable to do so with reasonable skill and safety to patients. Can you give me a practical example of this?

All of the following would violate this particular law. Please keep in mind these are only a few examples of this type of conduct. When in doubt, you should contact the WCA or the Chiropractic Examining Board

• A chiropractor who receives anecdotal information about a new technique should not use the technique on a patient until proficiency has been achieved through education and training.

• A chiropractor who has a significant mechanical problem with an adjusting table or other equipment should not use the table or equipment until it has been properly repaired.

• When encountering a condition outside one’s knowledge or experience, a chiropractor should not adjust the patient until they are confident that they have a thorough understanding of the patient’s condition and they have determined the condition to be treatable through chiropractic means.

It is against the law for a chiropractor to practice or attempting to practice beyond the scope of a license issued by the board, including but not limited to acts prohibited under s. Chir 4.05 (1). Can you give me a practical example of this?

All of the following would violate this particular law. Please keep in mind these are only a few examples of this type of conduct. When in doubt, you should contact the WCA or the Chiropractic Examining Board.

• Chiropractors may not adjust animals even if requested to do so by the animal’s owner unless they are under the direct, on premise, supervision of a licensed veterinarian.

• A chiropractor’s scope of practice is strictly limited. If a chiropractor questions whether something is inside or outside their scope of practice they should not rely on advice given to them by another chiropractor. They should obtain a written opinion from the chiropractic examining board.

• Chiropractors in other states are allowed to do things that are not allowed under the chiropractic scope of practice in Wisconsin. For example, even though a chiropractor may have been properly trained in the use of acupuncture in Minnesota, they may not use acupuncture as part of their chiropractic practice in Wisconsin.

It is against the law for a chiropractor to engage in any practice which constitutes a substantial danger to the health, welfare or safety of a patient or the public. Can you give me a practical example of this?

This standard can be used when a chiropractor engages in an activity that has not previously been ruled on by the board. Substantial danger to the health of the public may include:

• Adopting new clinical approaches for the history, examination, diagnosis, or assessment of a patient before these approaches have been taught at a chiropractic college.

• The methods used by a chiropractor or his or her staff to interface with their patients. This might include the communication methods used by doctors or staff, the privacy afforded patients preparing for treatment, or the privacy of the treatment itself.

• The utilization of specific diagnostic procedures or adjusting techniques before they have been taught at a chiropractic college or been recognized as reliable by the chiropractic community. The public’s safety might also be at risk based on the equipment or facilities utilized by a chiropractor for the treatment of a patient.

It is against the law for a chiropractor to fail to conduct a competent assessment, evaluation or diagnosis as a basis for treatment or consultation. Can you give me a practical example of this?

The examining board does not have a standard of practice upon which to base its decision. It relies on chiropractors from around the state that are chosen for their expertise in a specific area.

It is especially important for chiropractors with cash patients to remember that the payment mechanism is not material to the chiropractor’s responsibility to properly assess, evaluate, and diagnose the patient’s condition. The basis for discipline under this standard of conduct is likely to be a review of the chiropractor’s clinical documentation.

It is against the law for a chiropractor to aid, abet or permit an unlicensed person to practice chiropractic. Can you give me a practical example of this?

A chiropractor may not:

• allow a student waiting for their chiropractic exam results to examine or treat a patient.

• allow a chiropractic assistant to perform services for which she or he has not been properly trained (see delegation rules).

• allow a chiropractic assistant to perform services that are not allowed to be delegated to a chiropractic assistant (see delegation rules).

This includes:

• examining a patient (except for preliminary components allowed under the delegation rules).
• assessing the condition of a patient.
• diagnosing the patient’s condition.
• recommending or preparing the patient’s treatment plan

• treating the patient except for those services specifically authorized by the delegation rules. • independent preparation of the patient’s clinical documentation (note: there is nothing wrong with a CA acting as a note taker for the doctor).

It is against the law for a chiropractor to engage in sexual contact, exposure, gratification, or other sexual behavior with or in the presence of a patient. Can you give me a practical example of this?

Chiropractors, as part of the manner in which they practice, touch patients more frequently and more intimately than many other health care providers. Because many patients are experiencing chiropractic for the first time, they may not be aware of the adjusting techniques used by chiropractors. Chiropractors should consider having a CA in the treatment room if a patient is hesitant about the exam or adjusting process.

There is significant risk for violating this standard of conduct for chiropractors that:

• engage in “off color” joke telling.
• make personal comments about the patient’s appearance or attractiveness.
• touch a patient in any unprofessional manner.
• request that a patient remove clothing when it is not necessary for their evaluation or treatment.
• solicit personal information from the patient that is not necessary to evaluate their past health or their current condition.

It is against the law for a chiropractor to impersonate another chiropractor. Can you give me a practical example of this?

Chiropractors are required to report their work under their own identifying numbers. If a doctor has filed the proper corporation documents, they may bill for services utilizing the identification number of their service corporation. A chiropractor may never prepare clinical documentation under another doctor’s name. When a chiropractor provides vacation or illness relief, he/she must produce clinical documentation under their own name.

It is against the law for a chiropractor to refusing to render services to a person because of race, color, sex or religion. Can you give me a practical example of this?

All of the following would violate this particular law.

• There are separate state statutes that prohibit discrimination against patients with AIDS.
• While a chiropractor may prefer to see male or female patients, they may not discourage patients or restrict their practice to a single gender.
• Staff members should be advised never to ask an individual wishing to schedule an appointment for their race, color, sex or religion.

It is against the law for a chiropractor to obtain or attempt to obtain any compensation for chiropractic services by fraud. Can you give me a practical example of this?

All of the following would violate this particular law.

• Chiropractors must collect the deductibles and co-payments required by a patient’s insurance company. The use of “no out-of-pocket expense” payment arrangements may constitute insurance fraud and may violate this standard of conduct as well as s. 943.395, Stats.

• Patients who pay out of pocket for their services may request a billing that can be submitted to their insurance company for reimbursement. The amount shown on the bill must equal the amount actually paid by the patient. An amount shown on the bill greater than the amount paid by the patient would constitute insurance fraud.

• A patient may not be billed for services they did not receive. This includes:

o billing for evaluation management services at a level higher than actually performed.
o billing for CMT services at a level higher than actually performed.
o billing for physical therapy services in units higher than were actually performed or for services that were not performed.
o billing an inaccurate CPT code in order to receive greater reimbursement than is actually due.

It is against the law for a chiropractor to fail to release patient health care records to a patient in accordance with s. 146.83, Stats. Can you give me a practical example of this?

• A patient is entitled to a copy of their records whenever they request them. It would be a violation of this law to withhold a patient’s records because they refused to pay their bill or had an unpaid balance.

• It would be a violation of this standard of conduct to withhold a patient’s records when requested by another health care provider.

Original records or x-rays should never be given to a patient or other health care provider. Not only does the chiropractor expose themselves to malpractice risks if the records are not returned, the chiropractor violates the standard requiring records to be kept on each patient for 7 years.

The HIPAA laws put limits on the amounts that may be charged for patient records. A chiropractor should have no problems if they follow the amounts allowed by the state for copying records requested by a worker’s compensation carrier or an attorney.

It is against the law for a chiropractor to negate the co-payment or deductible provisions of a contract of insurance by agreeing to forgive any or all of the patient’s obligation for payment under the contract unless the chiropractor reduces the chiropractor’s claim to the insurance carrier in regard to that patient by an equal proportion. In this section, “co-payment or deductible provisions” means any terms in a contract of insurance with a third party whereby the patient remains financially obligated to the chiropractor for payment. Can you give me a practical example of this?

Under this standard of conduct a chiropractor may not waive the patient’s co-payment or deductible even if the chiropractor is trying to remain competitive with a managed care company. It is no violation of this rule for a chiropractor to adjust fees, but the fee charged must be accurately reported to any third party payor. It is also not a violation for a chiropractor to provide treatment without charge.

A chiropractor is not responsible if he or she bills for the patient’s co-payment or deductible and the patient cannot pay for reasons of financial hardship and the hardship is documented in the doctor’s records. If no documentation exists, the reasonableness of the chiropractor’s position might be the number of times co-pays or deductibles were waived compared to the number of patient’s seen by the doctor and the type of attempts made attempts to collect the amount due.

It is against the law for a chiropractor to advertise in a manner which is false, deceptive or misleading. An advertisement which does any of the following is false, deceptive or misleading:

(a) Contains a misrepresentation of fact.

(b) Is likely to mislead or deceive because of a failure to disclose material facts.

(c) Is intended to or is likely to create false or uninjured expectations of favorable results.

(d) Fails to prominently disclose complete details of all variables and material factors relating to any advertised fee.

(e) Contains any representations or implication that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived.

(f) Includes reference to or implies specialization or advanced training unless all of the following are true:

1. The specialty is recognized by a council of the American Chiropractic Association or the International Chiropractors Association.

2. The specialty requires at least 300 hours of postgraduate credit hours and passage of a written examination approved by the American Chiropractic Association or the International Chiropractors Association.

3. The title applied to the specialty by the chiropractor is the title applied by the American Chiropractic Association or the International Chiropractors Association.

(g) Includes reference to or implies advanced training unless all of the following are true:

1. The postgraduate training was received in one, unified program approved by the American Chiropractic Association or the International Chiropractors Association, or through one, unified program at a college accredited by the Council on Chiropractic Education and approved by the board.

2. The chiropractor has completed at least 100 hours of postgraduate training in the area in which the chiropractor claims advanced training.

3. The postgraduate training program includes successful completion of a written examination as a requirement for successful completion of the training program.

(h) Appears in any classified directory, listing or other compendium under a heading, which when considered together with the advertisement, has the capacity or tendency to be deceptive or misleading with regard to the profession or professional status of the chiropractor.

(i) Implies that the chiropractic services provided will result in emotional or spiritual benefits.

Can you provide some practical guidance?

Advertising is a very difficult area for the examining board to enforce because antitrust laws and the first amendment protect some types of advertising that the advertising standards of conduct appear to ban. If a chiropractor wants to use an aggressive approach to advertising, they would be well advised to send an advance copy of the advertising to the examining board’s legal counsel for review. If the board finds the advertising objectionable, the doctor should consider having his or her legal counsel discuss the matter with the board prior to running the ad.

If a chiropractor chooses to advertise that a patient may receive a group of services for a fixed price, it is very important that they list every service that will be received by the patient. For example, if a chiropractor advertises “free” services he or she must list each service that the patient will receive for “free”. Advertising may never be used to guarantee or imply that a patient will favorably respond to a doctor’s care.

A chiropractor may not use their advertising to imply that they have advanced training or education in any subject unless they have successfully completed at least 100 hours of postgraduate education in a specialty recognized by a council of the ACA or ICA. For example, a chiropractor that obtains a 48-hour CCSP certificate may not advertise their CCSP credential. A doctor successfully completing the test for the 100 hour CCSP program is allowed to advertise their credential.

HCFA places limits on ads directed to Medicare patients. For a current list of restrictions please contact the Medicare carrier.

When advertising is grouped according to specialty or subject such as the yellow pages, classified directories, or the Internet, a chiropractor may only advertise their services under classifications that directly relate to the chiropractic profession. For example, it would be a violation of this standard of conduct for a chiropractor to advertise their services under a “physical therapy” or “medical” classification.

While the care of a chiropractor may result in an improvement in a patient’s emotional or spiritual well being, a chiropractor may never, under any circumstances, advertise this as a benefit of chiropractic care. If a chiropractor chooses to use patient testimonials in their advertising, they should have a signed and notarized statement from the patient attesting that their statement was made voluntarily and giving the doctor permission to use the testimonial in their advertising.

These advertising rules apply to all forms of advertising including marketing done through office brochures, seminars and videos.

It is against the law for a chiropractor to knowingly provide false information to the board or its representative. Can you give me some practical advice?

The board has the authority and sufficient resources to fully investigate a complaint. It is better for a chiropractor to hire an attorney to represent them before the board than to provide false information to the board.

It is against the law for a chiropractor to fail to notify the board of having a chiropractic license, certificate, permit or registration granted by any other jurisdiction subject to disciplinary action. Can you give me some practical advice?

The Wisconsin Department of Regulation & Licensing now belongs to a nationwide system that links licensing boards from around the country. While it takes time for the systems to be updated and for the department to audit data from other states, it is only a matter of time before the department finds out about disciplinary action that occurred in another state.

It is against the law for a chiropractor to fail to notify the board of any criminal conviction, the circumstances of which relate substantially to the practice of chiropractic. Can you give me some practical advice?

Once again, since the board is likely to find out about a criminal conviction from another source, a chiropractor only compounds their situation by withholding this information from the board. Since an individual is innocent until proven guilty, there is no requirement to report to the board until a conviction has occurred.

It is against the law for a chiropractor to be convicted of a crime substantially related to the practice of chiropractic. What does this mean?

In the ever evolving field of health care, there are a plethora of laws dealing with chiropractic that are not listed in the statutes or rules governing the chiropractic profession. This standard of conduct covers the examining board in the event that they want to take action against a chiropractor that has been convicted of a crime not currently listed.

It is against the law for a chiropractor to violate a law, or aid or abet the violation of any law substantially related to the practice of chiropractic. What does this mean?

This is substantially the same as the previous question except that the examining board may decide that a chiropractor may be disciplined if they knowingly helped someone violate the law even if they were not convicted. An example might be a chiropractor that knows his or her associate makes up a diagnosis for a patient without actually examining the patient but takes no action to stop the practice.

If a chiropractor violates a law does it mean they will automatically lose his/her license?

A violation of these rules does not mean that a chiropractor will automatically lose their license to practice. If a complaint is brought against a chiropractor, the Department of Regulation and Licensing will institute an investigation. At the conclusion of the investigation, the department’s personnel will determine if they have sufficient evidence to warrant disciplinary action against the chiropractor. If they believe the actions of the chiropractor warrant disciplinary action, the chiropractor will have a full and complete opportunity to defend themselves. Even if discipline is warranted, the state has a full range of penalties available that do not include the suspension or revocation of a license to practice. Licenses are suspended or revoked only where the conduct has been particularly egregious.

May a chiropractor share ownership of their practice with other health care providers?

Prior to 1995 chiropractors were not permitted to co-own their businesses with any other health care providers. With the amendment of the service corporation bill in 1995 chiropractors have the option of sharing ownership with any of the following health care providers:

• Chiropractors
• Nurses
• Medical doctors
• Physical therapists
• Podiatrists
• Dieticians
• Athletic trainers
• Optometrists
• Pharmacists
• Psychologists
• Social workers
• Marriage and family therapists
• Audiologists
• Speech pathologists

There is no restriction on the number of professionals that may own a service corporation. In a large clinic setting there could theoretically be several dozen owners representing each of the professions listed above. Owning a service corporation does not relieve a chiropractor of his or her obligation to carry malpractice insurance.

An individual that is not licensed in one of the professions listed above may not have any part in the ownership or control of the service corporation. If any of the owners or the service corporation loses their license, for any reason, they must immediately sever their employment and their financial interest in the service corporation. A service corporation that fails to comply with this provision faces suspension or forfeiture of its practice.

May a chiropractor sign a child’s sports physical certificate?

A chiropractor is fully qualified to perform a sports physical and allowed to do so under their scope of practice. However, sporting organizations (most notably the WIAA) are free to set their own requirements regarding who must perform a child’s physical. There are organizations that have a rule requiring that the physical must be performed by a medical doctor. While the parent is free to ask if a physical by a chiropractor is acceptable, the organization may insist on the M.D. exam.

May a chiropractor sign a cross bow hunting permit?

Yes. Chiropractors are allowed to perform the exam necessary for an individual to obtain a crossbow permit. An individual is allowed to receive a crossbow permit if they are not able to use a bow and arrow and they meet any of the following:

• They have an amputation or other loss of one or more arms above the wrist.
• They have an amputation or other loss of the index or middle finger on the draw and release hand.
• They have a permanent substantial loss of function in one or both arms or one or both hands and fail to meet the minimum testing standards for one of the following tests:

- Upper extremity pinch
- Grip
- Nine-hole peg

• They have a permanent substantial loss of function in one or both shoulders and fail to meet the minimum standards of the standard shoulder strength tests.

Can a parent refuse to have their child immunized?

Yes. The Department of Health and Family Services is required to shall carry out a statewide immunization program to eliminate mumps, measles, rubella (German measles), diphtheria, pertussis (whooping cough), poliomyelitis and other diseases that the department specifies by rule. They must also have a program to protect against tetanus.

Any student admitted to any elementary, middle, junior or senior high school or into any day care center or nursery school must, within 30 school days, present written evidence to the school, day care center or nursery school of having completed the first immunization for each vaccine required for the student’s grade and being on schedule for the remainder of the basic and recall (booster) immunization series for mumps, measles, rubella (German measles), diphtheria, pertussis (whooping cough), poliomyelitis, tetanus and other diseases that the department has specified unless they have signed a written waiver.

The immunization requirement is waived if the student’s parent, guardian or legal custodian submits a written statement to the school, day care center or nursery school objecting to the immunization for reasons of health, religion or personal conviction.

Any time the school, day care center or nursery school notifies a student of the immunization requirements, it is required to let them know they have a right to sign a waiver.

It is against the law for a chiropractor to reveal confidential patient information without consent of a patient, except that information shall be revealed to the board or its representatives pursuant to investigation of a licensee or as otherwise by law. Can you give me a practical example of this?

The confidentiality of a patient is frequently violated because of the propensity of chiropractors and their staffs to discuss the names of current and past patients. While a patient is always allowed to discuss any aspect of their care, including the name of their treating chiropractor, a chiropractor or their staff is never allowed to reveal the name of a patient without the patient’s permission.

The federal HIPAA privacy laws are much more extensive than this particular rule. Please see the index for the questions dealing with privacy.

Can chiropractors in Wisconsin utilize homeopathic remedies in their practice?

No, homeopathy is not part of the scope of practice in Wisconsin. If a chiropractor were to provide homeopathic remedies to help diagnose a condition, treat or cure a condition, mitigate a condition, or prevent a condition, the homeopathic remedy would be considered a drug according to Wisconsin statute. Wisconsin law prohibits a chiropractor from prescribing drugs.

A chiropractor is also forbidden from prescribing homeopathic remedies for a specific physiologic purpose because state statue further defines a drug to be any substance intended to affect the structure or any function of the body of a person.

 

Why does it take so long to resolve complaints issued by the Department of Regulation & Licensing?

For a doctor who feels that a complaint filed against them is completely unjustified, it can be very frustrating as the state grinds through the review process. There are several factors that contribute to the long resolution process.

It is against the law for a chiropractor to fail to maintain patient records for a minimum period of 7 years after the last treatment or after the patient reaches the age of majority, whichever is greater. Can you give me a practical example of this?

This standard of conduct refers to the clinical records of a patient including the patient’s x-rays, the results of any diagnostic tests and records obtained from other health care providers. All must be kept for seven years from the date of the last patient office visit.

The records of children must be kept for 7 years or until the child reaches the age of 18. For example, you would need to keep the clinical records of a child who received their last chiropractic treatment at the age of 7 until the child reached the age of 18. You would need to keep the records of a minor who received their last chiropractic treatment at the age of 17 for 7 years.

This standard applies only to the clinical documentation of a chiropractor. Insurance, EOB’s, and administrative information may be destroyed as soon as it is no longer useful to you. Remember to save the information required by the Internal Revenue Service for your tax returns.

- Shortage of staff. The Department of Regulation & Licensing does not assign staff to a particular board. Investigatory staff must be shared among all of the department’s boards.

- Prioritization. The state assigns priority to cases based on the impact on public health and safety. Since there is a perpetual shortage of personnel, the “minor cases” suffer increased delay.

- Attorney delay. The doctor’s own attorney, may contribute to the delay by not responding promptly to requests for information from the department. While the first two factors are not easily affected, a doctor with a pending complaint can mitigate delays by being proactive with the department’s investigations.

I am enrolled in a diplomate program where I receive about 120 hours of continuing education a year. Can I transfer some of these CE hours so I don’t have to take continuing education for a couple of years after the diplomate program is over?

No. The requirement for 40 hours of continuing education is non-transferable which means that if you take more than 40 hours you may not apply them to another license period.

If I am required by the Chiropractic Examining Board to take additional courses as part of a disciplinary action, may I count those hours as part of my CE requirement?

No. Continuing education hours required as a consequence of a disciplinary preceding, informal settlement conference, or resolution of an investigation into your conduct or competence may not be counted towards the fulfillment of this CE requirement.

It is time to renew my license and I do not have the 40 hours of required continuing education. How will the state know that I have not taken my hours?

At the time of your license renewal, you must sign verifying that you have 40 hours of continuing education. If you do not have 40 hours, you will not meet the requirements for license renewal. The state may conduct random audits of doctors and checks for compliance as part of their disciplinary process.

If you fail to obtain 40 hours of approved education during a licensing period, the CE hours you obtain for the following period will be applied to the previous licensing period only. Since you were short in the previous period, they will not apply to the current licensing period. In other words, you are never allowed to “double count” your hours.

It is against the law for a chiropractor to perform professional services that are inconsistent with their training, education, or experience. Can you give me a practical example of this?

Here are two examples that would violate this particular law. Please keep in mind these are only a few examples of this type of conduct. When in doubt, you should contact the WCA or the Chiropractic Examining Board.

• The state requires chiropractors who wish to manipulate a patient while under anesthesia to have successfully completed a specialized training course before practicing this procedure.

• The state requires chiropractors that use physiological therapeutics as part of their practices to have successfully completed a 48 hour specialized course on these modalities.

How do I prove that I attended 40 hours of continuing education?

You must keep your CE vouchers for a minimum of 4 years. The Chiropractic Examining Board may do a random audit at which time you will have to prove that you attended the required number of hours. For your convenience, the Wisconsin Chiropractic Association maintains files for all Wisconsin chiropractors of their CE hours. To participate, send or fax the WCA a copy of your CE vouchers. If you take a course sponsored by the WCA, you do not need to do anything; these hours will be recorded automatically. The WCA will mail you a periodic update of your hours and will provide the necessary vouchers to the state if you are audited.

What types of programs does the examining board approve for credit?

Generally, the WCA, ACA, ICA or a chiropractic/medical college must sponsor a program in order to be approved by the board. In order to be approved for credit a program’s subject matter must relate to improving the clinical skills of a chiropractor and the material must generally be taught at the undergraduate or postgraduate level of a chiropractic college. Home study programs are only approved for credit when the board determines there is extreme hardship. Programs that emphasize business, management, or the insurance aspects of a chiropractic practice are not eligible for credit.

It is against the law for a chiropractor to obtaining or attempt to obtain a license through fraud or misrepresentation. Can you give me a practical example of this?

Current license holders would be affected by this standard of conduct if they attempted to renew their license without having obtained the required number of continuing education hours by attending courses approved by the examining board.

How long does it take from the time a complaint is filed until it is resolved?

The state does not set a timetable for investigating complaints. Unfortunately, because of limited investigatory resources, it can take a very long time to fully resolve even minor complaints.

It is against the law for a chiropractor to practice or attempt to practice while the ability to perform is impaired by physical, mental or emotional disorder, drugs or alcohol. Can you give me a practical example of this?

If a chiropractor has consumed any amount of alcohol or drug, they should strongly consider refraining from any patient interaction until the alcohol or drug has left their system. This “zero tolerance” guideline is much stricter than is required by this rule; however, chiropractors want to avoid the devastating consequences to their reputation of practicing while impaired by alcohol or drugs.

If a chiropractor suffers from a serious illness or sustains an injury that impairs their ability to practice, they must arrange for their patients to see another chiropractor until they have sufficiently recovered and are able to resume their practice.

It is against the law for a chiropractor to knowingly falsifying patient records. Can you give me a practical example of this?

All information entered into a patient’s record must be, to the best of the chiropractor’s knowledge, factually based. A chiropractor may never knowingly enter information into a patient’s clinical record that is not factually based to obtain insurance reimbursement or to justify his or her evaluation, assessment, diagnosis or treatment of the patient.

Chiropractors must accurately record all of the services provided to the patient regardless if the patient or a third party paid for the services. This includes using CPT codes exactly as they are described. A chiropractor may not select a CPT code that “closely fits” the service they have provided to a patient. The description of the CPT code must match in all elements of the doctor must use a miscellaneous CPT code.

It is not a violation of the law to update the patient’s file with more accurate information regardless of when the information is entered. For example, if clinical or diagnostic information was overlooked or misplaced, it should be entered into the patient’s record whenever it is discovered, even if records have already been sent to an insurance company.

It is against the law for a chiropractor to practice in a manner which substantially departs from the standard of care ordinarily exercised by a chiropractor. Can you give me a practical example of this?

This particular standard of conduct can be troublesome because of the lack of defined standards of care for the chiropractic profession.

The examining board could use this standard of conduct to discipline a chiropractor whose style of practice significantly deviates from the norm. Areas of concern might involve:

- The standard attire of doctors or patients during treatment.
- The setting utilized by a chiropractor for treatment.
- X-ray, examination, or treatment protocols used by a doctor.
- Communication practices utilized by a doctor or a member of the doctor’s staff.

It is against the law for a chiropractor to fail to exercise a reasonable degree of supervision over subordinate employees. Can you give me a practical example of this?

All of the following would violate this particular law.

• The chiropractor must always be on the premises when work is delegated to a staff person. For example, a staff person may not take x-rays or do any form of physical therapy on a patient when the doctor is at lunch or out of the office for any reason.
• Regardless of how busy the practice, a chiropractor is always responsible for the actions of a staff member.
• Staff members are not allowed to perform any clinical service unless it is allowed under the delegation rules.
• Even though staff members have received the required x-ray or PT training, a chiropractor is still responsible for all of their work.

May I count any continuing education program as part of my 40 hour CE requirement?

Only programs approved by the Chiropractic Examining Board count towards your 40 hour CE requirement. Never assume a CE program has been approved for credit by the examining board just because the program brochure has the words “credit applied for”. Each course needs to be approved individually, every time it is offered. Don’t assume that because the exact same course was approved for credit the previous biennium, that it will automatically be approved again. Call the examining board to insure that the program has been approved. Please note the WCA does not approve the continuing education courses, the Chiropractic Examining Board does.

No matter how good the program, the chiropractic examining board does not approve programs for credit after they have been held. Credit for each course must be applied for 75 days in advance of the first day of the program.

It is against the law for a chiropractor to engage in excessive evaluation or treatment of a patient. Can you give me a practical example of this?

A complaint of this type will come from patients who feel that their care went on well past the point of improvement in their condition or from insurance companies that are dissatisfied with the quality of clinical documentation.

Since published practice guidelines focus on treatment for non-complicated cases, it is extremely important that chiropractors document the severity of the condition(s) they are treating. This documentation can substantiate the need for more frequent exams or extended treatment for the patient with multiple or severe problems.