Q:
May a chiropractor use a cold laser as a treatment modality?
A: Chiropractors
may use cold lasers to treat patients but only if those uses have been
approved by the federal Food and Drug Administration.
Q:
Is it permissible for a chiropractic assistant to perform either exercises
or massage with a patient?
A: Section
446.02(7) of the Wisconsin Statutes provides that a chiropractor may
delegate the performance of adjunctive services to a non-licensed person,
provided that: 1) the services are performed under the direct,
on-premises supervision of the chiropractor; and that 2) the person
has adequate education, training, and experience to safely perform those
services. "Adjunctive services" means services which
are preparatory or complimentary to chiropractic adjustments of the
spine or skeletal articulations, or both. It does not include
making a chiropractic diagnosis or performing a chiropractic adjustment.
Under s. Chir
10.02 of the Wisconsin Administrative Code, a chiropractor may delegate
the performance of adjunctive services to an unlicensed person only
if all of the following conditions are met:
(1)
The chiropractor maintains records by which the chiropractor has verified
that the unlicensed person has successfully completed a didactic and
clinical training program approved by the board and covering the performance
of the delegated service. Successful completion of a training
program is demonstrated by attaining proficiency in the delivery of
that service to minimally competent chiropractic practice standards
as measured by objective knowledge and skills testing.
(2)
The chiropractor exercises direct supervision of the unlicensed person
performing the delegated service.
In addition,
s. Chir 10.05 of the Wisconsin Administrative Code, provides that a
chiropractor may delegate the performance of patient services through
physiological therapeutics that include but are not limited to heat,
cold, light, air, water, sound, electricity, massage, and physical
exercise with and without assistive devices to an unlicensed person
only if the delegation is consistent with s. Chir 10.02 and the unlicensed
person has adequate training, education and experience to perform the
delegated function to minimally acceptable chiropractic standards.
(emphasis added).
Q:
Are chiropractors permitted to do extremity manipulation?
A: The
Wisconsin Chiropractic Examining Board considers extremity manipulation
to be within the scope of chiropractic because, under s. Chir 4.03 of
the Wisconsin Administrative Code, the practice of chiroprctic includes
the application of chiropractic science in the adjustment of the spinal
column, skeletal articulations and adjacent tissue, which also includes
the use of procedures and instruments preparatory and complementary
to treatment of the spinal column, skeletal articulations and adjacent
tissue. Accordingly, extremity manipulations may be done, either
as preparatory and complementary to the treatment of the spinal column,
or separately.
Q:
Can a Chiropractor perform “Manipulation under Anesthesia”?
A:
With Manipulation under anesthesia (MUA), a chiropractor performs a
chiropractic adjustment while the patient is sedated. The Board has
authorized the use of MUA by chiropractors with adequate training under
certain circumstances.
In
1997, the Board set forth the following protocol for MUA:
1.
A chiropractor should be appropriately trained by qualified
chiropractic and medical instructors in a MUA certification course with
a minimum of 15 supervised MUA treatments prior to receiving course
certification. This course must be approved by the Commission on Accreditation
of the Council on Chiropractic Education (CCE).
2.
MUA is an extraordinary treatment involving additional risks
to the patient inherent in anesthesia and additional costs associated
with hospital/surgical center and anesthesiologist fees. Therefore,
MUA should be recommended and administered only for patients with chronic
and severe conditions demonstrated to be unresponsive to non-MUA chiropractic
adjustment and management.
3.
Prior to administering MUA, a chiropractor shall first:
a.
Refer the patient to another independent chiropractor
for a course on non-MUA chiropractic adjustment clinically appropriate
to the patient's condition for which MUA is recommended.
b.
Fully inform the patient about the risks of the procedure,
alternative modes of treatment, and obtain specific written informed
consent of the patient for the MUA procedure.
The
Chiropractic Examining Board revisited the issue and clarified its position
in February 2003 as follows:
4.
The anesthesia utilized in conjunction with MUA must be
administered by either an anesthesiologist who is a licensed physician
with a credential to practice medicine and utilize drugs, or a Certified
Registered Nurse Anesthetist under the direct supervision in a hospital
setting of a licensed physician with a credential to practice medicine
and utilize drugs.
Manipulation
under anesthesia does not constitute chiropractic treatment utilizing
drugs and does not fall within the proscription against the prescribing,
dispensing, delivery or administration of drugs.
