6123336 Health, Department of - Notice of Proposed Rulemaking - Rule Amendments for D.C. Board of Chiropractic
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DEPARTMENT OF HEALTH
NOTICE OF PROPOSED RULEMAKING
The Director of the Department of Health (“Department”), pursuant to § 302(14) of the District of Columbia Health Occupations Revision Act of 1985 (“Health Occupations Revision Act”), effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1203.02(14) (2012 Repl.)), and Mayor’s Order 98-140, dated August 20, 1998, hereby gives notice of the intent to take final rulemaking action to adopt the following amendments to Chapter 48 (Chiropractic) of Title 17 (Business, Occupations, and Professionals) of the District of Columbia Municipal Regulations (DCMR), in not less than thirty (30) days from the date of publication of this notice in the D.C. Register.
The purpose of the rulemaking is to set forth rule amendments regarding educational requirements, licensure requirements, examination, continuing education requirements, standards of conduct, and scope of practice, to bring the D.C. Board of Chiropractic up to date with current standards and best practices in the regulation of the chiropractic profession. Consistent with the aim of the Health Occupations Revision Act, this rulemaking will enhance professionalism within the community and operate in support of the health and welfare of the public.
Chapter 48, CHIROPRACTIC, of Title 17 DCMR, BUSINESS, OCCUPATIONS, AND PROFESSIONALS, is amended as follows:
Section 4805, DISTRICT EXAMINATION, is amended as follows:
Subsection 4805.4 is amended to read as follows:
4805.4 The District examination may include questions on the following:
(a) The District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq. (2007 Repl.));
(b) Title 17, Chapter 48 of the District of Columbia Municipal Regulations;
(c) Title 17, Chapters 40 and 41 of the District of Columbia Municipal Regulations;
(d) Scope of practice; and
(e) Ethics and boundaries.
Subsection 4805.6 is amended to read as follows:
4805.6 A passing score on the District Examination shall be seventy-five percent (75%). After failing to obtain a score of at least seventy-five percent (75%) on two (2) successive District examinations, the applicant shall appear before the Board before being permitted to retake the examination a third time. In the event of a third failure, the applicant shall not be permitted to sit for a fourth attempt for a period of one (1) year. An applicant practicing under the supervision of a licensed chiropractor while waiting to sit for the District Examination, who twice fails the examination, shall have the pending application status suspended for a period of ninety (90) days.
Subsection 4805.7 is amended to read as follows:
4805.7 Pursuant to the Act, an applicant approved for an initial license to sit for the next scheduled examination may request the Board's permission to practice under the direct supervision of a District licensed chiropractor for a period not to exceed six (6) months.
Section 4806, CONTINUING EDUCATION REQUIREMENTS, is amended as follows:
Subsection 4806.4 is amended to read as follows:
4806.4 An applicant for renewal of a license expiring on December 31, 2018 and all subsequent licensure terms shall submit proof upon request of the Board pursuant to § 4806.7 of having completed thirty (30) hours of approved continuing education credit during the two (2) year period preceding the date the license expires that include three (3) hours in communicable disease (including HIV-AIDS), two (2) hours in cultural competence and appropriate clinical treatment specifically for individuals who are lesbian, gay, bisexual, transgender, gender nonconforming, queer, or questioning their sexual orientation or gender identity and expression, and five (5) hours in any combination of ethics, risk management, documentation and record keeping, or cultural competency.
Subsection 4806.5 is amended to read as follows:
4806.5 A person in inactive status, within the meaning of § 511 of the Act, may qualify for a license by submitting an application to reactivate a license and submitting proof, pursuant to § 4806.7, of having completed fifteen (15) hours of approved continuing education credit for each license year after December 31, 1990, that the applicant was in inactive status.
Subsection 4806.6 is amended to read as follows:
4806.6 To qualify for a license, an applicant for reinstatement of a license shall submit proof, pursuant to § 4806.7, of having completed fifteen (15) hours of approved continuing education credit for each year that the license was expired.
Section 4807, APPROVED CONTINUING EDUCATION PROGRAMS AND ACTIVITIES, is amended as follows:
Subsection 4807.1 is amended to read as follows:
4807.1 The Board shall accept for credit continuing education programs provided or sponsored by the following:
(a) A chiropractic college accredited by the Council on Chiropractic
Education;
(b) The America Chiropractic Association;
(c) The International Chiropractors Association;
(d) The Federation of Chiropractic Licensing Boards Providers of Approved
Continuing Education (PACE) Program; or
(e) Approved by the District of Columbia Board of Chiropractic.
Section 4809, STANDARDS OF CONDUCT, is amended by adding a Subsection 4809.16 to read as follows:
4809.16 A licensee shall not make any false, misleading, or deceptive communication in any form of advertising nor shall the licensee utilize any form of advertising that has the capacity or tendency to deceive, mislead, or confuse the recipient in any manner including the following:
(a) Advertising that contains a misrepresentation of any fact including advertising that has the capacity or tendency to mislead, deceive, or confuse any potential recipient, either through false or misleading claims, or by failing to disclose relevant or material facts;
(b) Advertising that conveys the impression of professional superiority or other superior attributes that cannot be substantiated. A licensee shall not advertise that he or she has a certification or has attained diplomate status without having been conferred the title of diplomate or having received a certification;
(c) Advertising that has the capacity or tendency to create false or unjustified expectations of beneficial treatment or successful cures;
(d) Advertising that contains any guarantee of the results of any service;
(e) Advertising a service that the licensee is not licensed to perform in the District of Columbia;
(f) Advertising under a heading that may foster confusion about the professional status of the chiropractor or under a professional heading in which the chiropractor is not licensed; or
(g) Advertising a transaction that is in itself illegal.
Section 4811, SCOPE OF PRACTICE, is amended as follows:
Subsection 4811.1 is amended to read as follows:
4811.1 A chiropractor who is licensed to practice in the District of Columbia under the provisions of this chapter may provide the following chiropractic services:
(a) Locating, diagnosing, and analyzing subluxated vertebrae as follows:
(1) By x-ray of the spinal column;
(2) By physical examination; and
(3) By employing other non-invasive procedures such as MRI and CAT scan;
(b) Correcting vertebral subluxation displacement by applying specific localized force to the spine;
(c) Advising and instructing a patient about exercise, stress management, and nutrition;
(d) Referring a patient for specialized diagnostic testing, which may be necessary for chiropractic treatment or patient safety;
(e) Referring a patient to other healthcare practitioners as the chiropractor deems necessary; and
(f) Diagnosing and treating bodily articulations by means of manipulation or adjustments.
Subsection 4811.2 is amended to read as follows:
4811.2 A chiropractor who is certified by the Board to perform ancillary procedures pursuant to § 4803.3 may perform any physiotherapy for which the chiropractor has received specialized training at a program or institution listed in § 4807.1 provided the physiotherapy is preparatory or complementary to chiropractic care.
Section 4811 is amended to have these subsections added as follows:
4811.3 A chiropractor not licensed to practice in the District of Columbia but who is licensed and in good standing in any other state, territory, or jurisdiction of the United States or any other nation or foreign jurisdiction may engage in the practice of chiropractic if he or she is employed or designated in his or her professional capacity by a sports or performing arts entity visiting the District of Columbia for a specific sports or performing arts event subject to the following restrictions and rules:
(a) The practice of chiropractic subject to this rule shall be limited to members, coaches, or official staff of the team or event for which that chiropractor is designated. If services are requested by a specific athlete or performer, the practice of chiropractic shall be limited to services performed for that individual only;
(b) The practice of chiropractic as authorized by this rule shall be limited to the designated venue of the event or designated treatment area for the event. The Board, in its discretion, may audit, review, or inspect the venue and chiropractic services rendered;
(c) A chiropractor practicing under the authority of this section may use only those practices and procedures that are within the scope of chiropractic practice in the District of Columbia as authorized by statute and the rules governing chiropractic practice in the District of Columbia; and
(d) Unless otherwise determined by the Board, the visiting chiropractor shall request and receive written permission from the Board at least sixty (60) days before the start of practice in the District, and the visiting chiropractor may practice chiropractic in the District no more than fourteen (14) days during any calendar year.
4811.4 A student enrolled at an approved chiropractic college may perform chiropractic procedures provided the student has successfully completed at least one (1) academic year of schooling and the chiropractic procedures are performed under the supervision and direction of an authorized instructor duly licensed to practice chiropractic in the District of Columbia.
4811.5 A student enrolled at an approved chiropractic college may perform chiropractic procedures at a location other than the premises of the chiropractic college at which the student is enrolled, provided the student has successfully completed a minimum of three (3) academic years of chiropractic college and has met all of the chiropractic college's requirements concerning its student/preceptor program. The chiropractic procedures performed by the student shall be performed under the supervision and direction of a Chiropractic Preceptor. A duly authorized instructor or Chiropractic Preceptor shall be within the immediate patient treatment area, the clinic proper, and available to the student at all times.
4811.6 A student performing chiropractic procedures at a location other than the premises of the chiropractic college at which the student is enrolled and under the supervision and direction of a Chiropractic Preceptor shall be known as a "Chiropractic Intern" and shall not represent him or her self to the public as a licensed Chiropractor or use terms such as "Chiropractor", "Doctor of Chiropractic" or "D.C."
4811.7 The Chiropractic Preceptor shall be approved by the Board before supervising a chiropractic student. To qualify as a Chiropractic Preceptor, the chiropractor shall:
(a) Be licensed to practice chiropractic in the District of Columbia for not less than five (5) years;
(b) Not have had any public or private sanction against his or her license to practice chiropractic in the District of Columbia or any other state;
(c) Disclose if he or she has been convicted or found guilty of a violation of any law other than a minor traffic violation within seven years prior to his or her application to serve as a preceptor; and
(d) Have the written approval of the chiropractic student's chiropractic college to serve as an adjunct faculty member for the purpose of a student/preceptor program.
4811.8 Any chiropractic procedure performed by a chiropractic student shall be in compliance with all laws, rules, and regulations regarding the practice of chiropractic in the District of Columbia.
4811.9 The primary responsibility for the programming and treatment of the patient by the chiropractic student shall rest with the Chiropractic Preceptor or other authorized instructor.
4811.10 Documentation of all programming and treatment of the patient and all changes to the programming and treatment plans shall be reviewed and approved by the authorized instructor or Chiropractic Preceptor.
4811.11 The chiropractic college shall notify the Board of the specific dates that a Chiropractic Intern shall be serving as a Chiropractic Intern under the supervision and direction of a Chiropractic Preceptor.
4811.12 The Board's approval for any chiropractor serving as a Chiropractic Preceptor shall expire December 31st of each even-numbered year. The chiropractic college shall submit to the Board for reapproval the required documentation concerning each Chiropractic Preceptor during the last quarter of the even-numbered year.
Section 4899, DEFINITIONS, is amended to read as follows:
4899.1 For purposes of this chapter, the following terms shall have the meanings ascribed:
Act—The District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq. (2007 Repl.)).
Ancillary—any physiotherapy procedure used on a patient prior to, and complimentary to, receiving a chiropractic treatment.
Applicant—A person applying for a license to practice chiropractic or certification to practice ancillary procedures under this chapter.
Board—The D.C. Board of Chiropractic, established by § 216 of the Health Occupations Revision Act, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1202.16 (2007 Repl.)).
CAT scan—A diagnostic, medical, radiological scan in which cross-sectional images of a part of the body are formed through computerized axial tomography and shown on a computer screen.
Chiropractic Preceptor—Any person licensed as a doctor of chiropractic in the District of Columbia who is approved by the Board to supervise chiropractic students in the performance of chiropractic at a location other than the premises of the chiropractic college in which the student is enrolled.
Chiropractor—A person licensed to practice chiropractic under the Health Occupations Revision Act, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1205.01 et seq. (2007 Repl.)).
MRI—An imaging technique that uses electromagnetic radiation to obtain images of the body's soft tissues by subjecting the body to a powerful magnetic field, allowing tiny signals from atomic nuclei to be detected and then processed and converted into images by a computer.
NBCE—The National Board of Chiropractic Examiners.
Physiotherapy—Any external modality that the chiropractor uses on a patient before receiving a chiropractic adjustment or manipulation, that creates a physiological change in the human tissue condition, and that contributes to the overall improvement of the condition for which the patient is being treated.
Spinal adjustment or manipulation—A specific thrust applied to a subluxated vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct that particular articular malposition, and thus influencing neural integrity in that area.
Subluxation—A complex of functional or structural changes that occur in the spinal column that compromises neural integrity and thus may influence organ system function and general health.
Supervision—Having a licensed District of Columbia chiropractor in the same office on a continuous basis while the assistant is on duty. The supervising chiropractor should be immediately available for delegated acts that the chiropractic assistant performs. Telecommunication is insufficient for supervision purposes or as a means for directing delegated acts.
All persons desiring to comment on the subject matter of this proposed rulemaking action shall submit written comments, not later than thirty (30) days after the date of publication of this notice in the D.C. Register, to Phillip Husband, General Counsel, Department of Health, Office of the General Counsel, 899 North Capitol Street, N.E., 5th Floor, Washington, D.C. 20002. Copies of the proposed rules may be obtained between the hours of 8:00 a.m. and 4:00 p.m. at the address listed above, or by contacting Angli Black, Administrative Assistant, at Angli.Black@dc.gov, (202) 442-5977.
