2/1/13. Dr Benjamin S Lurie 3430 N Buffalo Dr #110 Las Vegas, NV Assemblyman Randy Kirner 401 S Carson Street Carson City, Nevada 89701

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1 2/1/13 Dr Benjamin S Lurie 3430 N Buffalo Dr #110 Las Vegas, NV Assemblyman Randy Kirner 401 S Carson Street Carson City, Nevada Re: Assembly Bill #73 Dear Assemblyman Kirner, As you may not be aware, the Chiropractic profession began in 1895 in Davenport, Iowa. The founder and developer of the learned profession are Dr. B.J. Palmer and Dr. D.D. Palmer. There are over 75,000 Chiropractic physicians in The United States currently practicing in a variety of Chiropractic fields and specialties. As many are not familiar, nor take time to understand our profession, I find having a better understanding of our profession will help you understand the language change and why the Chiropractic Physicians Board of Nevada is looking to change the current language. The profession of Chiropractic began not because of musculoskeletal pain, back pain or joint pain, it began from a chiropractic adjustments on a deaf man that regained his hearing shortly following that chiropractic adjustment. The profession began from a neurological condition that was corrected and restored to its proper function. Millions of consumers utilize Chiropractic Physicians for a variety of reason. These reasons can range from wellness care practioners, rehabilitation specialist, nutritionist, pediatrics/obstetrics, orthopedic conditions, radiology, sports rehab, neurologist and many more. Prior to entering a Chiropractic college, candidates must complete 4 years of undergraduate studies in the field of pre- medicine. Once accepted to a chiropractic college, students undergo over 4200 hours of Anatomy, Neurology, Bacteriology, Chiropractic theory and practice, Diagnosis and chiropractic analysis, Elementary chemistry and toxicology, Histology, Hygiene and sanitation, Obstetrics and gynecology, Pathology, Physiology, Radiology and Physiotherapy just to name a few. During the course of ones education, students are required to take and pass 4 separate national boards proficiency exams (NBCE), which are now required by all 50 States to practice in the field of Chiropractic. Chiropractic schools around the country follow the guidelines set forth by The Council of Chiropractic Education. The CCE is an autonomous, programmatic and institutional specialized accrediting agency. It is the only agency recognized

2 by the United States Department of Education to accredit Doctor of Chiropractic degree programs. The Council administers the process of accreditation, renders accreditation decisions, and establishes bylaws, policies, procedures, and accreditation requirements. The Council provides information and assistance to any institution seeking to establish an accredited DCP (Doctor of Chiropractic degree programs). The following is the mission statement of the CCE: CCE Vision and Mission Statements Vision Statement Promoting Excellence and Assuring Quality in Chiropractic Education Mission Statement The Council on Chiropractic Education is an autonomous accrediting body that serves the interests of the public, the profession and students by: Establishing and promoting standards of chiropractic educational quality and patient- centered healthcare. Ensuring the quality of chiropractic education programs by evaluating achievement of accepted standards. Encouraging improvement and the pursuit of excellence in chiropractic education. Advocating integrity in the governance, administration and delivery of chiropractic education programs. Advocating scholarly activity, research and service in chiropractic education. Informing the educational community and public of the nature, quality and integrity of chiropractic education. Serving as a unifying body for the chiropractic profession. The CCE also states, An accredited DCP (Doctor of Chiropractic degree programs) prepares its graduates to practice as primary care chiropractic physicians, and provides curricular and clinical evidence of such through outcome measures. CCE applies the understanding that in order to competently practice as a primary care chiropractic physician, DCP education trains its graduates to: D-2

3 Practice primary health care as a portal-of-entry provider for patients of all ages and genders focusing on the inherent ability of the body to heal and enhance function without unnecessary drugs or surgery. Assess and document a patient's health status, needs, concerns and conditions with special consideration of axial and appendicular structures, including subluxation/neuro-biomechanical dysfunction. Formulate the clinical diagnosis(es). Develop a goal-oriented case management plan that includes treatment, prognosis, risk, lifestyle counseling, and any necessary referrals for identified diagnoses and health problems. Follow best practices in the management of health concerns and coordinate care with other health care providers as necessary. Focus on neuromusculoskeletal integrity for the purpose of enhancing health and performance. Promote health, wellness and disease prevention by assessing health indicators and by providing general and public health information directed at improving quality of life. Serve as competent, caring, patient-centered and ethical healthcare professionals and maintain appropriate doctor/patient relationships. Understand and comply with laws and regulations governing the practice of chiropractic in the applicable jurisdiction. Upon graduating from a chiropractic college accredidated by the CCE, a student must have shown competency in the following areas as outlined by the CCE. They are as follows: CCE Clinical Education Meta-Competencies A graduate of a CCE accredited DCP is competent in the areas of: META-COMPETENCY 1 - ASSESSMENT & DIAGNOSIS An assessment and diagnosis requires developed clinical reasoning skills. Clinical reasoning consists of data gathering and interpretation, hypothesis generation and D-3

4 testing, and critical evaluation of diagnostic strategies. It is a dynamic process that occurs before, during, and after the collection of data through history, physical examination, imaging, and laboratory tests. REQUIRED COMPONENTS: A. Compiling a case-appropriate history that involves a process focused on patients health status, including a history of any present illness, systems review, and review of past, family and psychosocial histories for the purpose of directing clinical decision-making. B. Determining the need for and availability of external health records. C. Performing case-appropriate physical examinations that include evaluations of body regions and organ systems, including the spine and any subluxation/neurobiomechanical dysfunction, that assist the clinician in developing the clinical diagnosis(es). D. Utilizing diagnostic studies and consultations when appropriate, inclusive of imaging, clinical laboratory, and specialized testing procedures, to obtain objective clinical data. E. Formulating a diagnosis(es) supported by information gathered from the history, examination, and diagnostic studies. OUTCOMES: 1) Documentation of a list of differential diagnosis(es) and corresponding exams from a case-appropriate health history and review of external health records. 2) Determination and documentation of the significance of physical findings and thereby the need for follow-up through a physical examination, application of diagnostic and/or confirmatory tests and tools, and any consultations. 3) Generation of a problem list with diagnoses after synthesizing and correlating data from the history, physical exam, diagnostic tests, and any consultations. The Chiropractic Physicians Board of Nevada is aware of a recent letter ( ) that you recently received from Ms. Catherine French. Ms. French is the Director of Health Policy and Advocacy for a group called AANEM (The American Association of Neuromuscular and Eletrodiagnostic Medicine). I would first like to start off and agree with the spirit of this letter in reference to their position that only properly trained physicians should perform needle electromyography. Our D-4

5 board takes the exact same stance, as you will see. Unfortunately, what Ms. French and her letter failed to inform you of is that there are several groups around the United States that offer services for Neuromuscular and Electrodiagnostic Testing to health care providers. These groups, once hired by a physician, come into the office with their testing equipment and technician TECH to perform such testing. Following the procedure done mostly by technicians, not qualified trained physicians, the results are then sent to neurologists for interpretation and diagnostic study. As stated earlier in this letter, Chiropractic Physicians, upon completion of their doctorate degree, can further their education in a variety of fields, one of which is Neurology or DABCN (Diplomate, American Board of Chiropractic Neurologist). One of the top programs in the country for chiropractic neurology program is the Carrick Institute for Graduate Studies. Their program states, The curriculum is accredited by the American Chiropractic Neurology Board. Our program qualifies our learners to be eligible to sit for the Diplomate examination of the American Chiropractic Neurology Board. This specialty board in Neurology is recognized by the American Chiropractic Association, The American Chiropractic Association's Council on Neurology and the Council on Chiropractic Specialties. The American Chiropractic Neurology Board is a full member of the National Organization for Competency Assurance (USA) and is fully accredited by the National Commission for Certification Agencies. This is approximately a 4-year program with over 400 hours of clinical neurology. The program covers a wide variety of neurological conditions/disorders, neurological examinations, diagnosing, testing, interpretation of such testing, measurements, outcomes and assessments. Allowing this language change in statute will then give the Chiropractic Physicians Board of Nevada the ability to put into regulations, only those whom meet the qualifications for such NCV/EMG testing (Diplomate, American Board of Chiropractic Neurologist or equivalent) will be allowed to do so. As Ms. French stated in her , and as I agree, this testing should only be performed by properly trained physicians. Therefore, by having the language in regulations would keep the door closed for untrained chiropractors to perform such testing and allow only those properly trained chiropractic physicians to do such testing. It would be our goal as a board, as we sit for public safety, to possibly add into regulation that companies sending only technicians into chiropractic clinics to perform such testing would not be allowed. D-5

6 I look forward to speaking to you in person should you have any further questions. I am also available by telephone at (702) and by at Thank you! Dr Benjamin S Lurie Vice President Chiropractic Physicians Board of Nevada D-6

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