CHIROPRACTORS ‑- PRESCRIPTION OF ORTHOPEDIC DEVICES BY CHIROPRACTORS
Discussion of the circumstances under which a chiropractor may prescribe a back support for the treatment, maintenance and rehabilitation of a patient under his care and those under which a state agency will be required to pay for such services.
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January 29, 1976
Honorable Phyllis K. Erickson
State Representative, Second District
Olympia, Washington 98504 Cite as: AGLO 1976 No. 7
Dear Representative Erickson:
By letter previously acknowledged you have requested our opinion on two questions which we paraphrase as follows:
(1) By virtue of his license to practice chiropractic in this state under chapter 18.25 RCW, may a person so licensed prescribe an orthopedic back support for the treatment, maintenance and rehabilitation of a patient under his care?
(2) If question (1) is answered in the affirmative, is a state agency or political subdivision required by RCW 18.25.130 to pay for a back support prescribed by a licensed chiropractor for a person receiving benefits, salaries or wages or other compensation from such state agency or political subdivision if, under the same circumstances, payment would be made for such back support if prescribed by a person licensed to practice medicine and surgery under chapter 18.71 RCW?
We answer your first question in the manner set forth in our analysis and your second in the negative.
Chapter 18.25 RCW provides for the licensing of chiropractors; i.e., persons engaged in the practice of chiropractic. Although this term remained undefined by statute for many years, the 1974 legislature saw fit to establish such a definition. By § 7, chapter 97, Laws of 1974, 1st Ex. Sess., now codified as RCW 18.25.005, the legislature provided that:
"For the purpose of chapters 18.25 and 18.26 RCW, the term 'chiropractic' shall mean and include that practice of health care which [[Orig. Op. Page 2]] 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." (Emphasis supplied.)
The answer to your first question will thus depend, in each case, upon whether the presciption of an orthopedic back support may be said, factually, to constitute ". . . the normal regimen and rehabilitation of the patient . . ." in the light of the particular physical condition from which he is suffering. In those instances in which this factual question can, on the basis of competent evidence, be answered in the affirmative then, likewise, an affirmative answer to the first of the two legal questions which you have here posed may also be given.
Your second question also involves another aspect of chapter 97, Laws of 1974, 1st Ex. Sess. By § 2 of this act, now codified as RCW 18.25.130, the legislature provided that:
"Notwithstanding any other provision of law, the state and its political subdivisions shall accept the services of licensed chiropractors for any service covered by their licenses with relation [[Orig. Op. Page 3]] to any person receiving benefits, salaries, wages, or any other type of compensation from the state, its agencies or subdivisions." (Emphasis supplied.)
Assuming an affirmative answer to your first question in a given case, based upon the particular factual circumstances thereof, this statute would, by the same token, require a state agency or political subdivision to pay for theservice thus performed by the chiropractor. In other words, if, in a given case, the chiropractor in question was justified by the facts of the case in prescribing an orthopedic back support for his patient, and if under the same circumstances payment for that service would have been made by a state agency or political subdivision if the service had been performed by a licensed physician or surgeon, then, by reason of RCW 18.25.130,supra, payment will likewise have to be made for the corresponding service of the chiropractor.
This line of reasoning, however, does not support an affirmative answer to your second question, as we understand it, because the thing for which payment would be made under the terms of that question would not be theservice of prescribing the back support but, instead, it would be the resulting back support itself. RCW 18.25.130 relates only to the professional services of a chiropractor, including those involved inprescribing a back support in a proper case as outlined above, but not to the physical thing thus prescribed.
We trust that the foregoing will be of some assistance to you.
Very truly yours,
PHILIP H. AUSTIN
Deputy Attorney General