GEORGIA BOARD OF CHIROPRACTIC EXAMINERS Board Update

GEORGIA BOARD OF CHIROPRACTIC EXAMINERS Board Update

Legal Charge of the Georgia Board of Chiropractic Examiners The board shall possess and exercise such powers to protect the public health, safety and welfare through the regulation of the practice of chiropractic.

Board Members It is important to note that the consumer member is the only member who is not connected in any way to the practice of chiropractic. Front: Dr. Mary Watkins, D.C., President Left to Right: Dr. Joseph Krzemien, D.C.; Dr. David Wren, D.C.; Dr. Robert Alpert, D.C.; Dr. Andrew Krantz, D.C., Vice President; & Emily Campbell, Consumer Member (not pictured)

Board Staff Adrienne D. Price, Executive Director Kathy Osier, Licensing Supervisor Sonja Glover, Licensing Analyst Kimberly Candler, Complaints/Compliance Analyst Michelle Hornaday, Board Support Specialist Board Attorney D. Williams-McNeely, Assistant Attorney General

Statistical Data: Georgia licensed Chiropractors (as of 09/23/2018) 3,530 Licenses Issued: 2016 - 187 2017 - 179 2018 - 130 to date

2018 & 2019 Meeting Dates All meetings are held on Fridays at 9:00 AM at the Professional Licensing Boards Division in Macon, GA unless otherwise specified. The remaining meeting dates are as follows: November 2, 2018 January 11, 2019 March 8, 2019 May 17, 2019 July 19, 2019 September 6, 2019 November 1, 2019 All Board meetings are open to the public during open session in compliance with the Georgia Open Meetings Act. Matters which are confidential by law are discussed in Executive Session which is closed to the public. Investigative Subcommittee meeting dates are February 1, 2019 April 5, 2019 June 7, 2019 August 2, 2019 October 4, 2019 December 6, 2019 These meetings are not open to the public as complaints and investigations are confidential by law.

Responsibilities of license holder 1. Renew your license PRIOR to the expiration date of your license. 2. Notify the Board if your name changes and send in supporting documentation. 3.Keep your e-mail and mailing address up to date. www.sos.ga.gov/plb 4. Keep current with Georgia Law and Board Rules http://sos.ga.gov/plb/GeneralProvisions.htm 5. Notify the Board of any criminal convictions within 10 days of the conviction. 6. Display license in a conspicuous location in place of business

Investigative Committee makes recommendation s to the Board & the Board renders a decision on the case and/or begins the process again if more investigation is necessary. Complaint / Investigative Case File is received by the Board The Complaint Process The investigative findings are returned to the Investigative Subcommittee of the Board to make a recommendation regarding an action by the Board Determination is made as to whether or not the allegation would be a violation of Board laws, rules and policies If allegation is within the Board's jurisdiction, the complaint is referred to the SOS Investigations Division A detailed explanation of the complaint process may be located on home page of the Secretary of State website. http://sos.ga.gov/PLB/acrobat/Forms/99%20Reference%20-%20Complaint%20Process%20Details.pdf

Average Timeframes For Case Resolution As it is in criminal law, there are a number of reasons for the delay in the resolution of some cases. The variance in timeframes are directly related to whether or not the alleged act falls within the jurisdiction of the Board; the available resources to investigate the case (i.e. number of available enforcement officers per case load); responsiveness of witnesses when gathering evidence; receipt of a preponderance of evidence (convincing evidence and its probable truth or accuracy) in order to proceed to action; and each licensee’s constitutional right to due process & reconsideration (i.e. fair treatment with no deprivation of life, liberty, or property without first giving adequate notice under the law YEAR MONTHS DAYS 2018 3.25 91 2017 5.76 173 2016 5.17 155 2015 6.1 183 2014 8.63 259 Increase in timeframe due to cases that were under appeal/review for consent orders

Status of Complaints As of September 23, 2018, the Board had 78 open cases which fell within the following categories: Action in Another Jurisdiction 2 Quality of Care/Substandard 5 Advertising 6 Records Release Violation 8 Arrest, Conviction & Plea 1 Sexual Misconduct 6 CE Violation 6 Solicitation by Runner 1 Drug Diversion / Impairment 2 Student Loan Default 1 Failure to Meet Qualifications 2 Unlicensed Practice 6 Fraud/Misrepresentation 9 Unprofessional / Unethical Conduct 10 Malpractice 4 Violation of Board Order 1 Practicing Beyond Scope 7 Prescribing Violation 1 TOTAL 78

The Board Decision When considering information relevant to a complaint investigation, the Board may either: Close the case Conduct an additional investigation Issue a non-disciplinary action through: A Mitigating Letter – a settlement agreement between the Board and the Licensee/Respondent, i.e. if the individual meets certain conditions established by the Board, no public action will be taken and the case will be closed. A Letter of Concern – a statement from the Board that the allegations are of concern to the Board but the evidence does not rise to the level of a sanction or disciplinary action. Sanction or discipline a license by: A Private Order/Agreement – not available to the public but may be released to law enforcement agencies or lawful licensing authorities A Public Order/Agreement – is available for public review and is typically posted on the license verification site. Public actions are also reportable to the National Practitioner Databank (NPDB) and The Chiropractic Information

Statutory Changes There were no statutory changes which directly effected the chiropractic board during the 2018 Session of the Georgia General Assembly; however, the Board is operating under the following statutory changes which went into effect in 2016. O.C.G.A. § 43-1C “Georgia Professional Regulation Reform Act” – Provides for executive oversight of the Professional Licensing Boards to the office of the Governor of the State of Georgia. O.C.G.A. § 43-1C-2(3); 43-1-34 “Military Spouses and Veterans Licensure Act” – Requires professional licensing boards and other boards to adopt rules and regulations implementing a process by which military spouses and transitioning service members may qualify for licenses. O.C.G.A. § 43-19 “General Provisions of Law” – Requires professional licensing boards to consider certain factors relating to felonies before denying a license to an applicant or revoking a license and to provide for probationary licenses for participants in accountability courts. O.C.G.A. § 38-3 “Uniform Emergency Volunteer Health Practitioners Act” – Provides for regulation of volunteer health practitioners during a declared emergency O.C.G.A. § 43-1-33 “The Consumer Information and Awareness Act” - Requires

Rules Amended and/or Adopted in 2018 Board Rule 100-9-.01 Electrical and Therapeutic Modalities Board Rule 100-12-.01 Approved Chiropractic Schools or Colleges If you are interested in being notified of proposed rule amendments, it is suggested that you subscribe to the interested parties list by visiting http://sos.ga.gov/index.php/licensing , selecting the link for subscriptions on the home page and following the instructions to subscribe. Proposed Rules that have been posted for public comment can be found at http://sos.ga.gov/index.php/licensing/plb/14/chiropractor These rules are being discussed or were adopted by the Board; however, not all of them have been posted for hearing or completed the Governor proposed rules Oversight Committee approval process. As a result, the revised or new rules may not yet be visible or in effect on the website. To see when a rule was last updated, review the citations at the end of each individual rule on the board

Policy Amendments of 2018 Policy # 4 – Updated procedural guidelines and requirements for the reactivation. Policy # 5 – Authorizes staff to administratively process reinstatement applications under specified conditions and if application falls outside of those terms and conditions, staff is to prepare it for review by the Board. Policy # 7 – Provides procedural guidelines by which staff may conduct an audit of continuing education each renewal cycle. These policies are being discussed or were adopted by the Board; however, they have not completed the Governor Oversight Committee approval process. As a result, the revised or new policies are not yet be visible or in effect on the website.

Questions Patient records are to be maintained for how long? Rule 100-7.07: patient records must be retained for ten (10) years from the date of the last patient visit Can a D.C. withhold patient records if a patient has an outstanding bill? Rule 100-7.07: must be released in compliance with O.C.G.A. 31-33-1 regardless of any outstanding bill or financial matter

Patient Records Law O.C.G.A. §31-33 Health Records Georgia Patients Records laws can be found under the Laws, Policies & Rules on the Board’s website where O.C.G.A. § 31-333 is references. The law requires providers to maintain patient records for not less than 10 years from the date the patient was last treated. It further provides for charging a fee for copying and mailing patient records. A practitioner cannot refuse to release patient records if the patient has an outstanding balance. Per Board Policy #3, records must be released within 3-5 working days from receipt of a properly signed and executed request from a patient or legal designee.

Rule 100-7-.07 Patient Referrals and Patient Records Licensed chiropractors are required to refer patients to an appropriate heath care provider when it is clear that he/she knows or should have known that the patient condition is outside their scope of professional experience, training, or practice. If an office closes, the chiropractor must post a legal notice of closing in the local legal organ (newspaper) as to the date the practice is closing and where the patient records should be obtained The chiropractor must allow not less than thirty (30) calendar days to allow for retrieval of patient records

Patient Records continued The minimum, reasonable standard of care must be evident within the patient records and reflect that the chiropractor is practicing within the scope, is practicing ethically, insurance requisitions(if applicable), consent forms and notes which include examination results, treatments, diagnostics and clinical impressions. The minimum, reasonable standard includes but is not limited to documentation of: Subjective - The subjective component is the client’s report of how he or she has been doing since the last visit, and this includes the current visit. Objective - The objective component is straightforward and includes vital signs (temperature, blood pressure, pulse, respiration), documentation of the physical examination that was done, and results of laboratory or other studies that may be done during the course of this visit. Assessment - the clinician pulls together the subjective information gathered during the interview with the client and the objective findings of the physical exam (and, possibly, laboratory or other study results) and consolidates them into a short assessment in order to formulate a diagnosis Plan - The plan should include anything that will be done as a consequence of the assessment and may include recommendations for treatment.

Minimum Reasonable Standards The minimum reasonable standards of care not only include what is reflected within the patient record but it also extends to the chiropractors conduct, behavior and the ways in which chiropractors interact with their clients or potential clients (See Board Rules Chapter 7).

Are there advertising restrictions in Georgia law/and or rules?

100-4.-.01 Advertising 1.Defined advertising shall mean any information communicated in a manner designed to attract public attention to the public. 2. A licensee shall not make any false, misleading, or deceptive communication. 3. Advertising can not give impression of professional superiority. 4. Advertising that has the capacity or tendency to create false or unjustified expectations of beneficial treatment or successful cures. 5. Chiropractors may only use the terms chiropractor, doctor of chiropractic and/or D.C. The term Chiropractic Physician is NOT authorized. 6. Advertised services being offered free or at a discount must be presented in writing to and signed by the patient, clearly explaining that any further treatment will be provided at rates regularly charged by this office.

Appropriate Advertisments?

Additional Examples of Questionable Advertisements

Rule 43-1-19.1 Waiver of deductibles or copayments in healthcare plans; deceptive or misleading advertising -it shall be considered a deceptive or misleading practice for any person duly licensed and authorized to provide any type of health care services to advertise, as an inducement to attract patients, the waiver of a deductible or copayment required to be made to such person under the patient’s health insurance policy or plan.

Rule 100-7-.08 Contractual Pre-Payments for Services It is considered unprofessional conduct for any chiropractor to enter into a financial contract which obligates a patient for care or payment for care using coercion, duress, fraud, overreaching diagnosis, harassment, intimidation, or undue influence. The patient must be given a permanent copy of the signed contract; and the contract must provide a clearly defined refund policy typed in not less than 12 point font. An initial line must be next to the refund policy and must be initialed by the patient. The contract must contain the statement :“There is insufficient evidence to suggest that not receiving chiropractic care will lead to death, paralysis, disability, or permanent harm.” Said statement must be typed in not less than 12 point font. Any chiropractor who enters into a pre-payment financial contract with a patient must allow the patient 48 hours to sign and return the contract. During the 48-hour evaluation period from the time when a copy of the written contract is provided to the patient; no content of the contract can be altered.

Rule 100-7-.05 Sexual Misconduct "Patient" as used in this Section is any person, other than a spouse, who was being examined or who was under the care or treatment of the chiropractor when the incident or incidents of sexual misconduct allegedly occurred, regardless of whether the person was billed by or was paying for chiropractic services; regardless if the alleged sexual misconduct occurred outside of professional treatment sessions; or the alleged sexual misconduct was off the premises regularly used by the licensee for the professional treatment of patients and regardless of whether the person consented. A person shall be considered a patient until six (6) months has elapsed since the last date on which the chiropractor examined or treated the person.

Rule 100-7-.05 Sexual Misconduct Continued “Sexual Misconduct” as used in this Section means sexual impropriety which may include but is not limited to: Any behavior, gestures, or expressions which may reasonably be interpreted as inappropriately seductive or sexually demeaning; Inappropriate sexual comments about and to a patient including sexual comments about an individual’s body; Requesting unnecessary details of sexual history or sexual likes and dislikes; Making a request to date; Initiating conversation regarding the sexual problems, preferences, or fantasies of the licensee; Kissing or fondling of a sexual nature

Rule 100-9-.01 Electrical and Therapeutic Modalities There are questions as to what terminology we are allowed to use in describing chiropractic therapy. The terms “physiotherapy” or “physiotherapist” are now protected terms identified in the PT Code. We may use any of the following: Electrical and therapeutic modalities Physiological therapeutic procedures Chiropractic physical agent modality Chiropractic physiological therapeutic procedures

Rule 100-5-.02 CE Requirements 20 hours required per year 15 in clinical sciences 4 in ethics and risk management 1 in Georgia laws and rules Maximum of 3 in philosophy Maximum of 4 in clinical documentation No more than twenty (20) hours per biennial renewal period can be taken via audio/visual/electronic media, such as on-line/internet courses.

Rule 100-5-.02 CE Requirements Continued Each licensed chiropractor shall maintain in his/her own possession certificates of attendance at continuing education meetings for a period of 4 years from the date of the program. Each doctor of chiropractic is responsible for determining in advance that the courses which he/she proposes to attend are sponsored by an approved provider. A continuing education audit may be conducted on any licensee during renewal. When the renewal application is completed, all continuing education requirements should also be complete because at that time, each licensee is asked to attest to having met the CE requirements in accordance with the Board rules. If a licensee has not satisfied the CE requirements at the time he/she applies for renewal, the answer to the CE attestation question should be “NO.” PLEASE NOTE, THAT IF A LICENSEE ANSWERS “NO” TO HAVING MET THE CONTINUING REQUIREMENTS AT THE TIME HE/SHE APPLIES FOR RENEWAL, ALL HOURS MUST BE COMPLETED PRIOR TO THE EXPIRATION DATE OF THE LICENSE. LICENSEES WHO ANSWER “NO” ARE AUTOMATICALLY AUDITED. LICENSEES ARE SUBJECT TO DISCIPLINARY ACTION BY THE BOARD IF THE CE REQUIREMENTS ARE NOT MET IN ACCORDANCE WITH BOARD RULES AND POLICIES.

CE Requirements The board has voted to go into contract with CE Broker. This is a CE housing company. It will take a rule change to make it to be effective, we hope to have it in 2019.

License Renewal License renewal applications general go live anytime between 60-90 days prior to the expiration date of the license. Before attempting to renew, visit the Board website to see if there is a statement on the home page announcing that renewal is now live. The deadline to renew is 12/31 of even-numbered years. Fee 125. Late Renewal 01/01 – 03/31- Fee 225. 04/01 or later – Reinstatement Required No licensee can practice after 12/31 until the license has been renewed. The licensed D.C. is responsible for ensuring that the license is renewed timely; therefore if the licensee allows someone else to apply for the renewal on their behalf, the licensee will still be held accountable for the responses provided. As a result, it is strongly suggested that licensees complete the renewal application themselves. IMPORTANT If you applied for license renewal, always check the license verification page prior to the expiration date of your license to be sure that your license has been renewed and your expiration date has changed. You do this by visiting http://sos.ga.gov/index.php/licensing and then select the “Search for a Licensee” feature. Enter the search criteria, click “Search,” select your name to open the verifications page and then check the table ensure that the status says “Active” (or “Probation” if you practice under the terms of a public order) and the expiration date has changed. If the expiration date remains the same or there is some other status besides “active,” the renewal application is not complete and you should check your emails and/or

What About Chiropractic Assistants (C.A.)? Georgia law DOES NOT allow an unlicensed individual (like a C.A.) to work under a D.C.’s license to provide massage therapy services. C.A.’s can still perform other duties under the direct supervision of the D.C. to include but not be limited to: Physical Agent Modalities Patient history X-Rays with certification

Contact Information Georgia Board of Chiropractic Examiners 237 Coliseum Dr. Macon, GA 31217 (478) 207-2440 Fax (866) 888-1308 http:// sos.ga.gov/index.php/licensing/plb/14