ACS RETAINS TOP ATTORNEY TO SUE ADOI

 

 

 

 

The Arizona Chiropractic Board has found veteran Tucson chiropractor Dr. David Stender guilty of unprofessional conduct for using "scare tactics." The Board order states: "Respondent used deceptive and misleading information in his advertisement to frighten or intimidate prospective patients for marketing purposes."

Dr. Stender, like most chiropractors, warned patients that subluxations have a deleterious effect on health which may, like hypertension, atherosclerosis, elevated blood glucose and unremitting general stress, increase the risk of death. Dr. Stender also exposed the dangers of many prescription drugs. The Board rejected Dr. Stender's claims and his choice of references to the scientific literature. A harsh and vitriolic Board order against Dr. Stender is permanently posted on the Board's webpage. It takes a few isolated advertising statements out-of-context and paints Dr. Stender, an honest and sincere healer with an excellent reputation for integrity among his peers, as a fraud and con artist. The Board ordered him to take an 8 hour class in "critical evaluation of the literature." Such a class does not exist in the knowledge of ACS, nor is it understood why it would take 8 hours to teach this simple task.

ACS President Dr. Immerman issued the following warning to the profession: "Many of you are equally decent, sincere and honest, yet have posters and literature in your offices and on your websites containing statements about subluxation that the Board would consider illegal 'scare tactics.' Take preemptive action before the Board harshly attacks you. ACS members are invited to submit all materials to our office for review. We will advise whether they should additionally be analyzed by our expert healthcare attorney. Many of you will be subject to the same penalties as those received by Dr. Stender if you do not take action now."

All of Dr. Stender's troubles began with a complaint over failure to release records within the required 10 day time period. He did violate this rule and was issued a non-disciplinary advisory letter. To determine if his violation only consisted of failure to release records on time, the Board subpoenaed the entire patient file and thus uncovered the alleged "scare tactics." The Board wants observers to believe that such broad subpoenas are necessary even though everyone knows they are "fishing expeditions."

Dr. Immerman also stated: "The ridiculous broad scope v. focused subluxation scope shooting war in Arizona is at a peak. Congratulations to AAC, Board and CCGPP doctors Steve Baker, Dianne Haydon, Jim Badge, Wayne Bennett, Ed Weathersby, Arlan Fuhr, Terry Peterson, Craig Seitz and the others who have created a Board which will destroy any DC who promotes subluxation-based chiropractic. They have taken a few of Dr. Stender's statements out-of-context and mischaracterized him as a fraud. They are trying to stamp out subluxation-based chiropractic in Arizona. This will not stand when appealed to Superior Court. ACS calls upon the profession to support Dr. Stender's legal effort to overturn this outrageous ruling. We will provide details about how to help fund this effort in the near future."

The anti-subluxation forces in Arizona are very active. For background, see the article "Subluxation: dogma or science?" published in Chiropractic and Osteopathy, v. 13, 2005. Drs. Perle, Winterstein and Keating opined that "widespread assertion of the clinical meaningfulness of this notion (subluxation) brings ridicule from the scientific and health care communities  . . ." They state it is "essential" that "licensing authorities . . . reframe subluxation as something tentative rather than something certain." The article is posted at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1208927 In Arizona the Board is forcing the profession to portray subluxation as an entity with little certainty so as to halt the "ridicule." Dr. Stender is on the receiving end of this "clean-up" effort. You may be next. All it took in this case was a complaint over failure to release records on time.

Those who control the AAC agree with this agenda of the Board as seen by the fact that the AAC brought Dr. Perle to Arizona as a prime speaker at its recent 2008 convention. This is also consistent with the AAC's appointment of Dr. Badge as Chair of its Public Policy Legislative Committee. The NBCE Summer 2006 Monthly Report noted that Dr. Badge "formerly served on the National Board of Chiropractic Examiners (NBCE) for 18 years. He served as a District IV Director (1987-2005), Vice President (2000-2004) and President (2004-2005)." Dr. Badge also served on the Arizona Chiropractic Board of Examiners for 15 years, many as Chair. In June 2007 at a Board meeting he proclaimed that the Board and its members are operating properly, and that no changes are needed.

Dr. Immerman commented: "Jim has been the leading Arizona advocate for the Board for as long as I have been an advocate for insurance equality. That goes back more than 20 years. In the 1990s, he led the effort to give the Board authority to discipline your license if your fees are 'excessive.' ACS killed this further intrusion by the Board into DC practices. The fact that Jim is now running the AAC's legislative committee shows that the AAC's priorities are in the area of expanding Board regulation. Jim is the godfather of the Board in Arizona."

The anti-subluxation fervor in Arizona also comes from 2 CCGPP doctors: Arlan Fuhr and Wayne Bennett. Arlan is NICR's representative to CCGPP and a major participant. Wayne is the CCGPP District 5 and a coauthor. Both are known strong promoters along with Dr. Baker. Also, Dr. Weathersby was on the Arizona Board from 1994-2004 and then "ascended" to the presidency of FCLB in 2005 where he is still an officer. One of the few ACA governors practices in Mesa. Thus, you can see clearly why the Board acts as it does. ACS has now exposed the "power behind the throne" in Arizona.

There clearly is a tightly controlled plan to eliminate subluxation in Arizona except, as Dr. Perle's article says, as a very tentative hypothesis, probably best not to mention at all for fear of triggering "ridicule." This is occurring just as acupuncture treatment to correct imbalances in chi energy to treat almost any condition is sweeping the medical world. It never ceases that the chiropractic profession eats its young.

The Arizona Chiropractic Board has a long and sordid history of gross misbehavior. Read all of the fully documented details on the ACS Chiropractic Board webpage at www.AZChiropractors.org. You will find postings of court filings and rulings, complaints filed with state agencies, newspaper articles, and much more. Be sure to read all of this material and learn the truth of what is happening with the Board. Forewarned is forearmed.

Our sponsors are very special to ACS. They help make it possible to bring our written and electronic information to you. They help pay for the ink and postage! Won't you please consider them when you need a service or product? We obviously wouldn't do business with them if we didn't think they were good folks. Please be sure to give them a look. They are supporting your profession and deserve your gratitude for that.

The Arizona Documentation Seminar You Can't Miss

Don't miss breaking news -- sign up for the free monthly ACS e-newsletter at www.AZChiropractors.org, and check the frequently updated website regularly. Go to the homepage at the upper left corner, enter your email address, and strike enter. Then you will be in the loop.

Also, ACS posts Arizona Chiropractic Board meeting minutes on the ACS Chiro Board webpage for all to see. Now you can finally learn what the Board is doing every month at its meetings. ACS wants the profession to see exactly how the Board is (mis)behaving.

Status Report on ACS Legal Effort to Lower Copays and Deductibles

ACS is moving forward as quickly as possible to take legal action to force ADOI to properly interpret and enforce the 1990 ACS insurance equality law. This will lower copays and deductibles to equal those charged when patients see MDs for treatment of neuromusculoskeletal conditions with drugs and surgery. ACS' first attempt was stalled since it was based on an alleged illegal insurance policy without a mishandled claim. Now ACS is refilling with a mishandled claim.

Our nearly 300 members receive regular emails with updates about strategy, attorneys, legal filings and much more. This detail cannot be disseminated to the entire profession since it would fall into the hands of those against whom ACS is litigating. If you want to know all details and support this litigation which will breathe life into your insurance practice, join ACS. ACS is your action organization that actually makes change happen and is not satisfied with mere endless meetings that just involve talking about, but never actually solving, problems.

Medical Records Protocol:
You Need It for Relicensure, ACS Has It

The Chiropractic Board requires that you have a Medical Records Protocol on file in your office. ACS has retained a health care attorney to write such a protocol. This document has been newly revised in 2008 due to changes in the rules pertaining to chiropractic. ACS is the only organization that has retained an attorney who is a specialist in health care law to write a Medical Records Protocol. To get a copy, simply look in your email inbox if you are a member. If you are not a member, join today and we will email you a copy.

You can now get new patients by joining ACS since we have launched our popular online Find-A-Doc search engine for members. The ACS webpage appears high on the list when Internet searches are performed for Arizona chiropractors or chiropractic. To join ACS and be listed on this highly valuable referral search engine, go to www.AZChiropractors.org and complete an application. ACS is ready to help you today!

Attention members: If you have not yet done so, send ACS a note stating that you would like to be listed on the Find-A-Doc search engine. Don't miss out on this valuable new patient opportunity.

Editor's Note: This strong protest letter was sent by ANJC to CCGPP in April, 2008. ACS agrees with the content and so is reprinting the letter here. ACS members have generally supported the ICA Best Practices rather than the CCGPP Best Practices and ACS is likely to issue a position paper shortly. ACS calls upon the AAC to take a position on the CCGPP and ICA Best Practices documents as well.

April 16, 2008
ATTN: Cheryl Hawk, DC, PhD,
CCGPP Delphi Process Director
Chair, Scientific Commission CCGPP

Dear Dr. Hawk,

The Association of New Jersey Chiropractors (ANJC) Literature Search Committee has had an opportunity to review the March 2008 draft of CCGPP's Chiropractic Management of Low Back Disorders. It is noted that this document utilizes the Delphi Consensus Process to make recommendations concerning Frequency and Duration of chiropractic care. It is our understanding that CCGPP arranged to have Gary Globe, DC, PhD present this draft at a California Workers Compensation meeting on March 19, 2008. It is our further understanding that the purpose of this meeting was to demonstrate that the chiropractic profession is working toward providing its own set of recommendations on appropriate chiropractic care for Low Back Pain. It is further noted that the following tables, 1 and 2, (taken directly from the CCGPP draft) essentially represent the CCGPP recommendations.

At this time, the ANJC has serious concerns regarding this covert project. Specifically, the ANJC questions (1) why CCGPP is involved in the development and distribution of guidelines and/or specific treatment "cookbook" parameters for chiropractic care which is contrary to their stated purpose and promise to the profession, (2) the validity of utilizing the Delphi Consensus Process for generating chiropractic frequency and duration guidelines, (3) why the draft document has had not been released to the chiropractic profession for review prior to being submitted to outside agencies, and (4) why CCGPP is not utilizing Best Practices criteria for this purpose.

The ANJC is concerned that CCGPP has expressly and repeatedly stated that its function is to create "Best Practices" and not parameters or guidelines for care. It is noted, however, that the low back document contains several sections and tables with frequency and duration recommendations for the rendering of chiropractic care of low back disorders. It is further noted that the document contains no justification or references in support of the recommendations. Below are public statements made by CCGPP's representatives to allay the concerns of the chiropractic profession:

Best Practice: The Chiropractic Compass™ - By Mark Dehen, D.C., Chairman, CCGPP
"The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is currently in the process of developing the new "Chiropractic Compass." This is a best practices document designed to direct the doctor of chiropractic toward a comprehensive health solution for the patient, rather than providing only a cookbook recipe for a particular condition."  http://www.chiroeco.com/ccgpp/ccgpp5.php  "What is chiropractic's 'Best Practice' initiative?" - By Ronald J. Farabaugh, DC, Vice Chairman, CCGPP

GUIDELINE OR BEST PRACTICE?
"A guideline contains numbers and/or suggested therapy time frames that are often mistakenly applied as arbitrary limits. A Best Practice (BP) is a process/document that reviews the evidence and provides interpretation consistent with the chiropractic perspective as the providers involved in treating these cases, using chiropractic methods (Triano)." http://www.fclb.org/news/Article1(2004-09).pdf

THE ANJC SPECIFICALLY REQUESTS THAT CCGPP EXPLAIN ITS RATIONALE FOR DEVIATING FROM ITS ORIGINAL STATED PURPOSE OF CREATING BEST PRACTICES FOR CHIROPRACTIC CARE. BEST PRACTICES, IF PROPERLY EXECUTED, WOULD BE A DYNAMIC PROCESS THAT ALLOWS CHANGE AS NEW DATA AND RESEARCH IS PRESENTED.

The ANJC notes that CCGPP is utilizing the Delphi Consensus Process for generating its frequency and duration recommendations. This method relies on the selection of a panel of independent experts to come to conclusions after reviewing "seed statements" in a round after round approach. Additionally, the Delphi process gives anonymity to the experts during the consensus process. As such, instead of reflecting scientific evidence, the recommendations are merely the opinion of a small select anonymous group. No mention is made as to the criteria to be chosen as an expert, nor is information presented that would substantiate that the panel selected is best suited to represent the chiropractic community.

It appears the entire Delphi process utilized essentially entailed convening a panel of 40 individuals who were presented with frequency and duration "seed statements" that were prepared by CCGPP. After two "rounds" of discussing the seed statements, 36 of the 40 panelists reached agreement and the recommendations were established. These recommendations therefore represent nothing more than the willingness of 36 individuals to agree to seed statements developed by CCGPP. The ANJC feels strongly that the use of this process to determine chiropractic frequency and duration guidelines for chiropractic care is severely flawed, blatantly unscientific, and an injustice to the profession.

THE ANJC SPECIFICALLY REQUESTS THAT CCGPP EXPLAIN ITS RATIONALE FOR UTILIZING THE DELPHI CONSENSUS PROCESS INSTEAD OF UTILIZING SCIENTIFIC LITERATURE. THE ANJC ALSO REQUESTS THE CRITERIA UTILIZED BY CCGPP FOR THE SELECTION OF THE 40 PANELISTS AS WELL THE RATIONALE USED TO DETERMINE THAT THE OPINION OF THESE 40 INDIVIDUALS IS REFLECTIVE AND REPRESENTATIVE OF THE ENTIRE CHIROPRACTIC PROFESSION.

The ANJC notes that CCGPP has already covertly presented this draft at a California Workers Compensation meeting on March 19, 2008, this despite the fact that CCGPP has been well aware that the chiropractic profession opposed their development of treatment parameters. The ANJC questions why this draft was distributed and presented to outside agencies without being distributed for review by the chiropractic profession. The ANJC is concerned that if this document, purportedly supported by the majority or consensus of the profession, is released for public use, it will be widely circulated and improperly used by others with disastrous consequences to chiropractors nationally.

THE ANJC SPECIFICALLY REQUESTS THAT CCGPP EXPLAIN ITS RATIONALE FOR PRESENTING THIS DOCUMENT TO OUTSIDE AGENCIES PRIOR TO BEING DISTRIBUTED AND REVIEWED BY THE CHIROPRACTIC PROFESSION.

The ANJC notes that a plethora of scientific studies exist that contradict the opinion of the CCGPP panelists concerning frequency and duration of chiropractic care. In just one example, ICA has compiled 200 studies that contain data on frequency and duration for chiropractic care.* The 200 listed references constitute a small fraction of the chiropractic and spinal manipulation research published. When averaging treatment used in these 200 randomized clinical control and non-randomized clinical control studies (Level I and Level II studies) they show 25 treatments in seven weeks on average. It should be noted that these treatment parameters were simply to achieve minimal improvement of symptoms in the vast majority of cases, and not resolution of symptoms. Also, the vast majority of these papers excluded factors such as co-morbidities which would slow healing and require additional treatment for minimal improvement, above and beyond the numbers shown here. Some of these co-morbid conditions include obesity, smoking, sleep deprivation, diabetes, use of certain drugs and certain physical trauma. These 200 references exclude the vast majority of chiropractic studies which are mostly case studies. These facts come from the published literature and not from any consensus of experience or opinion.

THE ANJC SPECIFICALLY REQUESTS THAT CCGPP EXPLAIN ITS RATIONALE FOR UTILIZING THE OPINION OF 40 PANELISTS INSTEAD OF THE AVAILABLE SCIENTIFIC STUDIES IN FORMULATING ITS FREQUENCY AND DURATION GUIDELINES FOR CHIROPRACTIC CARE.

In closing, the ANJC asserts that the CCGPP frequency and duration recommendations concerning chiropractic care represent nothing more than the opinions of the 40 participants to a select group of unknown "seed" questions. The consensus reached for these select questions are not based on scientific evidence, and do not reflect the standard of practice in NJ or any other state. Furthermore, the ANJC endorses that chiropractic care plans should be based upon the unique needs of each individual patient, and case progress determined by objective chiropractic assessments of neurospinal function and quality of life, not arbitrary charts or opinions.

Sincerely,
Thomas J. Sidoti, D.C., Chairman
ANJC Literature Search Committee

Final comment by ACS: In addition to requesting a response to all of these questions from Dr. Hawk, ACS also requests responses from Arizona's 2 local CCGPP participants and representatives, Drs. Arlan Fuhr and Wayne Bennett. ACS will print their responses in the next issue of this newsletter.

Health Insurance a Hit with Members

It is by far the most popular member benefit offered by ACS since our formation in 1991. We waited a long time before recommending a health insurance product to members, 17 years in fact. Finally, after years of studying the market, ACS found a program well worth recommending to members.

The ACS health insurance plan covers all pre-existing conditions just like when someone takes a job with a large company. There is a 90 day waiting period. In addition to regular ACS dues and health insurance premiums, the only additional cost to members is the grand total of $100 per year. That's it. Members already have complete information about the insurance in their email inboxes. For more information, contact ACS. We watch out for Arizona chiropractors!

What Has ACS Done for You Lately?

ACS advocacy has resulted in Rep. Mark Anderson requesting a Special Formal Audit of the Arizona Chiropractic Board to fully uncover what Judge Miller, in the 2007 case of Dr. Pratt, called "excessive, arbitrary and capricious' discipline. (Ruling posted at http://azchiropractors.org/arizona-board.html. The ever-shrinking minority which believes the  Board is acting appropriately has yet to explain why an independent and objective Superior Court judge, having heard the best arguments put forth by an Arizona assistant AG representing the Board, ruled harshly against the Board.
     
ACS is the ONLY state association taking real action to resolve the discriminatory copays and deductibles. We have asked the Arizona Legislature to solve the problem and have now elected to legally challenge the Department of Insurance in a new strategy. While we introduce legislation and take legal action, others only talk and then talk some more. Only legislation and/or legal action, not mere talking, will get results with the copay and deductible issue. History proves that talk alone has NEVER resulted in significant insurance equality for chiropractors in Arizona.

ACS has a full-time veteran licensed DC at your service to answer all of your questions on any chiropractic issue. There is no claims denial problem we cannot address based on 28 years of experience in Arizona.

Allstate Sues DCs in Arizona, 4 Other States

October 2008 Announcement About
ACS New Member Benefits

The ACS Special Treasure Member Benefits are now available in PDF format for your convenience. Previously, they were in Word format that took much longer to open on your computer. The PDF documents have been sent to you. In addition, they have all been numbered and accompanied by a Table of Contents with separate categories. The complete list, with the Table of Contents and names and numbers of each document, is posted at http://azchiropractors.org/membership-benefits.html. If you want a copy of any single document, just send a request listing the number.

As always, if you get into a jam, pick up the phone call Dr. Immerman. He has been licensed here since 1980 dealing with every challenge faced by chiropractors. He has answers to just about every problem (25 cents per call extra for psychological help!). He is available to members to provide solutions full-time, 9-6 PM, M-F, 50 weeks per year. He also responds to member's emails within a few minutes.

ACS gets lots of questions about collecting from health insurance companies, handling PI cases, testifying, rebutting IME reports, dealing with Chiropractic Board issues, PPO and HMO questions, etc. We invite you ask us any chiropractic-related question.

Recently we have added MD-DC relationship consulting to the mix. We guide members in how to develop relationships with MDs and DOs that result in referrals to DCs, and opportunities for DCs to practice in the same office as the MDs or DOs. We have top notch attorneys to refer you to who know exactly how to set up the legal framework so you don't get in trouble like some have in the past.

Dr.  Immerman has testified 103 times in Arizona personal injury cases in the past 11 years.  With these legal appearances and the experience of writing nearly 1,000 rebuttal reports to IMEs and low speed impact experts, there is much knowledge and experience freely shared with members. This includes a vast library of all the up-to-date peer-reviewed journal articles on chiropractic, PI and many other health-related subjects which every forensic expert witness must have to be effective.

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