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CONFUSION IN REGULATIONS

Some of the confusion about what a chiropractor may and may not legally do can be traced back to the law itself. For instance, California law says chiropractors can practice whatever they are taught in school. And the State's law setting forth the curriculum of chiropractic colleges requires the study of minor surgery. Some chiropractors contend that thus in California the law gives them the right to perform minor surgery.

But the chiropractors who make this claim-they are identified with the socalled progressive segment of the profession and appear to be a distinct minorityrecently lost a round in court when they attempted to get a ruling in their behalf. A superior court judge ruled chiropractors cannot perform minor surgery and must, in fact, remain strictly within the field of chiropractic; that is, they must limit themselves to manipulation of the bones and spinal cord. This decision is being appealed.

Other conflicts over laws have developed. In Louisiana, a chiropractor is attempting to get the State to write a law which would take chiropractic out from under control by the State's medical board. In New York and other States where there are no laws governing chiropractic, the chiropractors contend their practice is extra legal. They liken their situation to the early days of the automobile, when these vehicles weren't against the law but were not specifically allowed or licensed by law.

Samual Grafton in his article in McCall's reports:

A certain number of M.D.'s have been impressed by chiropractic enough to make use of some of its methods and to offer their patients spinal manipulation. Medical opposition in this country is so strong that this type of acceptance has spread more rapidly abroad. A group of 200 West German M.D.'s including members of the medical school faculties, has formed an organization for research and work in chiropractic; one of its leaders, Prof. Dr. L. Zukschwerdt, professor of surgery at the University of Hamburg, has praised chiropractic in the German medical press, recommending that physicians not neglect the application of so worthwhile a method.

Dr. Luther L. Terry, Surgeon General of the U.S. Public Health Service, has said:

The concept of comprehensive health care has emerged within the past decade as scientific progress has taught the health professions that there can be no separation of their basic responsibilities: prevention, care, and restoration.

In the distant past, it was possible to separate our very few preventive measures from the treatment of acutely ill people. Later on, a few surgeons seized the opportunities offered by their care of severely wounded soldiers to develop rehabilitative or restorative medicine. After the war, rehabilitative services were extended to the industrially injured and subsequently to a larger group of handicapped persons in our national programs for crippled children and vocational rehabilitation.

The goal now is to make sure that preventive, curative, and restorative services are available to all persons who need them, at the times they are needed, and wherever they are needed.

We need to strengthen and expand our existing schools, and we need to build new ones. We need to recruit our best young men and women for careers in the health professions.

In reaching this goal, the doctor of chiropractic plays a most important part. However, if a comprehensive health program is to be provided it will be necessary for all health professions to keep pace with the rapidly expanding population explosion.

The doctor of chiropractic performs an important function in all walks of life. Spinal injuries can occur anywhere, and spinal misalinements, or subluxations, have been proven to occur under myriad conditions.

In every field of endeavor, whether it be in the city or on the farm, in industry or management, the doctor of chiropractic plays a most vital part in the vast role of the Nation's health team.

Doctors of chiropractic are highly trained men and women. The typical chiropractor has had a thorough and intense training in all subjects needed to practice his profession and to deal with the vital life-or-death problem of health service to the public. He is not learned in the administration of medicines or the performance of surgery, because he prescribes no medications and does no surgery. In fundamental subjects, however, such as anatomy, physiology, bacteriology, neurology, his training is equal to or superior to that of other practitioners of the healing arts. In addition to these, he alone is intensively trained in those subjects peculiar to chiropractic which deal with misalinements of the spinal column that pinch nerves.

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After earning a degree from an accredited college of chiropractic, the candidate normally must pass a comprehensive examination before a State or provincial licensing board before going into actual practice.

As in all professions, the educational process of the chiropractic profession is a continuing one. Seminars, symposiums, and similar type professional meetings are held frequently to discuss new techniques and developments.

There are thousands of doctors of chiropractic serving in every State of the Union, Canada, and in other parts of the world. It is estimated that some 35 million Americans have been to a doctor of chiropractic one of more times. In the United States, the geographic distribution of doctors of chiropractic indicate that chiropractic care is within easy reach of the residents of practically every community. Chiropractic is also practiced in Canada, Mexico, Denmark, Switzerland, England, Belgium, Germany, Sweden, Australia, New Zealand, South Africa, and other foreign nations.

Since the discovery of chiropractic in 1895, this profession has been constantly growing in size and stature and service to the American people. Within its confines of the spine and its relationship to the nervous system, chiropractic has built a most enviable record. It is the opinion of the International Chiropractors Association that S. 2078 can better serve the needs of the American people.

We hope that you members of the committee, as national thought leaders, will be responsive to the need of the Federal employees and favorably report this bill so they may utilize the services of chiropractors.

I wish to thank you personally for inviting me to present this testimony and to thank you on behalf of the International Chiropractors Association.

Senator METCALF. The next witness is Mr. Paul Badger. Mr. Badger has provided us with a statement that I have had an opportunity to glance through.

We are glad to have you here and you are here on behalf of the American Chiropractic Association.

STATEMENT OF PAUL L. BADGER IN BEHALF OF THE AMERICAN CHIROPRACTIC ASSOCIATION

Mr. BADGER. That is right.

Senator METCALF. We especially welcome you here as a prominent staff member of this committee.

Mr. BADGER. Thank you, Senator. I appreciate very much the opportunity to appear before you this morning and I want to make my comments quite brief.

Senator METCALF. Your statement will be incorporated in the record at this point. If you would summarize it, that will be nice. You have provided us with a copy of the statement and I have had an opportunity to glance through it.

(The prepared statement of Mr. Badger follows:)

PREPARED STATEMENT OF PAUL L. BADGER OF WASHINGTON, D.C., FOR THE AMERICAN CHIROPRACTIC ASSOCIATION

Chairman Metcalf and members of the subcommittee, my name is Paul L. Badger. I am an attorney practicing law in the District of Columbia. I am particularly happy to appear before this committee because of the fact that I am a former member of this committee's staff. As such, I am well aware of the outstanding record, and the many forward-looking contributions which this committee has made down through the years in the field of social legislation. I am appearing before you today in behalf of the American Chiropractic Association. We support and urge the enactment of the Burdick bill, S. 1710, as introduced.

The American Chiropractic Association is a voluntary membership nonprofit corporation serving the chiropractic profession throughout the United States of America as a representative service organization. The chiropractic profession, as you know, is a major professional health service dedicated to serving the public. As such, it is vitally concerned with all of the implications of those provisions of the U.S. Employee's Compensation Act which are related to the standards of health care provided thereunder for injured and disabled Government employees.

The Burdick bill, S. 1710 proposes to amend the U.S. Employees Compensation Act so that the services of chiropractors can be utilized in the care of injured and disabled Government employees who desire such care. This is not the first time legislation of this nature has been before Congress. In the 77th Congress, a bill was introduced in the House of Representatives by Congressman John H. Tolan of California. That bill was favorably reported by both subcommittee and the full Judiciary Committee of the House, which considered it. Unfortunately, action by the committee came so late in the session that no floor vote was taken on the legislation.

In the 79th Congress, Senator Abe Murdock of Utah introduced S. 178, which was similar to the present bill. Hearings were held by the Committee on Education and Labor of the Senate, under the chairmanhsip of Senator Fulbright of Arkansas. That committee favorably reported the bill by a unanimous vote. The report was No. 1317 of the 79th Congress. The bill passed the U.S. Senate unanimously June 14, 1946. I should like to read parts of that report and offer some additional comments on the views taken by members of the Education and Labor Committee.

The report points out that the purpose of this legislation is expressly to permit Federal employees who are injured in the performance of their duties and are entitled to receive medical service at Government expense, under the Employees Compensation Act, to utilize the services of chiropractors in those States, territories, and possessions of the United States where chiropractic is a licensed

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healing profession. Later, in the report, it was pointed out that in the States and the District of Columbia, and Puerto Rico chiropractic is a licensed healing profession. It was expressly stated that this legislation permitted treatment only to the extent and under conditions which chiropractors may practice in each State. It gives no authority for chiropractic to invade other areas of the healing art and I might add, here, that members of the chiropractic profession have no desire to do so. But, what the report stresses, and I would like to further emphasize this point-is that State jurisdiction in this matter is recognized as it has been traditionally recognized in other related areas.

The report stresses another very pertinent point by showing that the present interpretation of the law acts in a discriminatory fashion toward Federal employees and licensed chiropractic practitioners. In other words, the administration of the present law places the Federal Government in a position wherein it actually discriminates against its own employees by denying them the cherished right to choose the type of health care which they prefer a right enjoyed by hundreds of thousands of employees outside the Federal service.

During the hearings on the bills, introduced in the 77th and 79th Congresses, several employee groups testified that chiropractic care was desired by certain employees whose duties are likely to incur injuries which respond to chiropractic care. The report refers to this testimony, and the members of the committee declared that they were impressed by the large number of people who stated they felt chiropractic treatment resulted in quicker relief and remedy and hastened their return to work.

I should like to add that it would seem evident that the present law is discriminatory against employees who desire chiropractic care since it denies them a basic American right, the freedom of choice in selecting the type of care or the physician of their choice when these Government employees sustain an injury while on duty.

It is now 18 years since that report was written. The statements made in it are still true-and some of them are doubly true. The committee made favorable comment on the manner in which the chiropractic profession was raising its standards. I am pleased to say that the professional standards and the educational requirements of the chiropractic profession have all been raised to even higher levels in these past 18 years, as Dr. Dewey Anderson will point out.

The committee said that it was impressed by the fact that so large a number of people sought chiropractic care. Yet, I daresay that the number of people being served by chiropractic care today is double the number that it was when this report was written. The committee may be interested in knowing that during the past 5 years, hundreds of labor unions have negotiated contracts which included health benefits providing for chiropractic care for factory workers.

Many large industries have expanded their health insurance plans to include chiropractic care, when it was pointed out to them that this service was being denied their employees. In short, chiropractic is becoming more and more accepted by the American public as an essential healing art. We believe that it is time to modernize the law to end discrimination which exists. We should provide Government employees with the full range of care and treatment to which they are entitled when they sustain any disability while on duty. The employees themselves want such discrimination to end and they have indicated they want to have chiropractic treatment available when they have any type of injury which responds more readily to chiropractic treatment.

In conclusion Mr. Chairman, I would like to add one further comment. I was an employee of the U.S. Senate when this bill's predecessor, S. 178 of the 79th Congress, was unanimously approved by the Senate. I was employed by Senator Elbert D. Thomas of Utah, who as you know, was a member of this committee at that time, and its chairman for many years. If any one had told me at that time that this same legislation would still be pending before the Congress a generation later I would not have dared to believe them. But here we are today, and the same bill, unanimously approved by the Senate 18 years ago, is still waiting to be approved by the Congress of the United States.

It seems to me that this fact is almost incredible. Particularly because of the additional fact that during those intervening 18 years this committee has, as I have already indicated, considered and approved a long list of measures which have brought about many pioneering reforms in the field of social legislationwhich have set new standards in many areas for local governments, industry labor, and public and private institutions to follow. Usually the Federal Government has been far in the forefront and has taken the lead in establishing standards governing working conditions, wages, and hours of employment, pen

sions, retirement compensation benefits, health care, pure food and drug laws, sanitation, water pollution regulations, fair employment practices, child labor laws, mine safety regulations, and standards in many other areas-and industry, State and local governments, and private and public institutions have followed the Federal Government's leadership. But we are considering here today in this legislation a flagrant example of how the Federal Government has lagged far behind local governments, labor, industry, and many private institutions by failing to afford its employees the right to choose the type of medical care which they prefer. It seems to me, therefore, that our Federal Government should rectify this situation as quickly as possible and reassume the traditional role of leadership in this area that it has traditionally held.

I trust, Mr. Chairman, that this committee will follow the suggestions and guidelines laid down by two previous congressional committees and report this legislation favorably. I respectfully request that Senate Report 1317 of the 79th Congress, from the Committee on Education and Labor, a copy of which is attached hereto, be incorporated in the record of the hearing at this point. Thank you.

Mr. BADGER. The American Chiropractic Association is a voluntary membership, nonprofit corporation serving the chiropractic profession through the United States of America as a representative service organization. The chiropractic profession, as you know, is a major professional health service dedicated to serving the public.

As such, it is vitally concerned with all of the implications of those provisions of the U.S. Employee's Compensation Act which are related to the standards of health care provided thereunder for injured and disabled Government employees.

The Burdick bill (S. 1710) proposes to amend the U.S. Employees' Compensation Act so that the services of chiropractors can be utilized in the care of injured and disabled Government employees who desire such care. This is not the first time legislation of this nature has been before Congress.

In the 77th Congress, a bill was introduced in the House of Representatives by Congressman John H. Tolan of California. That bill was favorably reported by both the subcommittee and the full Judiciary Committee of the House, which considered it. Unfortunately, action by the full committee came so late in the session that no floor vote was taken on this legislation.

In the 79th Congress, Senator Abe Murdock of Utah introduced S. 178, which was similar to the bill presently introduced by Senator Burdick. Hearings were held by the Committee on Education and Labor of the Senate, under the chairmanship of Senator Fulbright of Arkansas.

That committee favorably reported the bill by a unanimous vote. The report was No. 1317 of the 79th Congress. The bill passed the U.S. Senate unanimously June 14, 1946. I should like to refer briefly to parts of that report and offer some additional comments on the views taken by the members of the Education and Labor Committee. The report points out that the purpose of this legislation is expressly to permit Federal employees who are injured in the performance of their duties and are entitled to receive medical service at Government expense, under the Employees' Compensation Act, to utilize the services of chiropractors in those States, Territories, and possessions of the United States where chiropractic is a licensed healing profession. Later, in the report, it was pointed out that in 47 States and the District of Columbia, and Puerto Rico chiropractic is a licensed healing profession.

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