Senator BURDICK. I want to thank Mr. Keating for a fine stateI might inquire, however, if members of his organization are beset with this type of physical trouble and to what extent they suffer from strains and sprains?

Mr. KEATING. We have one of the highest injury rate according to the Bureau of Employees Compensation. We have one of the highest rates of injury in the Federal Government. Our people, of course, walk routes delivering mail, a lot of them drive trucks delivering parcel post and collecting mail, and strains or sprains are very

common.

Many of our people do go to chiropractors. We have many, many cases brought to our attention where they have gone to a chiropractor, and because of this provision in the law, they have not been able to get the compensation due them. So, it is a very, very important piece of legislation as far as we are concerned.

Senator BURDICK. Do you know of employees who have gone to chiropractors and paid their bills out of their own pocket?

Mr. KEATING. They do, they have no other place to turn, because in all of the Health Benefit Acts, there is an exclusion clause in that prohibits the payment of an injury while employees are on duty for the Government. That is the responsibility of the Government. So they cannot get ordinary health benefit payments either. If they go to a chiroractor, they have to pay the bill themselves. Senator BURDICK. Thank you, Mr. Keating.

Senator METCALF. Thank you, Mr. Keating. I know that you can, without qualification, state that the Federal employees that you represent, which is a large representation, are in favor of this legisla

tion.

Mr. KEATING. They are very much in favor of this legislation. Senator METCALF. I regret very much the time that I have to leave has now finally arrived. Thank you for your appearance.

We also have statements from Mr. John O'Connor, legislative director of the United Federation of Postal Clerks; Mr. Greiner, president of the American Federation of Government Employees, and Mr. Emeigh, of the National Rural Letter Carriers' Association. They will be incorporated in the record at this point. (The statements referred to follow:)

PREPARED STATEMENT OF JOHN F. O'CONNOR, LEGISLATIVE DIRECTOR, UNITED FEDERATION OF POSTAL CLERKS

Mr. Chairman and members of the subcommittee, for the record and for purposes of identification, I am John F. O'Connor, legislative director of the United Federation of Postal Clerks. Our national headquarters are located in the Federation Building at 817 14th Street NW., Washington, D.C., and we are recognized as the national "exclusive" representative of postal clerks. We have a membership of approximately 160,000.

As an organization, we are in complete support of S. 1710 and S. 2078, introduced by Senators Burdick of North Dakota and Magnuson of Washington, respectively. These bills, if enacted into law, will provide an opportunity, under the Federal compensation law, for postal and Federal employees when injured on duty to use the services of all practitioners of the healing arts and not be limited n any way as at present.

Both bills are amendments to the present law to provide that employees may receive the services of chiropractors. We have long been in favor of this addition o the Compensation Act. As far back as 1945, Legislative Representative William [. Horner, one of my predecessors, testified in behalf of S. 178, introduced by the ormer Senator Abe Murdock, of Utah, and which proposed this same amendment o the Compensation Act.

It is not our intention to attempt to go into the technical details in any way concerning the healing arts as we feel that we are not competent to do so. We have some opinions concerning the possibilities and limitations of each of the healing arts. Many of us, and members of our families have been treated for various illnesses by doctors of medicine, osteopathic doctors, and doctors of chiropractic. As individuals, we have had the right and privilege to select the doctor which we thought would do the most good. We have found in the instances where we, or members of our families, have selected the chiropractic treatment because we thought it was needed that it proved very helpful. We think the same right should be extended to employees of the Federal Government under the Compensation Act.

Doctors of chiropractic can be extremely helpful to employees of the Federal Government for certain injuries, thereby reducing to a great degree the period of disability of the employee and lessening the amount necessary to be paid for compensation.

The road of the chiropractic healing art has not been an easy one since its inception some 60-odd years ago. Yet this healing art has thrived and has been beneficial to many, and this is proven by the fact that today there are many more schools teaching the chiropractic art than a few years ago; and the number of men and women practicing the art is far greater than a few years ago. Today, 46 States, as well as the territory of Puerto Rico and the District of Columbia have licensed chiropractors. The profession has continued to undergo changes and improvements, and has made great progress over the years through research and in raising its standard of treatment and practice.

A further indication of the recognition of the progress of this profession is that many States presently permit doctors of chiropractic art to practice under their workers compensation law. The Veterans' Administration has fully recognized chiropractic education under the GI bill and many hundreds of insurance companies allow doctors of chiropractic to make examinations for insurance.

We believe, quite definitely, that a chiropractic doctor can be helpful to Federal employees in many instances when injured, and we believe that in this enlightened day and age they should be recognized under the Federal employees compensation law. The chiropractic healing art can no longer be considered as visionary or impractical. It is a well-established healing profession and today chiropractic doctors have millions of patients indicating a general acceptance of this manner of healing by citizens of our country.

Mr. Chairman and members of the subcommittee, the membership of our organization desire the opportunity to have a free selection under the Compensation Act of any doctor they feel can be of help to them. The enactment of this legislation does not make it mandatory. It merely means that if the individual concerned, in his opinion, believes that he can secure better results he may, under the law, use the services of a chiropractor.

We trust the subcommittee will report favorably on this legislation. We also wish to thank you for the opportunity of appearing before the subcommittee and expressing our viewpoint.

PREPARED STATEMENT OF THE AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES

As an organization composed of Federal employees and dedicated to their welfare, the American Federation of Government Employees is keenly interested in any improvement which may be made to the Federal Employees Compensation Act. The reason is obvious-it is a law which provides benefits in an emergency, in a time of suffering, or upon the death of the wage earner member of a family. It is our desire to support any legislative proposal which will truly benefit Federal employees. If it relates to such a service as medical care, we believe it should not only meet standards of excellence but that it should also be supplied within the framework of adequate professional training and accepted ethical practice.

The two bills, S. 1710 and S. 2078, would amend the existing law by adding chiropractors to those practitioners of the healing art whose services are available and compensable under the act.

The proposed amendments ostensibly are designed to augment the services which are usable by Federal employees when they have suffered a physical injury or contracted a disease for which the law provides medical care or compensation. This is a worthy objective. Whether it is to be attained to the best interests of

the employees who will become beneficiaries of this law is a matter which should be determined by those who are trained in treating human ills and who are equipped to assess the training which is deemed necessary for the practitioner to function in a satisfactory manner.

The problem which this situation poses is similar to that which is related to the medical benefits or services provided for veterans of our wars and members of the active military service. It is largely a matter of determining the need for relieving various ills by persons trained and experienced in their diagnosis and treatment and who are prepared to prescribe treatment by medication or other means or to provide such corrective measures as surgery.

Within the scope of his training and skill, the chiropractor is recognized by public licensing authority as offering beneficial treatment. It is a licensing limited to a somewhat specific form of treatment which is exclusive of medication or surgery. The bills do not require anyone to avail himself of such treatment. They provide that it be offered under certain circumstances as are other medical services and that when utilized such service shall be included in that which is compensable under the law.

S. 1710 appears to equate chiropractic treatment with such ills as strains or sprains. These ailments comprised a significant portion of disabling nonfatal work injuries included in a study by the Bureau of Employees Compensation covering the decade 1952 to 1961. In this period there was a mounting rate of back injuries, other than vertebra and disk cases. The average rate was 355 per 100,000 employees for the last 5 years of the study, which was 24 percent above that for the preceding 5-year period.

The significance of strains or sprains is indicated in the cases reported to the BEC during the 3-year period 1958-60. Such injuries to the lower back numbered 11,993 cases, or 9.6 percent of the total. Strains or sprains to the back (general) numbered 9,284 cases, or 7.4 percent of the total. The average number of chargeable days per nonfatal disabling injury was 27. The average days for strains or sprains of the back varied from 16 for the upper back to 36 for the lower back. For the back (general) chargeable days average 19 per nonfatal disabling injury.

The American Federation of Government Employees is of the opinion that a decision as to the desirability of the proposed amendments in these two bills should be made after their impact on the welfare of beneficiaries of the Compensation Act has been carefully analyzed by experts in all related fields. It is our belief that medical or related service should be of the highest quality and that this standard should continue to prevail in all types of treatment authorized by the Federal Employees Compensation Act.

Thank you, Mr. Chairman, for making it possible to submit this comment on

these two bills.

TESTIMONY OF JOHN W. EMEIGH, SECRETARY, NATIONAL RURAL LETTER
CARRIERS' ASSOCIATION

Mr. Chairman, members of the subcommittee, I am John W. Emeigh, secretary of the National Rural Letter Carriers' Association, an organization composed of 43,000 regular, substitute, and retired rural letter carriers. I also serve as health insurance director of the rural carrier benefit plan of health insurance, an employee organization health plan under the Federal Employees Health Benefits Act of 1959.

May I first express the appreciation of the members of this association to Senator Quentin Burdick, of North Dakota, for the introduction of S. 1710 and to Senator Warren G. Magnuson, of Washington, for the introduction of S. 2078 which would amend the Federal Employees' Compensation Act to provide for payment of chiropractic services. We also appreciate the opportunity to appear before your committee and present the views and recommendations of this association.

It is important to first note that a definite problem does exist under the provisions of current law which denies coverage for chiropractics in workman's compensation cases. Employees who sustain work-connected injuries or disabilities may not presently elect treatment by chiropractic physicians if they desire to receive payment of, or reimbursement for required care and treatment under the Compensation Act.

The nature of a rural letter carrier's work involves a type of movement and constant stretching which does give rise to work-connected disabilities peculiarly subject to care and treatment of chiropractic. The fact that such treatment

cannot be paid for by the U.S. Government under the Compensation Act causes these employees to personally pay for care which, in our opinion, should be a responsibility of the United States.

The committee is, of course, aware of the fact that numerous health insurance plans presently provide such benefits to the insureds by making provision for payment to chiropractors. This coverage is granted in the rural carrier benefit plan of health insurance for non-work-connected injuries or disabilities. No payment, however, can be made under our insurance plan for any claim submitted for medical care costs or treatments in connection with on-the-job injuries or disabilities in those cases which are determined to be compensable under the Compensation Act. In compensable cases, therefore, the employee is denied benefits under both his health insurance and workmen's compensation. Our experience in making payment for chiropractic services would indicate that this is unfair to the employee. We maintain a constant review of claims in connection with administration of our health plan in order to assure proper payment under our program, and also to actuarially project our experience for the future in line with past and current experience. A check on claims submitted and paid does not produce any evidence that services in this chiropractic area of the benefit structure are generally overused or abused. Admittedly, in this area, just as in other areas of the benefit structure of any health plan, there is an occasional case which is considered either an abuse of the coverage by the insured individual, the doctor, the facility and/or over utilization of the benefits. We do not believe that the rare incidence of these claims is of sufficient gravity upon which any case can be built to continue to deny chiropractic coverage under workmen's compensation.

We do strongly recommend, however, that the "scope of practice" for chiropractic be specifically included in the language of any bill to be approved by the committee. Our experience in the operation of the rural carrier benefit plan indicates that definitive language is necessary in order to assure ethical chiropractic services.

We believe this could be accomplished by amending the Burdick bill, S. 1710, in subsection N by adding a new part (4) to provide a new definition as follows: "Scope of practice for chiropractic means spinal adjustments by hands and spinal X-rays to determine the presence or absence of vertebral subluxations or misalinements."

Such a definition would eliminate some current unethical practices which involve the use of quack machines and other questionable or medical practices. It should remove objections to the including of chiropractic under the Compensation Act and would, without question, permit sound, specific regulations and administration by the Secretary of Labor relative to this area of professional health care. The definition suggested as an amendment is the definition of chiropractie services appearing in the rural carrier benefit plan of health insurance. It has permitted sound administration of this benefit area of the plan.

It is also my understanding that this is a definition of chiropractic which is subscribed to by the International Chriopractors Association. With proper definition of the "scope of practice" in the legislation, we feel certain that adequate controls under the regulations of the Bureau of Employees Compensation would assure a proper administration of the act in regard to this type of healing care and treatment.

Mr. Chairman, this association wholeheartedly endorses legislation to provide chiropractic under the Compensation Act. We trust this committee will approve and report a bill which would permit the individual to exercise a free choice of health care in compensation cases and would remove the present discrimination against chiropractic.

Senator METCALF. The record will be held over until the 3d of July for further statements to be filed in support or opposition of this legislation. I thank you all for your coming here this morning. The subcommittee is adjourned.

(Whereupon, at 11:50 a.m., the subcommittee was adjourned.)

APPENDIX

SCOPE OF CHIROPRACTIC PRACTICE IN THE UNITED STATES (Prepared by the AMA, Washington office)

ALABAMA

The Code of Alabama,"adopted by the Act of Legislature of Alabama. Approved July 2, 1940. Supplements to 1955

Title 46, paragraph 259 (2837). The license issued to a chiropractic licentiate entitles him "to treat diseases of human beings by means of mechanotherapy according to the methods taught in the specific school, the teaching of which he proposes to practice, but shall not entitle him to practice major surgery or to prescribe or administer drugs."

ALASKA

Compiled Laws of Alaska, 1949, containing the general laws of the Territory of Alaska. (Published under authority of chapter 28, SLA, 1947)

Paragraph 35-3-2. Chiropractic defined. Chiropractic is defined as the science of locating and correcting interference with nerve energy transmission and expression within the human body, and the employment and practice of drugless therapeutics, including physiotherapy, hydrotherapy, mechanotherapy, phytotherapy, electrotherapy, chromotherapy, thermotherapy, thalmotherapy, corrective and orthopedic gymnastics and dietetics, which shall consist of and include the use of foods and such biochemical tissue building products and cell salts as are found within the normal human body, without the use of drugs or surgery (L. 1939, ch. 78, par. 2, p. 193).

ARIZONA

Arizona Revised Statutes, Annotated. Prepared under legislative authority laws 1956, chapter 129

Paragraph 32-925. Limitations upon practice of chiropractic. A person licensed under this chapter to practice chiropractic may adjust by hand any articulations of the spinal column, but he shall not prescribe or administer medicine or drugs, practice major or minor surgery, obstetrics or any other branch of medicine or practice osteopathy.

(Under the Arizona Statutes a practitioner of naturopathy or chiropractic is limited to nonsurgical and nonmedical methods *** Gates v. Kilcrease (1948) 66 Ariz. 328, 188 P 2d 247.)

ARKANSAS

Arkansas Statutes 1947. *** Compiled under the supervision of the Arkansas Statute Revision Commission. Supplements to 1955 (1956)

Paragraph 72-404. ***Chiropractors *** may adjust by hand the displaced segments of the vertebral column and any displaced tissue in any manner related thereto for the purpose of removing an injury, deformity or abnormality of human beings.

Paragrpah 72-405. Health and police regulations applicable.

***Chiro

practic practitioners hereunder shall be bound by all health police regulations of the State that shall apply to them and shall be qualified to sign death certificates and all other certificates pertaining to public health, with like effect as medical practitioners.