2 1 retary of Labor, are likely to cure or to give relief or to re2 duce the degree or the period of disability or to aid in lessen3 ing the amount of the monthly compensation. Such serv4 ices, appliances, and supplies shall be furnished by or upon 5 the order of United States medical officers and hospitals, but 6 where this is not practicable they shall be furnished by or 7 upon the order of private physicians and hospitals, or chiro8 practic practitioners, designated or approved by the Secre9 tary of Labor." 10 12 SEC. 2. Paragraph (e) of section 40 of such Act, as 11 amended (5 U.S.C. 790), is amended to read as follows: "(e) The term 'medical, surgical, and hospital services 13 and supplies' includes services and supplies by osteopathic 14 and chiropractic practitioners and hospitals as licensed by 15 State law and within the scope of their practice as defined 16 by State law." U.S. DEPARTMENT OF LABOR, Hon. LISTER HILL, OFFICE OF THE SECRETARY, Washington, D.C., February 7, 1964. Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: This is in further response to your request for our views on S. 1710, a bill to amend the sections 9 and 40 of the Federal Employees' Compensation Act, as amended. In our letter to you concerning this bill, dated September 30, 1963, we did not specifically comment on the fact that it would limit the use of chiropractic services to cases in which the employee's injury involves a strain or sprain. However, we did carefully consider this feature of the bill, and concluded that notwithstanding its restricted application, the proposal is subject to the objections we have previously stated. In addition to those objections, we might also call attention to the fact that certain ailments which are entirely unrelated to strains or sprains are sometimes first manifested by the same symptoms as they are. In such situations we doubt that a person who is not a medical doctor would be the best qualified to correctly diagnose the illness or to prescribe treatment therefor. For this reason, and the reasons discussed in our earlier letter, we are opposed to the enactment of S. 1710. Yours sincerely, W. WILLARD WIRTZ, Hon. LISTER HILL, U.S. DEPARTMENT OF LABOR, Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: This is in further response to your letter requesting comments on S. 1710, a bill to amend sections 9 and 40 of the Federal Employees' Compensation Act, as amended, and S. 2078, a bill to amend the Federal Employees' Compensation Act so as to permit injured employees entitled to receive medical services under such act to utilize the services of chiropractors. These bills would amend sections 9 and 40 of the Federal Employees' Compensation Act to grant statutory authority to chiropractic practitioners, within the range of their practice as defined by State law, to participate on an equality with doctors of medicine and osteopathic physicians in the treatment ofbe neficiaries under the act. In general, chiropractors, where licensed to practice under State law, are prohibited from the practice of surgery, and the administration or prescription of drugs or medicines. In addition to such statutory limitations, they usually have no hospital privileges. In view of these restrictions, it is doubtful whether Federal employees who sustain personal injuries in the course of their employment would be able to get adequate medical treatment under this particular theory of healing. Moreover, the Federal Employees' Compensation Act does not preclude the use of chiropractic services in appropriate cases. The services of chiropractors, physiotherapists and other specialists may be used where recommended by and carried out under the direction of a U.S. medical officer or a duly qualified physician trained and licensed to engage in the practice of medicine. In view of this fact, it is not necessary to amend the act to permit the use of such services. We, therefore, oppose the enactment of these bills. The Bureau of the Budget advises that there is no objection to the submission of this report from the standpoint of the administration's program. Yours sincerely, W. WILLARD WIRTZ, EXECUTIVE OFFICE OF THE PRESIDENT, BUREAU OF THE BUDGET, Washington, D.C., November 27, 1963. Hon. LISTER HILL, Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: This is in reply to your letters of June 20 and August 27, 1963, requesting the views of this office on S. 1710 and S. 2078, bills which would amend sections 9 and 40 of the Federal Employees' Compensation Act to permit the use of chiropractors. The Secretary of Labor is recommending against enactment of these bills in a report being made to your committee. The Bureau of the Budget concurs in the views of the Department of Labor in its report on S. 1710 and S. 2078, and accordingly recommends against enactment of these bills. Sincerely yours, PHILLIP S. HUGHES, Assistant Director for Legislative Reference. Senator METCALF. The hearing this morning on the two bills, S. 1710 and S. 2078, to amend the Federal Employees' Compensation Act. This will be held before a Special Subcommittee on Federal Employees' Compensation set up by our distinguished chairman, Senator Lister Hill, for this special purpose. The special subcommittee consists of five members, Senators McNamara, Morse, Javits, and Jordan, in addition to myself. Senator Hill has honored me by asking me to serve as chairman of this special subcommittee. The purpose of the hearing this morning is to determine whether the distinction which the Federal Government has drawn between physicians, surgeons, and osteopaths on the one hand, and chiropractors on the other can be supported. The two bills which have been referred to this special subcommittee and on which we are having these hearings would, in somewhat different degrees do away with the distinction by authorizing chiropractors, to provide chiropractic services under the Federal Employees' Compensation law, upon the request of the injured employee, within the scope of their practices as permitted and defined by the law of the States. Our first witness is my neighbor out West, Senator Burdick of North Dakota. Now let's get on with the hearing. Senator Burdick, we are delighted to have you before the subcommittee and you may proceed in any way you wish. STATEMENT OF HON. QUENTIN N. BURDICK, A U.S. SENATOR FROM THE STATE OF NORTH DAKOTA Senator BURDICK. Mr. Chairman, it is a pleasure to appear on behalf of S. 1710, to permit employees of the United States to seek chiropractic services under the U.S. Employees' Compensation Act. As you know, I introduced similar legislation in the 87th Congress and, as a member of this committee chaired a hearing on it in May 1962. I hope that this year we can demonstrate unmistakably the desirability and equity of early enactment of S. 1710. Approved in 1916, the U.S. Employees' Compensation Act provides for medical, surgical and hospital services for the treatment of injuries sustained by Federal employees in the course of their duties. Whenever available, these services are to be provided by the Public Health Service and similar Federal medical agencies. When not available, the bureau chief or supervisor authorizes the use of private practitioners from a list approved by the Secretary of Labor. While the law does not preclude chiropractors, it has been so administered that chiropractors are never or seldom granted the necessary authorization. A Federal employee injured on the job for a back injury goes to a chiropractor, believing he is entitled to compensation. He presents his bill to the Government, but it is refused on the grounds that chiropractic services must be recommended by a U.S. medical officer or a duly qualified physician-a recommendation that is never or seldom made. Mr. Chairman, 30 years ago osteopaths found themselves in this identical situation. They were shut out just as chiropractors presently are. Corrective action was taken in 1938 to include osteopaths within the definition of practitioners under the Compensation Act. The time is overdue when chiropractors should also be included. That is the purpose of my bill. All S. 1710 would do is to allow an injured Federal worker to have the Federal Government pay for his treatment by a chiropractor, if that is the kind of treatment he desires. The bill does not give chiropractors the right to prescribe medicine or to perform surgery. It simply recognizes the right of chiropractors to provide services in their field of competence, specifically in treating strains and sprains, a category of injuries that includes nearly half of all claims filed under the Compensation Act. In this connection, it should be noted that the States have traditionally set up the qualifications for practice in the healing arts. Forty-seven States, the District of Columbia, and Puerto Rico, in licensing chiropractors, have established guidelines. My State of North Dakota defines a chiropractor as follows: The practice of chiropractic shall mean the practice of physiotherapy, electrotherapy, and hydrotherapy as taught by chiropractic schools and colleges, and the adjustment of any displaced tissue of any kind or nature, but shall not include prescribing for or administering to any person any medicine or drug to be taken internally which is now or hereafter included in materia medica, nor performing any surgery, except as is provided in this section, nor practicing obstretics * * *. Elsewhere, the North Dakota statute provides that— * A licensed chiropractor may not use the title of doctor, physician, or surgeon, but may use the title doctor of chiropractic, or D.C. Mr. Chairman, the chiropractic profession is constantly improving its training programs and has attained a position of respect and responsibility in the healing arts. The competence of chiropractors is becoming more and more widely recognized. It is recognized by workmen's compensation departments in all but a handful of States. It is recognized by threefourths of the commercial health insurers in one or more of their policies. It is recognized increasingly in health plans of labor unions and industry. Why then, should the Federal Government be out of step? Why should a Federal employee be denied reimbursement for chiropractic services? The Federal Government, of course, should keep pace, and it should give its employees the right to consult chiropractors about injuries their profession is well qualified to treat. Enactment of S. 1710 would insure this result, and I respectfully urge your subcommittee to act favorably on it. Thank you, Mr. Chairman. Senator METCALF. Senator Burdick, as I understand it, your bill just provides for treatment of strains and sprains. Senator BURDICK. Yes. Senator METCALF. Even in those States where a broader permission is given, if there are such States it shall be limited? Senator BURDICK. Yes. Senator METCALF. Thank you, Senator Burdick, for your very helpful testimony. We hoped that Senator Magnuson may be here, and he may come in. We have a statement from Senator Magnuson and it will be included in the record at this point. STATEMENT OF HON. WARREN G. MAGNUSON, A U.S. SENATOR FROM THE STATE OF WASHINGTON Senator MAGNUSON. Mr. Chairman, I appreciate this opportunity to testify in favor of my bill, S. 2078. My measure would amend the Federal Employees' Compensation Act so as to permit injured employees entitled to receive medical services under such act to utilize the services of chiropractors. I have sponsored this and similar measures over the years because I believe that in those States where chiropractic is a licensed healing profession, the individual choice on the part of the patient should prevail. The purpose of my bill 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. Forty-seven States, Puerto Rico, the District of Columbia, the Canal Zone, most provinces in Canada-all have licensing laws which recognize chiropractic is a healing profession. The public is using the services of chiropractors in ever-increasing numbers. A large and growing number of people are convinced that the chiropractic method of treatment affords better means for the remedy and care of certain illnesses and injuries. Also, the chiropractic profession has been carrying on continuous and successful efforts to raise its educational requirements and professional standards. Only recently, a National Professional Association of Chiropractors combined its midyear directors' meeting with a demonstration staged by officials of the U.S. Food and Drug Administration in its fight. against medical quackery. Many Federal employees suffering injuries use the services of chiropractors. The Government is penalizing those employees injured in performance of their duty by causing them to pay for chiropractic treatment-even when such treatment hastens the employees' return to duty and reduces the cost of the injury to the Government. It has been stated that the Employees' Compensation Act gives the Commission discretion to permit the services of chiropractors to be utilized at Government expense. However, the Commission has so administered the law that the services of the chiropractor have to |