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 chiropractic 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.

53

CALIFORNIA

West's annotated California codes (1956)

***

Paragraph 1000-7. License to practice, issuance; practice authorized. which license shall authorize the holder thereof to practice chiropracti in the State California as taught in the chiropractic schools or colleges and also to use all necessary mechanical and hygienic and sanitary measures incident to the care of the body, but shall not authorize the practice of medicine, surgery, osteopathy, dentistry, or optometry, nor the use of any drug or medicine now or hereafter included in materia medica.

or

Paragraph 1000-15. Noncompliance with and violations of act. *** any licensee under this act who uses the word "doctor" or the prefix "Dr." without the word "chiropractor," or "D.C." immediately following his name *** or any other letters, prefixes or suffixes, the use of which would indicate that he or she was practicing a profession for which he held no license *** shall be guilty of misdemeanor ***

Paragraph 1000-13. Health regulations, death certificates, reports. Chiropractic licentiates shall observe and be subject to all State and municipal regulations relating to all matters pertaining to the public health, and shall sign death certificates and make reports as required by law to the proper authorities, and such reports are to be accepted by the officers of the departments to which the same are made. COLORADO

Colorado Revised Statutes 1953.

Edited *** under the supervision and direction

of the Committee on Statute Revision-Supplements to 1955

Chapter 23-1-2. Definition of chiropractic. Chiropractic is defined as the science of locating and removing interference with nerve transmission. A license to practice chiropractic granted by the board of examiners shall confer upon the licensee the right to practice chiropractic as defined and to use such other sanitary and hygienic measures necessary to such practice; use the title "doctor" or "Dr." when accompanied by the word "Chiropractor" or the letters "D.C." *** A license to practice chiropractic granted by the board of examiners shall not confer upon the licensee the right to practice surgery or obstetrics, prescribe, compound, or administer drugs or to administer anaesthetics.

CONNECTICUT

The General Statutes of Connecticut. Revision of 1949, published by authority of the State. Supplements to 1955

Chapter 209, section 4381. *** Any chiropractor who shall have complied with the provisions of this chapter (i.e. passed examinations) may adjust by hand any articulation of the spinal column, but shall not prescribe for or administer to any person any medicine or drug included in materia medica or perform any surgery or practice obstetrics or osteopathy.

Chapter 209, section 4385. Use of names and titles. No licensee under the provision of this chapter shall use the title "Doctor" or any abbreviation or synonym thereof unless he holds the degree of doctor of chiropractic from a chartered chiroprac.ic school or college, in which event the title shall be such as will designate the licensee as a practitioner of chiropractic.

Chapter 209, section 4386. Practice of chiropractic defined. The practice of chiropractic shall be understood to be the adjustment by hand of any or all of the articulations of the human vertebral column.

DELAWARE

Delaware Code Annotated. Prepared under legislative authority by the Revised Code Commission (1953). Supplements to 1956

Title 24, paragraph 701. Definition and limitation of chiropractic. Chiropractic is the science of locating and removing any interference with the transmission of nerve energy. A license granted under the provision of this act shall not entitle a licensee to use drugs, surgery, osteopathy, obstetrics, dentistry, optometry or chiropody.

Title 24, paragraph 715. Chiropractic practitioners subject to regulation. Chiropractic practitioners shall observe and be subject to all State and municipal regulations relating to the control of contagious and infectious diseases, and any

and all matters pertaining to public health, reporting to the proper health officer the same as other practitioners.

DISTRICT OF COLUMBIA

District of Columbia Code (annotated), 1951 edition. Published under the direction of the Committee on the Judiciary, House of Representatives. Supplements to January 2, 1956

The Code does not contain any definition of chiropractic, but it mentions the licensing of it in paragraph 2-120 (20:140).

"Drugless method of healing" is defined in paragraph 2-101 (20:121) as "any system of healing that does not resort to the use of drugs, medicine, or operative surgery, for the prevention, relief, or cure of any disease."

FLORIDA

Florida Statutes 1955. Paragraph 460.11. Definition, principles and practice, practitioners, chiropractic analysis. (1) For all purposes chiropractic is defined to be a noncombative principle and practice consisting of the science of the adjustment, manipulation, and treatment of the human body in which vertebral sublaxations and other malpositioned articulations and structures that are exerting pressure upon nerves and thus interferring with the normal transmission of vital energy from the brain to organs, tissues and cells of the body, thereby causing disease, are adjusted, manipulated or treated to their normal position, thereby restoring the normal flow of vital nervous energy which produces normal function and consequent health.

Prepared by Statutory Revision Department (1955)

(2) Any chiropractor who has complied with the provision of this chapter may: (a) examine, analyze, and diagnose the human living body and its diseases by the use of any physical, chemical, electrical, thermal or radionic method, and use the X-ray diagnosing, and may use any other general method of examination for diagnosis and analysis taught in any school of chiropractic recognized at any time by the Florida State Board of Chiropractic Examiners. (b) Chiropractors may adjust, manipulate, or treat the human body by manual, mechanical, electrical, or natural methods, or by the use of physical means, physiotherapy (including light, heat, water, or exercise) or by the use of foods and food concentrates, food extracts, and may apply first aid and hygiene, but chiropractors are expressly prohibited from prescribing or administering to any person any medicine or drug included in materia medica or perform any surgery, except as hereinabove stated, or practice obstetrics. (c) ***.

(d) Chiropractors shall have the use of the works of any State, County, or Municipal laboratory which is supported wholly or in part by public tax

money.

(3) The term "chiropractic" or "doctor of chiropractic" shall be construed to mean a practitioner of chiropractic as the same has been hereinabove defined, and the chiropractic method of examination is hereby defined to mean an analysis. Doctors of chiropractic may analyze the physical conditions of the human body to determine the abnormal functions of the human organism, and to determine such functions as are abnormally expressed, and how such functions are abnormally expressed, and the cause of such abnormal expression.

(4) Any chiropractor who has complied with the provision of this chapter is authorized to analyze abnormal bodily functions, and to adjust the physical representative of the primary cause of disease as is herein defined and provided, and as an incident to the care of the sick, chiropractors may advise and instruct patients in all matters pertaining to hygiene and sanitary measures as taught by recognized Chiropractic Schools and Colleges.

GEORGIA

Code of Georgia Annotated (1955)

Title 84-501. "Chiropractic" defined. The term "chiropractic" as used in this chapter means the adjustment of the articulation of the human body, including illium, sacrum, and coccyx, and in the use of electricity X-ray photography, but the X-ray shall not be used for therapeutical purposes (Acts 1921, pp. 166, 167).