S.B. 149

1

CHIROPRACTIC PRACTICE AMENDMENTS
2 1997 GENERAL SESSION
3 STATE OF UTAH
4 Sponsor: David H. Steele
5 AN ACT RELATING TO HEALTH; AMENDING THE CHIROPRACTIC PRACTICE ACT;
6 AMENDING THE DEFINITION OF UNLAWFUL CONDUCT AND PROVIDING
7 PENALTIES; AMENDING THE DEFINITION OF CHIROPRACTIC; AND AMENDING
8 THE SCOPE OF PRACTICE.
9 This act affects sections of Utah Code Annotated 1953 as follows:
10 AMENDS:
11 58-73-102, as renumbered and amended by Chapter 253, Laws of Utah 1996
12 58-73-601, as last amended by Chapters 247, 248 and renumbered and amended by Chapter
13 253 and last amended by Chapter 282, Laws of Utah 1996
14 ENACTS:
15 58-73-502, Utah Code Annotated 1953
16 Be it enacted by the Legislature of the state of Utah:
17 Section 1. Section 58-73-102 is amended to read:
18 58-73-102. Definitions.
19 (1) "Adjustment of the articulation of the spinal column" means performance by a
20 chiropractic physician by the use of passive movements directed toward the goal of restoring joints
21 to their proper physiological relationship of motion and related function, releasing adhesions, or
22 stimulating joint receptors using one or more of the following techniques:
23 (a) impulse adjusting or the use of sudden, high velocity, short amplitude thrust of a nature
24 that the patient cannot prevent the motion, commencing where the motion encounters the elastic
25 barrier of resistance and ends at the limit of anatomical integrity;
26 (b) instrument adjusting, utilizing instruments specifically designed to deliver sudden, high
27 velocity, short amplitude thrust;

1 (c) light force adjusting utilizing sustained joint traction or applied directional pressure,
2 or both, which may be combined with passive motion to restore joint mobility; and
3 (d) long distance lever adjusting utilizing forces delivered at some distance from the
4 dysfunctional site and aimed at transmission through connected structures to accomplish joint
5 mobility.
6 (2) "Board" means the Chiropractic Physician Licensing Board created in Section
7 58-73-201.
8 [(4)] (3) "Chiropractic physician" means a person who has been licensed under this chapter
9 to practice chiropractic.
10 [(5)] (4) "Diagnosis of the articulation of the spinal column" means to examine the
11 articulations of the spinal column of another human to determine the source, nature, kind, or extent
12 of a disease, vertebral sublixation, or other physical condition, and to make a determination of the
13 source, nature, kind, or extent of a disease or other physical condition.
14 [(6)] (5) "Elastic barrier" means the point at which the patient cannot move a joint by his
15 own means and through which movement is obtained or caused by a practitioner's skillful
16 treatment using the practitioner's hands in a manipulation of a joint by thrust of sudden, high
17 velocity, short amplitude so the patient cannot prevent the motion.
18 [(7)] (6) "Incisive surgery" means any procedure having the power or quality of cutting
19 of a patient for the purpose of treating disease, injury, or deformity, and includes the use of laser.
20 [(8)] (7) (a) "Manipulate the articulation of the spinal column" means use by a practitioner
21 of a skillful treatment using the practitioner's hands in a manipulation of a joint by thrust of
22 sudden, high velocity, short amplitude so the patient cannot prevent the motion. Movement of the
23 joint is by force beyond its active limit of motion.
24 (b) This manipulation commences where mobilization ends and specifically begins when
25 the elastic barrier of resistance is encountered and ends at the limit of anatomical integrity.
26 (c) Manipulation as described in this definition is directed to the goal of restoring joints
27 to their proper physiological relationship of motion and related function, releasing adhesions, or
28 stimulating joint receptors.
29 [(3)] (8) "[Chiropractic] Practice of chiropractic" means a practice of a branch of the
30 healing arts:
31 (a) the purpose of which is to restore or maintain human health, in which patient care or

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1 first aid, hygienic, nutritional, or rehabilitative procedures are administered; [and]
2 (b) which places emphasis upon specific vertebral adjustment, manipulation, and treatment
3 of the articulation and adjacent tissues of the spinal column, musculoskeletal structure of the body,
4 and nervous system;
5 (c) that involves examining, diagnosing, treating, correcting, or prescribing treatment for
6 any human disease, ailment, injury, infirmity, deformity, pain, or other condition, or the attempt
7 to do so, in accordance with Section 58-73-601;
8 (d) that involves diagnosing, prescribing treatment, or making a determination of treatment
9 necessity for another person's condition by means of:
10 (i) a physical examination of the person; or
11 (ii) a determination based upon or derived from information supplied directly or indirectly
12 by a third person; and
13 (e) h MEANS h when a person not licensed under this chapter directs a licensee under this
13a chapter to
14 withhold or alter the health care services the licensee has ordered.
15 (9) "Therapeutically position the articulation of the spinal column" means to adjust or
16 manipulate the articulation of the spinal column.
17 Section 2. Section 58-73-502 is enacted to read:
18 58-73-502. Unlawful conduct -- Penalties.
19 (1) "Unlawful conduct" includes, in addition to the definition in Section 58-1-501:
20 (a) buying, selling, or fraudulently obtaining any chiropractic diploma, license, certificate,
21 or registration; S [or] s
22 (b) aiding or abetting the buying, selling, or fraudulently obtaining of any chiropractic
23 diploma, license, certificate, or registration S [.] ;
23a (c) SUBSTANTIALLY INTERFERING WITH A LICENSEE'S LAWFUL AND COMPETENT PRACTICE
23b OF CHIROPRACTIC IN ACCORDANCE WITH THIS CHAPTER BY:
23c (i) ANY PERSON OR ENTITY THAT MANAGES, OWNS, OPERATES, OR CONDUCTS A BUSINESS
23d HAVING A DIRECT OR INDIRECT FINANCIAL INTEREST IN THE LICENSEE'S PROFESSIONAL
23e PRACTICE; OR
23f (ii) ANYONE OTHER THAN ANOTHER CHIROPRACTIC PHYSICIAN LICENSED UNDER THIS
23g TITLE, WHO IS ENGAGED IN DIRECT CLINICAL CARE OR CONSULTATION WITH THE LICENSEE IN
23h ACCORDANCE WITH THE STANDARDS AND ETHICS OF THE PROFESSION OF CHIROPRACTIC;
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Amend on 3_goldenrod February 21, 1997 23i (d) ENTERING INTO A CONTRACT THAT LIMITS A LICENSEE'S RESPONSIBILITY TO ADVISE

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23j THE LICENSEE'S PATIENTS FULLY ABOUT TREATMENT OPTIONS OR OTHER ISSUES THAT
23k AFFECT THE HEALTH CARE OF THE LICENSEES'S PATIENTS; OR
23l (e) DIRECTING OR INTERFERING WITH A LICENSED CHIROPRACTIC PHYSICIAN'S JUDGMENT
23m AND COMPETENT PRACTICE OF CHIROPRACTIC.
23n (2) "UNLAWFUL CONDUCT" DOES NOT INCLUDE:
23o (a) ESTABLISHING, ADMINISTERING, OR ENFORCING THE PROVISIONS OF A POLICY OF
23p DISABILITY INSURANCE BY AN INSURER DOING BUSINESS IN THIS STATE IN ACCORDANCE WITH
23q TITLE 31A, INSURANCE CODE;
23r (b) ADOPTING, IMPLEMENTING, OR ENFORCING UTILIZATION MANAGEMENT STANDARDS
23s RELATED TO PAYMENT FOR A LICENSEE'S SERVICES, PROVIDED THAT;
23t (i) UTILIZATION MANAGEMENT STANDARDS ADOPTED, IMPLEMENTED, AND ENFORCED BY
23u THE PAYER HAVE BEEN APPROVED BY A LICENSED CHIROPRACTIC PHYSICIAN, OR BY A
23v COMMITTEE THAT CONTAINS ONE OR MORE LICENSED CHIROPRACTIC PHYSICIANS; AND
23w (ii) THE UTILIZATION MANAGEMENT STANDARDS DO NOT PRECLUDE A LICENSEE FROM
23x EXERCISING INDEPENDENT PROFESSIONAL JUDGMENT ON BEHALF OF THE LICENSEE'S PATIENTS
23y IN A MANNER THAT IS INDEPENDENT OF PAYMENT CONSIDERATIONS;
23z (c) DEVELOPING AND IMPLEMENTING CLINICAL PRACTICE STANDARDS THAT ARE INTENDED
23aa TO REDUCE MORBIDITY AND MORTALITY OR DEVELOPING AND IMPLEMENTING OTHER
23bb CHIROPRACTIC PRACTICE STANDARDS RELATED TO THE STANDARDIZATION OF EFFECTIVE
23cc HEALTH CARE PRACTICES, PROVIDED THAT:
23dd (i) THE PRACTICE STANDARDS AND RECOMMENDATIONS HAVE BEEN APPROVED BY A
23ee LICENSED CHIROPRACTIC PHYSICIAN, OR BY A COMMITTEE THAT CONTAINS ONE OR MORE
23ff CHIROPRACTIC PHYSICIANS; AND
23gg (ii) THE PRACTICE STANDARDS DO NOT PRECLUDE A LICENSEE FROM EXERCISING
23hh INDEPENDENT PROFESSIONAL JUDGMENT ON BEHALF OF THE LICENSEE'S PATIENTS IN A
23ii MANNER THAT IS INDEPENDENT OF PAYMENT CONSIDERATIONS;
23jj (d) REQUESTING OR RECOMMENDING THAT A PATIENT OBTAIN A SECOND OPINION FROM A
23kk LICENSEE;
23ll (e) CONDUCTING PEER REVIEW, QUALITY EVALUATION, QUALITY IMPROVEMENT, RISK
23mm MANAGEMENT, OR SIMILAR ACTIVITIES DESIGNED TO IDENTIFY AND ADDRESS PRACTICE
23nn DEFICIENCIES WITH HEALTH CARE PROVIDERS, HEALTH CARE FACILITIES, OR THE DELIVERY OF
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23oo HEALTH CARE;
23pp (f) PROVIDING EMPLOYMENT SUPERVISION OR ADOPTING EMPLOYMENT REQUIREMENTS
23qq THAT DO NOT INTERFERE WITH THE LICENSEE'S ABILITY TO EXERCISE
23rr INDEPENDENT PROFESSIONAL JUDGMENT ON BEHALF OF THE LICENSEE'S PATIENTS, PROVIDED
23ss THAT EMPLOYMENT REQUIREMENTS THAT MAY NOT BE CONSIDERED TO INTERFERE WITH AN
23tt EMPLOYED LICENSEE'S EXERCISE OF INDEPENDENT PROFESSIONAL JUDGMENT INCLUDE:
23uu (i) AN EMPLOYMENT REQUIREMENT THAT RESTRICTS THE LICENSEE'S ACCESS TO
23vv PATIENTS WITH WHOM THE LICENSEE'S EMPLOYER DOES NOT HAVE A CONTRACTUAL
23ww RELATIONSHIP, EITHER DIRECTLY OR THROUGH CONTRACTS WITH ONE OR MORE THIRD-PARTY
23xx PAYERS; OR
23yy (ii) PROVIDING COMPENSATION INCENTIVES THAT ARE NOT RELATED TO THE TREATMENT
23zz OF ANY PARTICULAR PATIENT;
23aaa (g) PROVIDING BENEFIT COVERAGE INFORMATION, GIVING ADVICE, OR EXPRESSING
23bbb OPINIONS TO A PATIENT OR TO A FAMILY MEMBER OF A PATIENT TO ASSIST THE PATIENT OR
23ccc FAMILY MEMBER IN MAKING A DECISION ABOUT HEALTH CARE THAT HAS BEEN RECOMMENDED BY
23ddd A LICENSEE; OR
23eee (h) ANY OTHERWISE LAWFUL CONDUCT THAT DOES NOT SUBSTANTIALLY INTERFERE WITH
23fff THE LICENSEE';S ABILITY TO EXERCISE INDEPENDENT PROFESSIONAL JUDGMENT ON BEHALF OF
23ggg THE LICENSEE'S PATIENTS AND THAT DOES NOT CONSTITUTE THE PRACTICE OF CHIROPRACTIC
23hhh AS DEFINED IN THIS CHAPTER. s
24 S [(2)] (3) s Any person who violates any provision of this section or Subsection 58-1-501(1)(a)
25 or 58-1-501(1)(c) is guilty of a third degree felony.
26 Section 3. Section 58-73-601 is amended to read:
27 58-73-601. Scope of practice for a chiropractic physician.
28 (1) A chiropractic physician licensed under this chapter may engage in the practice of
29 chiropractic as defined in Section 58-73-102 in accordance with the following standards.
30 (2) A chiropractic physician may:
31 (a) examine, diagnose, and treat only within the scope of chiropractic as described in this
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Amend on 3_goldenrod February 21, 1997
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1 subsection;
2 (b) use x-ray for diagnostic purposes only;
3 (c) administer:
4 (i) physical agents, including light, heat, cold, water, air, sound, compression, electricity,
5 and electromagnetic radiation except gamma radiation; and
6 (ii) physical activities and devices, including:
7 (A) exercise with and without devices;
8 (B) joint mobilization;
9 (C) mechanical stimulation;
10 (D) postural drainage;
11 (E) traction;
12 (F) positioning;
13 (G) wound debridement, cleansing, and dressing changes;
14 (H) splinting;
15 (I) training in locomotion and other functional activities with and without assistance
16 devices; h [ [ ] and [ ] ] h
17 (J) correction of posture, body mechanics, and gait; h [ and
18 (K) acupuncture; ] h
19 (d) administer the following topically applied medicinal agents, including steroids,
20 anesthetics, coolants, and analgesics for wound care and for musculoskeletal treatment, including
21 their use by iontophoresis or phonophoresis;
22 (e) treat pain incident to major or minor surgery, cancer, obstetrics, or x-ray therapy;
23 (f) utilize immobilizing appliances, casts, and supports for support purposes, but may not
24 set displaced bone fractures;
25 (g) inform the patient of possible side effects of medication and recommend referral to the
26 prescribing practitioner;
27 (h) provide instruction in the use of physical measures, activities, and devices for
28 preventive and therapeutic purposes;
29 (i) provide consulting, educational, and other advisory services for the purposes of
30 reducing the incidence and severity of physical disability, movement dysfunctions, bodily
31 malfunction, and pain;

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1 (j) treat a human being to assess, prevent, correct, alleviate, and limit physical disability,
2 movement dysfunction, bodily malfunction, and pain resulting from disorders, congenital and
3 aging conditions, injury, and disease; and
4 (k) administer, interpret, and evaluate tests.
5 (3) A chiropractic physician may not:
6 (a) perform incisive surgery;
7 (b) administer drugs or medicines for which an authorized prescription is required by law
8 except as provided in Subsection (2)(d);
9 (c) treat cancer;
10 (d) practice obstetrics;
11 (e) prescribe or administer x-ray therapy; or
12 (f) set displaced fractures.
13 (4) A chiropractic physician shall assume responsibility for his examinations, diagnoses,
14 and treatment.
15 (5) Nothing in this section authorizes a chiropractic physician to prescribe, possess for
16 dispensing, dispense, purchase without a prescription written by a licensed and authorized
17 practitioner, or administer, except under Subsection (2)(d), a drug requiring a prescription to
18 dispense, under Title 58, Chapter 37, Utah Controlled Substances Act, or Title 58, Chapter [17]
19 17a, Pharmacy Practice Act.
20 (6) Only primary health care providers licensed under this title as osteopathic physicians,
21 physicians and surgeons, S [naturopaths, ] s and chiropractic physicians, may diagnose, adjust,
22 manipulate, or therapeutically position the articulation of the spinal column.




Legislative Review Note
as of 1-22-97 4:04 PM

A limited legal review of this bill raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel

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Amend on 2_goldenrod February 20, 1997