PRIOR PRINTER'S NOS. 1632, 1677, 1853, PRINTER'S NO. 4196 3763, 3956
No. 1362 Session of 1985
Report of the Committee of Conference
To the Members of the House of Representatives and Senate:
We, the undersigned, Committee of Conference on the part of the House of Representatives and Senate for the purpose of considering House Bill No. 1362, entitled: "An act providing for the licensing of chiropractors and the regulation of the practice of chiropractic; establishing the State Board of Chiropractic Examiners in the Department of State and providing for its powers and duties; providing for the supervision of schools COLLEGES of chiropractic, for the examination of applicants, for enforcement and for disciplinary actions; providing penalties; and making repeals," respectfully submit the following bill as our report: WILLIAM R. LLOYD, JR. GORDON J. LINTON MARVIN E. MILLER, JR. (Committee on the part of the House of Representatives.) JAMES J. RHOADES ROBERT J. MELLOW (Committee on the part of the Senate.)
AN ACT 1 Providing for the licensing of chiropractors and the regulation 2 of the practice of chiropractic; establishing the State Board 3 of Chiropractic in the Department of State and providing for 4 its powers and duties; providing for the supervision of 5 colleges of chiropractic, for the examination of applicants, 6 for enforcement and for disciplinary actions; providing 7 penalties; and making repeals. 8 TABLE OF CONTENTS 9 Chapter 1. Preliminary Provisions 10 Section 101. Short title. 11 Section 102. Definitions. 12 Chapter 3. State Board of Chiropractic 13 Section 301. State Board of Chiropractic. 14 Section 302. Powers and duties. 15 Section 303. Approval of chiropractic colleges. 16 Section 304. Certification to use adjunctive procedures. 17 Chapter 5. Licensure and Regulation 18 Subchapter A. Licensure 19 Section 501. Applications for license. 20 Section 502. Examination. 21 Section 503. Failure of examination. 22 Section 504. Reciprocity. 23 Section 505. Limited license. 24 Section 506. Refusal, suspension or revocation of license. 25 Section 507. Continuing chiropractic education. 26 Section 508. Professional liability insurance. 27 Section 509. Impaired professionals. 28 Subchapter B. General Regulation 29 Section 521. License required. 30 Section 522. Radiologic procedures; education and 31 training required.
1 Section 523. Reporting of multiple licensure. 2 Section 524. Display of certificate. 3 Section 525. Doctor of Chiropractic and abbreviation. 4 Section 526. Relationship with other branches of the healing 5 arts. 6 Section 527. Revoked licenses; reinstatement; reports to 7 the board. 8 Chapter 7. Penalty Provisions 9 Section 701. Practice of chiropractic without license 10 prohibited. 11 Section 702. Violation of other provisions. 12 Section 703. Civil penalty. 13 Section 704. Fines and penalties. 14 Chapter 11. Miscellaneous Provisions 15 Section 1101. Fees. 16 Section 1102. Current members of board. 17 Section 1103. Current licensees. 18 Section 1104. Existing regulations. 19 Section 1105. Reestablishment of agency. 20 Section 1106. Repeals. 21 Section 1107. Effective date. 22 The General Assembly of the Commonwealth of Pennsylvania 23 hereby enacts as follows: 24 CHAPTER 1 25 PRELIMINARY PROVISIONS 26 Section 101. Short title. 27 This act shall be known and may be cited as the Chiropractic 28 Practice Act. 29 Section 102. Definitions. 30 The following words and phrases when used in this act shall 19850H1362B4196 - 2 -
1 have the meanings given to them in this section unless the 2 context clearly indicates otherwise: 3 "Adjunctive procedures." Physical measures such as 4 mechanical stimulation, heat, cold, light, air, water, 5 electricity, sound, massage and mobilization. 6 "Board." The State Board of Chiropractic. 7 "Bureau." The Bureau of Professional and Occupational 8 Affairs. 9 "Chiropractic." A branch of the healing arts dealing with 10 the relationship between the articulations of the vertebral 11 column, as well as other articulations, and the neuro-musculo- 12 skeletal system and the role of these relationships in the 13 restoration and maintenance of health. The term shall include 14 systems of locating misaligned or displaced vertebrae of the 15 human spine and other articulations; the examination preparatory 16 to the adjustment or manipulation of such misaligned or 17 displaced vertebrae and other articulations; the adjustment or 18 manipulation of such misaligned or displaced vertebrae and other 19 articulations; the furnishing of necessary patient care for the 20 restoration and maintenance of health; and the use of board- 21 approved scientific instruments of analysis, including X-ray. 22 The term shall also include diagnosis, provided that such 23 diagnosis is necessary to determine the nature and 24 appropriateness of chiropractic treatment; the use of adjunctive 25 procedures in treating misaligned or dislocated vertebrae or 26 articulations and related conditions of the nervous system, 27 provided that, after January 1, 1988, the licensee must be 28 certified in accordance with this act to use adjunctive 29 procedures; and nutritional counseling, provided that nothing 30 herein shall be construed to require licensure as a chiropractor 19850H1362B4196 - 3 -
1 in order to engage in nutritional counseling. The term shall not 2 include the practice of obstetrics or gynecology, the reduction 3 of fractures or major dislocations, or the use of drugs or 4 surgery. 5 "Chiropractor." A practitioner of chiropractic. 6 "Commissioner." The Commissioner of Professional and 7 Occupational Affairs. 8 "Department." The Department of State of the Commonwealth. 9 CHAPTER 3 10 STATE BOARD OF CHIROPRACTIC 11 Section 301. State Board of Chiropractic. 12 (a) Establishment and composition.--There is hereby 13 established within the Department of State the State Board of 14 Chiropractic. The board shall consist of nine members as 15 follows: 16 (1) The commissioner. 17 (2) The Director of the Bureau of Consumer Protection in 18 the Office of Attorney General, or his designee. 19 (3) Two members representing the general public who 20 shall be appointed by the Governor with the advice and 21 consent of a majority of the members elected to the Senate. 22 (4) Five members, appointed by the Governor with the 23 advice and consent of a majority of the members elected to 24 the Senate, who are licensed to practice chiropractic under 25 the laws of this Commonwealth and who have been engaged in 26 the full-time practice of chiropractic in this Commonwealth 27 for at least five years immediately preceding their 28 appointment. No member shall be in any manner financially 29 interested in or connected with the faculty or management of 30 any school or college of chiropractic. No member shall be an 19850H1362B4196 - 4 -
1 officer, representative, agent or consultant to a local, 2 state or national professional society or private entity 3 which establishes standards adjudging the practice and fees 4 of licensed members of the chiropractic profession or shall 5 receive any remuneration in any form in an amount greater 6 than $5,000 from such society or entity, directly or 7 indirectly, or shall engage in any activity related to the 8 chiropractic profession for which he receives remuneration in 9 any form in an amount greater than $5,000, other than in the 10 ordinary course of the practice of chiropractic. 11 (b) Term and vacancies.--The term of office of each 12 professional and public member shall be four years from his 13 appointment or until his successor has been duly appointed and 14 qualified according to law but no longer than six months beyond 15 the four-year period. In the event that any member should die or 16 resign or otherwise become disqualified during his term of 17 office, his successor shall be appointed in the same way and 18 with the same qualifications as set forth in subsection (a) and 19 shall hold office for the unexpired term. No member shall be 20 eligible for appointment to serve more than two consecutive 21 terms. 22 (c) Quorum and officers.--A majority of the members of the 23 board serving in accordance with law shall constitute a quorum 24 for purposes of conducting the business of the board. Except for 25 temporary and automatic suspensions under section 506, a member 26 may not be counted as part of a quorum or vote on any issue 27 unless he is physically in attendance at the meeting. The board 28 shall annually select, from among its members, a chairman and a 29 secretary. 30 (d) Compensation.--Each member of the board other than the 19850H1362B4196 - 5 -
1 commissioner and the Director of the Bureau of Consumer 2 Protection shall receive $60 per diem when actually attending to 3 the work of the board. Members shall also receive the amount of 4 reasonable traveling, hotel and other expenses incurred in the 5 performance of their duties in accordance with Commonwealth 6 regulations. 7 (e) Attendance at meetings.--A member who fails to attend 8 three consecutive meetings shall forfeit his seat unless the 9 commissioner, upon written request from the member, finds that 10 the member should be excused from a meeting because of illness 11 or the death of an immediate family member. 12 (f) Attendance at training seminars.--A public member who 13 fails to attend two consecutive statutorily mandated training 14 seminars in accordance with section 813(e) of the act of April 15 9, 1929 (P.L.177, No.175), known as The Administrative Code of 16 1929, shall forfeit his seat unless the commissioner, upon 17 written request from the public member, finds that the public 18 member should be excused from a meeting because of illness or 19 the death of a family member. 20 Section 302. Powers and duties. 21 The board shall have powers and duties as follows: 22 (1) To provide for and regulate the issuance of a 23 license to any person: 24 (i) who meets the general and educational 25 qualifications of this act and who passes the examination 26 specified by the board; or 27 (ii) who meets the requirements for the issuance of 28 a license by reciprocity or of a limited license, as 29 provided for in this act. 30 (2) To decide matters relating to the issuance, renewal, 19850H1362B4196 - 6 -
1 suspension or revocation of licenses. 2 (3) To promulgate, adopt, and enforce in the manner 3 provided by law, the rules and regulations necessary to carry 4 out this act. 5 (4) To approve or disapprove chiropractic colleges in 6 accordance with section 303. 7 (5) To take appropriate actions to initiate injunctive 8 and criminal prosecution proceedings in connection with the 9 unlawful or unauthorized practice of chiropractic or other 10 violations of this act. Injunctive and criminal proceedings 11 shall be instituted in accordance with the act of October 15, 12 1980 (P.L.950, No.164), known as the Commonwealth Attorneys 13 Act. 14 (6) To provide for and schedule examinations in 15 accordance with this act and to contract with a professional 16 testing organization for the preparation and administration 17 of those examinations in accordance with section 812.1 of the 18 act of April 9, 1929 (P.L.177, No.175), known as The 19 Administrative Code of 1929. 20 (7) To conduct hearings and make adjudications, 21 including adjudications involving disciplinary actions. The 22 board may conduct such hearings or may designate a member of 23 the board or utilize a qualified hearing examiner to conduct 24 such hearings and to prepare adjudications, including 25 adjudications involving disciplinary actions, for final 26 revision and approval by the board. 27 (8) To keep a record showing the names and addresses of 28 all licensees under this act. 29 (9) To keep minutes and records of all its transactions 30 and proceedings, especially with relation to the issuance, 19850H1362B4196 - 7 -
1 denial, registration, formal reprimand, suspension and 2 revocation of licenses. In all actions or proceedings in any 3 court, a transcript of any board record or any part thereof, 4 which is certified to be a true copy by the board, shall be 5 entitled to admission in evidence. 6 (10) To submit annually to the House and Senate 7 Appropriations Committees, 15 days after the Governor has 8 submitted his budget to the General Assembly, a copy of the 9 budget request for the upcoming fiscal year which the board 10 previously submitted to the department. 11 (11) To submit annually a report to the Professional 12 Licensure Committee of the House of Representatives and to 13 the Consumer Protection and Professional Licensure Committee 14 of the Senate containing a description of the types of 15 complaints received, status of cases, board action which has 16 been taken and the length of time from the initial complaint 17 to final board resolution. 18 (12) To hold at least four meetings a year for the 19 conduct of its business upon giving public notice of such 20 meetings in the manner provided by law. 21 (13) To issue subpoenas, upon application of an attorney 22 responsible for representing the Commonwealth in disciplinary 23 matters before the board, for the purpose of investigating 24 alleged violations of the disciplinary provisions 25 administered by the board. The board shall have the power to 26 subpoena witnesses, to administer oaths, to examine witnesses 27 and to take testimony or compel the production of books, 28 records, papers and documents as it may deem necessary or 29 proper in and pertinent to any proceeding, investigation or 30 hearing held by it. Chiropractic records may not be 19850H1362B4196 - 8 -
1 subpoenaed without consent of the patient or without order of 2 a court of competent jurisdiction on a showing that the 3 records are reasonably necessary for the conduct of the 4 investigation. The court may impose such limitations on the 5 scope of the subpoena as are necessary to prevent unnecessary 6 intrusion into patient confidential information. The board is 7 authorized to apply to Commonwealth Court to enforce its 8 subpoenas. 9 Section 303. Approval of chiropractic colleges. 10 (a) Approval of colleges.--The board shall approve any 11 chiropractic college which is accredited by a chiropractic 12 accrediting agency recognized by the United States Department of 13 Education or the Council on Post-Secondary Accreditation, but 14 the board shall not approve any chiropractic college which is 15 not so accredited. 16 (b) Continuation of colleges pending accreditation.--Any 17 college which, on the effective date of this act, is not 18 accredited as provided in subsection (a) but which has been 19 approved by the board on the basis of a self-study and 20 inspection or has current status as a recognized candidate for 21 accreditation as provided in subsection (a) or whose graduates 22 were admitted to the most recent examination for licensure under 23 the act of August 10, 1951 (P.L.1182, No.264), known as the 24 Chiropractic Registration Act of 1951, shall have five years 25 from the effective date of this act in which to obtain 26 accreditation as provided in subsection (a). Such colleges shall 27 continue to offer chiropractic training and education in 28 accordance with the requirements of the Department of Education 29 of the Commonwealth. The Department of Education of the 30 Commonwealth shall periodically ascertain, by inspection and 19850H1362B4196 - 9 -
1 otherwise, the quality of instruction and facilities possessed 2 by such colleges. A person shall be admitted to the licensing 3 examination and shall be eligible for licensure if he otherwise 4 satisfies the requirements of this act and if he graduated from 5 any such college prior to the effective date of this act, 6 graduated within five years from the effective date of this act, 7 or graduated more than five years from the effective date of 8 this act but was enrolled at such college on the expiration of 9 five years from the effective date of this act. 10 Section 304. Certification to use adjunctive procedures. 11 (a) Qualifications.--In addition to its other powers and 12 duties under this act, the board shall have the power and duty 13 to certify qualified licensees to use adjunctive procedures. To 14 obtain such certification, a licensee shall submit an 15 application to the board on a form provided by the board showing 16 to the satisfaction of the board that the licensee: 17 (1) passed an examination for licensure to practice 18 chiropractic, which examination included the use of 19 adjunctive procedures, provided that no person shall be 20 required to take or pass an examination including the use of 21 adjunctive procedures in order to obtain a license under this 22 act; 23 (2) passed an examination on the use of adjunctive 24 procedures, which examination was prepared and administered 25 by a qualified and approved professional testing organization 26 in accordance with section 812.1 of the act of April 9, 1929 27 (P.L.177, No.175), known as The Administrative Code of 1929; 28 (3) completed a minimum of 100 hours of study in the use 29 of adjunctive procedures, as approved by the board; or 30 (4) used adjunctive procedures in the licensed practice 19850H1362B4196 - 10 -
1 of chiropractic for three years immediately preceding the 2 effective date of this act, provided that in order to 3 maintain such certification such a licensee shall, as part of 4 the continuing education required for renewal of a license 5 under this act, complete such additional study in the use of 6 adjunctive procedures as required by the board. 7 (b) Implementation.--The requirement for certification to 8 use adjunctive procedures shall not become effective until 9 January 1, 1988, provided that the board shall expedite review 10 of applications for certification beginning on the effective 11 date of this act. 12 CHAPTER 5 13 LICENSURE AND REGULATION 14 SUBCHAPTER A 15 LICENSURE 16 Section 501. Applications for license. 17 (a) Requirement for licensure.--An applicant for a license 18 under this act shall submit satisfactory proof to the board that 19 the applicant meets all of the following: 20 (1) Is 21 years of age or older. 21 (2) Is of good moral character. 22 (3) Has a high school diploma or its equivalent. 23 (4) Has completed two years of college or 60 credit 24 hours. 25 (5) Has graduated from an approved college of 26 chiropractic, with successful completion of not less than the 27 minimum number of hours of classroom and laboratory 28 instruction required by regulation of the board, which 29 minimum shall be at least 4,000 hours. 30 (6) Has passed the examination required under this act. 19850H1362B4196 - 11 -
1 (7) Has not been convicted of a felonious act prohibited 2 by the act of April 14, 1972 (P.L.233, No.64), known as The 3 Controlled Substance, Drug, Device and Cosmetic Act, or of an 4 offense under the laws of another jurisdiction which if 5 committed in this Commonwealth would be a felony under the 6 Controlled Substance, Drug, Device and Cosmetic Act, unless 7 the applicant satisfies all of the following criteria: 8 (i) At least ten years have elapsed from the date of 9 conviction. 10 (ii) Satisfactorily demonstrates to the board that 11 he has made significant progress in personal 12 rehabilitation since the conviction such that licensure 13 of the applicant should not be expected to create a 14 substantial risk of harm to the health and safety of his 15 patients or the public or a substantial risk of further 16 criminal violations. 17 (iii) Satisfies the qualifications contained in this 18 act. 19 An applicant's statement on the application declaring the 20 absence of a conviction shall be deemed satisfactory evidence 21 of the absence of a conviction, unless the board has some 22 evidence to the contrary. As used in this section, the term 23 "convicted" shall include a judgment, an admission of guilt 24 or a plea of nolo contendere. 25 (b) Renewal of licenses.--A license shall be renewed 26 biennially for a period of two years upon payment of the 27 biennial fee, provided that the licensee satisfies the other 28 requirements of this act. Any person who has failed to renew his 29 license for a period of longer than five years shall be required 30 to apply for a license in accordance with section 501(a) if he 19850H1362B4196 - 12 -
1 desires to resume practicing chiropractic. 2 Section 502. Examination. 3 (a) Admission.--The board shall admit to a standard 4 examination any applicant who has satisfied all of the 5 requirements of section 501 except for the requirement to have 6 passed the examination. The board may, in its discretion, permit 7 a student in good standing in his final semester in an approved 8 chiropractic college to be admitted to the standard examination, 9 provided he meets all the other requirements of this act, but he 10 must have certification of graduation from said college before a 11 license may be granted. 12 (b) Nature and content of examination.--The examination 13 shall be oral, practical and written, upon the principles and 14 technique of chiropractic and shall include the following 15 subjects: anatomy, physiology, histology, chemistry, pathology, 16 physics, bacteriology, diagnosis, hygiene and sanitation, 17 symptomatology, chiropractic analysis, X-ray, chiropractic 18 principles and a practical demonstration of chiropractic 19 technique. 20 (c) When conducted.--Examinations shall be conducted at 21 least twice each year. 22 (d) Testing organization.--All written, oral and practical 23 examinations required under this section shall be prepared and 24 administered by a qualified and approved professional testing 25 organization in accordance with section 812.1 of the act of 26 April 9, 1929 (P.L.177, No.175), known as The Administrative 27 Code of 1929, except that the oral and practical examinations 28 shall not be subject to section 812.1 until such examinations 29 are available from a testing organization. 30 (e) Score.--A license shall be granted to an applicant who 19850H1362B4196 - 13 -
1 meets the requirements of this act and who achieves: 2 (1) an overall score of at least 75% on the entire 3 examination; or 4 (2) an average score of at least 75% on the oral and 5 practical examination and a passing score on the written 6 examination administered by the National Board of 7 Chiropractic Examiners as such passing score is determined by 8 the national board. 9 Section 503. Failure of examination. 10 (a) Second examination.--Any applicant who shall fail any 11 examination shall, after the expiration of six months and within 12 two years, have the privilege of taking a second examination. 13 (b) Subsequent examinations.--The board may adopt 14 regulations governing the eligibility of applicants who have 15 failed to pass two examinations to be admitted to subsequent 16 examinations. 17 Section 504. Reciprocity. 18 The board may grant licenses without further examination to 19 individuals from other states and provinces of Canada if all of 20 the following conditions are met: 21 (1) The standards for licensing in such states or 22 provinces are substantially the same as those provided in 23 this act. 24 (2) Similar privileges are accorded persons licensed in 25 this Commonwealth. 26 (3) The applicants hold valid licenses. 27 (4) The applicable rules and regulations prescribed by 28 the board are complied with. 29 Section 505. Limited license. 30 (a) Requirements.--The following educational and 19850H1362B4196 - 14 -
1 professional requirements must be met in order to secure a 2 limited license which may be issued to an out-of-State or 3 foreign chiropractic school or college graduate for a period not 4 to exceed one year for the purpose of teaching in an approved 5 graduate chiropractic education program: 6 (1) The applicant must submit a letter of appointment to 7 teach or practice from a training institution in this 8 Commonwealth. 9 (2) The applicant must submit an application for 10 licensure consisting of evidence that all requirements 11 contained in this act have been met. 12 (3) The applicant must submit evidence that he has had 13 teaching experience or its equivalent which is acceptable to 14 the board. 15 (4) The applicant must submit to an oral examination in 16 his specialty conducted by a board member or the board's 17 designated representative. 18 (b) License to practice.--Persons granted limited licenses 19 under this section shall not be authorized to practice 20 chiropractic in this Commonwealth other than for the purpose of 21 teaching, which shall not include treatment of patients, and 22 those persons who subsequently desire to obtain a license for 23 the practice of chiropractic shall be required to meet the 24 standards for such license as set forth by regulation. 25 (c) Use of titles.--The use of titles such as "fellow," 26 "fellowship," "consultant," "visiting professor" or similar 27 designations of an individual in a health care institution does 28 not eliminate the need for proper licensure under this act for 29 the practice of chiropractic. 30 Section 506. Refusal, suspension or revocation of license. 19850H1362B4196 - 15 -
1 (a) Reasons enumerated.--The board may refuse to issue a 2 license or may suspend or revoke a license for any of the 3 following reasons: 4 (1) Failing to demonstrate the qualifications or 5 standards for a license contained in this act or regulations 6 of the board. 7 (2) Making misleading, deceptive, untrue or fraudulent 8 representations in the practice of chiropractic. 9 (3) Practicing fraud or deceit in obtaining a license to 10 practice chiropractic. 11 (4) Displaying gross incompetence, negligence or 12 misconduct in carrying on the practice of chiropractic. 13 (5) Submitting a false or deceptive biennial 14 registration to the board. 15 (6) Being convicted of a felony or a misdemeanor in the 16 practice of chiropractic, or receiving probation without 17 verdict, disposition in lieu of trial or an accelerated 18 rehabilitative disposition in the disposition of felony 19 charges, in the courts of this Commonwealth, a Federal court, 20 or a court of any other state, territory, possession or 21 country. 22 (7) Having a license to practice chiropractic suspended, 23 revoked or refused or receiving other disciplinary action by 24 the proper chiropractic licensing authority of another state, 25 territory, possession or country. 26 (8) Being unable to practice chiropractic with 27 reasonable skill and safety to patients by reason of illness, 28 drunkenness, excessive use of drugs, narcotics, chemicals or 29 any other type of material, or as a result of any mental or 30 physical condition. In enforcing this paragraph, the board 19850H1362B4196 - 16 -
1 shall, upon probable cause, have authority to compel a 2 chiropractor to submit to a mental or physical examination by 3 physicians approved by the board. Failure of a chiropractor 4 to submit to such examination when directed by the board, 5 unless such failure is due to circumstances beyond his 6 control, shall constitute an admission of the allegations 7 against him, consequent upon which a default and final order 8 may be entered without the taking of testimony or 9 presentation of evidence. A chiropractor affected under this 10 paragraph shall at reasonable intervals be afforded an 11 opportunity to demonstrate that he can resume a competent 12 practice of chiropractic with reasonable skill and safety to 13 patients. 14 (9) Violating a lawful regulation promulgated by the 15 board or violating a lawful order of the board previously 16 entered in a disciplinary proceeding. 17 (10) Knowingly aiding, assisting, procuring or advising 18 any unlicensed person to practice chiropractic, contrary to 19 this act or regulations of the board. 20 (11) Committing immoral or unprofessional conduct. 21 Unprofessional conduct shall include any departure from, or 22 failure to conform to, the standards of acceptable and 23 prevailing chiropractic practice. Actual injury to a patient 24 need not be established. 25 (12) Soliciting any engagement to perform professional 26 services by any direct, in-person or uninvited soliciting 27 through the use of coercion, duress, compulsion, 28 intimidation, threats, overreaching or harassing conduct. 29 (13) Failing to perform any statutory obligation placed 30 upon a licensed chiropractor. 19850H1362B4196 - 17 -
1 (14) Intentionally submitting to any third-party payor a 2 claim for a service or treatment which was not actually 3 provided to a patient. 4 (15) Failing to maintain chronological documentation of 5 patient care in accordance with regulations prescribed by the 6 board. 7 (16) Making representations that chiropractic treatment 8 will cure cancer or an infectious or communicable disease. 9 (17) Holding himself out as a specialist unless he 10 possesses a postgraduate certification in that specialty. 11 (18) Unconditionally guaranteeing that a cure will 12 result from the performance of chiropractic treatment. 13 (19) Failing to refer a patient to a licensed 14 practitioner of another branch of the healing arts for 15 consultation or treatment when a diagnosis of such patient 16 indicates that such a referral is appropriate. 17 (b) Discretion of board.--When the board finds that the 18 license of any person may be refused, revoked or suspended under 19 the terms of subsection (a), the board may: 20 (1) Deny the application for a license. 21 (2) Administer a public reprimand. 22 (3) Revoke, suspend, limit or otherwise restrict a 23 license as determined by the board. Unless ordered to do so 24 by a court, the board shall not reinstate the license of a 25 person to practice chiropractic which has been revoked, and 26 such person shall be required to apply for a license after a 27 five-year period in accordance with section 501 if he desires 28 to practice at any time after such revocation. 29 (4) Require a licensee to submit to the care, counseling 30 or treatment of a physician or physicians designated by the 19850H1362B4196 - 18 -
1 board. 2 (5) Suspend enforcement of its findings thereof and 3 place a licensee on probation with the right to vacate the 4 probationary order for noncompliance. 5 (6) Restore a suspended license to practice chiropractic 6 and impose any disciplinary or corrective measure which it 7 might originally have imposed. 8 (c) Procedure.--All actions of the board shall be taken 9 subject to the right of notice, hearing and adjudication and the 10 right of appeal therefrom in accordance with Title 2 of the 11 Pennsylvania Consolidated Statutes (relating to administrative 12 law and procedure). 13 (d) Temporary suspension.--The board shall temporarily 14 suspend a license under circumstances as determined by the board 15 to be an immediate and clear danger to the public health or 16 safety. The board shall issue an order to that effect without a 17 hearing, but upon due notice to the licensee concerned at his 18 last known address, which shall include a written statement of 19 all allegations against the licensee. The provisions of 20 subsection (c) shall not apply to temporary suspension. The 21 board shall thereupon commence formal action to suspend, revoke 22 or restrict the license of the person concerned as otherwise 23 provided for in this act. All actions shall be taken promptly 24 and without delay. Within 30 days following the issuance of an 25 order temporarily suspending a license, the board shall conduct, 26 or cause to be conducted, a preliminary hearing to determine 27 that there is a prima facie case supporting the suspension. The 28 licensee whose license has been temporarily suspended may be 29 present at the preliminary hearing and may be represented by 30 counsel, cross-examine witnesses, inspect physical evidence, 19850H1362B4196 - 19 -
1 call witnesses, offer evidence and testimony and make a record 2 of the proceedings. If it is determined that there is not a 3 prima facie case, the suspended license shall be immediately 4 restored. The temporary suspension shall remain in effect until 5 vacated by the board, but in no event longer than 180 days. 6 (e) Automatic suspension.--A license issued under this act 7 shall automatically be suspended upon the legal commitment of a 8 licensee to an institution because of mental incompetency from 9 any cause upon filing with the board a certified copy of such 10 commitment; conviction of a felony under the act of April 14, 11 1972 (P.L.233, No.64), known as The Controlled Substance, Drug, 12 Device and Cosmetic Act; or conviction of an offense under the 13 laws of another jurisdiction, which, if committed in 14 Pennsylvania, would be a felony under The Controlled Substance, 15 Drug, Device and Cosmetic Act. As used in this subsection, the 16 term "conviction" shall include a judgment, an admission of 17 guilt or a plea of nolo contendere. Automatic suspension under 18 this section shall not be stayed pending any appeal of a 19 conviction. Restoration of such license shall be made as 20 provided in this act for revocation or suspension of such 21 license. 22 Section 507. Continuing chiropractic education. 23 (a) Requirement for license renewal.--As a condition for the 24 biennial renewal of a license to practice chiropractic, a 25 licensee shall submit to the board evidence that he has 26 completed at least 24 hours of continuing chiropractic education 27 within the immediately preceding two-year period, provided that 28 this requirement for continuing chiropractic education shall 29 apply for the first time to the renewal of licenses in 1988. 30 (b) Qualifying education.--A licensee may receive credit for 19850H1362B4196 - 20 -
1 only those hours of continuing chiropractic education in a 2 program approved by the board and for only those hours directed 3 toward keeping the licensee apprised of advancements and new 4 developments in chiropractic which build upon the basic courses 5 required to practice chiropractic and which are in the following 6 areas: 7 (1) Anatomy. 8 (2) Physiology. 9 (3) Histology. 10 (4) Chemistry. 11 (5) Pathology. 12 (6) Physics. 13 (7) Bacteriology. 14 (8) Diagnosis. 15 (9) Hygiene and sanitation. 16 (10) Symptomatology. 17 (11) Chiropractic analysis. 18 (12) X-ray. 19 (13) Chiropractic principles. 20 (14) Chiropractic technique. 21 (15) Adjunctive procedures. 22 No credit shall be given for any course in office management or 23 practice building. 24 (c) Application by sponsors.--Prior to receiving board 25 approval for a program of continuing chiropractic education, a 26 sponsor shall submit to the board, in writing, the following 27 information at least 90 days prior to the date on which the 28 program is scheduled to be presented: 29 (1) Evidence that the sponsor's program would be 30 directed toward keeping the licensee apprised of advancements 19850H1362B4196 - 21 -
1 and new developments in chiropractic which build upon the 2 basic courses required to practice chiropractic and which are 3 in the areas specified in subsection (b). 4 (2) A detailed course outline or syllabus, including 5 such items as methods of instruction and testing materials, 6 if any. 7 (3) A current curriculum vitae of each instructor, 8 speaker or lecturer appearing in the program. 9 (d) Action on application.--The board shall notify each 10 sponsor, in writing, of approval or disapproval of the 11 application within 45 days of the receipt of the application. If 12 an application is disapproved, the board shall detail the 13 reasons for disapproval in order that the sponsor may cure any 14 defect and submit an amended application in a timely manner. 15 (e) Evidence of completion.--Each licensee, in order to 16 qualify for biennial renewal of his license, shall complete a 17 form provided by the sponsor and supplied by the board which 18 contains the name of the licensee, business address, name of the 19 sponsor and instructor, course taken, hours completed, date and 20 place of the continuing education program offered, and a signed 21 statement sworn and attested to by the licensee that the 22 licensee was fully in attendance at the program offered and that 23 the information in such form is true and correct. The licensee 24 shall be responsible for sending this form to the board. 25 (f) Notification.--The board, within 30 days after the 26 effective date of this act, shall notify all licensees subject 27 to this section that they will be required to complete 24 hours 28 of continuing education within the two-year period before the 29 renewal period commencing in 1988 and shall notify such 30 licensees of continuing education required when renewal 19850H1362B4196 - 22 -
1 applications are issued for 1988 and every renewal period 2 thereafter. 3 (g) Approved programs.--A continuing education program 4 offered by a chiropractic college approved in accordance with 5 this act and attended by a licensee must be accepted by the 6 board so long as the course requirements of this section are 7 met. 8 (h) Exceptions.--The board may make exceptions to the 9 continuing education program requirements in emergency or 10 hardship cases on the basis of evidence submitted in proof of an 11 emergency or hardship. 12 Section 508. Professional liability insurance. 13 (a) Insurance required.--As a condition for obtaining or 14 renewing a license to practice chiropractic in this Commonwealth 15 beginning with the 1988 license renewal period, an applicant 16 shall submit to the board satisfactory evidence that he has 17 obtained professional liability insurance, or that he has 18 established self-insurance for professional liability, in the 19 minimum amount of $100,000 per occurrence and $300,000 per 20 annual aggregate. 21 (b) Termination of coverage.--A licensee shall notify the 22 board within 30 days of the cancellation of his professional 23 liability insurance, the failure or refusal to renew his 24 professional liability insurance, or the termination of his 25 self-insurance for professional liability. The license of such 26 licensee shall automatically be suspended 60 days after such 27 cancellation, failure or refusal to renew, or termination and 28 shall not be restored until he submits to the board satisfactory 29 evidence that he has obtained professional liability insurance, 30 or that he has established self-insurance for professional 19850H1362B4196 - 23 -
1 liability, in the minimum amount of $100,000 per occurrence and 2 $300,000 per annual aggregate, provided that the board may 3 postpone such a license suspension until the board has 4 determined if a waiver should be granted pursuant to subsection 5 (c). 6 (c) Waiver of requirement.--The board may waive the 7 requirement that a licensee obtain professional liability 8 insurance and self-insurance for professional liability if, 9 after notice and a hearing, the board determines that the 10 licensee is unable to obtain such insurance or self-insurance 11 because of general market conditions rather than because of the 12 individual performance of that licensee. 13 (d) Self-insurance.--The board, after consultation with the 14 Insurance Commissioner, shall establish standards and procedures 15 for self-insurance pursuant to this section. 16 Section 509. Impaired professionals. 17 (a) Consultants.--The board, with the approval of the 18 commissioner, shall appoint and fix the compensation of a 19 professional consultant who is a licensee of the board, or such 20 other professional as the board may determine, with education 21 and experience in the identification, treatment and 22 rehabilitation of persons with physical or mental impairments. 23 Such consultant shall be accountable to the board and shall act 24 as a liaison between the board and the treatment programs, such 25 as alcohol and drug treatment programs licensed by the 26 Department of Health, psychological counseling and impaired 27 professional support groups, which are approved by the board and 28 which provide services to licensees under this act. 29 (b) Eligibility and disclosure.--The board may defer and 30 ultimately dismiss any of the types of corrective action set 19850H1362B4196 - 24 -
1 forth in this act for an impaired professional so long as the 2 professional is progressing satisfactorily in an approved 3 treatment program, provided that the provisions of this 4 subsection shall not apply to a professional convicted of a 5 felonious act prohibited by the act of April 14, 1972 (P.L.233, 6 No.64), known as The Controlled Substance, Drug, Device and 7 Cosmetic Act, or convicted of a felony relating to a controlled 8 substance in a court of law of the United States or any other 9 state, territory or country. An approved program provider shall, 10 upon request, disclose to the consultant such information in its 11 possession regarding an impaired professional in treatment which 12 the program provider is not prohibited from disclosing by an act 13 of this Commonwealth, another state, or the United States. Such 14 requirement of disclosure by an approved program provider shall 15 apply in the case of impaired professionals who enter into an 16 agreement in accordance with this section, impaired 17 professionals who are the subject of a board investigation or 18 disciplinary proceeding, and impaired professionals who 19 voluntarily enter a treatment program other than under the 20 provisions of this section but who fail to complete the program 21 successfully or to adhere to an aftercare plan developed by the 22 program provider. 23 (c) Agreement with board.--An impaired professional who 24 enrolls in an approved treatment program shall enter into an 25 agreement with the board under which the professional's license 26 shall be suspended or revoked but enforcement of that suspension 27 or revocation may be stayed for the length of time the 28 professional remains in the program and makes satisfactory 29 progress, complies with the terms of the agreement and adheres 30 to any limitations on his practice imposed by the board to 19850H1362B4196 - 25 -
1 protect the public. Failure to enter into such an agreement 2 shall disqualify the professional from the impaired professional 3 program and shall activate an immediate investigation and 4 disciplinary proceeding by the board. 5 (d) Disciplinary action.--If, in the opinion of the 6 consultant after consultation with the provider, an impaired 7 professional who is enrolled in an approved treatment program 8 has not progressed satisfactorily, the consultant shall disclose 9 to the board all information in his possession regarding said 10 professional, and the board shall institute proceedings to 11 determine if the stay of the enforcement of the suspension or 12 revocation of the impaired professional's license shall be 13 vacated. 14 (e) Immunity.--An approved program provider who makes a 15 disclosure pursuant to this section shall not be subject to 16 civil liability for such disclosure or its consequences. 17 (f) Reports to the board.--Any hospital or health care 18 facility, peer or colleague who has substantial evidence that a 19 professional has an active addictive disease for which the 20 professional is not receiving treatment, is diverting a 21 controlled substance or is mentally or physically incompetent to 22 carry out the duties of his or her license shall make or cause 23 to be made a report to the board, provided that any person or 24 facility who acts in a treatment capacity to an impaired 25 professional in an approved treatment program is exempt from the 26 mandatory reporting requirements of this subsection. Any person 27 or facility who reports pursuant to this section in good faith 28 and without malice shall be immune from any civil or criminal 29 liability arising from such report. Failure to provide such 30 report within a reasonable time from receipt of knowledge of 19850H1362B4196 - 26 -
1 impairment shall subject the person or facility to a fine not to 2 exceed $1,000. The board shall levy this penalty only after 3 affording the accused party the opportunity for a hearing, as 4 provided in Title 2 of the Pennsylvania Consolidated Statutes 5 (relating to administrative law and procedure). 6 SUBCHAPTER B 7 GENERAL REGULATION 8 Section 521. License required. 9 It shall be unlawful after the effective date of this act for 10 any person in this Commonwealth to engage in the practice of 11 chiropractic or indicate in any manner whatsoever the ability to 12 practice chiropractic unless licensed under the provisions of 13 this act, except that any person licensed or legally authorized 14 to practice chiropractic in this Commonwealth under any other 15 act shall thereafter continue to possess the same rights and 16 privileges with respect to the practice of chiropractic without 17 being required to be licensed anew under the provisions of this 18 act, and as fully as if he were licensed under the provisions of 19 this act; and to that extent, he shall be exempt from any 20 penalties under this act. 21 Section 522. Radiologic procedures; education and training 22 required. 23 (a) Supervision; educational requirements.--On and after 24 January 1, 1988, no auxiliary personnel shall perform radiologic 25 procedures on the premises of a chiropractor unless such person 26 is under the direct supervision of a chiropractor who is on the 27 premises at the time the X-ray of the patient is taken and 28 unless such person has passed an examination approved by the 29 board and administered in accordance with section 812.1 of the 30 act of April 9, 1929 (P.L.177, No.175), known as The 19850H1362B4196 - 27 -
1 Administrative Code of 1929. 2 (b) Exclusion.--The board shall, by regulation, provide for 3 the exclusion of an auxiliary personnel from performing 4 radiologic procedures if the continued performance of radiologic 5 procedures by the auxiliary personnel is determined by the board 6 to pose a threat to the health, safety or welfare of the public. 7 (c) Penalty.--It shall be unlawful under this act to 8 knowingly permit radiologic procedures to be performed in 9 violation of this section or in violation of the regulations 10 promulgated or orders issued in accordance with this section. 11 (d) Education and testing.--No auxiliary personnel who has 12 or obtains a license, certificate or registration issued by, or 13 on behalf of, a board within the Bureau of Professional and 14 Occupational Affairs shall be required to undergo any additional 15 education or testing pursuant to this section if radiologic 16 procedures were included in the education or the examination 17 which he or she was required to complete successfully in order 18 to be eligible for such license, certificate or registration. 19 Section 523. Reporting of multiple licensure. 20 Any licensed chiropractor of this Commonwealth who is also 21 licensed to practice chiropractic in any other state, territory, 22 possession or country shall report this information to the board 23 on the biennial registration application. Any disciplinary 24 action taken in such other jurisdiction shall be reported to the 25 board on the biennial registration application or within 90 days 26 of final disposition, whichever is sooner. Multiple licensure 27 shall be noted by the board on the chiropractor's record and 28 such state, territory, possession or country shall be notified 29 by the board of any disciplinary actions taken against said 30 chiropractor in this Commonwealth. 19850H1362B4196 - 28 -
1 Section 524. Display of certificate. 2 Every holder of a license granted by the board under this act 3 shall display the license in a conspicuous place in the office 4 where such person practices chiropractic. 5 Section 525. Doctor of Chiropractic and abbreviation. 6 Any person who has a valid license in accordance with this 7 act may practice chiropractic and use the title "Doctor of 8 Chiropractic" and the abbreviation "DC." 9 Section 526. Relationship with other branches of the healing 10 arts. 11 (a) In general.--This act shall not apply either directly or 12 indirectly, by intent or purpose, to affect the practice of any 13 other branch of the healing arts by any person duly licensed or 14 certified by the department to engage in such practice. 15 (b) Representation as a licensed physical therapist.--A 16 chiropractor shall not hold himself out in any manner to be a 17 licensed physical therapist unless he is duly licensed under the 18 act of October 10, 1975 (P.L.383, No.110), known as the Physical 19 Therapy Practice Act. 20 Section 527. Revoked licenses; reinstatement; reports to the 21 board. 22 (a) Surrender of license.--The board shall require a person 23 whose license has been suspended or revoked to return the 24 license in such manner as the board directs. A person who fails 25 to do so commits a misdemeanor of the third degree. 26 (b) Reinstatement after felony conviction.--Any person whose 27 license has been suspended or revoked because of a felony 28 conviction under the act of April 14, 1972 (P.L.233, No.64), 29 known as The Controlled Substance, Drug, Device and Cosmetic 30 Act, or similar law of another jurisdiction, may apply for 19850H1362B4196 - 29 -
1 reinstatement after a period of at least ten years has elapsed 2 from the date of conviction. The board may reinstate the license 3 if the board is satisfied that the person has made significant 4 progress in personal rehabilitation since the conviction such 5 that his reinstatement should not be expected to create a 6 substantial risk of harm to the health and safety of his 7 patients or the public or a substantial risk of further criminal 8 violations and if the person meets all other licensing 9 qualifications of this act, including the examination 10 requirement. 11 (c) Reports to the board.--An attorney responsible for 12 representing the Commonwealth in disciplinary matters before the 13 board shall notify the board immediately upon receiving 14 notification of an alleged violation of this act. The board 15 shall maintain current records of all reports of alleged 16 violations and periodically review the records for the purpose 17 of determining that each alleged violation has been resolved in 18 a timely manner. 19 CHAPTER 7 20 PENALTY PROVISIONS 21 Section 701. Practice of chiropractic without license 22 prohibited. 23 (a) Offense defined.--It shall be unlawful for any person 24 to: 25 (1) Engage or attempt to engage in the practice of 26 chiropractic or to hold himself out as a practitioner of 27 chiropractic unless he has first fulfilled the requirements 28 of this act and has been licensed by the board. 29 (2) Practice or hold himself out as a practitioner of 30 spinal adjustment or manipulation, spinal mobilization or 19850H1362B4196 - 30 -
1 manipulation of articulations of the human body for 2 therapeutic benefit unless he has first fulfilled the 3 requirements of this act and has been licensed by the board 4 or unless he has been licensed or certified in accordance 5 with another act of this Commonwealth. 6 (b) Penalty.--A person who violates this section commits a 7 misdemeanor of the third degree and shall, upon conviction, for 8 a first offense, be sentenced to a fine not to exceed $1,000, or 9 to imprisonment for not more than six months, or both. A second 10 offense shall be subject to a fine not to exceed $2,000, or 11 imprisonment for a term of six months to one year, or both. 12 Section 702. Violation of other provisions. 13 A person commits a misdemeanor of the third degree and, upon 14 conviction, shall be sentenced to pay a fine of not more than 15 $500, or to imprisonment for not more than six months, or both, 16 if he commits any act declared unlawful by any other provision 17 of this act, other than section 701, or if he: 18 (1) Makes misleading, deceptive, untrue or fraudulent 19 representations in the practice of chiropractic. 20 (2) Practices fraud or deceit in obtaining a license to 21 practice chiropractic. 22 (3) Displays gross incompetence, negligence or 23 misconduct in carrying on the practice of chiropractic. 24 (4) Makes a false or deceptive biennial registration 25 with the board. 26 (5) Violates a lawful regulation promulgated by the 27 board or a lawful order of the board previously entered in a 28 disciplinary proceeding. 29 (6) Knowingly aids, assists, procures or advises any 30 unlicensed person to practice chiropractic, contrary to this 19850H1362B4196 - 31 -
1 act or regulations of the board. 2 (7) Commits immoral or unprofessional conduct. 3 Unprofessional conduct shall include any departure from, or 4 failure to conform to, the standards of acceptable and 5 prevailing chiropractic practice. Actual injury to a patient 6 need not be established. 7 (8) Solicits any engagement to perform professional 8 services by any direct, in-person or uninvited soliciting 9 through the use of coercion, duress, compulsion, 10 intimidation, threats, overreaching or harassing conduct. 11 (9) Fails to perform any statutory obligation placed 12 upon a licensed chiropractor. 13 (10) Submits intentionally to any third-party payor a 14 claim for a service or treatment which was not actually 15 provided to a patient. 16 (11) Makes representations that chiropractic treatment 17 will cure cancer or an infectious or communicable disease. 18 (12) Holds himself out as a specialist unless he 19 possesses a postgraduate certification in that specialty. 20 (13) Unconditionally guarantees that a cure will result 21 from the performance of chiropractic treatment. 22 Section 703. Civil penalty. 23 In addition to any other civil remedy or criminal penalty 24 provided for in this act, the board, by a vote of the majority 25 of the maximum number of the authorized membership of the board 26 as provided by law or by a vote of the majority of the duly 27 qualified and confirmed membership or a minimum of four members, 28 whichever is greater, may levy a civil penalty of up to $1,000 29 on any current licensee who violates any provision of this act 30 or on any person who practices chiropractic without being 19850H1362B4196 - 32 -
1 properly licensed to do so under this act. The board shall levy 2 this penalty only after affording the accused party the 3 opportunity for a hearing, as provided in Title 2 of the 4 Pennsylvania Consolidated Statutes (relating to administrative 5 law and procedure). 6 Section 704. Fines and penalties. 7 All fines and civil penalties imposed in accordance with this 8 chapter shall be paid into the Professional Licensure 9 Augmentation Account. 10 CHAPTER 11 11 MISCELLANEOUS PROVISIONS 12 Section 1101. Fees. 13 (a) Adoption.--The board shall, by regulation, fix the fees 14 required for examination, licensure, renewal of licenses and 15 limited licenses. 16 (b) Insufficient revenue.--If the revenues raised by fees, 17 fines and civil penalties imposed pursuant to this act are not 18 sufficient to meet expenditures over a two-year period, the 19 board shall increase those fees by regulation so that the 20 projected revenues will meet or exceed projected expenditures. 21 (c) Increase by bureau.--If the bureau determines that the 22 fees established by the board pursuant to subsections (a) and 23 (b) are inadequate to meet the minimum enforcement efforts 24 required by this act, then the bureau, after consultation with 25 the board, shall increase the fees by regulation so that 26 adequate revenues are raised to meet the required enforcement 27 effort. 28 (d) Review.--Any regulation proposed under this section 29 shall be subject to the act of June 25, 1982 (P.L.633, No.181), 30 known as the Regulatory Review Act. 19850H1362B4196 - 33 -
1 Section 1102. Current members of board. 2 The presently confirmed members of the State Board of 3 Chiropractic Examiners constituted under section 461 of the act 4 of April 9, 1929 (P.L.177, No.175), known as The Administrative 5 Code of 1929, as of the effective date of this act, shall 6 continue to serve as board members until their present terms of 7 office expire, provided that any present board member whose term 8 has expired on or before the effective date of this act shall 9 serve until a successor has been appointed and qualified, but no 10 longer than six months after the effective date of this act. 11 Section 1103. Current licensees. 12 Any person who holds a valid license issued by the State 13 Board of Chiropractic Examiners under the act of August 10, 1951 14 (P.L.1182, No.264), known as the Chiropractic Registration Act 15 of 1951, prior to the effective date of this act shall, on and 16 after the effective date hereof, be deemed to be licensed by the 17 State Board of Chiropractic as provided for in this act. 18 Section 1104. Existing regulations. 19 Each rule, regulation or fee of the board in effect on the 20 effective date of this act shall remain in effect after such 21 date until repealed or amended by the board, provided that the 22 board shall immediately initiate the repeal or amendment of any 23 rule or regulation which is inconsistent with the provisions of 24 this act. 25 Section 1105. Reestablishment of agency. 26 This act, with respect to the State Board of Chiropractic 27 Examiners, shall constitute the legislation required to 28 reestablish an agency pursuant to the act of December 22, 1981 29 (P.L.508, No.142), known as the Sunset Act. 30 Section 1106. Repeals. 19850H1362B4196 - 34 -
1 (a) Absolute repeals.--The following acts and parts of acts 2 are repealed: 3 Section 461 of the act of April 9, 1929 (P.L.177, No.175), 4 known as The Administrative Code of 1929. 5 Act of August 10, 1951 (P.L.1182, No.264), known as the 6 Chiropractic Registration Act of 1951. 7 (b) General repeals.--All other acts and parts of acts are 8 repealed insofar as they are inconsistent with this act. 9 Section 1107. Effective date. 10 This act shall take effect immediately. E30L63JAM/19850H1362B4196 - 35 -