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Dynamic Chiropractic – March 25, 2008, Vol. 26, Issue 07

AMA Manual Limits DC Impairment Evaluations to Spine

But after the ACA cries foul, the AMA issues an immediate correction.

By Editorial Staff

After receiving a strongly worded letter from American Chiropractic Association (ACA) legal counsel, the American Medical Association (AMA) has announced that it will take "immediate and visible steps to counteract any potential confusion" regarding language in its Guides to the Evaluation of Permanent Impairment, Sixth Edition that restricted chiropractic impairment evaluations to the spine only.

Specifically, the language in question, found on page 20 in a section titled "Fundamental Principles of the Guides," states: "A licensed physician must perform impairment evaluations. Chiropractic doctors, if authorized by the appropriate jurisdictional authority to perform ratings under the Guides, should restrict rating to the spine." Upon learning of this language, ACA general counsel Thomas R. Daly sent a letter to the AMA on Feb. 7 that stated, in part:

"In our view, the action of the AMA in issuing this standard unlawfully restricts competition and excludes a competitive rival, i.e., doctors of chiropractic from the provision of impairment ratings. We note that neither the ACA, nor any other major chiropractic group, was approached or provided input in the standard setting process that established this new restriction."

"I would also point you to Wilk v. American Medical Assoc. ... You may recall that the United States District Court for the Northern District of Illinois, following an eight-week trial, held that the AMA was guilty of engaging in a nationwide illegal boycott in violation of the Sherman Act and imposed a nationwide injunction that is still in force."

"My client therefore believes and will argue that your recent action which implements a new and onerous restrictive standard on the practice of doctors of chiropractic violates existing antitrust law as well as the provision of the existing permanent Wilk injunction."

In a Feb. 20 response to the ACA, the AMA said it will change the language to read: "Impairment evaluation requires medical knowledge. Physicians duly recognized by an appropriate jurisdiction should perform such assessments within their applicable scope of practice and field of expertise." The AMA also said it will take the following steps immediately:

  • The AMA will send a letter to all purchasers of the guide for whom it has addresses, informing them of the correction. According to the AMA, those letters were to be mailed beginning on Feb. 22.

  • A similar letter will be inserted into all manuals prior to shipment in the future.

  • The AMA will post a notice in the AMA Press Online Catalog as well as on the Guides' Web page. Both notices will remain posted until the seventh edition of the Guides is published.

  • The correction will be announced in the next issue of The Guides Newsletter, scheduled for publication in late March.

  • Future printings of the Guides, Sixth Edition will include the correction.

  • An errata sheet for the sixth edition, to be issued in late March, will contain the correction, with special highlighting to give it greater visibility than other errata items.

As of press time, the ACA has just sent a second letter to the AMA, suggesting an alternate revision to the language in question: "Impairment evaluation requires medical knowledge. Doctors who are qualified in allopathic, osteopathic and chiropractic medicine duly recognized by an appropriate jurisdiction should perform such assessments within their applicable scope of practice and field of expertise."

In its follow-up letter, sent Feb. 22, the ACA notes, "[T]his language would track the existing language used in Chapter 2, page 23, which states as follows: 'Who performs impairment ratings? Impairment evaluation requires medical knowledge; therefore mostly doctors who are qualified in allopathic or osteopathic medicine or chiropractic medicine use the Guides to evaluate permanent impairment.'"

The second ACA letter also pointed out several instances in which the Guides use the term "medical doctor(s)" and omits mention of other providers. The ACA feels this language "gives the perception of discrimination against any other doctors (osteopathic, chiropractic, podiatric, etc.)." As of press time, the ACA has yet to receive a response from the AMA regarding these additional concerns.


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