Department of Veterans Affairs

Transcription

Attachment D:
Department of Veterans Affairs
Chiropractic Advisory Committee
Summary of Public Comments
The Department of Veterans Affairs (VA) Chiropractic Advisory Committee accepted public comments to assist in identifying
issues and concerns regarding the development and implementation of a chiropractic health program within Veterans Health
Administration (VHA). While some comments were received early in Committee deliberations, the majority were received
after draft recommendations were provided for public review and comment. The recommendations were posted on the
Committee’s Intranet site (www.va.gov/primary) on July 24, 2003 and were announced August 4, 2003 in the Federal
Register notice of the Committee’s September meeting.
The comments were provided to the Committee. This report summarizes the comments as they relate to each
recommendation and identifies the persons/organizations who have provided comment at any time during the Committee’s
work.
Summary of Comments
Recommendation
Introduction
Background
Comments
(footnote refers to list of persons/organizations providing
comments)
Objects to statement on page 1, lines 41-44 as reflecting
parochial interests. 303, 486
Follow-up by Committee
Comments noted. No change made.
Commends committee for including statement on lines 41- 44.
Goal is to give veterans another alternative for healthcare, not
to remove existing provider options. 472
Page 2, lines 39-45 – believes all new clinical services offered
by VA should work within the confines of the existing primary
care model. 472
Comments noted. See Recommendation 9, access to care.
Page 3, lines 18-25 – include a reference to the need for the
swift and timely implementation of the chiropractic program 486
Page 3, line 19 - Change phrasing of “appropriate access“ to
Word “appropriate” removed. Phrase now reads “Patients
“direct access”. Key to development of an effective policy on
chiropractic care is the guarantee of direct access. Patients
have difficulty accessing chiropractic care when a referral from
a medical doctor or nurse is required.23
have access to chiropractic care.”
Page 3, line 19 – use of the term appropriate should in no way
serve to justify any effort to obstruct, delay or in any way
impede the full integration of chiropractic services. Change to
“direct access” 486
See above.
Page 3, line 19 - Change phrasing to full access to reflect Dr.
Roswell’s comments that he felt direct access should be
available after the initial referral for all subsequent follow-up
visits. 303
See above.
Page 3, line 25 - remove phrase “in an appropriate manner” as
it serves no useful purpose. 303
Phrase “in an appropriate manner” removed.
A. Qualifications
Restrict qualifications to the basic criteria of state licensure with
a minimum number of years in practice. 11
VA qualification standards require delineation of education.
See VHA Handbook 1109.19, paragraph 5.e.
1. Education
requirement
Dept. of Education should expunge CCE as the official
accrediting agency for chiropractic colleges. 1
Not within charge of Committee.
Recommend limiting the Secretary’s approval to schools
recognized by the CCE. 21
Require graduation from a CCE accredited schools with those
who graduated from schools subsequently accredited by CCE
considered on an individual basis. 5
Require graduation from a CCE accredited school or its
equivalent or have such status granted by grandfathering
privilege as recognized by the accrediting agency. Graduates of
non-US programs should demonstrate equivalent accreditation.
Concern that requirement for graduation from a CCE accredited
school excludes those graduating prior to formation of CCE,
when school had interim period before full accreditations or
6
2
those graduating in future from a school accredited by some
other accrediting agency. 7
Support recommendation for the broader educational standard.
Objects to Comment on page 4, line 40-44 and requests its
removal. 23, 303
Comment rephrased to more accurately reflect the concern
expressed by some members of the Committee.
Recommends deletion of discussion of accrediting agencies as
irrelevant and urges committee recommend only degree from
an institution accepted for licensure. 486
Language of HR 2414 (HR 2357) states the educational
qualifications of chiropractors and models them on those used
for other professions in Title 38. Supports enactment of
amendments to Tile 38; Committee should employ the language
of the legislation (HR 2357) as the basis for the
recommendation 23, 303, 486
Phrasing in HR 2357 states “college of chiropractic
approved by the Secretary”. Recommendation as written by
Committee provides criteria to the Secretary on what
should constitute an approved college of chiropractic.
18, 19, 28*, 38, 78, 127, 164, 268, 462
2. Licensure
requirement
Current licensure in at least one US jurisdiction; verify licensure
information with the Chiropractic Information Network/Board
Action Databank (CIN-BAD); verify malpractice history by
confirmation of status with insurance carrier and NPDB. 6
Change term “licensure requirement” to “credentialing
requirements”. Urge the credentialing process be defined in
greater detail. Add “as verified with the Chiropractic Information
Network/Board Action databank (CINBAD) maintained by the
FCLB. Add “Further, any history of malpractice claims should
be disclosed by the applicant.” 25
3. Other
requirements
B.4. Scope of
practice
Credentialing requirements are spelled out in VHA
Handbook 1100.19, March 6, 2001 (available at http://
www.va.gov/publ/direc/health). Licensure is one part of
credentialing. Disclosure of malpractice and other adverse
actions is required. Comments will be referred to Office of
Quality and Performance for consideration.
PL. 107-135 requires chiropractic care for neuromusculoskeletal
conditions including the subluxation complex. 5
Comments noted, No change made.
Chiropractors must be allowed to use vertebral subluxation as a
primary diagnosis when appropriate. 7
3
Believe Congress acted to provide services not already being
offered by current DVA providers - the detection and correction
of subluxation; DVA should center its efforts on the
development of protocols that most effectively allow the doctor
of chiropractic to perform this unique function as part of the
greater health are team. 11
Scope of practice should focus on the diagnosis (evaluation) of
the chiropractic vertebral subluxation and the specific
chiropractic adjustment which only chiropractors are equated
and qualified to do; crossover or duplication of services such as
chiropractors engaging in full body (differential) diagnosis or
physical therapists attempting to manipulate the spine to correct
vertebral subluxations is inappropriate. 13
The recognition of the detection and correction or vertebral
subluxation as an integral part of the chiropractic purpose is of
utmost importance. The inclusion of subluxation correction
underscores the unique contribution of chiropractic and ensures
that DCs do not duplicate medical services already provided in
VA system.19
Of utmost importance that the reference to subluxation
correction be a part of any official VA policy; underscores
unique contribution of chiropractic and ensures DCs do not
duplicate services already provided in VA. 28 *, 78, 127, 164, 268, 462
Objects to phrasing of Recommendation 4, page 5, lines 39-40
as representing bias and prejudice of certain healthcare
physicians on this advisory committee. 23
See VHA Handbook 1100.19, paragraphs 4.c., and 6.
JCAHO requirement.- standard HR.3. Individual
competency is required for all professions.
Objects to phrasing of Recommendation 4, page 5, lines 39-40
– no similar limitations or statements of concern regarding the
core competencies of osteopaths, physical therapists,
neurosurgeons or other healthcare providers within the DVA
system. 303
See above.
Concerned about the phrase “provide a variety of chiropractic
care and services for neuromusculoskeletal conditions”.
Recommend the chiropractic scope of practice be limited to
This phrase is in PL. 107-135, Section 204 (d).
4
back pain and other conditions where medical practice
guidelines recommend spinal manipulation as effective
treatment. 21
Support the recommendation on scope of practice.
C. Services to be
Provided
(Privileges)
25
While chiropractors often deliver some services that might also
be delivered by physical therapists, the services delivered by
chiropractors should not be considered physical therapy.
Physical therapy is a separate, unique and distinct clinical
service from chiropractic. The integrity of each clinical service
should be maintained. Physical therapists and chiropractors
overlap scopes of practice but were not educated the same
way, do not make clinical judgments the same way, and do not
examine a patient from the same perspective. 472
Page 6, lines 17-26 – objects to highly questionable views on
the term “subluxation”; debate on these issues reflects ICA’s
concerns about the potential for ignorance and/or bias holding
program back. Subluxation care is specifically mentioned in the
statute as a unique area of chiropractic responsibility and
authority and has been a long-standing element in federal
health programs. 486
Allow full range of services doctors of chiropractic are licensed
to provide by state law; DVA policies and procedures should
recognize the full scope of the DC license with appropriate
ordering, referral and other privileges typically accorded
physicians. 10
Removed phrase “or complete”. Otherwise unchanged.
Chiropractors are deemed diagnosticians in every state and
trained to identify serious healthcare issues that would cause
them to refer patient to a primacy care provider.15
State boards are allowing an infiltration of services such as
physical therapy by basically untrained individual chiropractors.
Focus of chiropractic examination should be evaluation of
human spine, checking for the Chiropractic Vertebral
Subluxation complex; chiropractic spinal adjustment if non-
24
5. Minimum Initial
Privileges
5
duplicative and not the same as osteopathic manipulation,
physical therapy mobilization/manipulation, naprapathic moves
or therapeutic massage. 3
6. Other Initial
Privileges
Recommendation 5 is not consistent with Recommendation 19 #5 refers to management of care; # 19 refers to comanagement. Recommend the wording in Recommendation 5
be changed to co-management of care. 27
Committee did not perceive the phrasing of these 2
recommendations to be in conflict. No change made.
Add SMEG and thermography to list of privileges; constitute
appropriate chiropractic procedures. 19, 28*, 38, 78, 127, 164, 268
Include SMEG and thermography; instrumentation is and has
been in the core curriculum of chiropractic colleges for many
years and is used as a procedure to help in the analysis of the
vertebral subluxation. 20
Allow use of paraspinal thermal measurements. 24
Do not agree that SMEG and thermography should be added to
list of privileges. 462
Restrict practice to locating, analyzing and adjustment of
vertebral subluxation (misaligned vertebrae that cause nerve
interference). 1
The primary care physician is the appropriate medical point of
contact for patients. Recommends the results of laboratory tests
ordered by chiropractors be routinely shared with primary care
physicians to ensure quality and appropriate follow-up. 21
VHA Directive 2003-043, Ordering and Reporting Patient
Test Results directs that abnormal results be directed to the
ordering provider. First ‘Comment’ removed in entirety.
Need to clarify who will read and/or evaluate the results of tests.
See above.
Regarding surface electromyography and thermography,
Committee appears to have relied on an obsolete Job Analysis
conducted by the National Board of Chiropractic Examiners.
2003 Study “How Chiropractors Think and Practice” reported
86.9% of the chiropractors surveyed considered SEMG
appropriate for DCs scope of practice and 88.6% indicated
thermography appropriate. CCP CPG #1 rated both as
Remove reference to NBCE Job Analysis.
27
6
“established procedures”. Should include SEMG and
thermography on the list of minimal initial privileges. 18
7. Additional
Privileges
8. Publication of
Information Letter
D. 9. Access to
Chiropractic Care
DCs are portal of entry providers. 3, 488
Support full integration of chiropractic services as primary
contact providers within DVA system; insure access to
chiropractic care; chiropractors at the TX Back Institute are
integrated as full service musculoskeletal providers with direct
access by patients. 4
After extensive discussion by the Committee, the
recommendation and the dissenting recommendation were
rewritten, the rationale statements rewritten, realigned, or
removed, and a new comment by the 2 dissenting
members added.
Ensure unimpeded access to chiropractic care; Committee
should develop protocols for direct access to chiropractic care;
should explore advantages of utilizing doctors of chiropractic as
Primary Care Managers and evaluate this concept at various
DVA facilities. 10
See above.
Direct access; no mandatory referral requirement; chiropractic
care available at the request of the patient as a clearly identified
care option. 11
See above.
Open access is essential for the success of the program; most
allopathic physicians not trained to recognize need for
chiropractic services. 12
See above.
Portal of entry providers without need for referral. 13
See above.
VA health care cost will be greater if VA develops access
through a primary care provider (PCP). WA State has statistics
regarding lack of referrals to non-physician healthcare
practitioners when a PCP is managing care. Nationally, when
patients have the right to choose their healthcare practitioner,
use of alternative medicine is 30-50%. In WA when MDs
controlled access to alternative medicine, the use rate was less
than 3%. WA State law demands access to coverage for every
licensed health care practitioner in the state. 15
See above.
7
Comment from disabled veteran, also DC who utilizes VA
healthcare: must see primary care physician to get referral; can
take 3 weeks or more. Recommend patient be allowed direct
access.16
See above.
Direct access should be available to eligible veterans who
request it and patients should participate in making health care
decisions. Desirable for DCs to be integrated into the VA
system and function as members of the healthcare team.
Significant issue is whether a primary care physician (or other
provider) has the education, training, and clinical skills to
determine the safety and appropriateness of chiropractic care.
Medical schools/residency programs do not provide training in
chiropractic analysis. 1998 study in J Bone and Joint Surg
concluded current medical school training in musculoskeletal
medicine is inadequate. Primary care providers, with few
exceptions, lack the education, training and experience to
determine indications and contraindications to chiropractic care
and a generally not familiar with the variety of chiropractic
adjusting procedures. Eligible veteran requesting chiropractic
care would be seen by DC who would report finding,
recommendations, and chiropractic care plan to the primary
care provider.18
See above.
Oppose the use of medical gatekeepers to control access to
chiropractic services. American public has freedom to choose
chiropractors without referral by MDs; veterans deserve the
same right. Access would be determined by the personal
prejudices of medical provider. Requiring medical referral is
inappropriate since MDs receive no training in detection or
correction of vertebral subluxation; impracticable to give MDs
responsibility of determining appropriateness of chiropractic
care when have no training or experience in analyzing the
subluxation complex. 19, 28*, 78, 79, 82, 127, 153, 164, 268, 462
See above.
Requiring a medical referral before visiting a chiropractor’s
office is legally questionable. Chiropractors are by law a primary
health care provider and no referral is necessary. Taking away
a basis freedom from vets is very un-American. 128
See above.
8
After speaking with my patients that are veterans they are
encouraging direct access in the VA system. With the Iraq
crisis currently underway they have a difficult time accessing
care. Therefore, they believe that direct access would be the
most beneficial for them. Many times they have to return for
referral appointments which costs them money and time. 146
See above.
Veterans should have direct access without going to primary
care provider; delays in getting appointments with primary care,
Chiropractic has been historically and legally declared “separate
and distinct” from practice of medicine. Duplication of services
would be redundant as VA has on staff physiotherapists trained
in those services. 20
See above.
Against use of medical gatekeepers.
192, 489
See above.
MD's have no training whatsoever in Chiropractic and are
therefore not qualified to determine if a patient is a Chiropractic
candidate. People should realize that 82% of practicing medical
doctors failed a basic proficiency exam in treating
musculoskeletal conditions. You cannot treat mechanical
problems with chemicals.151
See above.
Committee should review the topic of access to care as
published by the WH Commission on CAM Policy and
reconsider using medical doctors as gatekeepers. Use of
medial gatekeepers is a gross injustice and discriminatory
hurdle to services.38
See above. WHCCAM did not make recommendation
regarding direct access.
Concurs with dissenting recommendation on page 10. 23
See above.
Supports the dissenting recommendation. Delaying access to
necessary care while waiting for referrals from an admittedly
overloaded intake system may constitute patient neglect. 25
See above.
Agree with dissenting recommendation and note the repeated
concerns about systemic backlogs in timely availability of
primary care providers and concerns about the detrimental
effect of inherent bias on veterans to obtain chiropractic
See above.
9
healthcare as mandated by law. Consider testing direct access
on a pilot basis in areas where overloads and backlogs for
primary care are most acute. 303
Would like information on those specialty services that do not
require referral from a primary care physician in order to
determine whether the argument against such direct access
might be appropriate for chiropractic.303
See above.
Patients deserve an opportunity to make their own decisions
about their own health care. 259
See above.
Believe veteran should be entitled to seek chiropractic care as a
matter of choice for conditions within chiropractic’s realm of
professional competence.; such access does not disconnect or
eliminate existing primary care case management and crae
relationships. Rejects as obstructionist and unreasonable the
argument that direct access by the choice of a beneficiary
compromises the primary care structure in place; rather it
obligates the agency to expand the decision options available to
eligible beneficiaries. Direct access could speed up access to
care by taking pressure off other segments of the system 486
See above.
Concur with Recommendation 9 with the exception that the
word “direct” should precede the word “access in line 28 to
make it clear that veterans may have direct access to their DC
once referred by their primary care provider. 303
See above.
Supports access only by referral from the primary care
physician. 21
See above.
Support recommendation to require referral from primary care
physician prior to accessing any new benefit; feel role of
primary care physician in monitoring and managing care of the
beneficiaries is essential to the successful implementation and
utilization of any new benefit. It is in keeping with the primary
care model that currently exists within VHA. 27
See above.
Would view unfavorably any recommendation to remove or
lessen the role of physicians as the primary provider of
See above.
10
healthcare. Urge omission of any references to chiropractors
being the “managers” of care for musculoskeletal conditions;
not appropriate to expand DCs role to the primary principal in
such care. 27
10. Continuity of
Care for Newly
Discharged
Veterans
Page 10, lines 24-31 – statements regarding the alleged
consequences of allowing direct access to chiropractic care are
speculative and bordering on paranoia that further reflects the
inherent underlying bias against DCs. 303
Comment removed.
Agrees with the requirement of a referral from a primary care
physician in order to access chiropractic care. Although
physical therapists practice independent of referral or direction
from physicians in many settings, in the VA physical therapists
practice collaboratively wit physicians within the VA primary
care model. Believes the same standards followed by all other
clinical services must apply to the chiropractic benefit. 472
See above.
Goal is to enhance the healthcare services available to
veterans; try a number of methods of delivering chiropractic
care. 5
Agree with recommendation, but a defined time frame for
chiropractic care should be specified, as veterans will need to
be evaluated and seen on a periodic basis by their primary care
provider. 27
See above.
If the referral requirement is removed for chiropractic care in
this situation, it should also be removed for any service that
military personnel may access directly while on active duty. 472
Objects to opinion stated on page 12, line 33-36. 23
Comment removed.
Believe comment on page 12, line 33 is evidence of bias
against chiropractic care. 303
Comment removed.
If chiropractic services are offered in such a setting, alternatives
to chiropractic care such as physical therapy must also be
Recommendation revised to recommend assignment of
primary care provider at earliest possible time.
11. Inpatient Care
12. Chiropractic
Care in CBOCs
11
available. Patients must be educated regarding all possible
modes of care and access to those services should be of equal
convenience. 472
13. Fee Basis Care
Provide chiropractic care primarily through doctors of
chiropractic who are hired as full-time employees. 10
14. Occupational
Health Programs
Believes DVA should draft and submit to Congress legislation
that would remove limitations on reimbursement for chiropractic
services under Federal occupational health programs. 23, 303
Not within Committee Charter. Federal OWCP is under
Dept. of Labor
Objects to statement on page 14, lines 1-12; reflects inherent
biases toward chiropractic; inappropriate for an Advisory
Committee that is supposed to be providing specific, concrete
recommendations to enhance rather than detract from the
integration of chiropractic into DVA. 303
DCs are trained and understand when they should refer
patients to the appropriate physicians for care; unnecessary to
point out the 3 areas specified in this recommendation. 23, 303
Comments noted. Slight rephrasing made for clarity.
Referral service agreements should clearly define appropriate
mechanisms for referral to or from chiropractic services.
Referral service agreements should exist for all clinical services
to ensure equitable treatment. Referral to chiropractic care
should not be easier to obtain than a referral to other clinic
service as this may unduly influence the veteran to seek
chiropractic care. 472
Agree with page 15, lines 26-29 and urge this statement be
retained in final recommendations. Two questions in this
recommendation need to be answered. The first refers to
patient symptoms - if a patient presents with no symptoms, how
can that patient be treated? Finally, the comments state that
chiropractic care requires multiple patient encounters over a
period of time. If that is the case, how cost effective will this
treatment be within the VA system? 27
E. Referrals to and
from Doctors of
Chiropractic
15. Screening of
Patients
16. Referral Service
Agreements
12
17. Referrals from
Doctors of
Chiropractic
F. Integration of
Chiropractic Care
into VHA
Comment on page 15, line 26-29 is irrelevant, as the
Committee’s charter has nothing to do with the capabilities of
other health care providers. 303
Disagrees that periodic care over an indefinite period of time is
acceptable practice. Utilization management is a hallmark of the
primary care model. Guideline for determining medical
necessity need to be in place prior to offering the chiropractic
benefit to veterans. 472
Asks that last sentence of 3rd comments (page 15, lines 39-42)
be removed. Believes mandatory referral requirement should
not apply to chiropractic care within DVA. 23
Eliminate sentence on page 15, line 39-42; deep concerns that
the matter of efficacy continues to be raised by some members
of the committee. 303
Maximize the positive impact of chiropractic care in relation to
improving patient satisfaction, improving patient outcomes,
reducing unnecessary surgical and diagnostic procedures,
reduce over-utilization of pharmaceuticals, reduce medical
errors and reduce healthcare expenditures; should be
considered full team members of the DVA healthcare delivery
apparatus. 10
Clear forceful direction from top management. 11
I am a disabled veteran as well as a chiropractor and am
grateful for the inclusion of chiropractic into our VA system. I
feel the transition of chiropractic services will be smooth and all
of the providers at the VA with whom I have spoken will
welcome the help. This is an opportunity for both chiropractic
and medicine to learn from each other for the betterment of the
patient. Certainly, that is paramount. 319
13
18. Coordination of
Care
19. Co-management
of Care
20. Placement of
Doctors of
Chiropractic within a
Health Care Team
Agree with recommendation. 27
Utilize model at NNMC; full integration of chiropractic care;
interactive interdisciplinary team; should report along clinical
lines of authority. 5
Consider models of collaborative care in Canadian health plan.
A good implementations model could be: 1) a chiropractic
physician on the primary care staff to assist with intake of
musculoskeletal complaints and/or 2) a “back pain/neck pain”
clinic with both medical and chiropractic practitioners working
together to evaluate and treat complaints.22
21. Site Selection
DCs should be placed at all DVA hospitals, clinics, and
treatment facilities, with the possible exception of those areas
where multiple DVA facilities are located in close proximity and
serve the same patient populations. 10
Recommendation rephrased.
22. Doctor of
Chiropractic Staffing
Enough doctors of chiropractic should be hired to adequately
serve the needs of the patient population and to be readily
accessible to those in need of chiropractic care.10
Recommendation rephrased.
Suggest recommendation not name a specific number of
chiropractic staff to be hired; determining factor should be
patient volume. 27
There is no clarification or description of the role of chiropractic
assistants. Unclear if persons working in a physical therapist
assistant capacity currently will be expected to act as a
chiropractic assistant also or if this is an entirely new
designation. Need to specify the level of supervision required
for a chiropractic assistant. Recommend these issues be
clarified in the final document. 472
Comments noted. No change made. Local facility HR
issue.
All clinical services deserve equitable treatment. Existing
Comments noted. No change made. No service has
8
23.Support Staff
24. Space
25. Co-location with
14
Collaborating
Providers and
Services
resources should not be diverted from existing services in order
to provide the new chiropractic benefit. Physical therapy and
chiropractic, as well as other clinical services, require uniquely
dedicated fiscal, human and physical resources. 472
“uniquely dedicated fiscal, human and physical resources”
26. Equipment
Recommend SMEG and thermography be added to the list of
equipment. 18
Comment noted. Comment revised to remove reference to
NBCE job analysis..
27.Orientation
Educate existing personnel on the availability and potential of
chiropractic care to facilitate a smooth implementation of the
program. 11
Comment noted. No changes made.
28. Ongoing
Education of
Providers
DoD project revealed expectations of healthcare staff changed
after professional interaction. 5
ACA and ACC should participate with DVA to implement and
maintain on a permanent basis an education campaign aimed
at educating DVA physicians and primary care managers
regarding the appropriate use and benefits of chiropractic care;
every DVA physician and primary care manager should be
required to complete this formalized training/education program.
Include demonstrations of chiropractic treatment for hospital
staff and doctors to assist them in making better decisions
about recommendations or advising against chiropractic
regimens. 22
Provide educational information to veterans about availability of
chiropractic care. 5
DVA should, in cooperation with the American Chiropractic
Association and the Association of Chiropractic Colleges,
develop, implement and sustain a public education campaign
designed to inform eligible veterans of the availability of
chiropractic care within the DVA system. 10
Rejects the comment on page 20, line 2 and asks that it be
stricken from the report. 303
Beneficiaries of veterans programs deserve full disclosure and
10
29. Education of
Patients
15
education regarding all options for treatment of health concerns.
472
30. Quality
Assurance
31. Performance
Measures
32. Evaluation of
Chiropractic Care
Program
33. Medical Staff
Voting Privileges
34. Continuing
Education
35. Oversight and
Consultation for the
Chiropractic
Program
Evaluation should include analysis of quality of care and patient
outcomes related to chiropractic care.21
Any new benefit should be monitored for efficacy, utilization,
and cost; important to determine if a new benefit is improving
the health care of beneficiaries. 27
Objects to the assertion that the chiropractic health care
program is somehow a “demonstration” project to be evaluated
and either continued or not after a period of time; rejects that a
special “test” or evaluation of the effectiveness of chiropractic
should be instituted at DVA or any assertion that DVA is still
trying to determine if chiropractic care should be offered to
veterans. 303
Comment noted. No changes made. All programs are
evaluated in some manner, e.g., recent cardiac care
program evaluation, with intent of improving services.
All Clinical services and clinicians should strive for an evidencebased practice model. 472
Each clinical service should be represented equally in the VA
facility. If chiropractors gain medical staff voting privileges, then
each clinical service present in the VA facility should have
voting representation. 472
Comment noted. No changes made. Determination is made
on local facility basis. These recommendations concern the
integration of DCs into VHA.
Establish Office of Chiropractic Services staffed by doctors of
chiropractic with appropriate authority and resources to oversee
chiropractic care within DVA on a permanent basis. 10
Rejects any special oversight or analysis of chiropractic care
that is not required of other health care providers; categorically
rejects the statement that chiropractic is “controversial” and
therefore requiring further Central Office oversight. Remove
All professions/programs have some sort of consultative/
oversight representation in Central Office.
16
comment page 22, lines 4-8. 303
36. Committee
Membership
37. Academic
Affiliations
All Chiropractic colleges should have affiliation agreements with
DVA facilities as do medical schools with clinical rotations. 5
Study risk of vertebral artery dissection by performing magnetic
resonance angiography of upper cervical region prior to and
after cervical manipulation. 2
Rejects that research should in any way focus on evaluation of
efficiency. Research is complete on this subject and irrelevant
to the task assigned to the Committee. 303
Comment noted. No changes made. Recommendation
uses term “efficacy”.
Appendix A:
Include the following – elbow, feet, knee, shoulder, wrist. 23
Appendix B:
Support model 3 – integration into a specialty service or service
line without specific liaison to primary care. 27
Appendix C:
Use of passive modalities such as electrostimulation and
ultrasound have been shown to prolong disability in
musculoskeletal conditions; provided references. Recommend
that physical modalities be provided through the physical
therapy department where they may be incorporated into a
regime of patient-active therapies in order to avoid duplication
of services; DCs could refer patients for PT services. 18
Add adjusting table, head rest paper, stool, writing surface
(desk). 23
Added to list.
Complete occupational study as quickly as possible. Amend
Title 38 to clarify Congress’ intent that doctors of chiropractic
should be hired under Title 38. 5
Occupational study underway. HR 2357 to amend Title 38
has passed House.
Hire full-time doctors of chiropractic at appropriate pay scale
levels and provided with benefits and career advancement
opportunities equivalent to other doctors with four-year clinical
degrees.10
38. Research
Other comments
17
Develop and communicate specific policies regarding
acceptable chiropractic standards of care and professional
conduct; notify both jurisdiction of practice and jurisdiction(s) of
licensure regarding any adverse action with complete disclosure
of relevant information to all chiropractic regulatory boards
where licensed .6
DVA should develop and implement policies that not only
provide access to chiropractic care, but, as deliberate policy
actively encourage the utilization of chiropractic care as a
substitute for less effective and more costly forms of traditional
care. 10
Ensure permanent employee status and establish a clear stable
career pathway for the doctor of chiropractic. 11
Chiropractic should be part of the total heath/disease care of
every veteran (and non veteran). Objective findings may be in
conflict with subjective complaints; likewise symptoms do not
correspond with examination of the neuromusculoskeletal
system, so there will continue to be diagnostic and analytical
disagreements. 14
Opposed to chiropractors being part of the VA system.
Literature says spinal adjustment might be beneficial during
weeks 3-4 for symptomatic control of acute low back pain only.
Literature indicates the benefits of neck adjustment do not
outweigh the risks. 17
Provided references on health benefits of long-term chiropractic
care. 18
Urge development of an additional recommendation to address
accountability and the exchange of information, i.e. To protect
the general public, we recommend that DVA notify both the
jurisdiction of practice and the jurisdiction(s) of licensure
regarding any adverse actions taken against doctors of
chiropractic practicing in the VA system. We also urge adoption
of a VA policy which allows complete disclosure of relevant
information to those jurisdictions’ chiropractic regulatory boards
18
to assist their expeditious investigations.
25
Concerned that some members of the Committee appear to
treat the chiropractic health benefit enacted by Congress as a
“demonstration” whose merits remain in question. Object to any
comments, recommendations or dissents that attempt to reopen debate on the efficacy or benefits of chiropractic care to
veterans. 303
VA should accept the Council on Chiropractic Practice Clinical
Practice Guideline Number 1: Vertebral Subluxation in
Chiropractic Practice as an acceptable standard of care within
the VA system. 313, +
Significant concern that the implementation of a new benefit,
such as chiropractic service, without additional resources, could
be detrimental to existing clinical services and the veterans
served by these services. Draft does not address how this new
benefit will be financed. VA must take the appropriate action to
ensure that physical therapy is a unique clinical service
separate and distinct from chiropractic and that appropriations
for this new benefit are allocated in the VA budget on an annual
basis. 472
Would like to see references within the document that clearly
include therapy disciplines as appropriate services to consult
with in order to provide comprehensive rehabilitation care.
Reference is made to the multidisciplinary team or to “other
appropriate VHA providers.” Would like physical therapists to
be specifically mentioned as one of the providers. Should be
very clear in the final document language that many clinical
services are appropriate options in the treatment of
neuromusculoskeletal conditions. 472
Support addition of chiropractic to Medicaid/VA; recommends a
specific company to do credentialing of DCs. 488
19
Persons/Organizations Providing Comments
* letters are the same
** body of letters are the same as those marked with * but have additional personal identification,
a few additional remarks reflecting the same points, or are abbreviated versions of the same
letter.
+ letters are the same
# identified self as veteran
Date
Name
1
9/28/2002
John V. Whaley, DC
2
3/8/2003
John C. Haumesser, MD
3
4
3/20/2003
3/20/2003
Gwain Zarbuck II, DC
Sidney H. Bernstein, MD et al
5
3/25/2003
David O’Bryon, JD, LLD
6
3/25/2003
Wayne C. Wolfson, DC
7
3/25/2003
Matthew McCoy, DC.
8
3/25/2003
David Chapman-Smith, LLB
9
3/25/2003
George McClelland, DC
10
3/25/2003
James D. Edwards, DC
11
12
13
3/25/2003
3/25/2003
3/26/2003
Ronald M. Hendrickson
Brian D. Reilly, DC
Parker Todd Zarbuck, DC
14
15
16
8/11/2003
8/12/2003
8/13/2003
17
8/18/2003
Doral Robb, DC#
Melinna Giannini
Seymour Shribnik, DC#
Preston, Long, DC, PhD (with 6
attachments)
18
19
8/18/2003
8/18/2003
Christopher Kent, DC
Terry Rondberg, DC
20
8/20/2003
Norris A. Erickson DC#
21
22
8/20/2003
8/20/2003
23
8/22/2003
Warren A. Jones, MD
Ward J. Henry, DC#
Government Relations Department,
American Chiropractic Association
24
8/22/2003
Rob Sinnott, DC
25
26
8/22/2003
8/25/2003
Richard L. Cole, DC
Jack Morgan, DC
Organization/ Location
Consumer Protection Committee on
Chiropractic Practice, Naperville, IL
Lead Orthopedic Surgeon, VA Western NY
Health Care System, Buffalo, NY
Legal Affairs Chairman, IL Prairie State
Chiropractic Assn., Rock Island, IL
Texas Back Institute, Plano, Tx
Executive Director, Association of Chiropractic
Colleges
President, Federation of Chiropractic
Licensing Boards
Editor, Journal of Vertebral Subluxation
Research; Chair, Guidelines Commit-tee,
Council on Chiropractic Practice
Secretary General, World Federation of
Chiropractic; General Council, Ontario
Chiropractic Assn.
Foundation for Chiropractic Education and
Research
Chairman, Board of Governors, American
Chiropractic Association
Executive Director, International Chiropractors
Association
Private Practice, IL
Madison, WI
President, Alternative Link. Albuquerque, NM
Weymouth, MA
President, Council on Chiropractic Practice;
Board of Directors, World Chiropractic
Alliance
President, World Chiropractic Alliance
Commander, American Legion Post No. 84,
Aurora, IL
Chair, Board of Directors, American Academy
of Family Physicians
CA
American Chiropractic Association
President, Association for Chiropractic
Educational Standards
President, Federation of Chiropractic
Licensing Boards
27
28
29
30
31
32
33
34
35
36
37
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
Darryl A. Beehler, DO
* Paul Edwards, DC
* Erin Elster, DC
** Brycen A. Hudock
* Chad Rohlfsen, DC
* Tony Curcuruto, DC
* Kurt Wipperfurth, DC
* Jonathan S. Priess, DC
** Dr. Hanifen
** Dermot Jinks
* Micah D. Carter, DC
President, American Osteopathic Association
Nampa, ID
Boulder, CO
Charlottesville, VA; WCA Intl Brd of Gov
Newton, IA
Santa Rosa, CA
Green Bay, WI
Portland, OR
“Student doctor of chiropractic”
Peabody, MA
Edmond, OK
Member, WH Commission on CAM,
Arlington, WA
Plano. TX
Manchester, MO
Ann Arbor, MI
38
39
40
41
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46
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48
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8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
Veronica Gutierrez, DC
* Ted Koenen, DC
** Craig Anderson, DC
* Darren Schmidt, DC, ND
* Matthew D. Colby, DC
* William F. Strieff, DC
* Bryan Zales, DC
* Scott Brodnax, DC
** John Cafferty, DC
* Howard Hadley, DC
* Jeremy Popp, DC
* Robert D. Helveston, DC
* Dennis Caudill, DC
* Lizette K. Eckert, DC
* Paul Schaffer, DC
* Alfonso Di Carlo, DC
* Christopher C. Cox, DC
* Steve A. Hawkins, DC
56
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8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
** Cara Davis
* Adam Propper, DC
* Dr. Jill Narlock, DC
* Tami Forsythe, DC
* Dwight Copeland, DC
* Mary Audia, DC
* Guy Anderson, DC
** Heide L. Hartmann-Taylor
* Thomas Pinard, DC
* Dale Lotter, DC
* Christian Gonsalves, DC
* Steven Lark, DC
68
69
8/25/2003
8/25/2003
** William Marc Goldenberg
* Nicole Buchanan, DC
70
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75
76
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8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
8/25/2003
** Akiba Green
* Treye Hovinga, DC
* John F. Przybylak, DC
** Brian Flannery, DC
** Jeff W. Dill, DC
* Timothy Jameson, DC
** Brian Murray, DC
* Deborah Peters, DC
Big Timber, MT
Clover, SC
Gresham, OR
Rochester, NY
Homewood, IL
Wauchula, FL
Kannapolis, NC
South Portland, ME
Santa Barbara, CA
Allentown, PA
Tucson, AZ
New Ulm, MN
Doctor of chiropractic student; Boiling Springs,
SC
Westport, CT
West Chester, PA
Cullman, AL
Fergus Falls, MN
Clinton, MI
Tucson, AZ
Sarasota, FL
Student, Palmer College of Chiropractic,
Davenport, IA
Phoenix, AZ
Student, Sherman College of Straight
Chiropractic, Spartenburg, SC
Snoqualamie, WA
Buffalo, NY
Central Regional Director ICA, Lakewood, WI
Pekin, IL
Castro Valley, CA
Hilliard, OH
Bloomfield, IA
21
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8/26/2003
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8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
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8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
George Roy#
Robert Richards, DC
* Chris Akey, DC
* Brian R. Sterns, DC
Daniel T. Barrett, DC
* Robert A. Berger, DC
* Christine Fallwell, DC
* Shadi Amin
* David Tribble, DC
* John Steigerwald, DC
* Scott E. Brunengraber, DC
** Philip R. Schalow, DC
* Jonathan M. Snyder, DC
* Josh Gilbert, DC
* Lynda Bribach, DC
* Lyle Love, DC
* Michael Schur, DC
* Robert Martines
* Fred J. Blum, DC
** Jason L. Pickel, DC
* Ramin Izi, DC
* Gary Bretow, DC
** Henry Wong
* Curtis E. Garner, DC
* Robert C. Dees, DC
* Norman Colby, DC
* Sue Schappert, DC
* Daniel Knowles, DC and Rochelle
Knowles, DC
* Melvin J. Rosentahl, DC
* Chris Serafini, DC
** Matthew Ferris
* Dannielle McClintock, DC
* Sylvia M. Skefich, DC
* Mario Milani, DC
** Anthony V. Bastecki, DC
* Michel N. Armaly, DC
* Jimmy Blanton, DC
* Michael J. Farrell, DC
* Bill Gallagher, DC
** Ellen S. Jackson, DC
* Stephen Weschler, DC
* Matthew Mix, DC
* Matthew B. Shifflett, DC
* Richard Sylvester, DC
* Eric R. Hartman, DC
* Andy DeHaven, DC
* Paul B. Patterson, DC
* James Easterling, DC
* P. Bruce White, Jr., DC
Erik W. Hanson, DC#
Andy Abele
** Mark Butler, DC
* Aaron Moreland
* Chris Jensen, DC
22
Scarborough, ME
North Bend, OR
Farmington, AR
Salem, OR
Saint Paul, MN
Palmyra, VA
Aliso Viejo, CA
Lee’s Summit, MO
Holbrook, NY
Rockford. IL
Circleville, OH
Salem, VA
Atlanta, GA
Kirkland, WA
Clarkesville, GA
Overland Park, KS
CA
Miami, FL
San Ramon, CA
Crested Butte, CO
Boulder, CO
Phoenix, AZ
Chiropractic graduate student, Davenport, IA
Alameda, CA
Santa Cruz, CA
Spring Hill, TN
Mauldin, SC
Huntington, WV
Glenside, PA
Scottsdale, AZ
Fairview, PA
Syracuse, NY
Belle Chasse, LA
Kilmarnock, VA
Holland, MI
Watervliet, MI
St. Louis, MO
Hartsville, SC
Batesville, IN
Bethel Park, PA
Student of chiropractic, St. Louis Park, MN
Bellingham, WA
132
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8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
* Pat Walsh, DC
* Brett Casanova
** Rick Hueffmeier, DC
** Richard P. Casanova, Dc
* Amy Kolman, DC
* Matt Hubbard, DC
* Craig McKee, DC
* Michael T. Denery, DC
** Chad Cotter, DC
* Mark C. Darling, DC
* Adam Austin, DC
** Jace H. Ferguson, DC
* Howard Short, DC
** Patrick S. Cooper, DC
Elizabeth C. Kressin, Dc
* Josh Johnston, DC
* Tracy Gabbert, DC
* John P. Rempel. DC
* Richard Humiston, DC
Christopher Brooks, DC
* Jason A. Weniger, DC
Gail Gilligan, DC
* Jason Ledford, DC
* David M. Gustitus, DC
* Derek A. Houtz, DC
* Brian Johnson, DC and Tracy
Johnson, DC
** Lisa Hannifin, DC
* Kristen O’Reilly, DC
* Heather A. Van Skyhock, DC
* Martha H. Bergner, DC
* Alice B. Elrod, DC
** Arno Burnier, DC
Christopher J. Rogers, DC
** Robert J. Manna, DC
* Landrum Williams, DC
* Don Lemberger, DC
* Tripp Stover, DC
** Brice Kovarik, DC
** Brent Reiche, DC
* Lora Kinter, DC
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8/26/2003
8/26/2003
8/26/2003
8/26/2003
* Eric C. Krohne, PhD
* Michael P. Cohen, DC
* Paula Frey, DC
* Scott Stachelek, DC
** Manon Fielding, DC
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8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
* Christopher H. Stewart, DC
* Nancy Parker, DC
* Brett D. Gallagher, DC
** Wade Lofton
* Teri Lorencen Stockwell, DC
* Allen R. Bastecki, DC
* Simon A. Senzon, DC
Davenport, IA
MN
Davenport, IA
Wales, WI
San Diego, CA
Staples, MN
Littleton, CO
Ft. Collins, CO
Raleigh, NC
San Diego, CA
Marysville, OH
Spencer, IA
Littleton, CO
Indianapolis, IN
NC
Alpharetta, GA
Wilmington, NC
Calhoun, GA
McVeytown, PA
Santa Barbara, CA
Burbank, CA
Grand Prairie, TX
Haslett, MI
Tucson, AZ
Eureka, MT
Durango, CO
Toluca Lake, CA
Rome, GA
Greenville, SC
Louisville, CO
Mechanicsville, VA
Lynnwood, WA
Pueblo West, CO
Executive Director, GA Chiropractic
Association
Toronto, Ontario
Montclair, VA
Hillsborough, NC
23
Madison, AL
Auburn, GA
Bakersfield, CA
Traverse City, MI
Ames. IA
Asheville, NC
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8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
8/26/2003
** James Stirton, DC
* Robert W. Dunn, DC
* William Berkowitz, DC
* Michael Quartararo, DC
* Carol E. Adams, DC
* Trey Stiles, DC
* Adrian Yeung, DC
Sacramento, CA
Seattle, WA
Arroyo Grande, CA
Ballston Spa, NY
Telluride, CO
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8/27/2003
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8/28/2003
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8/28/2003
8/28/2003
8/28/2003
8/28/2003
8/28/2003
8/28/2003
8/28/2003
** Steven Black
Avery N. Martin, DC
** Kenneth Fuller, DC
* W. Kurt Miler, DC
* Stephen D. Lee, Dc
* Jeffrey Smith, DC
* Rich Gorsuch, DC
* Eugene L. Packer, DC
** Robert Rogillio, DC
* Daniel R. Perkins, DC
* sacred mission @
* Jean Warrington, DC
* James A. Dahlin, DC
** Hans Conser, DC#
* Willie W. Kindred, DC
* J.M Sigafoose, DC
* Jerry Webb, DC and Simone
Webb, DC
* Elizabeth Faletti, DC
** Miriam Leean, Dc
* Jonathan Ewer, Dc
* Randy C. Moze, DC
* R. Scott Miner, DC
* John Paul Reeve, DC
* Damian A. Palmer, DC
* Jean-Marc Slak, DC
* James D. Eckert, DC
* Richard Clark, DC
* Heather Whittle, DC
* Yitzchack Freeman, DC
* Craig Stull, DC
* Debra Barnes, DC
* Desdemona Whitley, DC
* Cara A. Iovino
** Jonathan Berns
* Rick Eschholz, DC
* David Ullian, DC
* Jimmy Labrecque, DC
* Mike Montesano, DC
* Louis Abate, DC
** James R. Vana, DC
* Travis Hughes, DC
* Eric Mintz, DC
* Pete Gay, DC
* George C. Fraudin, DC
* Len Schwartz, DC
* Mitchell E. Falk, DC
24
Bothell, WA
Student of chiropractic, Parker College of
Chiropractic, Irving, TX
Savannah, GA
Sarasota, FL
Gainesville, FL
Keene, NH
North Easton, MA
Houston, TX
Hatboro, PA
Rocklin, CA
Bozeman, MT
Tempe, AZ
Kingston, WA
Kennewick, WA
Waupaca, WI
Dallas, GA
Norcross, GA
Hesperia, Mi
Burlington, MA
South Portland, ME
Dublin, GA
Kennesaw, GA
Jerusalem, Israel
MI
Brandon, MS
San Diego, CA
Sandy Springs, GA
Chiropractic student, Davenport, IA
Montpelier, VT
Fort Lauderdale, FL
N. Richland Hills, TX
Elmwood Park, IL
Boston, MA
Moline, Il
Keego Harbor, MI
ICA State Representative, Kennebunk, ME
Richboro, PA
Chairman, SC Board of Chiropractic
237
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8/28/2003
8/28/2003
8/28/2003
8/28/2003
8/28/2003
* Timothy Lenahan, Dc
* Andrew Sokol, DC
* Shawn Stubbs, DC
* Matthew R. Derosier, DC
* Jesus Castaneda, DC
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8/28/2003
8/28/2003
** J. Richard Burns, DC
* Carrey Tiller, DC
** John House, DC
* Brian Nardi, DC
* Kelli M. Uhlman, DC
* Jeana Thomas, DC
* Kevin M. Smith, DC
* Tim Henderson, DC
* Anthony Pivonka, DC
* Emily Stumpf, DC and J.T.
Stumpf, DC
* Steven L. Moon, DC
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8/29/2003
8/29/2003
8/29/2003
** Gwain Zarbuck II, DC
* Joshua K. Purcell, DC
* John R. Fisher Jr. DC
** John G. Goodfellow III, DC
* Jerry Dreessen, DC
* Jack Mansche, DC
David Sheitelman #
* Danny G. Lipes, DC
** Gene Putnam, DC
* Shahram Honari, DC
* Daniel E. Arnold, DC
* Brian Benson, DC
** Charles R. Dixon, DC
* Daniel Jacobazzi, DC
* L. Craig Crockett, DC
Dennis M. Cozzocrea, DC #
* Pamela S. Grindl, DC
* Virginia A. Steiner, DC
* Mindy A. Weingarten, DC
** Steven Cantor DC
* Garrett Fritts, DC
* Nancy Williver, DC
* Tom L. McAvoy, DC
* Luigi Di Rubba, DC
** Dennis Doyle, DC
* Aaron M. Peters, DC and Jennifer
M. Peters, DC
* Marc Wind, DC
** Roy M. Ostenson, DC
* Lane Luxon, DC
* Seth Chalfin, DC
* Scott Erichsen, DC
* Kay K. Secrest, DC
* Dale G. Kenny, DC
* Dean A. Chancey, DC
25
Examiners
South Amboy, NJ
Duluth, GA
Moody, AL
Dilworth, MN
San Antonio, TX
Professor, Palmer College of Chiropractic,
Davenport, IA
Baton Rouge, LA
Avon, CT
Denver, CO
Venetia, PA
Lake Kiowa, TX
Gilbert, AZ
Keene, NH
Concord, CA
Legal Affairs Chairman, IL Prairie State
Chiropractic Assn., Rock Island, IL
North Las Vegas, NV
Racine, WI
IL
Mountlake Terrace, WA
Greenfield, WI
Chiropractic student
Davenport, IA
Maui, Hawaii
Davenport, IA
Kokomo, IN
Prescott, AZ
Chandler, TX
St. Johs, AZ
Yakima, WA
Davenport, IA
Marion, IL
Port Orange, FL
Boca Raton, FL
San Francisco, CA
Landing, NJ
Cheshire, CT
DuBois, PA
Boulder, CO
Neenah, WI
Lynden, WA
Bergenfield, NJ
Algoma, WI
Algoma. WI
MAJ, USAF IRR
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9/3/2003
9/3/2003
** Donald W. Olson, DC
* Harald Conradi, DC
** Paul C. Sorchy II, DC
* Edward C. Deemer, DC
** Edward Hacmac, DC
* Heather Freedlund, DC
* Matthew Zimmerman, DC
* Stanley M. Miller, DC
* Moshe Newman, DC
* Asher Nadler, DC
* Keith McKim, DC
* Leonard Rosenblum, DC
* Allison Glass, DC
* Pamela Stone, DC
* Kenneth H. Ruf, DC
* Kevin J. Moore, DC
Association of Chiropractic Colleges
* Robert J. Scranton, DC
* Daniel Greenberg, DC
* Jason E. Hartle, DC
* James R. Darnell, DC
* Dustin J. Detrick, DC
* Kreg D. Huffer, DC
* Amy G. Debter, DC
* Chad Luce, DC
* John Marth, DC
* W. Atkinson, DC
Terry Rondberg, DC
* Mark A. Bassett, DC
* Heather Iannelli, DC
* Brian J. Harasha, DC
* Charles S. Emmons III, DC
* Russel Schroder, DC
Patrick Thomas, DC#
** Joanne Therriault, DC
* Ronald Perry, DC
* J. Dean Fitsgerald, DC
+ Robert Manna, DC
+ Liam P. Schubel, DC
+ Chad Rohlfsen, DC
+ Richard G. Stein, DC
+ Alan J. Lichter, DC
+Craig Finkelstein, DC
+ Bruce Grundy, DC
+ Marc Ott
Charles Jackson (did not receive
body of message due to virus)
+ Bruce Kesten, DC
+ Derek S. Atchley
+ Robert G. Casteel, DC
+ Dale V. Lotter, DC
+ Chad S. Young, DC
+ Tony Palmero, DC
+ Tania Howard DC
+ James P. Ramos, DC
26
Auburn, WA
Durango, CO
NRCC
Oklahoma City, OK
Milwaukie, OR
Winnebago, IL
Mt. Pleasant, SC
Troy, MO
Jerusalem, Israel
Los Angeles, CA
Nampa, ID
Sunderland, MA
Kennesaw, GA
Coon Rapids, MN
Palmer Chiropractic College
Association of Chiropractic Colleges
Margate, NJ
Jackson Center, OH
Jackson Center, OH
Jackson Center, OH
Jackson Center, OH
Chattanooga, TN
MA
President, World Chiropractic Alliance
Shelby Township, MI
Ft. Wright, KY
St. Louis, MO
Poughquag, NY
Corpus Christi, TX
Roosevelt, UT
Roosevelt, UT
Rome, GA
Freehold. NJ
Newton, IA
Washington, DC
Doylestown, PA
Peachtree City, GA
Chiropractic student
Oceanside, NY
Student, Palmer Chiropractic College
Green Bay, WI
Tucson, AZ
Paducah, KY
Sedro Woolley, WA
341
342
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9/3/2003
* Diane M. Zaccaria, DC
+ James W. King, DC
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9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
9/4/2003
+ Jonathan Berns, DC
+ Michael O’Brien, DC
+ Preston Tornell, DC
+ Jeffrey P. Clark, DC
+ Lyle, Love, DC
+ James D. Eckert, DC
+ Jamy Antoine, DC
+ Marvin C. Lee, DC
+ Stuart Druckman, DC
+ Jeffrey James, DC
+ Arlin T. Resco, DC
+ Andrew Smyth, DC
+ Adam J. Williams, DC
+ H.B. Powell, DC
+ Brett D. Gallagher, DC
+ Jonathan M. Snyder, DC
+ David Ginsberg, DC
+ Robert Martines, DC
+ Myron D. Brown, DC
+ James D. Moss, DC
* Rick Humiston, DC
+ Tim Ciolkosz, DC
+ Todd E. Plinke, DC
+ Lonnie Rudd, DC
+ Bonnie Travis, DC
+ Shervin Parvini, DC
+ Mayor Stephanie R. Grenier, DC
+ Patrick J. Walsh, DC
+ Roger J. Kasperbauer, DC
+ Charles G. Register, DC#
+ Fred Gerretzen, DC
+ Paula J. Sperry, DC
+ Asher Nadler, DC
+ Robert Wallace, DC
+ Ellen S. Jackson, DC
+ Dennis S. Brickner, DC
+ Mario Milani, DC
+ Richard M. Kuhns III, DC
+ Nancy J. Trimboli, DC
+ John Claussen, DC
+ Matthew B. Shifflett, DC
* Kyrie Kleinfelter, DC
+ Sean Alan Reese, DC
+ Garnett Stover, DC
+ Perry O. Rush, DC
+ David W. Basista, DC
+ Fred Clarke, DC
+ Michelle Mix, DC
+ Thomas F. Tauer, DC
+ Donald J. Cox, DC
+ Michael R. Zolper, DC
+ Robert D. Meadows, Sr., DC
27
Wilmington, NC
Auburn, CA
Student, Palmer College of Chiropractic,
Davenport, IA
Sioux City, IA
Lake Stevens, WA
Seattle, WA
South Portland, ME
Victoria, MN
Rancho Palos Verdes, CA
Gettyburg, PA
Los Angeles, CA
Clyde, KS
Norwood, MA
Okemos, MI
Salem, MO
Bakersfield, CA
Circleville, OH
Santa Clara County
Inman, SC
Sterling Heights, MI
Wilmington, DE
Amherst, NY
Kansas City, MO
Fortuna, CA
Auburn, GA
Santa Rosa, CA
Moscow, Russia
Eastham, MA
Los Angeles, CA
Huntington, NY
Fairview, PA
Springboro, OH
Spring Hill, TN
NC
Hammond, IN
Kilmarnock, VA
St. Charles, IL
Mechanicsville, VA
SC
Olathe, KS
Belle Chasse, LA
Richmond, VA
Libby, MT
Baraboo, WI
Atlanta, GA
395
396
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9/6/2003
9/7/2003
9/7/2003
9/7/2003
9/7/2003
9/8/2003
9/8/2003
9/8/2003
9/8/2003
+ John Adams, DC
+ Todd Caughey, DC
+ William F. Lawler, DC
* Todd W. Gignac, DC
+ Darrel Crain, DC
+ Elizabeth Faletti, DC
+ Kevin C Smith, DC
+ Jennifer Sherriff, DC
+ Jason B. Welker,DC
+ Ida Allen, DC
+ Jeff Shiflet, DC
Lisablu@ (no message, attachment
blank)
+ David V. Young, DC
+ Josh Watkins, DC
+ Brenda Hassebrock, DC
+ Christian Haug, Dc
+ Linda Dirlam, DC
+ Stuart C. Kordonowy, DC
+ Nicole Buchanan, DC
+ Teresa Fourre’, DC
+ Tanya Hinka, DC
+ Guy Anderson, DC
+ Randy C. Moze, DC
+ Craig Rogers, DC
+ Steven C. Eisen, DC
+ Joe Hassler, DC
+ Adrian Yeung, DC
+ Patrick T. Ryan, DC
+ Dale Andelkovic, DC
* Stephen C. Brower, DC
+ Dominiqe M. Scott, DC
+ Christopher J. Koch, DC
+ Robert A. Abbruzzese, DC
+ Soft Touch Chiropractic @
+ Lori Ugolik, DC
+ Daniel F. Allen, DC
+ Rich Eschholz, DC
+ Michael Montesano, DC
+ Gerald A. Anzalone, DC
+ Glenn Gabai, DC
Matt Willenkin, MD, DC
+ Bernard Kaseman, DC
+ Carolyn De Witt, DC
+ Terri L. Weed, DC
+ Israel Maldonado, DC
+ Charles L. Blum, DC
+ Dean L. Smith, DC
+ Alan Meden, DC
+ Thalia Duncombe DC
+ Martin G. Rosen, DC
+ Donald Gran, DC
+ David H. Pico, DC
+ D.W. Williams, DC
+ Jack Masche, DC
28
Grand Junction, CO
WA
Philadelphia, PA
Fairfield, CT
Hyde Park, UT
WI
Mesa, AZ
Prior Lake, WI
Houston, TX
Fargo, ND
Cedar Falls, IA
Asheville, NC
Phoenix, AZ
Holly Springs, GA
Delray Beach, FL
Fergus Falls, MN
Buchanan, GA
Kihei, HI
Philadelphia, PA
Fort Collins, CO
Bothell, WA
Redlands, CA
New Orleans, LA
Manhattan Beach, CA
Phoenix, AZ
Briarcliff Manor, NY
Macon, GA
Tucson, AZ
Montpelier, VT
Elmwood Park, IL
Peekskill, NY
Lancaster, PA
Tarzana, CA
Tarzana, CA
Boca Raton, FL
Oxford, OH
Pleasant Hills, PA
Parker College of Chiropractic
Wellesley, Ma
Palmer College of Chiropractic, Davenport, IA
New York City, NY
Coldwater, MI
Milwaukee, WI
449
450
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9/8/2003
9/8/2003
9/8/2003
9/8/2003
9/8/2003
9/8/2003
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9/8/2003
9/9/2003
9/9/2003
9/9/2003
9/9/2003
9/9/2003
9/9/2003
9/9/2003
9/9/2003
9/10/2003
+ William Martin Sloane, LLM
+ Steven G. Sanderson, DC
+ Mark H. Sussin, DC
+ Steven G. Sanderson, DC
+ Teresa J. Berry, DC
+ Angelo Querin, DDS, DC
+ Brad Wolf, DC
+ Veronica Gutierrez, DC
+ Michael T. Denery, DC
+ David T. Gruda, DC
+ Spence J. Jahner, DC
+ Eddy Cohen, DC
+ Ishi Rodriquez, DC
Bill Walsh, DC
+ Nicole Debroux, DC
+ Leroy, G. Moore, DC
+ Kosta Adamou, DC
+ Ty S. Ruddell, DC
+ Douglas R. Patterson, DC
+ Andrew Hajduk, DC
+ David Borges, DC
+ Margaret Brownlie, DC
+ Harold W. Roberts, Dc
472
9/10/2003
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481
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9/10/2003
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9/13/2003
9/16/2003
9/16/2003
9/16/2003
9/16/2003
9/17/2003
9/18/2003
9/23/2003
9/24/2003
9/24/2003
9/28/2003
Ben F. Massey, PT
+ Robert L. Fiss, DC; Jason K.
Bosko, DC; and Attilio A. Paci, DC
+ James E. Haley, DC
+ Heide L. Hartmann-Taylor, DC
+ Teri Stockwell, DC
* LaTisha Peterson, DC
+ Jamie K. Neithold-Nash, DC
+ Katie Bowman
+ Kelly A. Miller, DC
+ Barabara Bjerken, DC
Marvin Talsky, DC (attachment
blank)
+ Karl R.O.S. Johnson, DC
* Christopher G. Lee, DC
* Ronald Festa, DC
International Chiropractors Asso.
+ Emerson S. Taylor, DC
Grant Shapiro, DC
Christian Bartels, DC
*Thomas D. Barnes, DC
+ Katrina van der Merwe, DC
* William C. Keith, DC
29
Carlisle, PA
Marquette, MI
Rhinebeck, NY
Marquette, MI
Las Vegas, NV
CA, NM
TysonsCorner, VA
Arlington, WA
Staples, MN
DuBois,PA
Bozeman, MT
Bkln, Y
Antigo, WI
Sherman College of Straight Chiropractic
Newport Beach, CA
Gilbert, AZ
Vernon Hills, IL
South Lake Tahoe, CA
La Grange Park, IL
ID
President, American Physical Therapy
Association
Chambersburg, PA
Sarasota, FL
Chino Valley, AZ
Traverse City, MI
S. Dennis, MA
Recent graduate
Westfield, NY
Moorhead, MN
Shelby Township, MI
New Kensington, PA
International Chiropractors Association
Blanchester, OH
Doylestown, PA
Fayetteville, AR
Texas

Department of Veterans Affairs

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