The enchanted primary care practitioner

The enchanted primary care practitioner

New Mexico is truly the "Land of Enchantment," just not in the way the state's promoters intended when they adopted that tagline. They wanted to conjure a feeling of pleasure or delight, one definition of the word "enchantment." But enchantment's other meaning – witchcraft, sorcery, magic – comes closer to the true spirit of the place when you consider two bills before the state legislature this year. Both give practitioners of magical medicine – chiropractors and "doctors" of oriental medicine – expanded prescription authority, furthering the illusion that they are competent primary care providers.

New Mexico is the only state that allows prescription privileges for chiropractors. Chiropractors with only 90 hours of education and training beyond chiropractic school, which has virtually no instruction in pharmacology, can become "advanced practice chiropractic physicians." They can prescribe from a limited formulary approved by the chiropractic board. Input from the pharmacy and medical boards is required only if the formulary includes drugs for injection, dangerous drugs or controlled substances. Currently, chiropractors can prescribe, among other substances,

In other words, a hodgepodge of remedies, many of which are considered substandard in medicine and have little to do with musculoskeletal problems. Passing the law creating the "advanced practice chiropractic physician" was part and parcel of the plan to refashion chiropractors as "primary care physicians" and beat out the competition (naturopaths, for instance) who are claiming the mantle of "alternative" PCPs.

New Mexico Senate Bill 150 is the latest attempt to expand their prescriptive authority even further. In a move we've seen in other states, the bill would also make New Mexico default to the Council on Chiropractic Education to decide the scope of practice for NM chiropractors. That's not exactly what it says, but it is exactly what it does.

SB 150 creates three types of chiropractors: the garden-variety chiropractor (or "chiropractic physician"), the Level One advanced practice chiropractic physician, and the Level Two advance practice chiropractic physician. It also transforms chiropractic practice into chiropractic "medicine," a word liberally sprinkled throughout the text.

The level one chiropractor would have basically the same education and training as the current advanced practice chiropractor, but his prescriptive authority would be expanded to include prescription and injection of herbal medicines, live cell products, carbohydrates, sugars, dietary supplements, and bioidentical hormones without approval by the medical or pharmacy boards. Other drugs, including "dangerous drugs," could be added to the formulary "in collaboration with," but not necessarily approval of, the medical and pharmacy boards. "Dangerous drugs" is basically defined in the bill as prescription drugs other than Schedule I controlled substances.  For purely theatrical purposes, the bill goes on to define "dangerous drugs" as those that are not safe to use "except under the supervision of a chiropractic physician."

A "level two advanced practice chiropractic physician" would be able to

"prescribe, administer, inject and dispense dangerous drugs that are used in a standard primary care practice"

except for Schedule I and II controlled substances, unless the Schedule II controlled substance is on the chiropractic formulary.

Level one chiropractors are eligible to become level two chiropractors will the addition of 650 hours of education and training "from an institution of higher education or professional school that is accredited by an agency accredited by the federal department of education." In other words, chiropractic schools could set up these training programs.

SB 150 would also default to the NM chiropractic board and the Council on Chiropractic Education to determine the chiropractic scope of practice. As it now stands, scope of practice is defined by law as treating injuries, deformities "or other physical or mental conditions" with manual therapies, mechanical appliances, dietary supplements, homeopathic remedies, and other limited means. The bill would change this language to

"practice chiropractic medicine in accordance with board rules"

leaving it up to the chiropractic board to determine, with few limitations, what chiropractors could do. The bill also gives chiropractors

"the right to practice chiropractic medicine as taught and practiced in accredited colleges of chiropractic medicine and  . . . the right to diagnose, palpate and treat . . . physical or mental conditions by use of any methods provided in Board rules . . . ."

Chiropractic colleges are accredited by the Council on Chiropractic Education, which requires the colleges to educate and train students to practice primary care, or at least an ersatz version of primary care. 

In sum, if SB 150 passes, the chiropractic board would be free to allow chiropractors to diagnose and treat any disease or condition by any means short of operative surgery or Schedule I controlled substances. Schedule II controlled substances could be prescribed and administered (including via injection) if they "collaborate" with the pharmacy and medical boards.

The New Mexico Medical Society opposes SB 150. No word yet from that other nemesis of chiropractic "primary care" and expanded prescription authority, the International Chiropractic Association. These odd bedfellows successfully fought similar bills in the past. Let's hope they succeed again.

New Mexico already defines "doctors of oriental medicine" as primary care practitioners. It gives the Board of Acupuncture and Oriental Medicine the authority to issue certifications in injection therapy, intravenous therapy and bioidentical hormone therapy. A newly filed bill, House Bill 232, would add certification in "holistic integrative medicine" to any "doctor" of oriental medicine who is certified in all three.

Oriental medicine practitioners can already compound, dispense and administer herbal medicines, live cell products, and certain "dangerous drugs and controlled substances," among other substances. This bill would add, among other things, nitrous oxide and "substances used for detoxification and chelation." Thus, if HB 232 passes, "doctors" of oriental medicine who are appropriately "certified" by the board will be to remove mythical toxins with IV concoctions, including chelation as part of their "primary care" practice.

New Mexico is truly the Land of Enchantment, just the wrong kind. 

Points of Interest 01/30/2017
Points of Interest 01/28/2017