Articles by JCS
"Goin' to Jail for Chiro"
JC Smith, MA, DC
Today it's hard to imagine that over 15,000 DCs went to jail for practicing chiropractic care in the first half of the 20th century. These early healthcare libertarians were convicted under the guise of practicing medicine without a license, not for criminal activities or malpractice. Their real crime was actually getting sick people well without drugs or surgery, making their medical nemesis' claim of practicing medicine appear ridiculous. In fact, too many DCs spent too much time in jail before state scope laws were passed to protect these brave health professionals from unwarranted prosecution from the medical Nazis. Indeed, thousands of chiropractors paid a very large price to practice their healing art.
Their courage to face public humiliation and incarceration in order to keep the chiropractic principle alive bears similarities to other civil rights movements. These early chiropractic pioneers were willing to endure confinement, fines, and some gave the ultimate sacrifice--quitting their practices and moving on. There certainly wasn't much pleasure in fighting the medical wars early on for the chiropractic warriors who have fought in the trenches for chiropractic, except to bring a freedom of choice to their patients.
Goin’ to Jail: A New Meaning
While going to jail for chiropractic in the first half of the 20th century had taken on a meaning of bravery and sacrifice, today going to jail for chiropractic usually means conviction for fraud or sex harassment. With the burgeoning ranks of young chiropractors flooding the markets in many towns and cities, gimmicks that once were deemed unethical are now classified as illegal, such as using patient brokers, i.e., "runners," and NOOPE (no-out-of-pocket expense by waiving co-pays and/or deductibles).
The recent passage of the Kennedy-Kasselbaum bill made these insurance tricks a federal crime punishable by 5 years and/or $10,000 for each offense. Indicted DCs in Florida and Georgia are feeling the heat from the feds for their egregious abuses. Meanwhile, other marginal forms of insurance fraud continues, but not without suspicions from authorities, such as the MD-DC practices where the "rent a doc" simply signs forms to continue care rendered by the chiropractors.
"Goin' to jail for chiro" now has a new meaning that unfortunately taints the collective image of every DC rather than uplifting it as our predecessors did with their sacrifices. Newspaper articles and television news segments about some chiropractors doing illegal practices has done more to hurt our reputations than any single other activity in recent years. While recent research vindicates our clinical care, news articles about insurance fraud only add to the fuel that vilifies our profession as charlatans not to be trusted. Ugh.
While insurance fraud now has infected some of our colleagues as managed care continues to take a bite out of everyone's incomes, hopefully the concept of "goin' to jail for chiro" could take on another, newer meaning that once again is regarded as positive. Rather than insurance fraud connotations, what if concerned DCs were to picket every hospital in the US on the same day? Carrying placards that read: "Give Patients Freedom of Choice"; "Chiropractors are Doctors, too"; "Stop Unnecessary Back Surgeries"; "My Privilege Comes from My License"; "End Segregation in Hospitals"; "Liberate this Public Facility".
If every DC took one day off from work, brought a dozen patients and staffers along to the local hospital, dozens of people picketing in front of every hospital would create a publicity storm unlike anything else we could do. Every local and national newspaper and TV station would pick up on this huge effort and bring to light the discrimination every DC and chiropractic patient lives with daily. And talk about free publicity! Would DCs be arrested for picketing their local hospitals is doubtful, but it would be a small price to pay if it led to liberating public hospitals from the grasp of the medical men.
The fact that most public hospitals still exclude chiropractors on staff reeks of discrimination not unlike racial discrimination in public schools. How does one trade association walk into a public facility and exclude any and all competition under the guise of a "privilege" still confuses me. I thought my privilege to practice came from the state government which gave me my license, not from the local medical clan that has monopolized a public facility.
A case has already been made that this tradition of doling out staff privileges to a select few is basically discriminatory if the only reason is due to their type of license, as the Wilk case contended. Yet this practice continues without mention of the segregation that still exists to this day. Although the federal government took action with troops to de-segregate our public schools, no authority has ever helped chiropractors enjoy the same right of open access to a public facility. Could you imagine federal troops barging into a hospital with a chiropractor in their fold?
Not only have segregated hospitals kept their main competitors out of the loop of the mainstream healthcare delivery system, but their boycott of chiropractic has denied patients not only the best of care for the majority of LBP cases, it has denied them their legal right to informed consent. The fact that most LBP cases are routinely railroaded into the drug 'em, cut 'em medical methods without any mention of conservative manipulative therapy as an alternative. And when asked by patients about the possibility of chiropractic care as an option to surgery, most are given the classical voodoo diagnosis: "If you're stupid enough to let a quack crack your back, then don't come crawling back to me." Enuf said, ridicule taken, fear created, no more questions, case sold.
Some consider the use of taxpayers' money to augment the cost of the administration of our public hospitals as a normal cost for running a city, i.e., a "utility" service similar to the fire department. While this argument appears logical, on the other hand, there is a huge difference. The fact that we not only pay for the medical facility with tax dollars, but unlike the fire department, we aren't then asked to pay for their services afterwards. Could you imagine if your home caught on fire that afterwards the fire chief gave you a bill for $50,000? You would go ballistics, and rightfully so.
Just like with public schools, we aren't also asked to pay a tuition for our children to attend. But in our public hospitals paid for by tax dollars, a single trade association is allowed to monopolize the facility to the exclusion of anyone they want under the guise of staff privileges, then they charge the heck out of us with exorbitant costs only seen in the insulated world of health insurance. What's wrong with this picture?
End the Boycott
There is no logical explanation anymore to rationalize why public hospitals are dominated by medical associations to the exclusion of all others, especially to chiropractors, long the target of this discrimination and boycott. Considering that back problems are the third-leading reason for hospital admissions and surgery, the need for chiropractic care is obvious. Patients have legal rights to our care, which has been recommended since 1994 by the US Public Health Service’s guideline on acute low back pain. To deny SMT to patients denies them the best solution for many of their LBP, and it denies them legal informed consent. The bottom line is there is no good reason to keep chiropractors out of public hospitals.
To get the attention of the public requires more than periodic mention of the Wilk case in occasional magazine articles. We need nationwide attention to this blatant case of segregation in our public hospitals by a protest demonstration--the Selma of Chiropractic. A one day march on state capitols or public hospitals by every conscientious chiropractor in the states who wants to promote our inclusion into the mainstream would do more to enlighten the public than all the free exams, chicken dinners or NOOPE have ever done, plus it would be positive for our image, not negative.
For those DCs who want to get out of the last seat in the medical bus, a public demonstration would do wonders to cast the chiropractic side-show into the mainstream consciousness of the American media and public. Let’s carry our plea to the public and supersede the traditional medical bias that will never allow us in their domains. Just as blacks had to protest to sit in a ‘whites’ only restaurant or to ride in the front of the bus, it’s now time for courageous chiropractors to ‘act up.’