The Key Won’t Unlock
JC Smith, MA, DC
Although it has been well over 10 years since the Wilk antitrust suit was settled in favor of the plaintiffs/chiropractors, the insidious boycott of chiropractors from public hospitals continues despite this legal landmark. While a few DCs have gotten on the staffs of their local hospitals, for the most part, the vast majority of hospitals still exclude our healing art, and for good reason—we’re too cheap and we would be taking money out of their pockets. Ironically, only in healthcare is a “better mousetrap” frowned upon.
Considering the fact that the second-leading cause of office visits to all doctors are back-related, and the third-leading procedure done in American hospitals are back surgeries, it’s easy to see why hospital administrators and medical doctors are in disfavor of implementing a chiropractic program. Back pain is a huge moneymaker for these folks, and they have no interest in decreasing their profits by including chiropractors on staff, despite the recent plethora of research that verifies the clinical and cost-effectiveness of chiropractic spinal manipulative therapy.
For example, consider these costs: According to researchers (Carey et al.) from UNC, the average chiropractic case for LBP cost $800 per case. On the other hand, according to the State of Georgia Workers’ Comp stats, costs for surgical procedures ranged from $3,042 for a diskectomy to $6,243 for a spinal fusion, and hospitalization for a fusion ranges from $6,796 to $12,481 depending upon complications.
For the year 1999, there were 2,959 LBP cases reported in Georgia’s workers’ comp program costing taxpayers over $28,000,000. Of these nearly 3,000 cases, DCs cared for only 81 that cost a mere $79,000 in provider fees, which is less than one thousand per case. On the other hand, the medical cost per case was almost $10,000.
And for many patients, failed back surgery syndrome adds to the cost when patients receive multiple surgeries when are told, “Sorry, but the fusion didn’t ‘take,’ so let’s do another one.” (Talk about throwin’ good money in after bad!?)
So, as a for-profit hospital administrator, would you prefer seeing a chiropractor bring in only $800 per LPB case when they stand to gain thousands more using medical methods that have been shown to be less effective and more costly? In one study done by MetLife, a non-surgical low back case using only pharmaceuticals and physical therapeutics in a hospital costs $7,000, while a medical back surgery case averaged $14,000. Obviously the choice is to exclude the better mousetrap when the old one makes much more.
Their refusal to accept DCs on their hospital staffs speaks volumes—research be damn, full-steam ahead on more back surgeries and more profit. By now you all know that—it’s like preachin’ to the choir! Unfortunately, the public is mostly unaware of this sad situation, and they easily fall prey to this when the greedy surgeon tells them there is no alternative to surgery, and often the patients are given the voodoo diagnosis: “If you don’t have my surgery, you’ll get worse, and if you’re stupid enough to go to a chiropractor, don’t come crawling back to me after you’re paralyzed.” Honestly, this lie is being told daily to thousands of patients.
What makes this point most poignant is exemplified by my own attempt to desegregate the local hospital in Warner Robins. I took the same research, expert testimony and the Wilk case judge’s findings to the board, but they still refused to allow a DC on staff and to give patients a choice in their healthcare matters. As I was told by the chairman, “We ain’t gonna let no yankee judge tell us what to do.” And one medical doctor on the board told me, “We like to think our medical doctors know what’s best for these patients.” Indeed, their attitude seemed to be, “Don’t confuse us with the facts.” Indeed, the under-handedness of the board was incredible with their bias and refusal to acknowledge the facts and court findings.
At the end of my presentation, after the court reporter had turned off her recorder, the board’s attorney stood up and told the board “if you let a chiropractor on staff, you’ll lose the hospital’s accreditation.” Of course, a shock wave went through the board, negating everything I had just said. Although I told the attorney that I believed he was wrong since other hospitals had DCs on staff, the next day I phoned the state attorney general’s office and told him the story. After he stopped laughing, he informed me that there are no state or federal laws of that sort. Yet it shows the extent of lawlessness these medical folks will go to maintain their turf.
Even my attorney told me to “forget about it,” speculating that if I were to sue in the Southern District Federal Court and prevailed, out of sheer spite the board would ignore me and select some “closet” chiropractor who had never spoken out instead. Plus, he said, it would cost me over $125,000 in legal fees.
So, I took his advice and for over ten years have not broached this issue again, until recently, that is.
Just last week I was honored by the mayor of my town with a proclamation and the Key to the City for 20 years of outstanding service to the townspeople as well as for eleven years of organizing the Dawg Jawg. This last year we had over 125 dawgs and 300 people attend this event and raised over $1,500 for the animal shelter. It’s a good public relations event for my office; moreover, it helps needy animals and raises the morale of those kind-hearted folks who run the animal shelter.
When the mayor handed me this plaque in front of the City Council and onlookers, I was totally surprised and mostly speechless except to thank him and to give praise to my staff and the folks at the shelter who also contribute a lot to this effort. The next day I wrote the mayor a thank you letter and I asked him if this Key to the City would open the door to the hospital for me. As I told him, I find it quite ironic that I am afforded this award, but if he were in an accident and laid-up in the hospital, I couldn’t go in there to help him. Obviously this Key is purely symbolic, but the irony didn’t escape me—I’m good enough to get the Key to the City, but not good enough to be on staff at the public hospital.
I recall initially when I made this push to have a DC on the hospital staff, no other DCs in town would help me nor did any attend the board meeting, much to the attention of the board’s attorney who cited my lack of support among our own troops. Are DCs so disenfranchised that they have given up any hope to enter the mainstream? Are they so busy that they don’t need to? Or, are they so scared that they don’t want to suffer any humiliation from being rejected? Are all DCs this apathetic today because if our predecessors were as such, none of the 15,000 would have gone to jail for ol’ chiro? You tell me: Are DCs less confrontational today than yesteryear?
Nonetheless, waiting for the medical board to come to their senses and allow a DC on staff is well wishing at best. Until the law forces them to integrate, they will continue to boycott our services. I still think we DCs should stage a picket of every public hospital in the country that discriminates against DCs. (Remember: I did graduate from Berkeley) At least that would get the attention of the media to promote our cause, just as the recent Pro-Life demonstration on Capitol Hill.
Not only is this overt discrimination against DCs, the distributive injustice that Dr. Manga emphasized in his papers, it also denies patients their legal, informed consent to alternatives and denies them their freedom of choice, plus it drives up medical costs. Of course, this is par for the course whenever an industry fails to provide free enterprise in an open marketplace. In other words, the medical monopoly has no interest in opening its doors to competition no matter what improvements may be had for the consumers.
Just as Rev. Jessie Jackson has effectively played the race card to his advantage, why can’t we chiropractors play the “fair competition to lower costs” (the better mousetrap argument) or the “freedom of choice” card? We have the proof that SMT is preferable over surgery, we can prove we’re cheaper, safer, faster with longer-lasting results, and we can show the US federal guideline on LBP along with the many international studies which recommend SMT over surgery/drugs.
What we’re lacking is a powerful publicity campaign to engrain this notion of distributive injustice in healthcare into the public’s consciousness. Until we’re on the evening news making these points, we will continue to languish in the background wondering why we don’t have access to more patients, parity with medical professionals, or why we remain on the outside of the loop. Instead of political action to overcome these areas of inequality, we withdraw into a bunker mentality and rally around our spiritual motivators, chanting, “Innate heals all,” and name-calling at our opponents. Ugh.
Indeed, as Al Gore mentioned in his campaign about his “locked box” where he would keep untouchable issues like Medicare and Social Security, I daresay somewhere in a locked box is the key that we need to open these doors. Just how this will be done is a great mystery since the medical society has virtually locked us out of these public health care systems, few politicians want to embrace this concept of freedom of choice in healthcare for fear of upsetting the medical society, and our own profession seems uninterested in liberating hospitals with immediate action. Wait and pray for medical handouts seems to be the tactic of choice.
But, what do I know? I’m just a country chiropractor watching too many patients being railroaded into unnecessary back surgeries.