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House Committee on Veterans' Affairs
Subcommittee on Health

Hearing on Chiropractic Services
in the Department of Veterans Affairs
October 3, 2000

Letter from AMA Executive Vice President E. Ratcliffe Anderson, Jr., MD,
Opposing Legislation to Expand the Scope of Chiropractic Privileges

The Honorable Cliff Stearns
Chairman Subcommittee on Health Committee on Veterans Affairs
U.S. House of Representatives
338 Cannon House Office Building
Washington, DC 20515

Dear Chairman Stearns:

On behalf of the American Medical Association's (AMA) 300,000 physician and medical student members, I strongly urge you and the members of the Veterans Affairs Subcommittee on Health not to pass legislation that would expand the scope of chiropractic privileges beyond VHA DIRECTIVE 2000-014.

As you know, Section 303 of the Veterans' Millenium Health Care and Benefits Act (P.L. 106-117), which was considered and passed out of this Subcommittee, included a provision that requires the Department of Veterans Affairs (DVA) to establish a policy regarding the role of chiropractic treatment for veterans. This policy was effectively established under VHA DIRECTIVE 2000-014, which allows VHA facilities to offer chiropractic spinal manipulative therapy for musculoskeletal problems of the spine following a referral from a VA clinician. Further, DVA appropriately provided the regional VHA networks with the flexibility to determine the level of necessity for chiropractic services at the local level.

The AMA believes that expanding current statutory authority regarding the role of chiropractic services could lead to a substantial decline in the quality of health care provided to VA patients. We would especially take exception to any legislation that would allow chiropractors to serve as primary care physicians in VHA facilities. Chiropractors simply do not possess the years of specialized medical education and training of physicians necessary to engage in the practice of medicine. In addition, such a departure from the traditional patient-physician relationship is, at the very least, a significant public policy shift and could be in conflict with state health care licensing laws and regulations.

For the same reasons, we believe that this Subcommittee should not provide chiropractors with a special exception for direct access to VA patients without a referral. Not only could this result in underlying medical conditions going undiagnosed, it could preclude other more appropriate courses of treatment from being considered by the patient and the physician. In addition, forcing VHA facilities to provide direct access to chiropractors could undermine other more appropriate therapy programs already established within such facilities. A better approach is to continue to allow VHA facilities to determine the level of necessity for chiropractic services at the local level.

I appreciate having the opportunity to comment on these issues that could adversely impact the quality of care being provided to our nations' veterans. The AMA stands ready to work with you at any time on this or any other matter.


E. Ratcliffe Anderson, Jr., MD

cc: Members of the Subcommittee on Health

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This page was posted on October 18, 2000.