PRESIDING CHAIRMEN: Senator Crisco
Representative O' Connor
COMMITTEE MEMBERS PRESENT:
SENATORS: Hartley, DeLuca
REPRESENTATIVES: Witkos, Altobello, Dargan, Frey, Harkins, Nardello, Schofield, Williams, D' Amelio, Geragosian, Megna, Roldan
SENATOR FASANO: Thank you, Mr. Chairman. Chairman Crisco, Chairman O' Connor, Ranking Member Senator DeLuca, I want to thank you. I want to talků
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Proposed Senate Bill 249, which is AN ACT CONCERNING MEDICAL MALPRACTICE CLAIMS AGAINST CHIROPRACTORS.
This is a result, if I may, of a very good friend of mine, who actually resides in the Woodbridge area, who went to see a chiropractor, had her neck manipulated, went into a coma, fell, and had significant issues after that.
It came up that, apparently, there are a number of related instances dealing with manipulation of neck issues, and she is very concerned.
She has a group of people that she deals with across, not only across the State of Connecticut , but across the country, and she' s looking at the issues, and she came to this body for some help.
To the turn, if we could track the number of issues, predominantly, with respect to the manipulation of the neck.
This is one way of doing it. It' s our understanding that this type of tracking does not take place. I have talked to a number of chiropractors that have sent me emails that they' re upset that we put this bill forward. I have talked to them. Chiropractors have a place. Chiropractors are good doctors of chiropractic I think they do a good job.
However, I think we need to keep track of this. If you check the Internet, you' ll see a number of issues. Predominantly, this happens when there' s manipulation of the neck that separates certain veins in the back, and there' s interruption of blood flow.
My good friend was so harmed by this, and it' s her passionate plea that brought me here today with this bill. I had another bill on Public Health that was on the agenda for a public hearing.
It was my understanding that bill was going to go forward, and I was not, which dealt with a notification by the chiropractor to a patient to say, listen, there' s some adverse risk with respect to manipulation of the neck. You have a choice.
For some reason, and it' s my understanding with the chiropractic industry, that that bill would go forward and this bill may not.
For some reason, the day of the hearing I was arguing in the Appellate Court on a case, and that matter was pulled from the agenda. I have yet to determine the reason why. I' ve not been able to meet with the Chairs of Public Health, but, certainly, that was not my understanding of what my agreement was with the industry.
So now I' m here today to ask this Committee to go forward with this bill, because it would only be the chance of talking about this important issue. So that' s Senate Bill 249. Now, I' d be happy to answer any questions on either one of the two bills.
SEN. CRISCO: Thank you, Senator. Chairman O' Connor.
REP. O' CONNOR: Thank you Chairman Crisco. Going to the chiropractic matter, would you be okay with just that notification that this could have an adverse affect, or you know, I guess your latter statement that toward the end, would that be something that you' d like to move forward with, or do you want to go with more of the spirit of the bill that' s before us today?
SEN. FASANO: I prefer, I prefer, and my good friend disagrees with me a little bit on some of these issues, because she went through so much, and still is going through an awful lot.
I prefer the notice provision that we had in our Public Health, which is just to say, like with any medical procedure, but limiting it to the neck, with any medical procedure, you have a notice.
When you manipulate the neck, there is a risk, and you have a choice of doing it or not. So I prefer that instead of this, but as I said, that bill died, and that was not my understanding.
REP. O' CONNOR: Now would it be just for the neck, or would it be just in general practice of a chiropractor?
SEN. FASANO: I think just for the neck is fine for the issues that I' ve seen on the web, and talking to a couple of people in this group that my friend is associated with.
REP. O' CONNOR: Okay. Thank you.
SEN. CRISCO: Any other questions? Senator DeLuca? Any other questions? Just one thing Senator Fasano, refresh my memory, when we did malpractice reform, are the physicians required to notify the Insurance Department or in regards to malpractice claims? I can' t, just trying to check on that.
SEN. FASANO: Yes there was a notification. That' s my recollection.
SEN. CRISCO: But there is a record? You could go online and check with the Insurance Department on malpractice claims against physicians?
SEN. FASANO: Right. I, you know, I' m not 100% sure, but I--
SEN. CRISCO: I would think so. Okay.
SEN. FASANO: --I don' t know if it' s separated categories is the issue, if I may.
SEN. CRISCO: Would you include any other profession in there? Like as far as physical therapists or just medical doctors?
SEN. FASANO: You know a good question came up about physical therapists, and the chiropractor that met in my office to discuss this brought up physical therapist.
I believe anybody that manipulates that portion of the neck, because it' s so sensitive, should give that warning.
SEN. CRISCO: Thank you Senator. Any other questions? Thank you very much.
SEN. FASANO: I thank you, thank Members of the Committee.
SEN. CRISCO: Representative Caron? Are you ready for tomorrow?
REP. CARON: [inaudible-microphone not on]
SEN. CRISCO: 11:00?
REP. CARON: Oh that tomorrow, I thought you meant Valentine' s Day.
SEN. CRISCO: Thank you sir.
REP. CARON: Mr. Chairman, before we start I saw you and Representative D' Amelio earlier, and we had been complaining about our mutual back problems.
And mine just went out yesterday when I was vacuuming, so I just wanted to let you know that housecleaning is certainly hazardous to your health and if you guys can do something about that, I' d appreciate it. Somebody' s got to do the job--
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--Senate Bill 249. Dr. Mary Lavin.
DR. MARY LAVIN: Thank you. Senator Crisco, Representative O' Connor, and Members of the Committee, my name is Mary Lavin. I am a chiropractic doctor with 19 years of practice experience here in the State of Connecticut .
I also serve as Legislative Committee Chairperson of the Connecticut Chiropractic Association, and I am testifying on their behalf today in regard to Senate Bill 249 AN ACT CONCERNING MEDICAL MALPRACTICE CLAIMS AGAINST CHIROPRACTORS.
The Connecticut Chiropractic Association strongly opposes Senate Bill 249 for essentially three reasons.
First, we object to being singled out like this. A fundamental principal of fairness is that public laws should treat all people in similar circumstances the same.
Yet Senate Bill 249 fails this test. It requires malpractice data reports on chiropractic doctors but no one else.
Other medical professions are absent from the bill. Why is that? If malpractice data reporting is a concept that has merit, then each and every medical profession should be included in this bill. Singling us out like this is blatantly wrong, and unfair.
Second, Senate Bill 249 is a so-called solution in search of a problem. The inference of this bill is that there is a problem with malpractice claims in chiropractic.
Nothing could be further from the truth. The basic test here is in the area of what our members pay for malpractice insurance.
Typical malpractice premiums for chiropractic doctors in Connecticut are in the range of about $2,000 per year for full coverage. That' s $1 million per individual claim, $3 million for all claims.
Yes, I did say per year. I submit to you that if our profession had a problem in this area, it would show up in our premiums. It hasn' t because there is no problem.
Thirdly, Senate Bill 249 is redundant and not needed. A reporting mechanism exists right now in statute on medical malpractice claims data from the higher risk professions, and the state already reports malpractice information to the National Practitioner Data Bank in the U.S. Department of Health and Human Services.
To summarize, we have no problem with reporting of malpractice claims, as long as it is standardized for all healthcare procedures and providers.
If comparisons were being made to other professions, and other types of care, we feel very strongly that when looked at objectively, chiropractic would be found to be both highly safe and effective.
There is no malpractice or safety crisis regarding chiropractic treatment, and this piece of legislation provides no additional safeguards for the public different than those that already exist.
For these reasons, we oppose the bill and ask that you take no action on it. Thank you for giving me the opportunity to testify today. I will be pleased to answer any questions you might have.
SEN. CRISCO: Just a clarification. You know, according to the statute, physicians, surgeons, hospital, advanced practice registered nurse or a physician assistant all have to report malpractice, so why are you saying that, you know, no other professions are being asked to do this?
DR. MARY LAVIN: Well, that' s a good question. My understanding is first of all, all professions, all medical professions, no matter how much a malpractice claim is settled for, everyone has to report to the National Practitioner Data Bank. That' s done automatically. Your malpractice carrier has to do that.
The second thing that came into law, I believe it was in 2005, was in answer to a problem with the escalating medical malpractice premiums, and they were trying to collect data on why the premiums were so high.
My premium is $2,000 a year. I pay more for my car insurance than I do for malpractice insurance, so I don' t have a problem with our rates.
So I don' t think it' s the same criteria being set. If that answers your question?
SEN. CRISCO: No, it doesn' t, but that' s okay. We won' t belabor this.
REP. O' CONNOR: Thank you. Representative Williams.
REP. WILLIAMS: Thank you, Mr. Chairman. A couple of quick questions. One, the first being, the national reporting standard, can you elaborate a little more on how that differs from what' s been proposed in Senate Bill 249, if at all, or is this completely redundant?
DR. MARY LAVIN: In my mind it' s redundant in the fact that there already is reporting of all malpractice claims to this National Data Bank.
The standard that was set, I believe in 2005, was for the higher risk professions that pay extremely high medical malpractice rates, and those malpractice claims were going to be cold, so to speak, from all the malpractice reporting, and reported separately to the General Assembly so that their rates, how much they paid in malpractice claims could be compared to how much they' re paying in premiums, and see if there' s a discrepancy there.
So, they are two separate things, but there is a basis, a base line that all medical malpractice claims are reported to the National Data Bank.
REP. WILLIAMS: Then, to follow up on that, through the Chair, you said the average industry standard malpractice bill for a chiropractor is about $2,000 a year?
DR. MARY LAVIN: Correct.
REP. WILLIAMS: How does that differ from some of the higher risk professions. I mean, you know, OBGYNs, etc. Do you know what the average industry standard is?
DR. MARY LAVIN: I don' t know for all professions. I do know that my gynecologist again, just talking about rates, he pays about $80,000 a year for his malpractice.
So again, there' s a huge difference in rates, and I' m sure other professions, neurosurgeons and otherwise would be up there, too.
REP. WILLIAMS: And clearly that' s a function of risk.
DR. MARY LAVIN: Correct.
REP. WILLIAMS: And then lastly, through the Chair, I' d just ask if you can maybe clarify what your answer to what Senator Crisco' s question was, what the difference is between, if you' re aware of what the difference might be in the statute that he read to you, or the portion of the statute that he read to you, and what' s been proposed here. Are you familiar with that statute?
DR. MARY LAVIN: I was not here, but I did understand that this morning he did ask to add to the bill, something about informed consent. Is that what you' re asking?
REP. WILLIAMS: Well, I actually would like you to touch on that, but my question was, what Senator Crisco just read. He' s indicating that there may already be some reporting.
DR. MARY LAVIN: So what is the difference, you' re saying?
REP. WILLIAMS: Right. Well, maybe you can touch on the informed consent issue, which I' d like actually to hear about.
DR. MARY LAVIN: Okay. I apologize. I misunderstood your question.
REP. WILLIAMS: Oh, that' s okay.
DR. MARY LAVIN: From what I understand, earlier today, Senator Fasano did touch on adding informed consent to the hearing, or to this bill, and by standard practice we already provide notice to our patients on the effective areas, manipulations, and other forms of treatment.
If you want to require informed consent for chiropractic treatment, just as in this case, we feel that it' s unfair to be singled out, and I do understand it. I believe that bill is going to be raised in Public Health, and we' ll be happy to go into that further when that comes up.
REP. WILLIAMS: What bill? The informed, with regard to informed consent?
DR. MARY LAVIN: There' s a bill on informed consent that will be raised by Public Health.
REP. WILLIAMS: Okay, great. Thank you. Thank you, Mr. Chairman.
REP. O' CONNOR: Thank you. Any other questions? Thank you. Next speaker is Janet Levy.
JANET LEVY: Good afternoon, Senator Crisco, Representative O' Connor, and distinguished Members of the Insurance and Real Estate Committee.
My name is Janet Levy, and I live in Woodbridge , Connecticut . I am here to ask for your support in Senate Bill 249.
Senator Fasano had mentioned me earlier, and I' m his friend that he spoke about. But five years ago I went to a chiropractor. After what he told me was a simple and safe adjustment, he tore a left artery in my neck. I ended up having a stroke, emergency brain surgery to remove a blood clot in my brain.
After six weeks in the hospital I went home to try to get some semblance of my life back again. I was told that I' d probably never walk again, and I' d probably, the best I could do is walk with a quad cane.
Back at home, my husband hired occupational, physical, aquatherapists beyond the three months of insurance, that insurance helped pay for me.
He bought lots of expensive exercise equipment plus he hired someone to dress me and bathe me. After almost two years of spending nearly seven hours every day in therapy, I got my life back to where you see it is today. I' m not perfect, but thankfully I have recovered quite well, as you can see.
During this time, and certainly for months afterwards, I found out what happened to me was not an isolated incident. There appeared to be tons of information, articles, and studies on the Internet directly relating to the incidence of stroke to chiropractic spinal and cervical manipulation.
I found out that there was also a number of support and informative groups around the country that consisted of hundreds of victims who were suffering from the same effect of a chiropractic manipulation or even died from it.
I never, ever knew that chiropractic manipulation could cause a stroke or even have strokes at all, risks at all.
The only thing I ever read about them or saw was that they were safe, they' re inexpensive, they' re a natural alternative to medical science.
Risks of chiropractic manipulation have been discussed for years in almost every medical journal we found articles in. Not only in the United States but in Canada , Ireland , Australia , the U.K. , Denmark , Netherlands , Germany , Malaysia , Taiwan , and even Spain .
In fact, in 2006, the NCMIC, which is the nation' s largest provider of chiropractic insurance who alone insures 36,000 chiropractors, cautioned their chiropractors about not recognizing the signs of stroke after cervical manipulation.
The Chiropractic Benefits Services, another highly regarded chiropractic insurance carrier notes on their website that the increased frequency of malpractice suits in the United States have made professional liability insurance essential for all doctors of chiropractic.
They didn' t even have malpractice insurance before 1993.
Since chiropractic is becoming one of the fastest growing businesses in the country, according to the United States Department of Labor Statistics, and because chiropractic manipulation of the cervical spine is becoming increasingly popular, and more widespread, passage of Senate Bill 249 will call attention to the potentially devastating neurological sequence of events that can and do happen.
Making malpractice litigation and claims public will not only help chiropractors in the community become aware of a risk present in a particular treatment, but it will also alert the public that a certain chiropractor has maybe performed a manipulation improperly.
But most importantly, it will provide big incentives for the chiropractors to become more responsible.
For example, when the public found out that in the hospitals, you know, mistakes were made, and surgeons were amputating the wrong leg, or they were given the wrong blood, you know, the public became aware of it, and so you had your advocate and you made sure that it wasn' t going to happen to you.
Lastly, I must strongly state that we are not anti-chiropractic. We do not want to scare people away from chiropractors. That' s not what we' re trying to do. They have a place in society.
We would just like chiropractic physicians to adhere to the same standards as medical physicians, and that means that all malpractice claims or settlements must be made public.
Medical physicians are currently mandated by Connecticut law, which is right here. The law states that all licensed physicians, they call themselves chiropractic physicians. They have, in the survey, it will show you there is malpractice, they have to by law state all their malpractice.
Medical physicians are currently mandated by Connecticut law to provide this information. Chiropractors should not be afraid of this law but they should embrace it.
After all, it could probably serve to help not only their community better, but it would make it stronger.
And I also just want to add that National Practitioner Data Bank, which I have, and we did try looking up, it is, but it' s not public. You can' t get access to the information.
It does exist, but you have to, I mean, I' ll give it to whoever wants to read it, but you can' t get access to it, so it doesn' t do anybody any good.
And certainly, the kind of stroke that I had, you could, what happens when they do a neck manipulation, you have, your artery has like three layers, and when they do this neck manipulation it, well, in my case it tore the lining of the artery, which makes the blood flow between the arteries, and then that causes like an aneurysm.
And what happens is that the body tries to heal itself, so then there' s a blood clot, and a blood clot forms, and then the blood clot moves away, and it ends up in your brain.
And sometimes, like in my case, it ended up in my cerebellum, which I had to have the brain surgery on or it could happen and go to your brain stem, which causes devastating effects.
The victims that I know have, are paralyzed for life. They can' t speak. They can' t walk. They can' t eat. That' s what happens when it goes to brain stem.
And also, there are lots of people that go from a chiropractor' s office directly to the hospital because that' s when they crush it or they sever it, and you get the immediate stroke.
The way mine happened, it was up to two weeks, so I didn' t even know that it actually could happen later on. I' m walking around, and not knowing that that could possibly happen to me, and that' s the big problem that people don' t know.
I' m sorry, but thank you very much for giving me the opportunity to express my views, and I hope you will support Senate Bill 249.
REP. O' CONNOR: Thank you. Are there any questions? I have one quick one, and then I know Representative Witkos has one. How many members are in VOCA?
JANET LEVY: There' s actually hundreds of members. They' re not all victims in VOCA. There are family members, friends, supporters, everyone supporting the cause. There' s just so many victims out there that they need all kinds of help, and that' s what they do.
But VOCA originally was to, for awareness. I mean for legislation.
REP. O' CONNOR: Okay, and then in speaking with your chiropractor before getting, you know, the services that they rendered, did they talk about any risks associated with the manipulation of the neck--
JANET LEVY: No.
REP. O' CONNOR: --or cervical?
JANET LEVY: No. And we' ve had friends go in, and see if other chiropractors will do it. They don' t tell you about any risks.
Some of them, not all of them, some of them will hand a piece of paper, and they will go, you have to sign this as you' re sitting on the table or whatever, and then you say, what does it say? Oh, no, no, this is just what we have to do, HIPAA makes us, just sign it, whatever, it just has a risk, but there are no risks.
They will say, they do advertise, it is safe. It' s an alternative to medical science. The doctor kept saying to me, it' s safe, it' s safe, it' s safe. It' s not safe.
REP. O' CONNOR: Thank you. Representative Witkos.
REP. WITKOS: Thank you, Mr. Chairman. If this bill were to pass, is the ultimate goal to make those claims accessible to the public so they can make a decision whether they want to go visit that chiropractor or not, or is it for the industry to say, maybe this particular procedure, we have X amount of failures, if you will or complications, so maybe we shouldn' t allow that to be used.
JANET LEVY: We would hope that the industry will change, but I don' t think it' s going to because even the information that I gave you about the stroke, that comes off the chiropractic website, all that information they said of how the stroke happened. They know what happens.
I would hope that their industry polices itself. I would hope that other mechanisms would come in, and make sure that they do say the risk.
REP. WITKOS: Because, I mean, this just deals with claims that where there was a suit filed, and not necessarily a complaint.
So if we, if I was going to go seek out a chiropractor for a treatment, I would contact some agency, I would assume, to say well, are there any complaints or any, made against--
JANET LEVY: Well, you would, well, we were taught, I mean, I was taught, you go up and look under the physician before you go to one to find out how good a physician he is, and if you see his, you know, he' s been, had malpractice suits against him a few times, it does put up a red flag.
You might not want to go to him, but you certainly would say to him, look, you know, I' m really nervous about cervical manipulation, and you obviously had malpractice against you so, and maybe that could be something that he wouldn' t do with me the next time.
It should be all right to know if, like a regular physician, that malpractice does, that they had malpractice, and you would think other chiropractors would want that known against it because if they' re going to be a good chiropractor, why would they want to tolerate, you know, one that' s doing something to their own profession.
REP. WITKOS: Certainly. And one last question. Would you know which agency, would it be the AMA, the Department of Public Health, if you wanted to lodge a complaint against a chiropractor, I guess, since we' re talking about--
JANET LEVY: One in general?
REP. WITKOS: --one in general.
JANET LEVY: If you wanted to, you got to the Department of Health, but it' s not so easy. You have to bring, first of all, you have to wait until your lawsuit is over with, which takes--
REP. WITKOS: Well, irregardless of a lawsuit. Say I' m not, you' re not going to file a claim. You' ve had a bad experience--
JANET LEVY: Right.
REP. WITKOS: And it' s not suit-worthy, but you want to lodge a formal complaint.
JANET LEVY: Right.
REP. WITKOS: What agency would you go to? Do you know?
JANET LEVY: Department of Health.
REP. WITKOS: Okay. And do you know if that information is on public record, so if you could go to the Department of Public Health and say, how many complaints were lodged against--
JANET LEVY: Yes. We did so. Yes.
REP. WITKOS: Okay.
JANET LEVY: But most people don' t. It' s a whole big thing that they have to do in medical records and whatever, and when we talked to victims, they just want to get their lives back.
REP. WITKOS: Sure.
JANET LEVY: It takes two years to get, it' s a serious thing that happens here. It' s not like they can just get up and do it. It takes a couple of years to get better, and by that time, it usually happens between women between the ages of 25 and 48 that have young kids.
In fact, if I may just add one thing. In 2000, a highly respected Canadian stroke consortium in Toronto , which is doing a big thing on this, found that chiropractic neck manipulation is the single leading cause of damage to the neck and arteries leading to stroke in people less than 45 years old. So I think it has to be addressed soon.
REP. WITKOS: Thank you very much for your testimony.
JANET LEVY: Thank you.
REP. O' CONNOR: Thank you, Representative. Any other questions? Thank you. I' m sorry, Britt Harwe. Harwe.
BRITTMARIE HARWE: Good afternoon, Senator Crisco, Representative O' Connor, and distinguished Members of the Insurance and Real Estate Committee.
I would like to advise the Committee at this time that I have a paralyzed vocal cord, so please bear with me.
My name is Brittmarie Harwe. I' m from Wethersfield . I' m testifying in support of Senate Bill 249.
In 1993, when I was just 26 years old I had a stroke immediately following a chiropractic cervical adjustment. I was taken by ambulance to the hospital, and tests revealed that one of my vertebral arteries was crushed during the adjustment.
I was diagnosed with Wallenberg' s syndrome. It' s a neurological disorder, which includes left side paralysis, paralyzed vocal chord, and loss of the ability to swallow, among many other deficiencies. This happened the day before my daughter' s second birthday.
During the first few weeks in the hospital my prognosis was uncertain. It was unknown if I' d ever walk or talk normally again. There was even discussion about putting me in a nursing home.
Since I couldn' t swallow, a feeding tube was inserted. For the past 14 years, I have been unable to eat, and this is how I take all nutrition. The stroke has forever changed my life, and the lives of my family.
Since such severe injury is a possibility with chiropractic adjustment, regardless of the number of times it happens, malpractice information for chiropractors should be made public.
In fact, before going to any healthcare provider, my mother always told me to check on information available about a particular doctor before going to one.
I did this before going to this chiropractor, and I was unable to find out anything about him. In fact, even now, the only information that is available on the Department of Public Health' s website about chiropractors, is their license status, and if any disciplinary action was taken.
After my stroke happened, my attorney informed me that the, that my chiropractor not only injured me, but had a previous malpractice claim and a large settlement against him.
Had this information been available, it would have raised a red flag, and I may not have gone to him for treatment, or at the very least, I would have discussed my concerns with him so maybe he would not have performed the adjustment on me.
Malpractice claims against chiropractic physicians are not made public, but they are for all medical physicians.
The Connecticut Department of Public Health' s website provides a physician' s profile that is available for the public for all physicians licensed in Connecticut .
It includes information under license status, education, post-graduate training, as well as all malpractice claims brought against them, and the settlements.
This is mandated by Connecticut law. It should be the same for chiropractic physicians. In this age of technology we should have the ability to collect all information on our healthcare providers so we can make our own informed decisions about our personal health.
For these reasons, I ask for your support of Senate Bill 249. Thank you for your time.
REP. O' CONNOR: Thank you very much for your testimony. I guess the question that I asked the previous speaker is just to clarify, that they never mentioned that there was any kind of risk involved.
BRITTMARIE HARWE: When I asked my chiropractor, oh, I' m sorry.
REP. O' CONNOR: Go ahead. Go ahead. I think you' re along the same line of thought.
BRITTMARIE HARWE: I' m sorry for interrupting you. When I asked my chiropractor about any risks or problems, he informed me that some people experience a reaction.
He was a doctor. I didn' t know any different. I was only 26 years old at the time.
REP. O' CONNOR: Did you ask what the reaction could be?
BRITTMARIE HARWE: He said reaction, and I figured allergic reaction. I didn' t know. I didn' t understand, and he made it sound inconsequential, reassuring me that, no, very rarely does it ever happen.
Had he said there was a possibility of stroke, I think I, I know I would have not proceeded with that treatment. All I did was have a sore shoulder and neck.
I now know I had a pinched nerve, and it has since reoccurred one time in the past 14 years. I went to my doctor. I went to physical therapy. It took a month, but I was able to resolve the pain without taking any risk for a possibility of stroke.
So if he had told me, if he had said the word stroke for something as simple as what I had, no, I would not have taken the risk.
REP. O' CONNOR: Okay. And your attorney, I take it was in your case that they found out that there was a previous malpractice claim and an award?
BRITTMARIE HARWE: My attorney had actually participated in a previous case. He recognized the name of the chiropractor.
REP. O' CONNOR: I' m sorry. Can you repeat that answer? I didn' t hear it clearly.
BRITTMARIE HARWE: My attorney recognized the name of the chiropractor when he was reviewing the information that I brought him, and he had actually participated and sued that chiropractor before, so he was familiar with his name.
REP. O' CONNOR: Okay, thank you. Any other questions? Thank you very much for your testimony. Attorney Robert Hirtle.
UNIDENTIFIED SPEAKER: Not here.
REP. O' CONNOR: Doctor David Dziura.
DR. DAVID DZIURA: Senator Crisco, Representative O' Connor, Representative Witkos, and Members of the Insurance and Real Estate Committee, my name is Dr. David Dziura. I' m a chiropractic physician. I' ve been in practice since 1983.
I Chair the Insurance Relations Committee for the Connecticut Chiropractic Association. I' m past Chairman and present Committee Member for the Association' s Peer Review Committee.
I also serve as Quality Improvement Committee Chairman for Connecticut Chiropractic Network, which is an IPA providing chiropractic care for ConnectiCare and other plans in Connecticut , New York and Massachusetts .
As Quality Improvement Chairman I' m familiar with the review and oversight of chiropractors and other providers in the state, and by private entities or health plans.
This oversight process is called credentialing and re-credentialing as based on standards set forth by NCQA National Committee of Quality Insurance and URAC, Utilization Review Accreditation Commission.
The credentialing process includes investigation of all consumer complaints, patient satisfaction surveys, checking licensure, qualifications of each doctor, reviewing medical records for compliance and quality issues, reviewing utilization patterns and primary source verification with state licensing boards, regulatory agencies, federal agencies, Medicare and the National Practitioner Data Bank.
This process is repeated every three years. However, if there' s an individual complaint by a consumer, that is followed up on a much more timely fashion.
Infractions and deficiencies are treated with correction action plans or termination, depending on the nature of the problem.
The oversight of individual doctors is repeated by every accredited health plan. In addition, the State Board of Chiropractic Examiners investigates and reviews consumer complaints and patient complaints, licensing infractions, and every malpractice decision.
At the present time there' s regular and comprehensive oversight of chiropractors as well as other physicians, and for this reason I believe that Senate Bill 249 would be redundant and unnecessary.
And I' d try to answer any of your questions. There were some earlier questions I' d like to talk on if you have--
REP. O' CONNOR: Thank you. Yeah, I have a couple questions. You know, why do you think chiropractors should not be part of the reporting requirements as all other physicians are required?
DR. DAVID DZIURA: I believe they are. They are not part of the 2005 bill because we were never oppressed by the high cost of malpractice, because we are a safe and effective treatment.
The 2005 regulations came into being when the medical professions were looking for relief in the excessive hype, and the Legislature, I believe the intent to at that time was saying, hey, before we look at this and look at some protections for you as a profession, we have to understand what' s going on here.
Why are the premiums so high, or are they justified? And at that time we are not included in that, but there is data collection and oversight.
I don' t want to say that even if that bill, if you look to that legislation in 2005, that still is not made public from the standpoint of individual, what I' m telling, what I' m meaning to say is, cases that are settled out of court. That' s a private, that would change the entire judiciary system.
If there' s a private settlement, that stays private. I still have to report, however, that I had an action against me, and to the plan who' s reviewing the dollar amount as well.
REP. O' CONNOR: Yeah. It was probably an oversight that you weren' t included in the ' 05 bill, and I think, you know, if you want to be treated as physicians, then we might have to incorporate you because that is an ongoing annual endeavor that the Department' s conducting.
DR. DAVID DZIURA: I have full confidence that you would also find us safe and effective, and when you look at the National Practitioner Data Bank in the past 16 years, we' ve had 70 malpractice cases, and that' s four per year, so far less than the average 250 from the medical profession.
REP. O' CONNOR: This is a percentage because there might be a lot more doctors than there are chiropractors.
DR. DAVID DZIURA: I could get that number for you. I just thought I' d [inaudible] that but it is very low.
REP. O' CONNOR: Okay, and then the other thing, too, just as a matter of practice, do you brief your clients--
DR. DAVID DZIURA: Yes.
REP. O' CONNOR: --let me finish the question--
DR. DAVID DZIURA: Okay.
REP. O' CONNOR: --that there could be an adverse reaction or an adverse outcome based on the manipulation of the cervical spine or neck?
DR. DAVID DZIURA: Yes. Informed consent is a process, and we describe procedures, try to give some centering as far as aspects of what is the risk involved, what is the risk of not being treated, and what are the risk of alternatives.
Some doctors use a written process. Some, many more use a more valid oral process in explaining the treatment.
REP. O' CONNOR: Okay, and how common is what occurred to these, the previous two speakers as far as let' s say, stroke, or some kind of [inaudible].
DR. DAVID DZIURA: Research shows that there' s about one in five million.
REP. O' CONNOR: Thank you. Any other questions? Thank you very much for your testimony.
DR. DAVID DZIURA: Thank you.
REP. O' CONNOR: Tino Villani.
DR. AGOSTINO A. VILLANI: Good afternoon. My name is Tino Villani. I' m the Chair of the Chiropractic, Connecticut Chiropractic Board of Examiners.
The examining board hasn' t taken a position on this bill but would like to offer some information to the Committee for its consideration.
For reference purposes, the Connecticut Department of Health, in cooperation with 14 authorized examining boards, is responsible for ensuring public safety relative to just over 50 different licensed professions.
During the period defined from January, 2002 through December 31, 2006, the Department of Health received 4,941 complaints against license holders in Connecticut .
Of these complaints, 57, or 1% involved chiropractors. Of the 57 complaints, there were approximately 15 disciplinary orders issued by the Board.
During that same timeframe, there were approximately 1,404 complaints against medical doctors, which was 28%, 466 complaints against dentists, which was 9%, and 829 complaints against nurses, at 17%.
Relative to public reporting, the Board' s position has always been soundly in favor of public reporting of public safety information. In that sense, the Board may actually offer a remedy for some of the issues raised here today.
Certainly, any citizen in Connecticut with a complaint against a license holder can easily lodge that complaint to the Department of Health at no cost or effort.
They' re not required to secure counsel. It' s provided for them, and the process requires a third party, the Department of Health' s Investigative Unit, to look into the issue.
And should there be merit to warrant a hearing or disciplinary action, a consent or a meeting is held between the respondent, the individual chiropractor, and the attorneys from the Department of Health, and the respondent' s attorneys.
And if a resolution can be reached, a consent order is signed, which is public. If a resolution can' t be reached, the matter is referred to the Board and the disciplinary hearing occurs, and when that occurs the Board reaches a decision, and that' s public.
So essentially, any matter of public complaint that reaches a formal nature in the Department of Health is followed through with due process, and does become part of the public record.
Unfortunately, malpractice actions aren' t always adjudicated that way. Many, if not most of them, are resolved informally, and with the various types of process, which don' t meet the standard of due process, and therefore the reporting of those may be largely misleading to the public.
If I could make any recommendation at all it would be that serious matters of potential incompetence or negligence can be reported to the Board, and will be put through this process, and will be certainly available to the public as far as full disclosure.
SEN. CRISCO: [inaudible-microphone not on] Representative Witkos.
REP. WITKOS: Thank you, Mr. Chairman. When you' re saying full disclosure, how far does that, does that carry the actual doctor' s name, or is it just the practice in general.
DR. AGOSTINO A. VILLANI: No, no, the, I' m sorry--
REP. WITKOS: Will the public be able to go on and say, A,B,C Chiropractic Care, and go to that, look up specific chiropractors to see if there' s any complaints or claims against that specific individual chiropractor, or are they just going to say, one or two or however many against the firm?
DR. AGOSTINO A. VILLANI: No. After a formal hearing, the entire proceeding' s a public record, so the statement of charge is the nature of the complaint, the names of the involved license holders, and the memorandum of decision with the disciplinary action is all public information.
REP. WITKOS: Thank you. Thank you very much. Thank you, Mr. Chairman.
SEN. CRISCO: Thank you, Representative Witkos. Any other questions? Basically, one minute, doctor. Doctor. Doctor.
DR. AGOSTINO A. VILLANI: Oh, I' m sorry.
SEN. CRISCO: There' s a question. [inaudible] the interest is only in neck related cases, right?
DR. AGOSTINO A. VILLANI: No.
SEN. CRISCO: [inaudible] in this bill.
DR. AGOSTINO A. VILLANI: In this bill? I read the bill--
SEN. CRISCO: No, I' m talking about the original testimony. I don' t know if you were here.
DR. AGOSTINO A. VILLANI: Oh, yes, I heard the original testimony, yes.
SEN. CRISCO: Is there a problem with that, just with neck injuries?
DR. AGOSTINO A. VILLANI: Well, the hard question to answer. There' s no problem with it relative to volume of complaints or frequency of complaints.
Obviously, the problem with it is the severity of the potential consequence, and much examination of this has been done over the last 10 or 15 years, and indeed, I think it' s been established that there is a very small, but very real risk of this type of event occurring, and although, by all standards, medical standards, this risk has not been determined to obviate the use of the procedure.
It should be something that' s disclosed to the patient as part of the due diligence with the doctor before the procedure is done.
SEN. CRISCO: So if I, again, if I' m correct, you' re saying that it would be agreeable to make sure that the patients are informed, and again, I' m only referring to the neck situation.
DR. AGOSTINO A. VILLANI: Yeah, the standard of care in Connecticut would be that the patient should be informed of all the risks associated with the procedures being performed.
SEN. CRISCO: Because it' s interesting because any other tests, they particularly in a hospital when you go for an angiogram, they say that there' s a possibility of a stroke, etc. what have you, but I just wanted to clear that.
DR. AGOSTINO A. VILLANI: Yeah, and that should be the same here.
SEN. CRISCO: All right. Thank you very much. I just want people to realize that, you know, Committee Members are attending other Committees. It' s just the nature of the process, and so everything is appreciated.
Robert. Is Robert here? Robert Fromer. Sorry, Robert.
ROBERT FROMER: Hi. I, about 30 years ago, had severe neck pain, and decided--
SEN. CRISCO: Excuse me, Robert. For the record, you have to identify yourself.
ROBERT FROMER: Oh, sure. Robert Fromer. About 30 years ago I had severe neck pain from headaches, and so forth and so on, and so I went to a chiropractor who manipulated my neck.
Fortunately, I didn' t become a victim like two of the people that testified before.
Then, I had injured my lower back doing some moving and lifting, and I went to a chiropractor again, another chiropractor. Well, first I went to one, and then I went to another one. I injured my back a couple of times.
And they manipulated my back, and they took x-rays, and they told me, well, you have to come on a regular basis, and you have scoliosis, and then I observed, I' m very observant about things, and I observed the doctor' s office was full of different types of vitamins and medicines that they were trying to sell, and trying to promote to me for health.
I' m a pretty healthy person. I exercise and keep a very healthy diet. But anyway, I started talking to friends at work and other places who had gone to chiropractors, and something started to jump out at me.
Every one of these people also started, was being treated for scoliosis on a regular basis. Then I talked to a friend of mine who happened to be a nurse with a chiropractor, and she made me aware of the fact at that time, I don' t know what it' s like today, that chiropractors are trained in business practices how to market their profession to increase their business.
Then it started dawning on me that the treatment I was getting was only temporary. It was not permanent. It was just temporary, and so I started researching a little further and realized that manipulation doesn' t cure anything. It just gives you sudden relief.
It' s like a physician giving you a Vitamin B-12 shot. It gives you a sudden rush, but it doesn' t cure your problem long term.
And so I' m strongly supportive of this bill. If these people want to call themselves physicians, then they should be on the same level playing field as all other physicians, and statistics, there' s an old adage.
There are three types of lies. Lies, damned lies, and statistics.
Depending on what the statistics, how they were acquired, the type of modeling that was used to accumulate that information, that type of information is not presented.
They' re just giving you numbers and not placed in context as how much meaning should be attributed to those numbers.
So anything that you can do to regulate this profession more strongly to better control it, and make sure the public is aware of the potential dangers, I am all for, and I strongly urge and support you to do that.
I think it' s time for the Legislature and the government to be the dog that wags the tail instead of the tail wagging the dog. Thank you.
SEN. CRISCO: Thank you, Mr. Fromer. Any questions for Mr. Fromer? No? Thank you very much.