PROPOSED RULEMAKING
STATE BOARD
OF CHIROPRACTIC
[ 49 PA. CODE CH. 5 ]
Assistance of Unlicensed Supportive Personnel
[40 Pa.B. 2128]
[Saturday, April 24, 2010]The State Board of Chiropractic (Board) proposes to amend its regulations to add § 5.54 (relating to assistance by unlicensed supportive personnel), to read as set forth in Annex A.
Effective Date
The regulation will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.
Statutory Authority
The proposed rulemaking is authorized under sections 302(3) and 601 of the Chiropractic Practice Act (act) (63 P. S. §§ 625.302(3) and 625.601).
Background and Need for the Amendment
Under section 601 of the act, a licensed chiropractor may utilize ''the assistance of unlicensed supportive personnel performing under the direct on-premises supervision of a licensed chiropractor.'' That section also prohibits a licensed chiropractor from delegating ''any activity or duty to such unlicensed individuals which requires formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor.'' This rulemaking is intended toidentify the more commonactivities and duties that unlicensed supportive personnel may perform under the supervision of a licensed chiropractor and to identify those activities and duties that may not be delegated to supportive personnel. Those activities and duties not listed in the regulation would be permitted or prohibited in accordance with the statutory standard.
Description of the Proposed Amendments
The proposed rulemaking would first define in § 5.54(a) the term ''direct supervision'' as supervision provided without any intermediate supervision and define the term ''unlicensed supportive personnel'' as any person not licensed to practice chiropractic who is regularly employed by a chiropractor to assist a chiropractor. The proposed rulemaking would provide in § 5.54(b) that a licensed chiropractor may utilize the assistance of unlicensed supportive personnel as authorized in the regulation and that the chiropractor is professionally responsible for the actions of the supportive personnel. Under proposed § 5.54(f), the chiropractor must be physically on the premises and able to intervene whenever necessary while utilizing the assistance of unlicensed supportive personnel. Under proposed § 5.54(g), supportive personnel must be qualified by training, education or experience to perform any activity or duty that is delegated. Proposed § 5.54(h) would require the licensed chiropractor to make a diagnosis and evaluation, specify the treatment regimen and perform any aspect of the procedure that may not be delegated to unlicensed supportive personnel.
Proposed § 5.54(c) would list those duties and activities that the Board has recognized do not require formal education or training in the practice of chiropractic or the knowledge or skill of a licensed chiropractor and could be performed by unlicensed supportive personnel under the direct on-premises supervision of a licensed chiropractor. Under proposed § 5.54(c)(1), unlicensed supportive personnel could record the patient's chief complaint and presenting illness or condition; assist the patient in completing office forms; obtain pre-authorization for diagnostic testing; obtain and record the patient's vital signs; develop x-rays; instruct and monitor therapeutic exercises; help complete a physical activity readiness questionnaire; help prepare the patient for diagnostic studies; assist the chiropractor in performing electrocardiograms; assist in applying a cast, brace, appliance or orthotic; prepare laboratory specimens; perform range of motion testing; perform muscle testing; relay home care instructions to the patient; relay instructions for cast, brace, appliance or orthotic; elicit the patient's activities of daily living; set up and break down rehabilitation equipment; use rehabilitation equipment; clear rooms and clean/sterilize equipment; maintain the patient file and prepare for therapeutic encounter; perform extremity measurements; perform postural screening; render first aid; and perform therapeutic exercises and activities to include provision of direct one-on-one contact or constant attendance necessary to achieve the desired therapeutic results of the exercise. Because only a chiropractor certified to do so may perform adjunctive procedures, proposed § 5.54(c)(2) would separately list those adjunctive procedure activities or duties that may be performed by unlicensed supportive personnel under the direct on-premises supervision of a licensed chiropractor certified to use adjunctive procedures. Under proposed § 5.54(c)(2), unlicensed supportive personnel could: apply hot packs and cryotherapy; provide the contact required for the provision of whirlpool therapy and perform any necessary setup of equipment; perform electrical stimulation therapy to include provision of the supervision or constant attendance necessary during delivery of the therapy, placement of the electrodes and necessary setup of the electrical stimulation unit; perform ultrasound therapy to include provision of the supervision or constant attendance necessary during delivery of the therapy, actual delivery of the ultrasound therapy, and necessary setup of the ultrasound unit; perform mechanical traction therapy to include provision of the supervision necessary during delivery of the therapy, placement of the patient and necessary setup of the traction unit; perform therapeutic laser therapy to include provision of the supervision or constant attendance necessary during delivery of the therapy, actual delivery of the laser therapy, and necessary setup of the laser therapy unit; and perform other therapeutic modalities classifiable as adjunctive procedures to include provision of the supervision or constant attendance necessary during delivery of the therapy, actual application of the therapy when required, and necessary setup of the laser therapy unit.
Proposed § 5.54(d) would list those duties and activities that the Board has recognized require formal education or training in the practice of chiropractic or the knowledge or skill of a licensed chiropractor and may not be delegated to unlicensed supportive personnel. Under proposed § 5.54(d)(1), unlicensed supportive personnel may not perform chiropractic adjustment or manipulation, evaluate or manage a treatment plan, discharge a patient, order x-rays or other diagnostic tests, refer a patient to another practitioner, or perform venipuncture. Under proposed § 5.54(d)(2), unlicensed supportive personnel may not place needle electrodes.
Because this list is not exhaustive, under proposed § 5.54(e) any activity or duty not listed in the regulation would be evaluated under the terms of section 601 of the act to determine whether the activity or duty could be delegated to unlicensed supportive personnel.
Fiscal Impact and Paperwork Requirements
The proposed regulation will have no adverse fiscal impact on the Commonwealth or its political subdivisions. The regulation will impose no additional paperwork requirements upon the Commonwealth, political subdivisions or the private sector.
Sunset Date
The Board continuously monitors the effectiveness of its regulations. Therefore, no sunset date has been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on April 8, 2010, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor of comments, recommendations or objections raised.
Public Comment
Interested persons are invited to submit written comments, suggestions or objections regarding this proposed rulemaking to Regulatory Unit Counsel, Department of State, by mail at P. O. Box 2649, Harrisburg, PA 17105-2649, or by email at st-chiropractic@state.pa.us, within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin. Use reference No. 16A-4316 (assistance by unlicensed supportive personnel), when submitting comments.
KATHLEEN G. McCONNELL, D. C.,
ChairpersonFiscal Note: 16A-4316. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 5. STATE BOARD OF CHIROPRACTIC
Subchapter E. MINIMUM STANDARDS OF PRACTICE § 5.54. Assistance by unlicensed supportive personnel.
(a) The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:
Direct supervision—Supervision without any intermediate supervisory person.
Unlicensed supportive personnel—A person not licensed by the Board to practice chiropractic who is regularly employed by a licensed chiropractor or chiropractic practice to assist one or more licensed chiropractors.
(b) A licensed chiropractor may utilize the assistance of unlicensed supportive personnel as authorized in this section. The chiropractor is professionally responsible for the actions of unlicensed supportive personnel providing assistance under this section.
(c) Performing the activities or duties identified in this subsection does not require formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor.
(1) A licensed chiropractor may delegate the following activities or duties to unlicensed supportive personnel performing under the chiropractor's direct on-premises supervision:
(i) Recording patient's chief complaint and presenting illness or condition.(ii) Assisting patient in completing office forms.(iii) Obtaining preauthorization for diagnostic testing.(iv) Obtaining and recording a patient's vital signs.(v) Developing x-rays.(vi) Instructing and monitoring therapeutic exercises in the office.(vii) Helping complete physical activity readiness questionnaire.(viii) Helping prepare patient for diagnostic studies.(ix) Assisting the chiropractor in performing an electrocardiogram.(x) Assisting in applying a cast, brace, appliance or orthotic.(xi) Preparing laboratory specimens.(xii) Performing range of motion testing.(xiii) Performing muscle testing.(xiv) Relaying home care instructions to patients.(xv) Relaying instructions for cast, brace, appliance or orthotic.(xvi) Eliciting patient's activities of daily living.(xvii) Setting up and breaking down rehabilitation equipment.(xviii) Using rehabilitation equipment.(xix) Clearing rooms and cleaning or sterilizing equipment.(xx) Maintaining patient file and preparing for therapeutic encounter.(xxi) Performing extremity measurements.(xxii) Performing postural screening.(xxiii) Rendering first aid.(xxiv) Performing therapeutic exercises and activities to include provision of direct one-on-one contact or constant attendance necessary to achieve the desired therapeutic results of the exercise.(2) A licensed chiropractor who is certified to use adjunctive procedures may delegate the following adjunctive procedures activities or duties to unlicensed suppor- tive personnel performing under the chiropractor's direct on-premises supervision:
(i) Applying hot packs and cryotherapy.(ii) Providing the contact required for the provision of whirlpool therapy and performing any necessary setup of equipment.(iii) Performing electrical stimulation therapy to include provision of the supervision or constant attendance necessary during delivery of the therapy, placement of the electrodes, and necessary setup of the electrical stimulation unit.(iv) Performing ultrasound therapy to include provision of the supervision or constant attendance necessary during delivery of the therapy, actual delivery of the ultrasound therapy, and necessary setup of the ultrasound unit.(v) Performing mechanical traction therapy to include provision of the supervision necessary during delivery of the therapy, placement of the patient and necessary setup of the traction unit.(vi) Performing therapeutic laser therapy to include provision of the supervision or constant attendance necessary during delivery of the therapy, actual delivery of the laser therapy, and necessary setup of the laser therapy unit.(vii) Performing other therapeutic modalities classifiable as adjunctive procedures to include provision of the supervision or constant attendance necessary during delivery of the therapy, actual application of the therapy when required, and necessary setup of the laser therapy unit.(d) Performing the activities or duties identified in this subsection requires formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor.
(1) A chiropractor may not delegate the following activities or duties to unlicensed supportive personnel:
(i) Performing chiropractic adjustment or manipulation.(ii) Evaluating or managing a treatment plan.(iii) Discharging a patient.(iv) Ordering x-rays or other diagnostic tests.(v) Interpreting x-rays or other diagnostic tests.(vi) Referring a patient to another practitioner.(vii) Performing venipuncture.(2) A chiropractor may not delegate the following adjunctive procedure activities or duties to unlicensed supportive personnel: placing needle electrodes.
(e) Unlicensed supportive personnel may assist a licensed chiropractor by performing an activity or duty not identified in subsection (b) or (c) if the activity or duty does not require formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor and the unlicensed supportive personnel act in accordance with the other requirements of this section. A chiropractor may not delegate to unlicensed supportive personnel any activity or duty not identified in subsection (b) or (c) if the activity or duty requires formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor.
(f) An unlicensed supportive person may perform an activity or duty delegated by a chiropractor under this section only while the chiropractor supervising the unlicensed supportive person is physically present on the premises and able to intervene whenever necessary.
(g) A chiropractor may not permit an unlicensed supportive person to perform any activity that the supportive person is not qualified by training, education or experience to perform.
(h) The licensed chiropractor shall make the diagnosis and evaluation, specify the treatment regimen, and perform any aspects of the procedures that may not be delegated to unlicensed supportive personnel.
[Pa.B. Doc. No. 10-719. Filed for public inspection April 23, 2010, 9:00 a.m.]
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