The Board of Chiropractic Examiners (BCE) protects the state’s consumers from fraudulent, negligent or incompetent chiropractic care. It issues regulations and licenses, investigates possible insurance fraud and follows up on consumer complaints, overseeing about 14,000 licensees and 19 chiropractic schools and colleges, not only in California, but also in other states and Canada. The board ensures that chiropractic providers are adequately trained and meet performance standards for treating patients through its Administrative/Licensing Unit. It also sets educational standards for recognized chiropractic colleges, reviews complaints and investigates possible violations of the state’s Chiropractic Act. The independent board will transition to the new Business, Consumer Services and Housing Agency by July 1, 2013, as part of an executive branch reorganization proposed by Governor Jerry Brown.

Rules and Regulations (Chiropractic Board website)

Disciplinary Guidelines (Chiropractic Board website) (pdf)

Prior to creation of the Board of Chiropractic Examiners, the Board of Medical Examiners regulated the approximately 800 chiropractors practicing in California. The Chiropractic Initiative Act of 1922, passed with 59% voter approval, established legal requirements for chiropractic education, California licensure guidelines and the first board of chiropractic examiners.

In 1942, the California Chiropractic Association helped gain passage of legislation that included chiropractic services in the state’s Workers’ Compensation Act. The law also allowed chiropractors to be designated as primary care physicians if the chiropractor had treated the employee in the past and had their medical records.

The Board of Chiropractic Examiners remained an independent entity within state government until 1946 when it was added to the Department of Professional and Vocational Standards (which was renamed the Department of Consumer Affairs in 1970). Three years later the board was given authority to determine minimum requirements for teachers in chiropractic schools and colleges and approve chiropractic schools and colleges whose graduates may apply for license in California. Legislation The board also was empowered to carry out investigations. To support the expanding board activities, the license renewal fee increased from $2 each year to an amount set by the board that could range from $2 to $10 annually. In 1959, the fee-setting authority was moved to the legislature.

In 1976, the board was removed from the Department of Consumer Affairs and once again became an independent agency under the direct supervision of the Governor's Office.

In 2003, the state legislature passed a spate of worker’s compensation laws, one of which had a direct impact on chiropractors. Until then, California had no limit on the number of visits a person could make to a chiropractor for a work-related injury. SB 228 capped the number of visits at 24 for industrial injuries suffered on or after January 1, 2004, except for instances in which additional visits were authorized by an insurance carrier. The bill also called for the adoption of guidelines used by the American College of Occupational and Environmental Medicine, which suggested that the use of any chiropractic services had to be supported by nationally recognized, peer-reviewed guidelines based on high-quality medical evidence.

Governor Arnold Schwarzenegger, who received an honorary Doctor of Humanities degree from Cleveland Chiropractic College in 1999 and is a big booster of chiropractic treatment, put his former personal chiropractor, Richard H. Tyler, on the board in 2004. Two years later, the governor added Francesco “Franco” Columbu to the board. The chiropractor and two-time Mr. Olympia was body-builder Schwarzenegger’s best man when he married Maria Shriver.

The board clashed repeatedly with Executive Director Catherine Hayes and fired her in 2007. On what turned out to be her last day as executive director, Hayes accused the board of attempting to undermine a criminal prosecution of chiropractors and interfering with disciplinary actions against members of the profession. She told the board it had been acting illegally. Former board member Barbara Stanfield called the board’s actions a “coup.”

Hayes filed a lawsuit in 2008 against the board saying she had been fired for cooperating with a criminal investigation into the practice of chiropractors working on patients under anesthesia. She also alleged that lawmakers had not complied with California’s open-meeting laws.

In 2011, the state Senate unanimously approved a $600,000 settlement payment to Hayes. It was paid for with money withdrawn from the Board of Chiropractic Examiners’ funds.

Also in 2011, the board, as part of its enforcement policies, adopted regulations that require electronic criminal background checks for all licensees. All licensed and potential applicants have to provide their fingerprints via LiveScan, which records and stores them.

Chiropractic Legislative History (California Chiropractic Association)

Gauging the Impact of Workers' Compensation Reform in California (by Michael Devitt, To Your Health)

Agency History (California State Archives) (pdf)

Board Chief Is Fired After Accusations (by Peter Nicholas, Los Angeles Times)

Calif. Senate OKs Chiropractic Firing Settlement (Associated Press)

California’s governor appoints the Board of Chiropractic Examiners’ seven members.  Five board members are licensed Doctors of Chiropractic (D.C.), while the remaining two represent the public.  All members serve four-year terms.

Chiropractic care is based on the principle that spinal joint misalignments interfere with the nervous system. The belief is that this might result in lower resistance to diseases. The Board of Chiropractic Examiners regulates the chiropractic profession in California, issuing guidelines and licenses, investigating potentially fraudulent chiropractors, and stripping chiropractors of their licenses if consumer complaints are supported.

California’s governor appoints the board's seven members. Five board members are licensed Doctors of Chiropractic (D.C.), while the remaining two represent the public. All members serve four-year terms.

The Sacramento-based board employs an executive officer, who serves at the pleasure of the board and employs a staff that is responsible for its chiropractic licensing, continuing education and enforcing the state’s chiropractic regulations.

Chiropractors must abide by the board’s regulations, which give priority attention to alleged sexual misconduct, gross negligence or incompetence as well as insurance fraud. Criminal convictions by chiropractors, deceptive or misleading advertising, and unlicensed practice are also overseen by the board.

Patients who want to file a complaint against their chiropractor must submit the details in writing. Anonymous complaints are discouraged by the board. Depending on the board’s investigation, it might find that the chiropractor, if guilty of the complaint, receives a public reprimand, probation or license revocation. Instead of formal discipline, the board can also issue citations, which still appear on public records, but mainly involve minor violations of chiropractic laws and regulations.

The board administers two internal departments – the Compliance Unit and the Field Investigations Unit. The Compliance Unit handles complaints, conducts administrative investigations, recommends cases that might warrant disciplinary action to the state’s attorney general and issues citations and fines. The unit also acts as a probation oversight to chiropractors whose licenses are on probation due to disciplinary action. The Field Investigations Unit, which is comprised of four full-time time personnel who are not sworn law enforcement officers, works cases that have been referred to it by the Compliance Unit.

According to the non-partisan Legislative Analyst’s Office, the Board of Chiropractic Examiners acts as a deterrent to potential insurance fraud committed by chiropractors because of the its license revocation powers and its investigative provisions.

About the Board (BCE website)

About 70% of the board’s $3.7 million budget goes toward enforcement activities. Overall, 42.6% of its budget is spent on personnel and the rest goes for operating expenses and equipment.

The board does not receive any money from the California General Fund. Instead, all of its funding comes from the chiropractic profession through licensing and regulatory fees.

3-Year Budget (pdf)

Manipulation Under Anesthesia

In 1992, ABC and NBC aired reports within days of each other on a medical technique that was receiving enhanced scrutiny and engendering a measure of concern. They called it Manipulation Under Sedation Treatment (MUST), but its more enduring acronym MUA stands for Manipulation Under Anesthesia.

Patients receiving MUA are anesthetized so that their pain will not inhibit a clinician’s ability to work on their musculoskeletal system. MUA has been around since the 1930s. It was practiced by doctors of osteopathy in the ‘50s and ‘60s, largely abandoned in the ‘70s and early ’80 before making a big comeback under the guidance of Texas chiropractors and, shortly thereafter, their California co-practitioners.

In 1990, the California Board of Chiropractic Examiners adopted a statement approving the use of MUA. “A proper chiropractic adjustment, if within the scope of practice of section 302, is not made illegal simply because the patient is under anesthesia.” The board acknowledged that chiropractors may not utilize drugs in the performance of their duties, but drew a distinction between using drugs as part of a procedure and having a patient under the influence of drugs while a procedure is performed upon them. It was a distinction that would later be tested in court.

Chiropractors continued to practice MUA despite disputes with the state over Workmen’s Compensation claims and protests by the medical profession and insurance carriers. The board attempted to codify the legality of MUA in 2005, but ran afoul of the California Office of Administrative Law, which oversees the state’s rulemaking process. The Administrative Law office ruled the board failed to meet any of the five criteria for drafting such a regulation, noting its lack of an attorney or staff member with regulatory experience.

While those two agencies were squaring off, the issue landed in the courts. The San Joaquin District Attorney’s Office charged a group of chiropractors with practicing medicine without a license for using MUA, a procedure “not authorized for chiropractors,” on 123 patients. Although questions were raised about improper medical supervision of the anesthetic and extravagant costs being passed on to insurance companies, the actual legality of MUAs was central to the DA’s case. The case was dismissed in 2008 when the jury deadlocked on a verdict. The chiropractors then sued the DA’s office and Travelers Property and Casualty Co. in federal court, alleging their civil rights had been violated. Although the case was technically about fraud, the lawyer for the defendants said, “The thing that was driving the entire criminal prosecution was the performance of manipulation under anesthesia because Travelers and a whole bunch of other insurance companies did not want to pay for those charges.”

When the board officially affirmed its support for MUA with a resolution in 2007, Executive Director Catherine Hayes and its legal adviser warned them not to do it. In March 2007, the board fired Hayes at a stormy meeting centered around her contention that its actions supporting use of MUA were improper and illegal. One month later the board unanimously voted to reaffirm its belief that MUA was authorized under the 1922 Chiropractic Initiative Act.

In February 2010 the board passed new rules that affirmed chiropractors' ability to perform manipulation under anesthesia. The rules required that patients first see a physician and that the anesthesia be administered by a physician or a qualified health professional. Medical doctors were not happy, arguing that MUA falls outside the scope of a chiropractor’s practice and puts patients at risk. They likened the procedure to surgery, noted the use of drugs and argued that only physicians are equipped to deal with the potential danger involved.

This time the Office of Administrative Law approved the regulations and they became effective in March 2010.

Joint Manipulation Under Anest (by John Dillon, Anesthesiology News)

20/20" Examines Manipulation under Anesthesia (MUA) (Dynamic Chiropractic)

Calif. Physicians Object to Expanded Scope for Chiropractors (AMED News)

Group Rejects Questions of Improper Conduct (California Chiropractic Association)

Chiros Accused of Fraud File Civil Rights Lawsuits (York Insurance Group)

Guiding a Board Rule Into a Successful Regulation (BCE PowerPoint presentation)

The Board Fires Its Executive Director

Was it a political turf war between a new Republican administration and the outgoing, recalled Democrats? A philosophical disagreement over the role of chiropractors in our society? An ideological struggle over the role of government regulators? A debate over a controversial technique used by chiropractors? A brawl between new muscle-bound board appointees who didn’t take kindly to being pushed around by a woman executive director?

Whatever was going on at the Board of Chiropractic Examiners in 2007, it exploded at their March meeting when Executive Director Catherine Hayes was abruptly fired. The Governor Gray Davis-appointee was ostensibly removed over a dispute between her and the board concerning use of a chiropractic technique called “manipulation under anesthesia,” (MUA).

Governor Arnold Schwarzenegger’s ouster of Davis in 2003 held special meaning for the board and chiropractors. The new governor had a fondness for the profession and received an honorary Doctor of Humanities degree from Cleveland Chiropractic College in 1999. That year Schwarzenegger told the Sacramento Bee, “People who don't believe in chiropractic always ask me about it. I have now become like a spokesperson for chiropractic."

The governor selected his former personal chiropractor, Richard H. Tyler, for the board in 2004. Tyler, who had worked for a bodybuilding magazine, had a long history with Schwarzenegger and had picked him up at the airport when he first arrived in California. In 2006, the governor added Francesco “Franco” Columbu to the board. The chiropractor and two-time Mr. Olympia was body-builder Schwarzenegger’s best man when he married Maria Shriver.

Hayes’ clashes with the board were an ongoing affair. At a board meeting a few months earlier, according to the Sacramento Bee, Tyler argued with Hayes about what chiropractors could accomplish. “Tyler insisted that he had cured earaches in children by adjusting the atlas, the vertebra closest to the head, and using homeopathic remedies. He then took Hayes to task for signing a pending review of a case stating that ‘no forensic or scientific evidence’ supports claims that chiropractic and homeopathic remedies are helpful in curing earaches, adding that there is more than 100 years of proof.”

On what would turn out to be her last day as executive director, Hayes read a statement to the board accusing it of attempting to undermine a criminal prosecution of chiropractors and interfering with disciplinary actions against members of the profession. She told the board that it had been acting illegally and had deprived Californians of a strong regulatory agency that was supposed to protect the public.

After Hayes read her accusations to the board, the members adjourned to a closed-door session. When they returned, Hayes was told she was fired and board Chairman Tyler took over as interim executive director.

Former board member Barbara Stanfield called the board’s actions a “coup.” Influential conservative blogger John Fleischman said the scandal-ridden board was “supremely dysfunctional” and hailed the governor’s “efforts to clean up years of abuse” by the board. Mother Jones likened the debate between Hayes and the board to the creationist textbook wars in Kansas, although laced with homegrown California “flapdoodle.”

The “flapdoodle” included a dust-up between the board and the state Attorney General’s office. The board wanted its legal representative to be Shawn Steel, an attorney who specializes in defending chiropractors and was chairman of the state Republican Party during the 2003 Davis recall election. State law mandates representation by the attorney general. The board went so far as to try to exclude the deputy attorney general from its closed-door sessions but failed.

Hayes filed a lawsuit in 2008 against the board saying she had been fired for cooperating with a criminal investigation into the practice of chiropractors working on patients under anesthesia. She also alleged that lawmakers had not complied with California’s open-meeting laws.

In 2011, the state Senate unanimously approved a $600,000 settlement payment to Hayes. It was paid for with money withdrawn from the Board of Chiropractic Examiners’ funds.

Chaos on Chiropractic Board (by John Hill and Kevin Yamamura, Sacramento Bee)

Board Chief Is Fired After Accusations (by Peter Nicholas, Los Angeles Times)

Calif. Senate OKs Chiropractic Firing Settlement (Associated Press)

What's Really Going On at the State Chiropractic Board? (by John Fleischman, Flash Report)

Bring in the Cops! Schwarzenegger's Bodybuilder Appointees are Chiropractic Fanatics! (by Josh Harkinson, Mother Jones)

Critical Assessment by the Assembly and State Auditor

In March 2007, amid major turmoil at the Board of Chiropractic Examiners, the state Assembly conducted a committee oversight hearing to evaluate the agency. It documented a series of problems including: the illegal firing of its executive director; repeated violations of the open meetings law; improper attempts to interfere with employment of civil service workers; violation of the Administrative Procedure Act; and improper interference with an ongoing criminal prosecution. Committee Chairman Mike Eng blamed the problems on a lack of oversight. He said that unlike virtually all other state boards that license and regulate healthcare professions, the BCE is not part of the Department of Consumer Affairs (DCA). And the 1922 Chiropractic initiative that created the board forbids amendments to it by the legislature without a statewide vote.

“The overriding problem at the Chiropractic Board can be clarified by asking straightforward questions,” Eng wrote. “Who has the authority to make sure the Board conducts its affairs appropriately? Who has oversight responsibility for the actions of Board members? To put it simply, who is minding the store? The answer is nobody.”

Among his committee’s proposals were that the board be placed under the Department of Consumer Affairs, its board be confirmed by the Senate, the DCA director have authority to approve the board executive director and the legislature be given the power to amend the Chiropractic act. The proposals were contained in a broader bill that failed to become law.

The next year, the California State Auditor echoed many of the committee’s concerns in a report outlining 22 problems that needed to be addressed. And in 2009 the Los Angeles Times highlighted lax enforcement policies and procedures governing California’s health care oversight, many of which were applicable to the board.

The board responded directly to the Auditor’s concerns and within a year the auditor reported that 11 of its recommendations were fully implemented and the other 11 were partially addressed.

In 2011, the board announced it was proposing new regulations, partly in response to the Los Angeles Times articles, to enhance enforcement and administrative processes. The board also said it would amend regulations that applied to its disciplinary guidelines and applicant requirements.

What Is the Real Problem? (by Assemblyman Mike Eng, via California Progress Report)

2009 Implementation of Auditor’s Recommendations (California Auditor) (pdf)

Chiropractic Board Proposes Protection Regulations (by Debbie Snow, California Progress Report)

Proposed Regulations (BCE website)

Is There a Doctor in the House?

“Chiropractic is to medicine what Danielle Steel is to literature: popular with the public but, despite some inroads, largely derided by the medical establishment.” -- The Anesthesiology News.

They have long walked a line between orthodox and alternative medicine, searching for acceptance among the legal and medical communities. They have always had their devoted fans. Yet, the question remains. Are chiropractors really doctors?

This question has been debated since they began manipulating spines, massaging discs and calling themselves doctors. But many people, particularly those in the medical field, have dismissed chiropractors as not being “legitimate” doctors.

According to the Bureau of Labor Statistics, “doctors of chiropractic” or “chiropractic physicians” diagnose and treat patients with musculoskeletal system health problems. Chiropractics treat the effects of those problems on the nervous system.

Chiropractic was officially recognized by California when its voters passed the “Chiropractic Initiative Act” that took effect in December 22, 1922. Still, many remained skeptical of the authenticity of the chiropractic profession, sometimes referring to them as “quacks.”

In fact, in 1967 the American Academy of Orthopedic Surgeons took a firm stand against the chiropractic profession and said its members should avoid any connections with chiropractors and the industry.

But in 1968, the chiropractic field received a public relations boost when California’s insurance code was amended to extend insurance equality to chiropractors seeing insured patients. In addition, chiropractic care is included in Medicare, Medicaid, Federal Employees Health Care Benefits Programs, Federal and state workers’ compensation programs.

In 2009, the Joint Commission on Accreditation of Hospitals changed its policy to include Doctors of Chiropractic as physicians. Licensed chiropractors must have a four-year undergraduate degree and attend accredited chiropractor colleges. Some states allow chiropractors to perform primary care for patients, including delivering babies.

Chiropractic in the United States: Training, Practice and Research (ChiroWeb) (pdf)

Occupational Outlook Handbook (Bureau of Labor Statistics)

Chiropractic Is a Religion (ChiroTalk discussion board)

Dr. Fred Lerner, 2008-2012

Dr. Richard Tyler, DC, 2007 – 2008

Dr. Barbara Stanfield, DC, 2005 – 2006

Dr. Ronald Hayes, DC, 2003 – 2005

Dr. Jeffrey Steinhardt, DC, 2002 – 2003