Search terms: HOUSE BILL 195 |
BY HEALTH AND WELFARE COMMITTEE
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AN ACT
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REVISE DEFINITIONS AND TO MAKE TECHNICAL CORRECTIONS; AMENDING SECTION
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CODE, TO PROVIDE A CORRECT CODE REFERENCE; AMENDING SECTION 54-707,
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VIDE FOR CERTIFICATION IN CLINICAL NUTRITION; AMENDING CHAPTER 7, TITLE
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PROVIDE REQUIREMENTS FOR ADMINISTERING CERTAIN PRESCRIPTION PRODUCTS;
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VIDE THAT CHIROPRACTIC PHYSICIANS CERTIFIED IN CLINICAL NUTRITION MAY
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POSSESS CERTAIN LEGEND DRUGS AND TO MAKE A TECHNICAL CORRECTION.
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amended to read as follows:
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54-703. DEFINITIONS. As used in this chapter, the terms defined in
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this section shall have the following meaning, unless the context clearly
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indicates another meaning:
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(1) "Acceptable school of chiropractic" means any school of chiro-
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practic that meets the standards or requirements of a national chiropractic
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school accrediting organization acceptable to the board or that has status
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as a candidate for accreditation before such organization.
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(2) "Board" means the state board of chiropractic physicians.
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(3) "License to practice chiropractic" means a license issued by the
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board to a person who has graduated from an acceptable school of chiropractic
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and who has fulfilled the licensure requirements of this chapter.
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(4) "Person" means a natural person.
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(5) "Physician" means any person who holds a license to practice chi-
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ropractic; provided further, that others authorized by law to use the term
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"physician" shall not be considered physicians for the purpose of this chap-
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ter.
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(6) The "practice of chiropractic" means:
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(a) To investigate, examine, and diagnose for any human disease, ail-
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ment, injury, infirmity, deformity, or other condition; and
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(b) To apply principles or techniques of chiropractic practice as set
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of any of the conditions listed in subsection paragraph (a) of this
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subsection; or
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(c) To offer, undertake, attempt to do or hold oneself out as able to do
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any of the acts prescribed in subsections paragraphs (a) and (b) of this
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subsection.
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(2) "Board" means the state board of chiropractic physicians.
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(3) "Physician" means any person who holds a license to practice chi-
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ropractic; provided further, that others authorized by law to use the term
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"physician" shall not be considered physicians for the purpose of this chap-
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ter.
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(4) "License to practice chiropractic" means a license issued by the
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board to a person who was graduated from an acceptable school of chiropractic
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and who has fulfilled the licensure requirements of this chapter.
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(5) The word "person," the word "he," and the word "his," means a natu-
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ral person.
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(6) "Acceptable school of chiropractic" means any school of chiroprac-
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tic which meets the standards or requirements of a national chiropractic
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school accrediting organization acceptable to the board, or which has status
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as a candidate for accreditation before such organization.
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amended to read as follows:
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54-704. CHIROPRACTIC PRACTICE. (1) Chiropractic practice and proce-
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dures which that may be employed by physicians are as follows: (1) Tthe sys-
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tem of specific adjustment or manipulation of the articulations and tissues
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of the body; the investigation, examination and clinical diagnosis of condi-
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tions of the human body and the treatment of the human body by the application
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of manipulative, manual, mechanical, physiotherapeutic or clinical nutri-
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tional methods and may include the use of diagnostic X-rays.
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(2) As used in this section:
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(a) "Adjustment" means the application of a precisely controlled
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force applied by hand or by mechanical device to a specific focal point
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on the anatomy for the express purpose of creating a desired angular
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movement in skeletal joint structures in order to eliminate or de-
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crease interference with neural transmission and correct or attempt to
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correct subluxation complex; "chiropractic adjustment" utilizes, as
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appropriate, short lever force, high velocity force, short amplitude
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force, or specific line-of-correction force to achieve the desired
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angular movement, as well as low force neuromuscular, neurovascular,
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neuro-cranial, or neuro-lymphatic reflex technique procedures.
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(b) "Manipulation" means an application of a resistive movement by ap-
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plying a nonspecific force without the use of a thrust, that is directed
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into a region and not into a focal point of the anatomy for the general
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purpose of restoring movement and reducing fixation.
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(c) "Massage therapy," also called massology, means the systematic
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manual or mechanical mobilization of the soft tissue of the body by such
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movements as rubbing, kneading, pressing, rolling, slapping and tap-
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ping, for the purpose of promoting circulation of the blood and lymph,
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relaxation of muscles, release from pain, restoration of metabolic bal-
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ance, and the other benefits both physical and mental.
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(23) Nothing herein contained shall allow any a physician to:
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(a) Perform surgical operations or practice obstetrics; or
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(b) Prescribe, dispense, independently administer, distribute, or
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dDirect or suggest to the a patient that such patient shall use a drug,
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substance which, or product that:
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(i) Uunder federal law is required, prior to being dispensed or
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delivered, to be labeled with either any of the following state-
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ments:
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(i) 1. "Caution: Federal Llaw Pprohibits Ddispensing
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Wwithout Pprescription"; or
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(ii) 2. "Rx only"; or
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3. "Caution: Federal Llaw Rrestricts Tthis Ddrug Tto Uuse
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Bby or Oon Tthe Oorder Oof Aa Llicensed Vveterinarian"; or
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(iii) a product which iIs required by any applicable federal or
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state law, rule or regulation to be dispensed on prescription only
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or prescription drug order only, or is restricted to use by practi-
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tioners only.
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(4) Notwithstanding the provisions of subsection (3) of this section,
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a chiropractic physician certified in clinical nutrition may independently
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Code.
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(35) Chiropractic practice, as herein defined, is hereby declared not
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to be the practice of medicine within the meaning of the laws of the state
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nor liable to any prosecution thereunder, when acting within the scope of
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practice as defined in this chapter.
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amended to read as follows:
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54-705. EXCEPTIONS -- PROHIBITED PRACTICES -- NEGLIGENCE ESTAB-
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LISHED. (1) Under the circumstances described and, subject in each case to
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the limitations stated, the following persons, though not holding a license
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to practice chiropractic in this state, may engage in activities included in
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the practice of chiropractic:
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(a) A person licensed by this state pursuant to chapter 18, title 54,
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(b) A chiropractic assistant as shall be defined and regulated by the
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Code, but not including the adjustment or manipulation of articulations
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of the body, as specifically directed by a chiropractic physician as
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long as such directions are within the scope of chiropractic practice;
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(c) A person rendering aid in an emergency, for which no fee for the ser-
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vices is contemplated, charged or received;
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(d) A person residing in another state or country and authorized to
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practice chiropractic there, who is called in consultation by a person
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licensed in this state to practice chiropractic, or who for the purpose
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of furthering chiropractic education is invited into this state to con-
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duct a lecture, clinic or demonstration, while engaged in activities in
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connection with the consultation, lecture, clinic or demonstration, so
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long as he does not open an office or appoint a place to meet patients or
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receive calls in this state;
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(e) A person authorized to practice chiropractic in another state or
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country rendering chiropractic care in a time of disaster or while car-
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ing for an ill or injured person while at the scene of an emergency and
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while continuing to care for such person;
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(f) Nothing in this chapter shall be construed as preventing or re-
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stricting the practice, services or activities or requiring licensure
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pursuant to the provisions of this chapter, of any person licensed or
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registered in this state by any other law, from engaging in any health
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care profession or occupation for which such person is licensed or reg-
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istered;
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while engaged in the performance of his official duties;
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(h) A person administering a remedy, diagnostic procedure or advice as
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specifically directed by a physician;
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(i) A person administering a family remedy to a member of the family;
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(j) A person authorized or licensed by this state to engage in activi-
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ties which may involve the practice of medicine;
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(k) A person who administers treatment or provides advice regarding the
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human body and its functions that:
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(i) Does not use legend drugs or prescription drugs in such prac-
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tice;
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(ii) Uses natural elements such as air, heat, water and light;
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(iii) Only uses class I or class II nonprescription, approved,
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medical devices as defined in section 513 of the federal food, drug
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and cosmetic act;
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(iv) Only uses vitamins, minerals, herbs, natural food products
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and their extracts, and nutritional supplements; and who
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(v) Does not perform surgery;
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(vi) Requires each person receiving services to sign a decla-
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ration of informed consent which includes an overview of the
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health care provider's education which states that the health care
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provider is not an "M.D." or "D.O." and is not licensed under the
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provisions of this chapter;
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(l) Any person who practices massage therapy as defined in section
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(m) A chiropractic intern, as defined and regulated by the board, who is
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registered with the board to practice chiropractic under the direct su-
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pervision of a licensed chiropractic physician pursuant to a preceptor
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program adopted and developed by the rules of the board.
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(2) Except as provided in subsection (1) of this section, it is unlaw-
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ful for any person to practice chiropractic in this state without a license
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and, upon conviction thereof, shall be fined not less than one thousand dol-
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lars ($1,000) nor more than three thousand dollars ($3,000), or imprisoned
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for not less than six (6) months nor more than one (1) year, or by both such
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fine and imprisonment.
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(3) It is unlawful for any person to assume or use the title or desig-
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nation "chiropractor," "chiropractic physician," "doctor of chiropractic,"
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the initials "D.C.," or any word, title or abbreviation thereof calculated
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to induce the belief that he is engaged in the practice of chiropractic or to
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indicate to the public that such person is licensed to practice chiropractic
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pursuant to this chapter unless such person is so licensed, and upon convic-
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tion thereof, such person shall be fined not less than five hundred dollars
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($500) nor more than three thousand dollars ($3,000), or imprisoned for not
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less than six (6) months nor more than one (1) year, or by both such fine and
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imprisonment.
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(4) When a person has been a recipient of services constituting the un-
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lawful practice of chiropractic, whether or not he knew the rendition of the
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services was unlawful, proof of the rendition of unlawful services to the re-
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cipient, in an action against the provider of such services for damages al-
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legedly caused by the services, constitutes prima facie evidence of negli-
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gence, shifting the burden of proof to such provider of unlawful services.
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The following damages in addition to any other remedies provided by law may
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be recovered in such an action:
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(a) Amount of any fees paid for the unlawful services; and
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(b) Reasonable attorney's fees and court costs.
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(5) The board shall refer all violations made known to it to an appro-
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priate prosecuting attorney. The board shall render assistance to a prose-
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cuting attorney in the prosecution of a case pursuant to this section.
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amended to read as follows:
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54-707. POWERS AND DUTIES. The board shall have the authority to:
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(1) Hire or appoint employees, including an executive director, inves-
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tigators, attorneys, consultants and independent hearing examiners;
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(2) Establish, pursuant to the provisions of chapter 52, title 67,
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(3) Conduct investigations and examinations and hold hearings;
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(4) Revoke or suspend licenses to practice chiropractic after provid-
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ing the licensee with an opportunity for an appropriate contested case in ac-
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(5) In any disciplinary proceeding pursuant to this chapter to adminis-
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ter oaths, take depositions of witnesses within or without the state in the
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manner provided by law in civil cases, and shall have the power throughout
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duction of such books, records, and papers as it may desire at any hearing
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and, for that purpose, the board may issue a subpoena for any witnesses or
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subpoena duces tecum to compel the production of any books, records or pa-
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witness resides or may be found, which shall be served and returned in the
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same manner as a subpoena in a criminal case is served and returned. The fees
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and mileage of the witnesses shall be the same as that allowed in the district
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courts in criminal cases, which fees and mileage shall be paid from any funds
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in the state treasury in the same manner as other expenses of the board are
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paid. The licensee accused in such proceedings shall have the same right of
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subpoena upon making application to the board therefor. In any case of dis-
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obedience to, or neglect of, any subpoena or subpoena duces tecum, served
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upon any person, or the refusal of any witness to testify to any matter re-
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garding which he may lawfully be interrogated, it shall be the duty of the
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district court of any county in this state in which this disobedience, ne-
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glect or refusal occurs, on application by the board to compel compliance
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with the subpoena, to issue its order directing compliance with such sub-
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poena, and in the event of a violation of such order, to compel compliance
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with such order by proceedings for contempt as in the case of disobedience of
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the requirement of a subpoena issued from such court or for refusal to tes-
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tify therein;
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(6) Seek injunctive relief prohibiting the unlawful practice of chiro-
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practic;
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(7) Make and enter into contracts in the necessary performance of its
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duties pursuant to this chapter;
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(8) Develop and submit a proposed budget setting forth the amount nec-
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essary to perform its functions;
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(9) Perform such other duties as set forth in the laws of this state;
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(10) Provide such other services and perform such other functions as are
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necessary to fulfill its responsibilities;
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(11) Adopt rules to provide for reasonable fees and for administrative
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costs and to assess costs reasonably and necessarily incurred in the en-
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forcement of this chapter when a licensee has been found to be in violation
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thereof;
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(12) Adopt a rule requiring continuing education as a condition of con-
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tinued licensure or continued certification in clinical nutrition; and
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lish and operate a system of peer review for chiropractic physicians which
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that shall include, but not be limited to, the appropriateness, quality,
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utilization, and cost of chiropractic services and the ethical performance
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of chiropractic care.
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hereby amended by the addition thereto of a NEW SECTION, to be known and des-
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54-707A. FEES. (1) The board shall establish by rule fees for licen-
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sure under the provisions of this chapter including, but not limited to, the
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following:
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(a) Application fee not to exceed two hundred fifty dollars ($250);
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(b) Initial license fee not to exceed two hundred fifty dollars ($250);
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(c) Endorsement license fee not to exceed two hundred fifty dollars
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($250);
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(d) Annual renewal of license fee not to exceed two hundred fifty dol-
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lars ($250);
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(e) Inactive license fee not to exceed one hundred fifty dollars
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($150);
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(f) Temporary permit fee not to exceed one hundred fifty dollars
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($150);
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(g) Intern permit fee not to exceed one hundred fifty dollars ($150);
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(h) Continuing education provider application fee not to exceed five
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hundred dollars ($500); and
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(i) Clinical nutrition certification fee not to exceed two hundred
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fifty dollars ($250).
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(2) Fees charged pursuant to paragraphs (b), (c), (f), (g), and (i) of
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subsection (1) of this section shall be in addition to the application fee.
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(3) All fees received under the provisions of this chapter shall be non-
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refundable and shall be deposited in the state treasury to the credit of the
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occupational license account in the dedicated fund, and all costs and ex-
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penses incurred by the board under the provisions of this chapter shall be
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a charge against and paid from the account for such purposes, and the funds
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collected hereunder shall be immediately available for the administration
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of this chapter, the provisions of any other law notwithstanding.
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amended to read as follows:
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TIVE LICENSE -- CLINICAL NUTRITION CERTIFICATION. (1) The board shall issue
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licenses to practice chiropractic to persons who have qualified therefor in
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accordance with the provisions of this chapter. The board may refuse licen-
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sure if it finds that the applicant has engaged in conduct prohibited by sec-
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consideration the rehabilitation of the applicant and other mitigating cir-
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cumstances. Such licenses shall be issued after payment of the licensing fee
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in an amount to be fixed by the board not to exceed one hundred fifty dollars
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($150) An applicant for a license or permit under this chapter must submit
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the fee set by board rule. All licenses issued under the provisions of this
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chapter shall be subject to annual renewal and shall expire unless renewed in
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the manner prescribed by the board regarding applications for renewal, con-
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tinuing education, and fees. License renewal and reinstatement shall be in
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(2) The board may renew, on an inactive basis, the license of a A physi-
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cian holding a current active license in this state who is not practicing
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chiropractic in this state may be issued an inactive license. The physician
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must submit the fee set by board rule and a written request for an inactive
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license. The board shall fix and collect an inactive license fee for such an
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inactive license renewal in an amount not to exceed one hundred fifty dol-
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lars ($150) and eEach inactive license shall be issued for a period of one (1)
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year. A physician holding an inactive license may not engage in the practice
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of chiropractic in this state. If a A physician wishes wishing to convert his
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an inactive license to an active license, he must account to the board for
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that period of time in which he held an the license was inactive license and
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must fulfill requirements that demonstrate competency to resume practice.
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Those requirements may include, but are not limited to, education, super-
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vised practice and examination. The board may consider practice in another
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jurisdiction in determining competency. All fees authorized by subsections
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(1) and (2) of this section shall be paid to the bureau of occupational li-
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censes.
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(3) Whenever the board determines that an applicant for a license to
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practice chiropractic is not qualified for such a license pursuant to the
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provisions of this chapter, the board shall notify the applicant by certi-
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fied mail of its denial of licensure and the reasons for denial The board may
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issue a clinical nutrition certification to a licensee under this chapter
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who submits a completed application, pays the application fee set by board
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rule, and provides proof to the board of successful completion of the educa-
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hereby amended by the addition thereto of a NEW SECTION, to be known and des-
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54-716. ADMINISTERING PRESCRIPTION DRUG PRODUCTS. (1) A licensee un-
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der this chapter who is certified in clinical nutrition may obtain and in-
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dependently administer, during chiropractic practice, the following pre-
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scription drug products:
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(a) Vitamins:
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(i) Vitamin A;
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(ii) All B vitamins; and
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(iii) Vitamin C;
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(b) Minerals:
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(i) Ammonium molybdate;
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(ii) Calcium;
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(iii) Chromium;
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(iv) Copper;
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(v) Iodine;
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(vi) Magnesium;
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(vii) Manganese;
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(viii) Potassium;
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(ix) Selenium;
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(x) Sodium; and
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(xi) Zinc;
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(c) Fluids:
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(i) Dextrose;
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(ii) Lactated ringers;
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(iii) Plasma lyte;
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(iv) Saline; and
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(v) Sterile water;
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(d) Epinephrine; and
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(e) Oxygen for use during an emergency or allergic reaction.
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(2) The prescription drug products listed in subsection (1) of this
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section may be administered through oral, topical, intravenous, intramuscu-
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lar or subcutaneous routes. The route of administration and dosing shall be
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in accordance with the product's labeling as approved by the federal food and
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drug administration or with the manufacturer's instructions.
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(3) The prescription drug products listed in subsection (1) of this
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section shall be obtained from a wholesale distributor, manufacturer, phar-
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Code.
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(4) No vitamin or mineral may be compounded, as defined in section
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uct containing two (2) or more of the approved vitamins or minerals shall be
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obtained for office use from an outsourcing facility licensed under chapter
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(5) Nothing herein would remove or impact the ability of a chiropractic
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physician who does not obtain a clinical nutrition certification to continue
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to utilize nonprescriptive nutritional supplements.
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hereby amended by the addition thereto of a NEW SECTION, to be known and des-
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54-717. CERTIFICATION IN CLINICAL NUTRITION. (1) To qualify for cer-
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tification in clinical nutrition, a licensee of this chapter must have suc-
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cessfully completed a minimum of the following courses:
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(a) Seven (7) credits (seventy-seven (77) hours) of didactic human nu-
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trition, nutrition biochemistry and nutritional pharmacology; and
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(b) Twenty-four (24) hours of practicum in intravenous and injectable
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nutrient therapy, which must include: sterile needle practices, phle-
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botomy, proper injection techniques, intravenous therapy techniques,
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intramuscular injection techniques, safety practices, and use and ex-
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pected outcomes utilizing micronutrients, response to adverse effects,
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lab testing and blood chemistry interpretation.
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The courses required by this subsection must be taken from an accredited chi-
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ropractic college or other accredited institution of higher education and
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must be from an accredited program at the college or institution or be a pro-
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gram approved by board rule.
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For purposes of this section, "accredited" means accredited by an ac-
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(2) Until January 1, 2019, a licensee of this chapter who commenced ob-
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taining the education requirements of subsection (1)(a) of this section no
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earlier than January 1, 2013, and thereafter successfully completed those
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requirements, may be determined to have satisfied the requirements of sub-
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section (1)(a) of this section as provided in board rule.
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(3) The practicum required for certification in clinical nutrition by
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subsection (1)(b) of this section must commence and be successfully com-
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pleted after the effective date of this section and pursuant to board rule.
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(4) All active chiropractic physicians wishing to obtain certifica-
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tion in clinical nutrition must first successfully complete the education
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described in subsection (1) of this section.
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(5) In order to maintain clinical nutrition certification, a chiro-
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practic physician certified in clinical nutrition must obtain recertifica-
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tion in clinical nutrition every three (3) years pursuant to board rule.
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(6) All chiropractic physicians certified in clinical nutrition must
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maintain a current cardiopulmonary resuscitation (CPR) and basic life sup-
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port (BLS) certification, as well as have BLS equipment on the chiropractic
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premises where treatment is being performed.
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(7) Prior to providing a course of intravenous or injectable nutri-
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tion therapy, chiropractic physicians certified in clinical nutrition must
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provide to their patients informed consent documentation that explains
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the benefits and potential risks of the specific course of intravenous or
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injectable nutrition therapy that is being proposed. The physician must
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obtain from the patient written voluntary permission to perform the proposed
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therapy.
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amended to read as follows:
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54-1734. POSSESSION OF LEGEND DRUGS. (1) The following persons or
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their agents or employees may possess legend drugs for use in the usual and
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lawful course of their business or practice or in the performance of their
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lawful official duties, without a valid prescription drug order:
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(a) Pharmacists;
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(b) Prescribers;
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(c) Researchers who are prohibited from further distribution;
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(d) Hospitals and other institutional facilities;
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(e) Manufacturers and wholesalers;
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(f) Common carriers solely in the usual course of business of trans-
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porting prescription drugs;
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(g) Schools or other authorized entities possessing stock supplies of
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epinephrine auto-injectors pursuant to section 33-520A or 54-1733C,
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least one (1) individual who has completed the training requirement of
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(h) Persons, agencies and organizations possessing opioid antagonists
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of midwifery; and
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(j) Home health nurses or agencies, or hospice agencies, possessing
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emergency kits pursuant to rules of the board; and
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(k) Chiropractic physicians licensed pursuant to chapter 7, title
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(2) Veterinary drug outlets or their agents or employees may possess
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legend drugs, excluding controlled substances, for use in the usual and law-
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ful course of their business or practice or in the performance of their law-
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ful official duties, without a valid prescription drug order.