RE: Oregon only guidelines

[Guest guest]

Dear Dr. Holzapfel:

It looks like there is only a financial connection the Delphi PUG process

has with the OBCE at the present time. I would seek to sever this and fund

the committee from other sources. So as to get an idea of the costs, what is

the committee's annual budget? How long will the committee continue to

require funding?

I am very much in favor of developing guidelines, but not within the

confines of a government agency. By moving the committee to new funding

sources and new a location my objections would be dissolved. I believe that

the sanctions noted in the excerpt from your post below would be a non-issue

if the committee were disconnected from the OBCE, your work would get a

fresh start, and the OBCE would be freed from the political fallout (such as

a failure to get approval to increase license fees) that is inevitable where

a governmental agency establishes PUG's.

Sincerely,

Willard

Re: Oregon only guidelines

As to being " sanctioned " by the OBCE? To sanction

means to support, to approve of, even something that gives binding force

to a law (Webster's New World Dictionary). So yes, OBCE, as I

understand, " sanctions " the manual in so far as the information from the

manual can be used to further guide and educate not only the individual

chiropractor but also help the non-chiropractor understand our profession

better (i.e. the manual is NOT a club to beat wayward individuals into

submission...that is up to the law itself).

J. Holzapfel, D.C.

Albany, OR.

kjholzdc@...

http://docman.chiroweb.com

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or

otherwise distribute correspondence written by another member without his or

her consent, unless all personal identifiers have been removed.

[Guest guest]

,

I too have participated in this process from the first day and can attest

to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

the possibility that what we were collaborating on and slaving over for

long periods of time might be misinterpreted or construed as

administrative rules or law. One of our biggest concerns is that

everyone realize that we have been striving to formulate GUIDELINES and

not trying to create new law or rule. Our concern is to EDUCATE and not

administrate. Please forgive my emphasis. I am not shouting, just

trying to make a point that seems to keep coming up. In committe we have

literally agonized over grammar, punctuation, order, syntax, etc. with

significant debate and even a little controversy as we try to avoid

administrating and instead educate. This has been a difficult, tedious,

demanding, emotional, and even rewarding exercise. Sunny and Don both

try to emphasize the point that this material is to educate and guide,

not administrate. As to being " sanctioned " by the OBCE? To sanction

means to support, to approve of, even something that gives binding force

to a law (Webster's New World Dictionary). So yes, OBCE, as I

understand, " sanctions " the manual in so far as the information from the

manual can be used to further guide and educate not only the individual

chiropractor but also help the non-chiropractor understand our profession

better (i.e. the manual is NOT a club to beat wayward individuals into

submission...that is up to the law itself). Oregon Administrative Rules

are referenced in the manual where applicable as they apply to the

subject matter at hand but there is no intent for the manual to REWRITE

or add to administrative rule already written. I realize how difficult

this may be to fully understand. Like Sunny has done so many times

already I strongly encourage yours and any other interested individual's

participation in the Delphi process where you can specifically review

each and every sentence written, provide input and recommendations as

well as seek clarification over any confusing information written. I

cannot emphasize enough just how hard we have worked to keep the manual

written as an educational tool, NOT a club, law, rule, etc. Of course,

there will be those who will interpret the manual as just that. But we

have tried to write it so that an interpretation of that kind will be as

baseless as we can make it. I apologize for droning on, but read it and

let us know what you think...

J. Holzapfel, D.C.

Albany, OR.

kjholzdc@...

http://docman.chiroweb.com

[Guest guest]

Hi ,

Thank you for your thinking mind! Your assessment is correct: there is no governmental control over the outcome of the document.

There are areas where we are referencing the OARs as definition of what current standards are. After all, the OARs are part of our 'current literature base'. The OBCE is exercising no control over the content. Content is written, referenced and consensitized by the volunteer attendance from our state DC members. They will not have the weight of any law behind them. AND we are recognizing, in the way we write this document, that we want to define ourselves in such a manner as to prevent any attorney from using this material material against us in the future. Hours, days, weeks, years of thought are going into this document. It is being thought about in as many a thousand ways from Sunday as all of our little brains can generate.

Which is why participation by each of us is important. I, for one, am very aware that I don't think of everything. Which is why it takes all of us to keep all of us in practice.

Please do clarify this point to anyone interested. Spots are still open for assisting with the construction of the document. Bring your thoughts to the table. They are part of us.

Sunny ;'-)))

skierstyn

Oregon only guidelines

To all --While I am still preparing some thoughts on this entire subject, I have been very interested in the comments going back and forth and especially agree with Dr. Bertrand's comments. He brings up many great points that I had not thought of. It appears however that perhaps one of my strongest reasons for opposing the guidelines is not valid and I want to get some clarification on this:1. On 4-10-03 Don DC who serves on the guidelines committee writes, "It's not a government task, it's entirely driven by members from the field....It is not a board or government driven process other than they provide our meeting room, A.V. equipment and editorial/transcription assistance (and a lavish lunch.)"2. On 4-11-03 Sunny Kiersten who serves on the guidelines committee writes, "...the OBCE is supporting the cost, not dictating the course of the educational manual." and on 4-10-03 stated, "And this document IS being created outside of governmental regimen and BY voluntary participation of the profession. The OBCE is only providing the impetus and a meeting room and paying for the procurement of our requested literary research..."I conclude from theses remarks by two individuals whom are active on the guidelines committee that there is no control over the outcome of the document whatsoever and that the new guidelines which had their name changed to standards and are now called if I am correct the instructional manual will also not be supported, mandated, or referenced by any Oregon Administrative Rules in the future. They will as I understand it from you comments not be sanctioned by the OBCE, and will therefore not have the weight of the law behind them as I had understood they would. Could Dr. Kiersten, and Don or anyone else involved in the process please confirm and elaborate on this point?Also it appears as though I may have misrepresented this point so may I have your permission to clarify this to other parties Schmidt DC

[Guest guest]

Well I would like to interject a thought, maybe it has been brought up

already and I missed it if I did I apologise for the waste of space. First of

all I would like to thank those who are working on this project it is a huge

undertaking and commend you for your efforts. Now for my feable interjection

regardig laws, OAR's etc... If a document is created outlining guidelines

that is supported and endorsed by the OBCE although not meant to be a manual

or a law but it will be seen as our " usual and customary " therefore through

the insurance industry, detractors, chiropractic bashers, and legal wrangling

could be extrapolated to be THE industry standard, therefore by virtue of

acceptance as standards of care becomes usual and customary which are dicated

by ors's, guided by the oar's and enforcable by the OBCE! I am probably off

base but what the heck.

Dr. Charlie Caughlin DC

155 NW 1st Ave

Day, Or 97845

off 541-575-1063

hm 541-575-1103

fax 541-575-5554

----- Re: Oregon only guidelines

> ,

> I too have participated in this process from the first day and can attest

> to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

> the possibility that what we were collaborating on and slaving over for

> long periods of time might be misinterpreted or construed as

> administrative rules or law. One of our biggest concerns is that

> everyone realize that we have been striving to formulate GUIDELINES and

> not trying to create new law or rule. Our concern is to EDUCATE

> and not administrate. Please forgive my emphasis. I am not

> shouting, just trying to make a point that seems to keep coming up.

> In committe we have literally agonized over grammar, punctuation,

> order, syntax, etc. with significant debate and even a little

> controversy as we try to avoid administrating and instead educate.

> This has been a difficult, tedious, demanding, emotional, and even

> rewarding exercise. Sunny and Don both try to emphasize the point

> that this material is to educate and guide, not administrate. As to

> being " sanctioned " by the OBCE? To sanction means to support, to

> approve of, even something that gives binding force to a law

> (Webster's New World Dictionary). So yes, OBCE, as I understand,

> " sanctions " the manual in so far as the information from the manual

> can be used to further guide and educate not only the individual

> chiropractor but also help the non-chiropractor understand our profession

> better (i.e. the manual is NOT a club to beat wayward individuals

> into submission...that is up to the law itself). Oregon

> Administrative Rules are referenced in the manual where applicable

> as they apply to the subject matter at hand but there is no intent

> for the manual to REWRITE or add to administrative rule already

> written. I realize how difficult this may be to fully understand.

> Like Sunny has done so many times already I strongly encourage

> yours and any other interested individual's participation in the

> Delphi process where you can specifically review each and every

> sentence written, provide input and recommendations as well as seek

> clarification over any confusing information written. I cannot

> emphasize enough just how hard we have worked to keep the manual

> written as an educational tool, NOT a club, law, rule, etc. Of

> course, there will be those who will interpret the manual as just

> that. But we have tried to write it so that an interpretation of

> that kind will be as baseless as we can make it. I apologize for

> droning on, but read it and let us know what you think...

>

> J. Holzapfel, D.C.

> Albany, OR.

> kjholzdc@...

> http://docman.chiroweb.com

>

>

> OregonDCs rules:

>

> 1. Keep correspondence professional; the purpose of the listserve is

> to foster communication and collegiality. No personal attacks on

> listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

> forward, or otherwise distribute correspondence written by another

> member without his or her consent, unless all personal identifiers

> have been removed.

>

>

[Guest guest]

If you create guidelines, you can be sure that they will be used as

administrative rules.

J Holzapfel DC wrote:

> ,

> I too have participated in this process from the first day and can attest

> to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

> the possibility that what we were collaborating on and slaving over for

> long periods of time might be misinterpreted or construed as

> administrative rules or law. One of our biggest concerns is that

> everyone realize that we have been striving to formulate GUIDELINES and

> not trying to create new law or rule. Our concern is to EDUCATE and not

> administrate. Please forgive my emphasis. I am not shouting, just

> trying to make a point that seems to keep coming up. In committe we have

> literally agonized over grammar, punctuation, order, syntax, etc. with

> significant debate and even a little controversy as we try to avoid

> administrating and instead educate. This has been a difficult, tedious,

> demanding, emotional, and even rewarding exercise. Sunny and Don both

> try to emphasize the point that this material is to educate and guide,

> not administrate. As to being " sanctioned " by the OBCE? To sanction

> means to support, to approve of, even something that gives binding force

> to a law (Webster's New World Dictionary). So yes, OBCE, as I

> understand, " sanctions " the manual in so far as the information from the

> manual can be used to further guide and educate not only the individual

> chiropractor but also help the non-chiropractor understand our profession

> better (i.e. the manual is NOT a club to beat wayward individuals into

> submission...that is up to the law itself). Oregon Administrative Rules

> are referenced in the manual where applicable as they apply to the

> subject matter at hand but there is no intent for the manual to REWRITE

> or add to administrative rule already written. I realize how difficult

> this may be to fully understand. Like Sunny has done so many times

> already I strongly encourage yours and any other interested individual's

> participation in the Delphi process where you can specifically review

> each and every sentence written, provide input and recommendations as

> well as seek clarification over any confusing information written. I

> cannot emphasize enough just how hard we have worked to keep the manual

> written as an educational tool, NOT a club, law, rule, etc. Of course,

> there will be those who will interpret the manual as just that. But we

> have tried to write it so that an interpretation of that kind will be as

> baseless as we can make it. I apologize for droning on, but read it and

> let us know what you think...

>

> J. Holzapfel, D.C.

> Albany, OR.

> kjholzdc@...

> http://docman.chiroweb.com

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to foster

communication and collegiality. No personal attacks on listserve members will be

tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere. However, it

is against the rules of the listserve to copy, print, forward, or otherwise

distribute correspondence written by another member without his or her consent,

unless all personal identifiers have been removed.

>

>

[Guest guest]

And what is wrong with guidelines , or standards or any definition or

refinement in a profession ? There is nothing wrong , because any profession

should be able to give at least a baseline of rationale and process to what

it thinks or does. The lack of definition for far too long, has been a

problem with this profession...too nebulous, too out there and for some, too

sleazy. Most, if not all, professions have some sort of guidelines, or

statements that get everyone on the same page and this, is my mind, shows

maturity. Maturity of the profession and which, in time, is welcomed by the

true professional.

It just doesn't fly any more that everything is left up to the individual

doctor's interpretation of health, sickness, treatment, higher power, innate

etc. and therefore, another doctor couldn't possibly 'judge' the other

doctor's care because of all of the subtle (incomprehensible) nuances.

My point? :

There was a case years ago, which makes me sick to think about... A

Chiropractor in Oregon felt that 'nervous system problems' could be cured by

nasal insufflation. The doctor undertook care of the child and the child

worsened. The doctor made no attempt to find out the cause of the child's

'nervous system problems' and so the care went on and on, and the child

continued to worsen. Eventually, and not by the Chiro , the child was

diagnosed to have congenital hypothyroidism and was supplemented, but by

that time the damage was done and 'nervous system problems' were

irreversibly severe. Does nasal insufflation actually pump the pituitary

and really get the thyroid going on it's own ? I don't know, but I do know

that in this case if one is attempting to get things going normally, then

one had better get a thyroid level and/or get some supplementation of

thyroid hormone on board while one is conducting such an 'experiment' on a

developing brain....

To make a long story short, do you think the lawyer for the child could find

one doctor of Chiropractic that had the knowledge, if not the guts, to say

that prolonged hypothyroidism has negative consequences for a developing

brain, and that it was negligence to undertake 'treatment' of something that

you haven't even attempted to diagnose yet alone understand? No. Not one

doctor of Chiropractic would step up to the plate. Not one. And the lawyer

talked to many. How incredulous. How immature. How scary. How very, very

sad. But that was in the 70's, and today in 2003 , I profess that the

unwillingness to define one's profession, speak up, and be held accountable

, yes, accountable, is inexcusable. And, in fact, unprofessional.

I say look at all the things that have been published to date on the

practice. See what best fits the practice in Oregon , modify if necessary,

and get a consensus from Oregon practitioners as to whether or not it

accurately reflects the standard of practice here. No small task, but in the

long run, well worth it.

sharron fuchs dc

Re: Oregon only guidelines

If you create guidelines, you can be sure that they will be used as

administrative rules.

J Holzapfel DC wrote:

> ,

> I too have participated in this process from the first day and can attest

> to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

> the possibility that what we were collaborating on and slaving over for

> long periods of time might be misinterpreted or construed as

> administrative rules or law. One of our biggest concerns is that

> everyone realize that we have been striving to formulate GUIDELINES and

> not trying to create new law or rule. Our concern is to EDUCATE and not

> administrate. Please forgive my emphasis. I am not shouting, just

> trying to make a point that seems to keep coming up. In committe we have

> literally agonized over grammar, punctuation, order, syntax, etc. with

> significant debate and even a little controversy as we try to avoid

> administrating and instead educate. This has been a difficult, tedious,

> demanding, emotional, and even rewarding exercise. Sunny and Don both

> try to emphasize the point that this material is to educate and guide,

> not administrate. As to being " sanctioned " by the OBCE? To sanction

> means to support, to approve of, even something that gives binding force

> to a law (Webster's New World Dictionary). So yes, OBCE, as I

> understand, " sanctions " the manual in so far as the information from the

> manual can be used to further guide and educate not only the individual

> chiropractor but also help the non-chiropractor understand our profession

> better (i.e. the manual is NOT a club to beat wayward individuals into

> submission...that is up to the law itself). Oregon Administrative Rules

> are referenced in the manual where applicable as they apply to the

> subject matter at hand but there is no intent for the manual to REWRITE

> or add to administrative rule already written. I realize how difficult

> this may be to fully understand. Like Sunny has done so many times

> already I strongly encourage yours and any other interested individual's

> participation in the Delphi process where you can specifically review

> each and every sentence written, provide input and recommendations as

> well as seek clarification over any confusing information written. I

> cannot emphasize enough just how hard we have worked to keep the manual

> written as an educational tool, NOT a club, law, rule, etc. Of course,

> there will be those who will interpret the manual as just that. But we

> have tried to write it so that an interpretation of that kind will be as

> baseless as we can make it. I apologize for droning on, but read it and

> let us know what you think...

>

> J. Holzapfel, D.C.

> Albany, OR.

> kjholzdc@...

> http://docman.chiroweb.com

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print, forward,

or otherwise distribute correspondence written by another member without his

or her consent, unless all personal identifiers have been removed.

>

>

[Guest guest]

No , you are not off base. The potential of this possibility is

exactly why we are being so very careful with what we write and what we

approve. It is important that all be defined in the manner we want it

defined.in the manner we want ourselves to be judged . with as little and/or

as much wiggle room as possible.

Sunny K ;'-))

Re: Oregon only guidelines

>

> > ,

> > I too have participated in this process from the first day and can

attest

> > to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

> > the possibility that what we were collaborating on and slaving over for

> > long periods of time might be misinterpreted or construed as

> > administrative rules or law. One of our biggest concerns is that

> > everyone realize that we have been striving to formulate GUIDELINES and

> > not trying to create new law or rule. Our concern is to EDUCATE

> > and not administrate. Please forgive my emphasis. I am not

> > shouting, just trying to make a point that seems to keep coming up.

> > In committe we have literally agonized over grammar, punctuation,

> > order, syntax, etc. with significant debate and even a little

> > controversy as we try to avoid administrating and instead educate.

> > This has been a difficult, tedious, demanding, emotional, and even

> > rewarding exercise. Sunny and Don both try to emphasize the point

> > that this material is to educate and guide, not administrate. As to

> > being " sanctioned " by the OBCE? To sanction means to support, to

> > approve of, even something that gives binding force to a law

> > (Webster's New World Dictionary). So yes, OBCE, as I understand,

> > " sanctions " the manual in so far as the information from the manual

> > can be used to further guide and educate not only the individual

> > chiropractor but also help the non-chiropractor understand our

profession

> > better (i.e. the manual is NOT a club to beat wayward individuals

> > into submission...that is up to the law itself). Oregon

> > Administrative Rules are referenced in the manual where applicable

> > as they apply to the subject matter at hand but there is no intent

> > for the manual to REWRITE or add to administrative rule already

> > written. I realize how difficult this may be to fully understand.

> > Like Sunny has done so many times already I strongly encourage

> > yours and any other interested individual's participation in the

> > Delphi process where you can specifically review each and every

> > sentence written, provide input and recommendations as well as seek

> > clarification over any confusing information written. I cannot

> > emphasize enough just how hard we have worked to keep the manual

> > written as an educational tool, NOT a club, law, rule, etc. Of

> > course, there will be those who will interpret the manual as just

> > that. But we have tried to write it so that an interpretation of

> > that kind will be as baseless as we can make it. I apologize for

> > droning on, but read it and let us know what you think...

> >

> > J. Holzapfel, D.C.

> > Albany, OR.

> > kjholzdc@...

> > http://docman.chiroweb.com

> >

> >

> > OregonDCs rules:

> >

> > 1. Keep correspondence professional; the purpose of the listserve is

> > to foster communication and collegiality. No personal attacks on

> > listserve members will be tolerated.

> > 2. Always sign your e-mails with your first and last name.

> > 3. The listserve is not secure; your e-mail could end up anywhere.

> > However, it is against the rules of the listserve to copy, print,

> > forward, or otherwise distribute correspondence written by another

> > member without his or her consent, unless all personal identifiers

> > have been removed.

> >

> >

[Guest guest]

Dear Willard,

Your thoughts are interesting and I will enjoy watcing you pursue these

issues.

The truth of it is our work doesn't need a 'fresh start'…we are doing well

just as we are. And the loss of the OBCE funding increase had nothing to do

with the educational manual project.

Perhaps a recheck of the facts is in order. Sunny K

Re: Oregon only guidelines

>

> As to being " sanctioned " by the OBCE? To sanction

> means to support, to approve of, even something that gives binding force

> to a law (Webster's New World Dictionary). So yes, OBCE, as I

> understand, " sanctions " the manual in so far as the information from the

> manual can be used to further guide and educate not only the individual

> chiropractor but also help the non-chiropractor understand our profession

> better (i.e. the manual is NOT a club to beat wayward individuals into

> submission...that is up to the law itself).

>

>

>

> J. Holzapfel, D.C.

> Albany, OR.

> kjholzdc@...

> http://docman.chiroweb.com

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to

> foster communication and collegiality. No personal attacks on listserve

> members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

However,

> it is against the rules of the listserve to copy, print, forward, or

> otherwise distribute correspondence written by another member without his

or

> her consent, unless all personal identifiers have been removed.

>

>

[Guest guest]

Sharron,

Thank you thank you thank you. Well spoken. I couldn't agree more.

Minga Guerrero DC

In a message dated 4/15/2003 5:03:33 PM Pacific Daylight Time, SharronF@... writes:

And what is wrong with guidelines , or standards or any definition or

refinement in a profession ? There is nothing wrong , because any profession

should be able to give at least a baseline of rationale and process to what

it thinks or does. The lack of definition for far too long, has been a

problem with this profession...too nebulous, too out there and for some, too

sleazy. Most, if not all, professions have some sort of guidelines, or

statements that get everyone on the same page and this, is my mind, shows

maturity. Maturity of the profession and which, in time, is welcomed by the

true professional.

It just doesn't fly any more that everything is left up to the individual

doctor's interpretation of health, sickness, treatment, higher power, innate

etc. and therefore, another doctor couldn't possibly 'judge' the other

doctor's care because of all of the subtle (incomprehensible) nuances.

My point? :

There was a case years ago, which makes me sick to think about... A

Chiropractor in Oregon felt that 'nervous system problems' could be cured by

nasal insufflation. The doctor undertook care of the child and the child

worsened. The doctor made no attempt to find out the cause of the child's

'nervous system problems' and so the care went on and on, and the child

continued to worsen. Eventually, and not by the Chiro , the child was

diagnosed to have congenital hypothyroidism and was supplemented, but by

that time the damage was done and 'nervous system problems' were

irreversibly severe. Does nasal insufflation actually pump the pituitary

and really get the thyroid going on it's own ? I don't know, but I do know

that in this case if one is attempting to get things going normally, then

one had better get a thyroid level and/or get some supplementation of

thyroid hormone on board while one is conducting such an 'experiment' on a

developing brain....

To make a long story short, do you think the lawyer for the child could find

one doctor of Chiropractic that had the knowledge, if not the guts, to say

that prolonged hypothyroidism has negative consequences for a developing

brain, and that it was negligence to undertake 'treatment' of something that

you haven't even attempted to diagnose yet alone understand? No. Not one

doctor of Chiropractic would step up to the plate. Not one. And the lawyer

talked to many. How incredulous. How immature. How scary. How very, very

sad. But that was in the 70's, and today in 2003 , I profess that the

unwillingness to define one's profession, speak up, and be held accountable

, yes, accountable, is inexcusable. And, in fact, unprofessional.

I say look at all the things that have been published to date on the

practice. See what best fits the practice in Oregon , modify if necessary,

and get a consensus from Oregon practitioners as to whether or not it

accurately reflects the standard of practice here. No small task, but in the

long run, well worth it.

sharron fuchs dc

Re: Oregon only guidelines

If you create guidelines, you can be sure that they will be used as

administrative rules.

J Holzapfel DC wrote:

>,

>I too have participated in this process from the first day and can attest

>to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

>the possibility that what we were collaborating on and slaving over for

>long periods of time might be misinterpreted or construed as

>administrative rules or law. One of our biggest concerns is that

>everyone realize that we have been striving to formulate GUIDELINES and

>not trying to create new law or rule. Our concern is to EDUCATE and not

>administrate. Please forgive my emphasis. I am not shouting, just

>trying to make a point that seems to keep coming up. In committe we have

>literally agonized over grammar, punctuation, order, syntax, etc. with

>significant debate and even a little controversy as we try to avoid

>administrating and instead educate. This has been a difficult, tedious,

>demanding, emotional, and even rewarding exercise. Sunny and Don both

>try to emphasize the point that this material is to educate and guide,

>not administrate. As to being "sanctioned" by the OBCE? To sanction

>means to support, to approve of, even something that gives binding force

>to a law (Webster's New World Dictionary). So yes, OBCE, as I

>understand, "sanctions" the manual in so far as the information from the

>manual can be used to further guide and educate not only the individual

>chiropractor but also help the non-chiropractor understand our profession

>better (i.e. the manual is NOT a club to beat wayward individuals into

>submission...that is up to the law itself). Oregon Administrative Rules

>are referenced in the manual where applicable as they apply to the

>subject matter at hand but there is no intent for the manual to REWRITE

>or add to administrative rule already written. I realize how difficult

>this may be to fully understand. Like Sunny has done so many times

>already I strongly encourage yours and any other interested individual's

>participation in the Delphi process where you can specifically review

>each and every sentence written, provide input and recommendations as

>well as seek clarification over any confusing information written. I

>cannot emphasize enough just how hard we have worked to keep the manual

>written as an educational tool, NOT a club, law, rule, etc. Of course,

>there will be those who will interpret the manual as just that. But we

>have tried to write it so that an interpretation of that kind will be as

>baseless as we can make it. I apologize for droning on, but read it and

>let us know what you think...

>

> J. Holzapfel, D.C.

>Albany, OR.

>kjholzdc@...

>http://docman.chiroweb.com

>

>

>OregonDCs rules:

>1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

>2. Always sign your e-mails with your first and last name.

>3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print, forward,

or otherwise distribute correspondence written by another member without his

or her consent, unless all personal identifiers have been removed.

>

>

[Guest guest]

That, Mr Vick, is only speculation on your part. It has not been the tenor

or purpose of the Evidence Based Manual to create standards. Colwell

Re: Oregon only guidelines

> If you create guidelines, you can be sure that they will be used as

administrative rules.

>

> J Holzapfel DC wrote:

>

> > ,

> > I too have participated in this process from the first day and can

attest

> > to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

> > the possibility that what we were collaborating on and slaving over for

> > long periods of time might be misinterpreted or construed as

> > administrative rules or law. One of our biggest concerns is that

> > everyone realize that we have been striving to formulate GUIDELINES and

> > not trying to create new law or rule. Our concern is to EDUCATE and

not

> > administrate. Please forgive my emphasis. I am not shouting, just

> > trying to make a point that seems to keep coming up. In committe we

have

> > literally agonized over grammar, punctuation, order, syntax, etc. with

> > significant debate and even a little controversy as we try to avoid

> > administrating and instead educate. This has been a difficult, tedious,

> > demanding, emotional, and even rewarding exercise. Sunny and Don both

> > try to emphasize the point that this material is to educate and guide,

> > not administrate. As to being " sanctioned " by the OBCE? To sanction

> > means to support, to approve of, even something that gives binding force

> > to a law (Webster's New World Dictionary). So yes, OBCE, as I

> > understand, " sanctions " the manual in so far as the information from the

> > manual can be used to further guide and educate not only the individual

> > chiropractor but also help the non-chiropractor understand our

profession

> > better (i.e. the manual is NOT a club to beat wayward individuals into

> > submission...that is up to the law itself). Oregon Administrative Rules

> > are referenced in the manual where applicable as they apply to the

> > subject matter at hand but there is no intent for the manual to REWRITE

> > or add to administrative rule already written. I realize how difficult

> > this may be to fully understand. Like Sunny has done so many times

> > already I strongly encourage yours and any other interested individual's

> > participation in the Delphi process where you can specifically review

> > each and every sentence written, provide input and recommendations as

> > well as seek clarification over any confusing information written. I

> > cannot emphasize enough just how hard we have worked to keep the manual

> > written as an educational tool, NOT a club, law, rule, etc. Of course,

> > there will be those who will interpret the manual as just that. But we

> > have tried to write it so that an interpretation of that kind will be as

> > baseless as we can make it. I apologize for droning on, but read it and

> > let us know what you think...

> >

> > J. Holzapfel, D.C.

> > Albany, OR.

> > kjholzdc@...

> > http://docman.chiroweb.com

> >

> >

> > OregonDCs rules:

> > 1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

> > 2. Always sign your e-mails with your first and last name.

> > 3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print, forward,

or otherwise distribute correspondence written by another member without his

or her consent, unless all personal identifiers have been removed.

> >

> >

[Guest guest]

Hey –

I will give you my

impression on these issues as a nominal panel member.

“there is no control over the outcome of the document

whatsoever”

No. (I assume you mean

board control.)

“new guidelines which had their name changed to

standards”

Nope, still just

guidelines.

“are now called if I am correct the instructional

manual”

Apparently there was a name

change to that effect. I missed that meeting.

“the instructional manual will also not be supported,

mandated, or referenced by any Oregon

Administrative Rules in the future.”

I am not aware of any

linkage reference, or connection of these guidelines with the OARs except to

reference current OARs in the guidelines when appropriate. These

guidelines are not being written with the intent of laying a foundation for

future OAR changes.

“They will as I understand it from you comments not be

sanctioned by the OBCE, and will therefore not have the weight of the law

behind them as I had understood they would. “

The OARs are still our

“rule book” on the practice of chiropractic in the state of Oregon.

These are simply guidelines based on current scientific evidence and peer

agreement through the consensus process.

I would repeat what

and Sunny already said and invite you to become a participant in the

process. But I should warn you, I was joking about the lavish

lunch. Last time we had a sandwich.

Don ,

DC

Corvallis

Oregon only

guidelines

To all --

While I am still preparing some thoughts on this entire subject, I have been

very interested in the comments going back and forth and especially agree with

Dr. Bertrand's comments. He brings up many great points that I had not

thought of. It appears however that perhaps one of my strongest reasons

for opposing the guidelines is not valid and I want to get some clarification

on this:

1. On 4-10-03 Don DC who serves on the guidelines committee

writes, " It's not a government task, it's entirely driven by members from

the field....It is not a board or government driven process other than they

provide our meeting room, A.V. equipment and editorial/transcription assistance

(and a lavish lunch.) "

2. On 4-11-03 Sunny Kiersten who serves on the

guidelines committee writes, " ...the OBCE is supporting the cost, not

dictating the course of the educational manual. " and on 4-10-03 stated, " And this document IS being created

outside of governmental regimen and BY voluntary participation of the profession.

The OBCE is only providing the impetus and a meeting room and paying for the

procurement of our requested literary research... "

I conclude from theses remarks by two individuals whom are active on the

guidelines committee that there is no control over the outcome of the document

whatsoever and that the new guidelines which had their name changed to

standards and are now called if I am correct the instructional manual will also

not be supported, mandated, or referenced by any Oregon Administrative Rules in

the future. They will as I understand it from you comments not be

sanctioned by the OBCE, and will therefore not have the weight of the law

behind them as I had understood they would.

Could Dr. Kiersten, and Don or anyone else involved in the process

please confirm and elaborate on this point?

Also it appears as though I may have misrepresented this point so may I have

your permission to clarify this to other parties

Schmidt DC

OregonDCs

rules:

1. Keep correspondence professional; the purpose

of the listserve is to foster communication and collegiality. No personal

attacks on listserve members will be tolerated.

2. Always sign your e-mails with your first and

last name.

3. The listserve is not secure; your e-mail could

end up anywhere. However, it is against the rules of the listserve to copy,

print, forward, or otherwise distribute correspondence written by another

member without his or her consent, unless all personal identifiers have been

removed.

Your

use of is subject to the Terms of Service.

[Guest guest]

Dr. Colwell: I respectfully disagree. I am speaking from my actual experience

in contested case hearings with the OBCE.

Colwell wrote:

> That, Mr Vick, is only speculation on your part. It has not been the tenor

> or purpose of the Evidence Based Manual to create standards. Colwell

>

> Re: Oregon only guidelines

>

> > If you create guidelines, you can be sure that they will be used as

> administrative rules.

> >

> > J Holzapfel DC wrote:

> >

> > > ,

> > > I too have participated in this process from the first day and can

> attest

> > > to the fact that OVER AND OVER AND OVER AGAIN in committee we discussed

> > > the possibility that what we were collaborating on and slaving over for

> > > long periods of time might be misinterpreted or construed as

> > > administrative rules or law. One of our biggest concerns is that

> > > everyone realize that we have been striving to formulate GUIDELINES and

> > > not trying to create new law or rule. Our concern is to EDUCATE and

> not

> > > administrate. Please forgive my emphasis. I am not shouting, just

> > > trying to make a point that seems to keep coming up. In committe we

> have

> > > literally agonized over grammar, punctuation, order, syntax, etc. with

> > > significant debate and even a little controversy as we try to avoid

> > > administrating and instead educate. This has been a difficult, tedious,

> > > demanding, emotional, and even rewarding exercise. Sunny and Don both

> > > try to emphasize the point that this material is to educate and guide,

> > > not administrate. As to being " sanctioned " by the OBCE? To sanction

> > > means to support, to approve of, even something that gives binding force

> > > to a law (Webster's New World Dictionary). So yes, OBCE, as I

> > > understand, " sanctions " the manual in so far as the information from the

> > > manual can be used to further guide and educate not only the individual

> > > chiropractor but also help the non-chiropractor understand our

> profession

> > > better (i.e. the manual is NOT a club to beat wayward individuals into

> > > submission...that is up to the law itself). Oregon Administrative Rules

> > > are referenced in the manual where applicable as they apply to the

> > > subject matter at hand but there is no intent for the manual to REWRITE

> > > or add to administrative rule already written. I realize how difficult

> > > this may be to fully understand. Like Sunny has done so many times

> > > already I strongly encourage yours and any other interested individual's

> > > participation in the Delphi process where you can specifically review

> > > each and every sentence written, provide input and recommendations as

> > > well as seek clarification over any confusing information written. I

> > > cannot emphasize enough just how hard we have worked to keep the manual

> > > written as an educational tool, NOT a club, law, rule, etc. Of course,

> > > there will be those who will interpret the manual as just that. But we

> > > have tried to write it so that an interpretation of that kind will be as

> > > baseless as we can make it. I apologize for droning on, but read it and

> > > let us know what you think...

> > >

> > > J. Holzapfel, D.C.

> > > Albany, OR.

> > > kjholzdc@...

> > > http://docman.chiroweb.com

> > >

> > >

> > > OregonDCs rules:

> > > 1. Keep correspondence professional; the purpose of the listserve is to

> foster communication and collegiality. No personal attacks on listserve

> members will be tolerated.

> > > 2. Always sign your e-mails with your first and last name.

> > > 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print, forward,

> or otherwise distribute correspondence written by another member without his

> or her consent, unless all personal identifiers have been removed.

> > >

> > >

[Guest guest]

You will note from the comments that Dr. Kiersten makes in the attached document that was sent to allof you with her permission that the OBCE has no real control over the guidelines-standards-manual development process. As a result we are to conclude that the OBCE is therefore funding with our money, an activity over which it has not control.

J Schmidt, D.C. President

Oregon Doctors of Chiropractic

306 Oak St.

Silverton, OR 97381

phone 503-873-3641

fax 503-873-6200

E-mail jfsdc@...

[Guest guest]

To Charlie Caughlin DC

Day, OR

You are not off base at all, you are in fact right on the mark. Our chiropractic law ORS 684.0 was carefully crafted with attention to each and every word. That is why we have such a great law. Not only was just enough said, but careful attention was paid to not saying to much.

684.010(2b) "The chiropractic diagnosis [not medical diagnosis), treatment and prevention of body dysfunction (note they chose the word dysfunction and not disease)...and the effects thereof or interferences therewith... ( you are only now beginning to hear chiropractic philosophers such as Dr. Ted Morter DC discuss identifying ourselves as "subluxation and interference based").

The OBCE and the guidelines-standards-manual committee reference our medical records, our medical evaluation and our medical diagnosis. Some times we are even referenced as doing medical manipulation rather than chiropractic adjustments. This is not only allowing for perpetuation of a misunderstanding which justifiably irritates the medical profession, but it is blatantly illegal under our law.

The above is just three lines out of our carefully crafted law which allows for the public to understand what we are. Why do we need more? The reason is that this is not being designed for the public our patients, it is being designed for the public as in Chiropractic Health Plan of Oregon (CHP) and other third party payors who actually quite often do not have the same point of interest as your patient (in case you have not noticed).

684.010 (2a) The system of adjusting with the hands the articulations of the bony framework of the human body...(not manipulating. You cannot by definition and within our law do medical manipulation unless you are medical doctor. Do not ask another chiropractor who works within the medical model about this, ask a legislator-attorney or constitutional law attorney and see what they say.

684.155(4) states that the OBCE will "Make its personnel and facilities available to other regulatory agencies of this state or other bodies interested in the development and improvement of the practice of chiropractic in this state, upon such terms and conditions for reimbursement as are agreed to by the board and the other agency or body. " So are the guidelines for the development and improvement of the profession or the insurance industry? I maintain the later not the former and as a result I agree with Willard Bertrand DC that not only should the guidelines committee find other funding immediately, but they need to reimburse the OBCE for all expenses thus far. With the excess funds the OBCE should then go to the legislature and ask for a licensing fee reduction.

Than you for the input,

Schmidt, D.C. President

Oregon Doctors of Chiropractic

306 Oak St.

Silverton, OR 97381

phone 503-873-3641

fax 503-873-6200

E-mail jfsdc@...

[Guest guest]

Thank you Jim Vick Salem for the real and meaningful legal opinion. I would suggest you send you bill to the OBCE since they are down at the legislature trying to get another fee increase so they can continue on funding the guidelines process.

J Schmidt, D.C. President

Oregon Doctors of Chiropractic

306 Oak St.

Silverton, OR 97381

phone 503-873-3641

fax 503-873-6200

E-mail jfsdc@...

[Guest guest]

Dr. Schmidt:

The other side of this kind of comment I suppose, would be : See? OBCE totally controls the panel and therefore should be held to account as to why it spends time/money on something when it already knows the outcome ....

Process, not outcome, is an important point. End product that doesn't violate Oregon law is the goal of the process. So OBCE does have control of a sort. If it doesn't adopt that product, or the product is not appropriate in the face of DOJ, etc, yes, it does have control. Even slow learners like myself can see this.

I don't presume to belabor your point, I just don't understand what exactly you are trying to say. My opinion is the process of arriving at standards of care as defined by Oregon DCs within the laws of our particular practice act, strengthens the profession. I would think the end product, which manages to be inclusive of a wide range of philosophies and techniques, would be something to applaud. I don't see many specific examples within OCPUG that define 'what you CAN'T do'....

[Guest guest]

Dear Dr.

Carl:

I am using

a Regainer table protocol to re-establish normal balanced subluxation-free postural

curves as published in Spine by on et. al.

This is

not the endpoint of care, but is part of the core requirement for health.

Others would include normal blood pressure, the presence respiratory sinus arrhythmia

during abdominal breathing, optimum %body fat, routine aerobic and

strengthening exercises to include a solid core musculature, attainment of an

average VO2 Max, normal spirometry and ECG, relaxation skills verifiable by

EMG, balanced walking pattern, average reports on paper tests of daily

activities, and a normal routine physical examination including screens for

cancer, diabetes, hormonal imbalances, cardiac risk factors.

Are these

all in the OPUG’s? I wonder if we should all agree on each of these?

Willard

I use a guideline of a global

spinal model

(Pettibon, on et. al.). The

model was

contructed based on optimal

structure for

form and function.

Carl Bonofiglio

-------Original

Message-------

From: sunny kristyn

Date: Thursday,

April 17, 2003 17:23:10

drmfreeman@...; kjholzdc@...; jvick@...; JFSDC@...; Doc

Bono

Cc: vivianrockwell@...; GLOWCO1@...; rsribellia@...; sirrbe1st@...; chirodoc@...; bakfixer@...; tntchiro@...; sunchiro@...; l.g.rutherford@...; wellness@...;

drbobdc@...; cnolldc@...; goldenstaralpha@...; muffy777@...; steven_ellsworth@...; dduemling@...; dreric@...; twodocs@...; kristentraeger@...; hardentown@...; peterlind@...; lawtonchiropractic@...; Chcc@...; stefandc@...; kak@...; DSchm92293@...; Kmac@...; Pdetroitjoe@...; mail@...; tradeclimb@...; Kris_97303@...; BACDOC@...; mmmiller@...; gregghelms@...; AMDurrant@...; ehacmac@...; RPSDC@...; grsdc@...;

Subject: Re:

Oregon only guidelines

Carl, You are asking

something that isn't entirely written yet. How do you do it now?

And being concerned about

it…joining in the definition and writing would make sure you input is

there. Sunny

----- Original

Message -----

From: Doc Bono

drmfreeman@...

; kjholzdc@...

; jvick@...

; JFSDC@... ; skrndc1@...

Cc: vivianrockwell@...

; GLOWCO1@...

; rsribellia@...

; sirrbe1st@...

; chirodoc@...

; bakfixer@...

; tntchiro@...

; sunchiro@...

; l.g.rutherford@...

; wellness@... ; drbobdc@...

; cnolldc@...

; goldenstaralpha@...

; muffy777@...

; steven_ellsworth@...

; dduemling@...

; dreric@...

; twodocs@...

; kristentraeger@... ; hardentown@...

; peterlind@...

; lawtonchiropractic@... ; Chcc@... ; stefandc@...

; kak@...

; DSchm92293@...

; Kmac@... ; Pdetroitjoe@...

; mail@...

; tradeclimb@...

; Kris_97303@...

; BACDOC@... ;

mmmiller@...

; gregghelms@...

; AMDurrant@...

; ehacmac@...

; RPSDC@... ; grsdc@...

;

Sent: Thursday,

April 17, 2003 4:14 PM

Subject: Re:

Oregon only guidelines

What is maximum

Chiropractic improvement?

This is very vague. Are you talking symptoms, neurocalumeter readings, emg,

postural analysis.

Neuro/ ortho tests.

This is confusing.

What's the model.

Carl

-- Re: Oregon only guidelines

Maximun chiropractic improvement .. according to exams and professional

opinions. sk

skierstyn

Re: Oregon only guidelines

Thank you Jim Vick Salem for the real and meaningful legal

opinion. I

would suggest you send you bill to the OBCE since they are down at the

legislature trying to get another fee increase so they can continue on

funding the guidelines process.

J Schmidt, D.C. President

Oregon Doctors of Chiropractic

306 Oak St.

Silverton, OR 97381

phone 503-873-3641

fax 503-873-6200

E-mail jfsdc@...

[Guest guest]

Dr. Schmidt:

Regarding the need to use carefully chosen words in communication as well as legislation, I agree. Unless I'm mistaken, you seem to not be focusing on the disruptive interpretations long debated in the halls of chiropractic of what is and what isn't chiropractic. I hope we don't need to revisit that issue for the present.

I too am concerned about the various implications of using the word "adjusting" rather than "manipulating".

From what you write, I gather you object to the use of the word 'medical' used in the same hallowed ORS you initially praise. In review of the entirety of 684.155, I see no mention of the word 'medical'.

I have found only one used of the word 'medical' in 684.185 referring to 'independent medical examinations'.

Doing both 'Word' and 'Acrobat' search of OCPUG and the ORS as well as OAS sections it does not list ANY occurrences of the word MEDICAL in these document. Perhaps my computer is not performing, but for tonight I can't find your references. My concern for the implications of this language therefore is not currently as aroused as yours is. I shall try to ferret out suspicious phrases tomorrow

Further, I do not find your argument regarding 684.155 (4) at all convincing of evil intent. If you can show us all where such has been the case, we will all applaud.

If you wish to discuss the issue of 'guidelines', I will quote the entire portion of 684.010 (2)a and b to make sure we're on the same page:

684.010 Definitions. As used in this chapter:

(1) "Board" means the State Board of Chiropractic Examiners.

(2) "Chiropractic" is defined as:

(a) That system of adjusting with the hands the articulations of the bony framework of the human body, and the employment and practice of physiotherapy, electrotherapy, hydrotherapy and minor surgery.

( The chiropractic diagnosis, treatment and prevention of body dysfunction; correction, maintenance of the structural and functional integrity of the neuro-musculoskeletal system and the effects thereof or interferences therewith by the utilization of all recognized and accepted chiropractic diagnostic procedures and the employment of all rational therapeutic measures as taught in approved chiropractic colleges.

I think it is important to our discussion insure the inclusion of the words 'rational therapeutic measures'....

So is it your point, that having graduated from a chiropractic college, there is no need for oversight of the profession by the very legislative body that had the wisdom to define chiropractic, to license it, and to establish the OBCE in the first place?

In my opinion, the next step then is to question the need for licensure, or even for graduation from a chiropractic college.

I believe the abandonment of a written ' professional standard' is a huge step backwards.

yours in health,

Jack Pedersen, DC

Re: Oregon only guidelines

To Charlie Caughlin DC Day, OR You are not off base at all, you are in fact right on the mark. Our chiropractic law ORS 684.0 was carefully crafted with attention to each and every word. That is why we have such a great law. Not only was just enough said, but careful attention was paid to not saying to much. 684.010(2b) "The chiropractic diagnosis [not medical diagnosis), treatment and prevention of body dysfunction (note they chose the word dysfunction and not disease)...and the effects thereof or interferences therewith... ( you are only now beginning to hear chiropractic philosophers such as Dr. Ted Morter DC discuss identifying ourselves as "subluxation and interference based").The OBCE and the guidelines-standards-manual committee reference our medical records, our medical evaluation and our medical diagnosis. Some times we are even referenced as doing medical manipulation rather than chiropractic adjustments. This is not only allowing for perpetuation of a misunderstanding which justifiably irritates the medical profession, but it is blatantly illegal under our law. The above is just three lines out of our carefully crafted law which allows for the public to understand what we are. Why do we need more? The reason is that this is not being designed for the public our patients, it is being designed for the public as in Chiropractic Health Plan of Oregon (CHP) and other third party payors who actually quite often do not have the same point of interest as your patient (in case you have not noticed).684.010 (2a) The system of adjusting with the hands the articulations of the bony framework of the human body...(not manipulating. You cannot by definition and within our law do medical manipulation unless you are medical doctor. Do not ask another chiropractor who works within the medical model about this, ask a legislator-attorney or constitutional law attorney and see what they say.684.155(4) states that the OBCE will "Make its personnel and facilities available to other regulatory agencies of this state or other bodies interested in the development and improvement of the practice of chiropractic in this state, upon such terms and conditions for reimbursement as are agreed to by the board and the other agency or body. " So are the guidelines for the development and improvement of the profession or the insurance industry? I maintain the later not the former and as a result I agree with Willard Bertrand DC that not only should the guidelines committee find other funding immediately, but they need to reimburse the OBCE for all expenses thus far. With the excess funds the OBCE should then go to the legislature and ask for a licensing fee reduction.Than you for the input, Schmidt, D.C. PresidentOregon Doctors of Chiropractic306 Oak St. Silverton, OR 97381phone 503-873-3641fax 503-873-6200E-mail jfsdc@... OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

I don't know about the legal aspect of this issue, but I have been involved with several cases in which peer review has used the current guidelines as a basis from which to claim that a doc was practicing in an unethical or unprofessional manner. It turned out that the guidelines had been misinterpreted and treatment parameters did not apply in those cases. I think there continues to be concern that the new guidelines will be used to restrict care that an individual doctor feels is justified. To my reading of the current OCPUGs it is virtually impossible to restrict treatment. Will the new guidelines make it easier to set inviolable treatment parameters? In other words, a cervical strain is a 3 month diagnosis and if you treat for 3 months and a week you are in violation? There is not another profession that has such parameters on duration and/or frequency of treatment that I am aware of, so I don't know how this would shake out.

BTW, congratulations to Dr. Schmidt as the new president of ODOC. They are fortunate to have him in this role; has been a level-headed fighter for chiropractic rights as long as I have known him. Also, congratulations to Dr. Siegfried on his OBCE appointment; his perspective will be valuable in having a Board that is representative of the values of all of the field docs.

D Freeman Mailing address: 1230 Liberty Street NESalem, Oregon 97303ph 503 763-7300cell 503 871-0715

-----Original Message-----From: JFSDC@... [mailto:JFSDC@...]Sent: Wednesday, April 16, 2003 5:35 PMjvick@...; kjholzdc@...Cc: ; stearno@...; grsdc@...; RPSDC@...; ehacmac@...; Dr@ caffertychiro.com; AMDurrant@...; gregghelms@...; mmmiller@...; BACDOC@...; Kris_97303@...; tradeclimb@...; mail@...; Pdetroitjoe@...; Kmac@...; DSchm92293@...; kak@...; stefandc@...; Chcc@...; lawtonchiropractic@...; peterlind@...; hardentown@...; kristentraeger@...; twodocs@...; dreric@...; dduemling@...; steven_ellsworth@...; muffy777@...; goldenstaralpha@...; cnolldc@...; drbobdc@...; wellness@...; l.g.rutherford@...; sunchiro@...; tntchiro@...; bakfixer@...; chirodoc@...; sirrbe1st@...; rsribellia@...; GLOWCO1@...; vivianrockwell@...Subject: Re: Oregon only guidelinesThank you Jim Vick Salem for the real and meaningful legal opinion. I would suggest you send you bill to the OBCE since they are down at the legislature trying to get another fee increase so they can continue on funding the guidelines process.J Schmidt, D.C. PresidentOregon Doctors of Chiropractic306 Oak St. Silverton, OR 97381phone 503-873-3641fax 503-873-6200E-mail jfsdc@... OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

What are the other states doing, any feedback.

Carl Bonofiglio

-- RE: Oregon only guidelines

I don't know about the legal aspect of this issue, but I have been involved with several cases in which peer review has used the current guidelines as a basis from which to claim that a doc was practicing in an unethical or unprofessional manner. It turned out that the guidelines had been misinterpreted and treatment parameters did not apply in those cases. I think there continues to be concern that the new guidelines will be used to restrict care that an individual doctor feels is justified. To my reading of the current OCPUGs it is virtually impossible to restrict treatment. Will the new guidelines make it easier to set inviolable treatment parameters? In other words, a cervical strain is a 3 month diagnosis and if you treat for 3 months and a week you are in violation? There is not another profession that has such parameters on duration and/or frequency of treatment that I am aware of, so I don't know how this would shake out.

BTW, congratulations to Dr. Schmidt as the new president of ODOC. They are fortunate to have him in this role; has been a level-headed fighter for chiropractic rights as long as I have known him. Also, congratulations to Dr. Siegfried on his OBCE appointment; his perspective will be valuable in having a Board that is representative of the values of all of the field docs.

D Freeman Mailing address: 1230 Liberty Street NESalem, Oregon 97303ph 503 763-7300cell 503 871-0715

-----Original Message-----From: JFSDC@... [mailto:JFSDC@...]Sent: Wednesday, April 16, 2003 5:35 PMjvick@...; kjholzdc@...Cc: ; stearno@...; grsdc@...; RPSDC@...; ehacmac@...; Dr@ caffertychiro.com; AMDurrant@...; gregghelms@...; mmmiller@...; BACDOC@...; Kris_97303@...; tradeclimb@...; mail@...; Pdetroitjoe@...; Kmac@...; DSchm92293@...; kak@...; stefandc@...; Chcc@...; lawtonchiropractic@...; peterlind@...; hardentown@...; kristentraeger@...; twodocs@...; dreric@...; dduemling@...; steven_ellsworth@...; muffy777@...; goldenstaralpha@...; cnolldc@...; drbobdc@...; wellness@...; l.g.rutherford@...; sunchiro@...; tntchiro@...; bakfixer@...; chirodoc@...; sirrbe1st@...; rsribellia@...; GLOWCO1@...; vivianrockwell@...Subject: Re: Oregon only guidelinesThank you Jim Vick Salem for the real and meaningful legal opinion. I would suggest you send you bill to the OBCE since they are down at the legislature trying to get another fee increase so they can continue on funding the guidelines process.J Schmidt, D.C. PresidentOregon Doctors of Chiropractic306 Oak St. Silverton, OR 97381phone 503-873-3641fax 503-873-6200E-mail jfsdc@... OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

What are the other states doing, any feedback.

Carl Bonofiglio

-- RE: Oregon only guidelines

I don't know about the legal aspect of this issue, but I have been involved with several cases in which peer review has used the current guidelines as a basis from which to claim that a doc was practicing in an unethical or unprofessional manner. It turned out that the guidelines had been misinterpreted and treatment parameters did not apply in those cases. I think there continues to be concern that the new guidelines will be used to restrict care that an individual doctor feels is justified. To my reading of the current OCPUGs it is virtually impossible to restrict treatment. Will the new guidelines make it easier to set inviolable treatment parameters? In other words, a cervical strain is a 3 month diagnosis and if you treat for 3 months and a week you are in violation? There is not another profession that has such parameters on duration and/or frequency of treatment that I am aware of, so I don't know how this would shake out.

BTW, congratulations to Dr. Schmidt as the new president of ODOC. They are fortunate to have him in this role; has been a level-headed fighter for chiropractic rights as long as I have known him. Also, congratulations to Dr. Siegfried on his OBCE appointment; his perspective will be valuable in having a Board that is representative of the values of all of the field docs.

D Freeman Mailing address: 1230 Liberty Street NESalem, Oregon 97303ph 503 763-7300cell 503 871-0715

-----Original Message-----From: JFSDC@... [mailto:JFSDC@...]Sent: Wednesday, April 16, 2003 5:35 PMjvick@...; kjholzdc@...Cc: ; stearno@...; grsdc@...; RPSDC@...; ehacmac@...; Dr@ caffertychiro.com; AMDurrant@...; gregghelms@...; mmmiller@...; BACDOC@...; Kris_97303@...; tradeclimb@...; mail@...; Pdetroitjoe@...; Kmac@...; DSchm92293@...; kak@...; stefandc@...; Chcc@...; lawtonchiropractic@...; peterlind@...; hardentown@...; kristentraeger@...; twodocs@...; dreric@...; dduemling@...; steven_ellsworth@...; muffy777@...; goldenstaralpha@...; cnolldc@...; drbobdc@...; wellness@...; l.g.rutherford@...; sunchiro@...; tntchiro@...; bakfixer@...; chirodoc@...; sirrbe1st@...; rsribellia@...; GLOWCO1@...; vivianrockwell@...Subject: Re: Oregon only guidelinesThank you Jim Vick Salem for the real and meaningful legal opinion. I would suggest you send you bill to the OBCE since they are down at the legislature trying to get another fee increase so they can continue on funding the guidelines process.J Schmidt, D.C. PresidentOregon Doctors of Chiropractic306 Oak St. Silverton, OR 97381phone 503-873-3641fax 503-873-6200E-mail jfsdc@... OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Florida and (I believe) Ohio have guidelines. We have copies of the Florida's but not of the other state. Florida's is done in much the same outline form as Mercy. We made a decision to do a narrative format for ours and have maintained that format throughout the chapters. It seems to make the material much more readable and usable. Sunny K ;'-)

skierstyn

RE: Oregon only guidelines

What are the other states doing, any feedback.Carl Bonofiglio -------Original Message------- From: Dr. FreemanDate: Thursday, April 17, 2003 07:38:50JFSDC@...; jvick@...; kjholzdc@...Cc: ; grsdc@...; RPSDC@...;ehacmac@...; AMDurrant@...; gregghelms@...;mmmiller@...; BACDOC@...; Kris_97303@...;tradeclimb@...; mail@...; Pdetroitjoe@...;Kmac@...; DSchm92293@...; kak@...; stefandc@... Chcc@...; lawtonchiropractic@...; peterlind@...;hardentown@...; kristentraeger@...; twodocs@...;dreric@...; dduemling@...; steven_ellsworth@...;muffy777@...; goldenstaralpha@...; cnolldc@...;drbobdc@...; wellness@...; l.g.rutherford@attnet; sunchiro@...; tntchiro@...; bakfixer@...;chirodoc@...; sirrbe1st@...; rsribellia@...; GLOWCO1@...;vivianrockwell@...Subject: RE: Oregon only guidelines I don't know about the legal aspect of this issue, but I have been involvedwith several cases in which peer review has used the current guidelines as abasis from which to claim that a doc was practicing in an unethical orunprofessional manner. It turned out that the guidelines had beenmisinterpreted and treatment parameters did not apply in those cases. Ithink there continues to be concern that the new guidelines will be used torestrict care that an individual doctor feels is justified. To my reading ofthe current OCPUGs it is virtually impossible to restrict treatment. Willthe new guidelines make it easier to set inviolable treatment parameters? Inother words, a cervical strain is a 3 month diagnosis and if you treat for 3months and a week you are in violation? There is not another profession thathas such parameters on duration and/or frequency of treatment that I amaware of, so I don't know how this would shake out.BTW, congratulations to Dr. Schmidt as the new president of ODOC. Theyare fortunate to have him in this role; has been a level-headed fighterfor chiropractic rights as long as I have known him. Also, congratulationsto Dr. Siegfried on his OBCE appointment; his perspective will bevaluable in having a Board that is representative of the values of all ofthe field docs. D Freeman Mailing address: 1230 Liberty Street NESalem, Oregon 97303ph 503 763-7300cell 503 871-0715 -----Original Message-----From: JFSDC@... [mailto:JFSDC@...]Sent: Wednesday, April 16, 2003 5:35 PMjvick@...; kjholzdc@...Cc: ; stearno@...; grsdc@...;RPSDC@...; ehacmac@...; Dr@ caffertychiro.com; AMDurrant@aolcom; gregghelms@...; mmmiller@...; BACDOC@...;Kris_97303@...; tradeclimb@...; mail@...;Pdetroitjoe@...; Kmac@...; DSchm92293@...; kak@...;stefandc@...; Chcc@...; lawtonchiropractic@...;peterlind@...; hardentown@...; kristentraeger@...;twodocs@...; dreric@...; dduemling@...;steven_ellsworth@...; muffy777@...; goldenstaralpha@...;cnolldc@...; drbobdc@...; wellness@...;l.g.rutherford@...; sunchiro@...; tntchiro@...;bakfixer@...; chirodoc@...; sirrbe1st@...; rsribellia@junocom; GLOWCO1@...; vivianrockwell@...Subject: Re: Oregon only guidelinesThank you Jim Vick Salem for the real and meaningful legal opinion. I wouldsuggest you send you bill to the OBCE since they are down at the legislaturetrying to get another fee increase so they can continue on funding theguidelines process.J Schmidt, D.C. PresidentOregon Doctors of Chiropractic306 Oak St. Silverton, OR 97381phone 503-873-3641fax 503-873-6200E-mail jfsdc@... OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is tofoster communication and collegiality. No personal attacks on listservemembers will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However,it is against the rules of the listserve to copy, print, forward, orotherwise distribute correspondence written by another member without his orher consent, unless all personal identifiers have been removed.

[Guest guest]

Sunny,

I am slow on the 'uptake' at times and frankly with all the banter I get confused on the true facts.... Would you please state/restate for me the following? :

a) Why were the OPUG's developed to begin with ?

Are the current OPUG's out of date ?

c) Is the current process that you are involved in an 'updating' of OPUG ?

d) What will be the title of the 'new' document ?

e) What is the intended purpose and use of the 'new' document ?

thanks,

sharron fuchs dc

-----Original Message-----From: sunny kristyn [mailto:skrndc1@...]Sent: Thursday, April 17, 2003 7:58 AMJFSDC@...; jvick@...; kjholzdc@...; Dr. FreemanCc: ; grsdc@...; RPSDC@...; ehacmac@...; AMDurrant@...; gregghelms@...; mmmiller@...; BACDOC@...; Kris_97303@...; tradeclimb@...; mail@...; Pdetroitjoe@...; Kmac@...; DSchm92293@...; kak@...; stefandc@...; Chcc@...; lawtonchiropractic@...; peterlind@...; hardentown@...; kristentraeger@...; twodocs@...; dreric@...; dduemling@...; steven_ellsworth@...; muffy777@...; goldenstaralpha@...; cnolldc@...; drbobdc@...; wellness@...; l.g.rutherford@...; sunchiro@...; tntchiro@...; bakfixer@...; chirodoc@...; sirrbe1st@...; rsribellia@...; GLOWCO1@...; vivianrockwell@...Subject: Re: Oregon only guidelines

,

Setting 'inviolable treatment paramenters' would serve none of us. While that chapter is still in production, I would seriously doubt that that type of verbiage would survive a Nominal and/or Delphi consensus round. People don't yet seem to understand the breadth of the consensus process.

1) First round: The literature is researched, read and outlined; verbiage is written and consensitized and referenced (as possible by the literature available) by the Seed panel members charged with creating the verbiage. After that consensus...

2) second round: ...the verbiage is read, analysed and consensitized. If it doesn't pass consensus by the 15 - 20 members of that panel, the verbiage is returned to the seed panel who work on it again, according to the instructions from the Nominal Panel. When it is rewritten, the verbiage is again submitted to the Nominal Panel for review. Some things have gone through 12 drafts.

3) Third round: Once the Nominal Panel has agreed on the material, it is submitted to the Delphi Panel consisting of 100 other docs and content experts around the state. Only when that consensus process is completed, is the material submitted for printing.

So every word goes through the hands of approximately 120 people of our profession before it is set for publication. If you are worried about content ... put your kiester at the table and voice your opinion. In a consnesus process, you count. Seems to me that if a person chooses not to participate, that person gives up the right to complain. At the very least, that person's complaints seem specious.

Sunny Kierstyn

Re: Oregon only guidelines Thank you Jim Vick Salem for the real and meaningful legal opinion. Iwould suggest you send you bill to the OBCE since they are down at thelegislature trying to get another fee increase so they can continue onfunding the guidelines process. J Schmidt, D.C. President Oregon Doctors of Chiropractic 306 Oak St. Silverton, OR 97381 phone 503-873-3641 fax 503-873-6200 E-mail jfsdc@...

[Guest guest]

Hi Dr.

Sunny:

OK, now we

have had a taste of the nature of the controversy we are capable of brewing

with a simple issue, one that I believe is not even that important. Obviously,

even a peripheral issue such as this has a very high probability of spinning

out of control and creating strong adversarial confrontations.

open

discussion of a range of topics

after

review of the discussions, distill the topic to a minimum pivotal topic

that, if agreement can be found, will dissolve divergent opinions and

create maximum convergence of opinion.

Begin

detailed analysis of that topic with evidence, logic, intuition, and

opinon utilizing the list serve.

All

participants must TRUST that each other’s motives are not malevelant,

i.e., that we open ourselves up to some vulnerability in the discussions.

We

must respect each other’s right to refuse to change their opinion.

We must

accept the fact that some topics cannot reach convergence, and more importantly,

agree that when a topic fails to reach convergence that we will respect

that outcome. One way to respect divergence is to avoid labeling an

opinion as representative of the entire profession, when in fact, it

represents a majority of willing participants, or a majority of the available

government money, etc.

There

should be a sunset date on the opinion and a mechanism for change in the

light of new information or circumstances.

9,

10, 11, 12, etc What do you

think?

I suggest

we continue to pursue this topic, but consider most importantly, not the topic

itself, but the framework of the discussion of the topic. First and foremost we

have discussed the topics around PUG’s and have a clearly defined pivotal topic

at this point, i.e.,

Should the OPUG be funded and developed

outside of the venue of the OBCE?

I think it

is safe to say that this is the pivotal topic remaining where we might find

convergence, at this point.

Now here

is my current interest in discussion of this topic. You might have your own.

And as such that would be great. But I would suggest that we have some

mechanism to moderate a topic somewhat, to focus on the salient points and

discard those that will simply lead to a hardening of divergent opinions and

personalities. (If the Oregon DC List is not capable of doing this, I would be

happy to transfer this entire discussion to another list serve. I have one in

waiting called chiropractors@...,

but would prefer to keep on with what is already working if possible.)

Again,

here is my present line of thought on the above topic:

I would

propose that you move the OPUG meetings to a list serve format with deadlines

for final participation. This way everyone’s opinion is recorded and

considered, regardless of their physical presence in Salem or Portland. Actual

physical meetings may serve more as work sessions rather than policy setting

sessions.

I would

also propose that the existing guidelines, the meeting schedules, and the

annual budget be published to the list serve in their current state. This

eliminates any further mystery about the process and its possible outcomes. I

would not expect this of the CSO, ODOC, or of WSCC, but I think the OBCE, as a

governmental agency, would save $$$ in copy costs, and satisfy open government

requirements by providing this information.

Finally, I

would like to see us develop a set of guidelines for divergent discussions that

might promise to lead to convergence by achieving consensus, instead of

majority rule until the minority complains so much that the majority must back

down.

Respectfully,

Willard

-----Original

Message-----

From: sunny kristyn

[mailto:skrndc1@...]

Sent: Thursday, April 17, 2003

9:59 AM

drmfreeman@...;

kjholzdc@...; jvick@...; JFSDC@...; Doc Bono

Cc: vivianrockwell@...;

GLOWCO1@...; rsribellia@...; sirrbe1st@...; chirodoc@...;

bakfixer@...; tntchiro@...; sunchiro@...;

l.g.rutherford@...; wellness@...;

drbobdc@...; cnolldc@...; goldenstaralpha@...;

muffy777@...; steven_ellsworth@...; dduemling@...;

dreric@...; twodocs@...; kristentraeger@...;

hardentown@...; peterlind@...; lawtonchiropractic@...;

Chcc@...; stefandc@...; kak@...; DSchm92293@...;

Kmac@...; Pdetroitjoe@...; mail@...;

tradeclimb@...; Kris_97303@...; BACDOC@...;

mmmiller@...; gregghelms@...; AMDurrant@...;

ehacmac@...; RPSDC@...; grsdc@...;

Subject: Re: Oregon

only guidelines

Maximun

chiropractic improvement …. according to exams and professional opinions.

sk

skierstyn

-----

Original Message -----

From: Doc Bono

skrndc1@... ; drmfreeman@...

; kjholzdc@...

; jvick@...

; JFSDC@...

Cc: vivianrockwell@...

; GLOWCO1@...

; rsribellia@...

; sirrbe1st@...

; chirodoc@...

; bakfixer@...

; tntchiro@...

; sunchiro@...

; l.g.rutherford@...

; wellness@... ; drbobdc@...

; cnolldc@...

; goldenstaralpha@...

; muffy777@...

; steven_ellsworth@...

; dduemling@...

; dreric@...

; twodocs@...

; kristentraeger@...

; hardentown@...

; peterlind@...

; lawtonchiropractic@... ; Chcc@... ; stefandc@...

; kak@...

; DSchm92293@...

; Kmac@... ; Pdetroitjoe@...

; mail@...

; tradeclimb@...

; Kris_97303@...

; BACDOC@... ; mmmiller@...

; gregghelms@...

; AMDurrant@...

; ehacmac@...

; RPSDC@... ; grsdc@...

;

Sent: Thursday, April 17,

2003 9:19 AM

Subject: Re:

Oregon only guidelines

What is the end point of treatment?

Without out an end point how can there be guidelines.

Carl Bonofiglio

-- Re: Oregon only guidelines

,

Setting 'inviolable treatment paramenters' would serve none of us. While

that chapter is still in production, I would seriously doubt that that type

of verbiage would survive a Nominal and/or Delphi consensus round. People

don't yet seem to understand the breadth of the consensus process.

1) First round: The literature is researched,

read and outlined;

verbiage is written and consensitized and referenced (as possible by the

literature available) by the Seed panel members charged with creating the

verbiage. After that consensus.

2) second round: .the verbiage is read, analysed and

consensitized. If it

doesn't pass consensus by the 15 - 20 members of that panel, the verbiage is

returned to the seed panel who work on it again, according to the

instructions from the Nominal Panel. When it is rewritten, the verbiage

is

again submitted to the Nominal Panel for review. Some things have gone

through 12 drafts.

3) Third round: Once the Nominal Panel has agreed on the

material, it is

submitted to the Delphi Panel consisting of 100 other docs and content

experts around the state. Only when that consensus process is completed,

is

the material submitted for printing.

So every word goes through the hands of approximately 120

people of our

profession before it is set for publication. If you are worried

about

content . put your kiester at the table and voice your opinion. In a

consnesus process, you count. Seems to me that if a person chooses not to

participate, that person gives up the right to complain. At the very

least,

that person's complaints seem specious.

Sunny Kierstyn

Re: Oregon only guidelines

Thank you Jim Vick Salem for the real and meaningful legal

opinion. I

would suggest you send you bill to the OBCE since they are down at the

legislature trying to get another fee increase so they can continue on

funding the guidelines process.

J Schmidt, D.C. President

Oregon Doctors of Chiropractic

306 Oak St.

Silverton, OR 97381

phone 503-873-3641

fax 503-873-6200

E-mail jfsdc@...

[Guest guest]

Thank you Sunny. So it is my understanding that the OPUG's, in some people's minds, are in need of updating, the OPUG's have been in use and been accepted by the profession for a number of years and that the process of updating is now underway (with the help of the OBCE) in a manner that is defined and structured for production of a manual for 'evidence based' practice.

My further understanding is that the current discussion on this list serve involves concerns of some, that there is no need for updating, that the old and current OPUG's work just fine , that any further 'expansion' could be misconstrued to be legally binding and 'used' against practitioners, that it is not proper for the OBCE to be involved in any way, including financially, that the process is harmful, damaging and otherwise alienating some doctors in the field.... and that this process needs to stopped all together or removed from OBCE... or .......

Am I close ?

sharron fuchs dc

Re: Oregon only guidelines

Hi Sharon,

Having only been in the state 6 years now, I am unfamiliar with the origination of the OPUGs. Someone else will have to fill us in on those facts. (and please...FACTS, not opinions)

So yes and no, the new document is intended to update but really more expand the them.

The new title is: The Educational Manual for Evidence-based Chiropractic in Oregon.

The intended purpose is to provide an office guide for field doctors when they come up against problems or questions in a day's practice. It is also intended as definition for the lay public, the insurance industry and legal arenas. If we don't define ourselves, in today's atmosphere, they will do it for us.

Sunny

skierstyn

Re: Oregon only guidelines Thank you Jim Vick Salem for the real and meaningful legal opinion. Iwould suggest you send you bill to the OBCE since they are down at thelegislature trying to get another fee increase so they can continue onfunding the guidelines process. J Schmidt, D.C. President Oregon Doctors of Chiropractic 306 Oak St. Silverton, OR 97381 phone 503-873-3641 fax 503-873-6200 E-mail jfsdc@... <mailto:jfsdc@...>