February 22, 1996

The Kansas Chiropractic Association (KCA) has scored a direct hit on medical
doctors and the physical therapists.  We today received Kansas Attorney
General
Carla Stovall's Opinion No. 96-12 which clearly states that

MD'S CANNOT PERFORM MANUAL MANIPULATION

The Attorney General's Opinion will have far reaching effects because medical
doctors will also be prohibited from directing physical therapists to perform
the
procedure.  The KCA is elated over Attorney General Stovall's ruling which
will
protect the public from persons who do not have the necessary professional
training and qualifications.  The KCA applauds her courage for making a
decision
based on the law rather than politics.

For decades, the Kansas Medical Practice Act was assumed to give MD's
complete authority for any procedure they chose to perform.  While reviewing
their
statute, I accidentally discovered that there appeared to be no authority for
medical doctors to perform any procedure other than 'drugs and surgery'.  I
also
realized that if I was interpreting the law correctly, manipulation would
more
importantly be outside the scope of physical therapists.

During the last 10 years, every time I testified before the Kansas
Legislature on
this subject,  the physical therapists would counter with testimony that
manipulation has always been a part of physical therapy.   The Kansas
Attorney
General has now settled the issue.  Manipulation is outside the scope of
practice
of both medical doctors and physical therapists.  General Stovall's opinion
will now
protect the public from manipulation being performed by untrained persons.

The great thing about this opinion is that it defines chiropractic
manipulation
according to the Kirkaldy-Willis definition of moving a joint suddenly beyond
its
passive limit.  (In other words, a thrust outside the control of the patient)
 That
makes what we do outside the scope of medical doctors.  It's also nice that
this
prohibition will be prominently printed in the Kansas Statutes Book
immediately
following the Medical Practice Act."   

The key element is the term 'manipulation'.  Several states have statutory
language that prohibits others from performing 'chiropractic adjustments.'
Unfortunately, that has not stopped physical therapists from performing
manipulation.  They simply call it another name like 'mobilization' and go
right on
invading the practice of chiropractic.  This Opinion will now stop that in
Kansas.

Kansas has become the first state to have truly protected its chiropractic
practice
act by prohibiting medical doctors and physical therapists from performing
manipulation.  Watch Dynamic Chiropractic for the complete story.

Following are key excerpts from the concluding four paragraphs of 
Kansas Attorney General Opinion No. 96-12. dated February 20, 1996.

     "The legislature clearly intended the distinctions between healing arts
branches
not be obliterated.  K.S.A. 65-2835 (g) prohibits a licensee from the
invading the
field of practice of any branch in which the licensee in not licensed to
practice...."

     "Thus the overlap of the term does not mean that the professions or
healing
arts themselves overlap. For this reason it is useful to discuss manual
manipulation in the context of the practice of chiropractic.  Chiropractic
manipulation may involve lumbar invertebral joint adjustment which is a
passive
manual maneuver during which the three joint complex is suddenly carried
beyond
the normal physiological range of movement without exceeding the boundaries
of
anatomical integrity.  Kirkaldy-Wallis, Managing Low Back Pain 287 (2d ed.,
1988)."  

     "Similarly, K.S.A. 65-2869 which defines the practice of medicine
broadly is
not a license to practice a modality of treatment specific to another field
of the
healing arts."  

     "In light of the possible interpretations for the term manual
manipulation, in our
judgment the term must be interpreted in context.  It is thus our opinion
that.....chiropractic manual manipulation as taught in accredited schools of
chiropractic is not within the scope of practice of medicine and surgery as
defined
by K.S.A. 65-2869."

James Edwards, D.C., F.I.C.C.
Member, Kansas State Board of Healing Arts
Treasurer, Kansas Chiropractic PAC
Phone (316) 342-3188
FAX (316) 342-5208
DrJEdwards@aol.com