2017-2018 Regular Sessions



                                      June 21, 2017
        Introduced by M. of A. LENTOL -- read once and referred to the Committee
          on Higher Education
        AN  ACT  to  amend  the  education  law,  in relation to modernizing the
          chiropractic scope of practice; and to repeal  certain  provisions  of
          such law relating thereto
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
  1      Section 1. Section 6551 of the education law, as added by chapter  987
  2    of  the  laws of 1971, paragraphs a and b of subdivision 2 as amended by
  3    chapter 450 of the laws of 1983, and subdivision 3 as amended by chapter
  4    683 of the laws of 1991, is amended to read as follows:
  5      § 6551. Definition of practice of chiropractic.   1. The  practice  of
  6    the  profession  of chiropractic is defined as [detecting and correcting
  7    by manual or  mechanical  means  structural  imbalance,  distortion,  or
  8    subluxations  in the human body for the purpose of removing nerve inter-
  9    ference and the effects thereof, where such interference is  the  result
 10    of  or  related  to distortion, misalignment or subluxation of or in the
 11    vertebral column. 2.] the examination, evaluation, detection,  diagnosis
 12    of the human body and/or treatment or correction of: subluxations in the
 13    vertebral  column  or  other  articular segments by manual or mechanical
 14    means,   neuromusculoskeletal    conditions,    structural    imbalance,
 15    distortion,  and/or dysfunction of the human body and the effects there-
 16    of; including restoring nervous  system  integrity,  structural  balance
 17    and/or  function;  as  it may relate to any human disease, pain, injury,
 18    deformity or physical condition.
 19      2. a. The practice of chiropractic may include, but not be limited to,
 20    physical and functional examination of patients, health assessment, work
 21    capability assessment, handicap eligibility assessment, school and other
 22    sports assessment, school attendance assessment, spinal  health  assess-
 23    ment,  analysis,  or  to  give consultation, advice, recommendations and
 24    counseling regarding  anatomy,  physiology,  neurology,  general  health
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
        A. 8541                             2
  1    matters, wellness and health optimization by any means of communication,
  2    the use of imaging studies using ionizing and non-ionizing imaging meth-
  3    ods,   adjustment,  mobilization,  manipulation,  traction,  and  decom-
  4    pression,  and  ancillary  procedures  consisting of but not limited to,
  5    heat, cold, light, air, water, sound, electricity, massage, manual ther-
  6    apies, therapeutic exercise with or without assistive devices and  clin-
  7    ical  laboratory  testing  methods  approved  by the department as being
  8    appropriate to the practice of chiropractic.
  9      b. Chiropractic examination, diagnostic and treatment methods may also
 10    include electrodiagnostic testing and manipulation under anesthesia when
 11    appropriate education standards have been met and  as  approved  by  the
 12    department as being appropriate to the practice of chiropractic.
 13      c.  The  practice  of the profession of chiropractic allows a licensed
 14    chiropractor who has successfully completed a registered doctoral, post-
 15    doctoral or continuing  education  certification  program  of  a  higher
 16    education credential by an accrediting agency, which contains courses of
 17    study  in wellness care methods, nutrition, and dietary advice satisfac-
 18    tory to the department; use of wellness care methods and the ability  to
 19    engage  in  nutritional  counseling  and  dietary  advice, including the
 20    dispensing of food concentrates, food  extracts,  nutraceuticals,  vita-
 21    mins,  minerals,  and  other  nutritional  supplements  approved  by the
 22    department as being appropriate to, and as a part of,  the  practice  of
 23    chiropractic.
 24      3.  a.    A license to practice as a chiropractor shall not permit the
 25    holder thereof to use [radio-therapy, fluoroscopy, or any form of ioniz-
 26    ing radiation except X-ray which shall be  used  for  the  detection  of
 27    structural  imbalance,  distortion,  or  subluxations in the human body]
 28    ionizing radiation sources for the purposes of radiotherapy.
 29      b. The requirements and limitations with respect to the use of [X-ray]
 30    diagnostic imaging studies by chiropractors shall  be  enforced  by  the
 31    state  commissioner of health and [he] the commissioner is authorized to
 32    promulgate rules and  regulations  after  conferring  with  the  [board]
 33    department to carry out the purposes of this subdivision.
 34      c.  Chiropractors  shall retain for a period of three years all [X-ray
 35    films] diagnostic images taken in the course of their practice, together
 36    with the records pertaining thereto, and shall make such [filmsimages
 37    and  records available to the state commissioner of health or his or her
 38    representative on demand.
 39      4.  Chiropractors  may  use  diagnostic  clinical  laboratory  methods
 40    involving  chemical  or  biological  means  which  particular  tests and
 41    services shall be approved by the department as appropriate to the prac-
 42    tice of chiropractic.
 43      [3.] 5. A license to practice chiropractic shall not permit the holder
 44    thereof to treat for any infectious  diseases  such  as  pneumonia,  any
 45    communicable  diseases  listed  in the sanitary code of the state of New
 46    York, any of the cardio-vascular-renal or cardio-pulmonary diseases, any
 47    surgical condition [of  the  abdomen  such  as  acute  appendicitis,  or
 48    diabetes],  or  any benign or malignant neoplasms; to operate; to reduce
 49    fractures [or dislocations]; to prescribe, administer, dispense  or  use
 50    in [his] practice drugs or medicines[; or to use diagnostic or therapeu-
 51    tic  methods  involving  chemical  or biological means except diagnostic
 52    services performed by clinical  laboratories  which  services  shall  be
 53    approved by the board as appropriate to the practice of chiropractic; or
 54    to utilize electrical devices except those devices approved by the board
 55    as  being  appropriate  to  the practice of chiropractic. Nothing herein
 56    shall be construed to prohibit a licensed chiropractor who has  success-]
        A. 8541                             3
  1    [fully  completed  a  registered  doctoral program in chiropractic, which
  2    contains courses of study in nutrition satisfactory to  the  department,
  3    from  using  nutritional  counseling,  including  the dispensing of food
  4    concentrates,  food  extracts, vitamins, minerals, and other nutritional
  5    supplements approved by the board as being appropriate to, and as a part
  6    of, his or  her  practice  of  chiropractic.  Nothing  herein  shall  be
  7    construed  to prohibit an individual who is not subject to regulation in
  8    this state as a licensed chiropractor from engaging in nutritional coun-
  9    seling.] or controlled substances or to administer or  use  anesthetics.
 10    Chiropractors may use topical analgesic substances and anesthetic balms,
 11    salves or emollients or advise on over the counter substances.
 12      § 2. Section 6552 of the education law, as added by chapter 987 of the
 13    laws of 1971, is amended to read as follows:
 14      § 6552. Practice  of  chiropractic  and  use  of title "chiropractor",
 15    "doctor of chiropractic" or "chiropractic physician".    Only  a  person
 16    licensed  [or exempt] or otherwise authorized under this article [shall]
 17    to practice chiropractic [or] may use the title "chiropractor",  "doctor
 18    of chiropractic" or "chiropractic physician".
 19      § 3. Section 6553 of the education law, as added by chapter 987 of the
 20    laws of 1971, is amended to read as follows:
 21      § 6553. State  board for chiropractic.  A state board for chiropractic
 22    shall be appointed by the board of  regents  on  recommendation  of  the
 23    commissioner  for  the purpose of assisting the board of regents and the
 24    department on matters of professional licensing and professional conduct
 25    in accordance with section sixty-five hundred eight of this title.   The
 26    board  shall be composed of not less than [seven] eight members, includ-
 27    ing [at least four] seven licensed chiropractors[, one  licensed  physi-
 28    cian who is a doctor of medicine, one licensed physician who is a doctor
 29    of  osteopathy,  and  one  educator  who holds a doctorate or equivalent
 30    degree in either anatomy, physiology, pathology, chemistry or microbiol-
 31    ogy] in this state for at least five years and one public  member.    An
 32    executive  secretary  to  the  board  shall be appointed by the board of
 33    regents on recommendation of the commissioner.
 34      § 4. Section 6554 of the education law, as added by chapter 987 of the
 35    laws of 1971, subdivision 3 as amended by chapter 994  of  the  laws  of
 36    1971,  subdivision  6 as amended by chapter 133 of the laws of 1982, and
 37    subdivision 8 as amended by chapter 62 of the laws of 1989,  is  amended
 38    to read as follows:
 39      § 6554. Requirements  for  a  professional  license.  To qualify for a
 40    license as a chiropractor, an  applicant  shall  fulfill  the  following
 41    requirements:
 42      (1) Application: file an application with the department;
 43      (2) Education: have received an education, including [two] three years
 44    or  ninety  semester  hours of credit or equivalent trimester or quarter
 45    hours of credit of preprofessional college study  and  completion  of  a
 46    [four-year  resident  program  in chiropractic,] program of chiropractic
 47    education of not less than four academic years, or the equivalent there-
 48    of in accordance with the commissioner's regulations;
 49      (3) Experience: have experience  satisfactory  to  the  board  and  in
 50    accordance with the commissioner's regulations[:];
 51      (4)  Examination:  pass  examinations satisfactory to the board and in
 52    accordance with the commissioner's regulations[, in clinical  chiroprac-
 53    tic  analysis,  the  practice  of  chiropractic,  X-ray as it relates to
 54    chiropractic analysis, and examinations satisfactory to  the  department
 55    in  anatomy,  physiology, pathology, chemistry, microbiology, diagnosis,
 56    and the use and effect of X-ray] for the practice of chiropractic;
        A. 8541                             4
  1      (5) Age: be at least twenty-one years of age;
  2      (6)  Citizenship  or immigration status: be a United States citizen or
  3    an alien lawfully admitted for permanent residence in the United States;
  4      (7) Character: be of good moral character as determined by the depart-
  5    ment; and
  6      (8) Fees: pay a fee of one hundred seventy-five dollars to the depart-
  7    ment for [admission to a department conducted examination  and  for]  an
  8    initial  license  upon  completion  and passage of a department approved
  9    examination, a fee of eighty-five dollars for each reexamination, a  fee
 10    of  one  hundred  fifteen dollars for an initial license for persons not
 11    requiring admission to a department conducted examination, and a fee  of
 12    one hundred fifty-five dollars for each triennial registration period.
 13      §  5.  Section 6555 of the education law, as amended by chapter 537 of
 14    the laws of 1983, is amended to read as follows:
 15      § 6555. Exempt persons.  [Nothing in this article shall  be  construed
 16    to  affect or prevent a student enrolled in a college of chiropractic in
 17    this state from engaging in all phases of clinical practice under super-
 18    vision of a licensed chiropractor or physician in  a  curriculum  regis-
 19    tered  by  the  department.The  following persons under the following
 20    limitations  may  practice  chiropractic  within  the  state  without  a
 21    license:
 22      1. A student enrolled in any accredited college of chiropractic engag-
 23    ing  in  all phases of clinical practice under supervision of a licensed
 24    chiropractor or physician in a curriculum registered by the  department;
 25    or
 26      2.  A student who is performing a clinical externship or preceptorship
 27    in a chiropractic office or clinic setting and  who  is  enrolled  in  a
 28    chiropractic  school  which  meets  the  standards  satisfactory  to the
 29    department, provided such practice is under the direct supervision of  a
 30    licensed chiropractor for a maximum period of twelve months; or
 31      3.  Any chiropractor authorized to practice chiropractic while travel-
 32    ling from another state or country in which he or she  is  licensed,  to
 33    provide  chiropractic  services during any emergency services associated
 34    with any rescue, recovery or humanitarian relief  effort  provided  such
 35    practice is limited to the organized emergency services; or
 36      4.  A  chiropractor who is not a resident of this state who is legally
 37    qualified to practice in his or her state and  who  is  travelling  from
 38    another  state  for the purpose of providing chiropractic services for a
 39    specific purpose or event of limited duration; or
 40      5. Any chiropractor who is licensed in another state  or  country  and
 41    who  is  meeting  or  communicating with a chiropractor licensed in this
 42    state, for purposes of consultation, provided such practice  is  limited
 43    to such consultation; or
 44      6.  Any  chiropractor who is licensed in another state or country, who
 45    is visiting a chiropractic school or teaching facility in this state  to
 46    receive  chiropractic  instruction for a period not to exceed six months
 47    or to conduct chiropractic instruction, provided such practice is limit-
 48    ed to such instruction  and  is  under  the  general  supervision  of  a
 49    licensed chiropractor; or
 50      7. Any chiropractor who is authorized by a foreign government to prac-
 51    tice  in  relation  to  its  diplomatic,  consular  or  maritime staffs,
 52    provided such practice is limited to such staffs; or
 53      8. Any commissioned chiropractic officer who is serving in the  United
 54    States  armed forces or public health service or any chiropractor who is
 55    employed in the United States  Veterans  Administration,  provided  such
 56    practice is limited to such service or employment.
        A. 8541                             5
  1      §  6.  Section 6556 of the education law is REPEALED and a new sect
  2    6556 is added to read as follows:
  3      § 6556. Limited  permits.  Permits limited as to eligibility, practice
  4    and duration, shall be issued by the department to eligible  applicants,
  5    as follows:
  6      1.  Eligibility: The following persons shall be eligible for a limited
  7    permit:
  8      a. A person who fulfills all requirements for a license  as  a  chiro-
  9    practor  except  those  relating  to  the examination and citizenship or
 10    permanent residence in the United States;
 11      b. A licensed foreign chiropractor who meets guidelines  developed  in
 12    accordance with the commissioner's regulations;
 13      c.  A licensed foreign chiropractor or a foreign intern who is in this
 14    country on a non-immigration visa for the continuation  of  chiropractic
 15    study  who meets guidelines developed in accordance with the commission-
 16    er's regulations;
 17      d. Any graduate of a chiropractic school which meets standards  satis-
 18    factory  to  the department, provided such practice is under the general
 19    supervision of a licensed chiropractor for a maximum  period  of  twelve
 20    months from date of graduation.
 21      2.  Limit  of  practice.  A  permittee shall be authorized to practice
 22    chiropractic only under the supervision of a licensed  chiropractor  and
 23    only in a licensed chiropractic office or clinical setting.
 24      3.  Duration. A limited permit shall be valid for one year.  A limited
 25    permit may be renewed annually at the discretion of the department.
 26      4. Fees. The fee for each limited permit and for each renewal shall be
 27    one hundred five dollars.
 28      § 7. The education law is amended by adding a new section 6557 to read
 29    as follows:
 30      § 6557. Special provisions. 1. Non-liability of licensed chiropractors
 31    for first aid or emergency treatment.  Notwithstanding any  inconsistent
 32    provision  of any general, special or local law, any licensed chiroprac-
 33    tor who voluntarily and without the expectation of monetary compensation
 34    renders first aid or emergency treatment at the scene of an accident  or
 35    other  emergency, outside a hospital, doctor's office or any other place
 36    having proper and necessary chiropractic equipment, to a person  who  is
 37    unconscious,  ill  or injured, shall not be liable for damages for inju-
 38    ries alleged to have been sustained by such person or  for  damages  for
 39    the death of such person alleged to have occurred by reason of an act or
 40    omission  in  the  rendering  of  such  first aid or emergency treatment
 41    unless it is established that such  injuries  were  or  such  death  was
 42    caused  by gross negligence on the part of such chiropractor. Nothing in
 43    this section shall be deemed or construed to relieve a  licensed  chiro-
 44    practor  from  liability  for damages for injuries or death caused by an
 45    act or omission on the part of a chiropractor  while  rendering  profes-
 46    sional  services  in  the normal and ordinary course of his or her prac-
 47    tice.
 48      2. This article shall not  be  construed  to  affect  or  prevent  the
 49    following:
 50      a. The furnishing of any assistance in an emergency;
 51      b.  The  chiropractor  from being a primary portal of entry healthcare
 52    provider.
 53      3. There shall be no monetary liability on the part of, and  no  cause
 54    of  action  for  damages  shall  arise against, any person, partnership,
 55    corporation, firm, society, or other entity on account of  the  communi-
 56    cation  of information in the possession of such person or entity, or on
        A. 8541                             6
  1    account of any recommendation or evaluation,  regarding  the  qualifica-
  2    tions,  fitness, or professional conduct or practices of a chiropractor,
  3    to any governmental agency, chiropractic society, a hospital as  defined
  4    in  article twenty-eight of the public health law, a hospital as defined
  5    in subdivision ten of section 1.03 of  the  mental  hygiene  law,  or  a
  6    health  maintenance  organization  organized under article forty-four of
  7    the public health law or  article  forty-three  of  the  insurance  law,
  8    including  a  committee of an individual practice association or medical
  9    group acting pursuant to a contract with a health maintenance  organiza-
 10    tion.  The  foregoing shall not apply to information which is untrue and
 11    communicated with malicious intent.
 12      § 8. The education law is amended by adding a new section 6558 to read
 13    as follows:
 14      § 6558. Definition of chiropractic clinical assistant.   1. A  chirop-
 15    ractic clinical assistant is defined as a person certified in accordance
 16    with  this  article who works under the supervision of a licensed chiro-
 17    practor performing such patient duties as are assigned by the  supervis-
 18    ing  chiropractor.  A  chiropractic  clinical assistant may only provide
 19    patient services on the orders and instructions of a supervising  chiro-
 20    practor.  Supervision of a chiropractic clinical assistant by a licensed
 21    chiropractor shall be on-site supervision, but  not  necessarily  direct
 22    personal  supervision.  The  number  of chiropractic clinical assistants
 23    supervised by one licensed chiropractor shall not exceed  the  ratio  of
 24    four  chiropractic  clinical  assistants to one licensed chiropractor as
 25    shall be determined by  the  commissioner's  regulations  ensuring  that
 26    there  be adequate supervision in the best interest of public health and
 27    safety. Nothing in this section  shall  prohibit  a  hospital  or  other
 28    public  health  law article twenty-eight facility from employing chirop-
 29    ractic clinical assistants, provided they work under the supervision  of
 30    a  chiropractor, physician, nurse practitioner or other medical provider
 31    designated by the hospital or public  health  law  article  twenty-eight
 32    facility and not beyond the scope of practice of a chiropractic clinical
 33    assistant.
 34      2.  A certified chiropractic clinical assistant may only provide clin-
 35    ical services on the orders and instructions of a supervising chiroprac-
 36    tor.
 37      3. The scope of services for a certified chiropractic clinical assist-
 38    ant shall include assisting a chiropractor with providing certain  clin-
 39    ical  procedures  common and customary to the chiropractic setting which
 40    include, but are not  limited  to,  the  following:  collecting  general
 41    health  data,  such  as  the  taking  of an oral history, vital signs or
 42    neurological,  physiological  or  anatomical  measurements;   performing
 43    objective data collection tests common and customary to the chiropractic
 44    setting  including,  but  not  limited to dynamic or static surface EMG,
 45    thermography, heart rate  variability;  applying  thermal,  light,  air,
 46    water,  sound,  electrical  and  mechanical  modalities;  and monitoring
 47    prescribed rehabilitative activities.
 48      4. A certified chiropractic  clinical  assistant  must  be  adequately
 49    trained  in  the  proper  operation of any device or equipment and know-
 50    ledgeable of anatomy and the appropriate safety procedures and contrain-
 51    dications with respect to the clinical services he or she is directed to
 52    provide.
 53      5. Nothing in this section shall be construed  to  allow  a  certified
 54    chiropractic  clinical  assistant  to provide a chiropractic adjustment;
 55    manipulation; joint mobilization; perform radiological  tests  (X-rays);
        A. 8541                             7
  1    nutritional  instruction; and counseling or other therapeutic service or
  2    procedure which requires individual licensure in New York state.
  3      6.  Registration as a certified chiropractic clinical assistant is not
  4    required for individuals who  perform  administrative  activities  of  a
  5    non-clinical nature.
  6      § 9. The education law is amended by adding a new section 6559 to read
  7    as follows:
  8      § 6559. Duties of chiropractic clinical assistant and the use of title
  9    "chiropractic  clinical assistant." Only a person certified or otherwise
 10    authorized under this article  shall  participate  in  the  practice  of
 11    chiropractic  as  a  chiropractic  clinical  assistant and only a person
 12    certified under this section shall use the title "chiropractic  clinical
 13    assistant."
 14      §  10.  The  education  law is amended by adding a new section 6560 to
 15    read as follows:
 16      § 6560. Requirements for  certification  as  a  chiropractic  clinical
 17    assistant.
 18      1. Application: file an application with the department;
 19      2.  Education: have received an education and training in a chiroprac-
 20    tic clinical assistant program in  accordance  with  the  commissioner's
 21    regulations  and department of education; including but not limited to a
 22    minimum of twenty-four hours of didactic study;
 23      3. Experience: have experience  satisfactory  to  the  department  for
 24    chiropractic in accordance with the commissioner's regulations;
 25      4. Examination: pass an examination satisfactory to the department and
 26    in accordance with the commissioner's regulations;
 27      5. Age: be at least eighteen years of age;
 28      6.  Character: be of good moral character as determined by the depart-
 29    ment;
 30      7. Registration: all certified chiropractic clinical assistants  shall
 31    register  triennially  with  the education department in accordance with
 32    the regulations of the commissioner;
 33      8. Fees: pay a fee for an initial certificate of fifty dollars, and  a
 34    fee of fifty dollars for each subsequent triennial registration period.
 35      9.  A  certified  chiropractic  clinical assistant shall conduct them-
 36    selves within the boundaries of proper ethical behavior and shall adhere
 37    to acceptable standards of conduct regardless of whether  a  supervising
 38    chiropractor  or  person in a position of authority may order, impart or
 39    condone behavior or conduct which is improper.
 40      10. "Improper conduct", under  the  meaning  of  this  section,  shall
 41    include  conduct  delineated  under the chiropractic practice act, regu-
 42    lations, and such other New York state laws that may apply.
 43      11. The department may refuse  to  issue,  refuse  to  renew,  or  may
 44    suspend, revoke, censure, reprimand, restrict, or limit the registration
 45    of,  or  fine  any  person pursuant to the laws of New York state or the
 46    procedures set forth herein, upon one or more of the grounds for  disci-
 47    pline set forth in this article.
 48      §  11.  The  education  law is amended by adding a new section 6561 to
 49    read as follows:
 50      § 6561. Exemptions. 1. This article shall not be construed  to  affect
 51    or  prevent  a  chiropractic clinical assistant student from engaging in
 52    clinical assisting under the supervision of a licensed  chiropractor  as
 53    part  of  a  program  conducted  in an approved program for chiropractic
 54    clinical assistants or in a clinical  facility  or  health  care  agency
 55    affiliated with the program for chiropractic clinical assistants.
        A. 8541                             8
  1      2.  Supervision  of  a  chiropractic  clinical  assistant student by a
  2    licensed chiropractor shall be on-site  supervision  and  direct  super-
  3    vision.
  4      §  12.  The  education  law is amended by adding a new section 6562 to
  5    read as follows:
  6      § 6562. Limited permits. 1.  The  department  shall  issue  a  limited
  7    permit  to  an applicant who meets all requirements for admission to the
  8    certification examination.
  9      2. All practice under a limited permit shall be under the  supervision
 10    of  a  licensed  chiropractor  or  other  licensed medical provider in a
 11    public hospital, an incorporated hospital or clinic, a licensed proprie-
 12    tary hospital, a licensed nursing home, a public health agency, a recog-
 13    nized public or non-public school setting,  the  office  of  a  licensed
 14    chiropractor, or in the civil service of the state or political subdivi-
 15    sion thereof.
 16      3.  Limited permits shall be for six months and the department may for
 17    justifiable cause renew a limited  permit  provided  that  no  applicant
 18    shall  practice  under  any  limited permit for more than a total of one
 19    year.
 20      4. Supervision of a permittee by  a  licensed  chiropractor  shall  be
 21    on-site supervision and not necessarily direct personal supervision.
 22      5. The fee for each limited permit and for each renewal shall be fifty
 23    dollars.
 24      § 13. This act shall take effect on the first of January next succeed-
 25    ing the date on which it shall have become a law.