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Ohio chiropractors could make call on concussions

Source The Plain Dealer

By Brandon Blackwell, The Plain Dealer

COLUMBUS, Ohio – Some Ohio physicians are upset over a budget provision that would allow chiropractors to make the calls on putting student athletes with head injuries back in the game.

Senate lawmakers on Thursday are likely to pass a version of the budget, House Bill 59, that gives chiropractors the authority to clear the return of young athletes who are taken off the field for symptoms of a concussion or head injury. The move has upset those who say chiropractors do not have the proper training to handle the responsibility.

“I think that when we’re talking about serious head injuries to children, a physician’s training and scope of expertise is broader and more comprehensive than a chiropractor,” said Tim Maglione, senior director of the Ohio State Medical Association. “Chiropractors have a role in the continuum of care for athletes. We just don’t think it should go as far as assessing head injuries for young children.”

Supporters of the provision, however, say chiropractors receive rigorous training in neurology and are well qualified to make the assessments.

Current law gives doctors of medicine or osteopathic medicine the authority to clear a young athlete for a return to sports. The amendment would extend that authority to chiropractors.

Maglione sent a letter last month to the Senate asking lawmakers to toss the provision.

“The simple fact is that physicians are granted ultimate oversight…because they are best equipped in terms of education and training to act in that role,” Maglione said in the letter. “Those without adequate education and training should not be making return to play decisions independently.

“The training and education of a physician is vastly different and indeed more rigorous than that required for a chiropractor.”

The letter included signatures from officials with the Ohio Chapter of the American Academy of Pediatrics, Ohio Children’s Hospital Association, Ohio Athletic Trainers Association, Ohio Hospital Association and the Ohio Osteopathic Association.

Republican Rep. John Adams added the amendment to HB 59 in April before the House sent the budget to the Senate.

The amendment adjusts legislation passed in December during the General Assembly’s lame duck session that requires coaches and referees to take a player out of a game or practice who is showing symptoms of a concussion or head injury. Players are not allowed to return until cleared directly or under the guidance of a doctor of medicine or osteopathic medicine. Cleveland Clinic, University Hospitals and other health care organizations stood by the move.

However, some say the legislation wrongfully sidelined chiropractors from making return-to-play decisions.

“Doctors of chiropractic are sufficiently prepared to release concussed athletes back to normal activities,” said Adams, of Sidney, in a statement. “Per the Ohio State Chiropractic Board, chiropractors in the state of Ohio have been able to diagnosis, manage and clear individuals with concussions since 1975, and should continue to be part of the chiropractors scope of practice.”

Kreg Huffer, chiropractor and spokesman for the Ohio State Chiropractic Association, agreed and testified in favor of the amendment.

“For years doctors of chiropractic have served as high school team physicians, volunteering their time on the hardwood, football field and other athletic venues tending to athlete’s injuries,” Huffer said.

“We as an association and as a profession believe this was an unintended consequence due to the nature of the bill being passed during lame-duck.”

Huffer said chiropractors in the state are licensed only after completing 149 hours in neurology training, 271 hours studying X-rays and 168 hours of course work in orthopedics.

Nicholas Strata, director of legislative affairs for OSCA, said neurology training for chiropractors can be more rigorous than for doctors of medicine.

“We’re not saying MDs are not able to treat this issue. We are saying that we are able to treat this issue too,” Strata said.

After this week’s floor vote, HB 59 will move to a conference committee, where lawmakers from both chambers will put their finishing touches on the budget. The governor must sign the proposal by June 30.

“We are happy we could get to go back to practicing what we went to school for,” Strata said. “The game’s not over. We’re in the fourth quarter, but we’re winning.”

 

2 comments to Ohio chiropractors could make call on concussions

  • I think the comment that:

    …when we’re talking about serious head injuries to children, a physician’s training and scope of expertise is broader and more comprehensive than a chiropractor

    really misses the boat. What matters most to me is the RISK associated with that decision, both for the patient and the doctor.

    I would prefer that someone who specializes in head trauma be the “decider”. The average medical physician is no better trained than the average chiropractor in distinguishing the subtle manifestations that linger in post-concussion.

    In the case of safety, better to err on the side of caution.

  • Troy Holder, DC

    I recently attended a concussion summit in which I actually had the opportunity to discuss this with a few MD’s. The question wasn’t even whether Chiropractors were trained enough, it was whether the MD’s were even trained adequately themselves.

    Most MD’s miss the boat when it comes to correctly diagnosing concussions. This comes directly from the MD’s who presented the material. They were very open about the fact that many of the MD’s were not up to date on correctly identifying the signs and symptoms for a proper diagnosis and management.

    I was also surprised to see that incorporated in their therapy options were cranio-sacral therapy, massage therapy, as well as some others.

    Additionally, in talking with one of the MD’s, she noted that her experience found chiropractors to be more in tune with early diagnosis and proper management of concussions. Probably because we spend more time with our patients, listening to them and seeing visit to visit changes in their demeanor.

    One of the MD’s asked why I was there as a chiropractor (hahaha). I told them, “Well, we see a lot of car accident cases that involve head trauma/concussions. It’s always important to keep up to date on proper diagnosis and case management. W

    hile the MD’s are working with the patient on managing the psychological issues that arise with concussions, we are managing the neuromusculoskeletal problems that are associated with concussions.”

    MD: “Oh, that makes sense.”

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