RE: Thank you to everyone who spoke at the board meeting

January 20, 2006

I am a member of the Administrative Rules Committee. I am not a member of either professional association. I have no politicized axe to grind. I do not earn money from the practice of Chiropractic, nor from books, journals or lectures. I maintain a current active license. I work in a personal injury law firm. Records from Chiropractors and complaints about Chiropractors come to me not infrequently. I am faithful to the Chiropractic profession and ,having been in two car accidents, I am an active Chiropractic patient. Through my work I continually strive to find common language and understanding both within our profession and with other healthcare professions....

By Dr. Jaysun Frisch :

' The original question of requiring outcome measures seems to be quite simple in my mind, simply assess what ever you are treating and track the patient's progress, whether that is declining use of an inhaler with an asthma patient, subjective report of ability to concentrate or successfully complete tasks in an ADHD patient (two examples brought up today) and so on. '

My comments : Exactly. This question unfortunately was lost in the gross misunderstanding of the Rule and side taking. Even Dr. Freeman strayed from the question and although he eventually squeaked out the words that he 'believed in outcomes' , his dialogue on unrelated issue(s) got totally mixed up and left confusion and frank bewilderment. Then anger came out , including some vicious anger by some of the board members. Then refusal to mediate a compromise....... and then.... the original justification rule which had been gutted and filled with new language was passed ! No referral back the the Rules Committee, no real discussion amongst the Board members. Nothing. And sadly, what was hard fought and used as substance to keep managed care out of PIP this last session , was lost.

Imagine the forthcoming backlash. Don't like or think the legislature can mind our business ? Think again.

I'd bet the person from State Farm who was present but didn't say a word ,left the meeting shaking their head and laughing out loud. I can hear it now...........' they should be under the Board of Medical Examiners '.

sharron fuchs dc

From: [mailto: ] On Behalf Of Dr. Jaysun FrischSent: Thursday, January 19, 2006 11:10 PM Subject: Thank you to everyone who spoke at the board meeting

I would like to thank everyone that took the time, and spoke today at the board meeting. As a fairly new doctor with just a few years in practice so far, I had not previously been exposed to some of the points of view espoused by some of our more esoteric colleagues. I had come in support of the existing rules, as I do not find them to be restrictive or unreasonable in the least. I had never heard of Dr. Boothby before today, and my only previous interaction with Dr. Cafferty was during a visit to his office while in my first quarter at WSCC. This may anger some, and certainly only my opinion, but as Dr. stated so passionately, it seemed that some of the most vocal speakers were there with a personal or political axe to grind, instead of approaching the topic logically as did Drs. Freeman and Snellgrove. I also felt that Dr. Haas greatly simplified the definition of EBC (evidenced based care)which certainly clarified some of my own misconceptions. While I was not able to stay to the end of the meeting, the discourse seemed to really have revolved around the a perception of persecution on one side, and a perception that a lack of professional ethics and conduct exists on the other. The original question of requiring outcome measures seems to be quite simple in my mind, simply assess what ever you are treating and track the patient's progress, whether that is declining use of an inhaler with an asthma patient, subjective report of ability to concentrate or successfully complete tasks in an ADHD patient (two examples brought up today) and so on. just my two cents on the matter. I would love to hear some other impressions from other attendees, Thank you again. Dr. Jaysun G. Frisch, Clinical Assistant Western States Chiropractic College Outpatient Clinic

January 20, 2006

It would be interesting

to know some of the things in general that people complain about so the

profession can be proactive regarding patients, the general population and

other professionals. Thanks for

correcting misconceptions as well.

Larry Oliver, DC

Corvallis, OR

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-----Original

Message-----

From:

[mailto: ]On Behalf

Of Sharron Fuchs

Sent: Friday, January 20, 2006

2:22 PM

Subject: RE: Thank you

to everyone who spoke at the board meeting

I am a member of the

Administrative Rules Committee. I am not a member of either professional

association. I have no politicized axe to grind. I do not earn money

from the practice of Chiropractic, nor from books, journals or lectures. I

maintain a current active license. I work in a personal injury law firm.

Records from Chiropractors and complaints about Chiropractors come to me not

infrequently. I am faithful to the Chiropractic profession and ,having been in

two car accidents, I am an active Chiropractic patient.

Through my work I continually strive to find common

language and understanding both within our profession and with

other healthcare professions....

By Dr. Jaysun Frisch

:

' The original

question of requiring outcome measures seems to be

quite simple in my mind, simply assess what ever you are treating

and track the patient's progress, whether that is declining use of

an inhaler with an asthma patient, subjective report of ability to

concentrate or successfully complete tasks in an ADHD patient (two

examples brought up today) and so on. '

My comments :

Exactly. This question unfortunately was lost in the

gross misunderstanding of the Rule and side taking. Even Dr. Freeman

strayed from the question and although he eventually squeaked out the

words that he 'believed in outcomes' , his dialogue on unrelated issue(s)

got totally mixed up and left confusion and

frank bewilderment. Then anger came out , including

some vicious anger by some of the board members. Then refusal to

mediate a compromise....... and then.... the original justification

rule which had been gutted and filled with new language was

passed ! No referral back the the Rules Committee, no real discussion

amongst the Board members. Nothing. And sadly, what was hard fought

and used as substance to keep managed care out of PIP this last

session , was lost.

Imagine the

forthcoming backlash. Don't like or think the legislature can mind our

business ? Think again.

I'd bet the person from

State Farm who was present but didn't say a word ,left the meeting shaking

their head and laughing out loud. I can hear it now...........' they

should be under the Board of Medical Examiners '.

sharron fuchs dc

From: [mailto: ] On Behalf Of Dr. Jaysun Frisch

Sent: Thursday, January 19, 2006

11:10 PM

Subject: Thank you to

everyone who spoke at the board meeting

I would like to thank everyone that took the time, and spoke today

at the board meeting. As a fairly new doctor with just a few years

in practice so far, I had not previously been exposed to some of the

points of view espoused by some of our more esoteric colleagues. I

had come in support of the existing rules, as I do not find them to

be restrictive or unreasonable in the least. I had never heard of

Dr. Boothby before today, and my only previous interaction with Dr.

Cafferty was during a visit to his office while in my first quarter

at WSCC. This may anger some, and certainly only my opinion, but as

Dr. stated so passionately, it seemed that some of the most

vocal speakers were there with a personal or political axe to grind,

instead of approaching the topic logically as did Drs. Freeman and

Snellgrove. I also felt that Dr. Haas greatly simplified the

definition of EBC (evidenced based care)which certainly clarified

some of my own misconceptions. While I was not able to stay to the

end of the meeting, the discourse seemed to really have revolved

around the a perception of persecution on one side, and a perception

that a lack of professional ethics and conduct exists on the other.

The original question of requiring outcome measures seems to be

quite simple in my mind, simply assess what ever you are treating

and track the patient's progress, whether that is declining use of

an inhaler with an asthma patient, subjective report of ability to

concentrate or successfully complete tasks in an ADHD patient (two

examples brought up today) and so on. just my two cents on the

matter. I would love to hear some other impressions from other

attendees, Thank you again.

Dr. Jaysun G. Frisch, Clinical Assistant

Western

States Chiropractic College Outpatient Clinic

January 23, 2006

Sharron, Jaysun, OR

DCs,

For those that were at the OBCE meeting in

Portland last

Thursday, thanks for participating. I am always impressed by the passion

and commitment displayed by chiropractors, regardless of which “side”

they are on. It is important for the OBCE to hear from the wide range of

its stakeholders. If I could wish for anything for my profession, it

would be for an enhanced ability and willingness to disagree without being

disagreeable.

I too was concerned by the lack of focus

on the substance of the “Clinical Justification Rule.” In my

view, meaningful discussion was replaced by suspicion, innuendo and appeals to

fear that “chiropractic” is somehow being threatened by this rule

(which by the way was adopted quite some time ago).

I personally was not impressed by the

proponents of the new language as being in the best interests of the public.

And I am concerned about the effect of abandoning an evidence-based approach to

patient outcomes. The “anything goes” approach implicit in

the language of this proposed new rule may give chiropractors some sense of increased

personal and professional freedom, but it flies in the face of responsible

professionalism, IMHO.

In contrast to some who view evidence-based

health care as only the most current “flavor-of-the-month,” I would

suggest that any health care profession that retreats from science and rational

inquiry does so at its own peril. Supporters of the proposed new “clinical

rationale” rule may in fact win this particular battle, but loose the war

of maintaining this profession as a separate and viable health care option.

As a practical matter as I understand it,

the net result of the Board’s action at the conclusion of the public

meeting last week was to enter (again) into rule making to replace the existing

rule with the text supplied by Drs Boothby and Cafferty. The Board did

not, and could not, “adopt” the new rule without first going

through the formal rule making process At this point, it is not a done

deal that the rule has been “gutted and filled” with the language in

new proposal offered by Drs Boothby and Cafferty.

So, we are starting the process all over

again. If there is concern that the existing rule is good and the

proposed rule is not (or vise versa), then there is opportunity to comment

further during the rule making process over the next few mionths. Plus,

the OBCE will have the opportunity to express their reasons and rationale for

going into rule making (again) on this topic. It should be good reading.

A. Simpson, DC

From:

[mailto: ] On Behalf Of Sharron Fuchs

Sent: Friday, January 20, 2006

2:22 PM

Subject: RE: Thank you

to everyone who spoke at the board meeting

I am a member of the Administrative Rules

Committee. I am not a member of either professional association. I have no

politicized axe to grind. I do not earn money from the practice of

Chiropractic, nor from books, journals or lectures. I maintain a current active

license. I work in a personal injury law firm. Records from Chiropractors

and complaints about Chiropractors come to me not infrequently. I am faithful

to the Chiropractic profession and ,having been in two car accidents, I am

an active Chiropractic patient. Through my work I

continually strive to find common language and understanding both within

our profession and with other healthcare professions....

By Dr. Jaysun Frisch :

' The original question of

requiring outcome measures seems to be

quite simple in my mind, simply assess what ever you are treating

and track the patient's progress, whether that is declining use of

an inhaler with an asthma patient, subjective report of ability to

concentrate or successfully complete tasks in an ADHD patient (two

examples brought up today) and so on. '

My comments : Exactly.

This question unfortunately was lost in the gross misunderstanding of

the Rule and side taking. Even Dr. Freeman strayed from the question

and although he eventually squeaked out the words that he 'believed

in outcomes' , his dialogue on unrelated issue(s) got totally mixed up

and left confusion and frank bewilderment. Then

anger came out , including some vicious anger by some of the

board members. Then refusal to mediate a compromise....... and

then.... the original justification rule which had been gutted

and filled with new language was passed ! No referral back the

the Rules Committee, no real discussion amongst the Board members.

Nothing. And sadly, what was hard fought and used as substance

to keep managed care out of PIP this last session , was lost.

Imagine the forthcoming backlash.

Don't like or think the legislature can mind our business ? Think again.

I'd bet the person from State Farm who was

present but didn't say a word ,left the meeting shaking their head

and laughing out loud. I can hear it now...........' they should be under

the Board of Medical Examiners '.

sharron fuchs dc

From:

[mailto: ] On Behalf Of Dr. Jaysun Frisch

Sent: Thursday, January 19, 2006

11:10 PM

Subject: Thank you to

everyone who spoke at the board meeting

I would like to thank everyone that took the time, and spoke today

at the board meeting. As a fairly new doctor with

just a few years

in practice so far, I had not previously been

exposed to some of the

points of view espoused by some of our more

esoteric colleagues. I

had come in support of the existing rules, as I do

not find them to

be restrictive or unreasonable in the least. I had

never heard of

Dr. Boothby before today, and my only previous

interaction with Dr.

Cafferty was during a visit to his office while in

my first quarter

at WSCC. This may anger some, and certainly only

my opinion, but as

Dr. stated so passionately, it seemed that

some of the most

vocal speakers were there with a personal or

political axe to grind,

instead of approaching the topic logically as did

Drs. Freeman and

Snellgrove. I also felt that Dr. Haas greatly

simplified the

definition of EBC (evidenced based care)which

certainly clarified

some of my own misconceptions. While I was not

able to stay to the

end of the meeting, the discourse seemed to really

have revolved

around the a perception of persecution on one

side, and a perception

that a lack of professional ethics and conduct

exists on the other.

The original question of requiring outcome

measures seems to be

quite simple in my mind, simply assess what ever

you are treating

and track the patient's progress, whether that is

declining use of

an inhaler with an asthma patient, subjective

report of ability to

concentrate or successfully complete tasks in an

ADHD patient (two

examples brought up today) and so on. just my two

cents on the

matter. I would love to hear some other impressions

from other

attendees, Thank you again.

Dr. Jaysun G. Frisch, Clinical Assistant

Western States Chiropractic College Outpatient Clinic

January 24, 2006

Hi, Chuck;

With regard

to your comment, “The “anything goes” approach implicit in

the language of this proposed new rule may give chiropractors some sense of

increased personal and professional freedom, but it flies in the face of

responsible professionalism, IMHO.”, I don’t find this an accurate

characterization of the proposed language changes of that comprise the Clinical

Rationale Rule. The changes seem quite reasonable to me and are less

about “anything goes”, than they are about being less confining in

describing the materials that should be considered in supporting clinical

decisions.

Regarding

the comment, “I would suggest that any health care profession that

retreats from science and rational inquiry does so at its own peril.”, I

don’t believe it is reasonable to say that the Clinical Rationale Rule

retreats from science and rational inquiry just because it broadens the base of

resources and is less biased in determining resources that are appropriate to

discussion of clinical justification.

Your

comment, “At this point, it is not a done deal that the rule has been

“gutted and filled” with the language in new proposal offered by

Drs Boothby and Cafferty.” is completely inappropriate characterization

of the language changes and I, for one, am happy that the Board is

reconsidering the language of the rule.

Your

comments strike me as disingenuous and the tone and inaccuracy of your

characterizations seem to belie the statement, “If I could wish for

anything for my profession, it would be for an enhanced ability and willingness

to disagree without being disagreeable.”

I have

copied below a letter that I sent to the Board describing problems I see with

the Clinical Justification Rule and why the Clinical Rationale Rule is better.

You will find a quote from Dr. S.J. Tannenbaum of the College of Medicine and Public

Health, Ohio State

University, Columbus, Ohio.

Dr. Tannenbaum makes very clear some of the false premises that are

conscientiously omitted or hidden in the dialog over evidence based

medicine. The “take home” information here is that it isn’t

about the black and white issue that so many supporters of evidence based

medicine would have us believe. And, it isn’t about the paranoia of

bunch of greedy clinical incompetents. There is a middle ground of

rationality in which health care practitioners can make valid and appropriate

clinical decisions that can be identified by reasonable peers in a review of

the documentation of the patient’s care. We need to discuss how

practitioners can best arrive at a rationale to support clinical management of

a patient and how peers can see whether such a rationale exists to support the

clinical decisions that have been made in any particular case.

S.

Feinberg, D.C.

January 14,

2006

Oregon Board of Chiropractic Examiners

3218 Pringle Road SE #150

Salem, OR 97302-6311

Re:

Proposed Clinical Justification Rule 811-015-0010

Dear

Committee Members;

I write to

the Board in regard to the proposed Clinical Justification Rule 811-015-0010,

with the hope that the Board may consider modifications to the rule that may

preserve its virtues while eliminating aspects of the rule that are

unnecessarily specific or which unnecessarily emphasize one document or

consideration over another to support the clinical management of a particular

case.

An argument

has been put forward that the name of the rule should be changed from

“Clinical Justification” rule to “Clinical Rationale”

rule. I support the name change to Clinical Rationale rule. The

term “justification” is generally known to mean the act of

justifying or the state of being justified; a showing or proving to be just or

conformable to law, justice, right, or duty. In law,

“justification” is taken to mean the demonstration in court of a

sufficient lawful reason why a party charged or accused did that for which he

is called to answer. This term carries with it meaning that is pejorative

and a better term is available. No chiropractor should ever take the

position that chiropractic care should be provided to patients without

sufficient thought and consideration to what that care consists of and how much

care best suits the patient’s clinical need. As a profession, we

should describe the way in which such thought and consideration is made.

I don’t think there is a good argument against that. The problem I

see is simply that there are denotations, not to mention connotations, to the

word justification that may be considered accusatory as opposed to discursive

or illuminating. The idea of providing justification, supportive lawful

reason to support something may lend itself to simple questions of law such as

whether a driver has operated a vehicle in concordance with state law.

Justification becomes more problematic when applied to the decisions a

chiropractor makes in determining what care is best for a given patient.

Decision making in the clinical arena is sufficiently more complex and subtle

and it lends itself less to justification and more to the reasoned

considerations arrived at in forming a “rationale” for chiropractic

care. The term “rationale” is generally considered to mean an

exposition of principles or reasons. I think an exposition of reasons and

principles in support of a chiropractor’s clinical decisions is a better

standard to require and is a standard that is more realistic and consistent

with the complexities of practice.

As I read

the “Clinical Justification” rule, I am also troubled by what seems

to me to be an unnecessary specificity and preferential weighting to particular

documents that have been generated at various times within our

profession. I believe that it would be better to describe in less

restrictive terms the kind of materials and reasoning that a chiropractor

should reference in supporting clinical management in any particular

case. I believe that the changes that have been submitted to OBCE as the

“Clinical Rationale” rule are better in this regard. At the

end of the day, the argument supporting such clinical management will be seen

by those considering the validity of such argument as adequate or

inadequate. There is no need to specify OCPUG or any of the particulars

of examination and documentation, though that may well be material that is

appropriately used in preparing such arguments. Better, I believe, as the

Clinical Rationale rule verbiage recommends, to reference those general

categories of information and documents generated by the profession that may be

appropriate to reference in consideration of case management issues.

The

following is excerpted from an article by S. J. Tanenbaum of the College of Medicine

and Public Health at Ohio

State University.

Dr. Tanenbaum makes very clear some of the problems and rational inadequacies

of the “evidence based medicine” movement. He demonstrates

how inappropriate is some of the logic applied by supporters of the

“evidence based medicine” or “outcomes movement”.

It is not a question of whether clinical management in allopathic medicine or

in chiropractic care of the patient should be reasonable and appropriate.

It is more a question of whether or not the form that evidence/outcome based

health care proponents put forward for supporting clinical management decisions

is valid. Dr. Tanenbaum describes some serious problems in this

regard. Please consider Dr. Tanenbaum’s reasoning:

Evidence And Expertise: The Challenge Of The Outcomes Movement To

Medical Professionalism; Acad Med. 1999 Dec;74(12):1259-60. Tanenbaum SJ.

Division of Health Services Management and Policy, College of Medicine and

Public Health, Ohio State University, Columbus 43210-1234, USA.

“The outcomes movement--including evidence-based

medicine--challenges medicine as a profession by disputing what and how

physicians know. First, the movement considers probabilistic research to be

virtually the only way to arrive at knowledge in medicine. Second, it insists

on objective or impersonal knowledge (statistically manipulated, hard,

aggregate data). Such knowledge does not come from within the professional

relationship; rather it is gathered across relationships and is offered to the

practitioner from the outside. Third, the outcomes movement is motivated by a

desire for certainty, promising definitive solutions that will reduce variation

and waste. What professionals know, in contrast, is inherently and irreparably

uncertain. Fourth, the movement expects physicians to implement the findings

from probabilistic research through application. The inferential leap necessary

for treating an individual based on aggregate findings is mostly assumed away.

Finally, the outcomes movement promotes rule-based behavior on the part of

physicians in an effort, among other things, to eliminate variation in medical

practice. But professionals do not follow rules per se--they intuit what is

right in a situation, including, sometimes, that it is right to defer to a

rule. Professional knowledge in medicine is both larger and smaller than the

knowledge conceived of by the outcomes movement. The latter is built of

probabilistic research and translated into physician directives. Professional

knowledge, in contrast, partakes of statistical knowledge and bench science, as

well as various forms of personal knowledge, including the experiential.

Physicians will continue to need professional knowledge, which allows for the

complexity of physician experience and for the immediacy and individuality of

patients.”

I believe

that Dr. Tanenbaum has eloquently put forward some thoughts, which I believe

support the proposed changes in name and content of the “Clinical

Justification” rule as specified by documents recently submitted to the

OBCE as the “Clinical Rationale” rule. This change takes our

profession in the direction of responsible patient care and avoids some

pitfalls inherent in the “Clinical Justification” rule.

Sincerely,

S.

Feinberg, D.C.

From:

[mailto: ] On Behalf Of Chuck Simpson, DC

Sent: Monday, January 23, 2006

11:14 AM

Sharron Fuchs;

Subject: RE: Thank you

to everyone who spoke at the board meeting

Sharron, Jaysun, OR

DCs,

For those that were at the OBCE meeting in

Portland last

Thursday, thanks for participating. I am always impressed by the passion

and commitment displayed by chiropractors, regardless of which

“side” they are on. It is important for the OBCE to hear from

the wide range of its stakeholders. If I could wish for anything for my

profession, it would be for an enhanced ability and willingness to disagree

without being disagreeable.

I too was concerned by the lack of focus

on the substance of the “Clinical Justification Rule.” In my

view, meaningful discussion was replaced by suspicion, innuendo and appeals to

fear that “chiropractic” is somehow being threatened by this rule

(which by the way was adopted quite some time ago).

I personally was not impressed by the

proponents of the new language as being in the best interests of the

public. And I am concerned about the effect of abandoning an

evidence-based approach to patient outcomes. The “anything goes”

approach implicit in the language of this proposed new rule may give

chiropractors some sense of increased personal and professional freedom, but it

flies in the face of responsible professionalism, IMHO.

In contrast to some who view

evidence-based health care as only the most current

“flavor-of-the-month,” I would suggest that any health care

profession that retreats from science and rational inquiry does so at its own

peril. Supporters of the proposed new “clinical rationale”

rule may in fact win this particular battle, but loose the war of maintaining

this profession as a separate and viable health care option.

As a practical matter as I understand it,

the net result of the Board’s action at the conclusion of the public

meeting last week was to enter (again) into rule making to replace the existing

rule with the text supplied by Drs Boothby and Cafferty. The Board did

not, and could not, “adopt” the new rule without first going

through the formal rule making process At this point, it is not a done deal

that the rule has been “gutted and filled” with the language in new

proposal offered by Drs Boothby and Cafferty.

So, we are starting the process all over

again. If there is concern that the existing rule is good and the

proposed rule is not (or vise versa), then there is opportunity to comment

further during the rule making process over the next few mionths. Plus,

the OBCE will have the opportunity to express their reasons and rationale for

going into rule making (again) on this topic. It should be good reading.

A. Simpson, DC

From:

[mailto: ] On Behalf Of Sharron Fuchs

Sent: Friday, January 20, 2006

2:22 PM

Subject: RE: Thank you

to everyone who spoke at the board meeting

I am a member of the Administrative Rules

Committee. I am not a member of either professional association. I have no

politicized axe to grind. I do not earn money from the practice of

Chiropractic, nor from books, journals or lectures. I maintain a current active

license. I work in a personal injury law firm. Records from Chiropractors

and complaints about Chiropractors come to me not infrequently. I am faithful

to the Chiropractic profession and ,having been in two car accidents, I am

an active Chiropractic patient. Through my work I

continually strive to find common language and

understanding both within our profession and with other

healthcare professions....

By Dr. Jaysun Frisch :

' The original question of

requiring outcome measures seems to be

quite simple in my mind, simply assess what ever you are treating

and track the patient's progress, whether that is declining use of

an inhaler with an asthma patient, subjective report of ability to

concentrate or successfully complete tasks in an ADHD patient (two

examples brought up today) and so on. '

My comments : Exactly.

This question unfortunately was lost in the gross misunderstanding of

the Rule and side taking. Even Dr. Freeman strayed from the question

and although he eventually squeaked out the words that he 'believed

in outcomes' , his dialogue on unrelated issue(s) got

totally mixed up and left confusion and frank bewilderment. Then

anger came out , including some vicious anger by some of the

board members. Then refusal to mediate a compromise....... and

then.... the original justification rule which had been gutted

and filled with new language was passed ! No referral back the

the Rules Committee, no real discussion amongst the Board members.

Nothing. And sadly, what was hard fought and used as substance

to keep managed care out of PIP this last session , was lost.

Imagine the forthcoming backlash.

Don't like or think the legislature can mind our business ? Think again.

I'd bet the person from State Farm who was

present but didn't say a word ,left the meeting shaking their head

and laughing out loud. I can hear it now...........' they should be under

the Board of Medical Examiners '.

sharron fuchs dc

From:

[mailto: ] On Behalf Of Dr. Jaysun Frisch

Sent: Thursday, January 19, 2006

11:10 PM

Subject: Thank you to everyone

who spoke at the board meeting

I would like to thank

everyone that took the time, and spoke today

at the board meeting. As a fairly new doctor with

just a few years

in practice so far, I had not previously been

exposed to some of the

points of view espoused by some of our more

esoteric colleagues. I

had come in support of the existing rules, as I do

not find them to

be restrictive or unreasonable in the least. I had

never heard of

Dr. Boothby before today, and my only previous

interaction with Dr.

Cafferty was during a visit to his office while in

my first quarter

at WSCC. This may anger some, and certainly only

my opinion, but as

Dr. stated so passionately, it seemed that

some of the most

vocal speakers were there with a personal or

political axe to grind,

instead of approaching the topic logically as did

Drs. Freeman and

Snellgrove. I also felt that Dr. Haas greatly

simplified the

definition of EBC (evidenced based care)which

certainly clarified

some of my own misconceptions. While I was not

able to stay to the

end of the meeting, the discourse seemed to really

have revolved

around the a perception of persecution on one

side, and a perception

that a lack of professional ethics and conduct

exists on the other.

The original question of requiring outcome

measures seems to be

quite simple in my mind, simply assess what ever

you are treating

and track the patient's progress, whether that is

declining use of

an inhaler with an asthma patient, subjective

report of ability to

concentrate or successfully complete tasks in an

ADHD patient (two

examples brought up today) and so on. just my two

cents on the

matter. I would love to hear some other

impressions from other

attendees, Thank you again.

Dr. Jaysun G. Frisch, Clinical Assistant

Western States Chiropractic College Outpatient Clinic

January 24, 2006

Thanks Les.

I also have had similar concerns to the "justification" rule and have stated this publicly for some time. I agree with you and am also appreciative that the borad is re-considering.

Sharron this does not seem to be a gut & stuff situation, rather a second look at a rule. Nor , does it seem to signify a retreat from science... just my opinion , Chuck.

As to State Farm... I would ask the question, " Why are they there in the first place?" To "monitor" all those "bad" Dc's. If there cannot be a free exchange of ideas, regardless of opinion, then are we yet a democracy? Or, are we to bow to the theocratic ideaology of the third party payors? (ie, the money gods)

It is a complicated situation for all, yet even as we argue amoungst ourselves, it seems that we usually come up with a reasonable solution to the obstacles that face this great profession.

Respectfully,

Danno

RE: Thank you to everyone who spoke at the board meeting

Hi, Chuck;

With regard to your comment, “The “anything goes” approach implicit in the language of this proposed new rule may give chiropractors some sense of increased personal and professional freedom, but it flies in the face of responsible professionalism, IMHO.”, I don’t find this an accurate characterization of the proposed language changes of that comprise the Clinical Rationale Rule. The changes seem quite reasonable to me and are less about “anything goes”, than they are about being less confining in describing the materials that should be considered in supporting clinical decisions.

Regarding the comment, “I would suggest that any health care profession that retreats from science and rational inquiry does so at its own peril.”, I don’t believe it is reasonable to say that the Clinical Rationale Rule retreats from science and rational inquiry just because it broadens the base of resources and is less biased in determining resources that are appropriate to discussion of clinical justification.

Your comment, “At this point, it is not a done deal that the rule has been “gutted and filled” with the language in new proposal offered by Drs Boothby and Cafferty.” is completely inappropriate characterization of the language changes and I, for one, am happy that the Board is reconsidering the language of the rule.

Your comments strike me as disingenuous and the tone and inaccuracy of your characterizations seem to belie the statement, “If I could wish for anything for my profession, it would be for an enhanced ability and willingness to disagree without being disagreeable.”

I have copied below a letter that I sent to the Board describing problems I see with the Clinical Justification Rule and why the Clinical Rationale Rule is better. You will find a quote from Dr. S.J. Tannenbaum of the College of Medicine and Public Health, Ohio State University, Columbus, Ohio. Dr. Tannenbaum makes very clear some of the false premises that are conscientiously omitted or hidden in the dialog over evidence based medicine. The “take home” information here is that it isn’t about the black and white issue that so many supporters of evidence based medicine would have us believe. And, it isn’t about the paranoia of bunch of greedy clinical incompetents. There is a middle ground of rationality in which health care practitioners can make valid and appropriate clinical decisions that can be identified by reasonable peers in a review of the documentation of the patient’s care. We need to discuss how practitioners can best arrive at a rationale to support clinical management of a patient and how peers can see whether such a rationale exists to support the clinical decisions that have been made in any particular case.

S. Feinberg, D.C.

January 14, 2006

Oregon Board of Chiropractic Examiners

3218 Pringle Road SE #150

Salem, OR 97302-6311

Re: Proposed Clinical Justification Rule 811-015-0010

Dear Committee Members;

I write to the Board in regard to the proposed Clinical Justification Rule 811-015-0010, with the hope that the Board may consider modifications to the rule that may preserve its virtues while eliminating aspects of the rule that are unnecessarily specific or which unnecessarily emphasize one document or consideration over another to support the clinical management of a particular case.

An argument has been put forward that the name of the rule should be changed from “Clinical Justification” rule to “Clinical Rationale” rule. I support the name change to Clinical Rationale rule. The term “justification” is generally known to mean the act of justifying or the state of being justified; a showing or proving to be just or conformable to law, justice, right, or duty. In law, “justification” is taken to mean the demonstration in court of a sufficient lawful reason why a party charged or accused did that for which he is called to answer. This term carries with it meaning that is pejorative and a better term is available. No chiropractor should ever take the position that chiropractic care should be provided to patients without sufficient thought and consideration to what that care consists of and how much care best suits the patient’s clinical need. As a profession, we should describe the way in which such thought and consideration is made. I don’t think there is a good argument against that. The problem I see is simply that there are denotations, not to mention connotations, to the word justification that may be considered accusatory as opposed to discursive or illuminating. The idea of providing justification, supportive lawful reason to support something may lend itself to simple questions of law such as whether a driver has operated a vehicle in concordance with state law. Justification becomes more problematic when applied to the decisions a chiropractor makes in determining what care is best for a given patient. Decision making in the clinical arena is sufficiently more complex and subtle and it lends itself less to justification and more to the reasoned considerations arrived at in forming a “rationale” for chiropractic care. The term “rationale” is generally considered to mean an exposition of principles or reasons. I think an exposition of reasons and principles in support of a chiropractor’s clinical decisions is a better standard to require and is a standard that is more realistic and consistent with the complexities of practice.

As I read the “Clinical Justification” rule, I am also troubled by what seems to me to be an unnecessary specificity and preferential weighting to particular documents that have been generated at various times within our profession. I believe that it would be better to describe in less restrictive terms the kind of materials and reasoning that a chiropractor should reference in supporting clinical management in any particular case. I believe that the changes that have been submitted to OBCE as the “Clinical Rationale” rule are better in this regard. At the end of the day, the argument supporting such clinical management will be seen by those considering the validity of such argument as adequate or inadequate. There is no need to specify OCPUG or any of the particulars of examination and documentation, though that may well be material that is appropriately used in preparing such arguments. Better, I believe, as the Clinical Rationale rule verbiage recommends, to reference those general categories of information and documents generated by the profession that may be appropriate to reference in consideration of case management issues.

The following is excerpted from an article by S. J. Tanenbaum of the College of Medicine and Public Health at Ohio State University. Dr. Tanenbaum makes very clear some of the problems and rational inadequacies of the “evidence based medicine” movement. He demonstrates how inappropriate is some of the logic applied by supporters of the “evidence based medicine” or “outcomes movement”. It is not a question of whether clinical management in allopathic medicine or in chiropractic care of the patient should be reasonable and appropriate. It is more a question of whether or not the form that evidence/outcome based health care proponents put forward for supporting clinical management decisions is valid. Dr. Tanenbaum describes some serious problems in this regard. Please consider Dr. Tanenbaum’s reasoning:

Evidence And Expertise: The Challenge Of The Outcomes Movement To Medical Professionalism; Acad Med. 1999 Dec;74(12):1259-60. Tanenbaum SJ. Division of Health Services Management and Policy, College of Medicine and Public Health, Ohio State University, Columbus 43210-1234, USA.

“The outcomes movement--including evidence-based medicine--challenges medicine as a profession by disputing what and how physicians know. First, the movement considers probabilistic research to be virtually the only way to arrive at knowledge in medicine. Second, it insists on objective or impersonal knowledge (statistically manipulated, hard, aggregate data). Such knowledge does not come from within the professional relationship; rather it is gathered across relationships and is offered to the practitioner from the outside. Third, the outcomes movement is motivated by a desire for certainty, promising definitive solutions that will reduce variation and waste. What professionals know, in contrast, is inherently and irreparably uncertain. Fourth, the movement expects physicians to implement the findings from probabilistic research through application. The inferential leap necessary for treating an individual based on aggregate findings is mostly assumed away. Finally, the outcomes movement promotes rule-based behavior on the part of physicians in an effort, among other things, to eliminate variation in medical practice. But professionals do not follow rules per se--they intuit what is right in a situation, including, sometimes, that it is right to defer to a rule. Professional knowledge in medicine is both larger and smaller than the knowledge conceived of by the outcomes movement. The latter is built of probabilistic research and translated into physician directives. Professional knowledge, in contrast, partakes of statistical knowledge and bench science, as well as various forms of personal knowledge, including the experiential. Physicians will continue to need professional knowledge, which allows for the complexity of physician experience and for the immediacy and individuality of patients.”

I believe that Dr. Tanenbaum has eloquently put forward some thoughts, which I believe support the proposed changes in name and content of the “Clinical Justification” rule as specified by documents recently submitted to the OBCE as the “Clinical Rationale” rule. This change takes our profession in the direction of responsible patient care and avoids some pitfalls inherent in the “Clinical Justification” rule.

Sincerely,

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Chuck Simpson, DCSent: Monday, January 23, 2006 11:14 AMSharron Fuchs; Subject: RE: Thank you to everyone who spoke at the board meeting

Sharron, Jaysun, OR DCs,

For those that were at the OBCE meeting in Portland last Thursday, thanks for participating. I am always impressed by the passion and commitment displayed by chiropractors, regardless of which “side” they are on. It is important for the OBCE to hear from the wide range of its stakeholders. If I could wish for anything for my profession, it would be for an enhanced ability and willingness to disagree without being disagreeable.

I too was concerned by the lack of focus on the substance of the “Clinical Justification Rule.” In my view, meaningful discussion was replaced by suspicion, innuendo and appeals to fear that “chiropractic” is somehow being threatened by this rule (which by the way was adopted quite some time ago).

I personally was not impressed by the proponents of the new language as being in the best interests of the public. And I am concerned about the effect of abandoning an evidence-based approach to patient outcomes. The “anything goes” approach implicit in the language of this proposed new rule may give chiropractors some sense of increased personal and professional freedom, but it flies in the face of responsible professionalism, IMHO.

In contrast to some who view evidence-based health care as only the most current “flavor-of-the-month,” I would suggest that any health care profession that retreats from science and rational inquiry does so at its own peril. Supporters of the proposed new “clinical rationale” rule may in fact win this particular battle, but loose the war of maintaining this profession as a separate and viable health care option.

As a practical matter as I understand it, the net result of the Board’s action at the conclusion of the public meeting last week was to enter (again) into rule making to replace the existing rule with the text supplied by Drs Boothby and Cafferty. The Board did not, and could not, “adopt” the new rule without first going through the formal rule making process At this point, it is not a done deal that the rule has been “gutted and filled” with the language in new proposal offered by Drs Boothby and Cafferty.

So, we are starting the process all over again. If there is concern that the existing rule is good and the proposed rule is not (or vise versa), then there is opportunity to comment further during the rule making process over the next few mionths. Plus, the OBCE will have the opportunity to express their reasons and rationale for going into rule making (again) on this topic. It should be good reading.

A. Simpson, DC

From: [mailto: ] On Behalf Of Sharron FuchsSent: Friday, January 20, 2006 2:22 PM Subject: RE: Thank you to everyone who spoke at the board meeting

I am a member of the Administrative Rules Committee. I am not a member of either professional association. I have no politicized axe to grind. I do not earn money from the practice of Chiropractic, nor from books, journals or lectures. I maintain a current active license. I work in a personal injury law firm. Records from Chiropractors and complaints about Chiropractors come to me not infrequently. I am faithful to the Chiropractic profession and ,having been in two car accidents, I am an active Chiropractic patient. Through my work I continually strive to find common language and understanding both within our profession and with other healthcare professions....

By Dr. Jaysun Frisch :

' The original question of requiring outcome measures seems to be quite simple in my mind, simply assess what ever you are treating and track the patient's progress, whether that is declining use of an inhaler with an asthma patient, subjective report of ability to concentrate or successfully complete tasks in an ADHD patient (two examples brought up today) and so on. '

My comments : Exactly. This question unfortunately was lost in the gross misunderstanding of the Rule and side taking. Even Dr. Freeman strayed from the question and although he eventually squeaked out the words that he 'believed in outcomes' , his dialogue on unrelated issue(s) got totally mixed up and left confusion and frank bewilderment. Then anger came out , including some vicious anger by some of the board members. Then refusal to mediate a compromise....... and then.... the original justification rule which had been gutted and filled with new language was passed ! No referral back the the Rules Committee, no real discussion amongst the Board members. Nothing. And sadly, what was hard fought and used as substance to keep managed care out of PIP this last session , was lost.

Imagine the forthcoming backlash. Don't like or think the legislature can mind our business ? Think again.

I'd bet the person from State Farm who was present but didn't say a word ,left the meeting shaking their head and laughing out loud. I can hear it now...........' they should be under the Board of Medical Examiners '.

sharron fuchs dc

From: [mailto: ] On Behalf Of Dr. Jaysun FrischSent: Thursday, January 19, 2006 11:10 PM Subject: Thank you to everyone who spoke at the board meeting

I would like to thank everyone that took the time, and spoke today at the board meeting. As a fairly new doctor with just a few years in practice so far, I had not previously been exposed to some of the points of view espoused by some of our more esoteric colleagues. I had come in support of the existing rules, as I do not find them to be restrictive or unreasonable in the least. I had never heard of Dr. Boothby before today, and my only previous interaction with Dr. Cafferty was during a visit to his office while in my first quarter at WSCC. This may anger some, and certainly only my opinion, but as Dr. stated so passionately, it seemed that some of the most vocal speakers were there with a personal or political axe to grind, instead of approaching the topic logically as did Drs. Freeman and Snellgrove. I also felt that Dr. Haas greatly simplified the definition of EBC (evidenced based care)which certainly clarified some of my own misconceptions. While I was not able to stay to the end of the meeting, the discourse seemed to really have revolved around the a perception of persecution on one side, and a perception that a lack of professional ethics and conduct exists on the other. The original question of requiring outcome measures seems to be quite simple in my mind, simply assess what ever you are treating and track the patient's progress, whether that is declining use of an inhaler with an asthma patient, subjective report of ability to concentrate or successfully complete tasks in an ADHD patient (two examples brought up today) and so on. just my two cents on the matter. I would love to hear some other impressions from other attendees, Thank you again. Dr. Jaysun G. Frisch, Clinical Assistant Western States Chiropractic College Outpatient Clinic

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January 25, 2006

Danno and All,

As Dr Beebe said, “It is a

complicated situation for all, yet even as we argue amoungst ourselves, it

seems that we usually come up with a reasonable solution to the obstacles that

face this great profession.”

I certainly hope you are right!!

A. Simpson, DC

From: D Beebe,

D.C. [mailto:res0btan@...]

Sent: Tuesday, January 24, 2006

3:58 PM

S. Feinberg, D.C.; Chuck Simpson, DC; 'Sharron Fuchs';

Subject: Re: Thank you

to everyone who spoke at the board meeting

Thanks Les.

I also have had similar concerns to the " justification "

rule and have stated this publicly for some time. I agree with you and am also

appreciative that the borad is re-considering.

Sharron this does not seem to be a gut & stuff

situation, rather a second look at a rule. Nor , does it seem to signify a

retreat from science... just my opinion , Chuck.

As to State Farm... I would ask the question, "

Why are they there in the first place? " To " monitor " all

those " bad " Dc's. If there cannot be a free exchange of ideas,

regardless of opinion, then are we yet a democracy? Or, are we to bow to the

theocratic ideaology of the third party payors? (ie, the money gods)

It is a complicated situation for all, yet even as we argue

amoungst ourselves, it seems that we usually come up with a reasonable solution

to the obstacles that face this great profession.

Respectfully,

Danno

Thank you to

everyone who spoke at the board meeting

I would like to thank

everyone that took the time, and spoke today

at the board meeting. As a fairly new doctor with

just a few years

in practice so far, I had not previously been

exposed to some of the

points of view espoused by some of our more

esoteric colleagues. I

had come in support of the existing rules, as I do

not find them to

be restrictive or unreasonable in the least. I had

never heard of

Dr. Boothby before today, and my only previous

interaction with Dr.

Cafferty was during a visit to his office while in

my first quarter

at WSCC. This may anger some, and certainly only

my opinion, but as

Dr. stated so passionately, it seemed that

some of the most

vocal speakers were there with a personal or

political axe to grind,

instead of approaching the topic logically as did

Drs. Freeman and

Snellgrove. I also felt that Dr. Haas greatly

simplified the

definition of EBC (evidenced based care)which

certainly clarified

some of my own misconceptions. While I was not

able to stay to the

end of the meeting, the discourse seemed to really

have revolved

around the a perception of persecution on one

side, and a perception

that a lack of professional ethics and conduct

exists on the other.

The original question of requiring outcome

measures seems to be

quite simple in my mind, simply assess what ever

you are treating

and track the patient's progress, whether that is

declining use of

an inhaler with an asthma patient, subjective

report of ability to

concentrate or successfully complete tasks in an

ADHD patient (two

examples brought up today) and so on. just my two

cents on the

matter. I would love to hear some other

impressions from other

attendees, Thank you again.

Dr. Jaysun G. Frisch, Clinical Assistant

Western States Chiropractic

College Outpatient Clinic

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Checked by AVG Free Edition.

Version: 7.1.375 / Virus Database: 267.14.22/238 - Release Date: 1/23/2006

January 26, 2006

Dear Minga;

Your heart

and mind are always pointed in the right direction as far as I am

concerned. I’ve always appreciated the special effort you make to

draw everyone into the process when rules are being written and issues decided

by the Board. Your fairness is also a hallmark of your service on the

Board and is much appreciated. I’m sure that in an ideal situation

that discussion would have unfolded in an open manner, presented to the Board

in a timely way, and that the rule in question would have been decided as CR or

CJ and moved through the process of being ratified in an efficient

manner. Perhaps I’ve had my head in the sand in regard to the CJ

rule, but when I was recently made aware of the CR vs CJ issue, I felt that I

needed to say what I did, that the CJ rule carried with it some unnecessary and

potentially troublesome baggage and that the CR rule recommendations said

essentially the same thing in a less biased way. Better to make a late

change, however inconvenient to the rule making process than to find ourselves

stuck for some time with a rule that is flawed. I am very happy that the

Board is reconsidering the rule language and this gives me great confidence

that we have a conscientious board that is representative of the profession.

I don’t

know the context of the history that you have presented about various

personalities that were involved or asked to be involved in the rule making

process that you recapitulated in your post. Certainly, it seems like the

best thing is for all who have an interest in the matter to participate in the

process from the beginning. Writing of the rule, obtaining and integrating

feedback from the field into the process, and producing a rule that is

considerate of that feedback could happen more efficiently and with less wasted

effort, I am sure. Again, I don’t know the particulars of Dr.

Cafferty’s and Dr. Boothby’s participation or lack of participation

earlier in the history of this rule and perhaps they want to say what was on

their minds in regard to the history you have offered. The thing that I

found interesting and somewhat alarming, and the reason for my post to this

forum on the subject, was the tone of Dr. Simpson’s letter. His

comment that the CR rule language was an “anything goes approach” was hardly an honest characterization. His choice of

words like “gutted and filled” and suggestion that the CR language

change was a surreptitious effort to ruin a good rule for shady reasons seemed

like such baloney that I had to speak up. It reflected an attitude that

did not seem open to consideration of the real issues that the CR language

addressed and was more of an ad hominem attack on anyone who didn’t

support the CJ rule, as written. If we are going to bring everyone into

the tent and generate rules and decisions at the Board level that are broadly

reflective of the profession, it is important that we don’t polarize the

debate by our attitudes and language choices. Otherwise we’ll wind

up with as dysfunctional a decision making process as we see coming out of Washington, D.C.

And wouldn’t that be a shame.

Thanks for

all the time and effort you and the other Board members give to our profession.

S.

Feinberg, D.C.

From:

[mailto: ] On Behalf

Of AboWoman@...

Sent: Wednesday, January 25, 2006

5:40 PM

Cc: Jane.Billings@...;

.Bird@...; jwh@...; LoriLindley@...;

drjdm@...; Dave.MCTEAGUE@...; Estelle.C.-Kent@...;

grsdc@...; megehee@... mvissers@...

Subject: Re: Thank you

to everyone who spoke at the board meeting

Les and other listserv,

I wish to respond to this dialogue

from a personal position. My statements are not to be considered the opinion

of the entire OBCE. However, my statements come from the knowledge of

having attended ALL of the 2004-2005; year long process of meetings on the

OBCE, Rules

Advisory

Committee,

and well over 60% of the meetings from 2002-2004 as a member of RAC prior to my

appointment on the board. I am dismayed at the lack of understanding

surrounding the Clinical Justification rule adopted in Jan 2005. (I'll refer to

it as CJ

Rule) The new rule is Clinical Rationale (CR from this point fwd for

ease of typing). I am further disheartened that so few of my colleagues

attended the public sessions that were routinely announced to help craft

language, open debate, and dialogue surrounding this subject matter. It's ok

not to attend if you trust those that are involved in the work to do right by

the profession. I also need to clarify that I'm not opposed to further

discussion, mediation and re-wording of the language with concrete examples of

how it is not working. I've never been opposed to this process of discovering

what's best for the profession in a team effort. (There is a sunset clause in place in the CJ rule.

This means that we can open the language, re-work it to meet the intended

purposes in case it's interpreted or used incorrectly.)

The announcements for all RAC and OBCE meetings were made 30 days prior to each

meeting. They are always open to our stakeholders, this includes public

(patients, doctors, insurance reps, legislators etc). The rule went back and

forth from RAC to the OBCE for almost one year. Prior to the rule even being

considered, there were 2 surveys sent to the chiropractic population. The first

was to CAO members only; of which 99.9% responded with an affirmative approval

to continue work on and support creation of the rule. However, being thorough,

Dr. Saboe then sent a second survey to the entire population of DCs. Of the

responses returned, 89% supported the rule. It was only then that he came to

the OBCE with the proposal to work on the CJ rule. This is the history of the

first CJ rule adopted in January 2005.

In contrast, with the history of the

second rule; ODOC, sent no surveys prior writing the CR rule and further only

sent the written language to the board 2 weeks prior to our meeting on January

19th. We had only 2 weeks to review the language as it pertains to statutory

violation issues. We received in excess of 20 'carry-on letters' this means

they were handed to us or faxed to us within minutes of the meeting. We didn't

have time to review them all. We also received 20 + written comments to read

and discuss in the two weeks prior to the January 19th OBCE meeting. We

received all the written testimony from 2002-2005 in minutes of all meetings to

review. We NEVER had time to discuss the new CR rule with each other on the

board as a collective group. We don't know how it will affect our abilities to

sanction 'undertreatment' issues. Those of you who don't understand the

implications of undertreatment; please ask a colleague to explain how it

relates to IMEs. I have no time to delineate here. We have no idea how it might

pertain to our abilities to protect DCs who are wrongly accused of over

treatment by insurance companies or how it will protect patient rights when a

complaint is filed with the board against an insurance company. We simply

haven't had time to discuss all the possible scenarios this new rule language

might commit us to. The

new CR rule NEVER went to RAC for any discussion by your peers.

Is it good policy to let a vocal minority set a precedent for the silent

majority? You need to consider that and submit a verbal or written comment if

you feel so moved. I can't and won't decide for the entire profession. As board

president, I will simply continue with my volunteer job and work with the rules

my stakeholders present. I'll always do my best to see that a large group of

your peers can participate in creating language, even if it's language I'm not

in agreement with. The

frustrating part of the new CR rule, is that it did not receive

any review by the board or RAC nor was it open to public scrutiny over an

extended period of time as the other rule was. I am

in the minority on the board. I greatly prefer taking TIME to review new

ideas. Time and discussion with my peers has often helped shape ideas I'd not

thought of. It's changed my perspective. Several DCs asked for those present at

the OBCE meeting to consider UNITY in this area, open the floor to further

discussion that might help resolve the conflict and fears over this rule.

I believe it was first requested by Dr. Dean , but many others echoed the

sentiment. I am so grateful to those doctors that vocalized our need for unity.

Shortly after that, Dr. Meghee, a new board member asked Dr. Cafferty,

Dr. Saboe and Boothby if they might be open to unaffiliated professional

mediation to help find a common ground for the unity of our profession. Dr.

Saboe agreed to participate in mediation. Dr. Cafferty refused. I reiterated

the request for the sake of our profession. He refused again. Dr. Snellgrove,

'implored and begged' her exact words, for him to consider the damage to our

profession by not working together. He refused again. He would absolutely not

budge. He didn't attend the year long work to craft, suggest, modify and

give his opinion on the first CJ rule even tho he was invited, as were all DCs

in the state. This type of reasoning is so foreign to me. It appears to be so

closed to change or compromise. Our profession needs unity in this area. If you

have time to attend the next OBCE meeting, it may be your last time to help set

the stage for loving compromise and unity in our profession on this very

difficult issue. Please set aside March 16 if you're at all able to. Bring

concrete ways you think the old CJ rule is not working. Put all your comments in writing if

you plan on speaking. The board needs the comments in writing. Let

us know if you prefer that we have more debate at a rules advisory committee

meeting, if you'd like to personally help to that end or if you feel we should

accept the newly proposed Boothby, Cafferty CJ rule.

Minga Guerrero DC

President, OBCE

In a message dated 1/24/2006 1:32:45 P.M.

Pacific Standard Time, feinberg@... writes:

Hi, Chuck;

With regard to your comment,

“The “anything goes” approach implicit in the language of

this proposed new rule may give chiropractors some sense of increased personal

and professional freedom, but it flies in the face of responsible

professionalism, IMHO.”, I don’t find this an accurate

characterization of the proposed language changes of that comprise the Clinical

Rationale Rule. The changes seem quite reasonable to me and are less

about “anything goes”, than they are about being less confining in

describing the materials that should be considered in supporting clinical

decisions.

Regarding the comment, “I

would suggest that any health care profession that retreats from science and

rational inquiry does so at its own peril.”, I don’t believe it is

reasonable to say that the Clinical Rationale Rule retreats from science and

rational inquiry just because it broadens the base of resources and is less

biased in determining resources that are appropriate to discussion of clinical

justification.

Your comment, “At this point,

it is not a done deal that the rule has been “gutted and filled”

with the language in new proposal offered by Drs Boothby and Cafferty.”

is completely inappropriate characterization of the language changes and I, for

one, am happy that the Board is reconsidering the language of the rule.

Your comments strike me as

disingenuous and the tone and inaccuracy of your characterizations seem to

belie the statement, “If I could wish for anything for my profession, it

would be for an enhanced ability and willingness to disagree without being

disagreeable.”

I have copied below a letter that I

sent to the Board describing problems I see with the Clinical Justification

Rule and why the Clinical Rationale Rule is better. You will find a quote

from Dr. S.J. Tannenbaum of the College

of Medicine and Public Health, Ohio State University, Columbus,

Ohio. Dr. Tannenbaum makes

very clear some of the false premises that are conscientiously omitted or

hidden in the dialog over evidence based medicine. The “take

home” information here is that it isn’t about the black and white

issue that so many supporters of evidence based medicine would have us

believe. And, it isn’t about the paranoia of bunch of greedy

clinical incompetents. There is a middle ground of rationality in which

health care practitioners can make valid and appropriate clinical decisions

that can be identified by reasonable peers in a review of the documentation of

the patient’s care. We need to discuss how practitioners can best

arrive at a rationale to support clinical management of a patient and how peers

can see whether such a rationale exists to support the clinical decisions that

have been made in any particular case.

S.

Feinberg, D.C.

January 14,

2006

Oregon Board of Chiropractic Examiners

3218 Pringle Road SE #150

Salem, OR 97302-6311

Re: Proposed

Clinical Justification Rule 811-015-0010