Jerry Kopel

KOPEL: DORA RESEARCHERS ON CHIROPRACTIC PRACTICES DROP THE BALL

Sunset review fails to note six deaths

The researchers for the Department of Regulatory Agencies usually do a good job of unearthing all the pertinent background information before making their recommendations to the Legislature, but they aren’t perfect. For example, let’s examine their 2008 Sunset review of the Chiropractic Practice Act.

Present law prohibits “colonic irrigation therapy” under the definition of “chiropractic” — CRS 12-33-102 (1) — and also in CRS 12-33-117 (1) (l), the disciplinary section.

In its review, however, DORA labels that prohibition “outdated.” DORA also fails to explain why chiropractors are forbidden to use this “therapy.”

Here is DORA’s explanation, followed by my parenthetical comments.

“... the current definition includes an unusual provision that eliminates colonic irrigation therapy from the definition of chiropractic.

“The language was added a number of years ago (The 1985 law was amended in 1995 to make the language even stronger.) in response to a problem with a single practitioner. (It was a chiropractic office, and the “problem” was the deaths of six patients. Numerous other patients were made ill.)

“It is very unusual for practice acts to prohibit specific activities in this manner.” (Not so. See CRS 12-27-105, which prohibits administration of drugs by midwives.)

On Page 8 of DORA’s review, the staffer could have — but did not — mention that the 1995 chiropractic amendment to the disciplinary law included changing the violation of “treatment of a patient by colonic irrigation” to add “or allowing colonic irrigation to be performed at the licensee’s premises.” That was added to close a “loophole.” Rep. Paul Weissmann, D-Louisville, is the only 1995 co-sponsor still in legislative office.

The 1984 DORA Chiropractic Sunset Report states, “In 1979 and 1980, there were six deaths and numerous dysentery cases resulting from unsanitary colonic irrigation equipment used in a Western Slope chiropractic office.

“This tragedy and other testimony led the chiropractic board to prohibit the machines from being used unless certain conditions were met, but use of the machines was not prohibited altogether.”

In a 1984 meeting, DORA’s then-director, Wellington Webb, appeared before our Legislative Council subcommittee to urge further changes. His written comments should be in the DORA files on the Chiropractic Practice Act.

He told us:

“I’m sure each of you remembers the six deaths. Although one machine was responsible for the amoebic dysentery causing all six deaths, research by the State Department of Health indicated that several types of colonic irrigation machines are designed in a way that makes it nearly impossible to clean them properly.

“Also, there is no scientific evidence that colonic therapy actually has any therapeutic value. So, there is no demonstrated benefit to the therapy, and yet there is clearly a demonstrated potential for harm.

“It is not known how widespread is the use of colonic therapy in the chiropractic community. It has not been accepted in the medical community for decades.

“The majority of persons providing colonic therapy are unlicensed persons who call themselves colonic therapists,” Webb said, quoting a health department epidemiologist.

Webb agreed the “ban on use of the machines would address only part of the problem.”

But he added:

“On the other hand, the state has given each licensed chiropractor its stamp of approval in return for its expectation that a certain quality of care will be delivered. With respect to colonic irrigations, patients are paying for service without positive results.”

The 2008 DORA report does not include a repeal of disciplinary action when a chiropractic office uses “colonic irrigation therapy.” But the uninformative and inadequate references to “a problem,” and dismissing the
prohibition of colonic irrigation as “outdated” — if not cleared up and exposed by this column — would make any retention of the ban unlikely.

Colonoscopies are done by physicians who specialize in gastroenterology. People who use enemas are warned in print of their potential danger. It makes sense to continue to ban a treatment such as colonic irrigation if there is no demonstrated scientific evidence of benefits to the patients. DORA failed to provide such evidence.

There are 2,640 active chiropractic licensees in Colorado. From July 1, 2002, through June 30, 2007, there have been 364 decisions by the licensing board on disciplinary issues, and 231 complaints were dismissed.

Disciplinary actions totaled 133, including 73 dealing with probation or practice limitations. Of the 133, only 14 were license revocations.

DORA recommends, and I agree, that licensees who draw complaints should be required to answer such complaints. Presently, they are not “forced” to answer and, states DORA, “failure to respond ... prevents the board from obtaining all facts pertinent to the complaint.

“... matters that might otherwise be dismissed may have to be sent to the investigations unit.” DORA suggests failure to respond to a complaint within a specified time be the basis for a disciplinary action.

Jerry Kopel served 22 years in the Colorado House.