Hospital Allows Chiropractors to Treat Patients on Physicians’ Turf

Charles Neault lifts a patient’s left leg and bends it. “Does that cause pain?”

“Yeah,” grunts Gerald Addis, 36, who is flat on his back, grimacing with discomfort, at Canoga Park Hospital.

Neault nods knowingly. “Positive for leg pain,” he tells an assistant taking notes.

This may look like a standard physical examination, but there’s nothing routine about it. The balding man, whose nickname is Dr. Chuckles because of his sense of humor, is no medical doctor. He is a chiropractor leading an invasion of spinal biomechanics, as they sometimes call themselves, into the sacred domain of the physician.

The 72-bed hospital says it is the first in the state to welcome chiropractors, who have long been ostracized by the medical profession. Now, Neault and 29 other chiropractors can, with the approval of a staff physician, put patients in the hospital and treat them there. The hospital has even installed a special chiropractic flex table in a converted hospital room.

Hospital Staffs

“A lot of people are surprised that we would do this,” said Barbara Meyers, administrator at Canoga Park. Some hospital staffs might oppose opening their doors to people the American Medical Assn. had branded as quacks, but members of the board of directors at Canoga Park “have a lot of courage,” she said.

If it is courage, it seems to be spreading. Pacific Hospital of Long Beach is about to offer the same privileges to chiropractors. And the California Chiropractic Assn. predicted that a federal court ruling that the AMA had participated in an illegal 20-year boycott of chiropractors will help break down the barriers at other hospitals.

There are 7,000 licensed chiropractors in California, and their association says its surveys show that one in seven people in the state visited a chiropractor within the past two years.

Chiropractors trace their antecedents to Hippocrates, the ancient Greek physician, who they say wrote books on the subject. But experts say modern chiropractic dates back about 100 years to a grocer and “magnetic healer” named D. D. Palmer, who proposed spinal manipulation as a cure for various ailments.

The AMA has for decades denounced the practice as “quackery and cultism,” and in 1967 declared it unethical for physicians to be professionally associated with chiropractors.

Four chiropractors later filed suit. On Aug. 27, 1987, U.S. District Judge Susan Getzendanner ruled that the AMA’s anti-chiropractic campaign amounted to a conspiracy and boycott, and violated antitrust law.

Ruling in Illinois

“Keeping chiropractors out of hospitals was one of the goals of the boycott,” Getzendanner said in her ruling, handed down in Illinois.

Chiropractors say the ruling vindicates them. The AMA now flatly refuses to comment on chiropractors “or any other alternative form of medicine.”

The ruling aside, money is one reason for bringing the chiropractors in from the cold, hospital officials say. A tour of Canoga Park Hospital showed many rooms empty and one wing closed.

And hospital officials say empty beds do not pay the salaries of nurses, therapists, doctors and administrators. Tighter Medicare rules on what treatments will be covered by the government have made it difficult for many hospitals to keep patients in those beds, officials say.

Dr. Russell Shields, chairman of the board of directors at Canoga Park, said giving hospital privileges to chiropractors helped rescue an ailing Michigan hospital recently. He said he hopes that chiropractors can bring in enough patients to improve profits at Canoga Park, which has had “marginal profitability.”

More Patients Than Expected

“As the board chairman, my primary interest is to see that the bottom line stays black,” Shields said. No figures were available on the number of patients brought in by the chiropractors since the program began in September, but Shields said the number has exceeded expectations.

“It’s rather interesting what the desire for money will do to people,” Dr. Richard Johnson, chairman of the editorial board of California Physician magazine, said when told about chiropractors in hospitals.

“This is capitalism,” Shields said. “Every hospital in town has felt the economic crunch.”

But he denied that money is a primary reason for starting the programs at the Canoga Park and Long Beach hospitals. In his view, chiropractors are professionals who have long been discriminated against. “For once, they’re being respected,” he said.

Since state law forbids putting chiropractors on staff, the chiropractors brought into Canoga Park Hospital are known as “allied health professionals.” They are not yet equal partners with the medical staff. Neault’s patients must be admitted to the hospital by a supervising physician, and the chiropractor cannot order medication for his patients or issue instructions to the nurses.

Neault said chiropractors are not obligated to put a specific number of patients in the hospital to keep their affiliation with the facility. But he said each approved chiropractor is on provisionary status until he brings in five cases.

Canoga Park turned away some chiropractors after they claimed that they could cure gall bladder problems and diabetes, said Dr. Paul Diehl, an internist who oversees several of the 30 chiropractors with hospital privileges.

Pacific Hospital in Long Beach originally planned to take a step beyond the San Fernando Valley hospital by putting chiropractors on staff with physicians. But the state Department of Health Services quickly scotched the idea, warning in an April 27 letter that chiropractors are not on the list of practitioners allowed on a medical staff.

Now, the health department plans to send an investigator to scrutinize Canoga Park’s operation. Teresa Hawkes, deputy director of the department’s licensing and certification branch, said she wants to make sure that the hospital has adopted “appropriate policies and procedures” to guarantee the safety of patients.

Windfall Profits

Though his hospital plans to grant chiropractors the same status as did Canoga Park, Gerald Goldberg, administrator at Pacific, was not optimistic that chiropractic patients would generate windfall profits.

“Visions of chiropractors admitting a lot of patients with low back pain is unrealistic,” he said. “I don’t think it’s going to happen.”

Pacific decided to bring them in, he said, because it has a history of open-mindedness. Nurse-midwives have worked there for four years, he said.

Goldberg admitted that the decision has met with some staff opposition. Nonetheless, he said, he knows of other hospitals that are considering bringing in chiropractors.

Diehl, 29, said he is not affected by the old prejudices. “I think there’s a place for chiropractors,” he said.

The California Chiropractic Assn. cites a Washington state study published in the May issue of the American Journal of Public Health as evidence that people such as Diehl are not that unusual. The survey shows that only 3% of family doctors feel that chiropractors are quacks whom patients should avoid.

The majority, 66%, said they are uncomfortable with what chiropractors do but believe that they are effective for some patients.

Herniated Disc

But neither Neault nor Addis could be sure that the treatment would be effective in his case. The Moorpark man was advised by an orthopedic surgeon that he should undergo surgery for a herniated disc. Instead, he went to Neault’s Simi Valley office.

“I’m looking for an alternative before surgery,” Addis said.

Neault put him in the hospital for three days of rest and back manipulation on the flex table. Neault said he hoped to stretch the back and cause material that had seeped out of the disc to be sucked back in.

Addis walked out saying he felt better than when he walked in. However, there was no guarantee that Addis could avoid surgery, though he and Neault were optimistic.

“Some chiropractors have never stepped into a hospital except as a patient,” said Neault, reflecting on his new-found status. “This is a whole new experience.”

Having worked as a lab technician in a hospital, Neault is not as awed as some may be. But he admits to being “excited about this step. It’s just the inevitable future.”