Chiropractors, Physicians Hope to End Animosity, Heal Together

Dr. Ben Morovati, a chiropractor and a member of a profession once derided by the American Medical Assn. as quacks, recently earned the right to, as he puts it, sit on the good couch.

Morovati, with four other chiropractors, has opened a clinic at the Thompson Memorial Medical Center--believed by experts to be the first such chiropractic clinic at a hospital in the country.

One of Morovati’s first patients at the new chiropractic clinic was Sharon Skinner, a Burbank grandmother with neck and shoulder pain who is an X-ray technician at Thompson.

“I am a firm believer that chiropractors and medical doctors should work together,” Skinner said after her recent visit at which Morovati told her that the neck and shoulder trouble was causing the mysterious headaches she had been suffering for a year and a half. “I think they both have something to offer,” she said.

For years, that has been a minority view. Morovati, a Glendale chiropractor, describes that early relationship as similar to that between a reluctant homeowner and unfamiliar house guests. “We didn’t automatically assume we could sit on the good couch and put our feet on the table,” he said.

Thompson granted staff privileges to chiropractors a year ago in order to start using a new procedure, known as “manipulation under anesthesia,” in which chiropractors use their skill in making spinal adjustments with the help of medical doctors, drugs and a hospital operating room. The patient is anesthetized so the chiropractor can make more vigorous adjustments of the spine.

Since the late 1980s, chiropractors have earned staff privileges at as many as 150 hospitals, which allows them to perform examinations in hospitals and co-admit patients with the assistance of medical doctors. However, Thompson Memorial is the first hospital in the country known to have taken the relationship with chiropractors to the next level, creating a fully operational clinic staffed only by chiropractors who function within their own department at the hospital.

“Now we’re like two roommates,” said Morovati, although he quickly adds to his metaphor, explaining that in a hospital the medical doctor is still the roommate who holds the lease.

“That’s a first,” said Dr. Jon Buriak, chairman of the American Chiropractic Assn. hospital relations committee. “I don’t know of any other hospital who is doing that.”

Now, the patient who comes into the emergency room after wrenching his back while gardening can be immediately referred to a chiropractor. Don Kennedy, director of physician services at the 105-bed hospital, estimates that about a dozen patients a month ask for a referral to a chiropractor.

By opening the clinic, Kennedy expects the hospital will provide an easily accessible alternative treatment that can be far less expensive and time-consuming than drug treatments and surgery offered by medical doctors.

“It’s an idea that, when you start putting chiropractors into a hospital, becomes a natural thing,” said Dr. Richard Dietzen, a Chicago-area chiropractor, about Thompson’s clinic. “It sounds to me they are actually doing what we were trying to do here.”

Dietzen, who had chaired chiropractic services at Belmont Community Hospital in Chicago, tried to set up a chiropractic clinic in that hospital last year, but the effort fell through. “The timing just wasn’t right,” Dietzen said.

Skinner, 52, is not sure what caused her to develope the problem with her right shoulder and neck. But after a year and a half of physical therapy, which brought her from having 30% use of her arm to about 95%, Skinner was glad to find out her hospital was opening the chiropractic clinic.

“With a physical therapist, they are so booked up you have to take whatever time slot they have available,” said Skinner, who has four grandchildren. “Sometimes you have to wait six months.”

The battle between chiropractors and medical doctors has been raging for decades. In the 1960s the American Medical Assn. even declared it unethical for any of its members to professionally associate with chiropractors. A lawsuit by a group of chiropractors filed in 1976 countered that the AMA policy violated anti-trust laws.

The AMA finally rescinded its policy in 1980. That move would ultimately pave the way for the two groups to make referrals and for chiropractors to win staff privileges at hospitals, giving them the opportunity to co-admit patients.

But that did not end the suit, which continued until 1987, when a federal judge ruled that the AMA boycott had harmed the reputation of chiropractors and forced the AMA to publicly recant its past policy. The terms of the settlement of the lawsuit were not fulfilled until last year, and rifts between the two professions remain.

“Most of the medical doctors don’t understand what chiropractors do,” said Dr. G. Ron Austin, director of chiropractic services at Coast Plaza Hospital in Norwalk. But chiropractors said they have found that once they earn staff privileges, it becomes a prime opportunity to show medical doctors that they can work together.

At Thompson, the first step toward educating doctors about chiropractic was the creation of a manipulation under anesthesia program. This led, eventually, to the full clinic. And now, Kennedy said, the two camps are working together.

“Hopefully, we will be able to close the gap between medical doctors and chiropractors,” he said.

“We study the same things,” said Morovati, explaining that anatomy courses for a chiropractor are similar to those for a medical doctor. “But our approach is more hands-on rather than pharmacological.”

In the past it was more common for a chiropractor to make referrals to medical doctors, but both Morovati and Kennedy hope to turn that trend around.

“What we’re trying to do is get ahead of the game,” said Kennedy, who holds a private theory about where this trend will eventually lead. He hopes that eventually the state will require hospitals to recognize chiropractic services. “It’s just a matter of time,” he said.

Even with increased access to hospitals, Dr. Stephen Capps of Houston, who teaches manipulation under anesthesia procedure across the country, predicts that most chiropractors would not ultimately give up private practice.

But Morovati has discovered many advantages to working in a hospital. X-ray and other equipment are not always available to chiropractors in private practice. And if a patient really needs more care than a chiropractor can offer, he can quickly be steered to physicians at the hospital.

It’s a trade-off. A chiropractor in private practice can set his own hours and generally doesn’t have to worry about the voluminous paperwork a hospital generates. Still, the hospital access apparently adds status.

“We’re in a different stadium now,” Morovati said.