The Joint Committee on
Performance Evaluation and Expenditure Review
Report # 452
A Review of the Board of Chiropractic Examiners
Executive Summary
Introduction
The PEER Committee authorized a review of the Mississippi Board of Chiropractic Examiners. This review is a “cycle review,” which is not driven by specific complaints or allegations of misconduct.
Mississippi law prohibits individuals from practicing chiropractic in this state without a license. The Board of Chiropractic Examiners issues all licenses to practice chiropractic in Mississippi.
PEER sought to determine the effectiveness of the Board of Chiropractic Examiners’ oversight by answering the following questions:
Does Mississippi need a Board of Chiropractic Examiners?
What are the board’s responsibilities in regulating the practice of chiropractic?
Does the board’s licensing process provide assurance of competency of professionals?
Does the board fairly and consistently enforce regulatory requirements?
Conclusions
Does Mississippi need a Board of Chiropractic Examiners?
Yes. Risk factors associated with the chiropractic profession create a need for state government to protect the public. The State Board of Chiropractic Examiners, if it fulfills its function properly, should diminish or eliminate the profession’s potential risk to the public.
State government is responsible for protecting the public’s health, welfare, and safety. When potential risks to these exist, measures such as establishing a board to regulate a profession are available to diminish or eliminate the potential for risk.
The nature of the practice of chiropractic, particularly the use of chiropractic adjustments, presents a risk to the public if practitioners are not properly trained and regulated. State regulation of the chiropractic profession is necessary to reduce or eliminate risk to the public.
What are the board’s responsibilities in regulating the practice of chiropractic?
The board’s responsibilities in regulating the practice of chiropractic consist of licensing professionals and enforcing applicable laws and regulations.
The state’s regulation of chiropractic practice should ensure that chiropractors meet and maintain certain qualifications and competency requirements, act in a professional and competent manner, and comply with laws and regulations governing the profession. Failure to perform these duties could result in negative outcomes such as lack of chiropractor competence.
Does the board’s licensing process provide assurance of competency of professionals?
Yes. Through the use of a national licensure examination and continuing education requirements, the State Board of Chiropractic Examiners assures the competency of practitioners. However, the board has not developed and validated its state jurisprudence exam in accordance with accepted test construction standards.
As is the practice in most other states, the Mississippi Board of Chiropractic Examiners requires candidates to pass all four parts of a national examination prior to initial licensure. The board also requires them to pass its own state jurisprudence exam, designed to test knowledge of Mississippi laws regulating the profession of chiropractic. However, the board has not developed and validated the state jurisprudence exam for chiropractors in accordance with accepted test construction standards.
Does the board fairly and consistently enforce regulatory requirements?
No. Because of its insufficient complaint recordkeeping and tracking process and its reliance on informal methods to sanction noncompliant practitioners, the Board of Chiropractic Examiners does not fairly and consistently enforce regulatory requirements.
Although the board has a complaint process in place, its effectiveness is compromised because the system does not have written policies specifying the logistics of the complaint process, complete indexing to facilitate locating complaint files, or a sufficient complaint tracking system. The board also does not prioritize complaints based on their threat to public safety.
State law enumerates reasons for which the board shall refuse to grant a certificate of licensure or may cancel, revoke, or suspend the certificate of a practitioner. The law further states that any practitioner who is charged with a violation shall be furnished with a copy of the charges and shall receive a formal hearing before the board.
However, since July 2001, the board’s disciplinary actions have relied on consent decrees and letters of advice or guidance to chiropractors. None of these remedies is specifically provided for in statute. According to board officials, the board changed its procedure based on advice of legal counsel in order to expedite handling a backlog of complaints.
Recommendations
The Board of Chiropractic Examiners should ensure that the state jurisprudence exam meets professional testing standards by:
improving content validity (coverage) by including at least two questions from each area of chiropractic law;
improving face validity (presentation) of the licensure exam by editing typographical errors;
reporting items missed to the candidates for their own improvement; and,
providing basic statistical feedback to the board regarding the types of items missed.
The Board of Chiropractic Examiners should develop written policies regarding professional complaint filing and handling procedures. Specifically, complaint-handling procedures should address docketing, assigning case numbers, investigating, and resolving. Complaint records should be maintained for informal, anonymous, and written complaints. The board should also clearly state in its policies what information is available to the public. The board should track and analyze information on informal and anonymous complaints to identify areas of non-compliance or substandard treatment for possible investigation.
As required by MISS. CODE ANN. § 73-6-19 (4) (1972), the Board of Chiropractic Examiners should utilize formal hearings to sanction noncompliant practitioners and document its actions through formal orders in the board’s minutes.
The Legislature should amend § 73-6-19 to allow for consent decrees and letters of advice in any matter not involving quality of care.