November - December 2016 CCA Journal | Page 1 · San Joaquin, Santa Barbara, High Desert) [email protected] ... plication of any system there are disconnects and weaknesses

November - December 2016 | CCA Journal | Page 1

Page 2 | CCA Journal | November - December 2016©2016 NCMIC NFL 3474We Take Care of Our Own is a registered service mark of NCMIC Group, Inc. and NCMIC Risk Retention Group, Inc.

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If you selected your chiropractic malpractice insurance plan solely by price, did you consider what the lowest price may have cost you?

Can you be sure that your malpractice insurance will provide the best defense possible when you need it? Or, will they cut corners?

You’ve worked too hard for your reputation and your practice to leave things to chance. Don’t settle for anything less than NCMIC’s Malpractice Insurance Plan for D.C.s.

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When I needed it,

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The CCA Journal, California Chiropractic Association (ISSN 1060-1155) is published six times per year and electronically delivered to CCA members and non-members. © 2016 California Chiropractic Association. All rights reserved.

The Editor and Board of Directors of the CCA assume no respon-sibility for material contained in articles and advertisements pub-lished, nor does publication necessarily constitute endorsement by them. The publisher reserves the right to reject or cancel any ad-vertising for any reason at any time. Manuscripts, photographs and other material submitted cannot be returned. The CCA Journal is the official publication of the CCA. The CCA Journal is owned and published by the CCA for the purpose of promoting Chiropractic and general health progress. Although formally accepting and pub-lishing the reports of the various committees, and the essays read before or submitted to it, the CCA holds itself without responsibil-ity for the opinions, theories, or criticisms therein contained except when otherwise decided by special resolution. The entire contents of the CCA Journal are copyrighted by the California Chiropractic Association. No portion of this magazine may be reproduced, in any form, either in whole or in part, without the written consent of the publisher.

President’s Message

3 CCAPresident’sMessagebyLeslieHewitt,DC

Features

4 GovernmentalAffairsUpdate

6-10 VertebralArteryDissectionandChiropracticCare

13 MedicareUpdate:QualityPaymentProgramBegins

22-23 InsuranceUpdate:AnApproachtoHelpPatients FinanciallyaswellasPhysically

24-29 NewsFromCaliforniaChiropracticColleges

Seminars, Events and Activities

11 CCAE-ZMembershipApplication

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Journal Advisory Board

Darrel Crain, DC, [email protected]

Jay Shery, DCExecutive Committee [email protected]

Dr. Lisa [email protected]

Kayleigh Carey, [email protected]

Cris Forsyth, [email protected]

Advertising SalesSteve Berlin, C&S [email protected]

Vision: Doctorsofchiropracticastheprovidersoffirstchoiceforwellnessandtheoptimizationofhealth.

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Identity Statement:Thechiropractoristheprimarycareprofessionalforspinalhealthandwellbeing.

©2016 NCMIC NFL 3474We Take Care of Our Own is a registered service mark of NCMIC Group, Inc. and NCMIC Risk Retention Group, Inc.

Learn more about NCMIC today. Call 1-800-769-2000, ext. 3120 Or, visit www.ncmic.com/price

If you selected your chiropractic malpractice insurance plan solely by price, did you consider what the lowest price may have cost you?

Can you be sure that your malpractice insurance will provide the best defense possible when you need it? Or, will they cut corners?

You’ve worked too hard for your reputation and your practice to leave things to chance. Don’t settle for anything less than NCMIC’s Malpractice Insurance Plan for D.C.s.

“I would say that if

you are looking to

save money and go

with a cheaper

insurance company,

there is a reason

why it’s cheaper. …

When I needed it,

NCMIC was there.” Marc Rudin, D.C. Lenox, MA

Page 2 | CCA Journal | November - December 2016

CCA Board of Directors

StaffCris ForsythDirectorGovernmentalAffairs&[email protected]

Michelle BancroftAssociateDirectorGovernmentalAffairsext.136mbancroft@calchiro.org

California Chiropractic Association1451RiverParkDr.,Suite230

Sacramento,CA95815

Tel916.648.2727•Fax916.648.2738

E-mail:[email protected]

www.calchiro.org

www.californiachiropractic.com

Facebook:www.facebook.com/calchiro.org

Twitter:@calchiroasn

Kayleigh CareyMarketing&[email protected]

Kimberly DeWeeseDirectorofConventions&[email protected]

Mary WitcraftConventions&[email protected]

Leslie Hewitt, DC, [email protected]

Afshin Kaivan-Mehr, DC, [email protected]

Jay Shery, DC, Secretary & Insurance Department [email protected]

Brian Stenzler, DC, Immediate Past [email protected]

Danny Gambino, DC, Regional Director & Membership Department ChairRegion1Director&MembershipDepartmentChair(SanDiegoCounty,RiversideCounty,SanBernardinoCounty)[email protected]

Tim Gooing, DC, Regional DirectorRegion2Director(OrangeCounty,LongBeach,SanGabrielValley,LosAngelesSoutheastern)[email protected]

Grace Syn, DC, Regional Director & Conventions & Seminars Department ChairRegion3Director&Conventions&SeminarsDepartmentChair(LosAngelesMetro,SantaMonica,SanFernandoValley,VerdugoHills,VenturaCounty,LosAngelesSouthwest)[email protected]

Elizabeth Wisniewski, DC, Regional DirectorRegion4Director(MontereyBay,CentralValley,KernCounty,SanJoaquin,SantaBarbara,HighDesert)[email protected]

Andrew Williams, DC, Regional DirectorRegion5Director(SacramentoValley,ContraCosta)[email protected]

Robert Chatfield, DC, Regional DirectorRegion6Director(SanMateoCounty,SantaClaraCounty,Alameda)[email protected]

Casey Tucker, DC, Regional DirectorRegion7Director(NorthBay,SanFrancisco,NorthState,Redwood,Butte)[email protected]

John Bueler, DC, Director at [email protected]

David Paris, DC, Director at Large & Governmental Affairs Department [email protected]

Keith W. Carlson, Esq., Public [email protected]

Charlene Poderoso, Student [email protected]

Julie [email protected]

Debbie [email protected]


President’sMessage

Have you downloaded and installed theCCA Journal app? It’s totally free.When youaccessthemagazineonline,atwww.CCAjournal.com,youwillbeaskedifyouwanttoviewitinyourbrowserorinthenewapp.Whenyouselectappforthefirsttime,youwillbeabletodownloadyourappfromthestore.Whenthatisdone,youwillbeabletoviewyourmagazineonyourapp,evenwhenoffline.

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By Cris ForsythGovernmental Affairs Director

InAmerica,wearetaughtthatoursystemofgovernmentispredicatedonbalancingpowerthroughaseriesofchecksandbal-ances. Our Executive, Legislative and Ju-dicialbranchesofgovernmentare forcedtowork together, so thatnoonebranch can runamokwithpower.

Congresscreates laws,theExecutive implementsthose laws,andthe judiciaryadjudicates them.Butofcourse, in theap-plicationofanysystemtherearedisconnectsandweaknesses.Forexample,thejudicialbranchhasnopowertoforcecompli-ancewithitsdecisions.Thebureaucracyofgovernmentagen-cies tasked with implementing judicial decisions concerningourlawsofttimesseemawareofthecourtspowerlessnesstocompelaction.

TheU.S.SupremeCourtruledthatseparatebutequalisinher-entlyunequalandruledschoolsmustbedesegregated.Butitwasn’tuntiltheexecutivebranchsentouttheNationalGuardtoenforcetheruling,thatitwasimplemented.

Inchiropractic,thisparadigmhasplayedoutregardingtheDe-partmentofHealthandHumanServices(DHHS)recentconclu-sionthatchiropracticcare ismedicallyunnecessaryafterthefirstthirtytreatmentsandthat$359millionwasspentcover-ingunnecessarychiropracticcareintheMedicaresystem.Theycontendmaximumimprovementhasbeenreachedoncethirtytreatments are provided. That this conclusion is inaccurateisn’tthepoint.Thepoint isthecourtshavealreadyruledonthisissueandDHHSisactingasthoughthatfactisirrelevant.

A2011ClassactionsuitwasfiledbyagroupofMedicareben-eficiariesandothersinaVermontfederalcourt.Inthissuit,itwasallegedthatDHHS“imposedacovertruleofthumbthatoperatedasanadditionalandillegalconditionofcoverage,re-sultinginthetermination,reduction,ordenialofcoverageforthousandsofMedicarebeneficiariesannually.”

Judge Orders DHHS to Comply With SettlementIn the lawsuit, itwas proffered that an “Improvement Stan-dard”wasuniversallyapplied todenycoverage ifapatient’scondition had not improved. As a further consequence, thelawsuit claimed Medicare contractors and claims adjustersweredenyingcoveragegiventheexpectationthatthepatientwas deemed unlikely to improve, regardless that the caremightbenecessarytopreventfurtherdeterioration,ormain-tainthepatient’scurrentcondition.

Thegenesisofthislawsuitstemmedfromaplaintiffwhoneed-edlongtermphysicaltherapy.Thepatient’sdaughterreceivednotice fromDHHS thathermotherhad reachedherhighestpractical levelof independence.Naturally, the family arguedthecontinuedcarewasneeded tomaintain theprogressal-readymade.

In2013The federal court ruled thatDHHSmust educate itscontractorsandprovidersthatthis“ImprovementStandard,”was illegal.Fast forwardto2016andnotonlyhasDHHSnotimplementedthecourt’sdecision, itreleasestheaforemen-tionedreport.InAugustofthisyear,ChiefJudgeChristinaReissoftheUnitedDistrictCourtinVermontruledtheymustlaunchanimprovededucationalcampaign.

Althoughthelawsuitwasn’tfiledbychiropracticpatients,thecourtspecified:Medicaremustcoverskilledcareandtherapywhen they are “necessary tomaintain the patient’s currentconditionorpreventorslowfurtherdeterioration.”Thisdefini-tionisofagenericconceptofongoingcaretomaintainactivi-tiesofdailyliving.

Nowwearefacedwiththedichotomyofafederalcourt’sde-mandsoftheexecutivebranchtocarryoutitsdecisionandtheexecutivebranch ignoring thatdemand. It is clear there is adisconnectbetweenjudicialandexecutivebranches.

Wearetaughtthatourbranchesofgovernmentareco-equalinpower.Weknowfromourhistorythisisn’tentirelyaccurate.We shouldn’t expect it is necessary to involve the NationalGuardinthisinstance.Butwehaveeveryrighttoexpectthebureaucracyoftheexecutivebranchtohonorourconstitution.

GovernmentalAffairsUpdate

Formoreinformationonthistopic:

www.medicareadvocacy.org/medicare-info/improvement-standard/www.medicareadvocacy.org/wp-content/uploads/2016/08/Jimmo-2.pdfwww.cms.gov/medicare/medicare-fee-for-service-payment/SNFPPS/downloads/jimmo-factsheet.pdf

November - December 2016 | CCA Journal | Page 5September - October 2016 | CCA Journal | Page 5


Vertebral Artery Dissection And Chiropractic CareBy Gerard W. Clum, D.C.

On February 4, 2016Ms. KatieMay, awell-knownsocialmediafigurediedofinfarction of the brain that developedsecondary to bilateral vertebral arterydissections.Hercircumstances,priortodevelopmentoftheinfarction,involvedaphoto-shootpositioningtaskthatap-pears to have been the cause of herdissection(s). Shedevelopedneckpainimmediatelyfollowingthephoto-shootandsoughtcarefortheneckpainfromachiropractor.InOctober2016,theLosAngelesCountyCoroner’sreleasedare-portonthedeathofMs.May.Thereportnotedthat“Thecauseofdeathisduetoinfarctionofthebrainduetovertebralarterydissectionduetobluntforceinju-ryoftheneck”thereportcontinued“…forwhichshesoughttreatmentatBacktoHealthWellnessCenter.”

The passing of Ms. Katie May was atragicevent.It’sanimportantclinicalin-cidentfromwhichweneedtolearnasmuchaswecan.Webeginthisdiscus-sionbyofferingourgreatestanddeep-est sympathies to the family of KatieMayandtoherfriendsonheruntimelypassing.

Weneedtoexplorethesecircumstanc-esfromsixdifferentvantagepoints in-cluding:

1.Whathasbeenreportedinthepress.2.Whatwe thinkwe know about thesituationatthispoint.3.Whatisyettobelearnedinthiscaseasevidenceevolves.4.Howdothedetailsofthiscaseasweunderstand them,squarewith theevi-dencethat’sbeenpublishedtodate.5.Whatcanwelearnfromthisexperi-ence.

6.Whatyoucandodifferentlyconsider-ingtheinformationbroughtforward.

1. What has been reported in the press?

For those that have followed this casesince its earliest days in January andFebruary of this year, you know thatthere were reports that Ms. May hadfallenduring aphoto shoot andhad arathersevereinjurytoherneck.Thesereportswere later disputed and it hasbeen asserted by family and friendsthat this was not the case. However,there was a photo shoot. During thephotoshoot,Ms.Maywasrequestedtoholdaposethatcausedhertobe inapositionwithherbackarchedandherneckturnedtothesideforanextendedtime.Immediatelyafterthisactivity,sheexperiencedneckpain.Shewentontoreportinsocialmediathatshethoughtshehada“pinchednerve”followingthephotoshoot.

Itwasalsoreportedinthepopularpressin February and March that Ms. Maysought care from an emergency roomfor the neck pain and discomfort sheexperiencedfollowingthephotoshoot.We now know that this was not thecase.TothebestofourknowledgeMs.May did not attend to an emergencyroominJanuaryorFebruaryofthisyearforherneckpain.Wedoknowthatsheattended to a chiropractor on January27,29,andFebruary1.Wearenotsureif she attended to any other providersalongtheway.

The most thorough discussion of thecircumstancesofMs.Mayandherneckpain we have found to date was pub-lishedonOctober23bythePittsburghPost-Gazette. In this presentation, thereporterreferencedthatMs.Mayexpe-

rienced a high-velocity low-amplitudeadjustment, a low-velocity low-ampli-tudemanipulationandmechanicaltrac-tionwhen she visited the chiropractorin late January and early February ofthis year. It was also reported, in thePost-Gazette,that8hoursaftershewasseen by the chiropractor on February1 that she began to feel progressivelyworseandshedevelopeddizzinessandheadache, numbness and eventuallyslurredspeech.

Withtheavailabilityoftheautopsyre-port that was dictated on February 5,2016 and signed onOctober 21, 2016we now have further insight into thecircumstances of Ms. May followingher presentation to the Cedars SinaiHospitalEmergencyRoominLosAnge-les.At thattimeaCTshowednosignsofhemorrhageandaCTA “showedbi-lateral vertebral artery dissections andleft vertebral artery and basilar arteryocclusionwithstroke.”Tissueplasmino-gen activator (tPA) was administered.ThetPAdidn’tworkandtheclotbustingdrugdidnothavetheeffectthatitwashopedtohave.Attemptsweremadetoperform a thrombectomy on the leftvertebral artery and it was reportedsomeclotwasretrieved.Ms.May’scon-ditionworsenedandsheultimatelysuc-cumbedtothebraininfarctionandwaspronounceddeadonFebruary4,2016.

2. What do we know about the situation at this point?

The “SUMMARYOF EVENTS” stated intheautopsyreportnoted:“ACTscanre-vealedbilateralvertebralarterydissec-tions,whichoccurredafterchiropracticmanipulation.”Thisstandsincontrasttotheopinionsexpressedbyneurologistsreflectingonthiscasethatsawtheori-

ProfessionalUpdate


ProfessionalUpdate

Let’s lookatthebasicnumbersre-latedtovertebralarterydissection.Thenaturalhistoryofvertebralar-tery dissection is approximately 1caseper100,000peryear.Thisisanestimate of the occurrence of thisphenomenoninthepopulationandisnotrelatedtothepresenceorab-senceofanyformofhealthcare.

If we assume in the United Stateswe have a population of 350 mil-lionpeopleandthisoccursatarateof1per100,000,thatmeansonanannual basis in theU.S., therewillbe3,500vertebralarterydissectioncases.Ifweassumethatchiroprac-tors seeabout10%of thepopula-tion,thenthatmeans10%of3500or 350 of these phenomena willlikelycrosspathswithachiroprac-tor. (Thisassumesaperfectlyevendistribution across the populationand a perfect distribution amongthe chiropractic community. Weknowthat’snotrealbutasanillus-tration,let’susethisdata.)

We know from the literature thatthe fatality rate with vertebral ar-terydissectionisapproximately5%,again this is the natural history ofthis condition. Fivepercentof 350is17-18cases.Thissuggeststhat17or18casesofvertebralarterydis-sectionwillcrosspathswiththechi-ropractic profession annually—notbe causedby thembutpresent asdissectionsinprocessthatwillhaveafataloutcome.Thisalsosuggeststhat 332-333 fatal cases per yearwillcrossthepathsofmedicalpro-viders.Remember,thisisthenatu-ralhistoryof thiscondition.This isNOTdataderivedunderchiroprac-ticcare,thisissimplyhowthecon-ditionpresentsinthepopulation.

ginofthedissectionbeingthepositionshewasaskedtoholdduringthephoto-shoot.

The Coroner determined the vertebralarterydissectionyieldingtheinfarctiontobedueto“bluntforceinjuryofneck.”The report goes on to note in the fol-lowing sentence “Initial reports are ofaninjuryoftheneck[poseheldduringphoto-shoot] resulting inneckpain forwhichshesought treatment…”Acare-ful review of these writings can leadtoseveraldifferentconclusions,oneofwhich is the “blunt force injury of theneck” preceded the care rendered bythechiropractoranothercouldtakeittomeanthecareof thechiropractorwasthe“bluntforceinjuryoftheneck.”Any-onefamiliarwithmanualcervicalspinaladjustingprocedureswouldfindithardtoequatetheforcesofthatprocedurewith“bluntforceinjury.”Theliteratureonthestressesplacedonavertebralar-teryduringtheprocessesofanadjust-ment indicate that the forces involvedfallwellbelowthelevelsneededtoin-jureahealthyvertebralartery.

TheautopsyreportofOctober21,2016hascausedquestions, thought tohavebeen answered, to resurface. The au-topsy report notes a series of contu-sionsonthebody.Severalofthesearemost likely associated with the pres-ence of IV lines and other proceduresperformed on Ms. May in the emer-gency room. Of particular interest isthereportof“apurplecontusiontotheleftupperarmandthedistalleftupperarmneartheantecubitalfossa.Ayellowtogreencontusion isnoted to the leftupper chest.” Thesefindingswould beconsistent with a fall as first reportedandlaterdenied.WhencomparedwiththeCoroner’sillustrationaccompanyingthewrittenreportsuspicionincreases.

TheCoronerindicatedthathereliedon

a2007casereport tobasehisopinionthat “bilateral vertebral artery dissec-tion isararecomplicationofneckma-nipulationreportedinoneper100,000toonein2millionmanipulations.”ThespecificreferencemadebytheCoroneris interestingas is the commentmadebytheCoroneraboutthe literaturehecited. The2007 case report byAndresLeon-Sanchez, M.D. did not developfindingsofavertebralarterydissectionon imagingoronautopsy.Onautopsy,inthiscasereport,thevertebralarterywasnotedtobethrombosedbuttherewas no discussion of dissection of theartery.Further,theCoronergrosslymis-statedtheoccurrenceratesofbilateralvertebral artery dissection associatedwithchiropracticcare.ThereisNOliter-aturethatsupportsarateofoccurrenceof bilateral vertebral artery dissectionassociatedwithchiropracticcareasheindicated. Finally, the decision by theCoroner to rely on one of the lowestformsofevidence,acasereport,whileoverlooking case-control studies, case-crossover studies and a meta-analysisallknowntobefarmoreusefulintermsofthepowerbehindtheirfindingsthanasinglecasereport,ispuzzling.

3. What is yet to be learned in this case as evidence evolves?

Importantly,wedonotknowhowMs.MaypresentedforcareonJanuary27.We don’t know what symptoms shepresented with. We don’t know howtheychangedovertheensuingdays.

Wedon’tknowwhatwasdoneby thechiropractor to assess Ms. May whenshepresentedforcare.Weareataverysignificantdisadvantageinunderstand-ingthisinrelationshiptothechiroprac-ticinterface.Wealsodon’tknowwhatcarewasprovidedtoMs.May.Weun-derstand what the reporter wrote on

Continued on next page


October 23 of high-velocity low-ampli-tude, low-velocity low-amplitude ma-nipulationandmechanical tractionbutwe don’t know the details of the careprovided.Wedon’tknowwhattypeofadjustmentsMs.Maywasgivennordowe knowwhat type of traction proce-dureswereused.Wedon’t knowhowsherespondedtocareeachdayasshewentthroughthissequenceof3visits.

We don’t know if she presented withany signs or symptoms that the chiro-practor, or any clinician, should haveprovided a response. This could havebeen a very straightforward presenta-tion as mechanical neck pain with nosignsofneurologicalcomplications.Wealso don’t know if a referral was indi-cated or if the chiropractor made anyrecommendations to Ms. May aboutwhatsheshoulddoinresponsetohercircumstancessuchasareferralforad-ditionalstudiesorcare.

Also,wedon’tknowifMs.Maywasof-feredaninformedconsenttocarepriortothetimethatshereceivedchiroprac-ticcareandiftheinformedconsentof-fereddetailsofanypossibleassociationbetweenvertebralarterydissectionandchiropracticcare.Wedoknowonethingthat did come out from the Coronerhimself-astatementsayinghehasneverseenacaseofthistypeinhiscareer.

Forthistobethefirsttimethathesawsomething of this nature in his careermeansitis,aswewellknow,unique.Italsocausesus toquestion if theCoro-ner had an adequate appreciation forthenuancenatureofthisproblemandwas he aware of the literature associ-atedwithit.

4. How do the details of this case as we understand them, square with the evi-dence that’s been published to date?

This case is very consistent with thepublished scientific literature regard-ing vertebral artery dissection and ap-pearstofitthescenarioofadissectioninprogressperfectly.Theneckpainthepatient presented with on January 27waslikelyasignofthedissectionunder-waywhenshepresentedforcare.

Thecurrentthinkinginthesecasesisasfollows:thepatientdissects,thedissec-tionproducesneckpainandheadache,thepatientseekscarefortheneckpainandheadacheandtheygoontodevel-opemboliandstrokeatessentiallythesameratewhethertheyattendtoachi-ropractorortoamedicaldoctor.Thisisverycriticaltousfullyappreciatingandunderstandingthisdiscussion.

TheresearchthatwasgeneratedbyDr.DavidCassidyetal. in2008wasbasedonfindingsfromthepopulationoftheprovince of Ontario, Canada over a9-yearperiodgeneratingapproximately110millionperson/yearsofdata.Thesedatawereevaluatedforthepresenceofclinical information related to cervicalarterydissection.

What Cassidy found was that whenpeopledissecttheycommonlydevelop

neckpainandheadacheandtheyseekcare for theirpain.Whether theyseekcare from a chiropractor or they seekcarefromamedicaldoctor,theygoonto stroke at essentially the same rate.It is logical for us to assume that themedical doctors of Ontario were notprovidingcervicaladjustmentsandthechiropractorsinvolvedinthecarewereproviding cervical adjustments. Usingthisassumption, ifthereisnoincreaseinrisk,beyondthebackgroundrisk,as-sociatedwithmedicalcareseenamongthe patients under chiropractic care,then it’s logical to conclude thatwhatthechiropractorisdoinginhisorherof-ficeisnotcontributingtothisproblem.This same line of reasoningwas repli-cated in 2015by Kosloff and Eltonus-ingsimilarcriteriaamongMedicareandcommercially insured persons in theU.S. The2015 study resulted inadatapoolequivalentto5%ofthepopulationoftheU.S.anddevelopedfindingscon-sistentwithandreinforcingthefindingsofCassidyetal.from2008.

Thequestionsthatremainatthispointare first, was it possible for the chiro-practor to recognize an evolving dis-section in progress? and second, if so,did the chiropractor fail to recognizeanevolvingdissection?Ms.Maycouldhave presented in a very benignman-nershowingnosignssuggestiveofdis-sectionotherthanneckpain.Thenextquestionthenbecomes,ifshewasadis-section-in-progresspatient,didthecareofthechiropractorworsentheevolvingdissection that the patient presentedwith?

An intriguing question for us as chiro-practors looking at this matter is hadMs.Mayneversoughtcarefromachi-ropractor, had she gone to Starbucks

ProfessionalUpdate

Vertebral Artery Dissection And Chiropractic CareContinued from last page

Relative to physical examination, we were all taught George’s test in school. This test has too many false positive and too many false negatives. It is essentially of no useful clinical value.


insteadof thechiropractor,orhadshegonetoamedicaldoctororthemovies,wouldshehavehadthesamefateinthefinalanalysis?Wedon’tknowthat.Weneedtobecandidinevaluatingthefactsofthiscaseastheyemergeandlearnasmuchaswecanaboutthissituation.

5. What can we learn from this experi-ence?

Firstand foremost,asmuchasweseeneckpaindayinanddayoutanditbe-comesanormalroutineforus,weneedtocontinuetobealerttothepossibilityofdissectioninprogress.

Themostcommonsymptompresenta-tionofadissection inprogress isneckpainandheadache.Wewanttobealerttoneckpainandheadachethathasanunusual origin or unusual character toit.Whenthispresents,youwanttoex-plore the symptoms of neck pain andheadachewiththosepatientsasfullyaspossible.Youwanttolearnasmuchaspossibleaboutthetypeofpainthey’rehaving,thepresentationofthepain,thehistoryofit,howlongtheyhadthepain,whereitcamefrom,howitstarted.Youwant to look foruniquecharacteristicsintermsofthepainanditsintensity.

Patientswhoexperiencecervicalarterydissectioncommonlyspeakofpainthatis “unlikeanyneckpain (orheadache)I have ever had before.” Commentsexpressing thoughts of this nature areimportant for all clinicians to considercarefully. Among patients that experi-enceneckpainandheadachethepaininvolved isusuallyconsistentfromepi-sodetoepisode.Achiropractorwillof-tenhearfromapatient“Ihadoneofmyheadaches lastnight,”orsomethingtothiseffect.Theyknowtheirpain.Whenthey express a totally unique pain oranextremedepartureinthedegreeofthe pain this could be an indicator of

adifferentmechanismoforiginof thepain—suchasanarterialdissection.

Another opportunity for us to learnfrom this critical incident involves so-cial,clinicalvalueandlegalvalueofin-formed consent procedures and docu-mentation.Youcanmaketheargumentthatifthereisnogreaterriskforverte-bralarterydissectionunderchiropracticcare incomparisontomedicalcare for

Informedconsentisnotaslipofpapersigned at the front desk and put intoa file and that’s it. The patient shouldalways have an opportunity to discusswith you any questions or concernsthattheymighthave.Notwiththefrontdeskbutwithyou.Thedeliveryorpre-sentation of informed consent is veryimportantinthetotalityofprocess.

Thethirdstepintheprocessistomakesure your records reflect the informedconsent discussion. The elements in-clude:thedocumentationwaspresent-edtothepatient,thepatientsignedit,youdiscusseditwiththem,theydidordidn’t have any questions, you sign it,date it andmoveon.Obviously,main-tainacopyofinformedconsentsignedby the patient in the patient records.Over time update your informed con-sent as the literature evolves. If youdon’tknowwhere togo togetagoodinformed consent statement or infor-mationaboutthebestpracticesassoci-atedwiththisprocessconsultwithyourstate association legal counsel or yourstateboardofchiropracticexaminerstoassurethatyouarecomplyingwithyourstatelawsandregulations.

ChiroSecurehasdevelopedaveryusefulinformedconsentpacket thatnotonlyprovidesyouwithaninformedconsentstatement for your consideration butalsoprovidesyouwiththebackgroundliterature in summary form to be ableto fullyunderstandandappreciate thenuancesoftheinformedconsentandtobeabletoexplaintopatientstheinfor-mation. Continuingwith the theme ofwhatwecanlearnfromthisexperience,thisisagreatopportunitytoreviewthecurrent literature on this subject: Cas-sidy,2008,KosloffandElton,2015,andChurchandassociates,2016.

Cassidy was the seminal article estab-

ProfessionalUpdate

Continued on next page

personswithneckpainandheadache,howcanwedevelopan informedcon-sent?Thequestionisalsoaskedifthereistheneedforthechiropractortopro-vide informedconsent inpatientswithneckpainandheadache,isthesamere-quiredoftheirprimarycarephysician?

There is an association, whether it’stemporal or statistical, between chiro-practiccareandvertebralarterydissec-tion.Thereisalsothesameassociationbetweenmedicalcareandvertebralar-tery dissection. Association is not cau-sation.Themostrecentliteraturefromearly2016(Churchetal.)found(asdidCassidyandKosloff)noconvincingevi-denceofacausalrelationshipbetweenchiropracticcareandarterialdissection.Nonetheless,intheprocessofinformedconsentoneseekstoerronthesideofcautionand todiscuss associations forthe patient to be fully informed. Im-portantintheprocessofinformedcon-sent is thedeliveryofthe information.

The death of Ms. Katie May was most unfortunate and untimely. We can’t change anything about those circumstances. We can, and we must, learn as much as we can from this exceedingly rare event and to be keenly aware of a similar event in our offices.


ProfessionalUpdate

Vertebral Artery Dissection And Chiropractic CareContinued from last page

lishingtheideathattherewasnogreat-erriskofvertebraldissectionunderchi-ropracticcareincomparisontomedicalcare for patients presentingwith neckpainandheadache.Kosloffwasarepeatof the Cassidymodel usingUS data inamuch larger pool and came upwithevenstrongerresults.Churchpublishedin 2016, and it is very interesting be-cause it comes froma teamof neuro-surgeonsatthePennState InstituteoftheNeurosciences.Theyconcludedthatthereisnocausalrelationshipbetweencervical spine adjusting and vertebralarterydissection.

6. What can you do differently considering the information brought forward in this case?

Whenapatientpresentswithheadacheandneckpain,investigateitmorefully,thenteaseoutandexplorehowthepa-tientisdescribingthepain.Whentheyuseaphrase,somethinglikeorcloseto,“this pain is unlike anything I’ve everhadinmylife,”or“thisisunlikeanykindof neck pain I’ve ever had before,” or“it’s theworst neckpain I’ve everhadbefore,”payverycloseattention.Whentheycomeinandtalkaboutitbeingun-like anything they’ve ever had before,keep inmind they don’t routinely dis-sect their arteries.When they do dis-sectanartery,itproducesauniquepainthattheyveryrarelyexperience.

Thesecondbitofinformationfromthepatient’shistorytokeepaneyeonisafamily history of aneurysm or dissec-tion.Ifthereisahistoryofaneurysmordissection, there’sa5% likelihood thatthatpersonmaybemovinginthedirec-tion of aneurysm or dissection them-selves.

Anotherconsiderationfromthepatienthistory relates to collagen disordersthat lendthemselvestodissection.Forexample, Marfan’s disease. Marfan’sdisease is most commonly associatedwithdissectionoftheabdominalaortabut can involve the vertebral arteries.Osteogenesis imperfecta 1 increasesthe fragility in arteries. Ehler-Danlossyndrome III and VI also demonstrateincreased likelihood of dissection. Fi-bromusculardegenerationincreasesar-terialfragility.Fibromusculardegenera-tionhasthetendencytoappearmoreintherenalarteriesthanthevertebralar-teriesbutitsetsthestagefordissectioninanyarteryofthebody.Wealsowantto pay attention to clotting disorders.Patients with hypercoagulable stateshave a greater risk of thrombi/emboliformationthanthenormalpopulation.

Relative to physical examination, wewerealltaughtGeorge’stestinschool.Thistesthastoomanyfalsepositiveandtoomanyfalsenegatives.Itisessential-lyofnousefulclinicalvalue.Incontrast,taketheopportunitytolistenforbruitsat the base of the neck. If you hear abruit,considerareferralimmediately.Ifyoudon’thearabruit,that’sgood,butit doesn’t mean everything’s free andclear.Continue to lookatwhat’sgoingon.Beon the lookout forneurologicalchanges in general, and neurologicalchangeswithcervicalmotion,whetherthat’sactivemotionorpassivemotion.

What changes should you be lookingfor?Youwant to look for the5Ds, the3NsandtheA.Dizziness,diplopia,dys-phagia, dysarthria, drop attacks, nau-sea, numbness, nystagmus and ataxia.Ifwetakeeverypersonthatseesachi-ropractorbecausetheyhaveadegreeofdizzinessandreferthem,wewouldbe

filling everyMRI facility in the country10timesover!That’snotwhatweneedtodo.Whenyouthinkaboutthingslikedizziness,nauseaornumbness,theyarelessofaconcernindividually.Weneedtothinkabouthowtheycluster.

Whenpatientspresentwithdoublevi-sion, difficulty swallowing, or difficultyspeaking,thesearemajorstrokesigns.Wewanttopayverycloseattentiontothem. Nystagmus is another symptomthatwewant tomoveup the scaleofsuspicion. Be aware of all 9 of thesesymptomcategories.Somearerelative-lyurgent.Othersnotso,butthinkabouttheconstellationandthedevelopmentofthepatternthatthesesymptomsrep-resent.

If you suspect the possibility of a dis-section in progress, referral should bepursued. The urgency of the referralandtheendpointofthereferral—aneu-rologist’sofficeoranemergencyroom—willbedictatedbythecircumstanceof thepatient. Ifapatientrejectsyourrecommendationforreferral,documenttheconversation,noteyourrecommen-dation and the patient’s refusal to goalongwithyour counsel. If thepatientisaccompaniedbyanyone,notethere-jectionofyouradvicetothepatienttothemaswell.

ThedeathofMs. KatieMaywasmostunfortunate and untimely. We can’tchange anything about those circum-stances.Wecan,andwemust,learnasmuch aswe can from this exceedinglyrareeventandtobekeenlyawareofasimilareventinouroffices.Additionally,thisbackgroundinformationwillenableyoutobetteraddresstheconcernsandquestionsofourpatientsandthepopu-lationingeneral.



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MedicareUpdate

RepresentingCalifornia’s Chiropractors

2424 SE Bristol St., Suite 300Newport Beach, CA 92660

(949) 222-2008www.cjattorneys.com

•ProfessionalCorporationFormation

•BoardofChiropracticExaminersDefense

•Multi-DisciplinaryPracticeFormation

•Insurance&MedicareLitigation

•EmploymentCounseling&Litigation

Quality Payment Program Begins January 1st

By Dr. Tracy Cole

ManyofyouarealreadyawarethatthelegislationknownasMACRA or theQuality Payment Programwill fundamentallychangehowtheMedicareprogramoperatesbeginningJanu-ary1st.AswearestartingtoseequestionsaboutthisprogramontheMemberResourceCenter,Iwantedtoaddressafewoftheissueshere.Also,beawarethatIwillbeteachingthistopicalongwithcommonMedicarebilling issuesat theLaQuintabackyardseminarinJanuary.There isalready informationout there that is starting tocir-culateintheprofessionabouttheupcomingchanges.Letmeassure each of you that the information being presented isbasedsolelyonwhatCMShasreleasedsofaraboutthegen-eralchanges.Thereisnoaccurateinformationasofyetonhowsomeof thesechangeswill specificallyaffectusasaprofes-sion.

TheACAhasbeendoingyeomanwork to reviewover2,000pagesofdocumentsonthefinalizedrules.Someexamplesofwhatwedoknow:

•SmallpracticesthatbillMedicarechargesof$30,000orlessORsee100orfewerMedicarepatients(notvisits)peryearwillbeexemptfromthesechanges.

•NewpracticesthatareintheirfirstyearofMedicarepartBparticipationarenotsubjecttoparticipationforoneyear.

•Practicesthatwishtotesttheirsystemsbymakingatleastasmallamountofreportingtotheprogramin2017willavoidanegativeMedicarepaymentadjustmentin2019.

•Thosethatfeeltheyarereadytoreportallmeasuresoratleastenoughmeasuresforonepaymentperiod(90days)willseeasmallpositiveMedicarepaymentadjustment.

•Giventheshortturn-aroundtimeandthelackofclarityfromCMSonthechiropracticmeasures,itisanticipatedthatmostchiropracticofficeswilleitherspend2017testingtheirsystemsorreportinginfulltowardsthelatterpartoftheyear.

Needadditionalassistance?Dr.TracyColewillcontinuetore-leaseinformationasitbecomesavailable.Ifyouhaveaddition-alquestions,[email protected].

Dr.ColewillbeteachingthistopicalongwithcommonMedi-carebillingissuesattheCCABackYardSeminarheldinPalmSprings,January7-8,2017.

Formoreinformationandtoregister,clickhere.

http://cjattorneys.com/

http://calchiroseminars.org/palm-springs.html


NovemberNovember 16 – Santa Rosa CCA-North Bay District Presents 2016 Chiropractic Diagnosis & CPT CodingApprovedfor2mandatedCEhrs:CA-A-15-12-11476Speaker:SamCollinsHyattVineyardCreekHotel&Spa,170RailroadSt,SantaRosaToregister,contactDr.JakeQuihuisat(707)523-9850

November 17 – Foster CityCCA-San Mateo County District Presents Vertebral Subluxation complex with Visceral Concomitant – Applied Chiropractic TechniqueApprovedfor2mandatedCEhrs:CA-A-16-06-12259Speaker:EdCremata,DC,RNFosterCityRecCenter,TheCraneRoom,650ShellBlvd.,FosterCityTo register, https://vsc-and-visceral-concomitants.eventbrite.comorcontactDr.FloydMinana(650)286-4288

November 19-20 – San FranciscoCCA Fall 2016 Right in Your Back Yard 12-hour Relicensing SeminarApprovedfor12CEhours.HiltonSanFranciscoAirportBayfront,600AirportBlvd.,BurlingameCCA MEMBERS:Tosaveyourseat,youmustprovideacreditcardauthorizationintheamountof$25forEnrichment(hospitalityfeaturesmayincludehostedlunch,Wi-Fi,chargingstations,coffeeandtea)and$81foradeposit.$25willbechargedatthetimeofregistration.Ifyouattendtheseminar,the$81depositwillnotbecharged.Registeronlineatwww.calchiroseminars.orgorcallCCAat(916)648-2720,ext.120or141.

November 29 – SacramentoCCA-Sacramento Valley District Presents Continuity of Care Between ProvidersApprovedfor2gen.CEhrs:CA-A-16-10-12811Speaker:ChristopherStephenson,MDSutterClub,12209thSt,SacramentoToregister,contactDr.KaioDoxeyat(209)745-5728

November 29 – San LeandroCCA-Alameda County District Presents Ethics & Law: The Importance of Integrity Approvedfor2mandatedCEhrs:CA-A-16-10-12785Speaker:JamesNaccarato,DC,PhDTheEnglanderSportsPub&Restaurant,101ParrotStreet,SanLeandroToregister:http://alameda-cca.eventbrite.comorcontactDr.DanielleFratellone(925)484-2558

DecemberDecember 3-4 – Redondo BeachCCA & Rocktape Present FMT Basic & FMT Performance Certifications – Levels 1 and 2Approvedfor8gen.CEhrsforeachlevel:CA-A-16-09-12681&-12682Speaker:C.ShanteCofield,PTVSPSouthbay,2607ManhattanBeachBlvd,RedondoBeachToregister,contactRocktapeatwww.rocktape.comor(408)213-9550

December 10 – FolsomCCA & Rocktape Present FMT BladesApprovedfor8gen.CEhrs:CA-A-16-07-12384Speaker:TonyMikla,DPTBurgerPhysicalTherapy,1301E.BidwellSt,#101,FolsomToregister,contactRocktapeatwww.rocktape.comor(408)213-9550

December 10–11 - AzusaCCA & Midwest Rehabilitation Institute Present Shoulder Mechanics:Evaluation&RehabilitationApprovedfor14gen.CEhrs:CA-A-16-10-12815VariousSpeakersAzusaPacificUniversity,910E.AlostaAve,AzusaToregister,contact:www.midwestrehabilitationinstitute.com/event/shoulder-la/orcontactDr.AlexEarl,DCat(331)218-3288

CCA Seminars and Events CalendarCalendar


January 2017January 7-8 – La QuintaCCA Right in Your Back Yard 12-hour Relicensing SeminarWillbesubmittedfor13CEhrs.Topics:Fingernail&TongueAnalysis&Herbs,MedicareUpdates,X-rayLaQuintaResort&Club,49-499EisenhowerDr,LaQuintaCCA MEMBERS:Tosaveyourseat,youmustprovideacreditcardauthorizationintheamountof$25forEnrichment(hospitalityfeaturesmayincludehostedlunch,Wi-Fi,chargingstations,coffeeandtea)and$81foradeposit.$25willbechargedatthetimeofregistration.Ifyouattendtheseminar,the$81depositwillnotbecharged.Registeronlineatwww.calchiroseminars.orgorcallCCAat(916)648-2720,ext.120or141.

January 21-22 - San FranciscoCCA & Rocktape Present FMT Basic & FMT Performance Certifications – Levels 1 and 2Approvedfor8gen.CEhrsforeachlevel:CA-A-16-09-12681&-12682Speaker:StuartWilsonCrunch,61MontgomerySt,SanFranciscoToregister,contactRocktapeatwww.rocktape.comor(408)213-9550

Calendar

Save the Dates:2017 CCA Convention & MarketplaceJune1-4,2017ParadisePointResort&Spawww.calchiroconvention.org

2017 CCA Sports & Rehab SymposiumAugust18-20,2017Disney’sGrandCalifornianHotel&Spawww.calchirosports.org


May we highlightyour practice?

Community Outreach

Patient Success Stories

Volunteer Work

Send details to Kayleigh [email protected]


CCASeminars

Distance Learning CE SeminarsEthics—Online.Speaker:TracyCole,DCApprovedfor2hoursofmandatedCE:CA-A-16-07-12327Topurchasecourse(documentlinkse-mailedout),contactCCAat(916)648-2727,ext.141or120.

ThebelowOnlinecoursesareapprovedforCACEandareavailableviatheCCAwebsite:www.calchiro.orgClickontheEvents&CEtab,thenOnlineLearningonthedropdown.

Online courses (general CE hours unless mandated is listed):•ACase-BasedApproachtoSoftTissueInjury(4hrs)•ActiveCareoftheLumbarSpinefortheHealthCareProvider(6hrs)•AssessmentandManagementoftheHipfortheHealthCareProvider(6hrs)•BloodbornePathogensandCommunicableDisease(2hrs)•ChiropracticCareinPeripheralNeuropathies(12hrs)•ConceptsofaTeamChiropractor(10hrs)•EthicalIssuesinChiropracticPractice(6hrsor12hrs–mandatedCE)•Immunization:MakingInformedChoices(6hrs)•PatientCareinRadiology(6hrs)•PhysicalAssessmentandManagementoftheKnee(6hrs)•ProfessionalBoundariesinChiropracticPractice(6hrs–mandatedCE)•SoftTissueCareinChiropractic(6hrs)•SpecialImagingfortheChiropracticPatient(10hrs)•SpecialPopulationsinChiropractic–TheOsteoporoticPatient(4hrs)

FormoreinformationregardingCCAconventionsandseminars,contactMaryWitcraftattheCCAofficebycalling(916)648-2727,[email protected]




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For SaleMandatoryrequirementforautomaticprocessors-X-RiteSen-sitometerandDensitometer.$800.00-Paid$1500.•Hopeautomaticprocessorwithstand$500.00•5-8x10cassetteswith1/2speedbluescreens-$30/ea•2-14x17cassetteswith1/2speedbluescreens-$40/ea•1-14x17cassettewithhighdetailscreen-$40•Variablebrightx-rayviewinglight-$25•WolfIDflasher-$15CallJohnKosbau,D.C.at(916)955-0512

RETIRING.1996ZenithThompsonmodel0440SPwithpowerfront section.Wellmaintained, likenewupholstery, lowvol-umeoffice-$8000availableNov2016.MettlerSonicator716U/S nearly unused - $800. Intellect Legend Stim 2 channel,nearlyunused - $900.Hydrocollatormodel E-1 limiteduse -$100.CallDr.Homesleyat(530)533-2615.

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Positions Available

CHAIR OF PHILOSOPHY & TECHNIQUE-LifeChiropracticCol-legeWest,Hayward,CA.DoctorofChiropractic(DC)required.Sevenyearsequivalentteachingexperience.AssociateRankorequivalentexperience.Minimumoffiveyearsofpracticeex-perienceforDCs.Businessoracademicleadershipexperience.Pleaseapplyatjobs@lifewest.edu.PleasevisittheLifeChiro-practicCollegewebsiteforfulljobdescription:http://lifewest.edu/about/job-opportunities/

HEALTH CENTER MENTOR-LifeCollegeOfChiropracticWest,Hayward,CA.Musthaveaminimumoffiveyearspracticeex-perience.MusthaveacurrentlicensetopracticechiropracticinCA.MusthaveaclearrecordwiththeBoardofChiropracticExaminersinCAandallotherstateswherelicenseshavebeenheld.Maintainanactivex-raySupervisor&OperatorpermitwithCADept.ofPublicHealth.Pleaseseefulljobdescriptionathttp://lifewest.edu/about/job-opportunities/Toapply,[email protected]

CLINICIAN-PT Faculty - Palmer College of Chiropractic,WestCampus, San Jose,CA.The individual in thispositionwill beresponsible for themonitoringandassessing interns’perfor-manceintheclinicenvironment.Requirementsinclude:Doc-torofChiropracticdegree;3yearsminimumexperienceasafield doctor/chiropractic educator; current/active license forStateofCA.Visithttp://www.palmer.edu/JobOpenings/forfullpostingandapplicationinstructions.

FACULTY – FT DACBR - PalmerCollegeofChiropractic,WestCampus,SanJose,CA.Thisfacultypositionwillincludeassign-mentsinthechiropracticscienceswithanemphasisinradiol-ogyinstruction.DoctorofChiropracticDegreerequired;Diplo-mateoftheAmericanChiropracticBoardofRadiology(DACBR)required; 3 years prior teaching experience preferred. Visithttp://www.palmer.edu/JobOpenings/forfullpostingandap-plicationinstructions.

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SAN GABRIEL VALLEY FOOTHILLS - GREAT OPPORTUNITY. Prac-ticeAvailable.Aftertwenty-threeyears,Iamretiring.Leasemybuilding--includingallequipment--andgetallmypatients’files!This isamostlyWellness,CashPractice—outofnetworkwithall commercial insurance plans. Beautiful, free standingwellequippedofficewithprivateparking. Everythingyouneedtorunapractice—tables,computers,x-rays,staff,USandelectricstimetc.Locatedonamainavenue.Sellerismotivated.Email:[email protected]

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LAGUNA HILLS-Large4000squarefootmultidisciplinaryclinicincludesDC,MDandPTproviders.Collectionsofover1millionon2015.Therehabanddiagnosticequipmentandfurnishingswithavalueinexcessof$485,000.Asking$580kfortheclinictoincludeallaccountreceivables.Ownerwillstayfortransitiontothenewowner.Financingisavailable.ContactDr.PeseauatEpracticesalesbycalling:1(800)227-6603,email:[email protected]:www.epracticesales.com

LOS ANGELES - PRACTICE FOR SALE. Well respected doctorsellinghisPremier32yearpractice,inheartofWestLosAnge-leswithyearlycollectionsexceeding$460,00.00.Veryhighpa-tientretentionandnewpatientvolume.Wellappointed, fullyequipped1,400sq.officespace.Smoothtransitionguaranteed.ContactChiroEquityat908-419-7510orgreg@chiroequity.comforfurtherdetails.

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THRIVING LOS ANGELES BIRTH CENTER IN NEED OF CHIRO-PRACTOR.Newlyremodeledpractitionerrooms.Weare look-ing for someonewhowants togrowapracticespecializing inWomen (includingConception,Pregnancy, Labor,Postpartum)and/orPediatrics.Internalreferrals&opportunitiesforgrowthfortherightpersonwhoreallywantstocreateanameforher-self.Roomrental includessocialmedia&bloggingavailability.Checkoutourcommunity:www.gracefull.comemail:[email protected].

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InsuranceUpdate

An Approach To Help PatientsFinancially as Well as Physically

By Douglas C. FitzpatrickAttorney at Law

Sometimesitseemsthatthegainsmadebytreatmentcanbeoffset,at leastinpart,bythecostofcare,thepatient’stimeawayfromgainfulemploymentandtheinconvenienceofthetreatment process. This is especially true for patients whoare livingon-the-edgefinancially. What, ifanything,canthetreatingchiropractordoabout it?Shouldhealthcareprovid-ersassistpatientsbyguidingthemtoinsurancebenefitsandfinancialremunerationthatmaybeavailableasaresultofaninjury?Howproactiveshouldachiropractorbeindirectingpa-tientstobenefitsofwhichtheymaybeunaware?

Letmesuggestaparadigmshift thatcouldbeawin-win forbothpatientsandchiropractors:

The intake process could include gathering specific and tar-getedinformationthatdirectsthepatienttosourcesofreim-bursementfornotonlyyourfeesbutothercompensationaswell.Often,therearesubstantialbenefitsavailabletopatientsthatareoverlooked.Forinstance,ifyourfeeshavebeenpaidbythepatientwithacheckorcreditcard,whyshouldn’thealsobereimbursedthroughthemedicalpaymentbenefitsofhisautocoverage?Andafteryourfeeshavebeenreimbursedto the patient, why shouldn’t he also pursue compensationfromthedriverwhocausedtheaccident?

Considertheall-too-commonfactpatternwhichfrequentlyre-sultsinsofttissueinjuriestomotoristswhofindthemselvesinneedofchiropracticcareforrelief:Thepatient[“Driver#1”]isstoppedatatrafficlightwhilerunninganerrandforhisem-ployer.Hehasautocoveragewhichincludesmedicalpaymentbenefits.Healsohashealthinsurance.Driver#1isrear-endedbyanothermotorist[“Driver#2”]whoisalsoon-the-jobanddistractedbyanincomingtextmessage.Driver#2andhisem-ployerhaveautomobilecoverage.

Whatarethepotentialsourcesof reimbursementtothepa-tient? 1]Hismedpay coverage; 2]His health insurance; 3]Worker’scompensationbenefits fromhisemployer [remem-ber:thepatientwason-the-jobwhentheaccidentoccurred];4]Driver#2’sautoliabilityinsurancecoverage;5]Driver#2’semployer’s liabilitycoverage[remember: Driver#2wasalsoonthejobwhentheaccidentoccurred].

Theprospectofmultiple recoveries fromdifferent insurancecompanies doesn’t necessarily translate into payments fromeach. But itcould.Thepatientwouldneedtocommunicatewiththeinsurancecompaniestofindoutwhatthepoliciessayabout each insurer’s obligation to paybenefits.Which com-panyisprimarilyobligatedtopayforthecostsoftreatment?Which issecondarilyobligated? Whataretherightsofeachcompanytoreimbursementforbenefitspaid[“subrogation”]?

Itmayturnout,underourhypothetical,thatthepatientisen-titledtorecovertwoorthreetimesforthecostoftreatment.The prospect ofmultiple recoveries for the same charges isfacetiouslydescribedbysomeclaimsadjustersas“doubledip-ping.”Theinferenceisthatthepatientisdoingsomethingdis-honestbybenefittingfinanciallyfromtheaccident.

Ifdoubleortripledippingisavailablebecauseamotoristhaspurchasedprotectionintheformofinsuranceoritisabenefitofemployment,thereisnoreasonwhythepatientshouldnotreceivethosebenefitsANDalsopursuethepartywhocausedtheaccidentforadditionalcompensation.Iftheinjuredmotor-isthasacquiredcoveragefrommorethanonesourcethroughthepaymentofpremiumswithhard-earneddollars,benefitsshouldbepaidinaccordancewiththepoliciesnotwithstand-ingprotestationsof“doubledipping”byclaimsadjusters.

Howgratefulwouldyourpatientsbe if,aspartof the intakeprocess,youpointedthemtobenefitsandinsurancecoverageaboutwhichtheywereunaware?Howmuchgoodwillwouldyougenerateifyouhelpedpatientsfindcoveragetopaynotonlyyourfeesbutcompensationaboveandbeyondyourfees?

Itdoesn’tneedtotakesignificanttimeorenergytoaskques-tions, through the new patient registration process, which

How grateful would your patients be if, as part of the intake process, you pointed them to benefits and insurance coverage about which they were unaware? How much goodwill would you generate if you helped patients find coverage to pay not only your fees but compensation above and beyond your fees?


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promptthepatientto identify insurancecoverageandothersourcesofcompensationwhichwillmitigatethecostoftreat-ment.

Additional informationcanbefoundattheauthor’swebsite,www.selfhelpautoclaims.comalongwithANewPatientBen-efitsInquiryForm,inaPDFformat,whichcanbedownloadedwithoutcost.

Douglas Fitzpatrick studied law at Chicago-Kent College of

Law, the second oldest law school in the state of Illinois. Af-ter graduation, he moved to Arizona where he passed the bar exam in 1977. He taught law at Phoenix College while launch-ing his private practice. He has practiced law in Arizona’s state and federal courts for almost 40 years.

This publication is not intended to serve as a substitute for le-gal, tax or other professional advice. Laws regarding insurance coverage, liability and damages vary from state to state. If le-gal or other advice is required, the service of a qualified profes-sional should be sought.

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LifeChiropracticCollegeWest

Dr. Amit (Jimmy) Nanda ElectedChair of the Board of Regents

The Life ChiropracticCollege West BoardofRegentshasunani-mously elected Dr.Amit (Jimmy) Nandaas its new Chair. Dr.Nandahasservedon

theLifeWestboardsince2014andastheChairoftheGovernanceCommitteesince2015.

The election of Dr. Nanda, which fol-lowedtheappointmentofformerboardChairDr.RonObersteintobecomethecollege’sInterimPresident,isespeciallynotable since he is believed to be thefirstChiropracticCollegeBoardChairofIndianorigin.Dr.Nanda is anOntario-basedchiropractorand founderof theIndia Association of Chiropractic Doc-tors. He has focused significantly onpromotingdiversity–includingthroughenhancedrecruitmenteffortsandinter-national seminars – for LifeWest andthroughouttheprofession.

As a Life West graduate of 2003, Dr.Nanda is deeply committed to shep-herdinghisalmamaterintoacontinuedlegacyofexcellenceinchiropracticedu-cation.Hehasbeenaleaderinhelpingchiropractors expand their practicesandgrowtheir influenceinCanadaforthepast13years.DuringhiscareerhehasownedandoperatedanumberofchiropracticofficesthroughoutCanadaand India and is currently involved in

facilitatingtheexpansionofhealthser-vicesinbothcountries.

The principles of giving, loving, doingand serving have been the bedrock ofDr.Nanda’swork.Hehasbeeninvolvedin many mentoring programs such asanti-bullying and multicultural promo-tions for positive race relations. As apractitioner, he has offered free chiro-practiccaretomilitaryandpolicefami-liesand to those that couldnotaffordcare.Givingback isacorevalueofhislife.

In addition to Dr. Nanda’s election,board member Dr. Kristen Giles waselectedVice Chair of theBoard of Re-gents. Dr. Giles is a 2000 graduate ofParkerUniversity.Shemaintainsaprac-ticewithherhusband,Dr.PaulRuscica,inNapa,California.

Dr. Ron Oberstein Appointed Interim President at

Life Chiropractic College West

Dr. Ron Oberstein, a nationally recog-nized chiropractor and until recentlyChair of the Board of Regents of LifeChiropractic CollegeWest (LCCW), hasbeen named Interim President follow-ingthedepartureofDr.BrianKelly,whoservedasix-yeartermattheNorthernCalifornia institution. The college an-nounced that a presidential searchprocessisnowunderway,andthatthe

BoardofRegentshaselectedmembersJimmyNanda,DC,tosucceedDr.Ober-steinasChair,andKristenGiles,DC,toserveasViceChair.

Dr. Oberstein is a 1981 graduate fromLife Chiropractic College in Marietta,Georgia.Hehasawifewho is a chiro-practor and three daughters – two ofwhom are doctors of chiropractic andone who is currently studying at LifeWest. Dr. Oberstein has left the LifeWest Board of Regents and has as-sumedtheresponsibilitiesoftheOfficeofthePresidentoftheCollege.

BesideshisserviceontheBoardofLifeWest,Dr.ObersteinisapastVicePresi-dentof the InternationalChiropractorsAssociationandcurrently serveson itsboard and is significantly involved inmanyfacetsofengagementandprofes-sional development in the chiropracticcommunity.

Dr.ObersteinstatedthatunderDr.Kelly,“LifeWest has come into its own as anational leader in outstanding chiro-practic education and has significantlyadvancedourmissiontocreateabright-erfutureforhumanity.”

Dr.Oberstein,whoresidesinSanDiegobut frequents the Life West campus,is looking forward toworkingwith theteamatLifeWest.

“IamhonoredandproudtoserveLifeWestinthisnewrole.Thiscollegeistru-ly extraordinary. From theoutstandingfaculty, to the dedicated staff and thebrilliant and passionate students, LifeWesthasalltheingredientstocontinueto educate the very best chiropractorsintheworld.Iamexcitedtocontributetothisamazingcommunity.”

http://lifewest.edu/#&panel1-1


Life West is Proud to Present

Our New Sports Performance

Institute and Sports Chiropractic

Educational Program

Life Chiropractic College West’s SportPerformance Institute is built on thephilosophyofvitalism,whichmakestheprogramunusualinchiropracticeduca-tion. A vitalistic philosophy recognizestheinherentabilityofthebodytoself-organize and heal. This philosophy isespecially valuable to athletes as theypursueoptimalfunction.

Mostpeoplerecognizehowachiroprac-ticadjustmentbenefitsathletesinpainmanagementandrecovery froman in-jury. Professional athletes have slowlycome to rely on chiropractors in theirtrainingandrecoveryteams–but,thereissomuchmorethatchiropracticofferstoallathletes.

LifeWest’sSportsPerformanceInstituteis focused on the belief that a sublux-ation-free athlete will perform better,regardless of pain and injury. In fact,whenundergreatchiropracticcare,theathletewillbelesslikelytobeinjured.Whenweconsiderthepowerfulandin-tricate relationship between the brainand the proprioceptive senses, it be-comes clear that chiropractic adjust-mentsaffectthebodyandthebraininpowerfulwaysthathavesignificantval-ueforanyonewhofocusesonphysicalperformance.

LifeWestisdedicatedtotrainingchiro-practorstobecomepowerfulagents inhelping athletes tomanage their inju-riesandalso toexcel in theirpersonalexpression of health, wellness, vitalityandpeakperformance,by focusingonremovingsubluxations.

Life West’s Sports Performance Insti-tuteisavailabletoourstudentsinthreeparts.StudentscanjointheSPIcluboncampus,takeanSPIelectiveorjointheSportsPerformanceInstitute.

Studentsarementoredbyastrongros-ter of faculty members with years ofexperiencecaringforathletesfrompro

teams andworld class competitors, tohigh school athletes. Our faculty havecaredfortheOaklandA’s,TheCalBerke-leyBears,andmanyOlympicathletes.

LifeWestisexcitedtochangethesportschiropracticworldandsharechiroprac-tic’svitalisticmessagewithathletesev-erywhere.

The India MissionLifeChiropracticCollegeWestisproudtobeapartofaground-breakinginitiativetoexpandtheexperienceofchiropracticinIndia.Indiaisanancientlandsteepedintraditionanddeeplyconnectedtoarichandvibranthistory.ThepeopleofIn-diaarewell-versedineasternphilosophyandveryreceptivetothevitalisticmes-sageofchiropractic.TheentirecountryofIndiahas1.2billionpeopleandonly10full-timepracticingchiropractors.Thepeopleunderstandandareclamoringforouruniqueandeffectiveformofhealthcare.Weareuniquelypositionedtonotonlyprovideexcellentchiropracticcarebuttoalsomentorandshapetheunder-standingandexperienceofvitalistic,subluxation-basedchiropracticcareinIndia.

Forthisproject,LifeWesthasteamedupwiththeIndiaAssociationofChiroprac-ticDoctors (IACD) and the SantNirankariMission. The SantNirankariMissionprovidesamajorspiritual retreat twiceeveryyear (inNovemberandJanuary)whichdrawsover1.5millionpeopletoatemporarycityoverathreedayperiod.Thescaleof service isnearlyunimaginable. It takes60,000volunteers to staffeachevent.Thechiropractictenthasgrownexponentiallywitheachservicetripandneedsmanymoreexperiencedandcaringchiropractorstohelpusprovidecare.We need your help.

Wewelcomeexperiencedchiropractorstojoinusinthisunprecedentedchiro-practicmissionexperience.Youwillbeworkingalongsidechiropracticstudentsasweprovidecareforthousandsofpeopledaily.Thelevelofgratitudeandap-preciationyouwillreceivefromthepatientswillbeunlikeanythingyouhaveeverexperienced.Registeredandapproveddoctorswill haveaccommodationsandtransportationarrangedforthemincountry.Youwillonlyneedtotakecareofyourvisa,yourflightsandyouradjustingtable.Clickhereformoreinformation.

LifeChiropracticCollegeWest

http://lifewest.edu/the-india-mission/


The University has established a rela-tionship with the USOC whereby ourqualifiedsportsmedicineresidentscanparticipate in clinical rotations at theUSOC Training Center in Chula Vista.Theseclinicalexperienceswillbeonsiteatthetrainingcenter,andsupervisedbyUSOCclinicalstaff.

Our chiropractic doctors provide col-laborative,integrative,multidisciplinaryhealth care services to athletes regis-teredattheOlympicTrainingCenterinColoradoSprings,ChulaVistaandLakePlacid. It isourteam’sresponsibilitytoprovide evidence based sports perfor-mancemedicineinsupportofthetrain-ingandcompetitionneedsofeliteanddeveloping National Governing Body(NGB) athletes at the USOTC. It is anhonor to be chosen to be part of theUSOCSportsMedicineTeam.

Dr. Babikian Olympic Rotations

Over the last few years, Dr. AnnieBabikian has had the amazing oppor-tunity to complete several rotationsattwoUnitedStatesOlympicTrainingCen-ters.FirstinChulaVista,CaliforniawithSenior High Performance Health CareProvider, Drs. Kevin Pierce and BrettGuimardandinColoradoSprings,Colo-rado with Dr. Bill Moreau, ManagingDirectorofSportsMedicine for theUSOlympicCommittee(USOC),ChiefMed-icalOfficerfortheRioOlympicSummer

Games, 2016, andClinical Professor atSCU,andDr.DustinNabhan,AssociateDirector,ClinicalResearch&Multidisci-plinaryCarefortheUnitedStatesOlym-picCommittee.

Working at the Olympic Training Cen-terisbotharewardingandeducationalexperience. Chiropractors are highlyvalued and held to a high standard inthe world of Olympics and the rota-tions are an opportunity toworkwithsome of the best chiropractors andsportsmedicinedoctorsintheworldaswellassomeofthebestathletesintheworld.DuringhertimeattheOlympicTraining Centers, Dr. Babikian had thechance to work with athletes heading

tothe2016OlympicGamesinRioandParalympicathletesjustreturningfromParalympictrials.Shesaidthatworkingwith elite athletes is a lot of pressure,“they will be competing in the Olym-pics,sonotonlydoyouwanttoprovidethebestcare,youalsowanttoconsiderwhathasworked for them in thepastbecause they areused to things beingdoneaparticularway.”

For Dr. Babikian the knowledge shegainedduringherrotationisinvaluable.“TheOlympic TrainingCenter is at theforefrontofanynewevidencebeingdis-covered,andduringmyrotationthereIlearnedthemostuptodatediagnoses,examinationsandtreatmentprotocols.”

Therotationsprovidedherwithanewand different perspective as she hadtheopportunitytoobservethethoughtprocessandapproachofotherdoctors,andthenanalyzehowsheherselfwouldhave provided treatment and care. Inaddition,shestatedthatthebestthingshe learned throughher rotationswastovieweverypatientasanathlete,“itisawesometotreatsomeonewhoisrep-resenting our country, who is pushingtheir body to its highest potential andalsobeingabletoutilizethesameskillsandtreatsomeonewhoisnotnecessar-ilyanathletebutwhosebodyrequiresthesamefunctionsandcare.”

Dr. Annie Babikian is a clinical facultymember for SCU’s Spine Care Cen-ter and a Clinical Supervisor at SCUHealth System. She graduated from LaSierraUniversitywithadegree inBiol-ogy: biomedical sciences before earn-ing a Doctor of Chiropractic degreefrom Southern California University ofHealth Sciences. Shehas alwayshad astrong interest in themultidisciplinaryapproach topreventionand treatmentofmusculoskeletalinjuries.Dr.Babikianbecame the inaugural spine care resi-

SouthernCaliforniaUniversityofHealthSciences

SCUHS Establishes a Relationship With the USOC Training Center

Dr. Annie Babikian

http://www.scuhs.edu/


SouthernCaliforniaUniversityofHealthSciences

dent in May 2013 and completed theprograminMay2015.Shehascomplet-edtheDiplomatethroughtheAmericanChiropracticBoardofSportsPhysiciansandiscurrentlypursuingtheDiplomatethrough the Academy of ChiropracticOrthopedics.

Dr. Babikian expressedwhat an honoritwas tobe invitedbyDr.BillMoreautodoarotationattheColoradoSpringsOlympicTrainingCenterandthencom-plete twoother rotations inChulaVis-ta. “I learnedsomuchduringmytimethere and I hope I can bring back theknowledgetosharewithalltheinternsatSCUandutilizeitwithmypatients.”

Dr. Holder Attends2016 Paralympic Games

Sports Medicine Dr. Troy Holder hadan amazing opportunity to work as amedical service volunteer at the 2016Paralympics,intheroleofChiropractor

atthePolyclinicintheOlympicVillage.Dr.HolderisacurrentresidentofSCU’sSportsMedicineResidencyprogram.Hegraduatedin2010fromPalmerCollegeofChiropractorWest,beforeultimatelydecidingtopursueaChiropracticSportsMedicineResidencyatSCUtofulfillhispassiontoutilizehisskillsinhelpingath-letes.

Working at the Paralympics/Olympicsare thepinnacleofSportsChiropracticandforDr.Holdertheopportunity isadreamcometrue.Itrepresentsyearsofhis hardwork anddedication in chiro-practic care. He stated, “Itwas such arewardingexperience,Idon’tknowiforwhenIwillgetanopportunity likethisagain.Tosayitmeanstheworldtomeisanunderstatement.”

During Dr. Holder’s time at the Para-lympics he had the chance to workalongsideatrulyinterdisciplinaryteam.Doctorsandprovidersfromavarietyof

specialties, such as osteopath, physi-cal and occupational therapy, as wellasM.D.s and chiropractors, allworkedtogetherincollaborationforthebestin-terestoftheathletes.

ForDr.Holder,thebestthingaboutgo-ing to the Paralympicswas having theopportunity to work with such a highcaliberofathletesfromadiverserangeofsports.Heprovidedcareforathletesin powerlifting, paratriathlon, rowing,trackandfieldaswellascyclingandsit-tingvolleyball.Hestated,“Itwasgreatgettingtoknowthem,seetheiramazingdedicationandathleticism,andbeabletobepartofitall.”

Dr.Holderalsoexpressedimmensegrat-itudetoDr.JohnScaringe,BillMoreau,Melissa Kimura, andDavid Fosterwhowere all instrumental in helping himachievesuchanamazingopportunity.

SCU at the 2016 USA National Fencing Championship

Thispastsummer,SCUSpineCareDoc-tor, Annie Babikian, and Sports Medi-cineResident,Dr.ParkerDominiqueandTroyHolderhadtheopportunitytoas-sistatthe2016NationalFencingCham-pionship in Dallas alongside SCU alumandDirectorofSportsMedicineforUSAfencing Jeremy Summers. As the larg-est fencing tournament in theworld itdrawsinnearly4000competitorsfromall ages, competing for goldmedals in90 events. Drs. Babikian, Dominiqueand Holder all had the opportunity totreatathletesofallages,fromasyoungas8andasoldas80.Theysawevery-thingfromwrist,elbows,lowbackandshoulder injuries to puncture woodsandconcussions.SCUisproudandhon-oredbytheachievementoftheiralum-niandgratefulfortheirinvitingcurrentSCU residents and doctors to assist ateventssuchasthese.

American chiropractors and a Japanese chiropractor working together at the Polyclinic at the 2016 Rio Paralympic games. Left to Right: Jeremy Busch, Troy Holder, Kaz Isa (Japan), Josue Maysonet, Jason Kim, William (Buddy) Ramsey.


Palmer’s West Campus Hosts Community Town Hall Event With San Jose Mayor Sam Liccardo

PalmerCollegeofChiropractic

Palmer College of Chiropractic’s Westcampus hosted a special CommunityTown Hall event with San Jose MayorSamLiccardoonMonday,Oct.17.Oth-erTownHallparticipantsincludedWestCampus President Bill Meeker, D.C.,M.P.H., and Carl Guardino, CEO of theSiliconValleyLeadershipGroup(SVLG),apublic-policybusinesstradeorganiza-tion that advocates onbehalf ofmorethan 400 prominent SiliconValley em-ployers (including Palmer College) onissues,programsandcampaignsthataf-fecttheeconomichealthandqualityoflifeinSantaClaraCounty.

The Community Town Hall series, co-ordinated through the SVLG, featuresinformaldiscussionaboutvarioussocio-economic issues impacting the SiliconValley,aswelldiscussionspecifictotheregion in which the Town Hall eventis taking place (which, for the Oct. 17event, focusedon thenorthern regionofSanJose,wherePalmer’sWestcam-

pusislocated).TheprogramconcludedwithaQ&Asessionwiththeaudience.

“Palmer was proud to host the Com-munity Town Hall event with MayorLiccardo,andMr.Guardino,whichpro-vided an opportunity for members ofthePalmercommunity,aswellasbusi-ness and residential members of ourneighboringcommunity, tohavedirectinteraction with two prominent lead-erswhoplaykey roles in thedecision-makingprocessthatimpactsthequalityof life foreveryonewho livesorworksinSantaClaraCounty,”saidWestCam-pus President BillMeeker, D.C.,M.P.H.“HostingtheTownHalleventalsopro-videdauniqueopportunitytopromotethe various ways that Palmer impactsthe quality of life in the Silicon Valley,fromourcampus-clinicandnetworkofoutreachclinics,toourbroadparticipa-tionincommunityevents,astheSiliconValleyLeadershipGroup.”

Democractic Congressional Candidate Ro Khanna Visits West Campus

RoKhanna,DemocraticcandidateintheNov. 8 runoff-election for California’s17thCongressionaldistrictseat,visitedPalmer College of Chiropractic’s Westcampusrecentlyforatourofthecam-pus, and to learn more about PalmerCollegeandthechiropracticprofession.The17thdistrictencompassesportionsof Alameda and Santa Clara Counties,includingtheregioninwhichtheWestcampusislocated.

During his visit, Mr. Khanna met withWest Campus President Bill Meeker,D.C.,M.P.H., andwas joined by JamesMusick,D.C.,a1972PalmerDavenport

alumnus who maintains a practice inMilpitas, andalso servesanofficer fortheCaliforniastate-chaptersoftheACAandICA.

“I appreciate Mr. Khanna taking timetovisitour campus for thepurposeoflearningmoreaboutourprogram,andthemanyways thatPalmer serves thecommunity, including our network ofoutreach-clinicsthathavereceivedCon-gressionalrecognition,”saidDr.Meeker.

San Jose Mayor Sam Liccardo (center) participated in a recent Community Town Hall event at Palmer’s West campus, which included West Campus President Bill Meeker, D.C., M.P.H. (left) and Silicon Valley Leadership Group President/CEO Carl Guardino.

Ro Khanna (center), who won the Nov. 8 run-off for the Congressional seat in California’s 17th Congressional district, visited Palmer’s West campus prior to the election, where he met with West Campus President Bill Meek-er, D.C., M.P.H. (left) and James Musick, D.C. (right).

http://www.palmer.edu/clinics/san-jose/


PalmerCollegeofChiropractic

West Alumna Achieves “Dream” Appointment at Walter Reed

Stephanie Johnson, D.C. (West, ’12)was recently appointed as one of thechiropractors providing care for activemilitary-servicemembers in the Physi-cal Medicine and Rehabilitation de-partment at theWalter ReedNationalMilitary Medical Center (WRNMMC)in Bethesda,Md. – becoming the firstwoman to provide chiropractic care attheworld’slargestmilitarymedicalcen-ter.

“Working at Walter Reed is definitelythe dream — my reaction to havingbeen selected as one of the full-timechiropractors is currently an unknownadjective!”saidDr.Johnson,whogradu-atedwithhonors,wasactiveinmultipleprogramsandactivitiesasaWestcam-pusstudent,andserveda termasNa-tionalSACAchair.

Dr. Johnson isproudofherpioneeringappointment–inparticular,soabroad-erbaseofpatientscanbenefitfromchi-ropracticcare.

“It is important to have both womenandmen ina teamof chiropractors toprovideoptionsforpatientpreference,”said Dr. Johnson, whose chiropracticcolleagues include West ’89 alumnus

TerrenceKearney,D.C.,(whohasservedas one of the staff chiropractors since1999),andNameFernandez,D.C.

“In a military hospital, many individu-alsareusedtoonlyseeingamalechi-ropractor, so Ifind itmeaningful tobeawomanonboardtodemonstratethatour strength and skill parallels that ofmen. I find it especially important tobringawomantoateamofchiroprac-torstoserveasan inspirationtootherwomen who are looking for careerpathswithinthehealthfield.”

Dr. Johnson, a California native,was inspired to pursue a position atWRNMMC (which opened as theWal-terReedGeneralHospitalin1909,andishistoricallyknownas“ThePresident’sHospital”)followingherparticipationinPalmer’sVA/DoDInternshipprogramatWRNMMC.

“MyinternshipunderDr.(William)Mor-gan (West, ’85) ranksat the topofmycollective chiropractic experiences,”said Dr. Johnson, who continues toprovidecareforpatientsatherprivatepractice in Annandale, Virginia, twodaysaweek,andalsoservesasanemis-saryfortheFoundationforChiropracticProgress(F4CP).

“The multidisciplinary clinical-setting,the patient demographics, and the sixmonths of high-quality mentorshipwere unparalleled. The capacity toserveatWRNMMCwasincredible,andI knew that if an opportunity were toever arise towork at the hospital,myanswerwouldbearesounding,‘Yes!’”

Dr. Johnson’s patients at WRNMMCarepleasedbytheintegrationofchiro-practiccare intoDoDandVA-managedhealthcenters.

“Many express their appreciation by

making a point to say their chiroprac-ticvisitsarewhattheylookforwardtomost in their day, and comment thatchiropracticistheonlythingthatkeepstheirheadachesaware,ortheirbodiesfunctioning at optimal capacity,” saidDr. Johnson,aRegisteredYogaTeacher(RYT),whocompletedtheMarineCorpsMarathonin2014,andstudiesallformsof dance, including classical ballet andmodern,formorethan20years.

“Myopportunitytocareforactivemili-tary and veterans provides me with aunique and awesome way of saying,‘Thank you for serving to protect thisamazingcountrywegettocallhome’.”

Palmer to Again HaveMajor Presence at SVTT

Since the inaugural event in 1995, theSiliconValleyTurkeyTrothasgrowntobecome the largest timed-event of itstype in the U.S. – and, for the eighthyear in a row, Palmer’s West campuswillplayamajorrole intheThanksgiv-ing-morningevent,whichlastyeardrewmorethan20,000participants,andhasraised more than $5 million for localcharities.

PalmerCollegeisoneoftheSVTTspon-sors;theSportsCouncil(featuringdoc-tors and interns from the Palmer Chi-ropractic Clinics on the West campusin San Jose) provide complimentaryrace-day care; West campus studentsorganize an on-campus canned-fooddonationdrive(insupportoftheSVTT’s“CanDoChallenge”forSecondHarvestFood Bank) – and the multi-segmentPalmer Spine, carriedbyWest campusstudents, faculty and staff, is regardedas“thebackbone”oftheSiliconValleyTurkeyTrot.

Click here for additional informationabouttheSiliconValleyTurkeyTrot.

Stephanie Johnson, D.C., 2012 alumna of Palmer’s West campus – the first woman chiropractor at Walter Reed Medical Center.

http://svturkeytrot.com/


The California Chiropractic AssociationThe CCA Journal magazine

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