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Posted on 08-19-2016

End Of Session Madness

Here we go again.  Like I said last year, there’s March Madness and then there’s end of Session Madness.  With only two weeks left in this year’s legislative session and seemingly everyone in campaign mode, things are heating up under the Capitol Dome.

Tempers are short and fear and paranoia abound, and stress is a five letter word for just another manic Monday.  Most of this is a byproduct of a legislative process that allows for last minute policy decisions to be made, written, placed into legislation and voted on with near zero public scrutiny. 

I recall one year I staffed a bill that had taken two years to get to within a Senate Floor vote of getting to the Governor.  Near midnight of the last day of session, I received a call from a high level staffer in the Speaker’s office.  I was told “Congratulations, your bill is going to go the Governor and this is what it does.”  I have to admit, I was dumbfounded to find out they’d changed the bill so much it hardly resembled what I’d worked to achieve over a two-year period.  Countless hours and negotiations were rendered moot.  When I mentioned this fact the response was, “Oh, you misunderstood.  This was just a courtesy call.” 

Another time bills were being amended and rules waived right and left to the point where legislators had no bill analysis or even a summary of the bill to read before voting.  An author would be given an opening statement explaining the bill and a vote would be taken.  Earlier in the evening, when we actually had a cursory analysis to view, the author’s statement wasn’t on the bill before us for a vote.  I was in the back of the chambers as per usual and pointed this dichotomy out to my legislator who abstained on that vote.

As the evening wore on, it got to the point that my legislator approached me in the back of the Assembly Chambers to ask me what the bills did, and I had to respond I had no idea and suggested he stop voting until someone provided an analysis.  He took my advice and turned off the key on his desk, so no vote could be posted.  Other legislators noticed he wasn’t voting and, asked why, and then did the same.  Soon there weren’t enough votes to pass the bills and we had mini revolt on the Floor with the Majority Leader screaming at my legislator and others coming to my boss’ defense.

It was quite the hullabaloo, and for the first time in my career, session was recessed until policy staff could provide an analysis of what the bills actually did.

I bring this up because it’s the end of session and old school journalists like Dan Walters of the Sacramento Bee always cover this angle, but also because this year it will affect chiropractic directly.

Senate Bill 1160 – Utilization Review and 24-Visit Cap

SB 1160 (Mendoza) will be voted on in the closing days of this year’s legislative session.  This bill currently contains language that would eliminate the 24-visit cap. The Division of Industrial Relations (DIR) is working on putting in language that would not require UR until after the first 30 days for specific care (details of what this care will be is still unknown).  Unfortunately, according to my friends in the know, the language in the bill with respect to the cap will not survive the amendments that are forthcoming. 

Tackling the cap issue in SB 1160 is still considered premature.  DIR is not ready nor are they convinced that eliminating the cap is worth the risk.  They are loosening up UR in the amendments to SB 1160, which I think would further concern DIR if the cap was not in place.  By the time this is all worked out between the Governor’s people, the author, legislative leadership and stakeholders there will next to no time for discussion or review.

I’d like to make it clear that as DIR and stakeholders work on the amendments to SB 1160, no health care providers are allowed in that discussion.  We are not being excluded from these conversations because we are chiropractors, but rather because when it comes to Work Comp, health care providers are considered “vendors” in the system.  Therefore, we, like MDs and all others, are excluded.  This attitude defies logic and I’m as frustrated as I am fascinated by this attitude.  I intend to investigate its roots and work on eliciting a change.  Honestly, in 25 years in the legislature this is the only realm where I’ve seen stakeholders eliminated from providing input.

Tackling The 24-Visit Cap By Other Means

I’ve scheduled a meeting with the Director Christine Baker of DIR on September 6 to discuss the 24-visit cap.  CCA Workers’ Compensation Committee Chair, Dr. Moses Jacob, and committee member Dr. Wayne Whalen, and Monica Miller, will accompany me to the meeting.

I’m also scheduling a meeting with the Secretary of the Department of Industrial Relations to discuss these same issues.  As you may recall, the Secretary and I were staffers together back in the day.

Another issue we have to address is the recently released opioid guidelines featuring alternative care by the  Division of Workers’ Compensation (DWC).  In these guidelines yoga and other modes of alternative care are mentioned, but not chiropractic. Of course, chiropractic is listed in the labor code, but DWC chose not to list us in the guidelines.

This omission has to be redressed and will also be brought up in our conversations with the Director and Secretary.

Assembly Bill 1992 – Pre-Athletic Sports Physicals

Another matter we’ve been working on this week is CCA sponsored AB 1992 (Jones), pre-athletic sports physicals.  As you know, we’ve been trying to find a vehicle in the Senate to place the contents AB 1992 as it died in its first committee hearing.  Sadly, in spite of significant effort by our Senate friends - in particular the Minority Leader, Senator Jean Fuller - we were unsuccessful.

This doesn’t mean we haven’t been working on the issue though.  We intend to reintroduce the bill with a Senate author next year.  In addition, KFB Public Affairs is working to bring this issue to the media in advance of our efforts in the next session.

One opportunity in particular involves Dr. Ken Gilden, long-time CCA member practicing in San Diego. Dr. Gilden is the team doctor for his local high school football team yet the school  district does not  accept pre-sports physicals performed by him or other chiropractors. Dr. Gilden has petitioned the school board many times providing the board with extensive CCA legal and scope information regarding sports physicals. His efforts have been unsuccessful.

This situation came to the attention of one of Dr. Gilden’s players who is also his patient. This amazing young man was so outraged that his chiropractor was not allowed to provide his sports physical, that he decided to take his concerns to the school board himself and testified at a school district meeting.

This young man’s presentation was nothing short of phenomenal, videotaped, and exactly the kind of story KFB Public Affairs is looking for to pitch to the media. We’ve contacted the student’s parents who are happy to make their son accessible to the media. Many thanks to Dr. Gilden for checking in our progress with AB 1992 and providing us with this incredible story.

Having personal examples of how current standards affect real people (in this case Dr. Gilden and his student’s desire to have his physical be performed by his chiropractor) is a story that needs to be heard by the local communities, statewide and the legislature.

Election 2016 Update – Independent Expenditures

I met with our Independent Expenditure Committee consultant this week to go over our strategy for spending $400,000 this election cycle.  We’ve selected four races and devised a specific strategy to maximize our impact on those races. I can’t provide more details, although I’m dying to, due to the Corner’s growing audience.  I expect to dedicate a special edition of the Corner after the election to our seminal efforts, so that chiropractors throughout California will understand the level of sophistication their PAC activities have reached.

That’s all the news that’s fit to print, and some that probably isn’t…for now.

Comments Encouraged!

Did you know you can now comment directly on the Corner? Just look below for the comment box.

I encourage your feedback and questions. I look forward to hearing from you.

©2016 California Chiropractic Association. All rights reserved. Please do not disseminate in part or whole without prior permission. Questions or permission to disseminate? Contact Cris Forsyth at cforsyth@calchiro.org.

Bob Chatfield said:

Chris thanks for that detailed inside look and historical references. These are insights that are not necessarily widely known and I think it's great that as your audience grows the information that you give is more widely shared. People need to really understand this.

2016-08-19 17:38:51

cshieldsdc said:

This is the most leg. activity I'v seen since the days of Phil Brown, dc esq. and the Medical battle. We are in good stead..

2016-08-19 17:48:49

Dorrin B. Rosenfeld said:

Chris, That was a wonderful article and your discussions were so informative and up-to-the-minute. I really feel it was a valuable read and I'm so glad I'm a member of CCA!

2016-08-19 18:25:05

Dr Doug Gerad. said:

CCA makes me proud. You all are incredible!

2016-08-20 16:31:56

Delia Gorey said:

Cris , Thank you again for bringing this information to us so regularly . I so appreciate your historical perspective !

2016-08-20 20:04:22

Delia Gorey said:

Cris , Thank you again for bringing this information to us so regularly . I so appreciate your historical perspective !

2016-08-20 20:04:51

Dr. Brian Porteous said:

Thank you Chris for explaining how a Bill / Sausage is made with out the gore ... wish more DC s cared

2016-08-22 10:19:53

Richard Theobald, DC said:

Admitting I might not know all the details, it is my understanding from what I have read, that we are precluded from performing pre-athletic physicals because we are screening for conditions we do not treat. If this is the case, what value is it to indicate that we treat athletes, either professional or otherwise, and as such should therefore be allowed to perform the physicals. We are not screening the athletes that are treated, we are providing chiropractic care to our patients. That fact that they are athletes is incidental to the argument. We are being discriminating against because other providers are allowed to perform the physicals, despite not treating the conditions that are screened for. It would seem to me that we should argue from that prospective and that legal action might in the end solve this injustice.

2016-08-22 16:58:00

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