OVERVIEW The Medical Director for USA Boxing is interesting in expanding ringside physician opportunities for Chiropractors.  He is very enthusiastic about this.  Unfortunately, this information was passed on to the CEO of the FCA (Florida Chiropractic Association) who doesn't quite share the same enthusiasm.   THE CHIROPRACTIC CRUSADER A ROADMAP TO BECOMING A MAJOR PLAYER IN HEALTHCARE                                                                              BY FRED BECK, D.C.              EXPANDING PRACTICE OPPORTUNITIES IN THE WORLD OF SPORTS                                                MORE LOST OPPORTUNITIES  Part 1 of 2        I’ve performed as a ringside physician for the last seven years at the Florida Silver Glove boxing championships as well as the last few Junior Olympic boxing championships held in Florida.  At the Junior Olympic tournament in June of 2006, the national medical director for USA Boxing approached me.  He was interested in utilizing my services as a ringside physician to a fuller extent at additional events including many events held outside the United States.  He made it clear that hotel, airfare, food, and payment for providing ringside physician services would all be provided.  Unfortunately, I would need to get a rule change in regards to the bylaws of the Florida Boxing Commission.  This rule change would positively effect all Chiropractors in Florida that sit ringside or are interested on becoming ringside physicians.      USA Boxing, is the national governing body for Olympic-style boxing, It is the United States' member organization of the International Amateur Boxing Association (AIBA). USA Boxing is responsible for the administration, development and promotion of Olympic-style boxing in the United States.      USA Boxing sponsors many programs including the development of the sport and its athletes at the local, regional, and national levels.  They sponsor national and international dual competitions and select teams for international events, including the Olympic Games, World Championships, and Pan American Games.  USA Boxing, formerly known as the United States Amateur Boxing Federation, has governed men's amateur boxing in the United States since 1888. USA Boxing sponsors not only national and international competitions, but also clinics and training camps to help athletes and coaches learn international techniques.      Although I’ve acted with full authority as a ringside physician, it is presently a requirement that an M.D. or D.O. be present and they must sign off on my examinations and recommendations.  I’ve been fortunate that the M.D.’s and D.O.’s that sit ringside know me and trust my judgment.  They do not hesitate to sign off on my examinations and recommendations.      I perform pre-fight examinations and post-fight examinations.  I sit ringside and can stop a fight if necessary.  I administer emergency first aid; make a differential diagnosis of the injury sustained; and make recommendations on additional care if needed.  I make determinations at the pre-fight physical if the fighter is healthy and fit to box that day.  If my thorough examination indicates otherwise, the boxer is not allowed to compete.  If a boxer competes and is injured, I can put the boxer on a disabled list and require various tests and examinations be performed before being allowed to box again.      The medical director of USA Boxing has a high respect for Chiropractors he has worked with and is quite interested in getting us parity with the allopathic physicians in the sport of boxing.  This in turn would enable him to utilize our services more often.  I told him that I would relay that information to the Florida Chiropractic Association (FCA).  He told me that we would have his full support.  I met with the CEO of the FCA Debra Brown at the FCA Sarasota Convention later that month.  At that meeting, which was one on one, I discussed numerous Chiropractic issues in addition to the boxing issue.  I handed her complete files that included: documentation, contacts, correspondence, strategies etc, for each of the issues discussed.      At the meeting that I had with FCA’s Debra Brown there were four major issues discussed.  Issue one was the invite we had received from the Joint Commission of Accreditation of Hospitals to discuss my proposal of making Chiropractic a mandatory service at every U.S. hospital accredited by the Joint Commission.  I had been successful in getting my point across to the Joint Commission that the vast majority of hospitals in the United States were denying staff privileges to Chiropractors. And that Chiropractic care is a non-duplicated service and therefore not available from other hospital staff members.  Preventing Chiropractors from obtaining hospital privileges results in inferior care at the hospitals since Chiropractic research demonstrates such care to be the treatment of choice and sometimes the only effective treatment for various ailments. It was clear that even though the Joint Commission maintained a neutral position in regards to Chiropractors obtaining hospital privileges, the Commission was aware that Chiropractors were almost always being denied hospital privileges. It was my opinion that the Joint Accreditation of Hospitals was the only medical organization capable of fixing the problem.  Although the Commission maintained a neutral position, it was the Commissions own inaction that has allowed the hospitals to maintain a medical monopoly and unfairly prevent Chiropractors from obtaining privileges at member hospitals.  It was clear, that if the Wilk trial were held today the Joint Commission on Hospitals would have a hard time in defending itself in a anti-trust action.  The Commission understood my stance and was open to discuss this problem with the American Chiropractic Association.  Prior to talking to Debra Brown I spoke to the Joint Commissions general counsel, Harold J. Bressler, Esq. that told me the ACA had not contacted him even once in all these years to discuss my proposal with him.  At my meeting with Debra Brown I stated my opinion that I thought that the FCA should demand an answer as to why the ACA had failed to call the Joint Commission to set up a meeting to discuss my proposal.  I also offered the suggestion that if the ACA was unwilling to meet with the Joint Commission on Accreditation of Hospitals, the FCA might want to take some action on their own and meet with them.  Let’s face it; someone should be out there representing our profession when potential practice opportunities become available.      The second issue discussed with FCA CEO Debra Brown was the Social Security Disability Examination issue we discussed in an earlier column.  I had local, state, and regional Social Security personnel that believed that Chiropractors should be utilized to perform Social Security Disability examinations.  Paul Lambert, Esq., general counsel of the FCA, along with the ACA, met with the Social Security Administration and had a disastrous meeting.  I felt that this meeting was sabotaged from the get go.  I was upset why the FCA and ACA had not invited me or any of my high level Social Security Administration contacts to the meeting.  I did mention to Debra Brown that I thought that presently this is probably a dead issue since the FCA and ACA had done more damage than good at the meeting with the Social Security Administration.      The third issue discussed was my opinion that the FCA should be taking a more proactive position with Florida Special Olympics.  We have a very good relationship with the Florida Special Olympics and I thought we should not be taking that for granted.  I believe we should routinely let them know that as a profession we are there for them.  We should be nurturing our relationship with them.  Lets face it.  This profession is somewhat short on friends, so when you have one you should not take them for granted.  I’ve taught classes for the FCA in regards to the examination of special needs children and adults. At my classes I review the examinations and paperwork required to allow a Special Olympic athlete to participate in the Special Olympics.  I’ve provided Special Olympic Examinations to athletes in the Broward County School system for a number of years.  In addition, I’ve provided examinations to adult athletes at Goodwill Industries.  I’ve been nominated for Volunteer of the Year by the Broward County Special Olympics.  I have had extensive experience working with emotionally and mentally challenged children in both a recreational and educational setting.  I suggested to Debra Brown that the FCA offer another Special Olympics class at the National FCA Convention in Orlando, to be held 14 months later in August 2007.  I was not contacted to teach this class nor was such a class offered at the August 2007 convention.      The fourth topic discussed was the enthusiasm that the medical director for USA Boxing had in regards to expanding the role of Chiropractors as ringside physicians.  What happened?  I will discuss that in my next column. THE CHIROPRACTIC CRUSADER A ROADMAP TO BECOMING A MAJOR PLAYER IN HEALTHCARE                                                                              BY FRED BECK, D.C.              EXPANDING PRACTICE OPPORTUNITIES IN THE WORLD OF SPORTS                                                      MORE LOST OPPORTUNITIES Part 2 of 2        I mentioned in my previous column that I have been a ringside physician at the Silver Gloves competition in Florida for the past six years straight as well as a ringside physician for the Junior Olympic competition in Florida.  I reported that in June 2006, the medical director for USA Boxing approached me at the Junior Olympics and was interested in expanding the role of Chiropractors as ringside physicians.  Although my role as a ringside physician is exactly the same as the allopaths, a Medical or Osteopathic doctor is required to sign off on me on all examinations and recommendations.  The medical director of USA Boxing told me that If I were allowed to sign off on my own examinations and recommendations, many practice opportunities would become available as a ringside boxing physician.  I presented this information to Debra Brown, CEO of the Florida Chiropractic Association (FCA) later that month.      USA Boxing, is the national governing body for Olympic-style boxing, and is the United States' member organization of the International Amateur Boxing Association (AIBA). They sponsor national and international dual competitions and select teams for international events, including the Olympic Games, World Championships, and Pan American Games.       Debra Brown eventually notified me that the changes necessary would require the Florida legislature.  To attempt to make the changes through the legislature would require much time and money, and she wasn’t aware of any interest by other Chiropractors on this topic. The FCA would not back me on gaining expanded privileges in the ringside physician arena.  It was my opinion that anytime additional practice opportunities arise, we should go for it.  Especially when we have the medical director of USA Boxing, who is an M.D., telling me that he would give us his full support.      After doing some research, I was under the impression that I could avoid going to the legislature by filing a petition under the Chapter 120 Administrative Procedure Act. I petitioned the Florida Boxing Commission to change 548.002 (17) from “ Physician means an individual licensed to practice medicine and surgery.” to “Physician means an individual licensed to practice medicine and surgeryor any person licensed to practice Chiropractic medicine in this state.”  There is a 30-day time limit to respond to such a petition that passed, at which time I sent a demand letter.  My demand letter stated the qualifications and scope of practice by law that qualifies Chiropractors to be ringside physicians.  I quoted Chapter 120 extensively in my demand letter. I quoted Chapter 460 of the Florida Statutes.  460.403 (9) (a) (b) (c) describe the scope of practice which includes but is not limited to diagnosis and first aid.  I quoted the 2005 Florida Statutes, Chapter 766 “Medical Malpractice and Related Matters”; under 766.102 (9) (a) which made reference to a chiropractic physician’s legal authority to provide emergency medical services.  (9)(a) refers to emergency medical services being provided in a hospital emergency department. Also quoted was Florida Statute 1006 that clearly states the authority of Chiropractic Physicians to perform athletic examinations in Florida in section 1006.20 Athletics in public K-12 schools.  I made it clear that we are already licensed to examine, diagnose and provide emergency medical treatment and that is all that is required of a ringside physician. In my demand letter I quoted many statutes.  I also wrote that there is no precedent in the history of the chiropractic profession mandating that a medical or osteopathic physician must supervise a Chiropractor. Well to make a long story short, I thought I had written a magnificent demand letter.  It had lots of legal mumbo jumbo even though I am not an attorney.  Unfortunately, not being an attorney, I was incorrect in my belief that I could remedy the problem with the Chapter 120 Procedure Act.  The only way to make the change would be legislatively. Please note that a legislative change would not require any changes in regards to our present scope of practice.           I’ve tried to get the FCA interested in the project.  Debra Brown reported to me that she brought the boxing issue up at an FCA board meeting again. To my knowledge no action has been taken by the FCA to contact the medical director of USA Boxing to help work out a strategy in getting the legislative change we need.  I do not believe that the FCA will act on this opportunity because of the limited number of Doctors of Chiropractic involved in the sport.  Any inaction by any Chiropractic Association, that is in a position to advance practice opportunities for the profession is inexcusable. At the FCA National Convention in Orlando, Florida at the Saturday morning, August 18, 2007 Plenary session whose purpose was to challenge clinical thinking and inform the profession of ongoing research, a questionnaire was handed out to get feedback as to the doctors preferred classroom times for obtaining CE credit.  Two questions had been added to the survey.  They related directly to my efforts to get the FCA to assist me in efforts to expand practice opportunities for the profession.  Both questions required checking off either yes or no.  Question one asked, “Are you personally interested in seeking hospital privileges?”  Question two asked, “Are you personally interested in serving as a ringside physician for pugilistic events?”        My next column will discuss my own theory on subluxation.  The theory assumes that there is a lack of randomness in regard to subluxation.  Hypothetically, this should result in close to a 100% intra-examiner reliability; improved end results; more consistent and predictable outcomes; consistency in treatment throughout the treatment plan; improved research design; and research results that can be easily replicated in future studies.  I will categorize and integrate popular chiropractic techniques into a workable system that provides the practitioner various treatment options to achieve the same goal based on my theoretical subluxation model.    PRINTER FRIENDLY SPORTS ARTICLES IN FILE SHARING SECTION