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Second Regular Session
Sixty-first General Assembly
LLS NO. 980057.01 JLB
HOUSE BILL 981046
STATE OF COLORADO
BY REPRESENTATIVE Musgrave
A BILL FOR AN ACT
CONCERNING LIMITED PRESCRIPTIVE AUTHORITY FOR CHIROPRACTORS,
AND, IN CONNECTION THEREWITH, ESTABLISHING QUALIFICATION REQUIREMENTS
AND GROUNDS FOR DISCIPLINE.
(Note: This summary applies to this bill as introduced
and does not necessarily reflect any amendments that may be subsequently
Authorizes chiropractors who obtain limited prescriptive authority to prescribe and administer specified pharmaceutical agents. Prohibits the dispensing of a pharmaceutical agent directly from a chiropractor's office unless such agent is dispensed in a starter dose.
States that chiropractors with limited prescriptive authority may administer pharmaceutical agents by intramuscular, subcutaneous, sublingual or oral means, or by using a nasal spray or suppository. Defines "pharmaceutical agent" to mean legend nutritional supplements, legend botanical preparations, legend homeopathic preparations, noncontrolled legend analgesics, nonsteroidal legend antiinflammatory agents, and noncontrolled legend muscle relaxants.
Authorizes the state board of chiropractic examiners to promulgate rules to aid in the administration of the limited prescriptive authority program.
Requires applicants for limited prescriptive authority to complete 6,000 hours of fulltime chiropractic practice, 24 hours of course work in injections and injectables approved by an accredited chiropractic college, 96 hours of course work in pharmacology, pharmacokinetics, pharmacodynamics, pharmacotherapy, and emergency procedures, and 40 clinical residency hours under the supervision of a licensed doctor of medicine (M.D.) or a licensed doctor of osteopathy (D.O.).
States that chiropractors shall not maintain limited prescriptive authority unless they:
Requires that chiropractors with limited prescriptive authority provide the same level and standard of care with respect to their use of the defined pharmaceutical agents as that provided by any other regulated health care provider who is educated and trained in the use of the same classes of pharmaceutical agents and authorized to prescribe and dispense them.
Makes the following acts grounds for discipline:
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. 1233102, Colorado Revised Statutes, is amended to read:
1233102. Definitions. As used in this article, unless the context otherwise requires:
(1) "ACUPUNCTURE" MEANS THE PUNCTURE OF THE SKIN WITH FINE NEEDLES FOR DIAGNOSTIC AND THERAPEUTIC PURPOSES.
(2) "ADMINISTER" MEANS TO GIVE A DRUG BY INTRAMUSCULAR, SUBCUTANEOUS, SUBLINGUAL OR ORAL MEANS, OR BY USING A NASAL SPRAY OR SUPPOSITORY.
(1) (3) "Chiropractic"
means that branch of the healing arts which
THAT is based on the premise that disease is attributable to the
abnormal functioning of the human nervous system. It includes
the diagnosing and analyzing of human ailments and seeks the elimination
of the abnormal functioning of the human nervous system by the
adjustment or manipulation, by hand, of the articulations and
adjacent tissue of the human body, particularly the spinal column,
and the usage as indicated of procedures which
THAT facilitate and make the adjustment or manipulation more effective,
and the use of sanitary, hygienic, nutritional, and physical remedial
measures necessary to such practice. "Chiropractic"
includes the use of venipuncture for diagnostic purposes. "Chiropractic"
does not include colonic irrigation therapy. "Chiropractic"
includes treatment by acupuncture AND THE USE OF PHARMACEUTICAL
AGENTS, AS DEFINED IN SUBSECTION (7) OF THIS SECTION, when performed
by an appropriately trained chiropractor as determined by the
Colorado state board of chiropractic examiners. Nothing in this
section shall apply to persons using acupuncture not licensed
by the board.
means the puncture of the skin with fine needles for diagnostic
and therapeutic purposes.
(2) (4) "Chiropractic
adjustment" means the application, by hand, by a trained
chiropractor who has fulfilled the educational and licensing requirements
of this article, of adjustive force to correct subluxations, fixations,
structural distortions, abnormal tensions, and disrelated structures,
or to remove interference with the transmission of nerve force.
The application of the dynamic adjustive thrust is designed and
intended to produce and usually elicits audible and perceptible
release of tensions and movement of tissues or anatomical parts
for the purpose of removing or correcting interference to nerve
transmission and expression.
(3) (5) "Electrotherapy"
means the application of any radiant or current energies of high
or low frequency, alternating or direct, except surgical cauterization,
electrocoagulation, the use of radium in any form, and Xray
(6) "LIMITED PRESCRIPTIVE AUTHORITY" MEANS THE AUTHORITY TO PRESCRIBE AND ADMINISTER THE PHARMACEUTICAL AGENTS SET FORTH IN SUBSECTION (7) OF THIS SECTION.
(7) "PHARMACEUTICAL AGENT" MEANS THE FOLLOWING CLASSES OF PHARMACEUTICALS:
(a) LEGEND NUTRITIONAL SUPPLEMENTS;
(b) LEGEND BOTANICAL PREPARATIONS;
(c) LEGEND HOMEOPATHIC PREPARATIONS;
(d) NONCONTROLLED LEGEND ANALGESICS;
(e) NONSTEROIDAL LEGEND ANTIINFLAMMATORY AGENTS;
(f) NONCONTROLLED LEGEND MUSCLE RELAXANTS.
(4) (8) "Venipuncture"
means the puncture of a vein for the withdrawal of blood for the
purpose of diagnosis through blood analysis. Any blood analysis
shall be done by a chiropractor or by a commercial laboratory.
SECTION 2. 1233107 (1), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PARAGRAPH to read:
1233107. Board powers. (1) The board is authorized to and shall:
(i) ADOPT SUCH RULES AS ARE NECESSARY TO ADMINISTER THE APPLICATION PROCEDURES AND QUALIFICATION REQUIREMENTS OF CHIROPRACTORS SEEKING TO ACQUIRE AND MAINTAIN LIMITED PRESCRIPTIVE AUTHORITY PURSUANT TO SECTION 1233111.7. THE BOARD SHALL ALSO PROMULGATE RULES DESCRIBING THE CONTENTS OF EMERGENCY MEDICAL KITS AND SHALL ESTABLISH GUIDELINES FOR THE CLINICAL RESIDENCY HOURS TO BE COMPLETED FOR QUALIFICATION FOR LIMITED PRESCRIPTIVE AUTHORITY.
SECTION 3. Article 33 of title 12, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read:
1233111.7. Limited prescriptive authority requirements standard of care. (1) AN APPLICATION FOR LIMITED PRESCRIPTIVE AUTHORITY SHALL BE ON A FORM PROMULGATED BY THE BOARD FOR SUCH PURPOSE AND SHALL INCLUDE PROOF OF SATISFACTORY COMPLETION OF THE REQUIREMENTS SET FORTH IN THIS SECTION.
(2) TO QUALIFY FOR LIMITED PRESCRIPTIVE AUTHORITY, A CHIROPRACTOR SHALL HAVE SATISFACTORILY COMPLETED:
(a) A MINIMUM OF SIX THOUSAND HOURS OF FULLTIME CHIROPRACTIC PRACTICE;
(b) TWENTYFOUR HOURS OF COURSE WORK IN INJECTIONS AND INJECTABLES APPROVED BY A CHIROPRACTIC COLLEGE ACCREDITED BY THE COUNCIL ON CHIROPRACTIC EDUCATION;
(c) TWENTYFOUR HOURS OF COURSE WORK IN PHARMACOLOGY;
(d) SEVENTYTWO HOURS OF COURSE WORK IN PHARMACOTHERAPY, WHICH SHALL INCLUDE APPROPRIATE INSTRUCTION IN PHARMACOKINETICS, PHARMACODYNAMICS, AND EMERGENCY MEDICAL PROCEDURES;
(e) FORTY CLINICAL RESIDENCY HOURS UNDER THE SUPERVISION OF A DOCTOR OF MEDICINE (M.D.) OR A DOCTOR OF OSTEOPATHY (D.O.) LICENSED UNDER ARTICLE 36 OF THIS TITLE, PURSUANT TO RULES ESTABLISHED BY THE BOARD.
(3) A CHIROPRACTOR SHALL NOT MAINTAIN LIMITED PRESCRIPTIVE AUTHORITY UNLESS SUCH CHIROPRACTOR:
(a) FILES DOCUMENTATION WITH THE BOARD THAT HE OR SHE IS CERTIFIED BY THE AMERICAN HEART ASSOCIATION OR THE AMERICAN RED CROSS TO PERFORM ADULT AND INFANT CARDIOPULMONARY RESUSCITATION ("CPR") AS A HEALTH CARE PROVIDER; AND
(b) ALWAYS HAS AVAILABLE AN EMERGENCY MEDICAL KIT.
(4) A CHIROPRACTOR WITH LIMITED PRESCRIPTIVE AUTHORITY SHALL BE HELD TO THE SAME LEVEL AND STANDARD OF CARE WITH RESPECT TO SUCH CHIROPRACTOR'S USE OF THE PHARMACEUTICAL AGENTS SET FORTH IN SECTION 1233102 (7), AS THAT REQUIRED OF ANY OTHER HEALTH CARE PROVIDER REGULATED UNDER COLORADO LAW, EDUCATED AND TRAINED ON THE USE OF THE SAME CLASSES OF PHARMACEUTICAL AGENTS, AND AUTHORIZED TO PRESCRIBE AND DISPENSE SUCH AGENTS.
SECTION 4. 1233117 (1) (a) and (1) (v), Colorado Revised Statutes, are amended to read:
1233117. Discipline of licensees letters of admonition, suspension, revocation, denial, and probation grounds. (1) Upon any of the following grounds, the board may issue a letter of admonition to a licensee or may revoke, suspend, deny, refuse to renew, or impose conditions on such licensee's license:
(a) Using fraud, misrepresentation, or
deceit in applying for, securing, renewing, or seeking reinstatement
of a license,
taking an examination provided for in this article, APPLYING FOR
LIMITED PRESCRIPTIVE AUTHORITY, OR COMPLETING THE QUALIFICATION
REQUIREMENTS SET FORTH IN SECTION 1233111.7;
(v) Engaging in any of the following activities and practices:
and repeated ordering or performance
WILLFULLY AND REPEATEDLY ORDERING OR PERFORMING, without clinical
demonstrably unnecessary laboratory tests or studies;
ADMINISTERING, without clinical justification, of
THAT is demonstrably unnecessary;
failure FAILING to obtain consultations
or perform referrals when failing to do so is not consistent with
the standard of care for the profession; or
(IV) Ordering or performing, without clinical
justification, any service, Xray, or treatment
THAT is contrary to recognized standards of the practice of chiropractic
as interpreted by the board;
(V) PRESCRIBING OR ADMINISTERING ANY PHARMACEUTICAL AGENT NOT DESCRIBED IN SECTION 1233102 (7);
(VI) PRESCRIBING OR ADMINISTERING A PHARMACEUTICAL AGENT DESCRIBED IN SECTION 1233102 (7), WITHOUT HAVING LIMITED PRESCRIPTIVE AUTHORITY PURSUANT TO SECTION 1233111.7; OR
(VII) DISPENSING A PHARMACEUTICAL AGENT DIRECTLY FROM THE LICENSEE'S OFFICE UNLESS SUCH AGENT IS DISPENSED IN A STARTER DOSE.
SECTION 5. Effective date applicability. (1) This act shall take effect at 12:01 a.m. on the day following the expiration of the ninetyday period after final adjournment of the general assembly that is allowed for submitting a referendum petition pursuant to article V, section 1 (3) of the state constitution; except that, if a referendum petition is filed against this act or an item, section, or part of this act within such period, then the act, item, section, or part, if approved by the people, shall take effect on the date of the official declaration of the vote thereon by proclamation of the governor.
(2) The provisions of this act shall apply to acts occurring on or after the applicable effective date of this act.