1. GEORGIA BOARD OF CHIROPRACTIC EXAMINERS
Board Update

2. Legal Charge of the Georgia Board of Chiropractic Examiners
The board shall possess and exercise such powers to protect the public health, safety and welfare of the public through the regulation of the practice of chiropractic.

3. The members of the Georgia Board of Chiropractic Examiners come from various backgrounds and specialties within their profession; however, before any Board decisions can be rendered, a quorum (majority) of the Board Members must be present and the majority must be in agreement.

4. Board Members Dr. Mary Watkins, D.C., President
Dr. Andy Krantz, D.C., Vice-President
Emily Campbell, Consumer Member
Dr. Robert Alpert, D.C.
Dr. Joseph Krzemien, D.C.
Dr. David Wren, D.C.
It is important to note that the consumer member is the only member who is not connected in any way to the practice of chiropractic.

5. Board Staff Board Attorney Adrienne D. Price, Executive Director
Adrienne D. Price, Executive Director
Kathy Osier, Licensing Supervisor
Sonja Glover, Licensing Analyst
Kimberly Candler, Complaints/Compliance Analyst
Michelle Foster, Board Support Specialist
Board Attorney
D. Williams-McNeely, Assistant Attorney General

6. Statistical Data: Georgia licensed Chiropractors (as of 10/03/2016)
3,450
Licenses Issued: AY AY
AY (as of 10/03/2016)

7. Statistical Data Continued… Complaints/Disciplinary
The Board initiated 60 investigations in AY 2014 and 79 in AY To date in AY 2016, there have been 61 investigations related to unlicensed practice, arrests, records release violations, advertising violations, sexual misconduct, nonpayment of child support, fraud and a failure to meet standards of practice.
In AY 2014 the Board issued 9 Disciplinary actions / consent orders and 23 in AY 2015 and 7 in AY 2016 as of 10/03/2016 related to unlicensed practice, tracking of criminal probation, failure to meet continuing education requirements or failure to comply with the terms of a previous order.

8. 2016/2017 Meeting Dates
All meetings are held at the Professional Licensing Boards Division in Macon, GA unless otherwise specified. The meeting dates are as follows: November 4 January 6 March 3 May 5 July 21 September November 3 All Board meetings are open to the public during open session and are held in compliance with the Georgia Open Meetings Act. Tentative Investigative Subcommittee meeting dates are October 21, December 9, February 3, April 7, June 2, August 4, October 6, December 8. These meetings are not open to the public as complaints and investigations are confidential by law.

9. Board Members must be dedicated to attending the meetings…
but not in the midst of Snowmagedon!
When it becomes necessary to cancel a Board Meeting due to inclement weather, the Board may opt to hold a conference call to discuss cases or attempt to reschedule the meeting as soon as possible.

10. Licensure Process Applicants must submit: Completed Application;
$275 non-refundable application fee;
Transcript showing D.C. from CCE-accredited college;
Parts 1-4 National Board Examination (Pass=375);
Undergraduate transcripts documenting completion of not less than 60 quarter/90 semester hours;
Verification of licensure from all states where applicant holds or has ever held a license;
Passing score on Georgia law examination; and
Applicants wishing to have the Certified in Modalities designation must submit documentation of 120 hours of coursework in therapeutics.
Unexpired Secure and Verifiable Document and Affidavit of Citizenship
Other information as determined by the Board (i.e. verification of employment, a curriculum vitae, continuing education, etc.).

11. Licensure Process Continued…
Standard processing time may take up to 25 business days.
Processing time may be extended for the following reasons:
An incomplete application to include missing documentation, failure to complete forms accurately, insufficient funds for the application fee
Criminal history
History of Disciplinary Action by another jurisdiction or Board.
Submission of a Petition for Rule Waiver or Variance regarding certain regulatory requirements.

12. Complaint / Investigative Case File is received by the Board
Determination is made as to whether or not the allegation would be a violation of Board laws, rules and policies
If allegation is within the Board's jurisdiction, the complaint is referred to the SOS Investigations Division
The investigative findings are returned to the Investigative Subcommittee of the Board to make a recommendation regarding an action by the Board
Investigative Committee makes recommendations to the Board & the Board renders a decision on the case and/or begins the process again if more investigation is necessary.
The Complaint Process
A detailed explanation of the complaint process may be located on home page of the Secretary of State website.

13. Most common complaints
Unprofessional Conduct
Failure to Release Records
Unlicensed Practice
Substandard Practice
Malpractice Claims
Advertising
Practitioner’s failure to identify themselves as D.C., Chiropractor or Doctor of Chiropractic
This statute is also referenced in Board Rule
Sexual misconduct
Inappropriate interactions with patients/staff
Financial issues
Billing for services not rendered
Insurance billing discrepancies
Fee for service fees instead of service bundles (i.e. multiple services once cost one set fee, no have individual hourly rates attached to them.)

14. How To File An Online Complaint
Visit & Select the “Licensing” link at the top of the page

15. How to File An Online Complaint
Locate the “Submit a Complaint” button on the page and select it.

16. How to File An Online Complaint
Complete the online submission form in its entirety with as much information as you have available and select “Submit.”

17. Additional Methods For Filing a Complaint
A complaint may also be submitted via:
US Mail
Phone - Please be aware that if a complaint is submitted via the phone, pertinent information will be documented; however, the complaint process may not begin if the complainant does not submit the substance of the complaint in a written format.
Anonymous complaints are accepted; however, they may or may not be acted upon by the Board if the complainant fails to submit enough detail on which the Board may initiate an investigation
Complainant’s information is confidential during the course of the investigation; however, should the case proceed to hearing it is possible that the complainant’s identity may be realized. It is also possible for the licensee/respondent to surmise the identity of the complainant based on the information that is provided to them in order to illicit a response.

18. The Board Decision
When considering information relevant to a complaint investigation, the Board may either:
Close the case
Conduct an additional investigation
Issue a non-disciplinary action through:
A Mitigating Letter – a settlement agreement between the Board and the Licensee/Respondent, i.e. if the individual meets certain conditions established by the Board, no public action will be taken and the case will be closed.
A Letter of Concern – a statement from the Board that the allegations are of concern to the Board but the evidence does not rise to the level of a sanction or disciplinary action.
Sanction or discipline a license by:
A Private Order/Agreement – not available to the public but may be released to law enforcement agencies or lawful licensing authorities
A Public Order/Agreement – is available for public review and is typically posted on the license verification site. Public actions are also reportable to the National Practitioner Databank (NPDB) and The Chiropractic Information Network/Board Action Databank (CIN-BAD).
Deny the issuance of a license (which is also an action reportable to NPDB and CIN-BAD).

19. What is NPDB & CIN-BAD
National Practitioner Databank (NPDB) The National Practitioner Data Bank (NPDB), or "the Data Bank," is a confidential information clearinghouse created by Congress with the primary goals of improving health care quality, protecting the public, and reducing health care fraud and abuse in the U.S. See Table 1 for information on who can query and report to the Data Bank. -
The Chiropractic Information Network/Board Action Databank (CIN-BAD) is an inter-jurisdictional chiropractic board action database of information on public actions taken by chiropractic regulatory licensing boards and/or exclusions from Medicare/Medicaid reimbursement by the U.S. Department of Health & Human Services with regard to individual chiropractors. It is maintained by the Federation of Chiropractic Licensing Boards as a service to its member boards, to the health care community, and to the general public. -
Both databanks house public actions and help the Board to protect the public health, safety and welfare by enabling the Board to track those individuals who have violated the law and/or engaged in unsafe or unauthorized practices in other states.

20. How Does The Board Decide? Public or Private
Board decisions are made in accordance with the laws, rules and policies. Factors the Board considers several factors when determining whether to issue a public or private sanction to include:
Preponderance of the Evidence
Severity of the violation/allegation, i.e. was the patient harmed, the general public, the licensee?
Relevant precedent, i.e. was the same action taken in similar cases? Why or why not?
The Licensee’s/Respondent’s History with the Board, i.e. arrests, frequency of substantiated complaints, history of actions taken by other boards
If the action taken will help the licensee/respondent become a better practitioner

21. VS. TYPES PUBLIC ACTIONS TYPES OF PRIVATE ACTIONS
Denial – Board refusal to issue , grant, reinstate or renew a license
Revocation – The license is taken away from the license holder by operation of law, i.e. court order by an Administrative Law Judge or for failure to renew.
Suspension – The license holder is not allowed to practice for a period of time designated by the Board.
Probation – The license holder has practice restrictions, limitations, conditions and/or fines on the license as defined by Board Order/Agreement.
Reprimand – A formal order of reproof which may also include a fine or fee.
Surrender – The license holder signs an order or submits a signed statement voluntarily revoking his/her license
Cease and Desist – Order requiring a licensee, applicant or individual engaging in Unlicensed Practice to immediately cease said practice.
TYPES OF PRIVATE ACTIONS
Mental/Physical Examination – used when a licensee has displayed an inability to practice a business or profession licensed under this title with reasonable skill and safety to the public or has become unable to practice the licensed business or profession with reasonable skill and safety to the public by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type of material. The outcome may result in an additional private or a public action.
Suspension – The license holder is not allowed to practice for a period of time designated by the Board.
Probation – The license holder has practice restrictions, limitations, conditions and/or fines on the license as defined by Board Order/Agreement.
Reprimand – A formal order of reproof which may also include a fine or fee.

22. Current Issues of Interest
Increasing awareness and encouraging active participation in state organizations
Minimizing incidences of Unprofessional conduct/boundary violations involving solicitation by runners, sexual misconduct and conduct when using Social Media.
Educating chiropractors about how to effectively communicate with patients concerning practices/procedures
Inappropriate/over-reaching billing practices
Implementing rules that will assist chiropractors in improving upon documentation within the medical records.
Unlicensed practice and hesitation of local DA’s to prosecute cases

23. What About Chiropractic Assistants?
Georgia law does not allow an unlicensed individual (C.A.) to work under a D.C.’s license to provide massage therapy services.
C.A.’s can still perform other duties under the direct supervision of the D.C. to include but not be limited to:
Physiological Therapeutics
Patient history
X-Rays with certification

24. Statutory Changes for 2015 & 2016
O.C.G.A. § 43-1C “Georgia Professional Regulation Reform Act” – Became effective July 1, 2016 and provides for executive oversight of the Professional Licensing Boards to the office of the Governor of the State of Georgia.
O.C.G.A. § 43-1C-2(3); “Military Spouses and Veterans Licensure Act” – Became effective July 1, 2016 and requires professional licensing boards and other boards to adopt rules and regulations implementing a process by which military spouses and transitioning service members may qualify for licenses.
O.C.G.A. § “General Provisions of Law” – Became effective July 1, 2016 and requires professional licensing boards to consider certain factors relating to felonies before denying a license to an applicant or revoking a license and to provide for probationary licenses for participants in accountability courts.
O.C.G.A. § 38-3 “Uniform Emergency Volunteer Health Practitioners Act” – Became effective July 1, 2016 and provides for regulation of volunteer health practitioners during a declared emergency
O.C.G.A. § “The Consumer Information and Awareness Act” - signed
into law by Governor Nathan Deal on May 12, The new statute requires
that licensed health care practitioners provide for certain identification,
educational identifiers and signage in the workplace and in advertisements.
It also identifies the penalties for intentional violation of the provisions of the law.

25. Rule Amendments Adopted in 2015
Due to some of the new statutory changes, the Board is currently reviewing several rules and will likely post several for hearings during AY 2017.
If you are interested in being notified of proposed rule amendments, it is suggested that you subscribe to the interested parties list by visiting selecting the link for subscriptions on the home page and following the instructions to subscribe.
No matter what, it is very important for each licensee to…

26. Policy Amendments of 2015
Policy # 14 – Updated the requirements of the refresher course that applicants may take in lieu of the SPEC examination if the applicant has been out of the practice of chiropractic for five (5) years or greater.
* This policy was approved in the January 11, 2013 Board meeting.
* Amended September 18, 2015
Policy # 17 - Continuing education programs granted Board approval must submit a new application for approval each year. Applications are to be submitted at least sixty (60) days prior to the anniversary of the approval date from the previous year. The Board reserves the right to deny the acceptance of hours submitted from participants of any program which fails to timely submit a new application for approval. Blanket approval will be granted to state chiropractic organizations and accredited chiropractic colleges and universities upon receipt and review of a complete continuing education program application provided that the course(s) taught fall within the scope of practice of Georgia Chiropractic. A list of approved Continuing Education Programs for the current biennium will be posted on the Board website.
* This policy was adopted at the November 7, 2014 meeting.
* This policy was amended at the January 16, 2015 meeting.
THERE HAVE BEEN NO POLICIES REVISED IN AY 2016.

27. Patient Records Law O.C.G.A. §31-33 Health Records
Georgia Patients Records laws can be found under the
Laws, Policies & Rules on the Board’s website
The law requires providers to maintain patient records for not less than 10 years from the date the patient was last treated.
Further provides for charging a fee for copying and mailing patient records.
A practitioner cannot refuse to release patient records if the patient has an outstanding balance. Per Board Policy #3, records must be released within 3-5 working days from receipt of a properly signed and executed request from a patient or legal designee.

28. Patient Records continued…
The minimum, reasonable standard of care must be evident within the patient records and reflect that the chiropractor is practicing within the scope, is practicing ethically, insurance requisitions(if applicable), consent forms and notes which include examination results, treatments, diagnostics and clinical impressions.
The minimum, reasonable standard includes but is not limited to documentation of:
Subjective - The subjective component is the client’s report of how he or she has been doing since the last visit, and this includes the current visit.
Objective - The objective component is straightforward and includes vital signs (temperature, blood pressure, pulse, respiration), documentation of the physical examination that was done, and results of laboratory or other studies that may be done during the course of this visit.
Assessment - the clinician pulls together the subjective information gathered during the interview with the client and the objective findings of the physical exam (and, possibly, laboratory or other study results) and consolidates them into a short assessment in order to formulate a diagnosis
Plan - The plan should include anything that will be done as a consequence of the assessment and may include recommendations for treatment.

29. Minimum Reasonable Standards
The minimum reasonable standards of care not only include what is reflected within the patient record but it also extends to the chiropractors conduct, behavior and the ways in which chiropractors interact with their clients or potential clients (See Board Rules Chapter 7).
Is this an appropriate
advertisement?
Why or Why Not?

30. Additional Examples of Questionable Advertisements
Is this advertisement
appropriate? Why or Why
Not?
Are chiropractors raising
these types of issues within
the CE courses? Should
it be discussed?

31. CE Requirements Board Rule 100-5-.02 20 hours required per year
15 in clinical sciences
4 in ethics and risk management
1 in Georgia laws and rules
Maximum of 3 in philosophy
Maximum of 4 in clinical documentation
No more than twenty (20) hours per biennial renewal period can be taken via audio/visual/electronic media, such as on-line/internet courses.
Each licensed chiropractor shall maintain in his/her own possession certificates of attendance at continuing education meetings for a period of 4 years from the date of the program.
Each doctor of chiropractic is responsible for determining in advance that the courses which he/she proposes to attend are sponsored by an approved provider.
A continuing education audit may be conducted on any licensee during renewal. When the renewal application is completed, all continuing education requirements should also be complete because at that time, each licensee is asked to attest to having met the CE requirements in accordance with the Board rules.
If a licensee has not satisfied the CE requirements at the time he/she applies for renewal, the answer to the CE attestation question should be “NO.” PLEASE NOTE, THAT IF A LICENSEE ANSWERS “NO” TO HAVING MET THE CONTINUING REQUIREMENTS AT THE TIME HE/SHE APPLIES FOR RENEWAL, ALL HOURS MUST BE COMPLETED PRIOR TO THE EXPIRATION DATE OF THE LICENSE. LICENSEES WHO ANSWER “NO” ARE AUTOMATICALLY AUDITED AND IS SUBJECT TO DISCIPLINARY ACTION BY THE BOARD IF THE REQUIREMENTS ARE NOT MET BY THE EXPIRATION DATE OF THE LICENSE.

32. License Renewal
License renewal applications general go live anytime between days prior to the expiration date of the license. Before attempting to renew, visit the Board website to see if there is a statement on the home page announcing that renewal is now live. The deadline to renew is 12/31 of even-numbered years.
Fee $125.
Late Renewal 01/01 – 03/31- Fee $225.
04/01 or later – Reinstatement Required
No licensee can practice after 12/31until the license has been renewed.
It is the licensed D.C.’s sole responsibility to assure timely renewal of his/her professional license. 
IMPORTANT = If you applied for license renewal, always check the license verification page prior to the expiration date of your license to be sure that your license has been renewed and your expiration date has changed.
You do this by visiting and then select the “Search for a Licensee” feature. Enter the search criteria, click “Search,” select your name to open the verifications page and then check the table ensure that the status says “Active” (or “Probation” if you practice under the terms of a public order) and the expiration date has changed. If the expiration date remains the same or there is some other status besides “active,” the renewal application is not complete and you should check your s and/or contact the Board offices to make an inquiry.

33. Georgia Board of Chiropractic Examiners
Thank You
Georgia Board of Chiropractic Examiners
237 Coliseum Dr.
Macon, GA
(478)
Fax (866)