S.C. Code Regs. 25-5 - Professional Practices

Current through Register Vol. 45, No. 12, December 24, 2021

A. Lapsed or Expired South Carolina Licenses.
(1) A chiropractor whose license has been expired for more than twelve (12) months but four (4) years or less, may reactivate the license by submitting an Application for Reinstatement, satisfactory evidence of CE for each lapsed or expired renewal cycle, if applicable, and each renewal cycle's license fee plus the applicable penalty.
(2) A chiropractor whose license has been expired for more than four (4) years must complete a new application and take and pass the SPEC examination, or meet requirements in effect at the time of the new application.
B. Continuing Education (CE). As a pre-requisite for biennial renewal of a practitioner's license, the licensee must complete a minimum of thirty-six (36) hours of approved professional CE, no more than half of which may be online. "One continuing education (CE) hour" shall mean a minimum of fifty (50) minutes of interactive instruction or organized learning. Of the thirty-six (36) CE hours, two (2) hours are required in rules and regulations of the S.C. Board of Chiropractic Examiners (limited to four (4) hours per renewal period) and two (2) hours in risk management which include, but are not limited to, boundary or public health issues.
(1) Acceptable educational programs or courses are those that are:
(a) presented and/or sponsored by accredited chiropractic colleges;
(b) taught by post-graduate level instructors of an accredited college or school approved by the Board; or
(c) presented and/or sponsored by other individuals or organizations approved by the Board.
(2) In addition, CE may also be granted by:
(a) administering Part IV of the National Board of Chiropractic Examination, which may count toward fifteen (15) hours of CE per administration, including risk management and boundary issues credit;
(b) attendance at Federation of Chiropractic Licensing Boards/National Board of Chiropractic Examiners (FCLB/NBCE) meetings, which may be accepted as twelve (12) hours of CE per meeting;
(c) teaching a course at an accredited chiropractic college, which may provide the number of CE hours commensurate with the hours earned by the students taking the course;
(d) serving as a teaching assistant for a course at an accredited chiropractic college, which can earn one-half of the hours earned by students taking the course;
(e) out-of-state licensees meeting their home state's CE requirements, which will satisfy the Board's CE requirements;
(f) teaching an approved CE seminar, which may provide the number of CE hours equal to the number of hours taught in the course limited to eighteen (18) hours per renewal period; and
(g) attending a test committee of NBCE, which may be accepted as twelve (12) hours of CE per meeting.
(3) CE Exemption. Chiropractors who graduate from an accredited chiropractic college and become licensed to practice chiropractic within the same biennial license renewal period are exempted from the thirty-six (36) hour CE requirement during that same biennial renewal period. Their senior year chiropractic college classes and their license examination preparation and testing are deemed to adequately fulfill the aims of the CE requirement during this time period. This exemption is allowed only for those who graduate and are licensed within the same renewal period; chiropractic college graduates who become licensed during a renewal period other than that of their graduation are not eligible for this exemption.
(4) Sponsor Requirements. All sponsors seeking approval for educational programs must submit a written request to the Board Administrator at least ninety (90) days prior to the scheduled date of the presentation, be PACE (Providers of Approved Continuing Education)-approved (provided it is within the scope of chiropractic practice), South Carolina Chiropractic Association, Palmetto State Chiropractic Association, or other associations or organizations approved by the Board in its discretion. Non-PACE-approved providers shall:
(a) have a mechanism for the maintenance of records for no fewer than three (3) years;
(b) have a method of monitoring and verifying attendance;
(c) provide each participant adequate documentation of participation in the program to include:
(i) name and license number of participant;
(ii) name and address of the sponsoring individual(s) or organization;
(iii) name of program;
(iv) number of hours completed;
(v) date and location of program;
(vi) authorized signature.
(d) not present sales promotions during the CE seminar or presentation. Sales promotions are appropriate by sponsors or instructors outside the seminar or presentation, or outside the room during a seminar or presentation.
(5) Program Approval Requirements. Requests for program approval must include the following information:
(a) name and address of the sponsoring individual(s) or organization;
(b) instructors' name and credentials;
(c) outline of program content;
(d) the number of actual hours of instruction;
(e) the method of monitoring and certifying attendance;
(f) location at which the program will be presented;
(g) the dates on which the program will be presented;
(h) course approval is valid for two (2) renewal periods.
(6) Program approval will be based on the following criteria:
(a) The program will enhance the practitioner's knowledge and skill in the practice of chiropractic as defined by state law.
(b) The instructors are sufficiently qualified in the field of instruction either by practical or academic experience or both.
(c) The program will be held in a suitable setting, conducive to learning.
(d) Adequate monitoring or certifying measures are provided.
(7) Practice-building subject matter (administration, finance, etc.) will not be approved for license renewal.
(8) Comprehensive Approval. A comprehensive approval allows the provider or sponsor to submit an application indicating all course offerings for a given calendar year. Requests for a comprehensive approval may be submitted to the Board office at least ninety (90) days prior to the beginning of each year or ninety (90) days prior to the beginning of a scheduled program. Providers and sponsors shall be responsible for renewal approval.
C. Retention and Audit. Licensees must maintain copies of attendance certificates for four (4) years from the last renewal date. The Board may conduct random audits of licensees on an annual or biennial basis to certify compliance with CE requirements.
D. Waiver During Period of Temporary Medical Disability. The Board reserves the right to waive CE requirements for individual cases involving extraordinary hardship or incapacitating illness. A licensee may be eligible for waiver or extension who, upon written application to the Board and for good cause shown, demonstrates that the applicant is unable to participate in a sufficient number of regular continuing education programs for license renewal.
E. Therapeutic Modalities. Usage of therapeutic modalities is permitted only by those chiropractors who have passed the National Board of Chiropractic Examiners (NBCE) physiotherapy exam or a substantially equivalent future NBCE examination. Chiropractors licensed in South Carolina prior to June 1, 1986, are exempt from this examination. Therapeutic modalities are limited to those modalities within the chiropractic scope of practice.
(1) Permitted Machines. The following machines are approved for use in therapeutic modalities:
(a) high Frequency Diathermy: Shortwave diathermy, Microwave diathermy, Ultrasound;
(b) low Frequency Direct current: Low voltage galvanism, High voltage galvanism;
(c) alternating Current: Sine Wave, Faradic, Transcutaneous Stimulation;
(d) medium Frequency Current: Interferential;
(e) combination currents: Ultrasound with sine, Ultrasound with high voltage, Sine with galvanism;
(f) cold laser and intense pulse light (IPL) therapy;
(g) such other machines as may be approved by the Board, in its discretion.
(2) The following therapy procedures are approved for use in therapeutic modalities:
(a) heat: hot moist packs, heating pads, infrared, paraffin, ultraviolet;
(b) cold: cold packs, ice massages, ice therapy;
(c) hydrotherapy: whirlpool, hubbard tanks;
(d) nutritional therapies;
(e) exercise and massage;
(f) rehabilitation and rehabilitative procedures;
(g) manipulation under anesthesia.
(3) The following traction therapies are approved for use in therapeutic modalities: cervical, thoracic, lumbar, pelvic, intersegmental.
(4) Use of Diagnostic Equipment and Testing Procedures. A chiropractor may request diagnostic and testing procedures, consistent with all other applicable laws and regulations, and may perform those tests which are consistent with the chiropractic scope of practice as approved by the Board in its discretion.
F. Terms and Definitions.
(1) Accepted terms are Chiropractic Physician, D.C., Chiropractor, Doctor of Chiropractic.
(2) Chiropractors may not refer to themselves as physical therapists or physiotherapists.
G. Licensees must report CE hours to the electronic tracking system designated by the South Carolina Department of Labor, Licensing and Regulation for CE compliance and monitoring. Licensees who fail to meet the CE requirements will be notified in writing of their deficit, ordered to cease practice, and advised to obtain CE. Failure of the CE audit results in a lapsed license. After the Board is in receipt of the approved CE credits, the Board staff will reinstate the license to active status.

The following sanctions will be imposed:

(1) First Offense: Private Reprimand and $2000 fine.
(2) Second Offense: Hearing scheduled before the Board.

If evidence is received that the licensee continued to practice after an order to cease and desist from practice, the matter will be scheduled for a hearing before the Board, and the licensee will not be permitted to resume practice pending hearing and until further order of the Board.

H. Manipulation Under Anesthesia (MUA)
(1) For purposes of this regulation, Manipulation Under Anesthesia (MUA) means a manipulation of the spinal column and its immediate articulations by a licensed practitioner (DC, MD or DO) of a patient who is under the administration of anesthesia performed by a physician licensed in this state who is Board certified or Board eligible in anesthesiology by the American Board of Medical Specialties or American Osteopathic Association.
(2) Manipulation under anesthesia (MUA) may be performed by a DC in collaboration with an MD or DO, as long as the MUA is performed in accordance with this regulation. MUA shall be performed by two practitioners (a doctor of chiropractic, "DC," and a medical physician, "MD," or doctor of osteopathic medicine, "DO") who constitute the collaborative treatment team and have attained their certificates of training in MUA as described in this regulation. The two MUA practitioners must be in addition to the anesthesiologist. One practitioner must be designated primary practitioner; the second practitioner will serve as the first assistant. Practitioners, including MDs and DOs, performing MUA must be appropriately trained through a course of instruction approved by their respective boards.
(3) The practitioners must have proper training demonstrated by successful completion of a postgraduate educational course approved by their respective boards.
(4) The DC must have proper training demonstrated by successful completion of a postgraduate educational course approved by the Board or which has been approved by a Council on Chiropractic Education (CCE) accredited chiropractic college prior to performing the procedure.
(5) MUA must be performed in an appropriately licensed hospital or ambulatory surgical center or office based surgical facility approved by American Association of Ambulatory Surgery Facilities (AAASF); Accreditation Association for Ambulatory Health Care (AAAHC); the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); or the Healthcare Facilities Accreditation Program (HFAP), a division of the American Osteopathic Association; or any other agency approved by the South Carolina Board of Medical Examiners in statute or regulation.
(6) The patient must receive a medical evaluation and clearance prior to undergoing MUA. It is the responsibility of the MD or DO to conduct an appropriate medical evaluation regarding the patient's ability to undergo the procedure. A physician licensed and Board certified or Board eligible as a medical specialist in anesthesiology must complete an evaluation of the patient's suitability for undergoing anesthesia in accordance with American Society of Anesthesiologists (ASA) standards of care for Monitored Anesthesia Care (MAC).
(7) It shall be the responsibility of the practitioners (DC, MD or DO) to submit their documentation of appropriate training in MUA to their respective boards in accordance with the established parameters of this regulation.
(8) Patient safety shall be of paramount concern, and shall be regulated by proper training, patients' selection criteria, medical clearance for anesthesia, and by following the standards and protocols for the performance of MUA.
(9) Failure of a practitioner to follow the standard of care contained in this section while performing MUA shall constitute unprofessional conduct.


S.C. Code Regs. 25-5
Amended by State Register Volume 17, Issue No. 4, eff April 23, 1993; State Register Volume 23, Issue No. 6, eff June 25, 1999; State Register Volume 27, Issue No. 6, Part 2, eff June 27, 2003; State Register Volume 33, Issue No. 4, eff April 24, 2009; State Register Volume 37, Issue No. 6, eff June 28, 2013; State Register Volume 44, Issue No. 06, eff. June 26, 2020.

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