Part 1
General Information
Section 1.1 Purpose
(a) The Board of Chiropractic ("the Board")
has been created and given powers by Vermont law. Its purpose is to protect the
public health, safety and welfare. It does this by setting standards for
issuing licenses, licensing only qualified applicants, and regulating practices
of license holders.
(b) The Board
maintains a website at
http://vtprofessionals.org.
Practitioners should periodically consult the website for matters of interest
to the profession.
Section
1.2 Definitions
(a) "Accredited
school of chiropractic" means:
1) an
educational program leading to the doctor of chiropractic degree, accredited by
an agency that is approved by the board, and which is recognized by the United
States Department of Education for accreditation of programs of chiropractic
education; or,
2) a foreign
educational program that is accredited by a foreign chiropractic accrediting
agency which is recognized and endorsed by the Council on Chiropractic
Education (CCE-US).
(b)
"Board" means: the State of Vermont Board of Chiropractic.
(c) "Direct supervision" means: a
chiropractor agrees to procedures or treatment performed by appropriate
personnel by being physically present at the chiropractic facility for
consultation or intervention.
(d)
"Director" means: the Director of the Office of Professional
Regulation.
(e) "Good standing"
means: the professional holds a current, unrestricted license.
(e) "Office" means: Office of Professional
Regulation (OPR).
(f) "P.A.C.E."
means: Providers of Approved Continuing Education, which is a service of the
Federation of Chiropractic Licensing Boards.
(g) "Unprofessional Conduct" means: any
violation of
3 V.S.A. §
129a or 26 V.S.A. § 541. Unprofessional
conduct includes failing to comply with provisions of federal or state statutes
or rules governing the practice of the profession.
(h) "Unrestricted license" means: the
licensed or registered professional is not subject to a sanction.
(i) "V.S.A." means: Vermont Statutes
Annotated, the official compilation of statutes enacted by the Vermont
legislature.
Section 1.3
Definitions
Business Location The Board's business location is the Office
of the Secretary of State, Office of Professional Regulation, National Life
Bldg., North, FL2, Montpelier, VT 05620-3402. Address correspondence to "Board
of Chiropractic" at the same address.
Section 1.4 Definitions
Board Members and Officers The Board is composed of three
chiropractic physicians who are graduates of an accredited school of
chiropractic, and two public members. Each member has been appointed by the
governor for a five year term. A member may not serve more than two consecutive
terms on the Board. Officers are elected once a year.
Section 1.5 Definitions
Regular, Special and Emergency Meetings The Board holds at
least one regular annual meeting in September. It meets as needed, generally
monthly. The chair or two members may call a special or emergency meeting if it
is necessary. Information on meeting time and location maybe obtained from the
Office or online at http://vtprofessionals.org/. A
majority of Board members constitutes a quorum for all meetings. Formal action
may be taken at a meeting if a majority of those present and voting are in
favor of the action.
Section
1.6 Laws That Govern the Board
(a) The Board is created by Chapter 10 of
Title 26 of the Vermont Statutes Annotated, which establishes the Board's
responsibilities for setting standards, issuing licenses, and regulating the
profession.
(b) Board powers are
also conferred by subchapter III of Chapter 5 of Title 3 "Professional
Regulation," and the statutes creating and governing the Office of Professional
Regulation ( 3 V.S.A. §§ 121-131).
(c) In addition to the "Professional
Regulation" statutes, the Board is subject to other state laws including the
"Administrative Procedure Act" ( 3 V.S.A. §§ 801-849), the "Open
Meeting Law" ( 1 V.S.A. §§ 310-314), the "Access to Public Records
Law" ( 1 V.S.A. §§ 315-320), and the "Law of Professional
Regulation" ( 3 V.S.A. §§ 121-131).
(d) In contested cases, the Board follows the
Vermont Rules of Evidence, as amended by the Administrative Procedure Act.
These laws set forth the rights of applicants, license holders and members of
the public.
(f) The Office provides legal counsel to help
the Board comply with all laws affecting Board business.
Section 1.7 Board Rules
The Board's rules have the effect of law and govern its
proceedings. In making rules, the Board must follow the Administrative
Procedure Act, Chapter 25 of Title 3 of the Vermont Statutes Annotated. These
rules were approved by the Vermont Legislative Committee on Administrative
Rules before adoption and are presumed valid. These rules have the force of
law.
3 V.S.A. §
845(a).
Section 1.8 Legislative Changes Affecting
Rules
Legislative changes from time to time may create
inconsistencies between statutes and administrative rules. When a rule and a
statute are inconsistent, the statute governs.
Section 1.9 Legislative Changes Affecting
Rules
Advisory Opinions Interpretation of the meaning of Board Rules
and statutes often occurs when the Board is deciding an unprofessional conduct
case. The Board is not authorized to issue advisory opinions.
Part 2 Information for Applicants
Section 2.1 Legislative Changes Affecting
Rules
Need for a License No person may practice chiropractic in
Vermont without being currently licensed by the Board.
Section 2.2 Legislative Changes Affecting
Rules
Where to Request an Application Applications and more
information about the types of licenses and their requirements are available on
line at http://vtprofessionals.org or from the
Office.
Section 2.3
Legislative Changes Affecting Rules
Licensure by Examination Applicants for a license by
examination must have:
(a) reached the
age of majority;
(b) graduated from
an accredited school of chiropractic as defined by these rules;
(c) passed the written and practical
examinations approved by the Board. The examination(s) selected by the Board
are specified on application forms;
(d) for foreign-educated applicants whose
training, including texts, was not in the English language, successfully passed
the TOEFL examination or other similar examination approved by the Board,
and;
(e) successfully completed the
Board's jurisprudence examination. The examination questions are available from
the Office or online at
http://vtprofessionals.org.
Section 2.4 Legislative Changes
Affecting Rules
Unprofessional Conduct and Licensing Decisions A license may be
denied or conditioned if the applicant has engaged in unprofessional
conduct.
Section 2.5
Licensure by Endorsement
(a) An applicant who
is licensed and in good standing in another United States or Canadian
jurisdiction, whose licensing requirements are substantially equivalent to
Vermont, and who is otherwise eligible may be granted a license without written
competency examination.
(b) The
applicant must successfully complete the Board's jurisprudence examination. The
examination questions are available from the Office or online at
http://vtprofessionals.org.
Section 2.6 Right to a Written
Decision, Grant or Preliminary Denial
(a) The
Board will notify applicants in writing of all decisions to either grant or
deny a license or license renewal. If a license or renewal is denied, the Board
will give the applicant specific reasons and will also inform the applicant of
the right to appeal the Board's decision. This is called a "preliminary
denial."
(b) The Board, or the
Office on behalf of the Board, most often issues a preliminary denial of
licensure or renewal when it appears from the application and accompanying
documents that the applicant does not meet all of the requirements for
licensure, or because of unprofessional conduct, should not be granted a
license. When this occurs, the applicant is notified of the right to file an
appeal which is heard as a formal hearing by the Board. At the hearing the
burden of proof is on the applicant to show that the preliminary denial was in
error. After that hearing the Board issues a final decision in writing. If the
final decision is to deny a license or renewal, the written decision notifies
the applicant of his or her appeal rights.
Section 2.7 Right to a Written Decision,
Grant or Preliminary Denial
Right to Appeal Licensing Decisions If the applicant believes
that the Board's final decision concerning the denial of a license or renewal
is in error, the applicant may appeal the decision to the Director. The appeal
must be filed within 30 days of the date of the denial. An appellate officer
will review the record made before the Board for legal errors. Information
about the appeal process may be obtained from the Office or online at
http://vtprofessionals.org/.
Part 3 Information for Licensed
Chiropractic Physicians
Section 3.1 Right to a
Written Decision, Grant or Preliminary Denial
Display of License The Chiropractor's license, or a photo copy
if the licensee practices at more than one location, must be conspicuously
displayed in the licensee's place(s) of practice. Licensees may black out or
cover their residence address if it appears on the license.
Section 3.2 Right to a Written Decision,
Grant or Preliminary Denial
Renewing a License Licenses are issued for a two-year period,
and must be renewed by the expiration date printed on the license certificate.
The Office mails renewal notices in advance of the expiration date. A licensee
is responsible for renewal whether a notice is received or not, and a license
is not valid after its expiration. Those who practice after expiration of a
license are subject to late fees before renewal, possible unprofessional
conduct prosecution, or other penalties.
Section 3.3 Late Renewals
(a) A lapsed license may be renewed within
five years of expiration upon payment of the renewal fee, documentation of 24
hours of continuing education within 2 years preceding the application, and
late renewal fee.
(b) To renew a
license which has lapsed 5 years or more and the applicant has not held a
license in good standing to practice chiropractic in another U.S. or Canadian
jurisdiction during that period, a new application must be filed and
application fee paid. An applicant must
(1)
successfully complete within one year of applying the Special Purpose
Examination for Chiropractors or its successor or equivalent examination
approved by the Board; and,
(2)
successfully complete the Board's jurisprudence examination. The examination
questions are available from the Office or online at
http://vtprofessionals.org.
(c) A renewal applicant whose
Vermont license lapsed more than 5 years, but who has maintained a license in
good standing in another U.S. or Canadian jurisdiction must document completion
of 24 hours of continuing education in the two years preceding the
application.
Section 3.4
Late Renewals
Change of Name or Address A licensee shall notify the Office
within 30 days of any change of name or change of address. Notice of a change
of name must be accompanied by legal proof of the change.
Section 3.5 Late Renewals
Adjunctive Therapies Adjunctive therapies are therapies a
chiropractor may use in addition to chiropractic adjustment to treat patients.
Chiropractors may use adjunctive therapies in which they have been adequately
trained. Adjunctive therapies for chiropractic are physiotherapy modalities,
rehabilitative exercises, nutritional therapy, massage techniques and
acupuncture. Adjunctive therapy includes the use of topically applied
therapeutic agents incident to any of the above listed
therapies.
Part 4
Chiropractic Interns
Section 4.1 Late Renewals
Registration of Chiropractic Interns A student enrolled in the
fourth academic year of an accredited school of chiropractic, upon registration
as an intern, may practice under the supervision of a licensed
chiropractor.
Section 4.2
Late Renewals
Intern Registration An applicant for intern registration
must:
(a) show current enrollment in
an accredited school of chiropractic, and
(b) provide an agreement to supervise from a
Vermont licensed chiropractor.
Section 4.3 Late Renewals
Documentation Each licensed chiropractor who provides
supervision of an intern must create and retain a supervisor's report and all
records pertaining to services provided by the intern for no less than three
years after the internship concludes.
Section 4.4 Permitted Activities / Liability
(a) An intern may perform activities
delegated to him or her by the supervising chiropractor, including the
activities described in subdivision
521(3)
of title 26 under the direct supervision of the chiropractor.
(b) "The supervising chiropractor shall be
legally liable for such activities performed by the intern."
26 V.S.A. §
536.
Section 4.5 Permitted Activities / Liability
Board Jurisdiction Intern applicants and approved interns are
subject to the jurisdiction of the Board and subject to sanctions for any
unprofessional conduct found.
Part 5 Continuing Professional Education
Section 5.1 Permitted Activities / Liability
Approval of Continuing Education Programs A program or
activity is acceptable if it facilitates learning which contributes to the
growth of professional knowledge and competence.
Section 5.2 Permitted Activities / Liability
Exemption for Applicants Granted an Initial License to
Practice by the Office There is no continuing education requirement before the
first license renewal. For the subsequent renewals, the licensee must complete
and document 24 hours of continuing education. The Board recommends, but does
not require, continuing education for initial licensees during their first
licensing period
Section 5.3
Permitted Activities / Liability
Documentation Continuing education shall be documented on
forms available from the Office or on line
http://vtprofessionals.org.
Section 5.4 Permitted Activities / Liability
Failure to Certify Compliance A licensee who fails to certify
compliance with continuing education requirements on a renewal application may
be denied renewal.
Section
5.5 Permitted Activities / Liability
Corrective Action Plans The Board may require the licensee to
develop and complete a specific corrective action plan of remedial course work
within 90 days, See,
3 V.S.A. §
129(k).
Section 5.6 Continuing Professional Education
Records
(a) Responsibility for documenting the
acceptability of a program or activity and the validity of the credits rests
with the applicant.
(b)
Documentation should be retained for a period of four years after the
completion of the program.
(c)
Documentation should consist of the following: course outline, statement of
hours attended signed by the instructor, pamphlets, certificates of attendance
received during the instruction, receipt of registration, or brief summary of
the work content.
(d) Evidence of
satisfactory completion of courses taken for scholastic credit in accredited
universities and colleges is sufficient. Non-credit courses require a statement
of the hours of attendance signed by the instructor.
Section 5.7 Specially Designated Subjects
(a) In its discretion, the Board may
designate in advance not more than 12 hours in a specific subject area or areas
related to public health and safety in which licensees will be required to
obtain continuing education credit during the succeeding two-year license
renewal period.
(b) In exercising
its discretion, the Board will apply the following standards:
(1) there must be a demonstrated general need
for licensees to acquire and maintain competence in the specific subject area
or areas, including but not limited to an increase in complaints of
unprofessional conduct in the specific subject area or areas;
(2) the Board must be assured that continuing
education courses in the specific subject area or areas are reasonably
available to licensees; and
(3) the
Board must review any such designation prior to expiration of the two-year
license renewal period to ascertain whether the designation should remain in
place or should be removed.
Section 5.8 Time
(a) Only time spent in instruction, and not
preparation time, will be credited.
(b) For university or college courses, each
semester hour of credit shall equal 15 hours toward the requirement.
Section 5.9 Time
Case-by-case approval An individual course or activity may be
approved upon submitting to the Board a course outline, instructor
qualifications, sponsoring organization, and dates of presentation. Advance
approval is not required.
Section
5.10 Time
Pre-approval Courses in the following categories are approved
without further action by the Board:
(a) Postgraduate courses in core curriculum
subjects offered for credit by a CCE-accredited school;
(b) Courses approved for continuing education
credit by chiropractic boards of other states where the participant is licensed
and practicing;
(c) Courses
approved for continuing education credit toward category I of the Physician's
Recognition Award of the American Medical Association, provided that such
courses do not exceed 12 hours in a biennial renewal period;
(d) courses approved by P.A.C.E. for
continuing education.
Section
5.11 Time
Courses not approved Approval will not be granted for:
(a) Courses in practice management;
(b) Courses in financial
management.
Section 5.12
Time
Modification of Continuing Education Requirement Upon a
showing of hardship, the Board may in its sole discretion modify the continuing
education requirement.
(a) To apply
for modification, the licensee must submit a written statement not less than 60
days before expiration of the license renewal period setting forth the
conditions of hardship with specificity.
(b) After review, the Board shall send
written notification of its decision, and the reasons therefore, to the
licensee.
Section 5.13
Time
Format of Continuing Education Programs Continuing education
will be accepted if:
(a) it is a
course conducted or designed by a qualified instructor who will be able to
instruct and interact in the formats below:
(1) Classroom Instruction - Traditional
in-classroom, with instructor and student interaction and written
materials;
(2) Interactive
Television which permits continuous mutual communication between the instructor
and all students, continuous observation of the instructor by all students, and
continuous observation of all students by the instructor;
(3) Distance Courses /Online Delivery
Distance education courses are defined as programs whereby instruction does not
take place in a traditional classroom setting but rather through other media
where teacher and student communicate by electronic means; or
(b) it is self-study which may
include printed or electronic media, if the study is demonstrated by a
journal.
Section 5.14
Time
Journals The Board wishes to encourage practitioners to avail
themselves of technical, profession related literature whenever possible.
Toward that end, the Board will construe "individual course" as it appears in
Board Rule
5.9 to include practitioner
created journals.
(a) The Board will
permit continuing education credit for journals at the rate of one hour for
each 8 pages of chiropractic articles or texts read, summarized, and
documented. Each entry should be dated. Documentation must occur at the time of
the reading. Effective with the 2014 biennial renewal, practitioner created
journals may not be used for more than 12 hours of the 24 hours of required
continuing education.
(b) Journals
of chiropractic readings must be retained by the licensee for 4
years.
(c) Journals are subject to
audit upon request by the Board.
Section 5.15 Audits
(a) Each biennium, the Board shall conduct a
random audit of no fewer than ten percent (10%) of the licensees applying for
renewal. The Board may also audit currently conditioned licensees, late
renewing licensees, and licensees who in any of the preceding three (3) renewal
cycles were initially found to have not met continuing education renewal
requirements.
(b) When a licensee
appears on the audit list, the Board will require documentation from the
licensee showing a detailed account of the various credits claimed. The Board
will review the documentation and determine if continuing education
requirements have been satisfied.
(c) Licensees who upon audit are found to be
deficient in continuing education may be permitted 90 days to develop and
complete a corrective plan.
3 V.S.A. §
129(k).
(d) A licensee who fails to comply with a
corrective plan is subject to license suspension or other disciplinary action
by the Board.
Part
6 Competency Requirements of Licensees
Section
6.1 Audits
Ionizing Radiation
26 V.S.A. §
525 requires licensees to demonstrate
competency before applying ionizing radiation to human beings for diagnostic
purposes.
(a) Competency to apply
ionizing radiation to human beings is shown by graduation from a CCE accredited
school of chiropractic.
(b) upon
receipt of the application and payment of the required fee, the Board will
issue the ionizing radiation endorsement.
Section 6.2 Periodic competence
recertification
(a) A Board authorized
evaluator shall visit premises as the Board deems necessary to conduct a
competency evaluation of practicing chiropractors who use ionizing radiation on
patients.
(b) The evaluation shall
include, but not be limited to quality control evaluation, random film
evaluation for collimation, film blackening, positioning, appropriate patient
shielding, and processing; review of method of documentation of last menstrual
period (LMP); report of equipment type, including film/screen combinations; and
report on evaluation of processor chemicals and cleanliness of chemicals if
manual processing technique used.
(c) The evaluation shall also include a
quality control check of films selected randomly for diagnostic quality of film
and quality control (collimation, processing, and appropriate patient
shielding).
(d) the evaluation and
re-certification fee is set by statute.
Section 6.3 Periodic competence
recertification
Ionizing Radiation Endorsement Renewal An ionizing radiation
endorsement must be renewed every two years and a renewal fee must be paid. The
licensee is responsible for renewing on time. An ionizing radiation endorsement
not renewed by the expiration date will expire automatically. To reinstate an
ionizing radiation endorsement after it has expired, a licensee must apply to
the Board for approval and pay the required fee.
Section 6.4 Periodic competence
recertification
Violations The Attorney General or an OPR prosecuting attorney
or a State's Attorney may bring a civil action to enjoin continuing violations
of the law. Any person who applies ionizing radiation to human beings without
having the proper endorsement or license may be subject to civil or criminal
penalties.
Part 7
Minimal Record Keeping Standards
Section 7.1
Explanation
(a) These rules apply to all
licensed chiropractic physicians during the normal course of care with new or
established patients, regardless of whether the fee for services was charged,
reduced, or waived by means of advertisement or otherwise.
(b) Chiropractic records are maintained to
serve as a basis for planning patient care and for continuity in the evaluation
of a patient's condition and treatment; to furnish documentary evidence of the
course of the patient's clinical evaluation, treatment, and change in
condition; and to document communication between the practitioner responsible
for the patient and any other health care professional who contributes to the
patient's care.
(c) Chiropractic
records shall be legibly maintained and shall contain sufficient information
to:
(1) identify the treating doctor and
address where chiropractic care was provided;
(2) identify the patient;
(3) support the
diagnosis/assessment;
(4)
substantiate the treatment; and
(5)
document the course and results of treatment accurately.
(d) Patient records shall include, at a
minimum,
(1) patient histories;
(2) examination results;
(3) test results;
(4) records of substances dispensed,
administered, or recommended;
(5)
reports of consultations and hospitalizations; and
(6) copies of records or reports or other
documentation obtained from other health care practitioners at the request of
the physician whether relied upon by the physician in determining the
appropriate treatment of the patient or not.
(e) Initial and follow-up services (daily
records) shall consist of documentation of current status and treatment
rendered.
Section 7.2
Patient Records
(a) All patient records shall
include:
(1) patient history;
(2) condition presented or wellness care, or
both; and
(3) examination findings,
including x-rays when clinically indicated.
(b) Abbreviations may be used in a patient's
record, provided that the record also contains a legend or key explaining the
meaning of any abbreviations used.
Section 7.3 Providing records
A licensed chiropractic physician must provide copies of a
patient's records within 30 days, when the chiropractic physician receives a
written request for the records from the patient, the patient's representative,
or succeeding health care professionals or institutions. This rule applies to
patient records which are in the possession of or under the control of the
chiropractic physician.
3 V.S.A. §
129a(a)(8). Vermont statutes
set permissible fees for copying and providing records. See, e.g.
18 V.S.A. §
9419.
Part 8 Complaint Procedures
Section 8.1 Providing records
Disciplinary Procedure The Board follows the Office procedure
for processing, investigating, and prosecuting unprofessional conduct and
unauthorized practice complaints. A copy of the complaint procedure may be
obtained from the Office or online under "Disciplinary Procedures" at
http://vtprofessionals.org/.
Section 8.2 Grounds for Discipline
(a) Unprofessional conduct is defined by
statutes
26
V.S.A. §
541(b) and 3
V.S.A. § 129a. Both apply to licensees, applicants and interns.
Unprofessional conduct includes failing to comply with the administrative rules
governing the practice of a profession.
3 V.S.A. §
129a(a)(3).
(b) When a standard of unprofessional conduct
in
3 V.S.A. §
129a conflicts with a standard set forth in a
26
V.S.A. §
541 or a standard set in these
rules, the standard that is most protective of the public shall govern.
3 V.S.A. §
129a(e).
(c) No person subject to these rules may
provide services which he or she is not qualified to perform or which are
beyond the scope of his or her education, training, capabilities, experience,
or practice.
Section 8.3 Sanctions for
Unprofessional Conduct and Unauthorized Practice
(a) Vermont statutes permit the Board to
discipline a licensee following a hearing upon a finding of unprofessional
conduct. Possible disciplinary actions the Board may impose on a license may
include, but are not limited to:
(1) warnings
or reprimands;
(2) suspension for a
period of time to be determined by the Board;
(3) revocation;
(4) limitations on practice;
(5) setting conditions for practice or
resumption of practice;
(6) denial
of reinstatement; or
(7) imposition
of civil penalties.
(b)
All Board disciplinary actions are public records available online or from the
Office.
(c) The Board may levy a
civil penalty of up to $ 1,000.00 for each instance of unprofessional conduct
or unauthorized practice.
(d) A
person who violates
26 V.S.A. §
522 is subject to the penalties provided in
3 V.S.A. §
127(c).
