Testimony this week on a bill that would expand who could clear middle school and high school athletes to return to the playing field after a head injury revealed a split between medical doctors and chiropractors.
Currently, the state’s school sports statutes only allow medical doctors and doctors of osteopathic medicine to sign a written clearance following a concussion.
Bryan Payne, immediate past president of the Kansas Chiropractic Association, said during a legislative hearing that chiropractors currently are able to diagnose and treat concussions but aren’t allowed to sign the form to release their patients to play or practice.
“Chiropractic physicians are very well-trained to diagnose and treat concussions,” Payne said. “We go through an extensive period of our education, and all chiropractic programs hold that stringent education requirement.”
Chiropractors generally have more training in anatomy but less in physiology than medical doctors (M.D.) and doctors of osteopathic medicine (D.O.). Chiropractic school is similar in length to medical school, but chiropractors have fewer residency requirements afterward.
The proposed bill, HB 2016, was discussed Wednesday in the House Health and Human Services Committee. It would change the definition of health care provider within the school sports act from an M.D. or D.O. to a “licensee of the healing arts,” as defined by a separate state statute that includes chiropractors.
Sean Hubbard, who owns a chiropractic and balance center in Wichita, told the committee that after treating patients for head injuries, he must tell them to go back to their M.D. or D.O. to clear them to return to their field of play.
“(That’s) one more day off work, one more day out of school — and many of these kids I end up seeing have missed weeks of school at a time,” Hubbard said. “So that just adds another undue burden when they are ready to go back.”
One of Hubbard’s patients, Ryan King, a graduate student at the Fuqua School of Business at Duke University, has suffered four concussions. The first occurred when he was playing a club soccer game in high school. He told the committee how chiropractic care from Hubbard relieved symptoms that couldn’t be cured with more traditional medicine.
The symptoms from his concussions were so debilitating, King said, that he removed himself from sports between concussions, became depressed and had to take a semester off from college.
King’s pastor suggested he see Hubbard, and within a couple weeks of chiropractic care, King was able to go a full day without a headache.
He was shocked when he heard the Kansas State High School Activities Association and the state don’t give chiropractors the authority to clear athletes for competition. King said the current law is “doing a disservice to all Kansas athletes that have or will get concussions in the seasons to come.”
After the hearing, Rachelle Colombo, director of government affairs for the Kansas Medical Society, said there is a distinction between chiropractic training and medical training.
“Physicians should be the one to make the call on return to play,” Colombo said, “because physicians and those who work under a physician-led team are trained in a medical model that’s trained in the whole body.”
The medical society represents medical doctors from across the state.
Bart Grelinger, an M.D. and board-certified neurologist in Wichita, also told the committee that the treatment of concussions should stay within the traditional medical community.
Grelinger said physicians look at the patient holistically, considering what diseases they have, what medications they are on that could be affected by a head injury and what medications could help relieve symptoms.
“A concussion is going to make those particular medical diseases more problematic,” he said. “Physicians cannot be left out of the loop. … It affects the health of the patient far beyond just a concussion.”
Rep. Dick Jones, a Republican from Topeka, asked whether chiropractors and medical doctors could work together to treat concussions and clear athletes for play.
Grelinger said it’s an option, and referrals happen often in medicine. But Grelinger said care of head injury patients needs to be kept in a “physician-led group.”
After the hearing, Rep. Jim Ward, a Democrat from Wichita, said the bill’s future hinges on lawmakers’ level of confidence in chiropractors to diagnose and treat head injuries.
Doug Smith, executive director of the Kansas Academy of Physician Assistants, proposed an amendment to include physician assistants in the concussion clearance process. He said his organization is neutral on the underlying bill.
Ashley Booker is an intern for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.