STATE OF ARIZONA BOARD OF CHIROPRACTIC EXAMINERS Mission Statement The mission of the Board of Chiropractic Examiners is to protect the health, welfare, and safety of Arizona citizens who seek and use chiropractic care. WEB ADDRESS:

ASSETS  Agency  In-house investigator – Also assists with monitoring probationary licensees  Professional investigative consultants – Budget for 3 DC’s to review cases from a professional / technical aspect – Positions them to be expert witnesses for subsequent hearings – Assist with compliance reviews

MORE ASSETS  6 private investigators – as needed, on contract, to support chiropractic board - Geographically dispersed to assist rural investigations - Can assist in compliance monitoring - Undercover investigations -Own ½ time Assistant AG paid for by the board

BOARD RESPONSIBILITIES  To investigate complaints.  To oversee the general application of the laws governing the practice of chiropractic.  To update and develop regulations.

BOARD RESPONSIBILITIES  To address scope of practice and to better define both appropriate conduct by professionals and consumer expectations.  To continually review required credentials for doctors to practice safely, effectively and ethically.

BOARD RESPONSIBILITIES  To apply appropriate disciplinary action to doctors of chiropractic who may have broken the public trust through a violation of law.  To function in the global regulatory community to assist other professions or jurisdictions affected by chiropractic.

BOARD STRUCTURE  Governor appoints 5 members:  3 Doctors of Chiropractic  2 public members  The Board employs staff to carryout administrative, licensing and investigative functions.

BOARD STRUCTURE  Assistant attorney general provides legal counsel to Board / staff.  Board meets monthly, meetings open to public.

INVESTIGATIONS  A.R.S. § (B)  Board can open own complaints or receive complaints  Board notifies licensee as to the content of the complaint as soon as is reasonable.  Any person who reports or provides information to the Board in good faith is not subject to civil damages as a result of that action.

COMPLAINT INTAKE  In writing.  Board provided form or letter form.  Anonymous complaints are accepted.

STEP ONE  COMPLAINT ANALYSIS

Complaint No.: _________ Licensee: ____________Complainant: ___________ Date Received: _________Date Reviewed: __________ Allegation(s): ________________________________________________________________________ Possible Violation(s): ________________________________________________________________________ Document(s) Provided In Complaint: ________________________________________________________________________ Evidence Wanted/Needed By Investigator: ________________________________________________________________________ Witnesses: ________________________________________________________________________

STEP TWO  A letter is sent to the complainant that the complaint was received  A letter is sent to the doctor that they have received a complaint. The letter will contain allegations, laws possibly violated, a request for patient records, other documents and his continuing education for the past two years.

SUBPOENA AUTHORITY  A.R.S. § Right to examine and copy evidence; summoning witnesses and documents; taking testimony; right to counsel; court aid; process Board exec has subpoena authority

Subpoena authority allows investigator full access to all records – doctor doesn’t decide which files the investigator gets to review. Can subpoena from hospitals, clinics, public/private agencies. Cannot subpoena law enforcement records

Doctor has 5 days to challenge subpoena and ask for modification, but board does have authority to issue subpoena on demand (immediate.)

SUBPOENA  Will contain a list of requested information.  Ten day limit to provide information  Notice to the doctor of the penalty for not complying.  Notice to the doctor that HIPAA does not prevent the Board form accessing a patient’s information.

STEP THREE: RESPONSE RECEIVED  Copy of response is sent to the complainant.  Patient record is reviewed for compliance with all laws and rules.  Investigation is conducted and if needed interviews, additional subpoena’s and expert review are done.

BOARD BRIEF IS WRITTEN BY INVESTIGATOR The brief will contain:  A complaint summary.  The doctor’s response.  The complainant’s rebuttal.  The investigator’s analysis.

INVESTIGATOR’S ANALYSIS  Is written in bullet form (more objective)  Will contain the investigator’s findings as well as a summary of any interview or expert review.  Is a listing of supported facts.

FACTS Will contain:  The dates of possible violations or events.  The specific statute or rule possibly violated.  There is no opinion from investigator and no recommendation other than the following:

A REQUEST FOR BOARD TO:  Enforce a subpoena.  Use the Board’s authority to require the doctor to submit to physical or mental evaluation’s and testing.

STEP FOUR  The investigative file is presented to the executive director.  The investigation is approved as completed or  The investigator is instructed on what additional information is needed.

STEP FIVE  The investigation is approved as completed.  The Executive Director selects a Board meeting date to: – Hear the complaint – Dismiss the complaint on a consent agenda

STEP SIX  The complainant is notified of the date the Board will review their complaint.  The doctor is subpoenaed to appear at the Board meeting and is required to bring originals of patient files, x-rays, billings, examinations and daily notes.

STEP SEVEN: BOARD MEETING  Board receives all information to review a week prior to the meeting.  The Board allows statements from the complainant and then the doctor.  The Board then conducts questioning of the complainant, doctor and the investigator.

INVESTIGATOR RESPONSIBILITY  Answer all questions of the Board.  Inform the Board of possible omissions or if a misleading statement was made.

BOARD ACTIONS  Dismissal  Dismissal with a non-disciplinary advisory letter (public record)  Further investigation  Vote to formal interview  Vote to formal hearing

DISMISSAL  Dismissed complaints: The complainant and doctor receive a letter of dismissal.  Dismissal with non-disciplinary advisory letter: The complainant and doctor receive a dismissal letter. The doctor’s letter will contain the Board’s advisory.

FURTHER INVESTIGATION  The investigation is continued in the manner requested by the Board and directed by the executive director.  The complaint is then presented to the Board at the next available board meeting.

END OF INVESTIGATOR RESPONSIBILITIES Board hearing processes continue in accordance with Administrative Procedures Act

INVESTIGATOR CHALLENGES  Develop good communication relationship with both sides  Be willing to spend significant time and energy on each case – be thorough  Present facts to the board in an unbiased manner  Clarify complex cases – bring out relevant facts and issues