CONSOLIDATED NEWFOUNDLAND REGULATION 1101/96

Short title

1. These regulations may be cited as the Chiropractors Regulations.

203/94 s1

Definitions

2. In these regulations

(a) "Act" means the Chiropractors Act; and

(b) "association" means the Newfoundland and Labrador Chiropractic Association.

203/94 s2

Meetings

3. (1) There shall be at least one general meeting of the board at a time and place that the board may decide and the board may determine the amount of notice and the method of giving notice of the meeting to the membership provided that

(a) if the meeting will be dealing with proposed changes to the Act or regulations, notice shall be posted by ordinary mail at least 30 days before the scheduled date of the meeting; and

(b) the annual general meeting shall be no later than 60 days after the filing with the minister of the financial statements of the board for the preceding year and the registrar shall forward to members by ordinary mail an audited statement of the finances of the board for the preceding fiscal year.

(2) Only members of the board may participate in and vote at meetings of the board.

(3) The board shall at each general meeting present a report of the activities and proceedings of the board since the last general meeting.

(4) The chairperson of the board shall preside over all meetings of the board and in the absence of the chairperson, a member of the board elected at the meeting shall preside.

(5) A meeting of the board shall be conducted and votes taken in accordance with Roberts Rules of Order.

(6) A member of the board or a committee may participate in a meeting of the board or a committee appointed by the board by means of telephone or other communication facilities that permit all persons participating in the meeting to hear each other.

(7) A resolution in writing signed by all of the members of the board or of a committee appointed by the board shall be as effective as if passed at a meeting of the board or committee duly called, constituted and held.

203/94 s3

Remuneration

4. (1) A member of the board

(a) in attendance at the meetings of the board or committees of it;

(b) who is called upon to attend the legislature or court on business of the board; or

shall be paid the amount necessarily disbursed by him or her for expenses in connection with the attendance.

(2) Subsection (1) shall not apply where the member's attendance or engagement is as the result of a complaint into the conduct of that member.

(3) A claim for expenses incurred shall be submitted on an expense account form to be provided by the board and shall be signed by the person submitting the claim for payment.

(4) A payment under the foregoing provisions shall not be made unless first authorized by the board.

203/94 s4

Registration and applicant procedure

5. (1) A chiropractor granted licensure under section 10 of the Act must also fulfil the following requirements:

(a) provide full payment to the registrar of the annual dues as set in subsection 6(1) no later than a date to be determined by the board; and

(b) complete and return to the registrar an application form no later than a date to be determined by the board.

(2) Applicants seeking licensure under section 9 of the Act must also comply with the following requirements:

(a) that the applicant be 19 years of age and submit proof of being a Canadian citizen, birth certificate, or of being legally entitled to work in Canada with their application;

(b) that the applicant complete an application form and return it to the chairperson of the examining committee with the appropriate application and examination fees as prescribed by the board;

(c) that applications will not be considered for the current examination session if incomplete or if the following is not submitted to the examining committee:

(i) verification of all licences, if applicable,

(ii) 2 suitable recent photographs, passport style,

(iii) official chiropractic college, university and C.C.E.B. transcripts as soon as they become available, and

(iv) 3 letters of reference to be addressed to the board and mailed directly to the examining committee and that committee reserves the right to contact the references if further or specific information is required.

(3) Applications and all supporting documents must be received by the Newfoundland and Labrador Chiropractic Board Examining Committee at least 60 days before the examination date.

(4) An individual may withdraw his or her application up to 30 days before the examination date without forfeiture of the examination fee.

(5) After reviewing an application and credentials and if found to be in order, the examining committee shall recommend to the board that the applicant be allowed to sit for the provincial examinations.

(6) The file of the applicant shall be forwarded to the board and all forms and supporting documents become property of the board and once satisfied with the application and documentation, it shall then advise the applicant of the particulars regarding the examinations.

(7) Once the examination of the applicant is completed, the examining committee shall inform the board of the results and the board shall notify the applicant.

(8) If a successful applicant wishes to establish a practice in the province, a registration fee prescribed by and payable to the board and all applicable association dues shall be paid to the registrar before the licence is issued.

(9) If an applicant does not successfully complete the examination, the examining committee may, at its discretion, request that additional educational upgrading be completed before a subsequent re‑examination and an applicant may not write examinations more than 3 times.

203/94 s5

Annual fees

6. (1) Licences shall be issued for a period not exceeding 12 months.

(2) The annual fees for licensed members shall be determined and voted upon by the board at the annual general meeting.

(3) Each licensed member shall in each year on or before June 1 pay to the registrar the annual fee as determined under subsection (2) and if the member is otherwise in good standing, the registrar shall upon payment of the annual fee, issue a licence to the member.

(4) If a member fails to pay the required annual fee by July 1 in any practice year, he or she shall stand suspended.

(5) The board may reinstate an individual suspended under subsection (4) upon full payment of all arrears together with the annual fee for the practice year in which he or she is reinstated.

203/94 s6

Professional liability protection

7. (1) A chiropractor applying for licensure or relicensure shall, before commencing practice, present to the registrar proof of malpractice coverage or protection through the Canadian Chiropractic Association or proof of malpractice coverage or protection which shall be equivalent to or better than the professional liability protection offered by the Canadian Chiropractic Protective Association to its members.

(2) A chiropractor licensed under the Act shall as a condition of licensure advise the registrar in writing of cancellation, termination or loss of malpractice protection for any reason.

(3) Failure to notify the registrar within a 10 day period of an event referred to in subsection (2) shall result in immediate suspension of licensure and other disciplinary measures taken in accordance with the Act and regulations.

203/94 s7

Radiation safety and procedure

8. (1) Chiropractors licensed under the Act may provide x‑ray services to their patients at a private chiropractic x‑ray facility providing installation, operation and maintenance of that x‑ray equipment meets the terms and conditions of the Radiation Health and Safety Act and the Occupational Health and Safety Act and other laws of the province.

(2) A chiropractor licensed under the Act may provide x‑ray services to his or her patients by prescription at a hospital or other health facility following approval of a written application for privileges, directed to the hospital administrator or chief executive officer.

(3) Chiropractors prescribing x‑ray services under subsection (2) shall abide by all quality assurance and safety procedures established by the hospital or health facility.

(4) Payment for use of hospital or health facility x‑ray facilities shall be the responsibility of the patient for whom the service has been prescribed.

(5) The rates to be paid by chiropractors' patients to hospitals or health facilities for x‑ray services shall be determined by negotiation between the Newfoundland and Labrador Chiropractic Association, on behalf of chiropractic patients, the Newfoundland and Labrador Health Care Association, on behalf of member hospitals and health facilities and the Department of Health and those rates shall not include interpretation fees for radiologists.

(6) In utilizing x‑ray, members shall ensure that

(a) sufficient clinical indications exist for the taking of x‑rays;

(b) where acceptable x‑rays have already been taken and are available from a colleague or other health professional, additional x‑rays shall not be taken;

(d) the exposure technique is consistent with minimum radiation dosage to the patient to obtain maximum radiographic detail;

(e) sufficient views are taken to be of diagnostic value, with a minimum of 2 views, at right angles, of the area of interest for an initial examination;

(f) reasonable care is taken to protect the patient from excessive radiation with particular attention to protective devices and techniques such as collimation, gonad shielding, filtration and eye protection;

(g) reasonable care is taken with female patients of child‑bearing age to avoid exposure to x‑ray during pregnancy;

(h) each x‑ray film clearly shows the patient's age, sex, surname and initials, the date of exposure, identification of side, right or left views and position of the patient such as standing, sitting, A‑P or P‑A;

(i) where the use of full spine radiography is clinically justified, beam attenuation shall be employed between the focal spot and the body being examined to compensate for the various body densities which occur; and

(j) records of all x‑rays made of a patient and the technique used are maintained with the patient's file.

(7) A member shall not permit a person in his or her employ to use x‑ray unless that person is

(a) a member authorized by the board for the purpose;

(b) a graduate or student chiropractor operating under direct supervision of a member; or

(8) A chiropractor may not prescribe fluoroscopic or angiographic x‑rays.

(9) A chiropractor may only prescribe plain film radiographs of the skeletal system.

(10) X‑ray views shall be prescribed using the terminology contained in Essentials of Skeletal Radiology by T. R. Yochum and L. J. Rowe or another text that may be prescribed by the board.

203/94 s8

Auxiliary therapies

9. (1) Electro therapy consists of those therapeutic procedures or devices which utilize electrical current, directly or indirectly, for the purpose of producing therapeutic healing effect and control of pain.

(2) Thermo therapy consists of those therapeutic procedures or devices which use temperature or temperature change for the purpose of producing a therapeutic healing effect and control of pain.

203/94 s9

Code of conduct

10. Improper conduct shall include the following conduct:

(a) exceeding the lawful scope of practice or otherwise acting in contravention of the Act or the regulations made under the Act;

(b) failure by a member to abide by the terms, conditions and limitations of his or her licence;

(c) publishing, displaying or otherwise distributing material relating to the activities of the board in a form of public media, without prior approval from the board where that material contains

(i) intimate financial or personal information relating to a member of the association or a patient, or

(ii) information which if disclosed would otherwise contravene these regulations;

(d) offering to guarantee a cure either verbally or in writing or by advertising or otherwise;

(e) permitting, counselling or assisting a person who is not registered under the Act to engage in the practice of chiropractic in the province except as permitted by the Act or regulations;

(f) failing to maintain records that are required to be kept respecting a member's patients;

(g) falsifying a record in respect of an examination or a treatment of a patient;

(h) giving information concerning a patient's condition or professional services performed for a patient to a person other than the patient, his or her parent or legal guardian, without the consent of the patient, unless required to do so by law;

(i) failing to provide an itemized account if a request is made by a patient or a representative of the patient for an account;

(j) knowingly submitting a false or misleading account or false or misleading charges of services rendered to a patient;

(k) charging a fee for services not performed;

(l) charging a fee that is excessive in relation to the services performed;

(m) requiring fees in advance or offering discounts or other incentives for payment in advance;

(n) engaging in the practice of chiropractic while member's ability to perform a professional service is impaired by alcohol or a drug;

(o) sexual impropriety with a patient;

(p) making a misrepresentation respecting a treatment, device or technique;

(q) abusing a patient verbally or physically;

(r) conviction in a court of an indictable offence;

(s) conduct or an act relevant to the practice of chiropractic that, having regard to all of the circumstances, would reasonably be regarded as disgraceful, dishonourable or unprofessional;

(t) conduct contrary to the Code of Ethics set by the Canadian Chiropractic Association (CCA);

(u) non‑compliance with the continuing education requirements as set by the board;

(v) non‑compliance with x‑ray regulations set by the board; and

(w) examination or treatment of the spinal column, pelvis, extremities and associated tissues conducted without adequate exposure of or contact with that part or parts of the patient's body which are necessary for the procedures involved.

203/94 s10

Discipline committee

11. (1) The board shall appoint a discipline committee to receive and review complaints brought against a member and those complaints must be stated in writing.

(2) The practitioner against whom the complaint has been brought shall be informed by registered mail of the nature of the complaint.

(3) If in the opinion of the board a hearing is warranted, the practitioner shall be given a minimum of 30 days' notification by registered mail of the location and date on which the hearing will occur.

(4) If the member against whom the complaint has been registered fails to appear at the scheduled hearing, the discipline committee may proceed with the hearing in his or her absence, provided there is sufficient proof the chiropractor was notified by acknowledged receipt registered mail of the time and place of the hearing.

(5) Requirements in the Act for written notification of procedures and decisions of the discipline committee which are specified for the chiropractor against whom a complaint is made shall be accorded to the complainant as well.

203/94 s11

Advertising guidelines

12. (1) This section applies to a marketing activity undertaken or authorized by a member in respect of his or her chiropractic services.

(2) In this section

(a) "advertisement" means the use of space or time in public medium or the use of a publication such as a brochure or handbill to communicate with the general public or a segment of it for the purpose of promoting professional services or enhancing the image of the advertiser; and

(b) "marketing activity" includes

(i) an advertisement,

(ii) a publication or communication in any medium with a patient, prospective patient or the public generally, in the nature of an advertisement, promotional activity or material, a listing in a directory, a public appearance or other means by which chiropractic services are promoted,

(iii) contact with a prospective patient initiated by a member, or

(iv) the display or distribution of chiropractic educational or other material.

(3) A member may, in any medium of communication, undertake or authorize a marketing activity respecting his or her chiropractic services which is factual, accurate, verifiable and not otherwise in contravention of these regulations.

(4) A marketing activity undertaken or authorized by a member shall not be

(a) false;

(b) inaccurate;

(d) contrary to the best interests of the public or of the chiropractic profession or tending to harm the standing of the chiropractic profession; or

(e) contrary to these regulations.

(5) A marketing activity violates subsection (4) if it

(a) is calculated or likely to take advantage of the weakened state, either physical or emotional of the recipient or intended recipient;

(b) is likely to create in the mind of the recipient or intended recipient an unreasonable expectation about the results which the member can achieve; or

(6) A member shall not

(a) state that he or she speaks on behalf of the chiropractic profession unless he or she has been expressly authorized in writing by the board to state that official position of the chiropractic profession; or

(b) endorse or lend himself or herself as a chiropractor to the advertisement of any property, investment or service for sale to the public unless that property, investment or service relates directly to chiropractic.

(7) A member shall not

(a) use a firm name or office designation which violates subsection (4); or

(b) hold out his or her firm name so that it indicates more partners or associates than is in fact the case.

(8) The terms "associates", "centre" or "group" may be used as part of an office designation where 2 or more chiropractors are engaged together in a group practice at the same address but nothing in this subsection prohibits chiropractors from using the designation "clinic".

(9) A member shall not on his or her letterhead list or otherwise hold out that he or she is associated with a person who is not a licensed chiropractor under the Act except where that person is appropriately designated as

(a) a retired member or former member;

(b) a deceased member; or

(c) another health professional licensed or registered under the laws of the province that is associated with the member.

(10) A member may not maintain a sign for another member or maintain a listing for another member who has not been in active practice in that location for a period of one year, except in the case where that other member is a former member or deceased member and is so designated.

(11) A member who in any marketing activity includes a statement of fees indicating or intending to indicate the cost for a chiropractic service

(a) shall ensure that the statement sufficiently describes the fees and services in detail, including the fees and costs for and what is included in consultation, examination, report of findings, initial treatment, subsequent treatment, re‑examination, modality type and charge represented in numerical notation to enable the recipient or intended recipient to understand the nature and extent of the chiropractic services to be provided and the cost to the patient;

(b) shall not in an advertisement compare the fees charged by the member to those charged by another member;

(c) shall not agree to share and shall not share with a person who is not a member the member's revenues or profits in association with or in respect of a chiropractic service; and

(d) shall not use words or expressions such as "from...", "minimum" or "... and up" in referring to the fees to be charged nor shall advertisements indicate that a price is a discount, reduction or special rate.

(12) A member

(a) shall not use the title "specialist" or a similar designation suggesting a recognized special status or accreditation on letterhead or a business card or in another marketing activity unless that academic accreditation has been bestowed on him or her and has been recognized by the Canadian Federation of Chiropractic Regulatory Boards (CFCRB); and

(b) shall take all reasonable steps to discourage use, in relation to the member by another person of the title "specialist" or similar designation suggesting a recognized special status or accreditation in a marketing activity unless that academic accreditation has been bestowed on him or her and has been recognized by the CFCRB.

(13) A member shall retain for one year after the date of publication or broadcast of an advertisement or brochure and shall provide to the board upon request

(a) a copy of the publication;

(b) a recording of the broadcast made by use of an electronic media including radio, television and microwave transmission; and

(14) An advertisement in any medium shall first be approved by the board.

(15) A member shall, when called upon by the board or a committee designated by the board to do so, verify the statements made in his or her marketing activity.

203/94 s12

Continuing education

13. (1) The board shall appoint a committee to be known as the Continuing Education Committee.

(2) All licensed chiropractors shall be required to attend a minimum of 12 credit hours of continuing education in each 2 year period and of the 12 hours required, at least 6 hours shall be devoted to continuing education in the field of radiography.

(3) Seminars qualifying for credit hour approval must be one hour or longer.

(4) To determine if a seminar has been given the board's approval, a member may contact the chairperson of the Continuing Education Committee before attending that seminar.

(5) The following areas of interests and sources of post‑graduate and continuing education may be considered to be among those appropriate for professional growth to meet the requirements of the profession and expectations of society:

(a) programs in basic, clinical and chiropractic sciences and arts, in research, health planning, institutional protocol, insurance practices and procedures, peer review, industrial practices, forensic practices, insurance consultation, labour relations, patient counselling, philosophy of chiropractic and chiropractic principles;

(b) programs of independent study of professionally related journal articles, monographs, texts and other materials; and

(c) programs relevant to chiropractic presented at conventions, workshops, seminars and conferences that are presented, sponsored or approved by recognized, professionally related associations, organizations, governmental agencies or academic institutions having status with accredited agencies recognized by the board.

(6) Only chiropractic academic institutions having status with the council on chiropractic education may conduct post‑graduate courses leading to eligibility of board certification in specialized or select areas of chiropractic practice.

(7) A practising member of the board shall prove his or her compliance by submitting to the committee written acknowledgement in the form of a continuing education form set by the board from the sponsors of the accredited seminars indicating

(a) the date and subject matter of the seminar;

(b) the length of the seminar; and

and the final submission of acknowledgements in relation to a particular fiscal 2 year time period shall be received by the Continuing Education Committee no later than March 31 of that 2 year time period.

(8) A default of these requirements by a member constitutes misconduct under the Act and subjects that member to action by the board which has the power, in relation to that member, to

(a) reprimand;

(b) place on probation;

(d) cancel registration;

(e) fine; or

(f) make another disposition that it considers just in the circumstances.

(9) In these requirements, "accredited continuing education" means continuing education credit hours awarded to those programs which fall within the board's written policy statement on post‑graduate and continuing education requirements.

(10) Credit hours shall be considered for those programs which may include the following:

(a) a chiropractor may obtain 100% of his or her required credit hours from those programs which are approved by the board and 6 hours of diagnostic imaging, radiography, etc., in each 2 year time period is mandatory;

(b) a chiropractor may obtain a maximum of 3 of his or her required credit hours from those programs which are approved by the board and meet those requirements necessary to fall within this category;

(i) receive one credit hour for each one hour of presentation, and

(ii) be accepted to a maximum of 12 credit hours for each seminar;

(d) for preparing and presenting a continuing education lecture on a clinical theme to a peer group, a chiropractor shall receive 3 credit hours for each hour of presentation for a maximum of 12 credit hours for an original lecture presentation and the lecture must be for a minimum of one hour duration and the subject material shall be approved by the board;

(e) for completing a literature review on a scientific or clinical subject which would be suitable for publication in a referred professional health journal, a chiropractor shall receive 6 credit hours per original paper published;

(f) for preparing and publishing a scientific or clinical paper that has successfully been published in a referred health journal, a chiropractor shall receive 12 credit hours per published paper;

(g) for publishing a definitive book review of a new clinical science textbook that has not been reviewed locally and has been preapproved for review by the board, a chiropractor shall receive 6 credit hours per published review;

(h) for researching and writing a single patient case study or group of similar cases which must be a minimum of 1,000 words and which shall be preapproved by the board, a chiropractor shall receive 6 credit hours per published paper; and

(i) for subscribing to a professional journal, in addition to the journal of the Canadian Chiropractic College which has been preapproved by the board, a chiropractor will receive one credit hour per journal to a maximum of 2 credit hours.

(11) An approved seminar is one that has been accredited by the Continuing Education Committee before its scheduled date and meets the following criteria:

(a) that the exact length of seminar, including scheduled coffee or meal break is available to the board for review;

(b) that a brief summary of the seminar's educational content and relevance to chiropractic science, practice or principle has been forwarded to the board for review;

(d) that attendance records are kept at the seminar and forwarded to the Continuing Education Committee chairperson of the Newfoundland and Labrador Chiropractic Board; and

(e) that each presentation, seminar, must be a minimum of one hour.

(12) For the purposes of qualifying for practice certificate renewal

(a) seminars and education courses must have had credit hours preapproved by the Continuing Education Committee;

(b) credit hours for published material will be awarded in the fiscal year it was published;

(c) credit hours cannot be banked or used in a year other than the current fiscal period in which the credit hours were obtained;

(d) chiropractors must forward all necessary Newfoundland and Labrador Chiropractic Board Continuing Education forms to the Continuing Education Committee chairperson.

(13) A person applying for registration within the board's designated 2 year time period or who is registered as a registered member within the 2 year period may be required by the Continuing Education Committee to acquire a portion of the 12 hours of continuing education.

(14) If a registered member participates in an educational activity including but not restricted to a research related activity or a course leading to a university degree and the Continuing Education Committee is of the opinion that the educational activity qualifies as a chiropractic related session, the committee may credit the member with the number of continuing education hours that, in the opinion of the committee, the activity merits.

(15) At the expiry of a 2 year continuing education period, the registrar shall not issue an annual certificate to a member who

(a) has not acquired the required credit hours; or

(b) has not applied or been granted an extension of the time to acquire the sufficient credit hours.

(16) Notwithstanding subsection (15), a member whose application for an annual certificate has been refused because he or she has not acquired the number of hours of continuing education required may make application to the Continuing Education Committee for an extension of the time required to acquire credit hours.

(17) A member who has not acquired sufficient credit hours at the termination of the extended time period shall immediately have his or her annual certificate suspended.

203/94 s13

Record keeping

14. (1) Chiropractors licensed under the Act shall demonstrate to the board, upon request, evidence of satisfactory patient record keeping practices.

(2) Patient records shall be kept in 2 categories

(a) clinical; and

(b) accounting.

(3) Clinical records shall include the written or typed hard copy of the

(a) indication of reason for initial contact with chiropractor;

(b) history of presentation complaints and health status;

(d) x‑ray findings, where applicable;

(e) acceptance or referral of patient;

(f) treatment rendered each visit;

(g) record of progress or response to treatment; and

(h) date of each of the above.

(4) Accounting records shall include

(a) an appointment book or day record of attendance showing time, date and fees charged for patient visits, recording of cancellations and "no shows"; and

(b) an account or ledger card for each patient showing dates of service, fees charged and payments and this ledger may be computerized to facilitate billing.

(5) A computerized record of patient attendance for a particular period shall not be an acceptable substitute for the records required in paragraph (4)(a).

(6) A computer program referred to in paragraph (4)(b) shall be able to generate a hard copy showing all accounting transactions for each patient visit.

(7) Records referred to in subsections (3) and (4) are personal, individual and particular to each patient and must represent the product of the personal attendance and attention of the chiropractor upon the patient which information may be stored in but not generated by a computer and shall be available in hard copy form.

(8) All records, clinical and accounting shall be maintained for a minimum of 6 years.

203/94 s14

Repeal

15. The Newfoundland and Labrador Chiropractors Regulations, Newfoundland Regulation 203/94, are repealed.