Articles 2 & 9

Article 2. Practice of Chiropractic.....................11

§ 310. Change of Name
§ 310.1. Replacement License
§ 310.2. Use of the Title "Chiropractor" by Unlicensed Persons.
§ 311. Advertisements.
§ 312 Illegal Practice
§ 312.1 Ownership of a Chiropractic Practice
§ 312.2 Ownership of a Practice upon the Death or Incapacity of a Licensee
§ 313. Inducing Student to Practice Chiropractic
§ 314. Law Violators
§ 315. Mental Illness
§ 316. Responsibility for Conduct on Premises
§ 317. Unprofessional Conduct
§ 317.1. Chiropractic Referral Services
§ 317.5. Investigation and Enforcement Costs; Payment by Licentiate
§ 318. Chiropractic Patient Records/Accountable Billings
§ 319. Free or Discount Services

Article 9. Enforcement and Discipline.....................60

§ 384. Disciplinary Guidelines
§ 390. Issuance of Citations

§ 390.1. Criteria to Be Considered
§ 390.2. Violation Codes and Penalty
§ 390.3. Citations for Unlicensed Practice
§ 390.4. Contested Citations
§ 390.5. Compliance with Citation/Order of Abatement
§ 390.6  Notification to Other Boards and Agencies

§ 316. Responsibility for Conduct on Premises.

1. Every licensee is responsible for the conduct of employees or other persons subject to his supervision in his place of practice, and shall insure that all such conduct in his place of practice conforms to the law and to the regulations herein.
2. Where a chiropractic license is used in connection with any /premises, structure or facility, no sexual acts or erotic behavior involving patients, patrons or customers, including, but not necessarily limited to, sexual stimulation, masturbation or prostitution, shall be permitted on said premises, structure or facility.
3. The commission of any act of sexual abuse, sexual misconduct, or sexual relations by a licensee with a patient, client, customer or employee is unprofessional conduct and cause for disciplinary action. This conduct is substantially related to the qualifications, functions, or duties of a chiropractic license.

This section shall not apply to sexual contact between a licensed chiropractor and his or her spouse or person in an equivalent domestic relationship when that chiropractor provides professional treatment.

§ 317. Unprofessional Conduct.

The board shall take action against any holder of a license who is guilty of unprofessional conduct which has been brought to its attention, or whose license has been procured by fraud or misrepresentation or issued by mistake.

Unprofessional conduct includes, but is not limited to, the following:

1. Gross negligence;
2. Repeated negligent acts;
3. Incompetence;
4. The administration of treatment or the use of diagnostic procedures which are clearly excessive as determined by the customary practice and standards of the local community of licensees;
5. Any conduct which has endangered or is likely to endanger the health,welfare, or safety of the public;
6. The administering to oneself, of any controlled substance, or the use of any dangerous drug or of alcoholic beverages to the extent or in a manner as to be dangerous or injurious to oneself, or to any other person or to the public, or to the extent that the use impairs the ability of the person to conduct with safety to the public the practice authorized by the license;
7. Conviction of a crime which is substantially related to the qualifications, functions or duties of a chiropractor;
8. Conviction of any offense, whether felony or misdemeanor, involving moral turpitude, dishonesty, physical violence or corruption. The board may inquire into the circumstances surrounding the commission of the crime in order to fix the degree of discipline or to determine if such conviction was of an offense involving moral turpitude, dishonesty, physical violence or corruption. A plea or verdict of guilty, or a plea of nolo contendere is deemed to be a conviction within the meaning of the board's disciplinary provisions. The board may order a license to be suspended or revoked, or may decline to issue a license upon the entering of a conviction or judgement in a criminal matter.
9. The conviction of more than one misdemeanor or any felony involving the use, consumption, or self-administration of any dangerous drug or alcoholic beverage, or any combination of those substances.
10. The violation of any of the provisions of law regulating the dispensing or administration of narcotics, dangerous drugs, or controlled substances;
11. The commission of any act involving moral turpitude, dishonesty, or corruption, whether the act is committed in the course of the individual's activities as a license holder, or otherwise;
12. Knowingly making or signing any certificate or other document relating to the practice of chiropractic which falsely represents the existence or nonexistence of a state of facts;
13. Violating or attempting to violate, directly or indirectly, or assisting in or abetting in the violation of, or conspiring to violate any provision or term of the Act or the regulations adopted by the board thereunder;
14. Making or giving any false statement or information in connection with the application for issuance of a license;
15. Impersonating an applicant or acting as a proxy for an applicant in any examination required by the board for the issuance of a license or certificate;
16. The use of advertising relating to chiropractic which violates section 17500 of the Business and Professions Code;
17. The participation in any act of fraud or misrepresentation;
18. Except as may be required by law, the unauthorized disclosure of any information about a patient revealed or discovered during the course of examination or treatment;
19. The employment or use of persons known as cappers or steerers to obtain business;
20. The offering, delivering, receiving or accepting of any rebate, refund, commission, preference, patronage, dividend, discount or other consideration as compensation or inducement for referring patients to any person;
21. Participation in information or referral bureaus which do not comply with section 317.1 of the regulations;
22. Entering into an agreement to waive, abrogate, or rebate the deductible and/or co-payment amounts of any insurance policy by forgiving any or all of any patient's obligation for payment thereunder, when used as an advertising and/or marketing procedure, unless the insurer is notified in writing of the fact of such waiver, abrogation, rebate, or forgiveness in each such instance.

In all insurance billings where a waiver of a deductible or a co-payment is intended as an advertising and/or marketing procedure, the chiropractor's statement and insurance billing shall contain the following statement:

I/WE WAIVE CO-PAYMENT AND/OR DEDUCTIBLES. IT IS MY/OUR INTENTION TO DO THE FOLLOWING: (Indicate one choice below)

( ) BILL THE PATIENT $__________AFTER RECEIPT FROM YOU OF $___________ .

( ) WAIVE ANY FURTHER PAYMENT FROM THE PATIENT AFTER RECEIPT FROM YOU OF $__________ .

( ) IN CASES WHERE PREDETERMINATION OF INSURANCE BENEFITS IS NOT POSSIBLE, I/WE PROVIDE THE FOLLOWING WRITTEN EXPLANATION OF MY/OUR BILLING INTENTIONS: _______________________________________________________________

____________________________________________________________________________

23. Not referring a patient to a physician and surgeon or other licensed health care provider who can provide the appropriate management of a patient's physical or mental condition, disease or injury within his or her scope of practice, if in the course of a diagnostic evaluation a chiropractor detects an abnormality that indicates that the patient has a physical or mental condition, disease, or injury that is not subject to appropriate management by chiropractic methods and techniques. This subsection shall not apply where the patient states that he or she is already under the care of such other physician and surgeon or other licensed health care provider who is providing the appropriate management for that physical or mental condition, disease, or injury within his or her scope of practice.
24. The offer, advertisement, or substitution of a spinal manipulation for vaccination.
25. [Reserved]
26. The treatment for infectious disease, defined as a disease caused by pathogenic microorganisms in the body. This subsection shall not be interpreted to prohibit the treatment of neuromusculoskeletal or other conditions, diseases or injuries within the scope of practice of a chiropractor in any patient with an infectious disease.

§ 317.5. Investigation and Enforcement Costs; Payment by Licentiate.

1. In any order in resolution of a disciplinary proceeding before the Board of Chiropractic Examiners, the board may request the administrative law judge to direct a licentiate found to have committed a volition or violations of the Chiropractic Initiative Act to pay a sum not to exceed the reasonable costs of the investigation and enforcement of the case.
2. A certified copy of the actual costs, or a good faith estimate of costs where actual costs are not available, signed by the board bringing the proceeding or its designated representative shall be prima facie evidence of reasonable costs of investigation and prosecution of the case. The costs shall include the amount of investigative and enforcement costs up to the date of the hearing, including, but not limited to, charges imposed by the Attorney General.
3. The administrative law judge shall make a proposed finding of the amount of reasonable costs of investigation and prosecution of the case when requested pursuant to subdivision (a).

The board may reduce or eliminate the cost award, or remand to the administrative law judge where the proposed decision fails to make a finding on costs requested pursuant to subdivision (a).

4. Where an order for recovery of costs is made and timely payment is not made as directed in the board's decision, the board may enforce the order for repayment in any appropriate court. This right of enforcement shall be in addition to any other rights the board may have as to any licentiate to pay costs.
5. In any action for recovery of costs, proof of the board's decision shall be conclusive proof of the validity of the order of payment and the terms for payment.
1. Except as provided in paragraph (2), the board shall not renew or reinstate any license of any licentiate who has failed to pay all of the costs ordered under this section.
2. Notwithstanding paragraph (1), the board may, in its discretion, conditionally renew or reinstate for a maximum of one year the license of any licentiate who demonstrates financial hardship and who enters into a formal agreement with the board to reimburse the board within that one-year period for the unpaid costs. All costs recovered under this section shall be considered a reimbursement for costs incurred and shall be deposited in the fund of the board recovering the costs.
7. Nothing in this section shall preclude the board from including the recovery of the costs of investigation and enforcement of a case in any stipulated settlement.

§ 318. Chiropractic Patient Records/Accountable Billings.

1. Chiropractic Patient Records. Each licensed chiropractor is required to maintain all active and inactive chiropractic patient records for five years from the date of the doctor's last treatment of the patient. Active chiropractic records are all chiropractic records of patients treated within the last 12 months. Chiropractic patient records shall be classified as inactive when there has elapsed a period of more than 12 months since the date of the last patient treatment.

All chiropractic patient records shall be available to any representative of the Board upon presentation of patient's written consent or a valid legal order. Active chiropractic patient records shall be immediately available to any representative of the Board at the chiropractic office where the patient has been or is being treated. Inactive chiropractic patient records shall be available upon ten days notice to any representative of the Board. The location of said inactive records shall be reported immediately upon request.
Active and inactive chiropractic patient records must include all of the following:

1. Patient's full name, date of birth, and social security number (if available);
2. Patient gender, height and weight. An estimated height and weight is acceptable where the physical condition of the patient prevents actual measurement;
3. Patient history, complaint, diagnosis/analysis, and treatment must be signed by the primary treating doctor. Thereafter, any treatment rendered by any other doctor must be signed or initialed by said doctor;
4. Signature of patient;
5. Date of each and every patient visit;
6. All chiropractic X-rays, or evidence of the transfer of said X-rays.
2. Accountable Billings. Each licensed chiropractor is required to ensure accurate billing of his or her chiropractic services whether or not such chiropractor is an employee of any business entity, whether corporate or individual, and whether or not billing for such services is accomplished by an individual or business entity other than the licensee. In the event an error occurs which results in an overbilling, the licensee must promptly make reimbursement of the overbilling whether or not the licensee is in any way compensated for such reimbursement by his employer, agent or any other individual or business entity responsible for such error. Failure by the licensee, within 30 days after discovery or notification of an error which resulted in an overbilling, to make full reimbursement constitutes unprofessional conduct.

§ 319. Free or Discount Services.

Licensees may advertise that they will perform certain designated routine professional services free or at a discount if such advertising claims are truthful. However, no charge shall be made for any other professional services rendered or commodities provided to a patient during any office visit in which free or discounted services are offered or provided unless, prior to the accrual of any charges, the patient shall have been informed of the cost of such additional services and/or commodities and shall have agreed to pay for them.

For the purposes of this section, no separate charge shall be made for the professional evaluation of diagnostic tests or procedures which are provided free or without cost, or at a discount, whether such professional evaluation is made at the time of the initial office visit or at any later time.

Article 9. Enforcement and Discipline

§ 384. Disciplinary Guidelines.

In reaching a decision on a disciplinary action under the Administrative Procedure Act (Government Code Section 11400, et seq.), the board shall consider the disciplinary guidelines entitled "Disciplinary Guidelines and Model Disciplinary Orders" [revised September 23, 1999] which are hereby incorporated by reference. Deviation from these guidelines and orders, including the standard terms of probation, is appropriate where the board in its sole discretion determines that the facts of the particular case warrant such a deviation--for example: the presence of mitigating factors; the age of the case; evidentiary problems.

§ 390. Issuance of Citations.

1. The executive director of the board or his/her designee may issue a citation with an order of abatement against a licensee for any violation of the California Code of Regulations which would be grounds for discipline.
2. Each citation shall be in writing and shall describe with particularity the nature and facts of each violation specified in the citation, including a reference to the law and/or regulation alleged to have been violated.
3. The citation shall be served upon the individual personally or by certified mail.

§ 390.1. Criteria to Be Considered.

In the issuance of any citation, the following factors shall be considered:

1. Nature and severity of the violation
2. Length of time that has passed since the date of the violation.
3. Consequences of the violation, including potential or actual patient harm.
4. History of previous violations of the same or similar nature.
5. Evidence that the violation was willful.
6. Gravity of the violation.
7. The extent to which the cited person has remediated any knowledge and/or skill deficiencies which could have injured a patient.

§ 390.3. Citations for Unlicensed Practice.

The executive director or his/her designee may issue a citation against any unlicensed person who is acting in the capacity of a licensee under the jurisdiction of the board and who is not otherwise exempt from licensure. Each citation may contain an order of abatement fixing a reasonable period of time for an abatement. Any sanction authorized for activity under this section shall be separate from and in addition to any other civil or criminal remedies.

§ 390.5. Compliance with Citation/Order of Abatement.

1. Orders of abatement may be extended for good cause. If a cited person who has been issued an order of abatement is unable to complete the correction within the time set forth in the citation because of conditions beyond his/her control after the exercise of reasonable diligence, the person cited may request an extension of time from the executive director or his/her designee in which to complete the correction. Such a request shall be in writing and shall be made within the time set forth for abatement.
2. When a citation or order of abatement is not contested or if the order is appealed and the person cited does not prevail, failure to abate the violation within the time allowed shall constitute a violation and a failure to comply with the citation or order of abatement.
3. Failure to timely comply with an order of abatement is unprofessional conduct and may result in disciplinary action being taken by the board.