Battle over chiropractors' ability to do routine X-rays headed for B.C. court

A group of chiropractors in British Columbia is headed to court to obtain an injunction against a new rule that does not allow chiropractors to perform routine and repeat X-rays unless a physical exam or patient history indicates something is seriously wrong.

The chiropractors fighting the rules argue that the College of Chiropractors of B.C. is failing in its duties to “serve and protect” the public, as the changes “do not account for patients who have found tremendous benefits in chiropractic modalities that rely on X-rays.”

The rule changes adopted by the college in February will “prevent chiropractors from providing safe, ethical, and effective care to their patients.”

The group says in court documents that using radiographic imaging in their practice "to identify spinal dysfunction and subluxation" is taught in all accredited chiropractic colleges and is a “fundamental aspect” of a chiropractor's practice.

Those asking for the injunction say that the college does not have the authority under B.C laws to make amendments restricting the use of X-rays. They claim the Health Professions Act (HPA) and its relevant regulations allow chiropractors to use X-rays and other radiographic tools for diagnostic or imaging purposes.

The college does not have the authority under the HPA to make amendments that “run contrary to the express permission granted to chiropractor,” the court documents say.

Claire Immega, partner and co-chair of the commercial litigation practice group at Singleton Urquhart Reynolds Vogel LLP, says her firm is in discussions with opposing counsel about the timing for the injunction application. She expects it to be heard in early April.

She says her clients are asking the court to return chiropractors’ practice rights to the status quo before the Feb. 4 college vote that passed the amendment, pending resolution of the request for an injunction. That means asking the court to prevent the college from enforcing an amendment to the college’s “Professional Conduct Handbook,” which would “allow chiropractors to continue to order and take x-rays in accordance with . . . their professional training and judgment, as they have done for years.”

“This failure to address the rights of patients to select the health care options of their choice runs contrary to the college’s own stated policies and the laws of British Columbia,” the petitioners say. “Rather than relying on the expertise and clinical discretion of chiropractors, the amendments limit the use of X-ray imaging “to circumstances where serious pathology or clinical reasons to suspect serious pathology are identified.”

As well, the amendments do not recognize the rights of patients “to give consent or refuse to a particular form of available health care on any grounds.”

“Many chiropractic patients have found significant benefit from their access to chiropractic medicine techniques that use radiographic imaging,” the court documents state. “Many of these patients rely on this treatment to maintain their mobility, limit their pain, and maintain their health and wellness. As a result of the amendments, these patients . . . are potentially prevented from accessing their chosen treatment.”

Earlier this month, Langley chiropractor Melody Jesson filed a petition in B.C. Supreme Court on behalf of at least a dozen chiropractors, calling for a judge to overrule the college and reject the policy change.

The Mar. 10 petition alleges that the college’s actions “unfairly and unduly" restrain Jesson and other chiropractors' right to practice their trade.

“The restraint of trade is against public policy in that it contravenes the principle of freedom to conduct business. The restraint of trade in this instance cannot be justified as reasonable in the interests of the parties nor of the public."

The college has yet to file a response to the petition, and registrar Michelle da Roza said she was unable to comment while the matter is before the courts.

However, the B.C. college has enacted over the last few years several rules that favour the idea of “evidence-based” treatment as it tries to crack down on chiropractors who make misleading claims.

In the case of using X-rays, a review of scientific literature commissioned by the college suggests that there is no hard evidence that patients benefit from repeated radiographic imaging and that there are risks associated with repeated exposure to radiation.

Immega says the February vote to pass the amendments was based on “a single literature review commissioned by the college for the purpose of the change, which many chiropractors view as deeply scientifically flawed and biased.” She adds that chiropractors who rely on x-rays for their practice now face disciplinary action or are unable to continue to practice.

There have been national and international opposition to those findings and the actions of the B.C. college. The New York-based International Federation of Chiropractors and Organizations, for example, has circulated a petition against the college. In a Facebook post, the president of this organization Grant Dennis wrote that his group believes “this is being used as a ‘template’ or ‘proof of concept’ to be initiated in other areas of Canada, and that it will eventually [make] its way into other parts of the world.”

The college’s reliance on the one review also “demonstrated a lack of fairness in its decision-making process.” The group opposed to the new amendments say that during the Feb. 4 board meeting at which the amendments passed, there was "demonstrated bias and lack of fairness,” including disabling the comment function on the video conferencing platform and board members “repeatedly pushing for an early vote.”

Immega says modern x-rays cause very low amounts of radiation exposure. There have been zero reported cases of harm arising from chiropractic x-rays in British Columbia, and no complaints to the college regarding over-use of x-rays in chiropractic care.

“Many medical processes require x-rays,” she says. “Many dentists take annual x-rays without any specific clinical indication for the same. Patients are able to choose cosmetic and other medical treatments that require x-rays. It is our client’s position that chiropractic patients should have the same rights.”