Turf Battle Over Sports Physicals : Doctors Oppose Chiropractors on Checkups for School Athletes

In his nine years as a chiropractor, Tim Ursich has performed physical examinations on aspiring athletes, deciding whether the youths are fit to participate in sports at such high schools as Rolling Hills on the Palos Verdes Peninsula, Bishop Montgomery in Torrance and Redondo Union in Redondo Beach.

But if any of his young patients want to go out for sports at such schools as Banning, Carson or Gardena High--all part of the Los Angeles Unified School District--district regulations dictate they must be examined by a licensed physician and surgeon: a medical doctor or an osteopath.

Ursich and some of his colleagues, under the aegis of the increasingly active California Chiropractic Assn., are trying to get the regulation changed to allow chiropractors and other licensed health care practitioners to perform the physicals.

Their controversial campaign to change the regulation, scheduled for a vote today by a divided school board, has drawn vociferous opposition from the Los Angeles County Medical Assn.

‘Would Be Step Backward’

“We have been trying for years to progressively improve the medical care of the school athlete,” said Dr. Jerome (Jerry) Bornstein, an Encino orthopedist who has been a team physician since 1961 and a member of the medical association’s sports medicine committee.

“This would be a step backward, not forward,” Bernstein said. “I have respect for what chiropractors are trained to do in the healing arts, but I think they are overstepping (their qualifications) here.”

The debate in Los Angeles, where about 20,000 students a year are required to take sports screening physical exams, is being watched throughout California’s health care community. It comes at a time when chiropractors have been seeking--and getting--wider acceptance, in part through favorable court decisions and aggressive lobbying and public relations. Marking the debate, which has escalated rapidly since the issue was heard in the Board of Education’s Personnel and Schools Committee in August, is a tangle of medical and legal arguments fraught, both sides say, with political overtones.

‘Losing Some of the Pie’

“The MDs are starting to worry about the competition, that they’re losing some of the pie,” said Paul Lehman, director of public affairs for the chiropractic association.

But Dr. Charles McElwee, president of the county medical association and an orthopedic surgeon in Covina, said turf is not the issue.

“It’s scope of training,” McElwee said. “They are not physicians and they shouldn’t be practicing medicine. If (a patient) wants a true history and physical exam, they cannot get it from a chiropractor.”

Helen Hale, a pediatrician who is director of student health services for the district, said the school board requires a complete physical examination, including hearing, vision, heart, lungs and other internal organs and an evaluation of the musculoskeletal system, plus a medical history, before a youngster is allowed to participate in athletics. In most instances, the family pays the cost of the exam. If a child’s family can’t afford it, either one of the district’s 40 staff physicians or private doctors provide the service for free.

Board Member Rita Walters has been outspoken in her opposition to changing the regulations to include chiropractors, nurse practitioners and others. To fully protect the district from liability and to provide the best screening and care for its students, the exams ought to be done by physicians, she said.

“It’s unfortunate, but for some of these families, this (sports physical) may be the only time their teen-age children encounter a physician. I think they ought to see a fully licensed medical doctor,” Walters said.

But Jerilynn Kaibel, a chiropractor with practices in San Bernardino and Riverside counties and a member of the Beaumont Unified School District Board of Education, said chiropractors can do just as good an exam as medical doctors. She is convinced that chiropractors are well qualified to do physicals for Los Angeles, even though the exam is more thorough than that required in many other districts.

“L.A.’s exam is very comprehensive, and that’s good,” Kaibel said, “but it’s nothing outside the scope of chiropractic.”

There is wide disagreement about what chiropractors, whose training and practice centers on the musculoskeletal system, are trained and licensed to do.

Chiropractors want the district to follow the lead of the California Interscholastic Federation, the private association which oversees school athletic competitions throughout the state. The CIF allows the job of physical exams to be done by any “medical practitioner.” Several school districts in California, including several in Los Angeles and Orange counties, have patterned their own regulations after the CIF.

Other Districts’ Policies Cited

“School districts all over the state have decided there is no problem (with allowing chiropractors to do sports physicals). So why,” said Ursich, “is that different in Los Angeles?”

But Tom Byrnes, the CIF’s state commissioner of athletics, cautioned that the organization’s regulations are not meant to preempt local districts’ judgment in the matter of who should do the exams.

“We leave it to the local school districts to determine who is qualified . . . or what constitutes a proper exam,” Byrnes said, noting the federation a couple of years ago considered, then rejected, a proposal to change its regulations to accept exams only from licensed physicians and surgeons.

Both sides cite state law and court cases to bolster their arguments and both have threatened to sue if they don’t like the school board’s decision.

In a letter to school board President Jackie Goldberg, who has sought to have chiropractors allowed, attorney Michael J. Schroeder argued that “chiropractors always have been legally authorized to diagnose all conditions or diseases of the human body” and said there “is little question that the position that the district has taken is contrary to law.”

The district’s legal advisers said some of the legal issues, including scope of practice questions in a recent Sacramento court case on appeal, have yet to be fully resolved. Still, district staff attorney Ron Apperson said he believes “there is sufficient basis to allow the board to make a decision on the choice before them”--whether to keep its current policy or change it to more closely conform with the CIF regulations.