House Bill 1088 By: Representatives Mathiak of the 82nd, Reeves of the 99th, Jones of the 143rd, Greene of the 154th, Evans of the 57th, and others A BILL TO BE ENTITLED AN ACT To amend Chapter 9 of Title 43 of the Official Code of Georgia Annotated, relating to chiropractors, so as to replace the term "chiropractor" with "chiropractic physician"; to provide for certain persons licensed to practice chiropractic who visit this state for a specific sports or performing arts event; to allow licensed chiropractic physicians to use the term "chiropractor"; to protect the terms "chiropractor" and "chiropractic physician"; to amend Title 14 of the Official Code of Georgia Annotated, relating to corporations, partnerships, and associations, so as to provide for professional corporations jointly owned by chiropractic physicians and physicians; to amend Title 45 of the Official Code of Georgia Annotated, relating to public officers and employees, so as to provide for conforming changes in terminology; to amend various titles of the Official Code of Georgia Annotated, so as to provide for conforming changes in terminology; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes. BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: PART I SECTION 1-1. Chapter 9 of Title 43 of the Official Code of Georgia Annotated, relating to chiropractors, is amended by revising Code Section 43-9-7.2, relating to persons excepted from application of chapter, as follows: "43-9-7.2. Nothing in this chapter shall be construed as preventing or prohibiting the practice, services, or activities of: (1) Any person pursuing a course of study leading to a doctor of chiropractic degree, postgraduate training, or training as a chiropractic assistant, which is approved by the board as provided for in this chapter, if such person is designated by a title indicating student status, is fulfilling clinical training requirements for the attainment of a degree or certificate, and is under the supervision of a chiropractor chiropractic physician licensed under this chapter and approved by the board; (2) Any person licensed to practice chiropractic in this or another state who is employed as a professor or instructor by a chiropractic school or college located in this state or who is enrolled in or teaching a course of study designed to develop chiropractic clinical skills when chiropractic activities are required as part of an educational program sponsored by a chiropractic school or college, as provided for in Code Section 43-9-7, or other educational program as may be approved by the board. Such practice shall be conducted under the supervision of a licensed chiropractor chiropractic physician approved by the board. No such person shall be authorized to provide chiropractic services outside of the scope of the educational program and setting, nor shall such a person perform, or supervise the performance of, any chiropractic service provided on a fee-for-service basis without having first obtained a license in accordance with this chapter. The board shall have the authority to promulgate rules relative to such practice; (3) A chiropractor Any person licensed to practice chiropractic in good standing in any other state, territory, or other jurisdiction of the United States or of any other nation or foreign jurisdiction if that person is employed or designated in their professional capacity by a sports or performing arts entity visiting the state for a specific sports or performing arts event subject to the following restrictions: (A) A chiropractor's Such person's practice under this paragraph is limited to the members, coaches, and staff of the team or event for which that chiropractor person is employed or designated, and such practice shall only occur at the designated venue of the event; and (B) Any chiropractor person practicing under the authority of this paragraph may utilize only those practices and procedures authorized by this chapter and approved by board rule; and (4) Nothing in this chapter shall prohibit any person from assisting a duly licensed chiropractor chiropractic physician in the practices and procedures so authorized by this chapter, excluding the adjustment of the articulations of the human body, provided such person is under the direct order and supervision of a duly licensed doctor of chiropractic who is physically present in the facility or office." SECTION 1-2. Said chapter is further amended by revising Code Section 43-9-16, relating to scope of practice, as follows: "43-9-16. (a) Chiropractors Chiropractic physicians who have complied with this chapter shall have the right to practice chiropractic as defined in paragraph (2) of Code Section 43-9-1 and to evaluate, diagnose, and adjust patients according to specific chiropractic methods in order to correct spinal subluxations or to adjust the articulations of the human body. Chiropractors Chiropractic physicians shall observe all applicable public health regulations. (b) The chiropractic adjustment of the spine or articulations of the human body may include manual adjustments and adjustments by means of electrical and mechanical devices which produce traction or vibration. Chiropractors Chiropractic physicians who have complied with this chapter may also use modalities. Modalities include any physical agent applied to produce therapeutic change to biologic tissues including thermal, acoustic, noninvasive light, mechanical, or electric energy, hot or cold packs, ultrasound, galvanism, microwave, diathermy, and electrical stimulation. Chiropractors Chiropractic physicians who have complied with this chapter may utilize and recommend therapeutic procedures effecting change through the application of clinical skills and services that attempt to improve function, including therapeutic exercise, therapeutic activities, manual therapy techniques, massage, and structural supports as they relate to the articulations of the human body; provided, however, that the same shall not be construed to allow chiropractors chiropractic physicians to treat patients outside the scope of practice of chiropractic as set forth in this chapter. (c) Chiropractors Chiropractic physicians who have complied with this chapter may utilize those modalities and procedures described in subsection (b) of this Code section, provided the chiropractor chiropractic physician shall have completed a course of study containing a minimum of 120 hours of instruction in the proper utilization of those procedures in accordance with the guidelines set forth by the Council on Chiropractic Education or its successor and is qualified and so certified in that proper utilization. (d) Chiropractors Chiropractic physicians who have complied with this chapter shall have the right to sign health certificates, reporting to the proper health officers the same as other practitioners. (e) Chiropractors Chiropractic physicians shall not prescribe or administer medicine to patients, perform surgery, or practice obstetrics or osteopathy. (f) Chiropractors Chiropractic physicians shall not use venipuncture, capillary puncture, acupuncture, or any other technique which is invasive of the human body either by penetrating the skin or through any of the orifices of the body or through the use of colonics. Nothing in this subsection shall be construed to prohibit a chiropractor chiropractic physician who is licensed to perform acupuncture under Article 3 of Chapter 34 of this title from engaging in the practice of acupuncture. (g) A person professing to practice chiropractic for compensation must bring to the exercise of that person's profession a reasonable degree of care and skill. Any injury resulting from a want of such care and skill shall be a tort for which a recovery may be had. If a chiropractor chiropractic physician performs upon a patient any act authorized to be so performed under this chapter but which act also constitutes a standard procedure of the practice of medicine, including but not limited to the use of modalities such as those described in subsection (b) of this Code section and X-rays, under similar circumstances the chiropractor chiropractic physician shall be held to the same standard of care as would licensed doctors of medicine who are qualified to and who actually perform those acts under similar conditions and like circumstances. (h) A licensed practitioner of chiropractic may use only the title 'chiropractor,' 'chiropractic physician,' or 'doctor of chiropractic,' or 'D.C.' (i) Chiropractors Chiropractic physicians who have complied with this chapter may recommend the use of nutritional and dietary supplements. Any such recommendation of nutritional and dietary supplements shall not be construed to allow chiropractors chiropractic physicians to treat patients outside the scope of the practice of chiropractic as set forth in this chapter nor shall this subsection be construed to allow chiropractors chiropractic physicians to sell at a profit any such nutritional and dietary supplements without providing their generic name. Nothing in this subsection shall preclude compliance with Chapter 8 of Title 48, relating to the collection of sales and use taxes." SECTION 1-3. Said chapter is further amended by revising Code Section 43-9-19, relating to penalty, as follows: "43-9-19. It shall be unlawful for any person to practice chiropractic unless that person shall have first obtained a license as provided in this chapter and possesses all the qualifications prescribed by the terms of this chapter. Any person who practices or attempts to practice chiropractic without a license, or; who buys or fraudulently obtains a license to practice chiropractic, or; who violates any of the terms of this chapter,; or who uses the title 'chiropractic physician,' 'doctor of chiropractic,' 'chiropractor,' 'chiropractic,' 'D.C.,' or any word or title to induce the belief that such a person is engaged in the practice of chiropractic, without first complying with this chapter, shall be guilty of a felony and, upon conviction thereof, shall be punished by a fine of not less than $500.00 nor more than $5,000.00, or by imprisonment for not less than two nor more than five years, or both, at the discretion of the court. All subsequent offenses shall be separate and distinct offenses, and punishable in like manner." SECTION 1-4. Said chapter is further amended by replacing "chiropractor" and "chiropractors" with "chiropractic physician" and "chiropractic physicians", respectively, wherever the former terms occur in: (1) Code Section 43-9-1, relating to definitions; (2) Code Section 43-9-2, relating to Georgia Board of Chiropractic Examiners, members, qualifications, residence requirements, and terms; (3) Code Section 43-9-6.1, relating to authority of board; and (4) Code Section 43-9-12, relating to refusal, suspension, or revocation of licenses, subpoenas, other discipline, judicial review, reinstatement, voluntary surrender of license, injunctions, and statement of complaint. PART II SECTION 2-1. Title 14 of the Official Code of Georgia Annotated, relating to corporations, partnerships, and associations, is amended in Code Section 14-7-4, relating to professional services, by revising paragraph (4) of subsection (a) as follows: "(4) To the extent not inconsistent with the ethics of the professions involved or otherwise prohibited by law, chiropractors chiropractic physicians who are practicing within their scope of practice as established by law may organize and jointly own a professional corporation with physicians who are practicing within their scope of practice as established by law; provided, however, that nothing in this paragraph shall authorize chiropractors to attach the title 'physician' to such chiropractors' names or to the name of the professional corporation." SECTION 2-2. Title 45 of the Official Code of Georgia Annotated, relating to public officers and employees, is amended in Code Section 45-16-27, relating to when inquest to be held, special situations, coroner's fee, issuance of subpoenas, cost of copying, and limited disclosure of photographs, by revising subsection (c) as follows: "(c) When a coroner or a medical examiner or a medical examiner from the office of chief medical examiner, as established in Code Section 35-3-153, conducts an investigation into the death of an individual, the coroner, medical examiner, or medical examiner from the office of chief medical examiner shall be authorized to issue subpoenas to compel the production of any books, records, including but not limited to medical records from hospitals, medical clinics, psychiatric hospitals, physicians' offices, chiropractors' chiropractic physicians' offices, and any other health care healthcare delivery facility, or papers relevant to the cause of death including without limitation AIDS confidential information as defined by Code Section 31-22-9.1. Any books, records, or papers received by the coroner, medical examiner, or medical examiner from the office of chief medical examiner pursuant to the subpoena must be regarded as confidential information and privileged and not subject to disclosure under Article 4 of Chapter 18 of Title 50. The actual costs of copying any books, records, or papers for the purposes of responding to a subpoena under this subsection shall be paid out of county funds to the person or entity required to respond to that subpoena, and the governing authority of the county of which that coroner or county medical examiner is a public officer shall pay those costs within 30 days after a bill therefor is submitted to the county. A medical examiner from the office of chief medical examiner shall pay the costs of copying from state funds within 30 days after a bill therefor is submitted to the state." SECTION 2-3. The Official Code of Georgia Annotated is amended by replacing "chiropractor", "chiropractors", "Chiropractor", and "Chiropractors" with "chiropractic physician", "chiropractic physicians", "Chiropractic physician", and "Chiropractic physicians", respectively, wherever the former terms occur in: (1) Code Section 9-11-9.1, relating to affidavit to accompany charge of professional malpractice; (2) Code Section 14-10-2, relating to definitions relative to professional associations; (3) Code Section 31-7-131, relating to definitions for peer review groups relative to the regulation and construction of hospitals and other health care facilities; (4) Code Section 31-12A-2, relating to definitions relative to smoke-free air; (5) Code Section 33-20A-3, relating to definitions for patient protection relative to managed health care plans; (6) Code Section 33-20E-2, relating to applications to insurers and definitions relative to the "Surprise Billing Consumer Protection Act"; (7) Code Section 33-24-27, relating to provision for reimbursement for services within the lawful scope of practice of psychologists or chiropractors; (8) Code Section 33-24-59.24, relating to restrictions on payment methods prohibited, waiver of provisions prohibited, and enforcement; (9) Code Section 33-24-59.27, relating to right to shop for insurance coverage, disclosure of pricing information, and notice; (10) Code Section 33-39-3, relating to definitions relative to the collection, use, and disclosure of information gathered by insurance institutions; (11) Code Section 33-46-4, relating to definitions relative to certification of private review agents; (12) Code Section 40-2-74.1, relating to temporary, permanent, and special permanent parking permits for persons with disabilities; (13) Code Section 43-1-28, relating to volunteers in health care specialties; (14) Code Section 43-1-33, relating to advertisement, signage, and identifier requirements for health care practitioners; (15) Code Section 43-1-35, relating to expedited license by endorsement for spouses of active or transitioning members of the armed forces and license by endorsement for certain professions; (16) Code Section 43-1B-3, relating to definitions for patient self-referral relative to professions and businesses; (17) Code Section 43-28-15, relating to exceptions to operation of article relevant to occupational therapists; (18) Code Section 44-14-470, relating to lien on causes of action accruing to injured person for costs of care and treatment of injuries arising out of such causes of action; (19) Code Section 48-13-9, relating to limitation on authority of local government to impose regulatory fee, examples of individuals and entities which may and may not be subject to fees, and methods for determining fees; (20) Code Section 51-1-29.5, relating to definitions, limitation on health care liability claim to gross negligence in emergency medical care, and factors for jury consideration; (21) Code Section 51-2-5.1, relating to relationship between hospital and health care provider prerequisite to liability, notice regarding independent contractor status, and factors for consideration in determining status; and (22) Code Section 51-16-1, relating to definitions for COVID-19 pandemic business safety. PART III SECTION 3-1. This Act shall become effective upon its approval by the Governor or upon its becoming law without such approval. SECTION 3-2. All laws and parts of laws in conflict with this Act are repealed.