What the statutes mean

The Department of Regulation & Licensing recognizes that chiropractors are no different than any other member of society. A small percentage of them will experience problems with alcohol, narcotics and other drugs. As a result of their use of these substances, their professional skills may be impaired. While impairment is traditionally thought of as some form of substance abuse, its operative definition is broader. These rules only deal with chiropractors that are impaired due to alcohol or drugs. However, an impaired professional may also be defined as one who is unable to practice with reasonable skill and safety due to cognitive impairment caused by a stroke, Alzheimer’s disease or other illness.

There are several obstacles in identifying chemically dependent chiropractors. The first is the insidious manner in which the problem spreads through an individual’s life. The sequential impact usually follows a predictable course. The initial impact will be felt by the individual’s family and then gradually involve other activities in the chiropractor’s personal life before being noticed in the office. By the time aberrant behavior is noticed in the office, the chiropractor is usually in the late stages of chemical dependency. The second obstacle is that of denial, both the family’s denial and the chiropractor’s denial. The third obstacle is the conspiracy of silence. All of the individuals that come into contact with the impaired chiropractor, i.e. patients, staff, family and colleagues tend to rationalize the individual’s behavior.

Frequently asked questions

What is the intent of the impaired professionals program?

The intent of the department of regulation and licensing’s impaired professionals program is to protect the public from chiropractors who are impaired because of their abuse of alcohol or other drugs. They try to achieve this goal by providing an alternative to the formal disciplinary process for qualified chiropractors committed to their own recovery.

This program is an option when allegations are made that a chiropractor has practiced chiropractic while impaired by alcohol or other drugs or when a chiropractor contacts the department and requests to participate in this program. It is not intended to be an option in situations where allegations exist that a chiropractor has committed violations of law, other than practicing while impaired by alcohol or other drugs.

This program may be utilized in selected cases to promote early identification of chemically dependent professionals and encourage their rehabilitation. The Department of Regulation’s procedures for operating this program do not seek to diminish the prosecution of serious violations but rather attempts to address the problem of alcohol and other drug abuse within the enforcement jurisdiction of the department.

The purpose of this program is to intervene and confront the problem as quickly as possible. This is to prevent patients from being injured as a result of the chiropractor’s impairment. The goal of the program is treatment, not punishment. Depending on the severity of the individual’s problem, they may be able to continue to practice while receiving treatment. If their problem is severe enough to warrant in patient treatment, they will be allowed to return to practice as soon as they have successfully completed the treatment program.

How are impaired chiropractors brought to the attention of the Department of Regulation & Licensing?

A chiropractor may seek admittance to the program on their own behalf or they may be brought to the attention of the department through an informal complaint. An informal complaint is any written information submitted by any person to the division of enforcement, department of regulation and licensing or the chiropractic examining board that requests that a disciplinary proceeding be commenced against a chiropractor.

Must a chiropractor be assessed before eligibility for the program is determined?

Generally, yes. Prior to signing an agreement for participation, the chiropractor must obtain a comprehensive assessment for chemical dependency from a treatment facility or individual therapist approved by the department. The chiropractor must arrange for the treatment facility or individual therapist to file a copy of its assessment with the board. The assessment must include a statement describing the chiropractor’s prognosis for recovery. The assessment is waived only if the board and the chiropractor agree that it is not necessary.

How does Regulation & Licensing determine if a chiropractor is eligible for the program?

When the Department of Regulation & Licensing or chiropractic examining board receives an informal complaint involving allegations of impairment due to alcohol or chemical dependency, it is referred to the enforcement division for screening and/or investigation. The initial screening is done by a combination of individuals that work for the department including legal staff. Screening is a preliminary review of complaints to determine whether an investigation is necessary.

The department has the authority to dismiss the complaint if it believes that the matter is trivial. For example, if an informal complaint were brought against a chiropractor that was observed drinking at a social occasion, the board would likely dismiss the complaint if the drinking did not occur during working hours.

If, after screening, the complaint is found to have some merit, it is fully investigated. After investigation, informal complaints involving impairment may be considered for eligibility in the impaired professional program as an alternative to formal disciplinary proceedings.

A chiropractor who has been referred to the program and considered for eligibility will be provided with:

• an application for participation.
• a summary of the investigative results in the form of a draft statement of conduct.
• a written explanation of the chiropractor’s options for resolution of the matter through participation in the program or through the formal disciplinary process.

The final eligibility determination is made by the examining board liaison and program coordinator who review all of the relevant materials including investigative results and the chiropractor’s application for participation. They consider:

• the statement of conduct offered by the chiropractor
• the seriousness of other alleged violations
• the chiropractor’s prognosis for recovery

What if Regulation and Licensing determines that a chiropractor is not eligible for the program?

If a chiropractor is determined to be ineligible for the program, the chiropractor will be referred to the division for prosecution. A chiropractor that is determined to be ineligible for the program by the board liaison or the department may, within 10 days of notice of the determination, request the chiropractic examining board review the decision.

What are the requirements to participate in the program?

A chiropractor who participates in the procedure must sign an agreement for participation. The agreement essentially confirms that the chiropractor will abide by all of the requirements for participation that are contained in the following list. The board liaison may include additional requirements for an individual chiropractor if the circumstances of the informal complaint or the chiropractor’s condition warrant additional safeguards. The board or board liaison may include a promise of confidentiality that all or certain records shall remain closed and not available for public inspection and copying.

The chiropractor must:

• Remain free of alcohol, controlled substances, and prescription drugs, unless prescribed for a valid medical purpose.
• Timely enroll and participate in a program for the treatment of chemical dependency conducted by a facility or individual therapist approved by the department.
• Comply with any treatment recommendations and work restrictions or conditions deemed necessary by the board liaison or department.
• Submit random monitored blood or urine samples for the purpose of screening for alcohol or controlled substances, as required.
• Execute releases valid under state and federal law to allow access to the chiropractor’s counseling, treatment and monitoring records.
• Have the chiropractor’s supervising therapist and work supervisors file quarterly reports with the coordinator.
• Notify the coordinator of any changes in the chiropractor’s employer within 5 days.

• File quarterly reports documenting the chiropractors attendance at meetings of self-help groups such as alcoholics anonymous or narcotics anonymous.

What standards does Regulation & Licensing have for the approval of treatment facilities or individual therapists?

The board or board liaison will approve a treatment facility designated by a chiropractor for the purpose of participation in the impaired professional program if:

• The facility is certified by appropriate national or state certification agencies.
• The treatment program focus of the facility is on the individual with drug and alcohol abuse problems.
• Facility treatment plans and protocols are available to the board liaison and coordinator.
• The facility has a random monitored drug screening program of blood or urine as part of its treatment. If drug screens are not included, the facility supports such screens as an adjunct to the treatment they provide.
• The facility, through the chiropractors supervising therapist, agrees to file reports as required. These include quarterly progress reports and immediate reports if a chiropractor withdraws from therapy, submits a positive blood or urine screen, relapses, or is believed to be in unsafe condition to practice.

As an alternative to participation by means of a treatment facility, a chiropractor may designate an individual therapist for the purpose of participation in the procedure. The board liaison will approve an individual therapist who:

• Has credentials and experience determined by the board liaison to be in the chiropractor’s area of need.
• Agrees to perform an appropriate assessment of the chiropractor’s therapeutic needs and to establish and implement a comprehensive treatment regimen for the chiropractor.
• Forwards copies of the therapist’s treatment regimen and office protocols to the coordinator.
• Agrees to establish a random monitored drug-testing program of blood or urine. If drug screens are not established through the therapist, the therapist agrees to support such screens as an adjunct to the treatment provided.
• Agrees to file reports as required to the coordinator. These include quarterly progress reports and immediate reports if a chiropractor withdraws from therapy, submits a positive blood or urine screen, relapses, or is believed to be in unsafe condition to practice.

If a board liaison does not approve a treatment facility or therapist as requested by the chiropractor, the chiropractor may, within 10 days of notice, request the board to review the decision.

What access will the public have concerning the impaired professionals program?

An individual can not walk in off the street and ask to inspect records for the impaired professionals program. Any requests to inspect these records must be made to the Department of Regulation and Licensing’s records custodian. The custodian will evaluate each request on a case by case basis using the applicable law relating to open records and weighing whether the public interest in nondisclosure outweighs the public interest in access to the records. The factors considered by the custodian will include:

• the potential damage to the chiropractor’s reputation.
• the importance of confidentiality to the functional integrity of the program.
• the existence of any pledge of confidentiality.
• statutory or common law rules which accord a status of confidentiality to the records and the likelihood that release of the records will impede an investigation.

Treatment records for chiropractors that are receiving, or have received services for mental illness, developmental disabilities, alcoholism, or drug dependence will not be made available for public inspection. These records are confidential under state law. In addition, a chiropractor’s health care records are no different than any other member of the public. Those health care records are confidential and are not made available to the public without the informed consent of the chiropractor.

Statute excerpts

RL 7.01 Authority and intent
RL 7.02 Definitions
RL 7.03 Referral to and eligibility for the procedure
RL 7.04 Requirements for participation
RL 7.05 Agreeement for participation
RL 7.06 Standards for approval of treatment facilities or individual therapists
RL 7.07 Intradepartmental referral
RL 7.08 Records
RL 7.09 Report
RL 7.10 Applicability of procedures to direct licensing by the department

IMPAIRED PROFESSIONALS PROCEDURE

RL 7.01 Authority and intent.

(1) The rules in this chapter are adopted pursuant to authority in ss. 15.08 (5) (b), 51.30, 146.82, 227.11, and 440.03, Stats.

(2) The intent of the department in adopting rules in this chapter is to protect the public from credential holders who are impaired by reason of their abuse of alcohol or other drugs. This goal will be advanced by providing an option to the formal disciplinary process for qualified credential holders committed to their own recovery. This procedure is intended to apply when allegations are made that a credential holder has practiced a profession while impaired by alcohol or other drugs or when a credential holder contacts the department and requests to participate in this procedure. It is not intended to apply in situations where allegations exist that a credential holder has committed violations of law, other than practice while impaired by alcohol or other drugs, which are substantial. The procedure may then be utilized in selected cases to promote early identification of chemically dependent professionals and encourage their rehabilitation. Finally, the department’s procedure does not seek to diminish the prosecution of serious violations but rather it attempts to address the problem of alcohol and other drug abuse within the enforcement jurisdiction of the department.

(3) In administering this program, the department intends to encourage board members to share professional expertise so that all boards in the department have access to a range of professional expertise to handle problems involving impaired professionals.

RL 7.02 Definitions. In this chapter:

(1) “Board” means any examining board or affiliated credentialing board attached to the department and the real estate board.

(2) “Board liaison” means the board member designated by the board as responsible for approving credential holders for the impaired professionals procedure under s. RL 7.03, for monitoring compliance with the requirements for participation under s. RL 7.04, and for performing other responsibilities delegated to the board liaison under these rules.

(2a) “Coordinator” means a department employee who coordinates the impaired professionals procedure.

(2b) “Credential holder” means a person holding any license, permit, certificate or registration granted by the department or any board.

(3) “Department” means the department of regulation and licensing.

(4) “Division” means the division of enforcement in the

department.

(5) “Informal complaint” means any written information submitted by any person to the division, department or any board which requests that a disciplinary proceeding be commenced against a credential holder or which alleges facts, which if true, warrant discipline. “Informal complaint” includes requests for disciplinary proceedings under s. 440.20, Stats.

(6) “Procedure” means the impaired professionals procedure.

RL 7.03 Referral to and eligibility for the procedure.

(1) All informal complaints involving allegations of impairment due to alcohol or chemical dependency shall be screened and investigated pursuant to s. RL 2.035. After investigation, informal complaints involving impairment may be referred to the procedure and considered for eligibility as an alternative to formal disciplinary proceedings under ch. RL 2.

(2) A credential holder who has been referred to the procedure and considered for eligibility shall be provided with an application for participation , a summary of the investigative results in the form of a draft statement of conduct to be used as a basis for the statement of conduct under s. RL 7.05 (1) (a), and a written explanation of the credential holder’s options for resolution of the matter through participation in the procedure or through the formal disciplinary process pursuant to ch. RL 2.

(3) Eligibility for the procedure shall be determined by the board liaison and coordinator who shall review all relevant materials including investigative results and the credential holder’s application for participation. Eligibility shall be determined upon criteria developed by each credentialing authority which shall include at a minimum the credential holder’s past or pending criminal, disciplinary or malpractice record, the circumstances of the credential holder’s referral to the department, the seriousness of other alleged violations and the credential holder’s prognosis for recovery. The decision on eligibility shall be consistent with the purposes of these procedures as described in s. RL 7.01 (2). The board liaison shall have responsibility to make the determination of eligibility for the procedure.

(4) Prior to signing of an agreement for participation the credential holder shall obtain a comprehensive assessment for chemical dependency from a treatment facility or individual therapist approved under s. RL 7.06. The credential holder shall arrange for the treatment facility or individual therapist to file a copy of its assessment with the board liaison or coordinator. The assessment shall include a statement describing the credential holder’s prognosis for recovery. The board liaison and the credential holder may agree to waive this requirement.

(5) If a credential holder is determined to be ineligible for the procedure, the credential holder shall be referred to the

division for prosecution.

(6) A credential holder determined to be ineligible for the procedure by the board liaison or the department may, within 10 days of notice of the determination, request the credentialing authority to review the adverse determination.

RL 7.04 Requirements for participation.

(1) A credential holder who participates in the procedure shall:
(a) Sign an agreement for participation under s. RL 7.05.
(b) Remain free of alcohol, controlled substances, and prescription drugs, unless prescribed for a valid medical purpose.
(c) Timely enroll and participate in a program for the treatment of chemical dependency conducted by a facility or individual therapist approved pursuant to s. RL 7.06.
(d) Comply with any treatment recommendations and work restrictions or conditions deemed necessary by the board liaison or department.
(e) Submit random monitored blood or urine samples for the purpose of screening for alcohol or controlled substances, as required.
(f) Execute releases valid under state and federal law in the form shown in Appendix I to allow access to the credential holder’s counseling, treatment and monitoring records.
(g) Have the credential holder’s supervising therapist and work supervisors file quarterly reports with the coordinator.
(h) Notify the coordinator of any changes in the credential holder’s employer within 5 days.
(i) File quarterly reports documenting the credential holder’s attendance at meetings of self-help groups such as alcoholics anonymous or narcotics anonymous.

(2) If the board liaison or department determines, based on consultation with the person authorized to provide treatment to the credential holder or monitor the credential holder’s enrollment or participation in the procedure, or monitor any drug screening requirements or restrictions on employment under sub. (1), that a credential holder participating in the procedure has failed to meet any of the requirements set under sub. (1), the board liaison may request that the board dismiss the credential holder from the procedure. The board shall review the complete record in making this determination. If the credential holder is dismissed the matter shall be referred to the division.

(3) If a credential holder violates the agreement and the board does not dismiss and refer the credential holder to the division then a new admission under s. RL 7.05 (1) (a) shall be obtained for violations which are substantiated.

RL 7.05 Agreement for participation.

(1) The agreement for participation in the procedure shall at a minimum include:
(a) A statement describing conduct the credential holder agrees occurred relating to participation in the procedure and an agreement that the statement may be used as

evidence in any disciplinary proceeding under ch. RL 2.
(b) An acknowledgement by the credential holder of the need for treatment for chemical dependency.
(c) An agreement to participate at the credential holder’s expense in an approved treatment regimen.
(d) An agreement to submit to random monitored drug screens at the credential holder’s expense, if deemed necessary by the board liaison.
(e) An agreement to submit to practice restrictions at any time during the treatment regimen as deemed necessary by the board liaison.
(f) An agreement to furnish the coordinator with signed consents for release of information from treatment providers and employers authorizing the release of information to the coordinator and board liaison for the purpose of monitoring the credential holder’s participation in the procedure.
(g) An agreement to authorize the board liaison or coordinator to release information described in pars. (a), (c) and (e), the fact that a credential holder has been dismissed under s. RL 7.07 (3) (a) or violated terms of the agreement in s. RL 7.04 (1) (b) to (e) and (h) concerning the credential holder’s participation in the procedure to the employer, therapist or treatment facility identified by the credential holder and an agreement to authorize the coordinator to release the results of random monitored drug screens under par. (d) to the therapist identified by the credential holder.
(h) An agreement to participate in the procedure for a period of time as established by the board.

(2) The board liaison may include additional requirements for an individual credential holder, if the circumstances of the informal complaint or the credential holder’s condition warrant additional safeguards.

(3) The board or board liaison may include a promise of confidentiality that all or certain records shall remain closed and not available for public inspection and copying.

RL 7.06 Standards for approval of treatment facilities or individual therapists.

(1) The board or board liaison shall approve a treatment facility designated by a credential holder for the purpose of participation in the procedure if:

(a) The facility is certified by appropriate national or state certification agencies.
(b) The treatment program focus at the facility is on the individual with drug and alcohol abuse problems.
(c) Facility treatment plans and protocols are available to the board liaison and coordinator.
(d) The facility has a random monitored drug screening program of blood or urine as part of its treatment, or if drug screens are not included, the facility personnel assigned to the care of the credential holder support such screens as an adjunct to the treatment they provide.
(e) The facility, through the credential holder’s supervising therapist, agrees to file reports as required, including quarterly progress reports and immediate reports if a credential holder withdraws from therapy, submits a

positive blood or urine screen, relapses, or is believed to be in an unsafe condition to practice.

(2) As an alternative to participation by means of a treatment facility, a credential holder may designate an individual therapist for the purpose of participation in the procedure. The board liaison shall approve an individual therapist who:

(a) Has credentials and experience determined by the board liaison to be in the credential holder’s area of need.
(b) Agrees to perform an appropriate assessment of the credential holder’s therapeutic needs and to establish and implement a comprehensive treatment regimen for the credential holder.
(c) Forwards copies of the therapist’s treatment regimen and office protocols to the coordinator.
(d) Agrees to establish a random monitored drug-testing program of blood or urine, or if drug screens are not established through the therapist, the therapist agrees to support such screens as an adjunct to the treatment provided.
(e) Agrees to file reports as required to the coordinator, including quarterly progress reports and immediate reports if a credential holder withdraws from therapy, submits a positive blood or urine screen, relapses, or is believed to be in an unsafe condition to practice.

(3) If a board liaison does not approve a treatment facility or therapist as requested by the credential holder, the credential holder may, within 10 days of notice of the determination, request the board to review the board liaison’s adverse determination.

RL 7.07 Intradepartmental referral.

(1) A credential holder who contacts the department and requests to participate in the procedure shall be referred to the board liaison and the coordinator for determination of acceptance into the procedure.

(2) The division may refer individuals named in informal complaints to the board liaison for acceptance into the procedure.

(3) The board liaison may refer cases involving the following to the division for investigation or prosecution:

(a) Credential holders participating in the procedure who are dismissed for failure to meet the requirements of their rehabilitation program or who otherwise engage in behavior which should be referred to prevent harm to the public.
(b) Credential holders who apply and who are determined to be ineligible for the procedure where the board liaison is in possession of information indicating a violation of law.
(c) Credential holders who do not complete an agreement for participation where the board liaison is in possession of information indicating a violation of law.

(d) Credential holders initially referred by the division to the board liaison who fail to complete an agreement for participation.

RL 7.08 Records.

(1) CUSTODIAN. All records relating to the procedure including applications for participation, agreements for participation and reports of participation shall be maintained in the custody of the department secretary or the secretary’s designee.

(2) AVAILABILITY OF PROCEDURE RECORDS FOR PUBLIC INSPECTION. Any requests to inspect procedure records shall be made to the custodian. The custodian shall evaluate each request on a case by case basis using the applicable law relating to open records and giving appropriate weight to relevant factors in order to determine whether public interest in nondisclosure outweighs the public interest in access to the records, including the reputational interests of the credential holder, the importance of confidentiality to the functional integrity of the procedure, the existence of any pledge of confidentiality, statutory or common law rules which accord a status of confidentiality to the records and the likelihood that release of the records will impede an investigation.

(3) TREATMENT RECORDS. Treatment records concerning individuals who are receiving or who at any time have received services for mental illness, developmental disabilities, alcoholism, or drug dependence which are maintained by the department, by county departments under s. 51.42 or 51.437, Stats., and their staffs and by treatment facilities are confidential under s. 51.30, Stats., and shall not be made available for public inspection.

(4) PATIENT HEALTH CARE RECORDS. Patient health care records are confidential under s. 146.82, Stats., and shall not be made available to the public without the informed consent of the patient or of a person authorized by the patient or as provided under s. 146.82 (2), Stats.

RL 7.09 Report.

The board liaison or coordinator shall report on the procedure to the board at least twice a year and if requested to do so by a board.

RL 7.10 Applicability of procedures to direct licensing by the department.

This procedure may be used by the department in resolving complaints against persons licensed directly by the department if the department has authority to discipline the credential holder. In such cases, the department secretary shall have the authority and responsibility of the “board” as the term is used in the procedure and shall designate an employe to perform the responsibilities of the “board liaison.”