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 9                              A BILL
10
11   TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA,
12   1976, BY ADDING SECTION 40-9-42 SO AS TO PROVIDE
13   THE SCOPE OF PRACTICE OF A CERTIFIED ADVANCED
14   PRACTICE CHIROPRACTIC PHYSICIAN; TO AMEND
15   SECTION    40-9-10,   RELATING   TO   DEFINITIONS
16   CONCERNING         CHIROPRACTORS     AND      THE
17   CHIROPRACTIC PROFESSION, SO AS TO DEFINE CERTAIN
18   TERMS; AND TO AMEND SECTION 40-9-20, RELATING TO
19   THE LICENSURE OF CHIROPRACTORS, SO AS TO
20   PROVIDE A CHIROPRACTOR MAY BECOME CERTIFIED
21   AS    AN   ADVANCED      PRACTICE   CHIROPRACTIC
22   PHYSICIAN UPON THE SATISFACTION OF CERTAIN
23   REQUIREMENTS.
24
25   Be it enacted by the General Assembly of the State of South
26   Carolina:
27
28   SECTION 1. Chapter 9, Title 40 of the 1976 Code is amended by
29   adding:
30
31      “Section 40-9-42. (A)(1) An       APC-C      may     prescribe,
32   administer, and dispense amino acids, bioidentical hormones,
33   caffeine, dietary supplements, enzymes, epinephrine, gerovital,
34   glandular products, herbal medicines, homeopathic medicines, live
35   cell products, minerals, over-the-counter drugs, oxygen, procaine,
36   protomorphogens, sarapin or its generic, sterile saline, sterile
37   water, vapocoolants, and vitamins.
38        (2) The board, with advisory input from the State Board of
39   Medical Examiners and the State Board of Pharmacy, shall
40   establish:




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 1            (a) a formulary that includes all substances listed in
 2   subsection (A), including compounded preparations for topical and
 3   oral administration by an APC-C; and
 4            (b) a formulary for injection that includes the substances
 5   in subsection (A) that are within the scope of practice of an
 6   APC-C.
 7      (B)(1) An APC-C with a conditional prescription certificate or
 8   prescription certificate may, in addition to those substances
 9   specified in subsection (A), prescribe, administer, and dispense
10   drugs used in primary care practice, including compounded
11   preparations for topical and oral administration and injection,
12   testosterone in all its forms, and codeine in cough syrup.
13         (2) The board, with advisory input from the State Board of
14   Medical Examiners and the State Board of Pharmacy, shall
15   establish by regulation a formulary that includes substances listed
16   in this subsection.
17      (C) An APC-C may apply to the board for a conditional
18   prescription certificate on a form prescribed by the board. At a
19   minimum, information provided on this form must demonstrate
20   that the applicant:
21         (1) has successfully completed an educational program in
22   advanced clinical practice at a master‟s degree-level or higher or
23   equivalent from an accredited institution of higher education or
24   professional school, and either of these programs must include a
25   minimum number of clinical rotation hours set by the board by
26   regulation;
27         (2) holds a current license to practice chiropractic medicine;
28         (3) has successfully completed pharmacological training
29   from an institution of higher education approved by the board or
30   from a provider of continuing education approved by the board;
31         (4) within the five years immediately preceding the date of
32   application, has successfully completed an organized program of
33   education approved by the board and consisting of didactic
34   instruction of no fewer than four hundred and fifty classroom
35   hours from a combination of the following core areas of instruction
36   as determined by the board through regulation:
37            (a) pharmacology;
38            (b) physiology;
39            (c) pathophysiology;
40            (d) appropriate and relevant physical and laboratory
41   assessment; and
42            (e) clinical pharmacotherapeutics;


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 1          (5) within five years immediately preceding the date of
 2   application, successfully completed a clinical experience approved
 3   by the board, under the supervision of a medical doctor that at a
 4   minimum consists of:
 5            (a) four hundred hours or more of clinical rotation
 6   practicum in clinical assessment and pathophysiology; and
 7            (b) four hundred hours or more of treating one hundred or
 8   more patients with disorders relevant to the certified advanced
 9   practice chiropractic physician‟s clinical specialty;
10          (6) has malpractice insurance in place that is sufficient to
11   satisfy the rules adopted by the board and that will cover the
12   applicant during the period the conditional prescription certificate
13   is in effect; and
14          (7) a declaration from the supervising medical doctor that
15   the applicant has successfully completed the clinical experience.
16      (D) The board shall issue a conditional prescription certificate
17   if it finds that the applicant has met the requirements of subsection
18   (C). The conditional prescription certificate must be valid for a
19   period of two years, at the end of which the holder may again
20   apply pursuant to the provisions of subsection (C). During the
21   period that the conditional prescription certificate is in effect, the
22   board shall ensure that an APC-C with a conditional prescription
23   certificate:
24          (1) continues to hold a current license to practice
25   chiropractic and maintains malpractice insurance;
26          (2) has no disciplinary actions taken against the certified
27   advanced practice chiropractic physician by the board;
28          (3) only prescribes substances specified in subsection (B)
29   under the supervision of a medical doctor, informs the board of the
30   name of the medical doctor under whose supervision the certified
31   advanced practice chiropractic physician will prescribe substances
32   specified in subsection (B) and promptly informs the board of any
33   change of the supervising medical doctor;
34          (4) submits a report to the supervising medical doctor every
35   three months demonstrating twenty-five or more patient clinical
36   assessments, including diagnosis, medications prescribed and
37   outcomes; and
38          (5) has the supervising medical doctor review the report and
39   submit with the report a declaration that the certified advanced
40   practice chiropractic physician has met the conditions of items (1)
41   through (4) of this subsection to the board.
42      (E) An APC-C may apply to the board for a prescription
43   certificate. The application must be made on a form prescribed by

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 1   the board and at a minimum contain evidence satisfactory to the
 2   board that the applicant:
 3         (1) has a conditional prescription certificate for two years
 4   and has successfully prescribed substances specified in subsection
 5   (B) for two years;
 6         (2) has successfully undergone a process of independent
 7   peer review approved by the board;
 8         (3) holds a current license to practice chiropractic;
 9         (4) has malpractice insurance in place that is sufficient to
10   satisfy the rules adopted by the board; and
11         (5) meets all other requirements, as determined by rule of
12   the board, for obtaining a prescription certificate.
13      (F)(1) The board shall issue a prescription certificate if it finds
14   that the applicant meets the requirements of subsection (E).
15         (2) An APC-C with a prescription certificate shall:
16           (a) continuously hold a current license to practice
17   chiropractic;
18           (b) continuously maintain malpractice insurance, and must
19   quarterly provide evidence of his compliance with this
20   requirement; and
21           (c) satisfy the annual continuing education program
22   requirements required under item (G)(3).
23      (G) The board shall promulgate regulations concerning the:
24         (1) issuance and renewal of a conditional prescription
25   certificate and a prescription certificate;
26         (2) denial, suspension, or revocation of a conditional
27   prescription certificate and prescription certificate, including a
28   provision requiring the automatic suspension of a license to
29   practice chiropractic upon suspension of a prescription certificate
30   and revocation of a license to practice chiropractic upon revocation
31   of a prescription certificate; and
32         (3) annual continuing education requirements for an APC-C,
33   which must be in addition to continuing education requirements for
34   a chiropractic license and must require at least twenty-four hours
35   of continuing education.”
36
37   SECTION 2. Section 40-9-10 of the 1976 Code, as last amended
38   by Act 230 of 2010, is further amended to read:
39
40     “Section 40-9-10. As used in this chapter:
41     (1) „Certified Advanced Practice Chiropractic physician‟ or
42   „APC-C‟ means a chiropractor licensed under this chapter who has


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 1   obtained additional certification to prescribe and administer certain
 2   substances as provided in Section 40-9-42.
 3      (a2) „Chiropractic‟ is defined as that science and art which
 4   utilizes that uses the inherent recuperative powers of the body and
 5   deals with the relationship between the nervous system and the
 6   spinal column, including its immediate articulations and the role of
 7   this relationship in the restoration and maintenance of health.
 8      (b3) „Chiropractic practice‟ is defined as the spinal analysis of
 9   any an interference with normal nerve transmission and
10   expression, and by adjustment to the articulations of the vertebral
11   column and its immediate articulations for the restoration and
12   maintenance of health and the normal regimen and rehabilitation of
13   the patient without the use of drugs or surgery. Chiropractic
14   practice includes the prescription and administration of certain
15   substances as provided in Section 40-9-42.
16      (c4) „Analysis‟ is defined as physical examination, the use of
17   x-ray, and procedures generally used in the practice of
18   chiropractic.
19      (d5) Any A machine used in „chiropractic practice‟ or „analysis‟
20   must first be approved by the South Carolina Board of
21   Chiropractic Examiners.
22      (e6) „Preceptorship‟ or „residency training program‟ means a
23   clinical program of an approved college of chiropractic in which a
24   chiropractic intern or resident practices chiropractic under the
25   direct supervision of a licensed chiropractor.
26      (f7) „Chiropractic preceptor‟ means a person licensed under this
27   chapter who is approved by the board to supervise chiropractic
28   students in the performance of chiropractic at a location other than
29   the premises of a chiropractic college in which the student is
30   enrolled. A chiropractic preceptor must:
31         (1a) have been licensed to practice chiropractic in South
32   Carolina for not less than five years;
33         (2b) not have been publicly or privately sanctioned by a
34   chiropractic licensure board in any state;
35         (3c) sign a sworn statement that he or she has not knowingly
36   violated state or federal rules or regulations including, but not
37   limited to, those pertaining to the repayment of guaranteed
38   federally funded student loans;
39         (4d) receive written approval of the chiropractic college to
40   serve as an adjunct faculty member for the purpose of an
41   individual student‟s preceptorship or residency training program;



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 1         (5e) supervise no more than one chiropractic student at a time
 2   at a location other than the premises of the chiropractic college in
 3   which the student is enrolled.
 4      (g8) „Direct supervision‟ means the chiropractic preceptor must
 5   be within the immediate patient treatment area and available to the
 6   student at all times.”
 7
 8   SECTION 3. Section 40-9-20 of the 1976 Code, as last amended
 9   by Act 230 of 2010, is further amended to read:
10
11      “Section 40-9-20. (A)(1) No A person may not practice
12   chiropractic in this State without a license issued by the South
13   Carolina Board of Chiropractic Examiners as provided in this
14   chapter, except students participating in a preceptorship or
15   residency training program may perform without a license
16   chiropractic procedures under the direct supervision of a
17   chiropractic preceptor. These procedures and this supervision
18   must be practiced within the confines of the appropriate
19   chiropractic college or office of a licensed chiropractor.
20         (2) A person may not practice as an APC-C unless he
21   satisfies the additional requirements of Section 40-9-42.
22      (B) No charges A charge for a professional service may not be
23   made to any a patient or to his insurance company for any work
24   performed on the patient by the students a chiropractic student or
25   by the a licensed chiropractor on the college staff while
26   supervising the students a chiropractic student or by the a licensed
27   chiropractor in an office while supervising the students a
28   chiropractic student. However, the chiropractic college or the
29   office of the licensed chiropractor may charge the patient for the
30   actual costs and expenses it incurs for the use of its clinical
31   property or facilities by the patient.
32      (C) This section does not apply to any a chiropractic college
33   which has failed that fails to attain accredited status from the
34   Council on Chiropractic Education or its successors or from the
35   Commission on Accreditation of the Straight Chiropractic
36   Academic Standards Association.”
37
38   SECTION 4. This act takes effect upon approval by the Governor.
39                            ----XX----
40




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