Personal Health : Chiropractors Get New Respect From Hospitals

Michigan chiropractor James Gregg recalled his shock and wonder when a cardiologist on the staff of New Center Hospital in Detroit strode up recently and thrust four medical charts into his hands.

“These patients are complaining of chest pains and I can’t find anything,” he said gravely, according to Gregg. “You want to take a look?”

When Gregg recovered from his surprise at being consulted by a heart specialist, he hurried to check out the patients. All were suffering from spinal problems, not angina, and were discharged, he said.

For years chiropractors have been considered medical untouchables. They couldn’t get into the hospital even as patients, the joke went at a large Chicago medical facility.

But today, spinal manipulators are beginning to invade the sacred domain of the physician. The American Hospital Assn. estimates that between 50 and 100 hospitals nationwide have granted chiropractors the right to treat patients in their wards, most of these in the past two years. Hundreds of others now allow chiropractors to use diagnostic equipment such as X-rays.

‘Our Time Is Coming’

“We don’t consider ourselves to be ‘ only chiropractors’ any more,” said Louis Sportelli, a Palmerton, Pa., practitioner who is chairman of the board of the American Chiropractic Assn. “We’re starting to see the sun. Our time is coming.”

Many medical doctors, however, continue to regard chiropractors with skepticism and worry that their growing assertiveness will lead them into medical areas for which they have no training.

Of modern chiropractors, Dr. Charles McElwee, president of the Los Angeles County Medical Assn., said: “I think they’re better, better trained and they get in less trouble” than their forebears. But he said too many still try to treat conditions they are not trained to do. “I’ve seen people manipulated who had broken necks. God was with them that they didn’t get paralyzed.”

Whether they ever can get the respect they feel they deserve from mainstream medicine, chiropractors already have gained a higher profile through increasingly aggressive lobbying and advertising campaigns, some featuring such famous chiropractic patients as San Francisco 49er quarterback Joe Montana. Last year, for the first time, a chiropractor was taken abroad by the U. S. Olympic team to treat athletes.

They also are attempting to step into new areas of treatment, including a controversial proposal for the Los Angeles Board of Education to allow chiropractors to perform physical examinations for school athletes.

‘Everything Has Changed’

“Chiropractors are moving into a lot of what was traditionally considered medical territory, whether we like it or not,” said Dr. Ron Lawrence, a Los Angeles physician who served on the state Board of Chiropractic Examiners. “Everything has changed. It’s a new ballgame.”

While trend-setting Hollywood celebrities such as Jack Nicholson have been seeing chiropractors for a decade, two more recent events in the medical world have brought them new attention and status. First, U.S. District Judge Susan Getzendanner ruled in Chicago in 1987 that the AMA had mounted a 24-year campaign to destroy the practice of chiropractic.

After reviewing thousands of documents, including a 1971 American Medical Assn. memo pledging to “stop or eliminate the licensure of chiropractic,” Getzendanner handed down an injunction ordering the AMA not to interfere with a physician’s right to consult, refer patients to and work hand in hand with chiropractors. Her ruling is on appeal.

A second factor that has led hospitals to open their doors to chiropractors is hard economics. Since the federal government imposed new limits on Medicare payments in 1983, hospitals have been forced to watch the bottom line more closely; wards have emptied; some facilities have closed.

Alfred Moore, administrator at New Center Hospital, said that to survive, his hospital began “diversifying the use of our beds.” Sixty chiropractors are now on staff and Moore estimated that they have boosted the hospital’s income by 10% annually.

‘Great Leveler’

Said Sportelli: “Economics is the great leveler and has a way of eliminating prejudice.”

The 72-bed Canoga Park Hospital recently became the first in California to allow chiropractors to treat patients in the hospital.

At Canoga Park, Simi Valley practitioner Charles Neault bent over a bed recently and pushed on the legs of Gerald Addis, 36, and suffering from a herniated disc. Nurses trained to respect physicians openly gawked at the sight of a chiropractor in the hospital and laying hands on a patient.

“Does that hurt?” asked Neault, as he bent to his work. The patient grimaced, but said he preferred the pain to surgery.

Addis is not alone. There are 55,000 chiropractors in the United States and the chiropractic association says its surveys show that one in seven people visited a chiropractor in the last two years.

Many patients seem satisfied with their care. A 1983 Gallup poll showed that 70% of those who had consulted a chiropractor would do so again.

Practitioners are trained in the workings of the musculo-skeletal system. They believe adjustments of the spine can alleviate chronic pain and even prevent the need for surgery in some cases. There are 17 colleges of chiropractic in the United States and today’s practitioners are better trained than ever before, spokesmen said.

The attitude of medical doctors toward chiropractors moving into new treatment areas varies, but seems more accepting than when Dr. Joseph Sabatier Jr., the AMA’s chairman of the Committee on Quackery, who compared them in 1973 to rabid house pets--”cute but killers.”

The May issue of the American Journal of Public Health published a Washington state study that says only 3% of family doctors believe chiropractors are quacks.

A number of chiropractors said they are receiving more referrals--and more invitations to lunch--from physicians than ever before.

“I don’t know if it’s a quantum change, as much as an evolution in attitudes” toward chiropractors, said Dr. David Chernoff, president-elect of the Los Angeles County Medical Assn.

Said McElwee, president of the medical association: “Has the attitude changed? Yes. It had to change, it’s been mandated by law. Whether underlying feelings have changed a lot, I’m not certain.”

From Hippocrates

Even in discussing history, physicians and chiropractors hold divergent views. When chiropractors discuss their antecedents, they invariably bring up Hippocrates, the ancient Greek physician. But hostile medical doctors point to an American grocer and “magnetic healer” named D. D. Palmer, who a century ago proposed spinal manipulation as a cure for a wide variety of ailments.

Even today, some chiropractors profess to be able to cure diabetes and other non-musculo-skeletal ailments, sometimes with calamitous results. “I have seen things that made me shudder,” admitted one chiropractor.

But reputable chiropractors insist these “bad apples” are dying off.

For decades, though, the AMA has denounced the practice as “quackery and cultism,” and in 1967 declared it unethical for physicians to professionally associate with chiropractors. George McAndrews, the Chicago attorney who represented four chiropractors in their landmark lawsuit, said the AMA’s anti-chiropractic campaign so intimidated its members that a doctor once wrote an anguished letter to the medical association. A chiropractor had joined the local Rotary Club, he said. Must he resign? The AMA, McAndrews said, advised him to remain but warned him to be cautious.

Chiropractors say the AMA campaign against them helped shape a public image of the chiropractor as a bumbling cultist, while promoting physicians as all-caring, all-knowing. “There are no Dr. Kildare chiropractors on television,” said Sportelli.

Antitrust Ruling

But then on Aug. 27, 1987, Getzendanner ruled that the AMA’s anti-chiropractic campaign violated antitrust law. “Keeping chiropractors out of hospitals was one of the goals of the boycott,” she said. The AMA has appealed her ruling and now officially refuses to comment on chiropractors or “any other alternative form of medicine.”

In the wake of that ruling, however, hospital doors have begun to swing open to chiropractors.

It is impossible to know just how many hospitals have welcomed them, because the American Hospital Assn. does not keep records. The American Chiropractic Assn. lists 18 facilities that have gone so far as to put them on staff. Leading chiropractors and the AHA agree that the number allowing practitioners to work in the hospital, on staff or off, could be as high as 100.

And the pace of change is accelerating. “There is more and more and more of it,” Donna Wilson, AHA director of medical affairs, said of hospitals allowing chiropractors on their wards. “This is the right time for chiropractors to get their foot in.”

Chiropractors have made headway in other areas, too, using lobbying techniques and a growing talent for self-promotion. Walter Zelman, executive director of California Common Cause, said that in Sacramento, chiropractors have been “a very active lobbying group, giving away large amounts of campaign contributions for a modest-sized organization.”

But barriers still remain between chiropractors and physicians. After the Board of Chiropractic Examiners in California authorized pre- and post-natal chiropractic care in 1987, the California Medical Assn. filed suit. Sacramento County Superior Court Judge Steven Rodda ruled on Dec. 28 that such care was beyond their “scope of practice.”

For their part, some chiropractors are still nursing old wounds, even in the flush of victory. Corwin said hospitals have been taking him to nice restaurants in the San Francisco Bay Area, trying to persuade him to use his influence to bring his colleagues in to their facilities. So far, he has rejected their advances: “I said, ’10 years ago you wouldn’t let me in to take an X-ray. Now you’re begging me.’ ”