Health Professionals Appeal and Review Board: Skull Suture Manipulation On Children with Autism
On January 13, 2013, Ontario’s Health Professionals Appeal and Review Board met via teleconference to review a complaint. The case is documented on the CanLII website.
CFIC reproduces details of the file here for critical examination (colour-highlighted sections by CFIC); people concerned with the health-care system should evaluate this case not only with concern for the claims and treatments of the chiropractors but also consider the decision in relation to the newly-formed Ontario College of Homeopathy.
On July 21, 2015 CFI Canada issued letters of inquiry to leading Canadian autism and ADHD charities to request their policy or position statements on the use of Skull Suture Manipulation, and more generally regarding treatment of children with autism and/or ADHD by chiropractors. We will publish further information on this page.
If you have information regarding skull suture manipulation or treatment of children with autism or ADHD by a chiropractor, we will be pleased to receive that information to add to our references.
File # 12-CRV-0321
HEALTH PROFESSIONS APPEAL AND REVIEW BOARD
James Beamish, Designated Vice-Chair, Presiding
Samia Makhamra, Board Member
James Dault, Board Member
Review held on January 15, 2013 in Ontario (by teleconference)
IN THE MATTER OF A COMPLAINT REVIEW UNDER SECTION 29.(1) of the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, c.18, as amended
B E T W E E N:
K.M., DC and S.H., DC
The Applicant: T.P., MD,
The Respondents: K.M., DC, S.H., DC
For the College of Chiropractors of Ontario: Tina Perryman
DECISION AND REASONS
1. It is the decision of the Health Professions Appeal and Review Board to confirm the decision of the Inquiries, Complaints and Reports Committee of the College of Chiropractors of Ontario to take no further action.
2. This decision arises from a request made to the Health Professions Appeal and Review Board (the Board) by T.P., MD (the Applicant) to review a decision of the Inquiries, Complaints and Reports Committee (the Committee) of the College of Chiropractors of Ontario (the College). The decision concerned a complaint made by the Applicant, regarding the conduct and actions of K.M., DC and S.H., DC (the Respondents). The Committee investigated the complaint and decided to take no further action.
3. The Applicant is a physician who practices in Waterloo, Ontario.
4. The Applicant wrote a letter to the College on September 21, 2011 in which he objected to the methods of treatment and claims of the Respondents who practice at Barrhaven Family Chiropractic in Ottawa. Specifically, the Applicant objected to the Respondents’ use of the Turner Method of “skull suture manipulation” in the treatment of children with autism and Attention Deficit Hyperactivity Disorder (ADHD). According to the Applicant, the treatment advocated by the Respondents is “quackery” and beyond the scope of practice of chiropractors.
5. In addition, the Applicant objected to the testimonials posted on YouTube by the Respondents that he stated are “disturbing”, make false claims and violate the Guidelines on Advertising of the Chiropractic profession.
6. The Respondents stated that the Applicant has “been an outspoken critic of the Chiropracticprofession for many years.” The Respondents deny they are treating autism or ADHD but “treating children who are diagnosed with autism and ADHD.”
7. The Respondents state they are not violating the advertising standards of their profession.
The Complaint and the Response
8. The Applicant complained that the Respondents:
• used “disturbing” testimonials on the internet to promote “skull suture manipulation” to treat children with autism and ADHD;
• made false claims about their ability to manipulate skull sutures;
• violated advertising standards of the College; and
• treated autism and ADHD, which was outside the “scope of practice” of the Chiropractic profession.
9. The Respondents responded to the complaint as follows:
• They do not treat autism or ADHD but rather, they treat people who have been diagnosed with autism or ADHD;
• They detect subluxations of the skull and use the Turner method of cranial adjusting, which they believe is within their scope of practice;
• There is research that demonstrates that there is a small amount of cranial movement; and
• The testimonials that they have posted on their website and on YouTube conform to the College advertising standard in that they are accurate, factual, verifiable and readily comprehensible by the persons to whom they are addressed.
The Committee’s Investigation and Decision
10. The information obtained by the Committee in its investigation of this matter included:
• letter of complaint from the Applicant;
• confirmation of concerns from the Applicant;
• response from both Respondents;
• witness information from patients of the Respondents;
• articles from professional journals; and
• YouTube Video testimonial.
11. The Committee investigated the complaint and decided to take no further action.
12. The Committee reviewed the definition of autism spectrum disorder as published by the Autism Society of Canada as well as literature relating to ADHD. The Committee concluded, on the basis of that research, that although there is nothing to support a diagnosis that either autism or ADHD is caused by a disorder of the spine or joints, they appear to be neurological conditions and therefore within the scope of chiropractic practice. The Committee accepted that the Respondents were not treating autism or ADHD, but were treating the symptoms of those disorders by removing spinal or cranial subluxations that interfere with the optimal functioning of the body. The Committee stated that it viewed chiropractic care as a valid component in a patient’s autism/ADHD care plan. The Committee relied, in part, on a peer-reviewed article, Chiropractic and the Management of Children with Autism, by Dr. Brian Gleberzon. Dr. Gelberzon was a member of the Committee that considered the complaint.
13. The Committee referred to chiropractic literature and found that the question of whether cranial sutures are fused or flexible is not settled and appears to be a matter about which reasonable people may disagree. The Committee referred to clinical trials and case reports that discuss cranial therapy for children with autism and stated that the evidence that such therapy may be beneficial, though not robust, is not insignificant.
14. The Committee found that the persons who appeared on the YouTube testimonial provided statements that they stand behind their testimonial. The Committee noted that these persons were communicating their life experiences and appeared to be truthful and sincere. The Committee found nothing in the video to cause concern.
III. REQUEST FOR REVIEW
15. Dissatisfied with the decision of the Committee, in a letter dated May 8, 2012, the Applicant requested that the Board review the Committee’s decision.
IV. POWERS OF THE BOARD
16. After conducting a review of a decision of the Committee, the Board may do one or more of the following:
a) confirm all or part of the Committee’s decision;
b) make recommendations to the Committee;
c) require the Committee to exercise any of its powers other than to request a Registrar’s investigation.
17. The Board cannot recommend or require the Committee to do things outside its jurisdiction, such as make a finding of misconduct or incompetence against the member, or require the referral of allegations to a discipline hearing that would not, if proved, constitute either professional misconduct or incompetence.
V. ANALYSIS AND REASONS
18. Pursuant to section 33.(1) of the Health Professions Procedural Code (the Code), being Schedule 2 to the Regulated Health Professions Act, 1991, the mandate of the Board in a complaint review is to consider either the adequacy of the Committee’s investigation, the reasonableness of its decision, or both
Adequacy of the Investigation
19. An adequate investigation does not need to be exhaustive. Rather, the Committee must seek to obtain the essential information relevant to making an informed decision regarding the issues raised in the complaint.
20. The Applicant made the following submissions about the adequacy of the Committee’s investigation:
• The Committee should have gone outside the realm of chiropractic medicine to obtain scientific information regarding the treatment provided by the Respondents, including an expert opinion;
• The Committee should have visited the Respondents’ office to investigate the treatment that they were providing; and
• The Committee should have investigated what training the Respondents had in cranial therapy.
21. The Respondents submitted that the Committee’s investigation was adequate.
22. The Board finds that the Committee conducted an adequate investigation of the complaint. The Board notes that the standard to be considered and applied is that of chiropractic and not that of medicine. Although the Applicant, as a physician, might believe that certain aspects of the Respondents’ practice are “quackery”, chiropractic has been recognised in Ontario as a registered health profession. Subject to the oversight provided by the Board, the College assesses complaints it receives about the care and conduct of its members and regulates its members in accordance with the standards of that profession.
23. That being the case, the Board finds that it was not necessary that the Committee consider literature outside the scope of chiropractic or to seek an expert opinion from someone outside the chiropractic profession. The Board finds that the members of the Committee had sufficient expertise to determine whether the Respondents met the standards of chiropractic practice.
24. The Board finds that it was not necessary for the Committee to have conducted an examination of the Respondents’ practice, nor to have enquired into the training that the Respondents received for cranial therapy. The issue raised in the complaint was not whether the Respondents had the requisite skill and training to perform the therapy that they advertised, but whether the therapy itself was legitimate. The investigations proposed by the Applicant would not have assisted in that inquiry.
25. For the reasons stated above, the Board finds that the Committee conducted an adequate investigation in this matter.
Reasonableness of the Decision
26. In considering the reasonableness of the Committee’s decision, the question for the Board is not whether it would arrive at the same decision as the Committee, but whether the Committee’s decision can reasonably be supported by the information before it and can withstand a somewhat probing examination. In doing so, the Board considers whether the decision falls within a range of possible, acceptable outcomes that are defensible in respect of the facts and the law.
27. The Applicant noted that the scope of practice as defined in the Chiropractic Act does not refer to subluxations of the skull or to adjustments of the skull. As such, the cranial therapy advocated by the Respondents is outside the scope of chiropractic practice.
28. The Respondents stated that they treat subluxations and not the underlying condition, whether autism or ADHD. The treatment of subluxations is within the scope of practice of chiropractic.
29. The Board finds that the Committee reached a reasonable decision. The Chiropractic Act defines the scope of practice as follows:
3. The practice of chiropractic is the assessment of conditions related to the spine, nervous system and joints and the diagnosis, prevention and treatment, primarily by adjustment, of,
(a) dysfunctions or disorders arising from the structures or functions of the spine and the effects of those dysfunctions or disorders on the nervous systems; and
(b) dysfunctions or disorders arising from the structures of the joints.
30. The Committee stated, in its decision, that because autism and ADHD are considered to be neurological conditions, they are within the scope of chiropractic practice. The Committee did not specifically address the question of whether the manipulation of the skull, as opposed to spine or joints, is within the scope of chiropractic practice. Nevertheless, the Committee stated in it decision, “The traditional chiropractic perspective is that the removal of vertebral or cranial subluxations contributes to the optimal functioning of the body as a whole.” The Board finds this to be a reasonable conclusion given the expertise and experience of the members of the Committee.
31. Pursuant to section 35.(1) of the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991, the Board confirms the decision of the College to take no further action.
ISSUED April 2, 2013