The Guidelines for Chiropractic Quality Assurance and Practice Parameters, more commonly known as the Mercy Guidelines, were developed in 1993 by a 35-member commission initially “sponsored” by the Congress of Chiropractic State Associations (COCSA).
It is the position of the World Chiropractic Alliance (WCA) that no set of guidelines should be interpreted as a “standard of care” or be used by state licensing boards, chiropractic organizations, insurance companies, courts of law, or any other entity, to regulate or judge the practice decisions of any doctor of chiropractic. Instead, such guidelines are to be used only to assist doctors of chiropractic in providing the highest quality care to patients or to help non-chiropractors understand the scope and purpose of chiropractic. In addition, chiropractic guidelines should be the result of extensive input from the profession at large and address the primary purpose of chiropractic, the analysis and correction of subluxations.
By any of these standards, The Mercy document fails completely and is categorically rejected by the WCA. It is the position of the WCA that the Mercy Guidelines should not be used by any practicing doctor of chiropractic nor by any government, health care organization, insurance company or other party. In particular, the WCA condemns the use of the Mercy document by independent medical or chiropractic examiners as a means by which to judge the “medical necessity” of any care provided by a doctor of chiropractic.
Among the specific reasons for the WCA’s rejection of Mercy are:
The Mercy document restricts chiropractic to the treatment of low-back pain in adults. The WCA strongly promotes the use of chiropractic as an integral part of a total health and wellness regimen, suitable for all people — from infancy to old age — and regardless of the presence or absence of symptoms.
The Mercy document is easily interpreted as setting limits on the number of visits a patient should reasonably have with a doctor of chiropractic. It is the position of the WCA that each case — like each person — is unique and the determination of the duration of care should be a decision made by the doctor and patient.
The methodology of the Mercy conference was flawed. (See also the detailed examination of the methodological and application problems associated with Mercy.)
The Mercy conference was developed in a closed session by 35 panel members without input from the profession at large. No explanation was given as to how these 35 individuals were selected. A review of the people on the commission reveals an extremely heavy bias toward the more medicalized faction of the profession, despite the fact that it represents a minority of the profession as a whole. Only a few subluxation-based chiropractors were invited to participate and at least two afterward stated publicly that they felt they were included as “token” representatives but had no real affect on the proceedings.
The Mercy document was rushed into the hands of the insurance industry before most doctors of chiropractic had been given a chance to review it. Almost immediately, several members of the commission began marketing seminars, books and other merchandise about the document, raising serious questions regarding conflict of interest. The financial incentive of several members of the commission to profit from the acceptance of the guidelines throws significant suspicion on the motives behind their development and distribution.
The Mercy document was published in 1993 as a working document to be updated and revised. It has never been updated and, in June 2000, the California Chiropractic Association, which had contributed to the conference and was one of the few organizations to give the guidelines a provisional endorsement, passed a resolution ending its support, saying the document “no longer represents the present state of scientific evidence.”
Further, major funding for the commission was derived by companies owned by commission members or having direct ties to those members, adding another layer of economic involvement to the picture. Many of these companies were able to financially benefit from the findings of the conference and undoubtedly their financial aid had an influence on the outcome.
The Mercy document has been rejected by almost every chiropractic organization on national, state and local levels, including the organizations which initially sponsored it. Organizations and state boards which have rejected or withdrawn endorsement of the Mercy Guidelines document include:
|Alabama State Chiropractic Association|
|Alaska Chiropractic Society|
|Arizona Association of Chiropractic|
|Arizona Chiropractic Council|
|Arkansas State Board of Chiropractic Examiners|
|Association for Chiropractors of Greater Washington (D.C.)|
|California Chiropractic Association|
|Chiropractic Federation of New York|
|Chiropractic Society of Texas|
|Colorado Chiropractic Association|
|Congress of Chiropractic State Associations|
|Connecticut Chiropractic Council|
|Empire State (New York) Chiropractic Association|
|Florida Chiropractic Society|
|Georgia Board of Chiropractic Examiners|
|International Chiropractors Association|
|International Chiropractors Association of Indiana|
|Kansas Chiropractic Association|
|Kentucky Association of Chiropractors|
|Maryland Chiropractic Association|
|Massachusetts Chiropractic Society|
|Michigan Chiropractic Council|
|Minnesota Chiropractic Association|
|Mississippi Associated Chiropractors, Inc.|
|Nevada Chiropractic Association|
|New York Chiropractic Council|
|New Jersey Board of Chiropractic Examiners|
|Oklahoma State Board of Chiropractic Examiners|
|Pennsylvania Academy of Chiropractic Physicians|
|Washington State Chiropractic Association|
|Washington State Chiropractic Disciplinary Board|
In addition, the Mercy document has been ruled inadmissible as evidence for testimony on a soft tissue injury (Reeves vs. Flaherty, et al. Expert testimony by Robert Martines, D.C., Santa Clara Superior Court, March 1999; citation: Case # CV758647 Santa Clara County Eva Sue Reaves VS. David Flaherty)
Finally, a survey conducted by The Chiropractic Journal revealed that chiropractors around the country have overwhelmingly rejected adoption of the Mercy Guidelines.
For these reasons, and others not detailed in this paper, the World Chiropractic Alliance rejects The Guidelines for Chiropractic Quality Assurance and Practice Parameters and calls for its developers to publicly withdraw their support of this document as well.