Report 2007-117 Recommendations

When an audit is completed and a report is issued, auditees must provide the State Auditor with information regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year. Additionally, Senate Bill 1452 (Chapter 452, Statutes of 2006), requires auditees who have not implemented recommendations after one year, to report to us and to the Legislature why they have not implemented them or to state when they intend to implement them. Below, is a listing of each recommendation the State Auditor made in the report referenced and a link to the most recent response from the auditee addressing their progress in implementing the recommendation and the State Auditor's assessment of auditee's response based on our review of the supporting documentation.

Recommendations in Report 2007-117: State Board of Chiropractic Examiners: Board Members Violated State Laws and Procedural Requirements, and Its Enforcement, Licensing, and Continuing Education Programs Need Improvement (Release Date: March 2008)

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Recommendations to Chiropractic Examiners, Board of
Number Recommendation Status
1

To comply with Bagley-Keene, the chiropractic board should continue to involve legal counsel in providing instruction and training to board members at each meeting.

2

To comply with Bagley-Keene, the chiropractic board should continue to retain documentation of the steps it takes to publicly announce its meetings.

3

To comply with the administrative procedure act, board members should limit their communications related to board business so they do not engage in ex parte communications or compromise their ability to fulfill their responsibilities in enforcement hearings.

4

To comply with the initiative act, the chiropractic board should modify its current process so that board members make final decisions to approve or deny all licenses.

5

Additionally, board members should ratify all previous license decisions made by staff.

6

To comply with the political reform act, the chiropractic board should ensure that its filing official is aware of the role and responsibilities of the position and, similarly, promptly inform anyone replacing the filing official.

7

To comply with the political reform act, the chiropractic board should establish an effective process for tracking whether all designated employees, including board members, have completed and filed their statements of economic interests on time, thereby identifying potential conflicts of interest.

8

To comply with the political reform act, the chiropractic board should periodically review its employees? responsibilities to ensure that all individuals who are in decision-making positions are listed as designated employees in its conflict-of-interest code.

9

To enable them to conduct their chiropractic board business in a secure and confidential environment and make their actions and correspondence accessible when requested in accordance with the public records act, the chiropractic board should consider providing state e-mail accounts to its board members.

10

To continue improving their knowledge and understanding of state laws and board procedures, board members should continue using their newly adopted administrative manual as guidance for conducting board business.

11

To comply with Bagley-Keene provisions and state laws requiring board members to attend training within specific time frames, and to ensure that board members receive orientation within a reasonable amount of time of assuming office, the chiropractic board should ensure that staff retain documentation when they provide a copy of Bagley-Keene to a newly appointed board member.

12

To comply with Bagley-Keene provisions and state laws requiring board members to attend training within specific time frames, and to ensure that board members receive orientation within a reasonable amount of time of assuming office, the chiropractic board should continue to use the member appointment checklist and establish procedures to periodically record and monitor board member training.

13

To comply with Bagley-Keene provisions and state laws requiring board members to attend training within specific time frames, and to ensure that board members receive orientation within a reasonable amount of time of assuming office, the chiropractic board should continue to send new board members to the orientation that Consumer Affairs provides.

14

To adequately control its complaint review process, the chiropractic board should develop procedures to ensure that staff process and resolve complaints as promptly as possible by establishing benchmarks and more-structured policies and procedures specific to each step in its complaint review process.

15

To adequately control its complaint review process, the chiropractic board should establish time frames for staff to open a complaint case, complete an initial review, refer the case to an investigator or expert if necessary, and close or otherwise resolve the complaint by implementing informal discipline or referring for formal discipline to ensure that all complaint cases move expeditiously through each phase of the complaint review process.

16

To adequately control its complaint review process, the chiropractic board should periodically review the status of all open complaints and investigations and identify and resolve any delays in processing.

17

To adequately control its complaint review process, the chiropractic board should strengthen its enforcement policies and procedures to minimize the amount of time it takes staff to process consumer complaints before forwarding them to the attorney general or other law enforcement agency to ensure that it adequately assists attorneys and law enforcement agencies in enforcing the laws relating to the practice of chiropractic.

18

To ensure that its enforcement procedures are complete and to provide adequate guidance to enforcement staff, the chiropractic board should develop policies and procedures requiring that only a manager or a designated employee are allowed to make the final decisions on complaint resolution.

19

To ensure that its enforcement procedures are complete and to provide adequate guidance to enforcement staff, the chiropractic board should develop procedures to ensure that staff report the issuance of citations to other states? chiropractic boards and regulatory agencies.

20

To ensure that its enforcement procedures are complete and to provide adequate guidance to enforcement staff, the chiropractic board should develop procedures instructing staff when to open and how to process complaints generated internally.

21

To consistently process and resolve consumer complaints regarding the same allegation and to consistently process consumer complaints according to its enforcement policies and procedures, the chiropractic board should strengthen its existing procedures to provide guidance for staff on how to process and resolve all types of complaints and to ensure appropriate management oversight.

22

To ensure that its processes for prioritizing consumer complaints enable staff to clearly identify priority complaints and process them promptly, the chiropractic board should implement tracking methods, such as flagging priority cases during complaint intake, using multiple levels of priority categories, and assigning specific time frames to process those priority categories.

23

To ensure that its processes for prioritizing consumer complaints enable staff to clearly identify priority complaints and process them promptly, the chiropractic board should establish procedures that direct board management to monitor the status of open complaints regularly, especially those given priority status, to ensure that they do not remain unresolved longer than necessary.

24

To comply with all its regulations, the chiropractic board should carefully consider the intended purpose of the review panels and whether implementing them is the best option to fulfill that intent.

25

If the chiropractic board decides that another option would better accomplish the intended purpose of the review panels, it should implement the process for revising its regulations.

26

To ensure that it has the necessary resources to answer technical questions regarding quality of care and improper treatment that often arise, the board should fill its chiropractic consultant position.

27

In addition, the board should require the chiropractic consultant to act only in an advisory capacity and the executive officer to make all final enforcement decisions.

28

To adequately control the use of experts, the chiropractic board should establish policies and procedures requiring its staff to document interviews with experts, including the content of those discussions, to ensure that it refers cases to qualified experts with no conflicts of interest.

29

To adequately control the use of experts, the chiropractic board should consider entering into formal written contracts for services from experts or require experts to attest in writing that they have no conflicts of interest in cases assigned.

30

To adequately control the use of experts, the chiropractic board should strengthen its policies and procedures to ensure that its staff monitor experts on their adherence to the established 30?day deadline for reviewing complaint cases and submitting written reports.

31

To adequately control the use of experts, the chiropractic board should consistently evaluate experts? written reports and thoroughly document the results of the evaluations to ensure that the chiropractic board does not inappropriately refer complaint cases to experts who have not demonstrated quality work in the past.

32

To demonstrate that its employees meet the minimum qualifications for their positions, the chiropractic board should retain personnel documentation on all employees according to its record retention policy.

33

In addition, the chiropractic board should require its contractor for personnel services to comply with the same requirements.

34

To ensure that future chiropractic consultants are hired with the desired qualifications, the board should consider revising the position?s minimum qualifications to provide additional clarity on the phrase practice of chiropractic, similar to the board?s current requirements for experts.

35

To ensure that it is able to measure the overall efficiency of its licensing program in processing applications and petitions, the chiropractic board should establish time frames for all the types of applications and petitions the board processes.

36

To ensure that it is able to measure the overall efficiency of its licensing program in processing applications and petitions, the chiropractic board should establish a tracking system for applications and petitions to analyze where delays are occurring and ensure that applications and petitions are processed promptly.

37

To ensure that it is able to measure the overall efficiency of its licensing program in processing applications and petitions, the chiropractic board should establish a time frame for resolving appeals that includes milestones for each phase of the process.

38

To ensure that it licenses only individuals who are committed to following state laws and regulations, the chiropractic board should develop specific policies and procedures for staff to follow when the board receives a complaint against an applicant seeking licensure.

39

To defend its decisions on approved applications for satellite offices, corporations, and referral services, the chiropractic board should implement a standard of required documentation that includes identifying when and who conducted eligibility verifications.

40

To ensure that it is placing licenses in forfeiture status according to the initiative act, the chiropractic board should establish specific procedures for staff to follow when a licensee submits invalid payment with a license renewal.

41

To ensure that it is placing licenses in forfeiture status according to the initiative act, the chiropractic board should establish a tracking method to ensure that requests for repayment are sent promptly and all penalties are paid.

42

To ensure that its continuing education program complies with current regulations, the chiropractic board should require board members to ratify staff approvals of providers.

43

To ensure that its continuing education program complies with current regulations, the chiropractic board should ensure that its process to approve providers conforms to its regulations.

44

To ensure that its continuing education program complies with current regulations, the chiropractic board should comply with requirements for notifying a provider of board approval within two weeks following a scheduled board meeting and for notifying a provider of application deficiencies within three weeks of receiving the application.

45

To ensure that its continuing education program complies with current regulations, the chiropractic board should establish a process to track and monitor whether providers submit attendance rosters within 60 days of course completion.

46

To ensure that its continuing education program complies with current regulations, the chiropractic board should establish procedures for maintaining accurate documentation of continuing education audits of licensees.

47

To ensure that its continuing education program complies with current regulations, the chiropractic board should establish a mechanism to ensure that all relevant steps are taken before continuing education audits are considered complete.

48

To ensure that its continuing education program complies with current regulations, the chiropractic board should establish a process to track course audits conducted and a procedure for taking corrective action when the course reviewer identifies a deficiency.



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