can't touch this
A crackdown on sexual misconduct has stirred up a spinal flap among Oregon chiropractors.
by NICK BUDNICK
Three years ago, Mauro Civica was living a life worthy of the Hallmark Hall of Fame treatment. Raised in an orphanage in Rome, he had suffered a head-on auto accident in Hawaii in 1990 and was helped by a chiropractor, inspiring him to become one. In 1997, the handsome, affable immigrant bought a practice in Canby and made it thrive. With earnings of more than $300,000 a year, he could support his wife and three young kids and afford a house, an SUV, expensive jackets, and toys like a luxury Goldwing touring motorcycle.
"I wasn't supposed to be a doctor," the 42-year-old says with pride, his words laced with a strong Italian accent. "I was a gutter boy."
In late 1999, however, his life took an unhappy twist when an investigator from the Oregon Board of Chiropractic Examiners walked into his office asking about Civica's use of what is known as a "vaginal adjustment." In August 2000, before any hearing in which Civica could challenge his accusers, the licensing board issued a press release that led to an article in the Canby Herald, labeling him a "sexual predator."
For some of Oregon's 1,100 chiropractors, Civica's battle to clear his name has revealed a puritanical state bureaucracy that wants to limit health-care options for more than 300,000 Oregonians. For others, it has tarnished the image of a misunderstood profession that holds incredible promise.
The practice of chiropractic was founded in 1895 by Daniel D. Palmer, a grocer in Davenport, Iowa, who thought his manipulation of his janitor's spine cured the man's deafness.
Chiropractors believe that many diseases are caused by obstructions to the central nervous system that impair the body's natural ability to heal. Rather than studying pharmacology, chiropractic students spend their four years of training focusing on anatomy, getting hands-on experience in how to adjust misaligned vertebrae or loosen tight muscles that can cause pain.
Chiropractors soon became the star practitioners of the emerging alternative health scene but struggled for legitimacy elsewhere. Thousands of early chiropractors were jailed by for practicing medicine without a license. In 1990, the U.S. Supreme Court found that the American Medical Association's long-running "anti-quackery" campaign against chiropractic was an illegal "conspiracy" to take out a competitor.
Over the past 30 years, the "quack" tag has faded in the light of numerous studies showing that chiropractic is at least as good as traditional medicine for curing back and neck pain. With legitimacy, the number of practitioners has grown, particularly in the western states and in places like Portland, where Palmer moved in 1910 and where one of the nation's leading chiropractic institutions, Western States Chiropractic College, was founded in 1904. In the past 10 years, the number of licensed chiropractors in Oregon has grown by 34 percent. In the Northwest, all major health-care plans now offer chiropractic care.
Some chiropractors treat only neck and back pain, the most scientifically accepted practice--and the one most likely to be covered by insurance.
Others in the profession hail from the old-school philosophy of chiropractic, viewing themselves as primary-care physicians who are able to treat many conditions seemingly unrelated to the spine--everything from indigestion and eczema to menstrual problems and asthma.
"There's more to that than meets the eye," says Bill Dallas, president of Western States Chiropractic College, who himself has seen repeated, albeit unintended, improvements in menstrual cramps and childhood bedwetting. "There's so much clinical evidence...we're trying to separate how much of this is a placebo effect, how much of this is psycho-suggestion, and how much is actual physiology."
While some chiropractors are near-evangelistic in their testaments of success, most are wary of boasting of unconventional "cures," given their anecdotal and unproven nature. "We believe because we see it happening over and over and over again in our offices," says Salem chiropractor Darald Bolin. But, he adds, some of his colleagues are "a little too verbal" about their powers.
"Sometimes they're embarrassing," he says.
Civica is one of the true believers. In his desire to heal, he was willing to go where most of his colleagues do not, employing a technique that many chiropractors have never heard of--massaging muscles along the vaginal walls to relieve a certain type of lower-back pain. As a doctor, he says, "if my mom had the same problem, I wouldn't think twice before doing a vaginal adjustment."
Within three years of opening his practice, Civica sparked six complaints to the state chiropractic board, including four from female patients.
According to board documents, the women complained that he touched their vaginas in an offensive or painful way and asked them detailed and inappropriate questions about their sex life. Two said he touched the outside of their vaginas while examining or massaging them. One woman said Civica gave her a painful "vaginal adjustment," asked her if she'd engaged in anal sex and, when she responded "no," said, "too bad for your boyfriend."
According to the laws and rules regulating Oregon chiropractors, touching "personal" areas must be for an established medical purpose and with the patient's foreknowledge and consent. A doctor cannot touch in a manner designed to arouse either patient or doctor.
In the past four years, Oregon's 1,098 chiropractors and 577 chiropractic assistants have produced 48 sexual-misconduct complaints--a rate far higher than Oregon's licensed massage therapists, nurses, psychologists, counselors, social workers, dentists and medical doctors (see chart, page 29).
"The problem is so much more prevalent than anyone wants to admit," says Dallas. The college president thinks the profession is more conducive to sexual misconduct than say, the field of medicine, because chiropractors more often work alone. "You develop an intimate relationship with women, and when you're in that relationship you may be more attentive to them than their husbands are," Dallas says. "It's very easy to misinterpret the gratitude of that patient for something that it's not."
Board documents describe behavior that goes beyond misinterpretation: In 1995, for example, Steven E. Clifford of Lebanon adjusted the ribs of a woman who had not complained of rib pain, unfastening her bra in the process. Afterward, he replaced her breasts in the cups of the bra, saying, "Let's put these puppies back in here." That same year, a Grants Pass chiropractor, David A. Albrecht, was sued by a female patient who said he'd attempted to soothe her pain by kissing her bare buttocks "firmly and demonstratively." In 1998, David S. Heller of Ashland gave a "full-body hug" to a patient having marital problems, telling her, "I'm really good in bed."
A repeat offender, Heller was placed on three years' probation and required to have a chaperone when treating women. Albrecht was not disciplined. As for Clifford, he was given a year of probation and later moved to California, where he was recently sentenced to five years in prison for sex abuse.
Other complaints deal with criminal behavior never prosecuted in court. In 1999, the board placed Bryan J. Scott of Tualatin on 10 years' probation --including therapy, polygraph sessions and a ban on treating minors--after finding that seven years earlier he'd administered nitrous oxide to a 15-year-old girl, shown her sexually explicit videos, then had sex with her in his office. The board found that he'd done the same thing in 1982 with a 12-year-old.
As for Civica, the most damaging allegation came not from the four paying patients who complained, but from a 19-year-old whose father was best man at Civica's wedding. The complaint alleged that in 1998, when her family was visiting Civica, the young woman accepted the offer of an after-hours massage at the office of the man she considered a "second dad." As the massage progressed, the complaint alleges, Civica started feeling her breasts, stroked her vagina then performed oral sex on her, in a locked and darkened room. The complaint alleges that she did not protest because she was scared, but as soon as he started to unzip his pants, she jumped off the table to pull on her clothes.
She alleged that after the "massage," he told her he'd had sex with several patients. Not only that, but he allegedly told her he'd had his eye on her since she was 13, "waiting for her to be old enough to become a sexual partner," one board report said.
The sixth complaint against Civica came from Ayron Haley, a masseuse with whom he'd shared office space. She complained that Civica discussed some patients' conditions in front of others, violating their confidentiality. She also said the former reserve cop (for the town of Hubbard) had displayed a gun in the office and left a cartoon lying near the fax machine showing a headless, naked, large-busted female. It was titled "The Perfect Woman."
Civica says the cartoon was sent to him by a friend. "I thought it was funny," he says with a shrug.
But apart from the cartoon and some record-keeping problems, Civica denied all the accusations to the board. He told WW the 19-year-old made up the story because she wanted to stay home with her boyfriend the next time her parents came west for another visit.
The parents, however, believe their daughter. "I think Mauro is in denial," said the mother when contacted by WW. That view was shared by the state regulatory board, which initially proposed banning him from the profession.
Established in 1915, the Oregon Board of Chiropractic Examiners consists of seven volunteer members, appointed by the governor. Five are chiropractors, and two are "public" members who serve as consumer advocates. They're charged with setting policies and ruling on complaints, such as those that came from Civica's four female patients.
In January 2001, the board proposed revoking Civica's license, claiming he had intentionally touched women in a seductive manner and put his hands in sensitive places without first explaining why and obtaining consent. The board cited its psychologist's finding that the incidents with the gun and the darkened room showed a tendency toward "intimidation" and that Civica had "predatory tendencies." If Civica were allowed to continue to practice, the psychologist wrote, "it would place the public at risk."
Chiropractors accused of misconduct can request a full hearing before an independent hearings officer, who considers the evidence and makes a recommendation.
After five days of testimony from 26 witnesses, hearings officer Steven Tegger determined that by chiropractic's own standards, the 19-year-old was not a "patient" and her complaint therefore could not be considered by the board.
Stripped of that allegation, the board's whole "sexual offender" case was based on a "string of inferences...not supported by any credible evidence," Tegger said. For instance, none of the women testified to feeling "intimidated."
He also echoed Civica's belief that he had been the victim of a grudge: Two of the patients complained only after speaking to the masseuse, who told one of them Civica's "touch was obscene," board documents show.
Tegger agreed with the board that Civica had twice committed "boundary violations" by touching the outside of women's' vaginas in the course of his work. But Tegger essentially concluded that while the Italian chiropractor may be self-absorbed, insensitive and lecherous, his treatment was not intended to arouse his patients or himself.
The board's full-bore pursuit of Civica led to unintended consequences--and heat from the people who held its purse strings.
The board's focus on Civica created a backlog of complaints. So in early 2001, the chiropractic board asked the Legislature to approve a 50 percent fee hike--from $250 to $375 a year--to hire a second investigator. That's when the Oregon Doctors of Chiropractic entered the picture.
Two trade associations represent Oregon chiropractors in Salem. The largest, with about 350 members, is Chiropractic Association of Oregon, a group that is viewed as largely supporting science-based practices and cooperative with the licensing board. The Oregon Doctors of Chiropractic is smaller, with only about 100 members (chiropractors do not have to join either group) but more vocal. Its members believe enthusiastically that Palmer, the grocer, was on to something back in 1895, when he took credit for what seemed a miracle.
When Civica approached ODOC for help, he found kindred spirits like McMinnville's George Siegfried, who sometimes treats patients by inflating small, condom-shaped balloons inside their nostrils, and John Lawton of Salem, who says he can help drug addicts by hooking up wires to their ears and turning on the electricity.
For them, Civica was a case study in how the board wastes their money. Their first line of action was to oppose the proposed fee hike. The group contacted friends in the Legislature, including state Sen. Gary George, who says 12 years ago chiropractic saved him from having to undergo a risky $20,000 back surgery. George, a Republican from Newberg, programmed a speed-dial phone with a recorded message urging Oregon chiropractors to oppose the fee hike. Throughout the fight over fees, Civica's case lurked in the background. State Rep. Tom Butler, who also uses chiropractors, attacked the licensing board from his perch in the budget committee. Alerted to the proposed budget hike, Butler held a hearing in April 2001 that raked the board over the coals. The committee concluded that "we do not want you to spend money in continuing to pursue all these sexual predators," said the Ontario Republican, "unless you can prosecute them."
In the final state budget, the Legislature limited the board to a fee increase of $50, rather than $125.
Civica's case became even more of an issue after the Legislature adjourned. Despite the hearings officer's findings exonerating Civica, the board was reluctant to drop a costly, two-year investigation of a chiropractor who'd generated six complaints in three years.
"That was a well-founded case," says board chair Richard McCarthy.
So in September 2001, the board overruled the hearings officer and proposed to strip Civica of his license, banning him from the profession in Oregon forever.
By the time the board had finished rewriting the hearing officer's findings, the new version was barely recognizable. "It was like the Ducks stomped the Beavers, and then later the Beavers got to decide which touchdowns counted," says Civica's attorney, Thomas McDermott.
In November 2001, another ODOC ally, state Sen. Bill Fisher, asked the board for permission to attend Civica's final hearing. With Fisher in the room, the board backed off its proposed lifetime ban. Instead, it offered Civica seven years' probation, requiring that he undergo counseling and that a chaperone be present for female patients. Also, Civica had to cough up $15,000 for investigative costs.
At that point, Civica says, he could not afford to fight anymore. "Basically they get you by the testicles and there's nothing you can do about it," he told WW.
Many of his patients, who testified to the board that Civica was a caring, trustworthy doctor, were pleased his license was not revoked. But one complainant told WW, "I will never go to another male doctor again. How do you let a creep like that still practice?"
Siegfried says ODOC has no particular sympathy with accused sexual offenders: "We're talking about justice."
The Civica case continued to reverberate in Salem, as ODOC's legislative allies help up confirmation of appointees to the board. In May 2002, Butler suggested in a letter to the Chiropractic Association of Oregon that perhaps the real perverts were on the state board, which he said has an "abnormal fixation with sexual predation in the chiropractic profession."
Even Michael Freeman, a Salem chiropractor with a Ph.D in public health who is a nationally known scientist and expert witness, agrees that the board may be too quick to label complaints as sexual misconduct. Although Freeman works closely with established medicine and has little in common with the members of ODOC, he agrees that the licensing board seems to have it out for members of the group and others who use unconventional techniques.
Civica's attorney, McDermott, specializes in defending people in front of disciplinary boards, such as the Board of Medical Examiners. He says that in legal circles the chiropractic board is "well known as the rogue, out-of-control board."
Indeed, although the board cited the "vaginal adjustment" as evidence against Civica, the patient who complained about it told the board she got better a few days later, board documents show. And contrary to the board's belief, Karen Petzing, an assistant professor at Western States Chiropractic College, told WW that published studies have shown that massaging a certain set of hard-to-reach muscles through the vaginal walls can relieve pressure on the sacrum, the condition from which Civica's patient suffered. When board documents describing the procedure were read to her over the phone, Petzing said Civica's treatment sounded "pretty reasonable."
ODOC believes the board's efforts to regulate the profession with "evidence-based" guidelines will hamper its vast potential to heal people with new techniques like the vaginal adjustment. It also worries that reimbursement policies of managed-care plans are pressuring chiropractors to limit their practices to treating back and neck pain.
Dallas, head of Western States, agrees, in part, but says the group's resistance to regulation could destroy the profession's ability to compete for health-care dollars, as well as research funding. "I think medicine would like to find a way to get us under control and put us in a subordinate role probably equal to or less than a physical therapist," says Dallas.
Given the profession's newfound grasp on legitimacy, Hermiston chiropractor Leslie Feinberg agrees that if a chiropractor is generating a lot of complaints, the board should "err on the side of public safety."
Earlier this month, the battle played out on a gray drizzly morning in Salem, in a hearing room before the state Senate panel that reviews gubernatorial appointments.
While typical appointment hearings last 20 minutes or less, the discussion about the Oregon Chiropractic Board ran two and a half hours, with so many charges and countercharges that state Sen. Ryan Deckert later likened it to an episode of L.A. Law.
That afternoon, the full Senate postponed action on the board's appointments for the second year in a row, meaning two members are serving after their term has expired and three others have no idea whether they suddenly will be replaced. It now seems likely that incoming Gov. Ted Kulongoski will select the appointees next year, and that one or two will be ODOC members.
Last week, in a small office building in Salem, the board licked its wounds at its monthly meeting--and kept processing complaints. They discussed the case of Trev Wheeler, an Oregon chiropractor who has also practiced in Idaho and was recently indicted across the border for sexual abuse of a patient. They considered the case of John Platt, a member of ODOC's legislative committee, and discussed suspending him for "sexual misconduct"--specifically dating a patient for years, starting a decade ago.
As for Civica, his Hallmark life is over. After the board showdown concluded, his wife moved to Saskatchewan, filed for divorce and obtained custody of their three kids.
He now tends to his vastly reduced practice only three days a week, working as a waiter, blacksmith and sculptor to supplement his income. "When a person perseveres through something like this," he says, "it is because they are doing something they love."
HEALTH-CARE Hanky Panky
Complaints of sexual misconduct filed against licensed social workers and health-care providers in Oregon: 1998-2002
Figures were provided by each licensing board. Board of Nursing figure is an estimate based on fiscal-year data.