Introduction

In the summer of 1972, I had the opportunity to audit the practitioner training in order to explore for myself the origins of the rolling process which I had experienced. During that training I came to understand from Dr. Rolf how the dynamics of health were different from the tenants of medical science, a distinction which I have come to loam much more about since then.

As Ida Rolf discussed how she observed health to be an expression of the efficient functioning of an organism in its environment, she repeatedly remarked that Structural Integration was not a medical treatment. I observed my classmates hear her words but remain unclear about their significance in relation to a process which appeared to resolve so many problems often brought to the medical profession.

Only when I began to experience responsibility for my own health and saw what I previously knew as disease or illness to be an expression of a weakness or imbalance in my own efficiency, did I myself begin to appreciate her point. As I learned more about how to maintain my own health, I watched my attitudes toward medicine begin to change.

The following legal opinion is the product of my research into the medical malpractice and licensing laws from this new vantage point. I was curious to learn how the law defined medicine and wondered if there wasn’t room for Ida Rolf’s perspective within the accepted definitions of medical science. The research was sponsored by a unique group of medical doctors and lay practitioners of different holistic health perspectives in the San Francisco Bay Area who were becoming acquainted and beginning to learn from each other’s diverse backgrounds.

The research confirmed historically and legally what Dr. Rolf had helped me to understand in the context of studying how my body was designed to function efficiently. Medicine is a science of pathology and concerns itself with the diagnosis and treatment of disease. The regulation of professional roles relating to the dynamics of health did not seem to be comprehended by the medical statutes and related case law history.

The significance of this observation for Rolfers and Patterners lies in the extent to which it stimulates their thinking about a conceptual framework appropriately suited to their work, yet distinct from the familiar concepts of the medical model. The memorandum says only that the law leaves space for this development. It does not approach this subject, the cultivation of which is no easy task.

Practitioners should consider working with these ideas in the context of licensing, training, liability insurance, medical insurance investigations and payment, office maintenance, referrals to and from physicians and state regulation of their profession. These areas are currently being explored In the San Francisco Bay Area by practitioners of different holistic perspectives in seminar form. Legal standards are simply the codification of commonly accepted conceptual principles. Historically they evolve from the personal relationships between individuals who determine their own standards of relating to one another.

As a consultant in the area of medical malpractice and licensing litigation, I am now learning that a substantial portion of lawsuits and a good deal of public discontent with medicine stem from an unjustified allocation of responsibility for health within the physician patient relationship.

The assumption of responsibility by the individual is essential for the acceptance and success of all holistic health perspectives and in my opinion, this is where the significance of patterning demonstrates its indispensibility. It is on this issue of responsibility that holistic perspectives can be distinguished from medicine for purposes of civil liability and governmental regulation.

MEDICAL MALPRACTICE AND LICENSING LAWS AS THEY RELATE TO HOLISTIC PERSPECTIVES ON HEALTH

The opinions outlined in this report represent the product of research Into medical malpractice and licensing laws conducted for the Holistic Health Council. They are offered as general guidelines for those who may be concerned with these issues. As such they may be helpful in the development of one’s thinking about one’s individual application, but should not be considered as legal advice concerning a specific practice or professional relationship.

For the purposes of this discussion, holistic perspectives are considered to be those disciplines, practices, trainings, or approaches to health which direct attention to the overall health and vitality of the total person as contrasted to a particular illness, disease, or Injury. They include, but are not limited to, some forms of massage, Structural Integration, biofeedback, Gestalt training, dietary awareness, and many posture and movement awareness schools.

The initial research was conducted with two issues In mind, which were responsible for the manner in which my subsequent thinking has developed.

THE ISSUES

1. What risks does a physician assume when employing a holistic practice or when referring a patient to another medical or lay practitioner of a holistic perspective?

2. What risks does a lay practitioner assume when employing holistic practices professionally?

The law prohibits the practice of medicine by those not in possession of a license by criminal penalties. Licensed practitioners in the healing arts (including physicians, chiropractors, podiatrists, optometrists and many others) risk criminal penalties as well as professional discipline for cooperating with or assisting in the unauthorized practice of medicine. The first concept which must be understood for the consideration of both of the issues presented is how the law defines the practice of medicine.

Medicine is quite universally defined as the diagnosis and treatment of an illness, disease, or condition. The states vary on how this concept is expressed and the detail with which it is articulated. However, it was clear that these elements were basic to the definitions. Medicine, then is a science of pathology, and concerns itself in education and practice primarily with the dynamics of disease and illness.

My first observation, then, is that holistic perspectives, by definition, concern themselves with the health and vitality of the individual. Medicine, in its treatment of disease, restores the vitality and health indirectly – just as indirectly, holistic perspectives may alleviate disease or illness by restoring the individual’s health to where it can more sucessfully cope with a threatening influence. Holistic practices, then, need not be seen as the practice of medicine.

But how does this observation relate to the physician who, in his practice, employs holistic practices or refers a patient to a holistic practitioner? Standards of professional responsibility in medicine are determined in civil malpractice proceedings. The courts have developed the concept of the standard of practice to which a physician may be held accountable as that standard of skill, knowledge, and care which the average competent physician possesses. In other words, the standard for civil liability is defined by the actual practices accepted and employed by the medical profession. It changes over time in accordance with the change in medical knowledge and practice. What is important for this purpose is that the standard is by definition self-regulating and does not comprehend scientific or philosophical evidence not actually in practice in the medical community regardless of its veracity. A similar standard, which varies only in degree, not quality, applies to questions of professional discipline in medicine.

Consequently, the licensed physician risks civil liability and professional censure by applying holistic practices which are not accepted medical practice in treating his patients or in referring patients for such purpose. The physician may minimize such risks, however, to the extent that he can establish that the holistic perspective is not engaged in the practice of medicine.

What is suggested here is that physicians may relate professionally to Individuals in ways other than those defined by the limits of medical practice. In doing so, they are not acting as physicians, and care must be taken to express this separation of functions. Medical practice implies professional responsibility for diagnostic and treatment skills beyond there ach of those not possessed of medical training. This justifies the Imposition of civil liability upon the profession. In holistic practices, however, the primary responsiblity for health rests with the individual. In actual practice he is not a “patient under someone’s care.” The practitioner may often be seen as an educator, trainer, or facilitator. Nothing precludes the physician from assuming these roles apart from the practice of medicine. The re allocation of responsibility for health and health care suggested here may be particularly meaningful to the success of any given holistic practice where such success depends upon the knowing assumption of responsibility by the individual receiving attention.

The research and thinking which lies behind this discussion has also prompted a consideration of the means by which the distinctions offered may be documented in working relationships to protect the physician and lay practitioner against the dangers of misinterpretation by others. This subject, which is still in a developmental stage, is beyond the scope of this memorandum. It should be mentioned, however, that the extent to which the distinctions discussed here may protect physicians and practitioners depends upon the degree to which they may be documented in such a way as to apply to a patient at some future time, his personal representatives, or individuals not party to the Initial relationship such as professional disciplinary boards or law enforcement agencies. Although written agreements and correspondence may be helpful for this purpose, their composition should embody the individual aspects of varying relationships and the generalizations discussed herein should not be applied to specific circumstances.

Practitioners of holistic perspectives should avoid thinking of themselves and their clients in terms which derive from the medical model. The tendency to relate to medically defined concepts stems from the fact that medicine is perhaps the only conceptual framework within which we have defined health care relationships. As our understanding of health evolves, however, we need not continue to describe new experience in customary terms. If the distinction that holistic perspectives may be something other than medicine is a meaningful one, it may allow for the articulation of accurate concepts to describe new health perspectives and evolving health care relationships.
Practitioners of holistic perspectives should consider trying to articulate the appropriate conceptual framework within which their work might be understood without regard to concepts defined by the medical model. This is the first step toward securing protection from responsibilities belonging to other fields and the eventual recognition of holistic practices in their own right.Medical Malpractice Laws as They Relate to Holistic Health Perspectives