Auditor Generalspecial audit finds broad investigative and governance failures at Arizona Board of Chiropractic Examiners

A special audit presented to the Joint House and Senate Health and Human Services Committee found the Arizona Board of Chiropractic Examiners repeatedly requested information beyond the scope of complaints, handled some criminal allegations inconsistently and maintained weak policies that contributed to long complaint backlogs and open‑meeting lapses.

Lindsay Perry, legislative auditor general, introduced a special-request audit carried out by contractor Sjoberg Evashenk Consulting after a JLAC referral. "We were contracted to conduct the special audit of the Arizona State Board of Chiropractic Examiners," Perry said at the committee hearing. Consultant George Skiles presented the audit findings and told the committee the board has systemic problems in investigative scope, record requests and governance.

The audit examined 215 complaints received during the audit period and reviewed a judgmental sample of 70. The report found the board requested continuing education evidence in 60 of the 70 sample files even when continuing education was not relevant to the allegations, and in 24 of the 70 cases the board requested entire patient records including health histories and billing documents. "The board regularly requested information beyond the scope of the complaint allegations, which is contrary to its statutory authority," Skiles told the panel.

The audit listed seven objective areas and recommended 28 changes overall. Key findings included: - investigatory overreach: standardized subpoenas and templates led to requests for broad patient and practice records without demonstrated relevance to complaint allegations; the audit noted similar problems had appeared in a 2010 sunset review and were not sustained; - inconsistent enforcement: continuing-education and record-keeping requirements were enforced mainly against licensees who were the subject of complaints rather than across the license population, and the board used psychosexual evaluations unevenly; the audit found 13 substantiated boundary/sexual-misconduct allegations in the sample and psychosexual evaluations were ordered in only three of those cases; - failures to report criminal allegations: of 10 complaints the auditors identified as involving possible criminal conduct that had not been otherwise reported, the board reported only one to law enforcement; the auditors said delayed or missing referrals can prevent timely criminal investigations and increase public safety risk; - complaint timeliness: the board reduced its raw backlog from 78 open complaints in 2021 to 54 in April 2024 but, as of May 2024, 69% of open complaints had been unresolved for more than 180 days and high‑priority complaints averaged 551 days to resolve; the auditors detailed cases that took 966 days to reach a revocation; - open‑meeting and records handling problems: interruptions of public commenters, insufficient executive‑session notices, posting incomplete minutes and altering publicly posted recordings (the board had redacted names from audio postings) were cited as failures to follow open‑meeting law and transparency expectations; - conflict‑of‑interest weaknesses: the auditors found missing required disclosure forms, a lack of a special disclosure file and policies that did not require recusal in the manner required by statute.

The auditors recommended the board narrow subpoenas to relevant material, adopt policies for psychosexual evaluation use, report criminal allegations promptly to law enforcement, prioritize and resolve higher‑severity complaints within 180 days, cease using public resources to exhort licensees about legislation and comply fully with open‑meeting and conflict‑of‑interest statutes. "Stop subpoenaing information during investigations that is unrelated to complaint allegations," the auditors urged.

Alyssa Vanderveen, the boardexecutive director, told the committee the board has accepted all but one of the auditrecommendations and has already begun implementing many changes. "We are better, sharper, and refined," Vanderveen said, adding the board had started improving subpoena practices, introduced a licensure portal to collect renewal documentation and hired additional investigators. Vanderveen said the board agreed with most recommendations but will not adopt a fixed 48‑hour rule for reporting alleged criminal wrongdoing; instead the board said it will assess cases individually in consultation with the Attorney Generaloffice.

During committee questions auditors and the board discussed why subpoenas were broadened, how psychosexual evaluations are currently used and who decides to refer criminal allegations to law enforcement. Skiles and the auditors said existing templates and lack of pre‑issuance legal review contributed to overbroad requests. Vanderveen said the boardhas tightened oversight and now involves the assistant attorney general and the executive director to narrow requests and that Thentia licensure automation will help avoid duplicative requests.

Public commenters and counsel for licensees raised concerns about prolonged investigations and the effect on professionals whose cases remained open for years. Tom Marlow, counsel for a chiropractor mentioned during public comment, said some matters could have been resolved sooner if evidence from third parties (for example, U.S. Postal Service records in a separate complaint) had been processed instead of left pending for years.

The auditors reported the board agreed to implement 27 of 28 recommendations; the board told the committee it would implement the remaining recommendation (a strict 48‑hour reporting rule) in a different manner, reserving case‑by‑case discretion when referring criminal allegations. The auditor general's office said it will follow up on the board's progress and issue a report to the committee on implementation in a scheduled summer review.

Why it matters: the audit tied the board's investigative and governance failures to public safety and privacy risks, including longer investigations that may allow unfit practitioners to keep practicing, unnecessary disclosure or retention of sensitive records, inconsistent application of psychosexual evaluations and poor reporting of criminal allegations. The committee was told the problems arise from a combination of weak policies, staff turnover and insufficient internal legal review and controls.

Whathappens next: the audit is public, the board has agreed to most recommendations and the Auditor General's office will perform follow‑up work to track implementation. The committeedid not take a formal vote on the audit itself at this hearing; the auditors said they will return to report on implementation progress later this year.

Ending: the audit mobilized sustained questioning from senators and representatives about subpoena scope, the 180‑day benchmark for complaint resolution, and the board's practice of redacting recordings. The board said it will adopt written policies, train members and staff, and work with the Attorney Generaloffice to strengthen open‑meeting and referral practices. The Auditor General will follow up on the board's progress in coming months.