Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 501
Practice Compliance 37 CA

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

“Malpractice Avoidance”

I was just retained to represent a patient who was injured and is suing a chiropractor for hurting him. Historically, I have turned down every request to be involved at this level, however in this case after listening to the specifics and looking at the documentation I realized this is a classic case of a good doctor being grossly incompetent in accurately treating and reporting at every step.

 
NOTE: I withdrew from the case after 4 days of reviewing all the documentation and facts of the case. Not because the doctor isn’t culpable, but because when I am done with this doctor, I am concerned that he will not be allowed to practice again. I also do not believe that is fair and I do not want to be the cause of destroying someone’s career and life. I also believe the patient is entitled to justice, I just don’t want to be the arbiter. I prefer to spend my time teaching you how to avoid these situations and protect patients from unnecessary injuries based on following a protocol we were all taught in school.

 
First, this doctor used a travel card with cryptic notes, which to me was the “tell” that there would be problems in this case. The patient ended up needing emergency neurosurgery for treatment of a herniated disc that compressed the spinal cord soon after the chiropractic treatment.

 
If the doctor would have done a thorough examination and documented his care accordingly, I would never have taken this case nor be reporting to you. Unfortunately this doctor cut every corner and documented little to nothing.


This doctor treated patient’s lumbar spine for two months with no cervical findings or diagnoses and on the third month the patient came to the office complaining of a cervical problem after going to the gym for a workout on an elliptical bicycle. The chiropractor with absolutely no evaluation of the cervical spine started adjusting the patient’s neck. With no prior history of any problems the patient ended up with surgery 4 days later.

 
In the notes there was no cervical diagnoses, no clinical evaluation of the cervical spine and there were claims to the insurance company with no records of treatment. This is all very problematic.

 
The only defense that doctor can utilize is his notes as this was three years ago. We can never forget that problems don’t come tomorrow, they arrive years from now and all you will have left is what you have memorializing your documentation. Therefore it is incumbent upon you to ensure that years from now you will have an accurate record of what you did today.

 
I also found out the patient reported to the doctor immediately that he felt exquisite pain after the adjustment and the doctor stated that it was normal to feel that and give it time to go away. It didn’t and the doctor never followed up with the patient. Therefore… if the doctor did a complete evaluation, perhaps this could have been avoided. In addition, the MRI performed 2 days post complaint revealed a herniation that appeared to be recent based on the signal intensity.

 
I received the following today:

 
Mark:
 
I wanted to comment on your recent consult "Malpractice Avoidance".  When I first read it I felt sick because I thought if I had never met you I would have done the same things this doctor did.  Instead I made my entire staff read it and sign that they understood it because as patients become more and more familiar with you we are often asked to take short cuts by our patients to save them money or time.  It is important not to take those short cuts because they can risk the patient's health and your license.

I have found that if I repeat to myself throughout the day your mantra of "accurate diagnosis, prognosis and treatment plan" it helps me not to lose track of the need for accurate diagnosis and documentation before treatment.  

Last week a 22 year old patient called to return to care after a 4 year absence.  On the initial phone call she complained of mid back pain.  She denied any new injuries.  When she was told she needed to allow time for a through exam she complained for 5 minutes to my scheduling CA but eventually agreed. Upon our exam we discovered profound upper extremity weakness and reduced reflexes.  Remember no neck pain reported.  A c-spine and T-spine MRI was ordered and it revealed a disc/osteophyte complex that compressed the cord at C4/5.  Of course she consulted a neurosurgeon today. In the past I would have missed this finding and either hurt this patient or she would have been diagnosed by someone else ruining my reputation.

Sine I began your program our reputation in the community has skyrocketed, I now get patients who say I thoroughly checked you out and my doctor says you are the best. In the past 4 months I have gotten referrals from a primary care doctor, an orthopedic surgeon and a neurosurgeon.  That never happened before.  

I wanted to thank you for leading the way to Chiropractic becoming the primary care providers for everything spine.

Don Capoferri, D.C., DAAMLP  


 
 
Respectfully,



Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences

Academy of Chiropractic
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