Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1158
Infrastructure 243 I
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. -Mark Studin 2006
"When do I become a Whistle Blower on other DC's"
Dr Studin: your issue and we talked about this before is similar to other doctors’ issues that we've had now in one of the doctors issues, it is about the lack of ethics, but more importantly the potential poor quality of care being given. Now in the other doctor's situation, he did coverage, he does contract work occasionally and he does coverage because he's just getting his practice started. He went into this other doctor's office and it was a typical, the lawyer tells him what area the MRI. He does almost no evaluation, no reevaluation, virtually no documentation, no triage, no anything. He treats the patient as long as the lawyer tells them to stop, he stops and he's happy cause work keeps suffering. This doctor concerned that his license is on the line, he's being a whistleblower. He's reporting into to the licensure board. He thinks he's a public threat. Now what happened in your case?
Guest Doctor: similar situation work, attorney sent over a patient, worked him up, did everything like we should get the records from the hospital, ER ordered additional MRI, she had some severe symptoms, prior surgery in the brain, so I consulted the neurosurgeon on it. We ordered an upper cervical technique just to make sure the LR and apricot movements were there, had a neuroradiologist read it as well. I went over and spoke with him for about an hour on it. So I've had, an hour with the neurosurgeon and both of us with the neuro radiologist on the phone work in this case up. Things going well. She does have a herniation or a neck, but it's terrible. So I said to her, we may get a second opinion for this just for an epidural, but we're going to watch this and see how it does. she goes to her primary care just to fill her medications that she already had and primary care sees that she was in a car accident and because she tells her and looks up the report that from MRI that I ordered Caesars or herniation in orders in epidural. And so I said, we talked about it but let's kind of wait. Well through the system of health care, they referred her to up, the pain management contacted her and she thought that I ordered it because I told her I would order it. And so she went and had it done. Now her symptoms weren't that bad, but just because based off a report, there was a PA that never contacted me or anything, said she should go and get this done. Well she also told her she could probably get some massage while she went to a massage therapist. She went to it and before that she was in a chiropractor's office and the chiropractor went over to her and saw her and just said, oh, you have a stiff neck. And popped her neck. Is what she told me. If she came in and told me this, I had an injection and I went got my massage and I said, well where did you go get it? Because I needed an order. Well we need specifically done, she said it was a chiropractor's office. So that's what got me questioning. Well what else has been done? Cause she's known him in the past and she goes, well yeah, he comes over and just kind of snaps my neck once in a while just to, and I said, wait a minute, he knows that you weren't involved in an accident. She goes, yeah, I told him. And did you tell him that you were seeing me? And she goes, I did. But he said, it doesn't matter. I'm just going pop the neck you will be okay, here's my question, so the next thing I did, I was mad, but I was just kind of really worked this case up. We're doing a very good job, really good treatment plan. But so I was really upset, but first I requested his records because I wanted to see what's going on first before I start getting into anything here. So that's my dilemma.
Dr Studin: That's the right thing to do. So, the first thing is for coordination of care. You have to have a conversation with the PA in his primary office.
Guest Doctor: I actually did, thank you. I called them, I called her Dr. Edwards, the neurosurgeon I consultant with called as well because they were by the office just to verify the treatment when I was doing.
Dr Studin: So that's been cleaned up. They know better. So in the initial scenario that I discussed with the mill in Florida, whistle blowing is definitively critical because this doctor was actually in there treating patients and he's concerned for his license, and if he doesn't blow the whistle, they might blow back on him and say, well why did you report them? So, but yours is a different scenario. One is about the level of clinical care. So what you're going to do is look at the records. Obviously if there's no evaluation that there's no consideration of outside tests or anything else, then we have to have another conversation. So if there's no evaluation, if there is no mention of MRIs is no mention of anything else that's going on, well then the decision has to be made. You call the doctor and do you just tear him to pieces and tell him if he doesn't listen, you're reporting them to the licensure board or you would ignore him and just go to the licensure board by saying he's practicing out of the scope. For me personally, at this stage with this doctor, I would have a conversation with them. I wouldn't necessarily report them, but I have a very stern conversation and maybe even not you, maybe the neurosurgeon should call him and have that conversation. It puts some ethics in him and let the neurosurgeon say, I'm considering reporting you to the licensure board because you didn't practice where I work with a lot of chiropractors and you don't practice Any standard that I've ever worked with, not from you, but a quote unquote higher authorities. Someone knows better academically and clinically. Or You could just call them and say, I'm a little upset that you took my patient, but I'm more upset that you treated this patient blindly.
Guest Doctor: this is treating them blindly. that's because with a disc herniation from a pretty bad car accident, I have no idea what he's doing. He's twists and what happens if something comes back and she gets hurt and they're looking at me because this person Directional documentation of themselves.
Dr Studin: I would be very concerned. I might even write him, get his records. I might even write them a letter or have you an attorney right of a letter. Why don't you get the records? Let's see what happened. Let's see what he documented. If he documented nothing, then the Dr. Edwards might be best calling him, if he documented nonsense. I mean you're right. If you hurt this person, you're on the line, you're on the hook, you might have to report him to the licensure board just to protect yourself.
Guest Doctor: Yes. That's what I was doing. Cause I don't want somebody to come back and I just going to have my documentation. The bad part is, I feel bad as a patient doesn't know. They get this coordination from other people. And the conversation with the PA, in the past that would be very upset because, she said, why are you going to a chiropractor? all that stuff. But I took it for the opportunities. Now the more I know; I don't exactly educate when I hear somebody bad mouth is because they Don't know. So that was an opportunity to really reach out and talk to the pain Management PA. Plus the pain management doctor called me and apologize and so I said that was perfect, I could have yelled, I didn’t and I just said, hey, I want you to do it. That was the better approach rather than…
Dr Studin: But with this Chiro, it's really about protecting your patient first. You're licensed second. And he's just not practicing at any standard, so you're going to get the records, it's not a bullish, no one answer. So I’m not giving you a recommendation that I want other people to hear because there is no recommendation. It depends upon what he documented. If there's no documentation of any way…
Guest Doctor: it may be a teaching point for me. That's what I'm just trying to do. But the patient is the one that gets hurt.
Dr Studin: the patient can be hurt, number one. But number two, your license also has to be protected, so you don't know what this guy did or didn't do. Let's see what he did or didn't do based upon what he documented. And then we'll have a subsequent conversation. And the three choices are, you call them directly, you report them to the licensure board. You have your attorney write a letter stating, you can't because what are you going to state? I mean, if this patient gets hurt, you're on the hook because you're responsible for what you did with that patient. So when the patient comes back in, I would reevaluate them very thoroughly, just quietly, not making a big deal over to make sure there's nothing new that's popped up since your last evaluation. That's what I would do.