Academy of Chiropractic’s
Doctors PI Program
From the Desk of:
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“Co-Treating Doctors' Records, Electro-Trauma Patients & Your License”
Yesterday, I got a call from a doctor whose patient leaned against a fence and was electrocuted. After the “shocking” experience (that was so bad at so many levels), the patient experienced neck and back pain, along with headaches, and was rushed to the emergency room. Afterwards, the patient went to the chiropractor’s office and presented with the above symptoms.
The doctor worked up the patient and asked him/her about his/her emergency room experience. He/she responded that an EKG was performed and then he/she was sent home with minimal other care. The chiropractor began treating the patient and now the lawyer wants a report.
In conversation with the DC, I asked what the emergency room records showed and his answer was, “I don’t know, I only asked the patient.” My response was, “Holy CRAP!” It is a licensure standard in every state to pull in the records on your patient’s prior care for a specific condition, especially if understanding the full array of issues you are dealing with is potentially out of your scope.
Independently, I conferred with a neurologist, who is part of the clinical guidelines committee at North Shore/Cornell University Hospital System in New York, and asked him how he would handle this patient. I asked him because knows chiropractic very well, as before he accepted his current position in the teaching institution, we worked together for 10 years. His answer, based upon the information that I gave him, was that this patient needs a VEP (visual evoked potential), as the optic nerve is very long and will give the best evidence of permanent nerve damage. This should be followed by an SSEP (somato-sensory evoked potential), as this will give further evidence of permanent brain damage. Finally, an EMG/NCV should be done to see if any damage was done to the peripheral nerves. He went on to explain that the axons could have been damaged with the electrical current running through the patient’s body, affecting the proprioception of the patient. With the adjustment, the doctor could potentially do damage because the patient might not be able to perceive his/her level of resistance. These tests should be done prior to adjusting the patient to ensure his/her safety.
In addition, I spoke to a board member from the state education department. These departments are the governing bodies for our licenses and the message was clear and consistent across the country. If there are records that exist from another treating doctor or institution your patient has had an encounter with and they can potentially impact your diagnosis, prognosis and treatment plan, it is highly recommended that you gather those records prior to care or you could be exposed to misconduct charges. It is also an educational standard in most, if not all, states that the co-treating doctors send you those records immediately. As a result, if you have not gathered the records, you are exposed to both hurting your patient and losing your license. Will that happen? Probably not, but it does happen and you do not want to be the patient who went to the negligent doctor, nor do you want to be that negligent doctor.
Should a co-treating doctor not be cooperative, simply inform him/her that you will report him/her to the Department of Education in the form of a formal complaint and he/she will have to answer to the licensure board. In every case where I was given a hard time, that language worked like a charm. I was never a winner in that popularity contest, but who cares? I am a chiropractor and I got the records!
As for the lawyers, once you have the records of the co-treating doctors, inform the lawyers that you are in possession of all of the records and upon a formal request, you will include those records in your response, as they are in your files. This will save the lawyers $1000’s in disbursement and is a great service in building the relationship.