Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 177
“Compliance Alert: How Your Credentials Will Save You”
I usually get the call from a doctor after the lawsuit or the investigation has started, with the frantic plea for guidance about what he/she should do in order to protect his/her license, practice and family. This week was no different, but I also got a call from a doctor who wisely asked me the question before he “pulled his pants down” by rendering a narrative report that could have caused considerable problems.
As chiropractors, we treat within our scope and in virtually every state, we get extensive latitude in what we can treat. The scope of practice in one state closely resembles the scope in most states. “The detection and correction of vertebral subluxation and the effects thereof.“ That allows us to treat spinal vertebral subluxations and everything they cause as sequelae, which we all know can be virtually everything.
This gives us the latitude to care for the chronic, sports injury, trauma, pediatric, geriatric and every other type of case that comes through our doors, and we do. The problem arises when there is a problem or you are the target of a predatory insurance carrier or lawyer.
First and foremost, the rule is to always be the best-of-the-best in caring for your patients and be expert in what you do. That is the surest way to achieve success at the highest level in practice. With that understood, let’s go beyond the given of excellence. First the good, which will be followed by the bad and the ugly.
Yesterday, I received a call from a doctor who cared for a 5 year old, status post car accident, which occurred a few months ago. She is currently asymptomatic. Upon evaluation and x-rays, a 3mm translation at C5 on C6 in forward flexion was revealed and followed by a few months of care. The lawyer wants a detailed narrative on the condition and any residuals and wants it ASAP.
The doctor, who realized he was missing something, called me prior to sending any report and asked how he should document the finding. My answer was "STOP. Do not send anything yet." The first question was, "Did you send this patient to a pediatric orthopaedist?" The answer was no. The next question was, "Did you consult with the pediatrician?" The answer was no. The third question was, "Do you have any credentials in pediatrics?" The answer was no. The fourth question was, "Do you understand the long-term implication of anterolisthesis in flexion of a 5 year old?" The answer was again no.
If I was the defense lawyer, paid to protect the financial interests of the insurance companies and their stockholders, I would take this report that is a public document (it will be entered into evidence) and through interrogatories, ask the above questions. When I got the answers the doctor gave me, I would report this doctor for practicing out of his scope and endangering the health and welfare of a minor to the state licensure board.
I understand the reaction of many saying that this is “bullcrap,” as we do this every day. I have been in your shoes and not too long ago, would have agreed with you. However, put yourself in the position of the state board member who is sworn to protect the public, not you. What would he/she say when the answer came back, "I have no credentials and therefore no training and no referrals. I am totally clueless on the long-term implications?"
You could take the route of doing the "chiropractic 1-step, 2-step bullcrap shuffle" and try to BS your way out of the situation. That is the surest way to lose your license and be exposed to a host of other sanctions, possible never to practice again. The solution for the above doctor is to offer no reports yet. First he needed to refer the patient to a pediatric specialist and in this case chose a neurosurgeon because he has a great local relationship.
Let the medical specialist evaluate the child and certify that the child is in sound health and clear the patient for any future care that may be needed. Is it ideal? No. However, it is the best solution and should close the door behind you and open the door in front if more care is needed.
Now the bad. Another doctor called me last week informing me that an insurance company (accident case) had reported him to the state licensure board for treating a minor while not being a pediatrician. The state is considering taking his license away for 3 years with hefty fines. The complaint contended not that he treated the child, but that the child had a neuromuscular diagnosis, as we all do, and treated without a credentialed doctor evaluating the child for more significant problems that could expose the child to greater issues. The real issue, in my opinion, is that there is a pending case as a result of the accident and the carrier is trying to prevent the doctor’s testimony to win their case. Why else would the carrier report the doctor?
My solution for this doctor, considering he never referred the child for any second opinions and he has no credentials in pediatrics, is to base his defense on his 9 years of previous experience treating children and have his lawyer (already $100,000 in legal fees) work hard to cut a deal. Is it fair? No and yes.
You have to treat within your scope and your expertise. We are no different than the MD’s. All MD’s can do surgery. However, if you are a family practitioner and you choose to do brain surgery and the patient is hurt, although you are technically within your scope, you will lose your license because you are practicing outside of your credentials. You cannot hide behind the notions of "correcting subluxations" or "being a healer." I have heard that crap from too many doctors who have written really big checks or have lost their licenses.
The solution is quite simple. If you treat children, get credentials in pediatrics. That does not necessarily mean you should get a diplomate in pediatrics, but you should take formal courses and use your CV to protect you. Remember, your CV is a legal document that certifies you as expert in any specialty you choose. If you treat sports injuries, trauma cases, geriatrics, etc., get the credentials and protect yourself. In addition, learn more to help more, but the training must be formal post-doctoral credentials certified by a licensure board. Even if your licensure board doesn’t recognize the course for continuing education in your state, as long as some licensure board recognized the course, it is considered a valid credential. Your CV is one of the least understood tools, but it is a powerful practice builder and a powerful shield to protect you from the predators.