Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 188

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.

“Testimony Suggestions”

I received this today from Dr. Owens, who gave testimony where the lawyer attempted to discredit him as a chiropractor. He gave a great answer upon cross-examination with my suggestions that follow.
I just returned from testifying on an auto accident case. Among other things over the near 2 hours of testimony, one of the points the defense attorney kept bringing up was that I was not a “medical doctor” and, therefore, could not make a “medical” diagnosis. (Typical defense when they have nothing else.) Since the patient has a “medical condition,” my opinion was void and it was out of my scope of practice to comment on permanency.  “MDs prescribe medication and do surgery. All you do is manipulate the spine.”  One of the statements that I remember was, “Isn’t it true that as a chiropractor you cannot even give a patient an aspirin?”…Surely designed to test my ability to hold my temper, the jury actually leaned forward, awaiting my response. The place was dead silent. 
How would you handle that?  What would be your response to that line of questioning? After all, you are allowed to defend yourself…This is what I said…
“The difference within the professional licensure in NY (same really for all) in relation to medical doctors and chiropractors is based on treatment, essentially what we are 'allowed to do' under the law. This process targets treatment procedures.  If I had a patient that was in an accident, herniated an intervertebral disc and also presented with a hematoma (which is a bleeding brain), I would refer that patient to the appropriate medical provider who could intervene and “treat” that patien'ts bleeding brain. Let’s not confuse diagnosis with treatment. My chiropractic education, my post graduate education and my responsibility under the law requires me to provide an accurate diagnosis, prognosis and treatment plan. How the patient actually gets treated is irrelevant to permanency; it is there or it is not.  It is a diagnostic situation not a treatment. Therefore, my credentials allow me to make that call just like a medical doctor would.” 
That set the stage for the next 4 times that he brought that up.  "We are talking about diagnosis, not treatment," was my mantra for the rest of the morning.
Chiropractic’s ability to provide an accurate assessment of bodily injury is an important part of what we do and who we are.  Treatment is important, technique is important, but having the ability to recognize conditions that we do not treat is what builds relationships in both the medical and the legal communities. Do you have any other suggestions?
I offered this suggestion for the next time Dr. Owens testifies:
"Chiropractors are primary health care providers in the state of New York, a portal of entry into the healthcare system. If both myself and a primary care provider (MD) were to see a patient immediately post accident, we would both order an immediate MRI and if we both saw an epidural hematoma (bleeding in the brain), assuming the primary health care medical provider knows how to read an MRI, we would both refer the patient immediately to a neurosurgeon. Where the treatment varies has to do with what specialty it is based on. That is why the New York State Department of Education designates primary health care providers and chiropractic is included in this category. Therefore, it is within our scope of practice. If you have an issue with the designation or my scope of practice, take it up with the NY State Department of Education."
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