Chiropractic Standard of Care

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Chiropractic Standard of Care

• Leslie M. Wise, D.C.
• Professor of Clinical Sciences
• Sherman College of Straight Chiropractic
• Presented to the Palmetto State Chiropractic
  AssociationAugust 10, 2008

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Standard of Care

• The level at which the average, prudent provider
  in a given community would practice. It is how
  similarly qualified practitioners would have
  managed the patient's care under the same or
  similar circumstances.

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Standard of Care

• The minimal level of competency, knowledge, and
  judgment for which a physician can be held liable
  and legally accountable in tort law.

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Standard of Care

• The standard is determined by the reasonable
  diligence, skill, competence, and prudence as
  practiced by minimally competent practitioners in
  the same area of specialty or general field of
  practice who have similar facilities, services,
  equipment and options available to them.

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Standard of Care

• The standard of care is generally established
  through the testimony of experts.
• Exception res ipse loquitur cases. No expert
  necessary.

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Standard of Care

• Breaching the Standard of Care
  Negligence
• Negligence Injury a significant part of the
  formula for establishing malpractice

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Standard of Care is derived from
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Scope of Practice (law)

• thus location may alter the standard of care

varies from state to state
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What is taught in colleges...

• but CCE tries to insure uniformity

varies from college to college
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What is tested...

• is created by college experts and field
  practitioners, so uniformity is by consensus

on NBCE (and state tests)
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What chiropractors actually practice
How do we know? NBCE Job Survey, 2005
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Case Law
The verdicts in all previous cases set precedence
for standard of care.
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Guidelines and Documents

• CCP Guideline
• Mercy Guidelines
• ICA Clinical Protocols
• State Standard of Care documents

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Standard of Care considerations include
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• Initial Evaluation
• history
• palpation
• range of motion
• leg checks
• instrumentation
• ortho/neuro exams

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• Imaging
• right angle views
• area of complaint (?)
• CT / MRI referral

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• Assessment (clinical impression or diagnosis)
• differential diagnosis
• rule out
• working diagnosis (subject to change)

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• Plan of Care
• appropriate for diagnosis
• individualized for the patient
• includes reassessment and Plan B
• flexible in nature

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• Informed Consent (risk notification)
• explanation of procedures
• alternate procedures
• benefits to be expected
• explanation of material risks
• offer to answer any questions
• notification of freedom to withdraw consent

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• Clinical Procedures
• standard procedures (taught in colleges)
• evidence-based procedures
• notification of experimental procedures
• performed with reasonable skill

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Documentation

• minimum S.O.A.P format
• legible
• dated and signed
• document consent

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Documentation, contd.

• document non-cooperation
• phone call documentation
• outside test results
• concurrent care

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Re-assessment

• do examinations to document progress
• document lack of progress
• change care plan accordingly

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Referral

• discuss referral with patient
• refer to competent providers
• explain concurrent care

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Protection for subluxation-based chiropractors

• Patient education
• Notification of scope limitations
• Cooperation with other providers
• Adherence to a Guidelines document
• http//www.ccp-guidelines.org/guideline-2003.pdf
• http//www.icabestpractices.org

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Questions / Comments
Lwise_at_sherman.edu www.LeslieWiseDC.com
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