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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 Association August 10, 2008 . Standard of Care.

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Chiropractic Standard of Care

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Chiropractic standard of care

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

Standard of care

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.

Standard of care1

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.

Standard of care2

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.

Standard of care3

Standard of Care

  • The standard of care is generally established through the testimony of experts.

  • Exception: res ipse loquitur cases. No expert necessary.

Standard of care4

Standard of Care

  • Breaching the Standard of Care = Negligence

  • Negligence & Injury = a significant part of the formula for establishing malpractice

Chiropractic standard of care

Standard of Care

is derived from:

Scope of practice law

Scope of Practice (law)

  • thus location may alter the standard of care

varies from state to state

What is taught in colleges

What is taught in colleges...

  • but CCE tries to insure uniformity

varies from college to college

What is tested

What is tested...

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

on NBCE (and state tests)

What chiropractors actually practice

What chiropractors actually practice

How do we know?

NBCE Job Survey, 2005


Case law

Case Law

The verdicts in all previous cases

set precedence for

standard of care.


Guidelines and documents

Guidelines and Documents

  • CCP Guideline

  • Mercy Guidelines

  • ICA Clinical Protocols

  • State Standard of Care documents

Chiropractic standard of care

Standard of Care

considerations include:

Chiropractic standard of care

  • Initial Evaluation

    • history

    • palpation

    • range of motion

    • leg checks

    • instrumentation

    • ortho/neuro exams

Chiropractic standard of care

  • Imaging

    • right angle views

    • area of complaint (?)

    • CT / MRI referral

Chiropractic standard of care

  • Assessment (clinical impression or diagnosis)

    • differential diagnosis

    • rule out

    • working diagnosis (subject to change)

Chiropractic standard of care

  • Plan of Care

    • appropriate for diagnosis

    • individualized for the patient

    • includes reassessment and “Plan B”

    • flexible in nature

Chiropractic standard of care

  • 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

Chiropractic standard of care

  • Clinical Procedures

    • standard procedures (taught in colleges)

    • evidence-based procedures

    • notification of experimental procedures

    • performed with reasonable skill



  • minimum = S.O.A.P format

  • legible

  • dated and signed

  • document consent

Documentation cont d

Documentation, cont’d.

  • document non-cooperation

  • phone call documentation

  • outside test results

  • concurrent care

Re assessment


  • do examinations to document progress

  • document lack of progress

  • change care plan accordingly




  • discuss referral with patient

  • refer to competent providers

  • explain concurrent care


Protection for subluxation based chiropractors

Protection for subluxation-based chiropractors

  • Patient education

  • Notification of scope limitations

  • Cooperation with other providers

  • Adherence to a Guidelines document




Questions comments

Questions / Comments


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