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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
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
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
Standard of Care

considerations include:

Initial Evaluation
    • history
    • palpation
    • range of motion
    • leg checks
    • instrumentation
    • ortho/neuro exams
    • right angle views
    • area of complaint (?)
    • CT / MRI referral
Assessment (clinical impression or diagnosis)
    • differential diagnosis
    • rule out
    • working diagnosis (subject to change)
Plan of Care
    • appropriate for diagnosis
    • individualized for the patient
    • includes reassessment and “Plan B”
    • flexible in nature
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
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