Chiropractic Standard of Care

1. 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

2. 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.

3. 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.

4. 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.

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

6. Standard of Care • Breaching the Standard of Care = Negligence • Negligence & Injury = a significant part of the formula for establishing malpractice

7. Standard of Care is derived from:

8. Scope of Practice (law) • thus location may alter the standard of care varies from state to state

9. What is taught in colleges... • but CCE tries to insure uniformity varies from college to college

10. What is tested... • is created by college experts and field practitioners, so uniformity is by consensus on NBCE (and state tests)

11. What chiropractors actually practice How do we know? NBCE Job Survey, 2005 Text

12. Case Law The verdicts in all previous cases set precedence for standard of care. Text

13. Guidelines and Documents • CCP Guideline • Mercy Guidelines • ICA Clinical Protocols • State Standard of Care documents

14. Standard of Care considerations include:

15. Initial Evaluation • history • palpation • range of motion • leg checks • instrumentation • ortho/neuro exams

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

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

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

19. 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

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

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

22. Documentation, cont’d. • document non-cooperation • phone call documentation • outside test results • concurrent care

23. Re-assessment • do examinations to document progress • document lack of progress • change care plan accordingly Text

24. Referral • discuss referral with patient • refer to competent providers • explain concurrent care Text

25. 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 Text

26. Questions / Comments Lwise@sherman.edu www.LeslieWiseDC.com Text