“There but for the grace of God goes John Bradford,” a 16th-century martyr, upon seeing criminals led to execution. Often used to express empathy or avoid judging others’ misfortunes, it is a recognition that others’ misfortune could be one’s own.
I have heard Dr. Mark Studin say many times, " Would you rather win an argument with your wife, or would you rather not have the argument at all, because even if you win the argument, you still lose?”
When a patient visits a healthcare provider, they have a right to expect a certain level of care. This is known as the standard of care. The standard of care is based on the accepted practices for treating a particular condition. It takes into account the latest research, as well as the experience and expertise of the healthcare provider.
The term standard of care is a legal term and a medical concept. There is no single, universally recognized standard of care document or authoritative reference. The medical concept defines what practitioners should do in practice. The legal term used determines whether a practitioner failed to meet that expectation.
Let’s take a look at the standard of care for the doctor of chiropractic. The goal is to keep the reader from being the one who has the misfortune of what John Bradford observed and felt.
The Chiropractic Standard of Care
What is the standard of care in chiropractic? It refers to the level of care that a reasonably competent chiropractor practicing under similar circumstances would provide to a patient. It determines whether professional obligations to the patient have been met. Let’s take a look at some examples of breaches of the standard of care in the world of chiropractic.
Failure to Diagnose or Refer. Ignoring “red flags” symptoms such as signs of stroke or cervical arterial dissection in progress, fracture, spinal cord compression, cancer, or infection; continuing chiropractic treatment instead of referring patient to emergency care or a medical specialist. Example: A patient reports sudden severe headache, dizziness, slurred speech, and neck pain after manipulation. The chiropractor, you, dismisses the symptoms instead of sending the patient to the ER.
Performing Contraindicated Manipulation. Manipulating the spine when the patient has a condition that makes the chiropractic adjustment unsafe, such a: advanced osteoporosis, unstable fractures, spinal tumors, advanced rheumatoid arthritis, or acute disc herniation with neurological deficits. Example: Performing a high-velocity cervical adjustment on a patient with a known vertebral instability.
Excessive Force During Adjustment. Using unreasonable or overly aggressive causing injury, resulting in possible injuries such as fractures, disc injury, nerve damage or a vascular injury. Example: A chiropractor forcefully manipulates an elderly patient’s spine, causing rib fractures.
Failure to Obtain Informed Consent. Not explaining risks, benefits, alternatives and potential complications. Especially important for cervical manipulations because of the rare but serious risk of arterial injury and stroke. Example: A patient undergoes neck manipulation without being warned about material risks and later suffers complications.
Treating Outside Scope of Practice. Providing treatment or making medical decisions beyond your state’s scope of practice. Example: Advising a patient to stop prescribed heart medication without coordinating with the prescribing physician.
Ignoring Neurological Symptoms. Failing to respond to numbness, weakness, bowel / bladder dysfunction, progressive pain and/or loss of coordination. Example: A patient develops worsening leg weakness suggestive of cauda equina, but the chiropractor continues adjustments.
Poor Record-keeping. Failure to document informed consent, examinations, treatment rationale, patient complaints, or changes in condition. Example: Poor documentation can itself violate standards and also makes defense of care difficult.
Improper Use of Modalities or Equipment. Incorrect use of electric stimulation, traction devices, laser therapy, or ultrasound. Example: Applying electrical stimulation to a patient with a contraindicated implanted device.
Failure to Conduct Adequate Examination. Beginning treatment without medical history, neurological exam, orthopedic testing, and/or imaging when needed. Example: Manipulating the cervical spine without evaluating trauma history after a recent car accident.
Continuing Ineffective Treatment. Providing ongoing treatment despite no improvement, worsening symptoms and need for medical evaluation. Example: Seeing a patient for months for persistent severe pain without recommending imaging or referral.
Common Consequences of Not Meeting the Standard
Now let’s look at common/possible ramifications of a breach of the standard of care:
- Malpractice Liability. A provider may be sued for professional negligence if a patient can prove a duty of care existed, the provider breached the standard of care, the breach caused injury, and damages resulted.
- Compensatory Damages. The courts may award money for medical expenses, lost wages, pain and suffering, permanent disability, and future treatment costs.
- Disciplinary Action by Licensing Boards. Your state licensing boards may impose reprimands, fines, mandatory education, probation, and/or suspension or revocation of licensure.
- Loss of Professional Reputation. Allegations or findings of substandard care can damage patient trust, referral relationships, employment opportunities, and professional standing.
- Insurance Consequences. Malpractice insurers may require risk-management monitoring.
- Employment or Credentialing Issues. Hospitals, clinics, or insurers may terminate contracts, restrict privileges, or remove providers from networks.
- Regulatory or Criminal Consequences. In severe case, involving recklessness, fraud, impairment, or intentional misconduct, providers may face government investigations, civil penalties, and/or criminal charges.
- Patient Harm. The most significant consequence is often injury to the patient, including worsening condition, delayed diagnosis, permanent impairment, and emotional distress.
The standard of care is fundamentally anchored upon the principles of patient safety, clinical competence and the exercise of reasonable clinical judgement.
Standards of care are derived from multiple sources: statutes and regulations such as state laws and licensing boards, professional organizations such as the American Chiropractic Association and the American Medical Association, clinical practice guidelines, case law, and expert witness testimony.
It should be noted that the standard of care is not optimal care. Rather, it is barely acceptable care on one end and the ultimate in care on the other end.
The failure to adhere to a minimum standard of care renders the provider liable for negligence and malpractice. The failure to meet the standard of care is negligence, which can carry significant consequences. The standard of care is relevant in medical malpractice lawsuits.
Negligence occurs when a healthcare provider fails to meet the accepted standard of care, and that failure causes harm to the patient. If a doctor of chiropractic does not meet the standard of care as outlined by their state statues, they are subject to having their license revoked, suspended, limited, or denied.
Specialization and the Standard of Care
The standard of care can be different for a doctor who undertakes to “specialize.” A chiropractic radiologist, chiropractic neurologist, chiropractic internist, chiropractic orthopedist, chiropractic neurologist, or chiropractic sports practitioner will have a greater standard to be judged by their specialty and superiority to a general practice chiropractor.
Stay Current With the Standard of Care
The standard of care is not static; it evolves over time, and what was considered acceptable practice in the past may not meet the standard today. Maintaining current standards of care is critical in healthcare for several reasons: patient safety, quality of treatment, legal protection, professional accountability, improved patient outcomes, trust and credibility, and compliance with laws and regulations. In short, maintaining the current standard protects both the patient and provider.
In conclusion, the standard of care represents the level of judgement, skill and diligence that a reasonably competent doctor of chiropractic would exercise under similar circumstances. It is not defined by perfect outcomes, but whether clinical decisions align with accepted practices. Are you meeting the chiropractic standard of care?
Disclaimer: This document is provided for informational purposes only and does not constitute legal advice. For legal advice, consult your personal attorney
