DETROIT, Michigan - In an appeal from the Wayne County Circuit Court decision, the Michigan Court of Appeals has ruled in a case of "first impression" that a chiropractic physician did not have a duty to refer a patient to a "qualified medical practitioner" for treatment of an underlying heart problem that eventually resulted in her death. The court also held that a chiropractic physician "did not have a duty to recognize and diagnose" cardiac symptoms, since such conduct would require a chiropractor to undertake a "medical analysis" - specifically a differential diagnosis - and make medical determinations that the licensing stature in Michigan does not permit.
This is a case of "first impression" because these identical issues had not gone up on appeal previously, although there are some prior decisions in Michigan that deal with scope of practice, and the extent to which a chiropractic physician may be required to perform a complete physical examination in order to rule out other medical complications.
On February 3, 1995, Teresa Moore Braford died of myocardial infarction. A wrongful death and medical malpractice action was commenced by her estate against John R. O'Connor,DC, of the O'Connor Chiropractic Clinic in Livonia, Michigan.
The Wayne County Circuit Court trial judge ruled against Dr. O'Connor in motions brought by his attorney to have the case dismissed on the basis that a chiropractic physician did not have a duty to diagnose the decedent's non-chiropractic ailments, or to refer her to a medical doctor.
Teresa Braford first sought chiropractic care at the O'Connor Chiropractic Clinic in April 1994 for recurring headaches and numbness in her arms and hands. Dr. O'Connor diagnosed the pain as related to a cervical spine injury that occurred in 1975. Treatment commenced through the months of April and May 1994.
In July 1994, the patient was seen in the emergency room at Botsford General Hospital in Farmington Hills, Michigan, with symptoms of severe pain. She was released with instructions to consult with her chiropractor and neurologist, but to return if symptoms worsened.
Later that same month, she visited the O'Connor Chiropractic Clinic and told Dr. O'Connor that she had pain in her left chest area and both arms. Dr. O'Connor believed the pain was from her old injury. When he adjusted her back, the pain subsided. She was released from care in September 1994. In February 1995, her husband found her at home slumped on the couch; she was D.O.A. at the hospital. The diagnosis was myocardial infarction.
There were no prior cases exactly on point which set forth the parameters of a "chiropractor's duty to refer his or her own patient to another medical profession." The issue was if Dr. O'Connor had a duty to recognize and diagnose the patient's symptoms as a "medical" rather than a nonchiropractic problem, and whether he also had a duty to refer her to a medical practitioner.
Citing a 1985 scope of chiropractic case, Attorney General v. Benno, the Michigan Court of Appeals found that the dividing line between medicine and chiropractic care was also at issue. The chiropractic physician in that case wanted to conduct a comprehensive medical examination and differential diagnosis. The court strictly construed the Scope of Practice Act in Michigan, finding that the Michigan Public Health Code did not permit chiropractors to perform a differential diagnosis.
In applying Benno, lawyers for the plaintiff's estate urged that Dr. O'Connor should be held liable for "failure to recognize and diagnose Mrs. Braford's nonspinal ailments and refer her to another health care professional." The court held that, presuming all factual allegations pleaded by the plaintiff were true, the plaintiff failed to state a claim on which relief could be granted, Dr. O'Connor did not have a duty to refer her to a qualified medical practitioner for treatment of an underlying heart problem, and Dr. O'Connor did not have a duty to recognize and diagnose her cardiac symptoms. The court went on to state that "such conduct would require a chiropractor to undertake a medical diagnosis - specifically a differential diagnosis - and make medical determinations that the licensing statue does not permit.
The denial of Dr. O'Connor's motion to dismiss by a trial court was thereby reversed in Dr. O'Connor's favor.
John F. Vos, III, Esq.
National Association of Chiropractic Attorneys
Michigan representative
800-967-1234 x 5257
Fax: 248-746-4001
www.chiropractorsattorney.com
email: jvos@s4online.com
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