chiropractic standard of care leslie m. wise, d.c. professor of clinical sciences sherman college of...
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Chiropractic Standard of CareLeslie M. Wise, D.C.Professor of Clinical SciencesSherman College of Straight Chiropractic
Presented to the Palmetto State Chiropractic AssociationAugust 10, 2008
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 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 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 Care
•The standard of care is generally established through the testimony of experts.
•Exception: res ipse loquitur cases. No expert necessary.
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)
thus location may alter the standard of care
varies from state to
state
What is taught in colleges...
but CCE tries to insure uniformity
varies from college to
college
What is tested...
is created by college experts and field practitioners, so uniformity is by consensus
on NBCE (and state
tests)
Text
What chiropractors actually practice
How do we know?
NBCE Job Survey, 2005
Text
Case Law
The verdicts in all previous casesset precedence forstandard of care.
Guidelines and Documents
•CCP Guideline
•Mercy Guidelines
•ICA Clinical Protocols
•State Standard of Care documents
Standard of Care considerations include:
Initial EvaluationInitial Evaluation
history
palpation
range of motion
leg checks
instrumentation
ortho/neuro exams
ImagingImaging
right angle views
area of complaint (?)
CT / MRI referral
Assessment (clinical Assessment (clinical impression or impression or diagnosis)diagnosis)
differential diagnosis
rule out
working diagnosis (subject to change)
Plan of CarePlan of Care
appropriate for diagnosis
individualized for the patient
includes reassessment and “Plan B”
flexible in nature
Informed Consent (risk Informed Consent (risk notification)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 ProceduresClinical Procedures
standard procedures (taught in colleges)
evidence-based procedures
notification of experimental procedures
performed with reasonable skill
Documentation
•minimum = S.O.A.P format
•legible
•dated and signed
•document consent
Documentation, cont’d.
•document non-cooperation
•phone call documentation
•outside test results
•concurrent care
Text
Re-assessment
•do examinations to document progress•document lack of progress•change care plan accordingly
Text
Referral
•discuss referral with patient•refer to competent providers•explain concurrent care
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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
