The Assistant Who Adjusted: Delegation, Scope, and Advertising
Dr. M owns a three-room chiropractic office in Dover and splits her week between it and a satellite clinic. To reduce payroll, she directs her chiropractic assistant (CA)-who holds a high-school diploma and an online “spinal decompression certification”-to perform cervical adjustments on established patients when Dr. M is at the other office. The CA also begins offering “trigger-point dry needling” and “IV hydration” and advertises both on the clinic website. A patient receives a cervical adjustment from the CA, develops persistent numbness in the right arm, and complains to the Board. In her response, Dr. M writes that the CA is “certified,” that no Board rule expressly forbids assistants from adjusting, and that the IV service is supervised because she reviews the intake form the next day. The Board investigator requests the CA’s training records, the clinic’s delegation policy, and the advertising copy.
1. Identify the statutory and regulatory problems with Dr. M’s delegation and advertising, and explain why the CA’s “certification” does not cure them.
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Delaware’s chiropractic act limits practice to licensed chiropractors and makes it unlawful to practice, or hold oneself out as practicing, chiropractic without a license. A private certificate-especially an online one-is not a license and cannot expand the statutory scope of practice. Three problems follow.
First, cervical adjustment is a core chiropractic procedure. Delegating it to an unlicensed CA is aiding unlicensed practice and exposes Dr. M to discipline whether or not a rule uses the word “assistant.” Second, dry needling and IV hydration are not within the chiropractic scope defined by the Act and Board rules; they cannot be delegated or billed as chiropractic services. Third, advertising services the clinic cannot lawfully provide is misleading and independently sanctionable.
Dr. M’s “supervision” argument fails: reviewing an intake form the next day is not supervision of a procedure and does not convert an unlicensed person’s act into lawful care. The Board may issue a cease-and-desist order, impose fines, suspend or restrict Dr. M’s license, and refer the matter to other agencies.
2. What should Dr. M have done before allowing any unlicensed staff to participate in patient care, and how should she respond to the investigator now?
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Before any staff member touches a patient, Dr. M should have confirmed the statutory scope, written a delegation policy limited to non-clinical tasks, trained and documented competency, obtained informed consent for any lawful modality, and confirmed that the CA would not perform adjustments, diagnosis, or dry needling.
On receipt of the investigator’s request, she should preserve all records-the CA’s training file, schedules, advertisements, and billing-and not alter them. She should cooperate fully, produce the requested documents, and avoid ex parte contact with the complaining patient. She may retain counsel. In her response, she should separate admitted facts from legal argument, correct the advertising immediately, and propose remediation: retraining, a compliance audit, refunds where appropriate, and a written supervision policy. Candor and prompt corrective action mitigate sanctions; continued insistence that a “certification” authorizes adjustment aggravates them.