The Lapsed License, the Assistant, and the Backdated Certificates
Dr. L has held a Hawaii chiropractic license since 2015. Her license expired on June 30, 2024. The renewal notice went to an old address, and she did not complete the required continuing education. She continued treating patients for seven weeks, including performing 14 adjustments and signing two disability certificates. During that period, she also allowed her unlicensed chiropractic assistant to perform spinal screenings at a health fair and to give a quick adjustment to a coworker who complained of neck pain. The assistant had completed a weekend course and used the title chiropractic technician. Dr. L now wants to renew, pay a late fee, and backdate the two disability certificates so the patients do not lose benefits. She asks whether she can keep seeing patients while the renewal is pending.
1. What are the consequences of practicing on an expired license, and can Dr. L backdate the disability certificates?
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Practicing on an expired license is unlicensed practice. Hawaii does not treat a late renewal notice as a grace period. Each of the 14 adjustments and each certificate signed during the seven weeks was an encounter without current licensure authority, even if Dr. L believed her renewal was pending. That exposure is separate from the lapsed CE requirement and can support Board discipline under HRS chapter 436B.
Backdating the certificates would make the problem worse. A disability certificate is a representation of the date the provider examined or treated the patient and formed the opinion. Changing the date to preserve benefits is falsification, regardless of the motive. If the patients need benefits, Dr. L can issue new, accurately dated certificates only if she has a current basis to do so; she should not pretend the earlier signatures occurred on a licensed date.
She must stop seeing patients immediately, complete the CE, and apply for reactivation or reinstatement as the Board requires. She should disclose the expired practice and the assistant's adjustment in her application or in a separate written statement, because the Board will likely discover it through the complaint or audit.
2. Was the assistant's conduct permissible? Explain what unlicensed staff may and may not do.
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The spinal screening may be permissible only within narrow limits: no diagnosis, no treatment recommendation, no charge for a professional service, and clear disclosure that the assistant is not a chiropractor. A health-fair screening that merely measures posture or range of motion and refers abnormalities can be delegated if the chiropractor establishes written protocols and supervises it. The quick adjustment is different. An adjustment of the cervical spine is the core chiropractic act; an unlicensed assistant cannot perform it, even on a coworker, even with a weekend certificate, and even if the assistant calls it a technician service.
The title chiropractic technician is also risky if it implies licensure or independent practice. Hawaii does not license chiropractic technicians as independent adjusters. The chiropractor remains responsible for delegation and for the acts of staff within the practice. Allowing an assistant to adjust supports a charge of aiding unlicensed practice and failing to supervise.
Dr. L should immediately stop the assistant from any hands-on treatment, review the assistant's job description, document retraining, and ensure future screenings are limited to non-diagnostic tasks under direct supervision.
3. What steps should Dr. L take to return to lawful practice?
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First, she must stop patient care. A pending renewal does not authorize treatment. Second, she should complete the required continuing education, including any ethics or jurisprudence hours the Board requires, and retain certificates. Third, she should submit the correct reactivation or reinstatement application with all fees and a truthful explanation of the expired practice. If the Board requires a appearance or additional examination, she should comply.
Fourth, she should correct the record trail: preserve the two disability certificates as they are, do not alter them, and prepare a written chronology of the seven weeks and the assistant's adjustment. Fifth, she should notify her malpractice carrier and consider counsel before submitting the explanation. Sixth, she should audit the office for other unlicensed tasks and put delegation rules in writing.
Finally, she should not treat the late fee as the only issue. The Board can discipline even after renewal if it finds unlicensed practice, falsification, or inadequate supervision. Voluntary disclosure and corrective action may mitigate but will not erase the earlier conduct.