The Minor, the Repeat X-rays, and the Shredded Records

For a minor, consent generally comes from a parent or legal guardian. The mother's signature is a valid starting point for routine chiropractic evaluation and care. Joint legal custody, however, usually means both parents share authority over non-emergency health care decisions. The father should have been informed and, for a course of 14 X-ray series, his agreement or at least documented notice should have been sought. If the parents disagreed, Dr. N should have paused and sought clarification or a court order rather than proceeding on one parent's signature alone.

The X-ray consent is more specific. Full-spine radiographs on a minor involve radiation exposure and should be justified by a clinical question, not by routine scheduling. The consent should identify the reason, the number of views, and the risks. A signed form does not cure a decision that was not clinically indicated.

Dr. N should document who consented, what was explained, and any attempt to notify the father. If the father later objects, the record will show whether Dr. N acted reasonably or simply relied on the mother without inquiry.

No. An office policy cannot override Hawaii retention requirements. Health care providers are generally required to retain records for at least seven years after the last treatment, and records for minors may need to be kept longer because the retention period can extend beyond the age of majority. Destroying records at three years is too short and is especially problematic here because the patient was a minor and the records were recently destroyed.

The patient is now an adult and is entitled to access her own health record. The office should provide a copy, or a summary if the law permits and the patient agrees, within a reasonable time. It may charge a reasonable copying fee, but it cannot withhold records because of an unpaid balance or because the patient asked about X-rays. If part of the record was destroyed, the office should say so in writing, identify what was destroyed and when, and explain the circumstances. It should not reconstruct records from memory and present them as originals.

The destruction also creates a legal-hold problem. Once the patient requested the record, any pending or reasonably anticipated complaint should have stopped destruction. The office should preserve the remaining records and document the destruction policy review.

Repeat full-spine X-rays at each visit to check alignment are not supported by ordinary chiropractic practice. Once a baseline study answers the clinical question, repeat films should be ordered for a new finding, a change in symptoms, or a specific treatment decision, not simply because the patient is returning. Fourteen series in eight months in a minor is a substantial cumulative radiation dose and requires a clear justification for each study.

Informed consent for radiographs should cover why the images are needed, what alternatives exist, and the risks of radiation. For a minor, the discussion should include the parent and, where appropriate, the patient. The record should show the clinical indication and the consent discussion. A generic form signed at the first visit may not cover repeated studies months later.

If the Board reviews this case, it will ask whether the X-rays were clinically indicated, whether the number was excessive, and whether consent was documented. Dr. N should stop routine repeat imaging, review the remaining records, and be prepared to explain each series with objective findings. The patient's question is not an annoyance; it is a legitimate request for the rationale behind her care.