The Assistant Who Adjusts Patients
A 38-year-old chiropractor owns a busy clinic and employs an unlicensed chiropractic assistant. When the chiropractor is double-booked, the assistant performs 'manual traction and lumbar adjustments' on established patients, documents the treatment, and tells patients they are 'getting the same adjustment.' The assistant also recommends a 1,200-calorie diet and sells supplements to patients with diabetes. The chiropractor says the assistant has 10 years of experience and 'only does the easy cases.' The clinic bills insurers for the assistant's adjustments under the chiropractor's provider number. A new patient asks whether the assistant is a doctor, and the front desk says, 'She works under the doctor, so it's the same thing.'
1. Which tasks may the assistant perform, and which may not? Explain the delegation limits.
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A chiropractic assistant may perform administrative and supportive tasks, and may perform certain adjunctive procedures only if Board rules permit and the chiropractor provides the required supervision. The assistant may not perform spinal adjustments or manipulation. Adjustment is a licensed chiropractic act that requires a license; ten years of experience does not change that. The assistant also may not independently recommend a 1,200-calorie diet for patients with diabetes or sell supplements as diabetes treatment, because that is medical and nutritional management outside the assistant's authority and potentially outside the chiropractor's scope. The front desk statement that 'it's the same thing' is misleading. The chiropractor should immediately stop the assistant from adjusting, review which tasks are delegable, provide written protocols, and ensure direct supervision where required. The assistant should be trained on scope limits and documentation. The chiropractor remains responsible for all care rendered in the clinic.
2. What are the chiropractor's liability and board-discipline risks, and what corrective steps are required?
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The chiropractor faces board discipline for aiding and abetting unlicensed practice, failing to supervise, allowing false documentation, and submitting claims for services the assistant was not licensed to perform. Billing insurers for the assistant's adjustments under the chiropractor's number can also be insurance fraud and can trigger recoupment or criminal referral. Civil liability is likely if a patient is injured. Corrective steps include stopping the unlicensed activity, auditing the charts and claims for the period involved, refunding or reversing improper charges, notifying the malpractice carrier, and consulting counsel about self-reporting to the Board and insurers. The clinic should adopt written job descriptions, delegation policies, supervision logs, and patient disclosures that identify who is providing care. The chiropractor should document retraining and monitor the assistant. If the Board opens a complaint, cooperation and corrective action may mitigate sanctions, but they do not erase the unlicensed practice.