A Minor, a Self-Harm Disclosure, and Supplement Sales

Dr. L. must treat the disclosure as a serious safety issue, not as a chiropractic alignment problem. She should perform or arrange an immediate risk assessment, determine whether the patient is in imminent danger, and refer her to appropriate mental health or emergency services. If the risk is imminent, she should take reasonable steps to protect the patient, including contacting emergency services and informing the parent or guardian. Even if the risk is not imminent, a prompt mental health referral and documented follow-up plan are required. The record should include the disclosure, the assessment, the referral, and the communication with the family. Dr. L. should not promise confidentiality that prevents necessary safety steps, but she should limit disclosure to what is needed. If she has reasonable cause to believe the patient is being abused or neglected, she must follow Massachusetts mandatory-reporting requirements. Telling the patient that adjustments will balance her nervous system is not an adequate response and may delay necessary care.

Advertising must be truthful and not misleading. A claim that chiropractic "cures scoliosis and ADHD" goes beyond the accepted scope of chiropractic practice and is not supported by the kind of evidence the Board would expect. Scoliosis management may include monitoring, exercise, bracing referral, and supportive care, but a cure claim is misleading. ADHD is not a chiropractic condition, and suggesting a cure can cause patients to delay medical or psychological treatment. Selling supplements is not automatically prohibited, but the chiropractor must be able to justify the recommendation, disclose the financial interest, avoid false therapeutic claims, and document the basis for the product. A $300-per-month package sold to a minor after a self-harm disclosure raises particular concerns about pressure and exploitation. The Board may treat the advertising and sales practices as unprofessional conduct, false advertising, or excessive financial exploitation, depending on the evidence.

The file shows parental consent but no evidence that the minor assented to care or that the self-harm disclosure was addressed. The intake form and supplement receipts are not a treatment record. There is no mental health screening, no referral note, no explanation of the supplement recommendation, no informed consent discussion about the limits of chiropractic care for scoliosis, and no documentation of the advice given about self-harm. The Board expects records to identify the patient, history, examination, diagnosis, treatment plan, informed consent, services provided, responses to care, referrals, and any products sold. The absence of these elements makes it difficult to determine what Dr. L. actually did and whether the care was appropriate. Deficient recordkeeping is independently subject to discipline because it impairs continuity of care and the Board's ability to investigate. Dr. L. should not alter the record retroactively; she should provide a truthful supplemental statement if necessary and correct her consent and recordkeeping practices going forward.