The Assistant Who Adjusted the Lumbar Spine
Dr. Reed runs a busy two-room office. His chiropractic assistant has six months of on-the-job training and no formal credential. On a Saturday, Dr. Reed is alone and schedules three patients at once. He asks the assistant to place a patient on interferential current, apply ultrasound to the lumbar paraspinals, and do the routine lumbar adjustment on a 28-year-old established patient whose care plan says L1-L5 manipulation three times weekly. Dr. Reed will be in the next room with another patient. The assistant has never adjusted anyone. The patient asks whether the assistant is a doctor. The assistant says, I do everything the doctor does.
1. Which of Dr. Reed's delegated tasks are permissible, and which are not?
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Applying interferential current and ultrasound may be delegable supportive modalities if the assistant has documented training, the chiropractor has evaluated the patient, a written protocol exists, and the Board's supervision rule is met. The lumbar adjustment is not delegable. Spinal manipulation is a core chiropractic act reserved to a licensed chiropractor; the assistant's six months of on-the-job training and lack of credential do not qualify. The assistant also may not diagnose or design the care plan. Dr. Reed must personally perform or directly supervise only those tasks the Board allows; routine does not make an adjustment delegable. The assistant's statement that she does everything the doctor does is misleading and must stop.
2. What supervision and competence requirements apply, and what should Dr. Reed change?
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The assistant must work under the level of supervision the Board requires, generally with the supervising chiropractor on the premises and available for delegated modalities. Dr. Reed should verify the assistant's training for each modality, keep a written delegation list, and ensure the assistant does not see patients independently. Scheduling three patients while alone in two rooms undermines direct supervision. He should reduce overlapping appointments, be physically present during delegated care, and document who performed each service. He should also check whether the assistant needs registration or certification with the Board.
3. How should the office address the patient's question about whether the assistant is a doctor?
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The assistant must not imply she is a chiropractor or physician. She should state her actual title and that Dr. Reed is the treating chiropractor. The office should correct the statement, document the conversation, and train staff on title use and advertising. Misrepresenting credentials can support a Board complaint for unprofessional conduct and may mislead patients about who is performing the adjustment.