The Subpoena, the Sparse Note, and the Derogatory Comment
Dr. M treated a 34-year-old patient for low back pain after a rear-end collision. Over 12 visits, most notes read: 'S: feels better. O: palpation. A: subluxation. P: adjust.' One note adds: 'Patient is annoying and probably drug seeking.' There is no record of informed consent, no initial neurological examination, and no copy of the patient's x-ray report. The patient now has an attorney. The attorney sends a subpoena for the complete chart, and the patient sends a signed authorization, then calls the next day and leaves a voicemail revoking it. The patient also asks to add a one-page statement to the chart saying she never received a treatment plan. The office manager wants to send the entire chart to the attorney because 'a subpoena is a court order' and to delete the drug-seeking line because it is embarrassing.
1. How should the office respond to the subpoena and the patient's voicemail revocation?
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Do not release the chart on the subpoena alone. A subpoena duces tecum is a demand for records, not necessarily a court order, and Minnesota law plus HIPAA require a valid patient authorization or an appropriate court order or protective order before protected health information is disclosed in this setting. The signed authorization initially looked valid, but the patient then revoked it. Even if the revocation was left by voicemail, the office should treat it as notice, stop the release, and ask the patient to confirm the revocation in writing. The office should tell the attorney that release is on hold pending a valid authorization, court order, or qualified protective order. If the attorney obtains a proper order, release only what the order requires after legal review. The manager's belief that 'a subpoena is a court order' is wrong and could result in an unlawful disclosure.
2. What is wrong with the documentation, and how should the derogatory comment be handled?
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The notes are far below an acceptable chiropractic record. They lack a meaningful history, objective findings, neurological screening when indicated, an assessment tied to the findings, a treatment plan, informed consent, response to care, and copies of imaging or reports relied on. A note that says only 'palpation' and 'subluxation' does not show what was measured, what changed, or why continued care was appropriate. The drug-seeking comment is unprofessional and potentially biased; it also becomes part of the legal record. It must not be deleted or rewritten. The correct approach is to preserve the original entry, add a dated and signed addendum explaining the clinical context if there is one, and correct future documentation. Deleting or altering an original note after a records request looks like spoliation and undermines credibility. The office should also review consent and imaging-file practices.
3. How should the patient's request to add a statement to the chart be handled?
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The patient should be allowed to submit a written statement for the record. Under HIPAA-style amendment rules, a provider may deny a requested amendment if the record is accurate and complete, but the patient must be told the reason and permitted to add a statement of disagreement. That statement should be kept with the record and included in future disclosures, or a summary should be provided if the statement is lengthy. The office should not simply paste the patient's statement in as though it were the chiropractor's note, and it should not destroy the original. The request should be logged with the date received and the response. This preserves both the patient's rights and the integrity of the clinical record.