The Prescription Pad and the Blood Pressure Advice

Missouri’s chiropractic practice act defines chiropractic as the art and science of locating and correcting subluxations and related musculoskeletal conditions; it does not authorize prescribing or dispensing legend drugs. Prednisone and cyclobenzaprine are prescription drugs, so Dr. Alvarez cannot lawfully prescribe them, telephone them to a pharmacy, or dispense them from office stock. The vitamin B12 supply does not change the analysis unless a separate lawful authority applies. Using a prescription pad left by a former physician tenant is worse than a scope problem: it misrepresents who issued the order and can support fraud or unprofessional-conduct allegations. The correct response is to explain the limit, refer the patient to urgent care or her primary care physician for medication evaluation, and document the referral and the reason. If the patient’s radicular findings suggest serious pathology, the referral should be timely, not contingent on scheduling six weeks of adjustments. The Board will look at whether the DC recognized the boundary, protected the patient from delay, and avoided any act implying prescriptive authority.

Telling a patient she can stop lisinopril after an adjustment is outside chiropractic scope and clinically dangerous. Hypertension management requires medical evaluation, and a chiropractor may not direct a patient to discontinue a prescribed antihypertensive. The 158/94 reading is not by itself an emergency, but it is abnormal and must be addressed rather than ignored. Dr. Alvarez should document the reading, ask about symptoms and medication adherence, advise the patient to contact her primary care physician or urgent care for blood pressure management, and avoid any statement that adjustment substitutes for medication. If the patient had chest pain, severe headache, neurologic deficit, or another red flag, he should arrange emergency evaluation. The chart note should reflect the elevated pressure, the advice given, the referral, and the patient’s response. This is both a scope-of-practice issue and an informed-consent/documentation issue. A Board reviewing the case would ask whether the DC practiced within the statutory definition and whether the patient was exposed to foreseeable harm because a nonmedical practitioner gave medication advice.

A work release can be within a chiropractor’s role if it accurately reflects objective findings and the patient’s functional limits, but it must not overstate the DC’s authority or become a disability certification beyond the condition being treated. Dr. Alvarez can document his examination, diagnosis within chiropractic scope, treatment plan, and work restrictions tied to the musculoskeletal problem. He should avoid certifying conditions outside his scope or giving a release that implies he has cleared the patient for all duties if he has not. The Department of Transportation physical is different: a DOT medical examiner’s certificate may be issued only by a clinician listed on the FMCSA National Registry and qualified under that program. Unless Dr. Alvarez holds that separate certification, he cannot issue the DOT certificate or a substitute note saying the patient cannot take the physical. He should explain the distinction, provide a chiropractic work status note if appropriate, and refer the patient to a qualified DOT medical examiner. The chart should show the basis for any restriction and the referral.