The Rib Adjustment, the Waiver, and the Instagram Post

The adjustment allegation is a boundary and sexual-misconduct issue. The Board will ask whether the contact was clinically necessary, whether Dr. Hale explained it, whether a chaperone was offered, and whether the comment was demeaning and sexualized. A single chart line does not document any of that. The settlement offer is independently serious: offering to waive a bill in exchange for withdrawing a Board complaint can be characterized as obstruction, witness tampering, or an attempt to interfere with the investigative process. The Instagram post raises confidentiality and advertising issues. Posting identifiable before/after x-rays and a patient description without written authorization may violate patient-confidentiality and advertising rules, even if the patient’s name is omitted. The tattoo and the clinical details make her identifiable. Together, the conduct supports allegations of unprofessional conduct, boundary violation, failure to maintain adequate records, and misuse of patient information. The Board may also consider whether the office manager acted at Dr. Hale’s direction or within the practice’s authority.

The Board typically receives the complaint, assigns an investigator, and gathers records and statements. If the evidence supports charges, the Board or its authorized representative files a complaint or notice of charges setting out the alleged violations and the statutes or rules involved. Dr. Hale must receive notice and a meaningful opportunity to respond and to be heard. He may be represented by counsel, present evidence, cross-examine witnesses, and challenge the Board’s evidence. The matter may be resolved by consent order or settlement, or it may proceed to a contested hearing before the Board or an administrative hearing officer, depending on Missouri procedure. The Board’s decision must be supported by the record, and Dr. Hale may seek administrative review and ultimately judicial review. The Board should not decide on ex parte communications or undisclosed evidence. Because the allegations involve sexual misconduct and patient confidentiality, the Board may also consider interim restrictions if patient safety requires them.

He should have explained the rib technique before contact, obtained consent, and offered a chaperone or used a clear drape. He should have avoided personal comments about the patient’s body. The chart should have described the indication for the rib adjustment, the position, the consent, the response, and any objective findings. If photographs were to be used for education or marketing, he needed a separate written authorization that identified the use, explained the risks of disclosure, and allowed revocation. He should not have allowed an office manager to contact a complaining patient about withdrawing the complaint; any communication about the complaint should have gone through counsel or the Board process. Once the complaint was filed, he should have preserved records and avoided social media entirely. These steps would not guarantee a favorable outcome, but they would show respect for boundaries, informed consent, and the regulatory process.