Cervical Adjustment, Dizziness, and a Medication Recommendation

Mississippi chiropractic scope centers on the diagnosis and adjustment of spinal subluxations and the use of adjunctive physical measures. A high-velocity, low-amplitude cervical adjustment is within scope if performed competently and with appropriate screening. So is counseling the patient about lifestyle and referring her to a physician. But Dr. C crossed the line when he told her to cut her lisinopril dose in half. Chiropractors may not prescribe, dispense, or adjust prescription medications; that is the practice of medicine. Even if he had said ‘ask your doctor about your dose,’ he would need to document the advice and the referral. His statement that the adjustment ‘restored nerve flow’ and that medication was ‘masking the real problem’ is both unsupported and misleading. The dizziness and warfarin use are red flags that required further evaluation before manipulation. The Board can discipline for exceeding scope, incompetence, and unprofessional conduct. The lack of prior complaints goes to sanction, not to whether the conduct violated the Act.

Before cervical manipulation, Dr. C owed the patient an informed-consent discussion that included the material risks-especially vertebrobasilar events, fainting, and bleeding risk in a patient on warfarin-and the alternatives, including conservative care and medical evaluation. Consent must be obtained from the patient, documented, and tailored to her history. The standard of care also required a focused history and screening: dizziness with neck rotation, hypertension, and anticoagulation are red flags. At minimum, he should have checked blood pressure, asked about anticoagulants, performed a neurological and vascular screen, and considered deferring manipulation until a physician evaluated her. If he lacked the training to screen, he should have referred. The fall and faint required immediate assessment and documentation. His failure to document the dizziness, the medication advice, and the fall breaches recordkeeping standards and undermines any later claim that he warned her. The Board will likely use the record gap as evidence of incompetence and as an aggravating factor.

The Board should separate the clinical misadventure from the documentation and medication advice. The cervical manipulation itself may be defensible if the Board finds it was within scope and performed with some screening, but the record does not show screening. The medication advice is a clear scope violation and a serious public-health risk. The documentation failures are independent violations and aggravating because they prevent the Board and the patient from reconstructing what happened. In deciding discipline, the Board should consider: no prior discipline in 12 years; the patient’s TIA and hospitalization; Dr. C’s failure to recognize red flags; his misleading explanation of ‘nerve flow’; and his lack of remediation. Likely sanctions include suspension, a period of supervised practice, additional education in cervical screening and recordkeeping, a civil penalty, and restrictions on treating hypertensive or anticoagulated patients until cleared. Revocation is possible but not automatic. The Board should articulate findings on each ground so the decision can survive substantial-evidence review.