The 120-Hour 'Spinal Correction Technician'
Dr. A practices in Fargo and employs Kyle, who has no chiropractic license. Kyle completed a 120-hour online 'spinal correction' course and, for the past 14 months, has performed high-velocity, low-amplitude spinal adjustments on about 30 patient visits per month. Kyle also tells patients which 'subluxation levels' are causing their symptoms and signs intake forms as a 'chiropractic technician.' Dr. A is on-site three days a week, reviews 10% of Kyle's charts weekly, and requires patients to sign a consent form that says Kyle works under Dr. A's supervision. Kyle works alone two days a week. A patient files a complaint after Kyle adjusts her neck and she develops severe vertigo. Dr. A tells the Board investigator that delegation is lawful because Kyle is supervised, patients consent, and no one has been harmed before.
1. Is Kyle's activity lawful under North Dakota chiropractic law? Explain the statutory and regulatory reasoning, including whether Dr. A's supervision or the patient consent form changes the analysis.
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No. North Dakota limits chiropractic diagnosis and spinal adjustment to persons who hold a chiropractic license. A technician who completes a 120-hour online course is not licensed, and the Board's rules at most allow unlicensed assistants to perform administrative or supportive tasks-not to diagnose subluxations or deliver high-velocity adjustments.
Supervision does not convert an unlicensed act into a licensed one. The legal question is who performs the restricted act, not who is nearby. A consent form also does not waive licensure; patients cannot consent to treatment by an unlicensed person. Dr. A is therefore likely aiding and abetting unlicensed practice and failing to supervise properly. The fact that no prior patient was harmed is irrelevant: the violation occurs each time Kyle adjusts or diagnoses. The Board may issue a cease-and-desist order, discipline Dr. A, and refer Kyle for unlicensed practice.
2. What immediate steps should Dr. A take to limit patient harm and Board exposure?
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Dr. A should immediately stop Kyle from performing adjustments, diagnosing subluxations, or giving clinical advice. Kyle may be reassigned to administrative duties only, with written notice that clinical tasks are prohibited. Dr. A should preserve all records, audit the 14 months of charts for adverse events and red flags, and contact any patient who may have been harmed. Billing must be reviewed so that services performed by Kyle are not billed as Dr. A's licensed services. Dr. A should self-report to the Board before the investigation expands, cooperate fully, and obtain written delegation and supervision policies. Records must not be altered. Corrective action should be documented, and staff should be trained on scope-of-practice limits.
3. What range of Board actions and collateral consequences is foreseeable, and what process is due?
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The Board can investigate, subpoena records, and hold a contested-case hearing. Possible outcomes include a reprimand, civil fine, probation with monitoring, suspension, or revocation of Dr. A's license, plus a cease-and-desist order against Kyle. Because unlicensed practice is involved, the Board may refer the matter to prosecutors. Collateral consequences include malpractice exposure, insurer audits, and repayment demands.
Due process requires notice of the charges, a meaningful opportunity to respond and present evidence, and an impartial decision-maker. Dr. A should retain counsel, preserve evidence, and avoid ex parte contact with Board members. The Board's authority is remedial and protective, not punitive alone, so demonstrating immediate correction and patient protection can affect the outcome.