The Assistant Who Adjusts
A solo chiropractor in a Nebraska town employs a chiropractic assistant with six months of on-the-job training. The doctor is out of state for a family wedding and has left a voicemail approving 'maintenance adjustments' for four established patients with chronic low back pain. The assistant has the treatment rooms set up and the schedule shows 9:00, 9:30, 10:00, and 10:30. The front desk tells callers the assistant is 'certified in chiropractic adjustment' and that 'the doctor supervises by phone.' One patient has new numbness in the saddle area and asks to be seen sooner. The assistant says she can 'do the same adjustment the doctor does.' The clinic's website lists the assistant as 'Dr. [Name], Chiropractic Physician' and advertises a '$39 new-patient adjustment special.' The doctor's license is active. The assistant is not licensed in any health profession.
1. May the assistant perform the scheduled adjustments while the chiropractor is out of state?
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No. A chiropractic adjustment is within the licensed practice of chiropractic, and an unlicensed assistant may not perform it merely because the licensed chiropractor approves by voicemail. Nebraska law permits assistants to perform defined supportive duties under supervision, but the supervisor must actually supervise and the assistant may not practice chiropractic independently. Phone approval from another state is not adequate supervision for a hands-on adjustment, and the assistant's lack of any license makes the plan unlicensed practice. The chiropractor should cancel or reschedule the adjustments and arrange coverage by another licensed chiropractor if patients need care. The assistant may perform only tasks expressly allowed by Board rules and only within the applicable supervision standard. The fact that the patients are established and have chronic pain does not convert the adjustment into a delegated supportive task.
2. How should the clinic handle the patient with new saddle-area numbness, and what problems arise from the website and front-desk statements?
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New saddle numbness is a red flag for cauda equina syndrome and requires urgent medical evaluation; it is not a maintenance adjustment. The assistant should not assess or treat it independently. She should tell the patient that a licensed chiropractor must evaluate the new symptom and that, given the red flag, the patient should seek emergency or same-day medical care. The website and front-desk statements create separate exposure: listing an unlicensed assistant as 'Dr. [Name], Chiropractic Physician' misrepresents licensure, and advertising 'certified in chiropractic adjustment' implies a credential the assistant does not hold. A '$39 new-patient adjustment special' may also raise advertising and fee-splitting issues if it is not accurately described. The chiropractor should correct the representations immediately and document the correction. The disciplinary risk is not only the unauthorized adjustment but also misleading the public about who is licensed.