The Patient's Disclosure About a Colleague
A patient in her 30s tells her chiropractor that her previous chiropractor, Dr. X, treated her while he smelled of alcohol, slurred his words, and once fell asleep during a manual therapy session. She says Dr. X told her 'this stays between us' and that she is afraid to report because he is a family friend. She also discloses that Dr. X prescribed her a muscle relaxer, which she filled at a pharmacy. The current chiropractor has treated her for two visits and has no other evidence. Dr. X is licensed and practices in the same town. The patient asks the chiropractor not to tell anyone. The chiropractor's office is busy and the patient is scheduled for a recheck in two weeks. The chiropractor wonders whether patient confidentiality prevents any report.
1. Does patient confidentiality prevent a report about Dr. X, and what should the chiropractor do?
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Confidentiality does not give the chiropractor discretion to remain silent when a mandatory reporting duty applies. Nebraska requires health care practitioners to report suspected child abuse or neglect, and separate Board and credentialing rules address impaired or unprofessional practice by licensed practitioners. The patient's account of a colleague treating while apparently intoxicated and falling asleep during care is a reportable safety concern, not a private social matter. The chiropractor should explain that she must report the safety concern, make the report to the appropriate Board or DHHS authority, and avoid promising secrecy she cannot keep. She should not investigate Dr. X, confront him, or attempt to verify his blood alcohol level. The patient's fear of retaliation should be documented, and the report should be factual: what the patient said, when, and the limits of the chiropractor's knowledge.
2. What about the disclosure that Dr. X prescribed a muscle relaxer, and how should this be documented?
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That disclosure independently suggests practice outside the chiropractic scope, because Nebraska chiropractors do not prescribe legend drugs. The current chiropractor should include it in the report as a separate concern, but should not assume the prescription was unlawful without more information; the patient may be mistaken about who prescribed it. The note should record the patient's words in quotation marks where possible, the dates or approximate times, the patient's request for confidentiality, the explanation that a report is required, and the fact that a report was made. Avoid conclusory labels such as 'Dr. X is an alcoholic.' Record objective observations and the source of the information. The two-week recheck should not be used as a reason to delay a safety report; the report should be made promptly.