The Assistant Who Adjusts
A New Mexico clinic is owned by Dr. R. He employs Marcus, who has 12 years of experience as a 'spinal therapist' but no chiropractic license. Dr. R. trains Marcus to perform 'routine lumbar rotations' when Dr. R. is treating another patient. Marcus writes 'manual therapy' in the office note; Dr. R. signs the note and the clinic bills 98941 under Dr. R.'s NPI. A new patient with acute L5 radiculopathy and progressive weakness is adjusted by Marcus while Dr. R. is in another room. Two days later the patient reports increased numbness and foot drop. The Board receives a complaint. Dr. R. tells the investigator that Marcus only performed mobilization, not a chiropractic adjustment, and that his signature was a routine supervision signature.
1. Is Marcus's conduct the practice of chiropractic under New Mexico law? Does the label 'manual therapy' or 'mobilization' change the analysis?
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The label does not control; the substance of the act does. If Marcus is applying a manual force to a spinal segment to move it beyond its normal range or to correct a subluxation, that is a chiropractic adjustment and falls within the practice of chiropractic. Calling it 'mobilization' or 'manual therapy' does not convert an unlicensed adjustment into a lawful ancillary service. New Mexico law permits chiropractors to delegate certain tasks to trained personnel, but the core chiropractic diagnosis and adjustment must be performed by a licensed chiropractor unless a specific rule authorizes otherwise. Marcus has no license, so his performance of the procedure is unlicensed practice. Dr. R.'s training of Marcus does not create legal authority. The Board would look at what Marcus actually did, not at the note's wording.
2. What is Dr. R.'s responsibility for delegation, supervision, records, and billing?
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Dr. R. remains responsible for the care he supervises and for the clinic's records and claims. He cannot delegate the core chiropractic adjustment to an unlicensed person and then insulate himself with a 'supervision signature.' The record must accurately identify who performed the service, what was done, and the patient's response. A note saying 'manual therapy' when an adjustment was performed is misleading and may be a recordkeeping violation. Billing 98941 under Dr. R.'s NPI when Marcus performed the service is also problematic because the claim represents that the chiropractor provided the service. Dr. R. should correct the record only by adding a truthful addendum, not by altering the original note, and should disclose the delegation arrangement to the Board. He should also review all similar notes and claims and stop the practice immediately.
3. How should the Board treat the patient's foot drop and Dr. R.'s signed note?
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The foot drop and progressive numbness are red flags that required prompt evaluation. The Board would ask whether Dr. R. assessed the patient before and after the procedure, whether he recognized the worsening neurologic signs, and whether he referred the patient for urgent medical evaluation. If Marcus performed the adjustment while Dr. R. was in another room, Dr. R. may have failed to provide adequate supervision and may have breached the standard of care. The signed note is a separate concern because it suggests Dr. R. attested to a service he did not perform or misdescribed what happened. That can support findings of unprofessional conduct, recordkeeping violations, and insurance fraud, in addition to unlicensed practice by Marcus. Patient harm aggravates the disciplinary exposure.