Chiropractor's Clinic: Spinal Thrusts, an Unlicensed Aide, and Insurance Billing
Marcus holds an active New Mexico massage therapist license and works two days a week in a chiropractic office. The chiropractor, Dr. Reyes, has begun scheduling "spinal alignment massage" appointments in which Marcus is expected to apply forceful manual traction and rotational thrusts to the cervical spine immediately after the doctor's adjustment. Dr. Reyes also asks Marcus to train the front-desk receptionist, who holds no license, to perform 15-minute chair massages on waiting patients, and to bill those sessions to health insurers using Dr. Reyes's provider number. Marcus is told that because he is an employee, the doctor "carries the liability," and that refusing will cost him the position. A patient with acute neck pain and dizziness after today's adjustment is scheduled next. Marcus depends on this income and has no other offers.
1. Evaluate the "spinal alignment massage" assignment, including the cervical thrusts.
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The assignment exceeds massage scope. Forceful manual traction and rotational thrusts to the cervical spine constitute spinal manipulation, which belongs to the chiropractor's scope, not the massage therapist's. Massage therapists may address soft tissue-muscle, fascia, connective tissue-but not perform high-velocity, low-amplitude thrusts or attempt to reposition vertebrae.
The risk is concrete: cervical manipulation carries a risk of vertebral artery injury, and the described sequence (adjustment followed by forceful thrusts from a non-chiropractor) compounds it. Marcus should decline the thrust component in writing, request a written description of his duties, and offer only soft-tissue work within his scope and training. If Dr. Reyes insists, Marcus should not perform it. Employment pressure does not expand scope, and "the doctor carries the liability" does not transfer the licensee's personal accountability.
2. Identify the problems with the receptionist chair-massage plan and the insurance billing, and state Marcus's obligations.
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There are two separate violations. First, training an unlicensed receptionist to perform chair massage is facilitating unlicensed practice: the receptionist may not perform massage for compensation, and Marcus may not help her do it. Second, billing insurers under Dr. Reyes's provider number for services that are massage-and, for the receptionist's sessions, not provided by a licensed person at all-is billing fraud, regardless of who employs Marcus.
"The doctor carries the liability" is not a defense: licensees are personally accountable for their own conduct and for knowingly aiding improper conduct. Marcus should refuse both requests, put the refusal in writing, keep copies, and decline to sign or submit the claims. He should consider reporting the billing issue to the insurer or a fraud unit, and consult the Board about the unlicensed-practice and scope issues. He may need to leave the position; losing a job is preferable to losing a license.
3. The patient with acute neck pain and dizziness after the adjustment arrives for a session. What should Marcus do?
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Dizziness and acute neck pain after a cervical adjustment are neurologic warning signs, not a routine massage indication. Marcus should not begin massage. He should keep the patient still and supervised, take vitals if trained, and ask about visual changes, numbness, weakness, slurred speech, or difficulty walking. If any neurologic symptom is present, he should call emergency services; otherwise he should arrange urgent medical evaluation.
He should notify Dr. Reyes immediately as the treating provider and document the timeline, symptoms, who was notified, and the transfer of care. The event should go through the clinic's incident-reporting process. Treating the neck to "loosen" it could delay care for a serious event, and a therapist who proceeds because the schedule is full has confused customer service with clinical judgment.