Delegation of Traction and Electrical Stimulation to an Unlicensed Assistant
Dr. A, an Oklahoma-licensed chiropractor, operates a single-doctor clinic with two unlicensed front-desk staff. The staff member with three years' experience has been asked to perform 'manual cervical traction' and apply electrical stimulation to 12 patients each morning while Dr. A adjusts patients in another room. The assistant has no formal certification. Dr. A reasons that traction and electrical stimulation are 'not adjustments' and that the assistant has watched the procedures many times. One patient, a 58-year-old with hypertension and a recent fall, asks the assistant whether the traction is safe given his neck pain and dizziness. The assistant says, 'It's fine; we do it all the time,' and proceeds. Dr. A is not in the room during the exchange and does not review the patient's history before the assistant begins. The clinic has no written delegation policy or training log.
1. May the unlicensed assistant perform the cervical traction and electrical stimulation? Explain the delegation and supervision limits that apply to an Oklahoma chiropractor.
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No, not as described. The Board's delegation framework lets chiropractors use unlicensed staff for supportive tasks, but the licensed doctor must retain diagnosis, treatment planning, and patient safety. Here the assistant would be applying traction and electrical stimulation to a patient with hypertension, a recent fall, neck pain, and dizziness. Those facts are red flags that require a doctor's history and examination before any modality is chosen. The assistant also gave clinical reassurance ('It's fine'), which is advice outside an unlicensed person's scope and could delay care. Even where a trained assistant may set up a modality, the doctor must be on the premises, available for direct supervision, and must issue a patient-specific order. Dr. A was in another room, had not reviewed the history, and had no written policy or training log. That combination supports a finding of inadequate supervision and unprofessional conduct.
2. What should Dr. A have done before allowing any delegation, and what should be documented?
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Before delegation, Dr. A should: (1) verify the assistant's training and competence for each task; (2) adopt a written delegation policy that lists permitted and prohibited tasks; (3) personally take a history and perform an examination, especially for the 58-year-old with hypertension, fall, and dizziness; (4) obtain informed consent for the modality; (5) write a patient-specific order with parameters; and (6) remain physically present and available for supervision. The record should document the doctor's evaluation, the order, the assistant's training, the modality settings, the patient's response, and any adverse event. The assistant should be instructed not to give safety advice or interpret symptoms; any patient question about risk should go to Dr. A. If the Board's rule requires direct supervision, Dr. A cannot be in another room adjusting other patients while the assistant independently runs the modality.