Atlas Subluxation, Hypertension, and Medication Advice

Issue: whether hypertension management and advice to stop a prescription drug fall within chiropractic. Rule: Act 188 defines chiropractic around locating and correcting vertebral subluxations and their effects on the nervous system, plus adjunctive procedures authorized by the Board. It does not authorize prescribing, dispensing, or managing prescription medications, or treating systemic disease such as hypertension. Analysis: Taking a blood pressure reading and noting it is acceptable screening. Telling the patient to stop lisinopril is medical management, not chiropractic. Claiming that an atlas subluxation causes hypertension and that chiropractic 'treats the cause' is an unsupported causal claim outside the statutory scope. The device sale and 12-week schedule do not cure the scope problem. Conclusion: The advice was outside scope. The chiropractor should have referred the patient to his family physician for the elevated blood pressure and confined care to the neuromusculoskeletal complaints.

A compliant plan: record the blood pressure and symptoms; tell the patient the reading is elevated and needs medical evaluation; expressly decline to advise stopping or changing lisinopril; send a same-day referral to the family physician; obtain specific written informed consent for adjustment that discloses risks, alternatives, and the fact that chiropractic is not treatment for hypertension. If selling traction, disclose the price, the chiropractor's financial interest, the return policy, and that the device is optional; avoid pressure. Document the patient's questions and any refusal. Co-management of neck pain is appropriate only with consent to communicate with the physician and with medical clearance if needed. If the blood pressure were severely elevated or the patient had chest pain or neurologic deficits, emergency referral would be required. Conclusion: screening and referral are within scope; medication advice, disease claims, and exploitative sales are not.

The Board would likely investigate practicing outside scope, unprofessional conduct, false or misleading statements, failure to refer, inadequate informed consent, financial exploitation, and recordkeeping deficiencies. Key facts: the exact statements about stopping medication; the chart note; the justification for cervical radiographs; device-sale receipts and disclosures; the consent form; whether the patient was harmed; and whether any referral was made. The Board may rely on expert testimony about the standard of care. Discipline can include reprimand, suspension, revocation, civil penalties, and continuing education. The patient may also pursue malpractice. The reasoning point is that good intentions do not cure a scope violation: a chiropractor cannot convert a medical condition into a chiropractic one by labeling it a subluxation effect.