Impaired Colleague, Patient Safety, and the Duty to Report
At 2:15 p.m. a chiropractor arrives at a shared clinic and smells alcohol on the breath of his colleague, who is slurring words and unsteady. The colleague is scheduled to adjust a 78-year-old woman with severe osteoporosis and a recent vertebral compression fracture. The colleague says he had 'two beers at lunch' and asks the chiropractor to 'swap the next two patients' so he can sober up. The chiropractor knows the colleague has had two prior Board complaints and is afraid of ruining his career. He lets the colleague finish the day but watches through the doorway. Two hours later the patient calls to report severe new back pain after her adjustment. The chiropractor wonders whether he must report the colleague and whether patient confidentiality prevents it.
1. What was the chiropractor's immediate duty when he observed the impaired colleague before patient care?
Read the worked answer
The immediate duty is patient protection. An unsteady, slurring chiropractor should not perform adjustments, especially on a 78-year-old with severe osteoporosis and a recent compression fracture, because the risk of harm is foreseeable. The chiropractor should have intervened before the scheduled visit: remove the colleague from patient care, arrange safe transportation, notify the clinic supervisor or coverage, and ensure the patient was seen by an unimpaired provider or rescheduled. 'Watching through the doorway' is not adequate supervision and does not satisfy the duty to act. The colleague's prior complaints increase, not decrease, the need for intervention. Conclusion: the chiropractor should have prevented the treatment rather than merely observing it.
2. Does the chiropractor have a duty to report the colleague to the Board? Does patient confidentiality prevent reporting?
Read the worked answer
Yes, there is a professional duty to report a licensee who is impaired or practicing incompetently and poses a risk to patients. The Board's ethical and regulatory framework is designed to protect the public, and patient confidentiality does not shield information needed for a Board investigation. The chiropractor should report the observed facts, not rumor: the alcohol odor, slurred speech, unsteadiness, the request to swap patients, and the treatment that followed. He may also direct the colleague to an impaired-professional program, but that does not replace the Board report. Waiting until after a patient was harmed is too late. Conclusion: confidentiality is not a barrier; failure to report can itself be unprofessional conduct.
3. After the patient's call reporting severe new back pain, what should the chiropractor do for the patient and for the record?
Read the worked answer
The patient needs prompt clinical evaluation for new severe pain after adjustment, especially given osteoporosis and a compression fracture. The chiropractor should arrange urgent assessment, consider imaging or emergency referral if there are red flags, and communicate with the patient's physician. He should document the call, symptoms, advice, referral, and outcome in the patient's record. The clinic should also preserve the colleague's schedule and treatment records and disclose the adverse event as required. The report to the Board should be updated with the patient's outcome. The chiropractor should not alter or downplay the record. Conclusion: patient care comes first, documentation must be complete and truthful, and the Board report should include the adverse event.