1. Chiropractic Standard of Care Leslie M. Wise, D.C. Professor of Clinical Sciences Sherman College of Straight Chiropractic Presented to the Palmetto State Chiropractic Association August 10, 2008

2. Standard of Care The level at which the average, prudent provider in a given community would practice. It is how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances.

3. Standard of Care The minimal level of competency, knowledge, and judgment for which a physician can be held liable and legally accountable in tort law.

4. Standard of Care The standard is determined by the reasonable diligence, skill, competence, and prudence as practiced by minimally competent practitioners in the same area of specialty or general field of practice who have similar facilities, services, equipment and options available to them.

5. Standard of Care The standard of care is generally established through the testimony of experts. Exception: res ipse loquitur cases. No expert necessary.

6. Standard of Care Breaching the Standard of Care = Negligence Negligence & Injury = a significant part of the formula for establishing malpractice

7. Standard of Care is derived from:

8. Scope of Practice (law) thus location may alter the standard of care varies from state to state

9. What is taught in colleges... but CCE tries to insure uniformity varies from college to college

10. What is tested... is created by college experts and field practitioners, so uniformity is by consensus on NBCE (and state tests)

11. Text What chiropractors actually practice How do we know? NBCE Job Survey, 2005

12. Text Case Law The verdicts in all previous cases set precedence for standard of care.

13. Guidelines and Documents CCP Guideline Mercy Guidelines ICA Clinical Protocols State Standard of Care documents

14. Standard of Care considerations include:

15. Initial Evaluation history palpation range of motion leg checks instrumentation ortho/neuro exams

16. Imaging right angle views area of complaint (?) CT / MRI referral

17. Assessment (clinical impression or diagnosis) differential diagnosis rule out working diagnosis (subject to change)

18. Plan of Care appropriate for diagnosis individualized for the patient includes reassessment and “Plan B” flexible in nature

19. Informed Consent (risk notification) explanation of procedures alternate procedures benefits to be expected explanation of material risks offer to answer any questions notification of freedom to withdraw consent

20. Clinical Procedures standard procedures (taught in colleges) evidence-based procedures notification of experimental procedures performed with reasonable skill

21. Documentation minimum = S.O.A.P format legible dated and signed document consent

22. Documentation, cont’d. document non-cooperation phone call documentation outside test results concurrent care

23. Text Re-assessment do examinations to document progress document lack of progress change care plan accordingly

24. Text Referral discuss referral with patient refer to competent providers explain concurrent care

25. Text Protection for subluxation-based chiropractors Patient education Notification of scope limitations Cooperation with other providers Adherence to a Guidelines document http://www.ccp-guidelines.org/guideline-2003.pdf http://www.icabestpractices.org

26. Text Questions / Comments Lwise@sherman.edu www.LeslieWiseDC.com