Understanding What Leads to Common Malpractice Claims
The most common allegations in chiropractic malpractice claims are related to these three things:
- Failure to properly diagnose a patient’s condition
- Failure to provide or perform proper treatment
- Failure to timely refer the patient for further evaluation
While all patients are unique, there is a common flow in the process of care from the first visit to the last. The first step is to ascertain the patient’s subjective complaints, obtain a thorough patient history, and perform a thorough physical examination and any necessary diagnostic tests. These findings are then reviewed and considered in order arrive at a diagnosis.
Once a diagnosis is reached, treatment options are reviewed with the patient and a treatment plan developed. Once the treatment plan is implemented, the patient is periodically reassessed to evaluate the patient’s progress with treatment. If the patient is not progressing as expected with treatment, the treatment plan is reevaluated. Does the patient have new or different complaints? Does further diagnostic testing need to be performed? Do alternative treatment techniques need to be performed? Should a different diagnosis be considered? Does the patient need to be referred for further evaluation?
The treatment plan is either continued because the patient is progressing as expected, the treatment plan is changed, or the patient referred for further evaluation based upon the reassessment findings. Ultimately, the patient receives appropriate treatment for his/her condition.
If any of these steps are omitted, there is an increased chance of a missed or inaccurate diagnosis and/or inappropriate treatment leading to worsening of the patient’s condition, prolonged pain, the need for additional treatment or surgery, or a catastrophic outcome.
Risk Management Strategies to Avoid Common Malpractice Claims
When it comes to managing risk, proper documentation in the patient’s record is of utmost importance. The record should be an accurate, clear, legible, and a contemporaneous account of your care of the patient. Anyone reading the record should be able to understand your examination and diagnostic test findings, your specific treatment of the patient, your rationale for decisions related to treatment, diagnostic testing, referrals, etc. In the event of a lawsuit, a properly documented patient record will be key in your defense.
Risk Management Strategy #1: Obtain and document the patient’s subjective complaints. Should the patient bring a lawsuit alleging your treatment caused increased pain or disability, your record will show the type and severity of pain and any activity limitations present at the time of initial presentation. Your record may show that the patient presented with the same amount of pain or activity limitations they are alleging were caused by your treatment. Your documentation should include:
- Location of pain
- Onset of pain
- Type of pain
- Severity of pain
- Previous treatment for the presenting complaint (if any)
- Activities limited by pain
- The type of work they do
Risk Management Strategy #2: Perform a thorough history and physical examination prior to implementing treatment. If treatment is provided prior to performing a thorough history and physical examination, you run the risk of providing treatment that may be contraindicated causing injury or worsening of the condition.
Risk Management Strategy #3: Document the results of any diagnostic tests ordered and account for any positive findings. Document the diagnostic test performed or ordered, the reason for ordering the test, who performed the test, and the results of the test. If the test shows positive findings, document your plan to address the positive findings and any changes to your plan of treatment, if any, based upon the positive findings.
Risk Management Strategy #4: Timely refer. If the patient is not progressing as expected, account for other possible etiologies, especially potentially serious conditions. Be aware of “red flags” indicating need for further evaluation or referral. For example, if the patient is exhibiting altered sensations, such as worsening gait or neurological deficits, clonus or footdrop. Timely referrals can help protect the doctor from a lawsuit or help defend a doctor in the event of a lawsuit and can ensure the patient receives appropriate care.
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“OUM” and “OUM Chiropractor Program” do not refer to a legal entity or insurance company but to a program or symbol of a program underwritten, insured, and administered by ProAssurance. The information contained on the OUM Chiropractor Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.
