Romantic relationships in any office setting often don't end well. But when you're a DC, testing those boundaries with patients can have legal implications – even when the relationship is consensual.
Posted in Examiner eNewsletter on Thursday, July 22, 2021
As many people know, sitting at a desk all day can cause any number of aches and pains from bad posture and ill-suited office chairs. That’s why Jennifer Knepp decided to seek regular chiropractic care from a local practice that was recommended by a work colleague experiencing similar issues.
Knepp’s first visit to Riverside Chiropractic in October 2018 went well, and after an assessment by Dr. Philip Walter, Knepp agreed to a course of treatment that would include regular weekly adjustments to help alleviate her work-related issues.
Over the course of several appointments, Knepp and Dr. Walter engaged in a number of conversations about personal matters and noticed they had a lot in common. By November 2018, the professional relationship progressed to one of a more personal nature, including meeting for coffee and having lunch after an appointment. On one occasion, Dr. Walter visited Knepp’s home to drop off a book he had agreed to let her borrow. Matters progressed, and by February 2019, the relationship became sexual.
Complicating matters further was the fact that Dr. Walter was in the middle of a divorce. During a couples’ therapy session with his soon-to-be ex-wife, Dr. Walter confided in his therapist that he was having an affair with a current patient. Because Dr. Walter’s actions were inappropriate for a doctor-patient relationship, his therapist felt that she was in a position to be a mandatory reporter, and reported him to the board for investigation.
In addition to engaging in an inappropriate doctor-patient relationship, the investigation uncovered that Dr. Walter failed to maintain patient files and proper documentation. Dr. Walter treated Knepp during her initial consultation visit in October 2018, continued to treat her throughout the time that their relationship took a personal turn, and did not cease to treat her even after their relationship had turned sexual. He continued to see her as a patient even up until the time of his board investigation. Despite treating Knepp for more than a year by the time the board investigation was launched, Dr. Walter did not maintain records of any treatments or appointments after November 2019, about the time their relationship started to move beyond something strictly professional.
After investigations were complete, the board issued the following sanctions:
- A two-year suspension, with 12 months of that being a stayed suspension (meaning Dr. Walter could still work and treat patients during that period)
- The insured was ordered to complete Center for Personalized Education for Physicians (CPEC) Professional Problem Based Ethics (ProBE) classes on ethics and boundaries.
- He also had to complete an essay examination and achieve satisfactory scores on that essay in order to continue practicing.
- A $10,000 civil fine, to be paid out of pocket.
It’s important to note that while malpractice insurance can cover costs associated with claims, the costs of things like civil fines and coursework are always at the insured’s own (sometimes great) expense.
What Can We Learn?
Set Clear Boundaries
Patients and DCs do develop friendly relationships; conversation and rapport is a completely normal and expected part of the chiropractic profession. But you must set boundaries and make those boundaries clear. Even asking a patient to coffee, or accepting a coffee invitation, can have unwelcome implications. Other things to avoid: seeing patients after hours, outside of the clinic, or visiting a patient at home. If a patient is being overly aggressive or acting inappropriately, the first step is talking to the patient directly and asking them to stop. If the behavior continues, you really have no choice but to refer the patient.
If for any reason something happens to threaten the doctor-patient relationship – and that could mean a patient who is romantically interested in their DC, a DC who is attracted to a patient, or mutual interest in each other – you must refer the patient out. Immediately.
Leaving a paper trail is not only the ethical thing to do, but may also help in the event that an incident becomes a claim. Document treatments, conversations, referrals, timelines. Document, document, document.
If you are questioning your actions and whether or not they are ethical, it may be within your best interest to notify your licensing board. If it then turns into an inquiry, please contact your malpractice carrier to see what, if any coverage may be afforded to assist you.