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Balance scale of treatment and perception

Myofascial Care and Sexual Boundaries—A Case Study

Dr. Jeff Jontas practiced in my hometown. On a cloudy afternoon, he called me for help. He was distraught and related that a local detective had requested his presence at the police station for questioning. Dr. Jontas had been accused of improperly touching a female patient and the incident was being investigated.

The doctor related that the state board of chiropractic examiners was sending a representative to evaluate this accusation.

I was familiar with Dr. Jontas as he had attended one of my ethics, jurisprudence and sexual boundary continuing education courses, and he thought that I might be of assistance to him. He was regarded in our community as a person of integrity and character. He was a member of a respected family of chiropractors who practiced in our state. I agreed to meet with him and his attorney.

Before questioning at the police station, I met Dr. Jontas at his attorney’s office. The attorney conducted the meeting and asked Dr. Jontas to provide a narrative description of his interaction with the patient that led to the accusation of sexual impropriety.

Doctor Recommends Trigger Point Therapy

Dr. Jontas reported that a 37-year-old female named Sue sought his care. He had assessed the patient and provided a diagnosis of pectoralis minor myofascial trigger point syndrome. Dr. Jontas recommended trigger point therapy with the massage therapist employed by his office to be followed by chiropractic care rendered by him. Sue consented to this plan of action, and care was initiated.

On the patient’s third visit, she presented for massage therapy. Unfortunately, the therapist called in sick that day. Aware of the situation, Dr. Jontas offered to provide the trigger point therapy. He recounted that he entered the treatment room and the patient was wearing a gown. He recalled that she was still wearing her pants and bra under the gown as directed. He reported that he was in the treatment room alone with the patient.

In a manner that was typical in his office, Dr. Jontas showed the patient a photograph from a chiropractic textbook that depicted the technique that he would utilize during that visit. In the textbook photograph, a doctor was providing trigger point therapy to the pectoralis minor muscle. The photo depicted a technique to protect women from inadvertent exposure or contact with the breast. The gown was carefully maintained, and the patient’s hands were placed in a position over the breast to avoid any inappropriate contact.

Patient Consents to Technique

After Dr. Jontas showed the technique photo to Sue, she provided verbal consent for him to administer myofascial trigger point therapy and chiropractic adjustment. Dr. Jontas provided care to the patient as described. He emphatically denied touching the patient’s breast. He reported that the massage therapist performed subsequent visits for trigger point therapy. The patient was seen several visits further and reported significant relief. She was released from active care, having reached a therapeutic plateau.

Dr. Jontas related that approximately one month after his last visit with the patient, he received a telephone call from a local city detective requesting his presence at the police station for questioning. Dr. Jontas reported that he agreed to a meeting. He immediately contacted his malpractice carrier.

Upon arriving at the police station, Dr. Jontas was questioned by a detective and a member of the state board of examiners in the presence of his attorney. Following that questioning, I was called into a conference room to meet with the detective and the board representative. I was qualified as a postgraduate instructor, having been approved by our state board of examiners to teach ethics, jurisprudence and sexual boundaries.

Perspectives on Treatment

The detective described the course of events. I was asked to comment on the circumstances of the therapy and the manner with which it was provided. I described trigger point therapy of the pectoralis minor musculature. I indicated that the method of treatment described by Dr. Jontas was reasonable and acceptable as taught at chiropractic colleges.

I provided images from chiropractic textbooks that depicted the therapy delivered to the patient. Several days later, I received a call from Dr. Jontas. He indicated that the photos that I provided were shown to the patient. The patient stated that the care rendered by Dr. Jontas reflected the care depicted in the textbooks. With this realization and testimony, the police decided to drop all charges against Dr. Jontas.

What Can We Learn?

Following this course of events, I contacted the member of the state board who attended those investigatory meetings. We reviewed some of the finer points of the case and the ways in which chiropractors could protect themselves against such accusations of impropriety. We discussed the following means to mitigate accusations of sexual impropriety by Doctors of Chiropractic:

  • Due to the hands-on nature of chiropractic care, at times, with the best intentions, inadvertent contact can be made that is unintended. It is important to discuss with patients in advance, the inherent nature of chiropractic care and physical contact. If inadvertent contact occurs, it is important to acknowledge the contact and apologize directly to the patient.
  • In a perfect world, chiropractors could have a staff member present in examination and treatment rooms when treating patients of the opposite sex. We agreed that many chiropractors do not have the staff or financial means to provide this level of security. If

    patients consent to chiropractic care that is proximal to sexually delicate areas, it might be beneficial to have a staff member present.

  • When providing chiropractic care proximal to sexually delicate areas such as the breast, buttock and groin, doctors may offer to make referrals to colleagues of the same sex to the patient for that care.

  • Chiropractors need to ensure patient comfort. This may include providing them free access to the door so they do not feel trapped. If possible, leave the door ajar.

  • Make a copy of illustrations from chiropractic textbooks for review with the patient and then have the patient sign and date that copied image to confirm consent. Carefully document discussions of diagnostic and therapeutic recommendations and informed consent in the patient file.

Professional Boundaries Guidance

Even DCs with the best intentions can find their motives questioned. Learn about important boundary considerations by going to www.ncmic.com/boundaries.

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