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Practice Issue: Charts Not at All Locations

Different practice situations can place a D.C. at risk for a malpractice allegation or board investigation. Consider what problems can occur when updated charts are not available at all locations.

Sarah Marcourt, D.C., just graduated from chiropractic school when she took a position as an associate with an experienced doctor with two practices in a small Midwestern town. While her short-term goal was to get hands-on experience, she ultimately wanted to grow her patient base and open her own practice.

Dr. Marcourt practiced at both office locations. Sometimes, patient charts were at the other practice location and not immediately available to her. Sarah raised this issue with the hiring doctor. However, she did not follow up to see if it was resolved. She was hesitant to press the issue because she thought if she “made waves,” the doctor would fire her. She would then lose the patient base she had worked diligently to build up.

One day, Dr. Marcourt saw a patient who had received care for carpal tunnel syndrome at the other office location. Before Dr. Marcourt began treating the patient, she noticed the chart was not available, and she expressed her concern about this to the patient. Though Dr. Marcourt treated the patient appropriately, the patient had an unsuccessful outcome. In a situation like this where the patient has an unsuccessful outcome, a disciplinary complaint against both doctors may result.

What Can We Learn?

If Dr. Marcourt believed the lack of availability of the chart precluded her from being able to properly treat the patient, she should have asked the staff to obtain what she needed from the chart. Then, she should have continued to try to resolve this issue for all other patients. She should not have expressed these concerns to the patient.

If there are issues that impact the ability to properly render chiropractic care, the D.C. must raise these issues and follow up to ensure the matters are resolved to everyone’s satisfaction.

There can be no compromise in issues involving patient care. There is no defense for using an X-ray that is non-diagnostic in quality, billing for X-rays not taken (which is fraud), or for compromising on the availability or quality of the records.

In similar cases, doctors have had to defend themselves against disciplinary allegations before their state board. The doctors then have been put in the unpleasant position of having to testify against the practice that employs them about their protocol concerns, as well as deal with any sanctions applied by the board.

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