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Dynamic Chiropractic – October 22, 2001, Vol. 19, Issue 22

Not without a License, You Don't!

By Rodney M. Phelps, JD, DC
One of the most frustrating feelings facing a student about to enter a professional career requiring a license is being almost there, knowing full well that you are competent to answer questions and give well-founded, well-meaning advice on virtually any issues which your academic career has prepared you to give. I faced this at the end of my law school days, as well as when I got into the public clinic at Parker College.

Unfortunately, giving health care advice, let alone adjusting someone, could result in you being accused of "practicing chiropractic without a license," which could, in turn, mean that you might never be able to get your license to practice your chosen profession.

I am serious when I say "give advice," because all it takes to establish the doctor-patient relationship is reliance by the patient on the advice given by the doctor. I am currently working on a malpractice case in which the family doctor never saw the infant, just got the symptoms from the mother over the telephone, and on two separate occasions reassured the mom that the child was merely suffering from a cold, and not to worry. The child had meningitis, is now deaf in one ear, and has significant visual problems and severe learning difficulties. There was reliance on the doctor's advice, and now there is a viable malpractice case.

This means that until the license is in your hand, you cannot tell your brother-in-law what it sounds like he is suffering from and how to treat it; you cannot "playfully" adjust a neighbor who has a crick in her neck.

Do not assume that you are covering yourself by offering a disclaimer that you really can't offer health care advice before you go ahead and examine, diagnose or adjust. If you want to really help someone who is suffering from a physical condition which you believe chiropractic could help, you will refer the person to a chiropractor you know, or have that person call the state or local chiropractic association for a referral.

No one can sympathize more than I with the soon-to-be-doctors who have been encouraged in class and in the clinic to discuss their knowledge of chiropractic and general health care concerns, yet have to remain silent when a friend has a physical condition that has been repeatedly covered in the academic arena.

The point is, your advice and counsel should remain restricted to the academic setting and you should restrict your opinions about the diagnosis and treatment of health problems to purely hypothetical situations, or to situations in which you cannot later be accused of having people rely on your "expertise" to their detriment. The problem is that you risk crossing the line of "practicing chiropractic without a license" as soon as you apply your fledgling knowledge of health care to a real person with real physical symptoms.

Your first taste of the exhilarating feeling of helping people through chiropractic comes in the public clinic of your college, but you are heavily supervised and curtailed in what you can do for a patient. Having visited 20 of the 22 chiropractic colleges in the world, I know that the clinic doctors take great pains to ensure that the examination, diagnosis and treatment of patients is of the very best quality available. One of the reasons all colleges carry malpractice insurance for the public clinics is because everyone makes mistakes, even the clinic doctors.

If you undertake the awesome responsibility of having a person rely on your advice, that malpractice insurance won't cover you outside of the clinic, and a judgment against you based on a civil claim would add considerably to your already high chiropractic college debt load. The plaintiff's attorney would also have to bring in the board of examiners to establish that you weren't licensed at the time of the alleged offense, which would certainly cause the board to reconsider your licensure.

Although NCMIC cannot provide information on just how many claims they get based upon practicing chiropractic without a license (due to privacy laws), I do know that it happens more frequently than you would imagine. This means that if you are practicing without a license, your malpractice insurance won't be in effect at the time of the offense.

Since the fall of 1999, I have handled a half-dozen cases in Texas, Oklahoma and Tennessee in which well-intentioned chiropractic college graduates have started practicing before they had their licenses in hand. Some of the graduates were under the assumption that they needed to get their yellow page ads in place, or to start examining, diagnosing and adjusting patients, only to have delays in receiving their licenses. It all boils down to the fact that they were practicing without a license, and the boards of examiners in their jurisdictions did not take kindly to such a willful flaunting of the prohibition to practice without a license.

In most states, if the examiners are aware of these activities, they can refuse to allow you to take the state exams. If they determine that you have been engaging in the practice of chiropractic after the exams have been taken, they can refuse to give you a license. If you already have your license in hand, they can rescind, suspend or revoke that what you have worked so hard to obtain.

The Bottom Line
  1. Unless you are under the careful supervision of a clinic doctor in a clinic setting, don't try to offer health care advice to those seeking your assistance.

  2. Do not advertise your services before you have your license in hand. You may know a lot about health care, but you still do not know enough to take a potential patient's health concerns into your hands. That's what doctors are paid to do.

  3. Wait until you have passed your state licensure requirements and have your license in hand before you act like a chiropractor.

Rodney Phelps, JD,DC
Dallas, Texas

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