March 13, 2020
Coronavirus & Risk Management for the Chiropractor
We have received numerous calls over the past several days from our insureds about situations involving their practices, patients and communities in regards to
. We will attempt to address the most significant issues we are all facing as chiropractors while we tend to the care and healing of our patients.
At ChiroFutures we feel strongly about the role of chiropractic as a staple in supporting the health and well being of the public along with other salutogenic measures to enhance health and well-being.
Our goal is not only to mitigate the malpractice risk to you, your practice and staff but also to assist you in providing a safe and healthy environment for the public to receive your care.
Please know that
of this is meant to add to the fear and panic that is already out there. Our intention is not to scare you. Our intention is for you to understand
risks given the current situation.
We can not and will not tell you how to practice but we can tell you
where the risks are
and then you can make informed decisions about
how much risk you want to take on
Bear with us as this issue has many moving parts and it is nearly impossible to address every issue that will come up.
We offer all of this in the spirit of promoting positive health choices and celebrating healthy lifestyles for your practice members.
You Are Subject to Public Health Laws
First and foremost please understand that as chiropractors we are subject to and must follow all federal and state laws, rules and regulations regarding public health. This is in addition to the chiropractic laws and rules in our states.
Please make sure you understand this distinction in regards to public health law. The expectation is that you are aware of your responsibilities as a licensed health care provider in your state and that you follow these public health regulations.
You should become
familiar with what
has put out in terms of guidelines and requirements for addressing COVID-19.
Staff Training & Education
Please remember that your staff are most likely not licensed health care providers so whatever they say or do is going to come back to you as you are ultimately responsible for everything they say or do in regards to your practice and your practice members.
In that regard you should be sure to educate and train your staff on the current situation and what your office is doing to mitigate any risks to them and your practice members.
You should be having ongoing discussions with your staff on proper sanitation, disinfection, personal hygiene and general awareness in regards to their surroundings, patient situations and keeping a safe office environment. Be sure your staff are provided with specific training on preventing transmission of infectious agents.
Document all this training.
Don't forget HIPAA. Reporting to the media or the public at large about an identifiable patient, or the disclosure to the public or media of specific information about treatment of an identifiable patient generally may not be done without the patient’s written authorization. This only addresses HIPAA. Be aware that more stringent federal and state laws may further limit uses and disclosures of patient identifying information, particularly in the context of infectious disease. Make sure your staff understands HIPAA and Privacy issues in this regard.
In regards to your staff (and practice members for that matter) keep in mind that they may not have the same philosophical orientation toward health and disease that you have. While it is crucial that you educate your community about the role of chiropractic in health and well being, please understand the risk you are placing
in should anyone feel like they are being forced to do something they don't want to do. Your words and actions may not be perceived by everyone the way you intended. And those perceptions could end up resulting in a malpractice accusation or board complaint. Keep in mind that what you are saying to your staff and practice members may be shared with their families and friends who could end up with concerns about what you are telling the community.
Office Procedures & Policy
As the situation and number of people involved grows over the coming weeks, you and your staff may want to consider asking your practice members to let you know ahead of time if they are under the weather and perhaps schedule them for a quieter time during the day.
Perhaps you should consider not seeing a certain practice member in the office if they are expressing symptoms. Perhaps its feasible for you to provide house calls for those that are better off not coming into the office.
Consider eliminating patient penalties for cancellations and missed appointments related to illness.
Please understand that the CDC criteria for managing potential COVID-19 patients is that:
"Mildly ill patients should be encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management".
So if you are going to see "mildly ill" practice members be sure to assess and triage any with acute respiratory symptoms and risk factors for COVID-19. Perhaps triage them over the phone. If they come into the office, consider using Standard Precautions when dealing with them.
If your clinical suspicion is heightened after evaluating them, and they are referred and end up testing positive for COVID-19 - make sure you understand the implications of them having been in your office and your responsibilities in reporting to the health department. This will effect you, your family, your staff, their family, your patients and their families. You get the idea.
Depending on your location, the size of the outbreak in your area and the volume of practice members you see, you may want to consider rotating patient days. For example: seeing pediatric members on different days or different times than the elderly or immunocompromised.
If you have a children's play area you may want to consider removing toys or intensifying your disinfection practices in those areas. Switch to other activities for children to do while they are in the office that minimizes the risk of spread.
Marketing & Social Media
We understand that there are many opinions and perspectives regarding the origins, morbidity and mortality related to the virus. There is also a great deal of data being shared around the internet and social media. Some good and some - not so good.
We are not going to address any of the controversial issues surrounding this. What we stress to you in terms of
risk is that the only data and the only experts that will be relied upon in a suit or complaint against you are those that are considered authoritative in the field of public health such as the WHO, the CDC, the Federal Government and your state public health department.
We encourage our insureds to educate their practice members on the role of chiropractic in health and healing and even its role in supporting a healthy immune system. Just as even the main stream media and health care outlets are encouraging people to remain calm, lower stress levels, get plenty of sleep, supplement with Vitamin D, avoid excess alcohol, reduce sugar consumption, get plenty of exercise and eat healthy foods. All of these, including chiropractic care, are
salutogenic and promote health.
These are all proactive things we can all do to support our health and immune systems.
What we urge you to understand is that promoting chiropractic care for the treatment of
ANY infectious disease
, including one like COVID-19 that is now considered a pandemic, is specifically
outside the chiropractors' scope of practice
. Suggesting or stating in any way, shape or form that chiropractic or chiropractic adjustments will stop COVID-19 or cure someone of it puts
under a great deal of risk. Putting those statements on the internet so a public health authority now has evidence that you made the statement(s) only makes matters worse - and their job of prosecuting you that much easier.
Record-Keeping & Documentation
We reached out to one of our Risk Management experts Kate Rufolo-Dreher DC for guidance in the area of record-keeping and documentation in regards to this situation. Dr. Rufolo-Dreher offered the following:
You should be charting that you are being proactive in protecting and identifying individuals who may present to your practice with possible exposure (and then of course reporting as necessary). In regards to your chart notes she suggested the following as a template:
Patient was questioned with regard to recent travel and exposure to illness including COVID 19. The patient denies recent travel to any current region or country of outbreak nor having been exposed to anyone at risk to their knowledge. The patient denies any of the following: productive cough, non-productive cough, bronchitis, respiratory infection, sore throat, fever, nausea, vomiting, diarrhea, severe fatigue not associated with travel, myalgia and arthralgia.
For those practicing in an area where there are already known exposures the charting might include the following changes:
Upon questioning, the patient denies any of the following: productive cough, non-productive cough, bronchitis, respiratory infection, sore throat, fever, nausea, vomiting, diarrhea, severe fatigue not associated with travel, myalgia and arthralgia. The patient was advised to contact PCP immediately for any change in health status.
She recommends that you actually ask these questions and then document accordingly. For the vast majority of you and your patient population this will at least show that you are charting properly. This is a health care issue and a risk management issue.
In Closing . . .
We understand that there is a great deal of panic, stress and misinformation right now over this issue. Our goal is not to add to that panic, stress and misinformation.
Our goal is to reduce
risk and thereby hopefully reducing risk to your practice members. More importantly our goal is that the public, the government, health care workers and your community view you as a reliable resource for information about their health and the health of the public.
We want what we believe
For everyone to understand the value and unique service that we provide as chiropractors and our role in providing a vitalistic, salutogenic approach to health.
Please do not hesitate to let us know if you have any questions and/or concerns over the coming weeks and months as this situation unfolds.
Yours in Chiropractic
Matthew McCoy DC, MPH
CEO & Co-Founder
Anthony Carrino DC, FICPA
President & Co-Founder