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Dynamic Chiropractic Canada – September 1, 2009, Vol. 02, Issue 05
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Planes, Trains and Protecting Yourself

Treating Patients Outside Your Office

By Greg N. Dunn, DC

I received a call from a chiropractor a few weeks ago. He was very excited because he had been asked to treat athletes overseas at a series of sporting events.

He was doing due diligence by calling me; he wanted to make sure his professional liability protection would cover him if an allegation of injury arose while working with these athletes.

Some in our profession have developed special skills and advanced expertise. We may be asked to lecture or demonstrate our techniques to groups of chiropractors or other health professionals. Some, as is the case with the chiropractor who called me, have gained advanced knowledge and expertise in the area of sports-injury evaluation and treatment. These chiropractors are often asked to travel with athletes or teams, and/or be present at sporting events. Other chiropractors may volunteer their time at charitable events. There are also times when a chiropractor might be on holiday and be asked for advice and treatment by people impressed with the doctor's credentials and reputation.

With all of these scenarios as contextual backdrop, let's consider the ramifications of treating patients outside of your own office. In my experience, doctors often do not think about the potential legal and professional liability risks they are taking on board in each of the above situations.

Jurisdiction Matters

When treating patients outside of your own clinic, two distinct possibilities govern what you must do to structure yourself administratively and clinically. The first situation is when you are treating patients outside your office, but within the jurisdiction in which you are licensed (and protected either by the Canadian Chiropractic Protective Association or an insurer). The second situation is when you are practicing outside of your office in a jurisdiction in which you are not licensed (or protected by the CCPA or a private insurer).

Within your jurisdiction of licensure: If you are outside your office but within your jurisdiction of licensure, you will still be protected for incidents that may lead to allegations of professional liability. There are no special requirements that need to be met with respect to your regulatory board or to your professional liability provider. The caveat is that you still must maintain the same standards of practice you conform to in your own chiropractic office. You must also practice within the same scope of practice that is mandated by the licensing authority. You must pay close attention to privacy issues as well as the documentation of your treatment encounter.

Informed consent is no different in these situations, either. It must be obtained, and the best way to verify that this has been done is have the patient acknowledge it in writing.

Outside your jurisdiction of licensure: The ramifications are far more complex when you are travelling outside of your jurisdiction of licensure and you wish to provide care, demonstrate techniques at a seminar, etc. There are several possible situations that we encounter in this category. I will attempt to take you through them to give you an idea of what is involved.

If you are invited to travel with a sports team outside your jurisdiction of licensure, the CCPA can protect you when treating members of that team and those travelling with the team in an official capacity. In these cases, you must apply in advance and comply with certain specific guidelines. The two most stringent conditions are that you only treat members of that team and its entourage (all will be presumed to reside within your jurisdiction of licensure).

You must also be officially appointed by the team and will need to have this in writing. The CCPA will then provide you with the necessary documentation and instructions. There are no additional steps to take regarding licensure in the locale you are providing care, as long as you only treat team members and select others as outlined above.

Serving on a Health Care Team

Another very common situation we advise members on is if you are appointed to be part of the health care team at an Olympic Games, Pan Am Games or similar type of athletic event within Canada. In these cases, you would be able to treat any athlete from any country attending the event - with the following provisos: you would have to be officially appointed to the health care team, you would have to apply to the CCPA in advance, you would need to be provided a temporary license in the jurisdiction of the games (usually the organizing committee arranges for this) and you would have to conform to the same standards of care expected of you in your office. You would also have to be aware of and conform to the scope of practice for that specific jurisdiction. These situations are quite common and easily arranged.

More difficult to arrange is the situation in which you are invited to participate outside of Canada as a health care professional at an event, but you are not acting as a team doctor for a Canadian team, nor are you part of the Canadian health care team at the event. This is essentially the same situation faced by the doctor I described in the opening lines of this article. Your Canadian professional liability protection would not be able to protect you in these cases. Also, you would have to have temporary licensure in the jurisdiction where you are treating, find a local provider of professional liability protection, and conform to the standard of practice and the scope of practice in that local.

This is not always possible to do, especially on short notice. The first step to take is ask for the local organizing committee to assist you. A call to the local licensing authority is your next step. If you can clear the licensing hurdles, the chiropractic association in the country you are visiting should be able to give you contact information for local insurers.

Teaching Outside Your Jurisdiction

The most difficult situation to deal with involves chiropractors teaching a technique at a seminar outside of their jurisdiction. As unlikely as it may be, an attendee at a seminar could allege an injury from treatment. (It actually happens more often than you might expect.) So, if you are licensed in Ontario, giving a seminar in Nebraska and you apply your treatment technique to a chiropractor from Missouri who then claims an injury and brings a lawsuit in Nebraska or Missouri, what are the implications for you?

You would face hiring a lawyer out of your own pocket to defend the lawsuit. You might be prosecuted by the Nebraska licensing authority for practicing without a license and possibly fined. You might also have a complaint lodged against you to the College of Chiropractors of Ontario that you would have to defend. What a costly mess! Has this happened? Yes it has!

A Final Scenario

When you are on holidays in another country, have you been asked to treat someone? What do you do in such a situation? If you treat them, you are on your own. You would have no protection, for the same reasons as outlined above. You would not be licensed in that jurisdiction, so you could not be protected.

In some cases, it is easy to provide your professional expertise and treat patients outside of your own office and jurisdiction of licensure. In other cases, it may not be worth the risk and potential catastrophic financial consequences. As with all matters of practice legality and risk, investigate carefully before you make any commitments.

Dr. Greg N. Dunn graduated from Canadian Memorial Chiropractic College in 1976. A past president of the Manitoba Chiropractors' Association and the Canadian Chiropractic Association, he served on the board of the Canadian Chiropractic Protective Association from 1990 until his appointment as chief operating officer of CCPA in September 1999. Dr. Dunn is also a national and international lecturer on the topic of risk and risk management.

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