Transferring Patient Care to a Chiropractor?

[Mountain Res-Q]

This was a “scenario” that I recently encountered and I am not sure on the legalities of this… so… I have never transferred patient care to anyone other than to a MD, RN, or Medic (unless it is an AMA). However, legally, could an EMT or Medic transfer care of a 911 patient (ortho issues) to a Chiropractor? I know the circumstances in which this might be presented as a possibility would be nearly impossible to contemplate, but hypothetically….

 

[JPINFV]

I have two very large issues with transfering care of 911 patients to a DC. First, they don't practice emergency medicine (or an emergency related field. For example, straight transfer to surgery for trauma patients or interventional cardiology for AMIs). Second, they lack the training and authority to practice unrestricted medicine like MDs and DOs. If DOs were limited only to osteopathy (like, well, anyone trained outside of the US), then I'd make the exact same argument about transfering patients to osteopaths (again, in contrast to osteopathic physicians).

 

[Akulahawk]

Chiropractors don't have the necessary medical or surgical training (that I'm aware of) to be able to properly care for 911 patients. As JPINFV also noted, they're also not licensed to practice unrestricted medicine.

If the patient chooses to AMA, and they may legally do so, then that's their business. I will NOT, however, transfer care to a Chiropractor. As such, the Chiropractor does not, and will not, receive a patient report from me, verbal or written.

 

[Veneficus]

Even if you could hand off care to one, I would think they are aware enough of their limitations to not accept care of a patient that required EMS.

 

[exodus]

Lol, just wondering, what was this scenarios? hah

 

[wyoskibum]

Depends on your service.....

This was a “scenario” that I recently encountered and I am not sure on the legalities of this… so… I have never transferred patient care to anyone other than to a MD, RN, or Medic (unless it is an AMA). However, legally, could an EMT or Medic transfer care of a 911 patient (ortho issues) to a Chiropractor? I know the circumstances in which this might be presented as a possibility would be nearly impossible to contemplate, but hypothetically….

If you are a 911 response, then you should transport your patients to the ED. It the patient is stable and just needs transport to the doctors office, chiropractor, or a direct admit to ICU, medical unit, then the call should go to an IFT service.

 

[firecoins]

Under what circumstances would you bring a patient to a chiropractor?

If a patient calls 911, they go to the ED. So are you saying the ED has a chiropractor as the primary practioner?

 

[PrincessAnika]

are you referring to a transport? Like bls transport called to p/u pt and take to chiro? if so i would not have an issue with that.....that's not any different than transporting to a nutritionist or a psych appt....kwim?

 

[Mountain Res-Q]

Lol, just wondering, what was this scenarios? hah

LOL... okay, so technically speaking this is not a true 911 Response in an Ambo scenerio. In that type of scenerio I wwould never transport (outside of IFT) to anything short of an ED or LZ. However, here it is....

At the Winter Gig, we have a semi-retired Chiropractor working part time as a heavy equipment operator. He ran his own practice for years and still does occasional shifts in the field, but is well on his way to retirement. On occasion I have patients that are ortho in nature where the best I can do is evaluation and immobilization. At that point, the patient has the option of an Ambo or to sign out AMA and self transport to an ED. However, on a few occassions I have signed out these patients only to have the Chiroprator wander by and offer his services to the patient. Now, I know how that sounds... "WOE!!! Should he be doing that?" Ya, I know, it raises my eyebrows too and I AM NOT handing over care. They sign out and then (once they are not my patient) he "takes over".

Two examples: An employee once took a really bad fall on some ice and was in such bad back pain that he could not even move. He refused care from me since all I would do is board him and transport by ambo. However, he did seek help from Chiropractor (who had adjusted him in the past). okay... not too bad... On the other hand, recently I had a minor with a dislocated finger. I splinted and his Gaurdian was going to transport for reduction a the ED. The Chiropractor witnessed this and wanted to know why I didn't reduce. Lowley EMT, remember? Although I would have done so in the SAR Environment. So the Chiropractor asked the Gaurdian if he could look. They removed my spinting and after feeling around, the Chiropractor pulled everything back into place; and they were greatful.

What makes this interesting, of course, is the legal side of things. Obviously the Chiroprator is taking on some responsibility that might be in poor judgement. I have no liability as I did what I could and then signed them out AMA. The business might have some liabilty because an employee was playing Chiroprator when that is not in his job description (the owners are aware and looking into it). The question that the EMTs were discussing after was whether or not we could legally hand patient care over to a Chiropractor... It was an interesting question that got me thinking...

 

[firecoins]

Thats not transferring care to a chiropractor. If the patient RMSs and let the chiropractor do something, that is there problem.

 

[Mountain Res-Q]

Thats not transferring care to a chiropractor. If the patient RMSs and let the chiropractor do something, that is there problem.

Ya... as I said... I DID NOT transfer care to the Chiropractor... the question was hypothetical as to would it be legal for a Choropractor to dirrectly assume patient care from an EMT (or Medic)?

I, like others, say no. However, I wanted fact based opinions from other sources to solidify my stance.

 

[FDWhitey]

I think the liability for you (or other EMT/Medics) is way too high to even consider it! First, it is a 911 (emergency) patient and a Chiro is not trained to treat an emergency patient. Second, you are transferring the patient to a lower level of training.

I think one of the other issues to consider in the "scenario" would be is this a true 911 emergency... MVA, Fall/Hip fx, Blunt trauma... Or, is this a patient who has an appointment for the Chiro and can't drive due to chronic back pain? In the chronic patient I would recommend them to a local non-emergency transport company.

Whitey

 

[JPINFV]

Second, you are transferring the patient to a lower level of training.

How do you figure that?

 

[CAOX3]

If you want to take responsability as a doctor on scene you can ride in with us, do the paperwork and give the report.

I have never had an instance on scene where someone stated "Im a doctor I want to take responsability for the care of this patient."

 

[JPINFV]

If you want to take responsability as a doctor on scene you can ride in with us, do the paperwork and give the report.

I have never had an instance on scene where someone stated "Im a doctor I want to take responsability for the care of this patient."

You should never see a chiropractor do that since they don't hold legal practice rights to see to the patient's needs.

 

[FDWhitey]

How do you figure that?

I don't believe that a chiro is a higher or same lvl of care as a medic when responding to a true 911 emergency. This is my opinion - no facts to back it. And, I am pretty certian my medical director would hav ea serious issue with it as well, lol!

 

[Mountain Res-Q]

I don't believe that a chiro is a higher or same lvl of care as a medic when responding to a true 911 emergency. This is my opinion - no facts to back it. And, I am pretty certian my medical director would hav ea serious issue with it as well, lol!

ehhh... a Chiropractor 100% has a higher level of medical education than an EMT... but that still doesn't mean that a Chiropractor is higher when it comes to the "EMS Chain of Command", which is where the question comes from... Is it legal to transfer care to one when the medical need is ortho in nature? For that matter, a Dentist has a higher level of medical knowledge than an EMT in his area of practice, doesn't mean I would willingly transfer an MVA patient over to one... that is, unless the cc was molar pain secondary to vehicle rollover... LOL... j/k...

 

[CAOX3]

You should never see a chiropractor do that since they don't hold legal practice rights to see to the patient's needs.

I was speaking in general about MDs

If they want to go flashing their credential and making a scene then they will in fact ride or they will move along, nothing personal.

I have never experienced it.

 

[Akulahawk]

Exactly. In California, there are no provisions for any prehospital provider to transfer care to a Chiropractor while functioning in the prehospital environment. Now then, if I'm simply providing non-medical transport, then my role is basically that of a taxi driver. Once a person becomes a "patient" at the BLS level or higher, then I can only transfer care to certain persons, and a DC is NOT one of them.

In the instances that Mountain Res-Q wrote about, I'd want the patient to formally AMA before the patient decides to seek other care on their own.

 

[FDWhitey]

I have never experienced it but it does pose the question on what to do when responding to an MVA with a patient complaining of neck/back pain... and they insist in transport to chiro only!?! At our next Rescue Lt. meeting I'm going to hit our medical director with it just to get him flustered, lol!