About that Broken Rib . . .
It’s prime time Wednesday afternoon in your office and you can hear the buzz of practice members from the waiting room. Al, who has been a loyal practice member for several years, is in for his monthly spinal check-up. You started taking care of Al following a stroke he had at 78 years of age and he came in asking if there was anything you could do to help him as everyone else had told him he was “as good as he’s gonna get”.
You explained the chiropractic story, he decided to give it a shot and he’s been coming in ever since. He believes chiropractic has improved his quality of life, his sleep and his movement. His wife, who is also a practice member, agrees.
As you are checking and adjusting him you catch up on the latest about their kids and grandkids (they are all practice members too). There is nothing out of the ordinary today but when you adjust Al’s 4th dorsal you feel and hear a loud “pop” and a “snap” that doesn’t seem right. Al knows it too and has some difficulty taking in a deep breath.
You take him back for some x-rays and sure enough there it is: a non-displaced fracture of the 4th rib on the right. You show it to Al and his wife and send him to the orthopedist you have a good relationship with for evaluation and tell Al to come back later in the week.
That night you start wondering if Al is going to sue you. No way, you think. Heck, he and his wife even bring you and your office staff cakes and pies on a regular basis and your office visits with him and the rest of the family always end with hugs.
You contact your malpractice insurer either way the next morning and tell them what happened and they tell you to just sit tight. Your orthopedic colleague calls you that afternoon and tells you about his visit with Al. He recommended rest and offered Al pain meds and a brace but Al didn’t see the point. The ortho says he should be fine in 6 weeks or so.
Al shows up for his routine appointment the following week saying it’s still sore and hurts when he has to take a deep breath or move around a lot but otherwise he feels alright. He lays down on the table but points his finger at you as he does saying “just don’t break anything else” and lets out a laugh.
Relieved, you think to yourself that there is nothing to worry about and you are correct.
Al never files a claim.
But what would have happened if he did?
Certainly there is no way to predict the outcome in cases like these but there are a couple of things to keep in mind when it comes to malpractice cases. First, there has to be some type of harm that took place. In this case a very clearly fractured rib that is undisputed as to its cause. But secondly, there must be a breach of the standard of care.
And this is where it gets complicated and the most important thing in this regard are your records. Your records are either going to document that your actions were consistent with the standard of care of a reasonable chiropractor practicing in a similar fashion or they are not.
Did you use a technique that you should not have used? Was there a more appropriate technique to use? Should you have been adjusting Al at all? Since you’ve been taking care of Al for so long did you get lazy when it comes to doing re-exams and documenting your visits with him?
All of these things and more will go into the expert witness on the other side opining whether or not you deviated from the standard of care and whether or not that fractured rib could have been avoided.
Remember, you can’t escape the fact that there is risk in practice but you can lessen that risk by paying close attention to how you manage your patients and document your care. Every practice member may not be as understanding as Al.
As always I look forward to your feedback, comments and suggestions.
Matthew McCoy DC, MPH
CEO & Co-Founder
ChiroFutures Malpractice Program
