Mask issues are the number one issue we are seeing in regards to questions from chiropractors right now. "Can I write a doctors note so that a patient's kids don’t have to wear masks"? "Can I write an exemption for my staff"? "Do my and I staff have to wear masks"?

The first thing to understand is that I am answering this with a malpractice insurance company hat on - not my personal opinion about masks or even the scientific evidence for or against them.

The issue is NOT whether or not you can write an exemption for someone - the issue is who or what entity comes after you for doing it and what do they do to you.

For example - you write an exemption for a child patient so they don't have to wear one in school and then the child gets COVID and then the parents want to blame you. Or another child in his class gets it and they say they got it from the child you wrote the letter for. Or the school has to be shut down and it gets blamed on you. There are so many possible scenarios.

Will the state board get involved? The Department of Health? Attorney General?

Will they start looking into your practice and your COVID Policies?

The question you have to ask yourself is - is it worth it?

Only you can decide whether or not you want to take on the risk. Just do it with eyes wide open.

For example if someone files a Board complaint against you for not masking then understand that depending on your board they could shut you down while your complaint is adjudicated.

Here is what we have been telling people in regards to the mask issue in general.

The first thing you want to do is review your state, county, city and local department of health orders, rules guidelines and mandates on this.

You also want to kook at what your state chiropractic board says. For example, like several other state boards the chiropractors on the North Carolina Board have come out and stated they are required. And they do not provide for any exemptions. Yes - that is absurd but so is much of what chiropractic boards are doing these days.

Look and see if these orders allow for exemptions and what those are. In the case of a school for example MAKE CERTAIN that what the principle or parent tells you is actually written down in a policy. If they just verbally told you that they will accept a letter from a chiropractor - forget it. Get it in writing.

In regards to your office - If you believe you and or your staff are eligible for any of the exemptions, then do what you need to do in order to qualify for them - if that’s what you want and you understand the risks.

Be sure to be PROACTIVE about your decisions either way and put it into your COVID Policy and Procedures.

DO NOT let any patients come into your office without first knowing what that mask policy is.

Mask complaints arise especially when a patient shows up to your office unaware that you are not masking and they get concerned because they believe you lured them into a hotbed of infection. And then they tell EVERYBODY including your board and everyone on social media.

Decide if you are going to offer to wear masks for someone if they request it or none at all.

For example: Keep in mind that some pregnant women right now are masking out of fear that if they test positive their child will be taken away from them at time of delivery.

Perhaps you could offer certain times or days of the week for maskers or a separate room. The more “reasonable” you are the better when and if a complaint is filed and investigated.

Keep in mind also that departments of health will ask you what your COVID procedures are (including masking) if someone identifies you as a potential source of infection through contact tracing. If those public health officials feel you are being safe then they may not make you shut down.

Understand that all of the ranting and raving about the ADA etc does not apply unless you have a bonafide medical exemption that is documented.

That means if a board asks you for that documentation you will have to provide it.

Will you have an exam in your file that certifies your disability and/or exemption? Will your staff?

Will the child you wrote the exemption for in school have a documented issue that precludes wearing masks and will you have a related exam that certifies this?

Will the board honor it? The Department of Health? The Attorney General?

Or will they instead go after you for some type of fraud, deception or anything else that they can lump under “Unprofessional Conduct”.

Remember who controls the chiropractic regulatory boards in this country. They are generally NOT chiropractors who practice in a vitalistic, salutogenic, subluxation model and may not see health, COVID and the world through the same lens as you do.

About the HIPAA issue and the belief that they can’t ask you this or that etc. Go back and read your PRACTICE ACT and the public health law in your state that you are LEGALLY required to follow. You will find that regulatory boards have BROAD latitude to look under your hood, kick your tires and determine if you are fit to practice (physically & mentally) and that you are following all public health orders.

Even if and when a bonafide exemption exists (meaning a DISABILITY) under ADA all the business or other entity is required to do is offer a “reasonable accommodation”.

Schools are especially strict about adhering to the ADA rules and regulations. So a “reasonable accommodation” for the child who can't wear a mask is most likely going to be a looser fitting mask.

Depending on the orders in your state a business may not have to allow you to enter without one. That would be considered “unreasonable” because they believe that you would be putting lives at risk.

Are there exceptions to that? Of course, but those will be found in your state, county, city and local orders.

For example in Georgia, the Governor’s orders say no jurisdiction can put orders in place that are more or less stringent that the Governor's. And the Georgia Governor has stated publicly that mask mandates are “unenforceable”. This is despite the fact that several cities in Georgia have mandated masks. Now it will be up to citizens in those jurisdictions to file suit.

Everybody wants to rant and rave on social media until it comes time to actually step up, find an attorney and start suing people and entities. Decide ahead of time how far you are willing to take it and then make your decisions based on how much risk you are willing to take on in your life and your business.

These are difficult times for chiropractors practicing in a subluxation, vitalistic and salutogenic model. Navigate the waters carefully.