Disclaimer Regarding Death, Paralysis, Disability and Permanent Harm Required

Georgia joins a number of states around the country that have adopted strict rules and regulations regarding how financial contracts are handled by chiropractors. In response to complaints by patients and other chiropractors that they felt manipulated by so called “scare care” tactics practiced by a few unethical chiropractors these boards have adopted rules that limit the amount all chiropractors can charge patients as well as restrict what chiropractors are allowed to advise patients regarding the role of chiropractic in health and disease.

The Georgia Board has adopted a rule that mandates chiropractors using a prepay financial contract must use the following statement in the contract:

There is insufficient evidence to suggest that not receiving chiropractic care will lead to death, paralysis, disability or permanent harm.

The law in Georgia defines chiropractic as follows:

'Chiropractic' means the adjustment of the articulations of the human body, including ilium, sacrum, and coccyx, and the use of X-ray, provided that the X-ray shall not be used for therapeutical purposes. The term "chiropractic" shall also mean that separate and distinct branch of the healing arts whose science and art utilize the inherent recuperative powers of the body and the relationship between the musculoskeletal structures and functions of the body, particularly of the spinal column and the nervous system, in the restoration and maintenance of health. Chiropractic is a learned profession which teaches that the relationship between structure and function in the human body is a significant health factor and that such relationships between the spinal column and the nervous system are most significant, since the normal transmission and expression of nerve energy are essential to the restoration and maintenance of health.

The law goes on further to define subluxation and its generally untoward effects as follows:

'Subluxation' means a complex of functional or pathological articular changes that compromise neural integrity and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.

While epidemiological evidence that vertebral subluxation leads to increased mortality is lacking, the contention that the presence of subluxation leads to compromised health is literally written into the law.

Making the rule even more curious is the following requirement:

Any chiropractor who enters into a pre-paid financial contract with a patient shall determine and record the patient’s clinical objective which the pre-paid care is designed to achieve and provide the patient with a copy of this objective.

While clearly defined expectations of outcomes is a hallmark of patient centered care and indeed even part of the informed consent process, this rule seems to be imposing a higher standard on the chiropractor using pre-pay than a chiropractor who does not. One chiropractor is being held to a higher standard in terms of their consent process than any other just by virtue of how the patient pays for their services. The same can be said for the disclaimer on death, paralysis, disability and permanent harm – one is left with the impression that chiropractors who do not use pre-paid financial contracts are allowed to make such suggestions. One wonders if chiropractors specializing in the mangement of work related injuries or personal injury are allowed to address the issue of disability and permanent harm.

Chiropractic regulatory boards are grappling with a changing landscape in the clinical practice and business of chiropractic. On the one end there are examples of providers charging what some believe to be large sums of money for care contracts and on the other end those providers who are charging what some believe to be ridiculously low fees for no frills care. Both of these extremes alter the marketplace for the average practicing chiropractor but so far only those charging higher fees for more complex care seem to be bearing the brunt of the regulatory boards.