Your authority to
practice chiropractic comes from the state via the license they have granted to
you.
This license is given to you personally, as an individual. You do not
have the authority to allow anyone
to do clinical work on your behalf unless
it is specifically allowed under this rule and the individual has
the training
required by the state.
A person that works for you (including
a nurse) may never adjust a patient, make a diagnosis, or do any
portion of
an orthopedic, neurologic or chiropractic exam unless they are a licensed chiropractor.
Regardless
of the individual’s training or experience in other health
care fields, you do not have the authority to delegate
any of this work. Violations
of this rule are very serious. Not only do you face possible disciplinary action
by the state, you also leave yourself exposed to serious malpractice risk.
One of the first things done by an attorney in a malpractice
case is to review every aspect of the patient’s care.
As part of that
review, an attorney will not only review all of the clinical documentation for
possible mistakes
but will also ask for the identity of the person who provided
each service.
Just imagine a chiropractor’s chances
in a malpractice case if the patient’s attorney can show that the person
who provided care who did not have the proper education and training (even if
it is unrelated to the care that caused the injury).
Service
X-Ray
The
unlicensed person must have adequate training, education and
experience to
perform the delegated function to minimally acceptable chiropractic standards.
Special
Requirements
Before an individual may take x-rays, they must take a
48-hour
educational program and pass an exam in the following topics:
Preliminary
Patient History
The unlicensed person must have adequate training, education
and experience to perform the delegated function to minimally acceptable chiropractic
standards.An unlicensed person must take an educational program and pass an exam.
“Preliminary
patient history” means the process of gathering baseline data regarding a
patient, including the nature of the chief complaint, family history, and medical
history. It is intended as a starting point for further inquiry by the chiropractor
into the patient’s condition
Service
That May Be Delegated
Service
Physiological
Therapeutics
The unlicensed person must have adequate
training, education and
experience to perform the delegated function to minimally
acceptable
Special Requirements
You may delegate the performance of some
services to an unlicensed person
(an unlicensed person is anyone, including
a nurse, not licensed as a chiropractor)
only if all of the following conditions
are met:
- The
individual must demonstrate proficiency in the delivery of that service to minimally
competent chiropractic practice standards as measured by objective knowledgeand
skills testing.
- You
must exercise direct supervision of the unlicensed person performing the delegated
service.
Direct supervision means that you must always be on the premises
when the service is being provided.
Your staff may not perform delegated services
if you are off for the day, at lunch, or out of the office
running an errand.
- You
retain ultimate responsibility for the manner and quality of any service that
you have delegated
to an unlicensed person.
Practical
advice
A
chiropractor is not allowed to delegate services to an unlicensed individual until
after a person has
completed their training and passed the exam. This is true
even if the chiropractor is short of staff and
just needs an individual to
“fill in” for a short period of time. To avoid this problem, it is best
to cross
train as many of your employees as possible.Some individuals who are
trained as “chiropractic technicians”
receive education and training
in a number of areas that are not covered by these rules. Regardless of their
training,
a chiropractor may not delegate any services except those explicitly named in
this rule.
Statute excerpts
10.01
Definitions
10.02 Delegation of adjunctive services to unlicensed persons
10.03 X-ray services
10.04 Patient history
10.05 Physiological therapeutics
10.06 Chiropractor responsibility
Chir 10.01 Definitions.
In this chapter:
(1)
“Adjunctive services” means services which are preparatory or complementary
to
chiropractic adjustments of the spine or skeletal articulations, or both.
“Adjunctive services”
does not include making a chiropractic diagnosis
or performing a chiropractic adjustment.
(2)
“Preliminary patient history” means the process of gathering baseline
data regarding a
patient, including the nature of the chief complaint, family
history, and medical history.
(3) “Unlicensed
person” means a person who does not possess a valid license to practice
chiropractic in this state pursuant to ch. 446, Stats.Chir
10.02 Delegation of adjunctive services to unlicensed persons.
A chiropractor
licensed under ch. 446, Stats., may delegate the performance of adjunctive
services
to an unlicensed person only if all of the following conditions are met:
(1)
The chiropractor maintains records by which the chiropractor has verified that
the unlicensed
person has successfully completed a didactic and clinical training
program approved by the board
and covering the performance of the delegated
service. Successful completion of a training program
is demonstrated by attaining
proficiency in the delivery of that service to minimally competent
chiropractic
practice standards as measured by objective knowledge and skills testing.
(2)
The chiropractor exercises direct supervision of the unlicensed person performing
the delegated service.
Chir
10.03 X-ray services.
A chiropractor may delegate x-ray examination procedures
to an unlicensed person only if the delegation
is consistent with s. Chir
10.02 and the unlicensed person has successfully completed a course of instruction
comprising at least 48 hours and including the following components: introduction
to x-ray examination; physics
of x-ray examination; anatomy; patient positioning;
safety measures; machine operation; exposure techniques and
accessories; processing
and dark room techniques; film critique and quality assurance; professionalism;
recordkeeping;
emergency procedures, summary; and successful completion of
an examination on the content of the course of
instruction. The chiropractor
shall comply with s. Chir 4.04 before delegating the performance of x-ray services
to an unlicensed person.
Chir
10.04 Patient history.
A chiropractor may delegate the completion of a
preliminary patient history to an unlicensed person only if the
delegation
is consistent with s. Chir 10.02 and the unlicensed person has adequate training,
education and experience
to perform the delegated function to minimally acceptable
chiropractic standards.
Chir
10.05 Physiological therapeutics.
A chiropractor may delegate the performance
of patient services through physiological therapeutics that include
but are
not limited to heat, cold, light, air, water, sound, electricity, massage, and
physical exercise with and
without assistive devices to an unlicensed person
only if the delegation is consistent with s. Chir 10.02 and the
unlicensed
person has adequate training, education and experience to perform the delegated
function to minimally
acceptable chiropractic standards.
Chiro
10.06 Chiropractor responsibility.
A chiropractor who delegates the performance
of any adjunctive service to any unlicensed person retains ultimate
responsibility
for the manner and quality of the service.
