Chiropractic Expert Witness On Standard Of Care Part 2

In Defining the Chiropractic Standard Of Care, chiropractic expert witness Richard K. Skala, D.C., writes:


Based on the definitions above, as well as my medical legal experience, the chiropractic standard of care can be summed up as follows:

“What a prudent, competent state licensed chiropractic physician in the same general region (state) would do under the same or reasonably similar situations or circumstances.”


Like all health care professions, chiropractic physicians are trained in schools/colleges of chiropractic (43 worldwide)*. In the USA, each of the 17 chiropractic colleges are accredited based on a number of criteria, not the least of which is their respective basic science, and clinical science curriculum. Within these curriculum is contained the foundation for the Chiropractic Standard of Care. In addition to college curricula, the chiropractic profession is supported by established scientific, empirical, and clinical evidence. Over the course of time, a consensus of opinions and conclusions regarding things such as the scope of use of various forms of chiropractic treatment, where these methods are taught, and the clinical utility and proper application for any specific condition(s) for which the treatment is applied are all factors of consideration. In certain cases or jurisdictions Case Law may prove relevant in defining specific aspects of the standard of care on a legal basis.

So what are the more common lapses in standard of care that end up in a law suit or board compliance action? (This list is by no means complete.)

1. Lack of informed consent given to the patient signed by the patient 2. Adverse consequence resulting from treatment 3. Negative side effects of the treatment employed
4. Misdiagnosis 5. Failure to diagnose 6. Failure to reexamine 7. Failure to refer 8. Failure to keep adequate records 9. Altering patient records

In any case involving breach of “Standard of Care” there are going to be advocates on either side of the question diligently working to advocate their side of the argument. Each case will largely depend on the condition of the chiropractic records, and the impressions, opinions and conclusions of the experts who review those records and eventually give testimony. This article is by no means a treatise on the subject of the “Chiropractic Standard of Care.” It does set forth my experience and the general concepts relating to questions that arise over the “Chiropractic Standard of Care.” Each and every case is unique with its own set of facts. At the end of the day, even with the availability of the outline above, and others like it, the best I can say is not too far afield from Justice Potter (and I in no way compare my intelligence to his intelligence and wisdom when I say this): “I shall not today attempt further to define the kinds of material I understand to be embraced within the medical records reviewed and perhaps I could never succeed in intelligibly doing so. But I know what breach of the Chiropractic Standard of Care looks like when I see it.”


A Doctor of Chiropractic since 1976, Dr. Skala provides consultation and expert witness services for attorneys regarding Personal Injury; Industrial Medical-Legal Cases; Standard of Care involving General Chiropractic, Manipulation Under Anesthesia (MUA), Non-Surgical Spinal Decompression, and Extracorporeal Shockwave (EWST); Chiropractic Licensure Compliance California, and Workers Compensation. Declared an expert witness by the California Workers’ Compensation Appeals Board, he is a California Qualified Medical Evaluator (QME), a Certified Industrial Disability Evaluator, and a certified AMA Impairment rater.