He Wrote the Book: DE Chiropractor and Member of Health Care Advisory Panel Offers Sneak Peek at Medical Records Text

I am pleased to have as my guest this week Dr. Douglas Briggs of First State Health & Wellness. Dr. Briggs is the chiropractic representative on the State Workers’ Compensation Health Care Advisory Panel. The Panel was responsible for promulgating the Health Care Practice Guidelines, Utilization Review system, and other cost containment measures that were adopted in 2007 and 2008 as part of an overhaul of our medical treatment statute, 19 Del. Code Section 2322.

 Dr. Briggs is the "go-to guy" for chiropractic. In addition to serving on the Panel and patient care, he performs defense medical evaluations on the issue of chiropractic compliance with the Health Care Practice Guidelines.

Here is what Dr. Briggs has to offer for the edification of attorneys on the issue of medical record review:

Attached please find an excerpt from the CAM chapter of "Medical Legal Aspect of Medical Records" 2nd ed. - due to be published later this year. This is the section on chiropractic notes:

Chiropractic records

It is not only necessary, but also the acceptable standard of care for any healthcare practitioner to fully document the patient's condition, the treatments rendered, and the patient's progress. Patient records are viewed as files of evidence, which third-party liability carriers use to evaluate adequacy of treatment. Obviously the patient records of different health care providers will vary according to the type of treatment rendered.

However, every provider in every discipline is accountable for the care provided to a patient. Records must consistently define the patient's condition, clearly objectify the findings during the course of treatment, and document the patient's progress.

Chiropractic terms and abbreviations vary from practitioner to practitioner and often depend on the physician's background and training.

Chiropractic records should be summarized in the same manner as other medical records. Procedures performed in the office should be described in detail. It is reasonable to expect that records are clear, concise, and legible. The dilemma from the non-chiropractor reviewer perspective is that the chiropractic records are often difficult to interpret. If the chiropractor has used idiosyncratic abbreviations and terms, it is reasonable that the reviewer ask that the chiropractor translate the records. The attorney who needs to understand the records should plan on meeting with the chiropractor, expecting to pay for his time, and go through the crucial records. Another alternative is to ask the chiropractor to prepare a narrative report that explains the records, treatment, and prognosis.

Editor's comment:  Now that medical treatment is measured against the (somewhat) more objective standard of the Health Care Practice Guidelines rather than the nebulous criteria of "reasonable and necessary" (at least some of the time), the Board is looking for more concrete measures of compliance, improvement, benefit, etc.-- whether we are talking about what is noted on the clinical exam such as range of motion or sensory deficit, the level of pain complaint documented by Visual Analog Pain scale, the gains achieved from one treatment session to the next. Look at some of the UR decisions previously reported at this site and see if you agree that cases can be won -- or lost-- by what is recorded in the clinician's chart.

Thank you, Dr. Briggs for joining us; we hope you will weigh in the next time with the "down low" on what is brewing with the Health Care Advisory Panel. Inquiring minds want to know....:>)

 Cassandra Roberts