The Board of Registration of Chiropractors received a request for an advisory opinion concerning the inspections of solo practices. In addition to responding to that specific inquiry by letter, the Board wanted to make the following information available to all interested parties.
The Board appreciates the importance of balancing the needs of consumer protection with the rights of licensees to practice their professions without undue interference. To that end, the average solo practice verification inspection is typically completed within 10 minutes, and often even less than that. The investigator waits to be acknowledged by staff or the licensee and provides a business card to that person. Typically, the investigator then immediately informs that staff person or licensee of the following:
- The investigator will wait for the chiropractor to finish with any patient because patient care is not to be interrupted.
- The chiropractor may dedicate a staff person to assist the investigator in lieu of the doctor.
- The inspection is general in nature and there has not been a complaint filed against the chiropractor (unless the investigator is in fact on site in response to a complaint).
Below please find questions about solo practice inspections received by the Board and the Board's responses:
- Does the Board believe that 233 CMR 4.16 requires a chiropractor to speak to investigators, although that is not listed in the regulation? If so, how is a chiropractor to know that is a requirement?
Chiropractors are expected to know and comply with all regulations and laws governing the practice of chiropractic in Massachusetts. Section 4.06(18) of the Board's regulations authorizes the Board to take disciplinary action against any chiropractor who fails to "cooperate with the Board or its agent with regard to inspections or investigations." Refusing to allow an investigator to complete the inspection described in 233 CMR 4.16, either by insisting that the investigator come back later or by refusing to speak to the investigator, is a failure to cooperate, and thus constitutes grounds for disciplinary action under 233 CMR 4.06(18). In such a scenario, both 233 CMR 4.16 and 233 CMR 4.06(18) are relevant to allegations against an uncooperative licensee, but the paramount regulation becomes 233 CMR 4.06(18).
- Has the Board taken any steps to ensure that site inspections conducted by investigators pursuant to 233 CMR 4.16, do not unreasonably interfere with a chiropractor's patient care and business?
Yes, both the Board and the Division of Professional Licensure emphasize to investigators the importance of not disrupting patient treatment. Although the unexpected arrival of a board representative can be disconcerting, Board investigators make every effort to make the process as unobtrusive and cordial as possible. When approving the solo practice verification form, the Board ensured that the form was brief and capable of being completed expeditiously. The Division has not received any allegations of unreasonable interference by investigators during an unannounced inspection.
- Does the Board expect that a chiropractor will interrupt direct patient care and meet with an inspector as soon as the inspector arrives, thus to the detriment of the patient? If not, is there a reasonable time that the chiropractor can ask the inspector to wait or return e.g., the next available free time in their schedule?
The Board does not expect a chiropractor to interrupt the care of the patient being treated when an investigator arrives. However, once the treatment of that patient has been completed, the Board expects a chiropractor to take a few minutes between patients to assist the investigator or to identify an available staff person to assist the investigator. It is not appropriate for a chiropractor to request that an investigator wait through multiple patient appointments or return at another time in order to complete his or her investigation. The Board recognizes that unannounced inspections are the most effective means of assessing the true nature of activity at a particular location and the optimal manner of fulfilling the Board's consumer protection mission. Requiring an investigator to wait for a prolonged period or make two trips to the same practice would defeat the unannounced purpose of these verification inspections and constitute an inefficient use of public resources.
- How does the Board determine whether a licensed Chiropractor has "cooperated" with an inspection within the meaning of 233 CMR 4.06(18), if there is no requirement that they speak with the investigator under the 233 CMR 4.16? For example, is it acceptable for a chiropractor to make his office space available to the inspector for an office inspection and ask the inspector to return at another time to conduct the interview portion of the inspection? If so, is there a reasonable time that the chiropractor can ask the inspector to wait?
The Board looks at the totality of circumstances surrounding an inspection to determine if a chiropractor has failed to cooperate with a Board investigator in violation of 233 CMR 4.06(18). The Board considers communication to be an essential component to cooperation. As to the remaining issues raised in this question, please refer to the Board's responses to questions 1 and 3 above.
- What safeguards can a chiropractor reasonably expect from the investigators who are performing the inspections to protect any patients from undue anxiety or concern due to the presence of an inspector from "the Board"?
The Board has never received any report of a patient having "undue anxiety or concern" because of the presence of a Board representative. All site visits are handled as swiftly and unobtrusively as possible. The Board further believes that most consumers expect active oversight of individuals licensed by state or federal government. It would be impossible for the Board to prevent unique individuals from having undue reactions, as by definition undue means unwarranted, unjustifiable, or excessive.