Medical Malpractice Implications of Alternative Medicine

Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review

“…Nevertheless, while malpractice claims against massage therapists, chiropractors, and acupuncturists occur less often than claims against traditional practitioners and often involve less serious injuries, CAM practitioners are still subject to the ethical and legal implications of their practice. 92 Indeed, there are risks related to these interventions, e.g., chiropractic manipulation may be associated with significant risks, including arterial dissection leading to stroke (approximate incidence = 0.005%), epidural hematoma, disc herniation, and myelopathy. [93][94][95][96][97] Some have argued that these adverse events are not causally related but rather only associations and that the benefits of chiropractic manipulation may still outweigh the risks.…”

Referrals and Shared or Collaborative Care: Managing Relationships With Complementary and Alternative Medicine Practitioners

“…42,43 There are exceptions, however. Questions about liability have arisen in the context of conventional health care providers, but the cases did not specifically address referral to CAM practitioners.…”

“…35,[43][44][45] Direct liability (ie, the referral itself or the physician's concurrent or later care was negligent) could result if, for instance, the physician's referral to a CAM practitioner delayed or eliminated the patient's opportunity to receive needed conventional health care, provided that, as in any negligence action, the plaintiff could also establish that he or she suffered harm as a result and that the referral was unreasonable under the circumstances (ie, fell below the standard of care). 43 Studdert et al 43,46 have suggested that, as knowledge about the appropriateness of various forms of CAM increases, physicians may be held liable if they refer patients for therapies that they know or should know would not benefit the patient. Liability for referral could also be attached if the physician knew or ought to have known that the practitioner to whom he or she was making the referral provided unsafe care or was unqualified or that referral to a more appropriate or specialized practitioner was warranted.…”

“…This liability is most likely to arise if the physician supervised the care, employed the caregiver, or jointly treated or managed the patient's care. 43 …”

“…A jointly owned or operated clinic, or delivery of care with CAM practitioners in an "integrated" unit in a hospital, raises the possibility of a finding that the practitioners were engaged in a joint undertaking, because integration by definition implies a high degree of coordinated diagnosis and care. 43,44,48 Thus, some degree of consultation about integration of treatment efforts and plans, even if not †For instance, Alberta requires consultation with a physician or dentist before an acupuncturist begins treatment and referral to a physician or dentist if the condition does not improve within a few months and imposes other limits on acupunctur- through a formal structure, may raise the potential of a finding that the patient's treatment was a joint undertaking. A joint undertaking does not always result in joint liability, however.…”