What makes this case important to chiropractors is that the therapist rented space in a chiropractic office, even though he was not the DC's employee or associate. This situation could actually put the chiropractor at risk of being involved in a lawsuit.

According to Terry A. Rondberg, DC, the problem has been affecting more and more doctors in recent years.

"Many DCs now run multidisciplinary offices and either employ, associate with, or lease space to physical therapists, massage therapists, acupuncturists, nutritionists, or other health care providers," he stated. "As 'unfair' as it sounds, it's possible for a doctor to be sued and held responsible for the actions of non employees who happen to work in the same office. According to the concept of 'vicarious liability' you can be named in a lawsuit even if you've never seen the patient in question."

Leslie Wise, DC, noted in an article for Institute for Chiropractic Ethics: "As professionals, in chiropractic practice, dealing with the public, we need to remember that there are occasions where we may reap what others have sown."

The insurance experts at CNA insurance added this explanation: "When you have a professional practice, you can be held responsible for overseeing the patient care provided by associates, other licensees, technicians, and everyone else even vaguely connected to your practice. If an insured is sharing space (including subleasing their own space) with any other health care professional and there is or can be any perception of an association between the practitioners (no matter how remote) by the patient or lay public, it is virtually guaranteed both parties will be named in a claim by an injured patient."

To make matters worse, these secondary providers often fail to obtain their own insurance policies. When an attorney is looking for someone to sue, the DC is often the most attractive target. Even if you aren't ultimately held legally liable, it will still take a great deal of time, money and effort to remove yourself from the case.

In addition, a DC's liability increases if any of the secondary providers are authorized to perform procedures beyond the chiropractic scope of practice. Depending on the state, this may include PTs, nurses, nurse practitioners, and others. Most boards prohibit or strongly advise against employing or contracting with persons with licenses in ancillary medical disciplines outside of chiropractic.

Vicarious liability can occur even when no actual agency relationship exists. If a patient comes to your office and receives care from another person, that patient could sue you if there was a reason to assume that you "ran" the office, and had authority over the person providing care. This can happen simply because your name is on the door.

The same thing applies if you're in a partnership or group practice. As a member of the group, you could be faced with vicarious liability issues should ANY member of your group practice be sued. Again, your risk is greater if the treating doctor doesn't have an insurance policy of his or her own.

"You increase your exposure to lawsuits and board complaints any time you have employees or share space with other professions -- even if you don't have authority over them," Dr. Rondberg emphasized. "This doesn't necessarily mean you need to avoid these situations, but you definitely need to protect yourself."

According to Timothy Feuling, president of Chiropractic Benefit Services, there are three steps to take to do that:

1. Before entering into any type of space sharing agreement, carefully consider your potential liability risks. It may make sense to discuss the issues with an attorney, even drawing up a contract outlining each person's responsibilities and specifically addressing malpractice insurance requirements.

2. Secure proof of current malpractice insurance with the same limits as your own coverage from every health care provider DC, MT, PT, etc. who works in proximity to you and has the potential to create a vicarious liability issue for you.