Frank J. Amato, D.C., of Bellport, New York, makes it clear to all new patients that he provides chiropractic care for the entire family, and thinks it's important for all members of a family to be examined and receive adjustments.

Yet, the New York State Board for Chiropractic slapped Dr. Amato with a suspension, a $7,000 fine, and mandatory community service, after a former patient complained that he advised her to get chiropractic help for her nine-year old son, who showed signs of possible scoliosis.

After he appealed the decision, the Board increased the penalty from a two-month to a 24-month suspension, accusing him of "treat(ing) symptomless patients."

As the chiropractic profession increasingly embraces the concept of family practice and wellness care, the potential ramifications of this case were felt throughout the nation.

"If our licensing boards begin condemning chiropractors for educating the public on the benefits of family care or for caring for asymptomatic people, the entire 21st century chiropractic paradigm is in jeopardy," stated Terry A. Rondberg, D.C., president of the World Chiropractic Alliance (WCA). Dr. Amato is a member of the WCA and a long-time advocate of family wellness care.

The case in question involves a patient who had been diagnosed with scoliosis when she was 12 and went to Amato with complaints of neck pain and weakness, low back pain, leg pain, headaches, menstrual problems and other symptoms.

She late credited Dr. Amato's care with a significant reduction in her symptoms and consistently praised him and the care she received. In routine three-month progress evaluations, the patient stated that she had no complaints.

As he did with all patients, Amato repeatedly recommended that she bring her husband and son in for checkups as well. Although reluctant, she eventually also brought her son in for an examination after Amato told her he observed signs of "postural anomalies" which could indicate the boy also suffered from scoliosis.

The office examination routinely included x-rays and Amato advised the patient he could not care for her son unless he was able to verify his suspicions with radiographic evidence. Although Amato told her there would be no additional charge for the x-ray, she refused and the boy never received chiropractic care.

Amato continued to adjust the woman, and continued to recommend that she bring her son in for chiropractic care as well, often expressing his concerns about his physical condition. In her regular evaluation during this period, she noted that "the office is thorough, professional, and clean."

Six weeks after the boy's aborted examination, the mother canceled all future appointments, requested copies of her x-rays, and terminated her relationship with Amato's office.

Shortly thereafter, Amato sent her a final bill for $252 and a letter reminding her that her son should be checked by someone else. In appealing the disciplinary findings, Amato's attorney, Steven Legum, explained that he had written the letter because "it still weighed on his mind that the child had a serious problem."

Although she first attempted to dispute the bill amount, when told that the Board does not involve itself in financial disputes, she filed a complaint saying the letter was an unethical attempt at pressuring her into bringing her son in for treatment. She claimed Amato refused to care for her unless she also brought her son in for adjustments. The Board charged him with "placing undue influence on a patient for financial gain."

Amato's lawyer says the entire case is without merit, particularly since the letter was sent after the patient-doctor relationship had been severed.

"That letter cannot, under any construction, be viewed as an unprofessional act since it was not in the context of his relationship with his patient," the Appeal argued. "Rather, as Dr. Amato explained, he was trying to prevail upon (the patient) to follow up with the diagnosis of her child to obtain an x-ray to confirm whether or not he was suffering from scoliosis."

Amato's appeal examines another, potentially more important, issue – that of possible prejudice by the chairperson of the New York Board, Dr. Margaret Verhagen.

According to Amato's attorney, Dr. Verhagen, who chaired the hearing panel, "demonstrated overt manifest antagonism and prejudice toward the respondent," and the panel's judgement was "infected by her prejudicial and biased actions."

Transcripts of the hearing provide evidence that Verhagen repeatedly criticized Amato's procedures and patient education methods.

At one point, she scolded him for distributing posture evaluation cards, a popular patient education tool which encourages patients to make observations about family members' posture.

"How dare you allow someone that is not a chiropractor to evaluate their family as to their spinal condition," she admonished him. "It took me four years of chiropractor school to learn that, and 15 years of practice to feel confident. How dare you let a layperson do that?"

Her criticism extended even to his treatment of the mother. "There is nothing in your records that talks about any kind of neurological testing," Verhagen lectured. "If this woman had paresthesia in her legs, she should have been examined in a much more thorough way as opposed to a postural scale. So procedure, techniques-wise, you are off the mark."

Amato's attorney took exception to her remarks. "This was beyond the scope of the charges and the patient never even alluded to any issue concerning problems with the nature of the care," he noted. "Rather, the only reasonable conclusion is that Dr. Verhagen was simply conducting an inquest hoping to find other reasons to criticize, castigate, chide and otherwise deride Dr. Amato."

Her animosity toward Amato is evident, too, in the severe penalties the Board placed on him, penalties which his attorney labeled as "shockingly disproportionate to the offense."

Although admitting that he encouraged referrals by raffling off a television set, the sentence was clearly given for the "offense" of supposedly trying to influence his patient to bring her son in for care.

Yet, his attorney argued, even if he were guilty of such an action, the sentence was extreme. "Superimposed upon the loss of income and the devastating effect of the suspension to Dr. Amato's professional practice, a substantial monetary penalty was also recommended. Most appalling and most graphically demonstrating the impropriety of the Panel's action both on its findings and on its recommendation of punishment, is the direction that Dr. Amato engage in public service."

The panel specified that the 100 hours of public service outside the chiropractic profession be conducted in a hospital or other medical facility. Yet, the appeal pointed out, "Dr. Amato's license as a chiropractor does not allow him to provide any services in a medical facility or AIDS clinic. What then could Dr. Amato do in such facility? Clearly, he could be a delivery boy, he could assist the licensed practical nurses, he could clean bed pans. ...This recommendation is shocking and appalling and disproportionate to any offense. It will serve no purpose either for Dr. Amato or for society in general, for this professional man to be so degraded."

In addition, Amato was sentenced to attend 36 hours of an approved college level course on Ethics and Jurisprudence.

After the appeal was filed with the New York Board of Regents, Amato was faced with another shocking development. "I was informed that, upon review, they were increasing the penalty to a full 24-month suspension, citing my desire to 'treat symptomless patients,' and for recommending 'knowingly unnecessary' treatment and for scaring a young child," he explained.

Although the case is now in the New York Appellate Court, Amato was forced to go on suspension as of January 20, 2002. His motion to stay the Board's decision while the appellate court decides his case was denied and he is considering the possibility of selling his practice and leaving chiropractic.

For now, he is managing to keep his office open with the help of friends. "Dr. Susan DeVito, Dr. Robert McEvoy, and Dr. Gus Cossifos are giving up their personal time to cover my practice and help out a friend," he told The Chiropractic Journal. "I can never repay them."

Dr. Rondberg stated, "We are going to do whatever we can for Dr. Amato. We feel it is important to provide assistance to all our members, and to all doctors who are victimized by board members who allow personal animosity to cloud their judgement."

The World Chiropractic Alliance has long defended the right of all D.C.s to provide chiropractic care to all members of the family, including children and those without overt symptoms. "To say that chiropractic should only be provided to adults or to those in pain or exhibiting other physical symptoms is to deny the benefits of chiropractic to a vast portion of the population, including those who may need it most. The WCA cannot condone such actions and will not sit by while doctors are persecuted for their dedication to chiropractic principles."