Often, the success of a malpractice court case will hinge on your ability to refute testimony from an "expert witness." Frequently, these witnesses are either medical doctors or chiropractors who use the Mercy Guidelines (officially named the "Guidelines for Chiropractic Quality Assurance and Practice Parameters") to claim you failed to meet "medical standards" or perform in a professional manner.

In order to make your case effectively, you will need to prove to the court that the document does not represent the accepted standard of care for the chiropractic professional. Since you will be judged by the standard which applies to your peer group, you must show that the Mercy document does not pertain to your peer group (chiropractors in general and subluxation-based chiropractors in particular).

When the Mercy document was first developed in 1992, it was released to the insurance industry even before most field doctors had a chance to review it. Instantly, insurance adjusters began using the guideline to justify slashing claims and refusing payment for chiropractic services. Just as quickly, plaintiff attorneys began hiring chiropractic "experts" who would use the guidelines against the defendant doctors.

This has become a particularly serious situation with subluxation-based doctors, since the Mercy Guidelines do nothing to support that practice objective and have been interpreted to suggest that chiropractic is a treatment for neuromusculoskeletal complaints in adults and not indicated for children or asymptomatic patients. Whether this is a valid interpretation is not relevant. Virtually from its publication, the Mercy document has been used in this manner and was therefore of grave concern to almost all chiropractic organizations.

Most chiropractic organizations (including the World Chiropractic Alliance, International Chiropractors Association and even the Congress of Chiropractic State Associations, which originally called for the Mercy Conference) have rejected the document. Even many of the groups that were involved in the Mercy Center Consensus Conference and funded the effort -- including the American Chiropractic Association -- have not endorsed it.

This almost universal rejection is a key to discrediting the Mercy document in court, along with the "experts" who rely on it as a weapon against the doctor of chiropractic.

However, in court, it is not enough to merely present the long list of organizations that have rejected the Mercy document. You will need to show precisely WHY the Guidelines were so soundly repudiated by the profession.

Fortunately, this has been shown to be a fairly easy task since the arguments against the Mercy Guidelines are abundant and persuasive.

According to the WCA's position paper on Mercy, one of the main reasons why the Mercy Guidelines cannot be accepted as evidence in a chiropractic case is that the methodology used by the Mercy conference to develop them was flawed.

An examination of the methodological and application problems associated with Mercy is available on the WCA website (wwww.worldchiropracticalliance.org/positions/mercy2.htm).

In addition, the composition of the conference did not reflect the full spectrum of philosophies and purposes found in the profession. No explanation was ever given as to how the 35 individual conference members were selected, and a review clearly indicates an extremely heavy bias toward the more medicalized faction of the profession. Only a few subluxation-based chiropractors were invited to participate and at least two afterward stated publicly they felt they had been included as "token" representatives but had no real affect on the proceedings.

These 35 members developed the document without input from the profession at large, in closed sessions. Further, major funding for the commission was derived from companies owned by commission members or having direct ties to those members, adding the potential for conflict of interest.

In many instances, doctors of chiropractic have successfully discredited the Mercy Guidelines in court by preparing themselves and their attorneys with the information available from the WCA website. In one such case, the Mercy document was ruled inadmissible as evidence for testimony on a soft tissue injury (Reeves vs. Flaherty, et al.) -- an important, precedent-setting judicial decision.

While the WCA information should be sufficient to have the court disregard any testimony from "Mercy" witnesses, doctors also need to come prepared with valid, widely accepted guidelines that support their case.