For chiropractors, one of the most important characteristics of chiropractic is that it is drug-free. This has become increasingly important to patients as well, particularly with the ongoing revelations about the staggering death toll due to drug reactions and errors.

According to an Institute of Medicine report in Jan. 2000, hospitalized patients suffer about 2,216,000 serious ADRs (adverse drug reactions), causing more than 106,000 deaths annually, making it the fourth leading cause of death -- ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths.

Another report (Am J Med, 2000;109(2):87B94) said that these statistics did not include the number of ADRs that occur in ambulatory settings, or the estimated 350,000 ADRs that occur in U.S. nursing homes each year.

Obviously, drugs can be deadly. It's also clear from other reports as well as clinical experience, that many people take far too many drugs, including drugs that don't do them any good.

It's tempting, therefore, to try to help patients by giving them advice about decreasing or eliminating the medications they are taking. Yet, doctors of chiropractic must always remember that such advice -- even though seemingly benign -- is not within the scope of practice of chiropractic and can lead to serious repercussions.

Since the CBS Reports focus on malpractice prevention, this isn't the place to explore the issue of patient welfare at this time. However, looking only at the situation from a risk management point of view, giving any advice about medication can leave you vulnerable to lawsuits and board complaints.

A recent case in Pennsylvania points out the serious consequences of such actions.

In Sept. 2002, a Pennsylvania D.C. was indicted by a federal grand jury on charges that she defrauded Medicaid while treating a patient.

The health care fraud charges stemmed from the doctor billing Medicaid for manipulation when, in fact, she claimed to be "treating" the woman's epilepsy.

According to court records, the doctor recommended that the patient discontinue medication for her epileptic seizure disorder. The patient subsequently died.

The maximum penalty for health care fraud involving the death of a patient is life imprisonment and a $250,000 fine, according to federal officials.

The doctor allegedly told the patient that her seizures would stop within three days after discontinuing the anti-convulsive medication that had been prescribed by her medical physician.

According to the indictment, the patient did as the D.C. recommended, and discontinued the medication. She later suffered violent seizures, and died of dehydration, inhalation of her own vomit and pneumonia.

This, of course, is an extreme case that was compounded by the doctor billing Medicaid for about 40 sessions, and falsely describing her treatment as "spinal manipulations" without referring to her diagnosis or treatment of the epilepsy which would have, in itself, been against the law. (Like most state scope laws, the Pennsylvania Chiropractic Practice Act bars a chiropractor from treating or dispensing advice for a disease or illness and from dispensing, prescribing or regulating medications.)

But the same premise exists when you give a patient any advice about prescription or over-the-counter drugs.

While you should inform patients that correcting vertebral subluxations can help the body attain a more healthy state and may make drugs unnecessary, you should never give specific advice or recommendations concerning discontinuing or decreasing the use of any medication being taken by a patient.