June 2007

Court limits DCs in NJ to adjustments of spine

A panel of appellate judges ruled last month that the practice of chiropractic is limited to adjustments of the spinal column and does not include such practices as manipulation to extremities. The ruling reversed a jury verdict in a case involving chiropractic treatment on a patient's knee.

A 52‑year old female patient sued Anthony L. Riello, DC, and Peter E. Lowenstein, DC, for malpractice, claiming she suffered torn cartilage after the doctors treated her knee and had to undergo two surgeries as a result.

The Association of New Jersey Chiropractors objected strenuously to the judgment and vowed to appeal the decision to the state Supreme Court.

"The Association of New Jersey Chiropractors strongly disagrees with the Appellate Division's ruling in the Bedford case as it relates to the manipulation of a patient's knee within the normal scope of chiropractic care," the group's legal counsel said.

Originally, Superior Court Judge Frank A. Buczynski Jr. had ruled that "the scope of chiropractic practice in New Jersey permits chiropractors to adjust a patient's knees and other extremities." During the trial, an expert witness testified for the defense that extremity manipulation is a common practice in chiropractic offices. The major issue under contention during the trial was whether or not the two doctors acted within the legal scope of practice or deviated from the accepted standard of care, not whether the torn cartilage was caused by the treatment. The jury found in favor of the chiropractors.

In overturning the verdict, appellate judges Michael Winkelstein, Jose L. Fuentes and Linda G. Baxter said a new trial had to be held and a determination made whether the doctors caused the plaintiff's injury.

"We conclude that the scope of chiropractic in New Jersey is limited to adjustments of the spinal column and does not include the adjustment of other joints," the panel's opinion read.

The statute in question reads: "The scope of practice of chiropractic shall remain as defined in existing statutes. Nothing in this act shall be deemed to prohibit a chiropractor from caring for chiropractic subluxation as determined by chiropractic analytical procedures. Chiropractic analysis which identifies the existence of a subluxation may be the only basis for chiropractic care."

The judges expanded on their ruling by pointing out that the "statute specifically limits the scope of chiropractic practice to that encompassed by N.J.S.A. 45:9‑14.5. And, while the statute permits recognized 'chiropractic analytical procedures,' which may allow a chiropractor to maneuver a patient's limbs to assist in adjusting the patient's spine, that is not what occurred here. Dr. Riello testified that it was plaintiff's knee he adjusted; he did not testify that he manipulated her knee to correct or adjust a subluxation of her spine."

The opinion also notes that "Dr. Santiago testified that chiropractors independently adjust extremities, including knees, and he explained to the jury how to properly adjust a knee. He also noted that the purpose of a knee adjustment is to 'open up' that particular joint; he did not say a knee adjustment was performed to affect a subluxation of plaintiff's spine."