Illinois Chiropractors: Are You Aiding and Abetting the Unlicensed Practice of Medicine?

Aiding and abetting the unlicensed practice of medicine can be a potentially disastrous minefield for chiropractors, and often does not involve any knowing or intentional violations of the law. Often, the seemingly innocuous delegation of certain tasks to assistants or others can inadvertently lead to scrutiny and legal action by the Illinois Department of Professional Regulation (IDFPR)

Included among the over 40 enumerated bases for disciplinary action against chiropractors and physicians set forth in the Illinois Medical Practice Act (225 ILCS 60/1 et seq.) is “aiding and abetting an individual not licensed under this Act in the practice of a profession licensed under this Act.”

What Exactly is the “Practice of Medicine”?

The problem arises because the Medical Practice Act, despite its title, nowhere defines exactly what the “practice of medicine” entails. Section 22 of the Medical Practice Act directs the IDFPR to adopt rules that set forth standards to be used in determining several violations and terms under the Act. However, it does not require the Department to set forth explicit standards defining the practice of medicine.

As one court explained, the reason the legislature did not define “the practice of medicine” in the definitions section of the Act is “because a flexible definition of the practice of medicine is required in a statute intended to govern various healers from osteopaths to herb doctors. Siddiqui v. IDFPR, 718 N.E.2d 217 (4th Dist. 1999).

What Can and Cannot Be Delegated

Obviously, not every task that a chiropractor or physician performs on a daily basis constitutes the practice of medicine. Maintaining medical records, taking blood pressure, preparing a patient for treatment – all of these can be delegated to trained staff.

Specifically, Section 54.2 of the Medical Practice Act allows physicians and chiropractors to delegate authority to certain individuals:

  • Physicians can delegate patient care tasks to a licensed practical nurse, a registered professional nurse, or other licensed person practicing within the scope of his or her individual licensing Act.
  • Physicians can also delegate such tasks to physician assistants or advanced practice nurses.
  • In an office or practice setting and within a physician-patient relationship, a physician may delegate patient care tasks or duties to an unlicensed person who possesses appropriate training and experience provided a health care professional, who is practicing within the scope of such licensed professional’s individual licensing Act, is on site to provide assistance.
  • No physician may delegate any patient care task or duty that is statutorily or by rule mandated to be performed by a physician.

What cannot be delegated, and what do not constitute “patient care tasks,” are the diagnosis of illnesses, and the development of treatment plans, including prescribing drugs. Siddiqui v. IDFPR, 718 N.E.2d 217 (4th Dist. 1999).

How You Can Stumble Into Trouble

Chiropractors are not authorized to prescribe controlled substances, but they need to be cautious of their role and the role of any subordinates in any treatment plan that involves prescription medication. A recent complaint brought by IDFPR against a chiropractor offers a prime example of how a chiropractor can innocently stumble into an “aiding and abetting” problem involving prescriptions.

A chiropractor shared office space with a licensed M.D. As a courtesy to the M.D., the chiropractor allowed his secretary to hand out valid prescriptions signed and dated by the M.D. to patients who would come by for appointments and told by the M.D. to pick up the prescription at the front desk when they leave.

The IDFPR asserted that this practice constituted the unlicensed practice of medicine by the chiropractor’s secretary, and sought to suspend or revoke the chiropractor’s license for aiding and abetting this unlicensed practice. The chiropractor no doubt believed that he and his secretary were simply performing ministerial tasks – not the practice of medicine – by facilitating the delivery of a valid prescription issued by a licensed physician. But the fact that the IDFPR saw such action as a basis for disciplinary proceedings should give all Illinois chiropractors pause as they consider the ways in which they could find themselves in trouble with licensing authorities.

Chiropractors should ensure that they have developed specific protocols and procedures that define the permissible roles and actions of nurses, assistants, and others in their practice and be wary of delegating any tasks that may involve the diagnosis and the use of professional medical judgment in deciding on a course of treatment.

Louis R. Fine: Chicago Chiropractor License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of chiropractors, physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois chiropractor’s license and get you back to your patients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.