cAN YOU TAKE X-RAYS FOR ANOTHER
DOCTOR?
It is becoming less common for every chiropractor to have
an x-ray facility in his own office. With
increasing frequency, chiropractors decide that they want to refer out for x-ray
services. Sometimes they ask a
fellow chiropractor to produce x-rays for them. This leads to a question of whether it is legal for a
chiropractor to produce x-rays on a technical basis at the order of another
doctor.
The short answer to this question is “Yes,
it is fine to do this - if you want to - but watch out for that ‘want
to’ part!”
Before you decide whether you want to take
x-rays for another doctor, it is vital for you to consider one thorny problem:
Who is going to interpret the x-rays?
Professional standards and case law certainly make it quite
clear these days that someone must be officially responsible for
interpreting the x-rays and providing a report to the patient, as well as for
archiving that report as a part of the patient’s health care record.
If you, as the doctor who produces the films, are going to
be interpreting the x-rays, you must decide whether you are comfortable with
signing an official written report of radiologic findings for a patient who is
not your own patient. For a DACBR
or other radiologist this is an expected part of doing business, but a general
practice DC may or may not want to assume this responsibility for himself, even
though it is legal for him to do so.
If you decide that you do not want to fill this
role, it may initially sound easier to simply expect the referring doctor to
interpret the x-rays. The referring
doctor may even be quite happy to do this - and may even expect it - but it is
not as easy as it sounds.
There’s always a liability question lurking in the
background. What happens if the
referring doctor misses a diagnosis? What
if that mistake causes damages for the patient?
There would, of course, be a lawsuit filed.
It would not, however, name only the referring doctor.
The malpractice suit would also name the doctor who produced the x-rays.
Admittedly, it’s an unusual circumstance, but it is wise, as a matter
of routine risk management, to prepare for this unfortunate circumstance by not
entering naively into a situation with potential liability over which you
yourself have little control.
In malpractice cases, vicarious liability always
seems unfair, but it is a fact of life that cannot be avoided by ignoring it.
If you decide that you want to
produce x-rays on a technical basis for another doctor, be sure to first obtain
good legal advice. It is
probably not possible to entirely avoid vicarious liability, but a few things
might help to reduce the risk.
The first factor, always the most important, is to make
sure that the patient is informed and completely understands the service being
provided. Your attorney may advise
the use of a informed consent document that specifies the respective
responsibilities of the two doctors involved.
For example, the document might specify that the x-rays are being taken
on a technical basis by Doctor A, and that Doctor A is responsible only for
ensuring that they are produced in a safe manner and are of diagnostic quality,
whereas Referring Doctor B is responsible for the interpretation of the x-rays.
In some offices Doctor A might employ an x-ray technician who produces
the x-rays. In this case, the informed consent document could notify the
patient that Doctor A does not even see the x-rays, and that the patient’s
treating doctor B is responsible for all factors relating to interpretation and
provision of information to the patient.
Your attorney would also need to assist you in drawing up a
contract between Doctor A and Referring Doctor B. Each doctor should make sure that
the other has an active malpractice policy and should be certificate
holders on those policies so that each receives a copy of the
other’s declarations page with each annual renewal.
It would also be a good idea to consider HIPAA factors,
although any covered health care provider may share protected health information
with another health care provider for treatment purposes without a business
associate contract. At any rate,
privacy provisions might be something to consider in the contract.
Once these factors are handled, it is then necessary to
determine the proper way to bill for services:
