Please Meet Attorney Ayesha Mehdi, Columnist for the NCC
Ayesha Mehdi, JD, MHSA, partner at Spencer Fane, LLP
Depositions tips for Chiropractic Doctors
Personal injury cases are a part of nearly every chiropractic physician's practice. It is estimated that one-third of all motor vehicle crash victims are treated by chiropractors. Many of the collision injuries treated by chiropractors involve whiplash, soft tissue injuries, musculoskeletal injuries, strains, and sprains. As part of your practice, you are frequently called upon to provide testimony during depositions in personal injury cases. The credibility of a chiropractor depends on how long he or she has been treating the plaintiff since the incident and what he or she projects the plaintiff's needs will be in the future. Credibility also increases when a chiropractor aggressively treats a patient immediately after an accident, and then reduces treatment to a point where the patient is told to come in on an as-needed basis.
Defense counsel will usually take your deposition. Expect plaintiff’s counsel to meet with you briefly before the deposition. During that meeting, you should share the facts that you hope to develop through your testimony, review your records thoroughly and request plaintiff’s counsel to demonstrate how a defense lawyer will try to use the facts to weaken your testimony and to warn you of any expected areas of cross-examination. Also, have plaintiff’s counsel point out to you specifically what may be argued to be a pre-existing condition of the patient. Plaintiff’s counsel will want to ensure that you can establish that the injury was caused as a result of the accident and that your treatment was reasonably necessary for the patient to function more normally. He or she will expect you to testify to facts that demonstrate how the injury prevented the plaintiff from working in the past and how the injury will affect the plaintiff’s ability to earn income in the future.
During the deposition, defense counsel may ask questions about your pre-deposition meeting with the plaintiff’s lawyer. Respond by keeping your answers vague. For example, you may state that you briefly met plaintiff’s counsel before the deposition and simply discussed your treatment. Do not give any indication that would suggest that the plaintiff’s counsel prepared you for the deposition. One way to protect yourself is to hire your own counsel for the deposition. Also, note that you may be questioned about your relationship with the plaintiff’s attorney. Again, honesty is the best policy. Generally, it is best practice to provide your patients with a list of attorneys that they may consult with. This will ensure that there is no bias when you give your testimony.
During the deposition, be aware that defense counsel will use any positive statement in the medical records to suggest that the plaintiff is no longer suffering from the injury, and if there is no improvement, then defense counsel may argue that the patient’s visits with you were a waste of resources and time. Do not get frazzled by this tactic. Another technique would be to undermine your treatment because you are not a medical doctor. Ignore the tone behind such questioning and simply tell the truth about the scope of your practice, without becoming defensive or apologetic. Further, it is common for plaintiff’s attorneys to provide certain physicians with letters of protection in which a lawyer promises that before distributing any settlement funds or jury awards to his or her client, he or she will contact the physician and make sure that the doctor’s bill has been taken care of. Defense lawyers will try to create the impression that the doctor has a financial interest in the case. Again, do not get defensive. Simply state that it is standard practice to obtain a letter of protection, and it does not create a financial interest in the case, since you will get paid regardless of what happens in the lawsuit.
Overall, you need to be prepared for depositions. Hire a lawyer if you need to, and do not stress. Just know that you should not feel compelled to answer every question, and as long as you were to the point and honest, you did fine. Finally, rest assured that if there are any errors in the answers given, many states (including Nevada) and the federal rules provide an opportunity for you to attach a correction sheet to the transcript together with an explanation for the change.
Ayesha Mehdi, JD, MHSA is a partner at Spencer Fane, LLP, a national law firm with 18 offices across the country. She focuses her practice on representing health care practitioners, along with various health care businesses, in connection with corporate, transactional, licensure, and regulatory matters. She counsels clients on fraud and abuse; health information technology (HIT) and compliance, including the Stark II physician self-referral law, the Medicare/Medicaid anti-kickback statute, corporate practice and fee-splitting restrictions; antitrust; health information privacy and security (HIPAA and HITECH Act); and health care reimbursement.
The First-Ever Public NCC Anti-Opioid Seminar!
Las Vegas, Nevada – June 7, 2019 –For the first time in United States history, chiropractic physicians are fighting the opioid addiction crisis, and right now is your chance to be part of it. The NCC immediately needs each member to invite two patients to our first public education anti-opioid seminar. The event will include a powerful and emotional video, a discussion of the opioid crisis by chiropractic physician panelists, and a chance for attendees to ask our panelists their own questions about opioids. The purpose is to steer patients toward chiropractic as the best way to fight pain.
During the past year-and-a-half, an introductory video, worth tens of thousands of dollars, was produced. The work was entirely donated to the NCC by numerous members of the Las Vegas production community, who were personally touched by the opioid addiction tragedy. The ten minute video stars Nevada State Chiropractic Board president, Dr. Jason O. Jaeger, and features NCC board chairperson, Dr. Stephanie Youngblood. In addition to opening each public seminar, the video will soon be shared, online, with NCC members through a private YouTube channel so members may share it with their patients. The long-term plan is to take the anti-opioid education program to a national audience.
The idea for the anti-opioid public education program was brought to the NCC by network television news producer Michele Kane, who wrote, produced, and directed the video and is coordinating and producing the seminars with her husband, technical director Jon Kane. CoverEdge Television owner, Rich Travis, whose company produces Las Vegas news coverage for many national and international programs, provided months of shooting and editing. Scot Rammer, composer for many commercials and numerous shows on the Las Vegas Strip, contributed music. Jon Jacobson, who lost his partner at Oakdale Post Audio to an opioid overdose, provided technical audio support. Other contributions came from Dr. Mel Pohl and the Las Vegas Recovery Center, Dr. Sherry McAllister and the Foundation 4 Chiropractic Progress, Clark County coroner, John Fudenberg, two recovering patients who tell their stories, and three parents who share what it was like to lose their children to overdoses.
The inaugural free public seminar is scheduled for Saturday, June 29th, from 6 to 7 PM at the offices of Dr. Nicole Harmel at 8879 W. Flamingo Road, Suite 101, in Las Vegas. Space is very limited, so tell your patients who want to attend that they need to sign up today by calling NCC anti-opioid committee director, Michele Kane, at (702) 466-9078. NCC members, please feel free to print this media release and display it in your offices and/or hand it out to patients. If you’re not an NCC member but want to be part of this historic program, join the NCC today by clicking here for the NCC membership form. Then host a seminar by contacting NCC anti-opioid program director Michele Kane by phone at (702) 466-9078 or by e-mail at email@example.com
Nevada Chiropractic Council's
Resolution Supporting the
To Clinical Decision-Making
Whereas, the Nevada Chiropractic Council (NCC) is a professional organization, the mission of which is to protect and enhance the chiropractic profession through organized leadership, education, and the promotion of the chiropractic discipline and practice; and,
Whereas, the NCC works to protect the right of individual chiropractors to choose the clinical procedures within the chiropractic standard of care and practice, that he or she believes best address the patient's complaint and/or diagnosis; and,
Whereas, the "performance, ordering, or use of x-ray" is included in the definition of "chiropractic" in the Nevada Public Health Code NAC 634.412, which states the following:
Competence. (NRS 634.030)
1. A licensee shall maintain competence in:
(a) The application of chiropractic; and
(b) The production and interpretation of radiographs; and,
Whereas, radiology is a scientifically proven component of the chiropractor's clinical practice, as the role of diagnostic radiology is clinically useful in evaluating multiple aspects of human spinal anatomy, biomechanics, postural faults, misalignments, vertebral subluxation complex, and other pathologies; and,
Whereas, one of the primary tasks of the NCC is to educate and inform Nevada's chiropractic community, other organizations, and the public on the latest requirements and trends in chiropractic treatment protocols; and,
Whereas, the NCC recognizes the need for scientific evidence to support chiropractic care provided by chiropractors across the state and the nation, and that the utilization of rational, evidence-based clinical guidelines and "best practice" documents are critical ways to implement research findings into clinical practice; and,
Whereas, the NCC also recognizes that clinical practice guidelines have the potential to streamline healthcare delivery, improve patient outcomes, and increase safety by using best available scientific evidence and broad consensus to develop appropriate care parameters; and,
Whereas, the NCC further recognizes that clinical practice guidelines do not, cannot, and should not represent a "set-in-stone" prescription of care, as they do not take into account such critical factors as the judgment of the chiropractor and the individual circumstances and values of the patient; and,
Whereas, the NCC is aware of recent publications from the American Board of Internal Medicine (ABIM) Foundation, as part of the ABIM Foundation's Choosing Wisely® campaign, regarding the appropriateness of radiological spinal imaging for patients with low-back pain during the six weeks after onset in the absence of red flags; and,
Whereas, the NCC Board of Directors fundamentally rejects the statement in this document that states: "Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags."; and,
Whereas, the NCC recognizes that entities such as insurance companies and insurance claims reviewers are using this publication to deny the use of radiographic studies to patients and deny reimbursement for such studies to chiropractors; and,
Whereas, in 2015, the NCC Board of Directors, while stipulating that no guideline can replace the clinical decisions made by a chiropractor in the course of treating an individual patient, passed a Resolution promoting and supporting the evidence-based science for appropriate radiologic evaluations of patients seeking chiropractic care developed by the Practicing Chiropractor's Committee on Radiology Protocols (PCCRP); and,
Whereas, the NCC Board of Directors has not been made aware of any subsequent evidence-based radiological guidelines or protocols that would supersede or render obsolete the PCCRP's Guidelines, including the Choosing Wisely® document from the ABIM Foundation;
Now, therefore, be it resolved by the NCC Board of Directors, that we re-affirm our Resolution to promote and support the PCCRP's Guidelines.
Now, therefore, be it further resolved by the NCC Board of Directors, that all Nevada doctors of chiropractic who utilize radiologic evaluations in their practice, familiarize themselves with the PCCRP x-ray Guidelines, which can be accessed online at www.pccrp.org.
Approved by formal NCC Board of Directors vote on October 11, 2017.
January 24, 2018 8:30 AM PST
The NCC Fights for Chiropractors’ Right
to Take X-Rays
Las Vegas, Nevada - January 24, 2018 - The NCC Board of Directors formally reaffirmed its resolution to promote and support the PCCRP’s Guidelines allowing Nevada chiropractic physicians to take X-rays. It did so by passing the Opposition to the Choose Wisely X-Ray Position.
The NCC supports the right of chiropractic physicians to use their professional judgment and expertise to determine what is best for each patient and to practice any techniques, including the taking and reading of x-rays that fall within the scope of practice in the State of Nevada.
Dr. John Brown moves to oppose the “Choose Wisely X-Ray Position” and accept the NCC position paper on the “Opposition to the Choose Wisely X-Ray Position.”
"Doctors of Chiropractic must be able to offer the best care possible for their patients, which includes the use of radiology,” says NCC Board president, Dr. Stephanie Youngblood. “Chiropractic physicians have used diagnostic radiology as an integral tool in quality patient assessment for more than one-hundred years. The Choose Wisely guidelines do not take into consideration that, for subluxation analysis, X-ray has been a standard part of the initial examination in order to give the patient the highest quality and safest care."
NCC treasurer Dr. John Brown. says, “Just last week I saw a tumor in the upper part of a lung on our cervical X-rays. Last year we detected a type of cancer in someone’s pelvic bone, because we take X-rays. Many types of cancer metastasize to the spine. Even if we only detect cancer in a patient once a year, taking X-rays can save a life."
“I recently had a young 15-year-old male patient, who had been suffering from back pain for a few weeks. He did not remember anything that may have happened to cause his pain. His X-ray showed a pars fracture in his lower lumbar spine that was mildly unstable. This changed my treatment plan significantly and avoided any further injury that could have occurred if I had not taken X-rays" says NCC northern Nevada Director, Dr. Adam Ingles.
The NCC Board of Directors recommends that all Nevada doctors of chiropractic, who utilize radiologic evaluations in their practice, familiarize themselves with the PCCRP X-ray Guidelines, which can be accessed online at www.pccrp.org.
For more information, please contact the Nevada Chiropractic Council at firstname.lastname@example.org.
NCC, 500 South Rancho Drive, Suite 9, Las Vegas, NV 89106
June 27, 2017 6:30 AM PST
Two Nevada Chiropractic Physicians Board Members Honored
Las Vegas, Nevada – June 27, 2017 – Nevada Governor Brian Sandoval has received a letter honoring two members of the Chiropractic Physicians’ Board of Nevada. The letter, from the Federation of Chiropractic Licensing Boards, specifically recognizes CPBN president Dr. Benjamin Lurie and secretary/treasurer Dr. Jason Jaeger. Jaeger and Lurie, who are NCC members, were commended for their commitment to protecting the health, safety, and welfare of Nevada citizens. The honor was issued after the FCLB’s annual May meeting in Orlando, Florida.
State board members from the U.S. and provincial regulators from Canada attend each year as volunteers to teach and learn from each other to upgrade the quality of chiropractic regulation and public protection. States and provinces benefit, because FCLB membership guarantees access to cost-saving ideas, advance warning about new challenges, and opportunities to pool resources with other boards.
The annual FCLB educational conferences help board members, staff, and representatives from the offices of the Attorneys General identify emerging problems and solutions in healthcare regulation. This year’s educational program included presentations on several critical issues, including chiropractic mobility, regulatory ethics, sunset reviews, licensure exams and services of the National Board of Chiropractic Examiners, the effective use of settlement agreements, regulatory leadership and several other topics.
The NCC needs energetic people to participate in order to protect the safety of the public in Nevada and the rights of the silver state’s chiropractic physicians. If you are an NCC member, get involved. If you are not a member yet, join.
For more information, please contact the Nevada Chiropractic Council, email@example.com.
June 21, 2017 6:30 AM PST
Major Support Announced on Reimbursement Parity Issue
Las Vegas, Nevada – June 21, 2017 –Nevada is going to have the support of a major southern California chiropractic and health science university in the fight for insurance parity. NCC member Dr. Jason Jaeger requested the June 5th meeting in Los Angeles with the Southern California University of Health Sciences, which is his alma mater. He wanted an opportunity to explain to university administrators that reimbursement parity will end up helping patients.
It follows that if there are more graduating chiropractic physicians, there will be more options with which to fight the opioid addiction epidemic. University administrators love the idea. Chiropractic physician and university president, Dr. John Scaringe, has been a member of the university faculty for more than twenty-five years. He says that it’s a great idea for states to work together and collaborate on the parity issue, because there is strength in numbers.
Dr. Jaeger asked if the Nevada chiropractic community could count on the school to support the parity issue. Dr. Scaringe said yes.
The NCC and its members are a very proactive group, but we need energetic people to participate now more than ever in protecting the safety of the public in Nevada and the rights of the silver state’s chiropractic physicians. If you are an NCC member, get involved. If you are not a member yet, join.
For more information, please contact the Nevada Chiropractic Council, firstname.lastname@example.org
Please Help Preserve the Anti-Discrimination Language
in Section 2706a of the Affordable Health Care Act
We, the members of the NCC are very concerned about the language in the new versions of the Affordable Health Care Act (AHCA) currently being drafted by the United States Senate and Congress and how it could negatively impact the opioid addiction crisis in the United States as well as in the State of Nevada.
Currently, Section 2706a of the existing Affordable Health Care Act (Obamacare) eliminates discrimination against healthcare providers of different license types. At this time, both federal and Nevada law deem that a chiropractic physician holds physician status, equal to medical, osteopathic, dental, and podiatric doctors. However, in the most recent draft of the House AHCA bill, the anti-discriminatory language has been eliminated. If the same happens in the Senate, and we lose the language in 2706a, a situation could be created that may worsen the opioid crisis in the United States. If chiropractic physicians no longer have reimbursement parity with other doctors, qualified chiropractic physicians, who offer patients a drug-free solution to pain, could be driven away from practicing chiropractic. In addition, patients could also be discouraged from seeking relief from chiropractic, if their insurance companies won’t help pay for their care by chiropractic physicians. If that should happen, we anticipate that more patients who seek pain relief would be driven to using opioids. The NCC is dead set against that happening.
Chiropractic, in its purest form, involves no pain medication. Therefore, we believe that chiropractic could go a long way toward preventing patients from resorting to the use of opioids, becoming addicted, and needlessly dying from overdoses.
The NCC implores you to support and fight for retaining language of equality. Nevada Governor Brian Sandoval recently detailed in his State of the State address that the three solutions to the opioid addiction crisis are chiropractic, acupuncture, and counseling. Please let us know that we can count on your support and possibly an amendment from you that stands up for health care equality in our great nation. Eliminating such language would be a huge step backward that could result in a terrible health care domino effect.
Please cut and paste this letter and send it to the Senators listed below. Remember to add your name, title, and address.
List of Nevada Senators and Staff
Catherine Cortez Masto
Carl Segerblom, health legislative aide
Rachel Green, health legislative aide
Full senators contact list
U.S. Senate: Senators of the 115th Congress
U.S. Senate: Senators of the 115th Congress
_Senators of the 115th Congress
April 28, 2017 6:30 AM PST
A Great Step Forward in Insurance Reimbursement Equality
Las Vegas, Nevada – April 28, 2017 –The Nevada Chiropractic Council (NCC) is very excited to announce a major development in its fight for equal insurance reimbursement for Nevada’s chiropractic physicians.
Following a meeting, Dr. Jason Jaeger just revealed the following:
“The NCC and its Equality in Reimbursement Subcommittee met with one of the state and country’s top insurance providers. Preliminary discussion was very positive and brings hope that Nevada’s chiropractic physicians will soon be reimbursed at rates equivalent to their medical and osteopathic counterparts.”
As you know, the fight for equal reimbursement has been waging for at least a decade. Another NCC member heavily involved in the battle is past president, Dr. Bobby Moore.
“Chiropractic physicians have been insisting for many years that insurance companies need to follow federal and state law by reimbursing Nevada chiropractic doctors at the same rates paid to other doctors. Today’s chiropractors have the same legal physician status as other providers, the same enormous student loan debt, and the same, if not more, credit hours in college as medical doctors. Yet chiropractic physicians are still routinely reimbursed at lower rates for services than other medical providers, even though we all use the same codes. The new development is sure to be another positive turning point for chiropractic physicians in Nevada and all over the world,” said Moore.
Current NCC board president, Dr. Stephanie Youngblood, has also been heavily invested in the struggle for equal reimbursement.
The NCC will update members as quickly as details become available. In the meantime, if you are not yet a member of the NCC, join! If you are a member, get involved. The NCC is a vital group of chiropractic doctors and assistants who work hard to make a positive difference for our patients and our practices. The more of you who make your voices heard in the NCC, the faster we will accomplish great goals.
For more information, please contact the Nevada Chiropractic Council, email@example.com
April 26, 2017 6:30 AM PST
The State Assembly will now schedule SB 437 to be heard, probably this week, at which time the bill will be assigned to committee. The bill came from the Senate Committee on Commerce, Labor, and Energy and will be assigned to the Assembly Committee on Commerce and Labor.
"It's not over yet. We all still need to be on high alert and ready to act at a moment's notice," stated Dr. Lurie.
For more information, please contact the Nevada Chiropractic Council, firstname.lastname@example.org
NCC Congratulates the Texas Chiropractic Board of Examiners on the Passing of the Sunset Bill
Dear Nevada Chiropractors:
Thank you to those of you who contacted the Senate on Commerce, Labor and Energy in opposition to SB 437.
"Dr. Lurie, legislative chair for the Chiropractic Physicians Board of Nevada, has moved the current position on SB 437 to NEUTRAL. The PT Board and the PT Association have agreed to remove the controversial language in Section 2 at this time."
Dr. Lurie stated that he and the Board's lobbyist are monitoring SB 437 very closely. If there is any language that changes that would be a concern to public safety and protection, Dr. Lurie stated that they will immediately update the NCC as well as the NCA.
Dr. Lurie wants to thank all those chiropractic physicians who took a moment to write letters to the Senate Committee on Commerce, Labor, and Energy in opposition. "Everyone had a big impact on this bill."
Thanks so much!
Dr. Stephanie Youngblood
April 7, 2017 7:30 PM PST
Back to the Drawing Board for SB 437
On February 7, 2013, the Nevada Attorney General issued its opinion confirming Nevada law:
“The law is clear that a licensed physical therapist is not authorized to practice medicine, osteopathic medicine, homeopathic medicine, chiropractic, or any other form or method of healing. In addition, the practice of physical therapy specifically prohibits chiropractic adjustment. Finally, because manipulation and adjustment of the human body require licensure by the Chiropractic Physicians’ Board in the State of Nevada, a physical therapist may not lawfully perform any manipulation or adjustment of the spine or any other articulation of the human body that involves chiropractic thrust manipulations and adjustments. Thrust manipulations and/or adjustments are recognized chiropractic techniques and beyond the scope of authorized activity for a physical therapist.”
Media Release February 13, 2017 PM PST
Big Progress in the Struggle for Parity!
Media Release Jan. 31, 2017
The Cats Out of the Bag
Now We Can Finally Share
What We Have Been Doing Last Year
hint... Equal Reimbursement per the Nevada Division of Insurance
NCC member Dr. Jason O. Jaeger, who just spoke before the State Division of Insurance in Carson City about the equal reimbursement issue, will be a guest speaker at this month's general membership meeting.
January 18, 2017
NCC Leads the Way with Anti-Discrimination Reimbursement for NV Chiropractic Physicians
Carson City, Nevada – Jan. 18, 2017 – Dr. Jason O. Jaeger, formerly a State Southern Director of the Nevada Chiropractic Council (NCC) and currently the secretary/treasurer for the Nevada Chiropractic Physician’s Board,
New Research: Chiropractic Reduces Opioid Medication by 57% Former Dartmouth Doctor
MARCH 22, 2017 • KIRO COFFEE
New research from a former Dartmouth Doctor presented at the New Hampshire Annual Chiropractic Association meeting states that seeing a chiropractor can reduce opioid prescriptions by as much as 57%.