“The buck stops here” – don’t blame mistakes on someone else

This immortal phrase was popularized by President Harry S. Truman who had it written on a plaque on his desk in the Oval Office of the White House.

The sentence was to signify the fact that the President had the ultimate responsibility for decision-making and the ultimate responsibility for all decisions.

What relevance does that phrase have to do with the practice of chiropractic? Frankly, everything!

A doctor who is a sole practitioner may well acknowledge that the “buck stops with them.” That would seem like a logical conclusion since he or she may be the only “doctor in the house.” While that is the apparent conclusion, the result is not always the case. Sometimes the importance of the phrase seems to be lost on practitioners who may be associates or independent contractors within a health care team. A chiropractor may operate such practices, another regulated health care practitioner or a non-regulated individual who owns the office, equipment and provides the support staff and all facilities necessary to carry on chiropractic practice.  

In the situations involving group practices – whether with another chiropractor or a non-regulated individual, the phrase “the buck stops with the doctor” may, unfortunately, be replaced by: “teamwork is essential so that you can blame the mistakes on someone else.” As might be expected, the last phrase doesn’t work within the context of professional practice.

Serious consideration must be undertaken by every doctor, whether a sole practitioner or practising in an environment owned by another individual, as to the responsibilities of a chiropractor as it relates to the statute, regulation, by-laws, standards, guidelines and policies of the regulatory body in all aspects of the practice.  Every file, intake form, computer record, financial statement, billings and receipts, together with anything that emanates for or on behalf of a patient is the ultimate responsibility of the practitioner.  

There are far too many examples of disciplinary hearings wherein a practitioner will espouse the fact that the billings or insurance forms were prepared or submitted by someone in the office other than the doctor. Who provides the forms or does the billings in the office is irrelevant when considering that it is the practitioner who is responsible for ensuring that everything – and no less than everything – is correct. Blaming the owner of the practice, the support staff or even the computer program will not justify practice errors, and there should be evidence that such a review took place. This also applies to matters like the consent form signed by the patient. It cannot be left to staff to deal with its execution, failing which, the document has no substance or validity and may well be used contrary to its intended purpose.

The responsibilities set out above are not merely related to financial issues but also include matters relating to patient records. Regulated health care practitioners are accustomed to the term “HIC,” which is the acronym for “health care custodian.”  A doctor is responsible for the security and privacy of his or her patient records. When carrying on practice within an environment established by a non-regulated health care practitioner, serious concern must be undertaken by the associate practitioner to ensure that the records are appropriately secured and privacy is maintained.  If or when the relationship between the two parties is terminated, the health care practitioner has a responsibility to ensure that a properly regulated practitioner becomes the subsequent “HIC” for patient records. It is of no interest to the patient or a regulatory body that the doctor and the owner of the clinic have an agreement relating to patient files. The appropriate legislation regarding privacy and patient records supersedes any such contract. The patient files cannot be abandoned.

In conclusion, every part of professional practice is the responsibility of the doctor, whether as a sole practitioner, associate or partner.  The benefits of being an associate and having a lack of apparent contractual obligations when dealing with the office and such matters as cleaning, staffing or even turning off the lights at night, does not diminish the responsibility of ensuring compliance with patient interaction, billings, patient records, etc.  To ensure regulatory compliance, a chiropractor has to be cognizant of what is happening in the office and ensure that everything that has to do with his or her professional practice complies with what is required by the regulatory body and any other relevant organization such as an insurance company, a privacy commissioner or worker’s compensation board. To paraphrase the adage: “the buck stops with the doctor.”

Allan Freedman is a Toronto-based lawyer and an instructor at the Canadian Memorial Chiropractic College, teaching risk and practice management. You can contact him at allan@amf-law.ca.