Can chiropractors order MRIs under anesthesia?

[urge]

Claustrophobic back pain adult with usual comorbidities. "Needs MRI under GA" because they have already tried "the pill" unsuccessfully.

Ordered by a chiropractor, who is going to ***** around with the films and if the radiologist's lecture says something bad then will refer to real doctor.

Discuss.

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[gaspasser2004]

I'm assuming there are medicolegal and clinical angles to this posting.

Mediolegal
I am not familiar with state/medical staff bylaws that allow a chiropractor to order radiological studies. Obviously, I wouldn't do the case if the chiropractor wasn't legally allowed to order the study.

Another related issue is manipulation under anesthesia (MUA). In Texas, this issue is still not resolved between the medical and chiropractic board whether MUA is the practice of medicine or chiropractic. Unfortunately, the "cash and carry" aspect of this practice makes it too appealing for some providers.


Clinical
Who here hasn't questioned a diagnosis by a surgeon, OB, etc. when providing an anesthetic? As a consultant, if you strongly feel the radiological study is not indicated then you should take it up with the chiropractor. Fortunately, this appears to be an elective (and not emergent) study, so there should be no harm to the patient if you delay the anesthetic to get more information.

There is a funny case in Board Stiff III where a morbidly obese patient with presumed cauda equina syndrome demands "conscious sedation" for her MRI and then proceeds to hop up from the gurney onto the MRI table. The "boards" answer is that cauda equina is a potential neurosurgical emergency and that it is not your place to question the diagnosis during the urgent/emergent workup.

 

[bostonblaz]

It depends if you get paid or not.

 

[IlDestriero]

It depends if you get paid or not.

I think that you're right on the money. The issue of whether or not the radiologist will be paid is clear. If they book it, the insurance question is taken care of. The insurance company MAY elect not to pay YOU for the anesthetic if they don't accept the chiropractor as a person able to determine the medical necessity of the GA/MAC for the scan. If it is not urgent, and it may be if there are new deficits, etc, make them go to their PCP who can document their need for GA/MAC. That's your out if they try not to pay. Call the chiropractor directly and find out exactly what is going on and if you think that it can wait until they see the PCP first. Kids are so much easier.

 

[SleepIsGood]

Claustrophobic back pain adult with usual comorbidities. "Needs MRI under GA" because they have already tried "the pill" unsuccessfully.

Ordered by a chiropractor, who is going to ***** around with the films and if the radiologist's lecture says something bad then will refer to real doctor.

Discuss.

Over on the Pain forum, there's a Chiropractor who's trying to claim equivalency to a physician. He's just trying to convince people that he is an 'attending' and that there's science.

Quackery!!!!

Of course there are only like 2 of us on that forum that actually speak up against this guy.

 

[jwk]

Easy answer at my hospital - we don't do anesthesia or sedation for MRI cases, period, no exceptions.

Many years ago our hospital asked us if we would do these cases. We indicated we would do it ONLY if they purchased a full complement of MRI-rated anesthesia machines, monitors, carts, pumps, airway equipment, EVERYTHING, and that it would come out of someone else's capital budget, not ours. They refused - we politely declined.

 

[IN2B8R]

Easy answer at my hospital - we don't do anesthesia or sedation for MRI cases, period, no exceptions.

Many years ago our hospital asked us if we would do these cases. We indicated we would do it ONLY if they purchased a full complement of MRI-rated anesthesia machines, monitors, carts, pumps, airway equipment, EVERYTHING, and that it would come out of someone else's capital budget, not ours. They refused - we politely declined.

How do they handle peds patients who need an MRI?

 

[IlDestriero]

How do they handle peds patients who need an MRI?

They probably refer them out to me.

 

[jwk]

How do they handle peds patients who need an MRI?

There are two world-class pediatric hospitals in Atlanta - they do them there.

And as far as the OP - chiropractors don't have privileges at any of the hospitals I've ever been affiliated with, nor should we be involved with ANY type of chiropractic-based examination or care IMHO. If they can talk a private MRI center into letting them get scans, that's their issue.

 

[IlDestriero]

There are two world-class pediatric hospitals in Atlanta - they do them there.

And as far as the OP - chiropractors don't have privileges at any of the hospitals I've ever been affiliated with, nor should we be involved with ANY type of chiropractic-based examination or care IMHO. If they can talk a private MRI center into letting them get scans, that's their issue.

I used to get about 1 consult a month for ESIs from the chiropractor at my old hospital. I would see the patients, but only did the injections in a couple of them as they were not appropriate. He eventually got annoyed with me and referred them to someone else. Win, win.

 

[IN2B8R]

They probably refer them out to me.

You can have those kids, I'll settle for a Micheal Jackson like client.

 

[IN2B8R]

There are two world-class pediatric hospitals in Atlanta - they do them there.

And as far as the OP - chiropractors don't have privileges at any of the hospitals I've ever been affiliated with, nor should we be involved with ANY type of chiropractic-based examination or care IMHO. If they can talk a private MRI center into letting them get scans, that's their issue.

And how 'bout those fat ass clausterphobic adults? Ship them out as well? Damn, you guys must have enough volume from other services that, really, stuff like this must not put a big dent into the income.... Nice!

 

[core0]

There are two world-class pediatric hospitals in Atlanta - they do them there.

And as far as the OP - chiropractors don't have privileges at any of the hospitals I've ever been affiliated with, nor should we be involved with ANY type of chiropractic-based examination or care IMHO. If they can talk a private MRI center into letting them get scans, that's their issue.

You don't need privileges to order outpatient tests. Most FPs that order MRIs don't have inpatient privileges. For that matter given insurance companies predilection for dictating where they want tests done you really have no control over where the test will be done (ie in relation to privileges).

To answer the OPs question, when we felt (or a patient felt) they need an MRI under anesthesia the radiologist took care of it and they were the ordering physician. In GI it was the same. If some one referred us a patient for a colonoscopy who needed anesthesia the practice arranged it where the physicians had privileges. Works the same now in academics. If a patient needs anesthesia for an IR procedure, we refer them and IR takes care of arranging anesthesia.

Now whether a chiropractor should be able to order an MRI is a different story. It going to largely depend on what the state practice act says. In most states they have a license to preform and interpret radiology studies as pertains to x-rays.

David Carpenter, PA-C

 

[Hamhock]

nor should we be involved with ANY type of chiropractic-based examination or care IMHO..

QFT.

As much as I do not like to use such terms ('QFT'), I feel this discussion calls for me to pretend I am a youngster.
In a war - with Dr. Noctors and independent CRNA's - how much $$ could the most "free-market"/libertarian anesthesiologist possibly consider enough to cooperate/mingle with quacks like chiros?

I am not an anesthesiologist - dare I say EM resident! - who still respects you folks...please don't extinguish this respect.

HH, MD (quack hater)

 

[jwk]

And how 'bout those fat ass clausterphobic adults? Ship them out as well? Damn, you guys must have enough volume from other services that, really, stuff like this must not put a big dent into the income.... Nice!

See post #6 above. I guess maybe someone is doing these somewhere, but it's not us. Our MRI department runs non-stop all day, so I don't think they lack for business either. Are there THAT many people that really need a GA for an MRI?

 

[urge]

Are there THAT many people that really need a GA for an MRI?

Yes there are. 8 or so a week over here.

 

[pd4emergence]

I think the chiropractor question should result in a view of the hospital bylaws. If they are allowed to order the test, and you guys provide that service for the hospital, you are unfortunately not in a good position to refuse. Whether you get paid or not is a different question. If they are allowed to order the test but the insurance company won't reimburse because a chiropractor ordered the MRI, you may want to try having the radiologist document the failed MRI attempt and his/her rec that you guys be present.

JWK, we tried that approach a few years ago with our hospital, gave the all our demands for a MRI compat machine, syringe pumps, monitors etc. Unfortunatetly they bought everything we asked for. We do lots of kids which I don't mind. The closest children's hospital is 3 hrs away. The adults get to me. At least you can justify a kid not being able to be still for 45 minutes. The adults, I just want to tell them to be still or not have the study. We don't make jack from MRI's, all the kids are medicaid and so are most of the adults. The question came up not to long ago as to whether we would continue the service. My personal opinion is that we are the only hospital in the area that offers this service, parents would have to drive 3 hours for an MRI if we didn't. As long as we break even on them we will continue doing them. We will see what happens in the future.

 

[kmurp]

I think the chiropractor question should result in a view of the hospital bylaws. If they are allowed to order the test, and you guys provide that service for the hospital, you are unfortunately not in a good position to refuse. Whether you get paid or not is a different question. If they are allowed to order the test but the insurance company won't reimburse because a chiropractor ordered the MRI, you may want to try having the radiologist document the failed MRI attempt and his/her rec that you guys be present.

JWK, we tried that approach a few years ago with our hospital, gave the all our demands for a MRI compat machine, syringe pumps, monitors etc. Unfortunatetly they bought everything we asked for. We do lots of kids which I don't mind. The closest children's hospital is 3 hrs away. The adults get to me. At least you can justify a kid not being able to be still for 45 minutes. The adults, I just want to tell them to be still or not have the study. We don't make jack from MRI's, all the kids are medicaid and so are most of the adults. The question came up not to long ago as to whether we would continue the service. My personal opinion is that we are the only hospital in the area that offers this service, parents would have to drive 3 hours for an MRI if we didn't. As long as we break even on them we will continue doing them. We will see what happens in the future.

Good for you to keep up this MRI service for your community. Good anesthesia groups (I feel) need to do these kind of things as a service to the community they live and work in. The hard part is in deciding when it's too much (financially). Every group has it's "loss leaders": it might as well be something that's really needed.

 

[jwk]

JWK, we tried that approach a few years ago with our hospital, gave the all our demands for a MRI compat machine, syringe pumps, monitors etc. Unfortunatetly they bought everything we asked for. We do lots of kids which I don't mind. The closest children's hospital is 3 hrs away. The adults get to me. At least you can justify a kid not being able to be still for 45 minutes. The adults, I just want to tell them to be still or not have the study. We don't make jack from MRI's, all the kids are medicaid and so are most of the adults. The question came up not to long ago as to whether we would continue the service. My personal opinion is that we are the only hospital in the area that offers this service, parents would have to drive 3 hours for an MRI if we didn't. As long as we break even on them we will continue doing them. We will see what happens in the future.

You're situation is definitely different than ours - we're in the big city and don't do kids except for ear tubes and tonsils.

 

[IN2B8R]

See post #6 above. I guess maybe someone is doing these somewhere, but it's not us. Our MRI department runs non-stop all day, so I don't think they lack for business either. Are there THAT many people that really need a GA for an MRI?

Psssst, in case you have not noticed, the entire U.S. population is clausterphobic, depressed, OCD, freakish about any type of needle stick/"painful" surgery, and just outright would like to get a f*ckin' cheesburger with fries while the MRI machine is rolling.... So, yeah, there indeed are that many people who need sedation for an MRI!

 

[2win]

Psssst, in case you have not noticed, the entire U.S. population is clausterphobic, depressed, OCD, freakish about any type of needle stick/"painful" surgery, and just outright would like to get a f*ckin' cheesburger with fries while the MRI machine is rolling.... So, yeah, there indeed are that many people who need sedation for an MRI!

Very well put my friend...very well.
What is the percentage of US population on antidepressants?
Or - with a "chemical imbalance"?
2win