OMM legal issues

[dyspareunia]

Do patients sign release forms before receiving OMM?

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[Siggy]

Do patients sign release forms before receiving OMM?

When I've done/seen OMT performed both in patient and out patient, the answer would be no. Why would a release be needed for some muscle energy or thoracic HVLA?

 

[Poliscidoc]

Do patients sign release forms before receiving OMM?

Have you ever went to the doctor for the first time and signed 10+ papers and read them all? There are 2-3 attorneys at my dads law firm that do nothing but create and revise doctors paperwork with the sole purpose of avoiding a lawsuit. Chances are most offices will have you sign some type of "waiver".

 

[dyspareunia]

Have you ever went to the doctor for the first time and signed 10+ papers and read them all? There are 2-3 attorneys at my dads law firm that do nothing but create and revise doctors paperwork with the sole purpose of avoiding a lawsuit. Chances are most offices will have you sign some type of "waiver".

I thought procedures needed to have their own waiver.

 

[Poliscidoc]

I thought procedures needed to have their own waiver.

You could always classify OMT (broadly) as a procedure (guessing here) or have them sign some type of blanket waiver that may or may not hold up if it comes to that...

 

[Siggy]

I thought procedures needed to have their own waiver.

In general invasive risky procedures need waviers. A UA is a "procedure" (it has a CPT code afterall) and doesn't require a special wavier. Neither does other basic procedures like IV starts, BGL checks, NG tubes, etc. All of those procedures get a basic wavier included in the legal paperwork signed before care is initiated.

 

[dyspareunia]

In general invasive risky procedures need waviers. A UA is a "procedure" (it has a CPT code afterall) and doesn't require a special wavier. Neither does other basic procedures like IV starts, BGL checks, NG tubes, etc. All of those procedures get a basic wavier included in the legal paperwork signed before care is initiated.

Isn't there a decent amount of risk with certain OMM techniques? So if you harm the patient somehow you are completely unprotected since there's no release form for it?

 

[GUH]

Isn't there a decent amount of risk with certain OMM techniques? So if you harm the patient somehow you are completely unprotected since there's no release form for it?

OMM, including HVLA, is safe in the hands of a skilled DO who watches for contraindications. Serious permanent damage from OMM is quite rare.
There are a lot of procedures that are more risky than even the "riskiest" OMM.

 

[dyspareunia]

OMM, including HVLA, is safe in the hands of a skilled DO who watches for contraindications. Serious permanent damage from OMM is quite rare.
There are a lot of procedures that are more risky than even the "riskiest" OMM.

Yea so are many invasive procedures, yet they all have legal backups.

 

[Siggy]

Isn't there a decent amount of risk with certain OMM techniques? So if you harm the patient somehow you are completely unprotected since there's no release form for it?

"Certain" is the key word. Prone cross handed thoracic HVLA in a relatively healthy patient? Nope. Muscle energy just about anyplace? Err... nope. Pretty much the contraindications (relative or absolute) for OMM falls under the heading of "don't be an idiot." You know, fractures, cancer, patient refuses, etc.

 

[dyspareunia]

"Certain" is the key word. Prone cross handed thoracic HVLA in a relatively healthy patient? Nope. Muscle energy just about anyplace? Err... nope. Pretty much the contraindications (relative or absolute) for OMM falls under the heading of "don't be an idiot." You know, fractures, cancer, patient refuses, etc.

Yes I understand.. Don't be negligent and there shouldn't be a problem.

Things happen. Patients sue for any reason they can think of.

 

[DocVapor]

Yes I understand.. Don't be negligent and there shouldn't be a problem.

Things happen. Patients sue for any reason they can think of.

So... where would you draw the line for needing a signature on an explicit waiver? You could CYA all day long but it would cost so much time and effort that you'd be losing out in the long run considering just how rare complications due to OMM are. And there's a good chance your patients would get so fed up with it they'd find someone else. If you did miss a red flag that was present and you went thrusting on someone's lumbar compression fracture, then you better get out your wallet regardless.

 

[babdoc]

Isn't there a decent amount of risk with certain OMM techniques? So if you harm the patient somehow you are completely unprotected since there's no release form for it?

As far as procedures go, OMT is pretty safe. However, there is well documented risk of modalities like cervical HVLA such as carotid dissection. Most of the studies that report this seem to be retrospective case series. Overall it's probably pretty safe in experienced hands.

 

[dyspareunia]

So... where would you draw the line for needing a signature on an explicit waiver? You could CYA all day long but it would cost so much time and effort that you'd be losing out in the long run considering just how rare complications due to OMM are. And there's a good chance your patients would get so fed up with it they'd find someone else. If you did miss a red flag that was present and you went thrusting on someone's lumbar compression fracture, then you better get out your wallet regardless.

No idea where I would draw the line. It seems like there is no line drawn though.. everything OMM/OMT related is without documentation of consent or acknowledgement of risk.

If I were an OMM practicing person I would probably have it in all of my "new patient" forms.

 

[DocVapor]

No idea where I would draw the line. It seems like there is no line drawn though.. everything OMM/OMT related is without documentation of consent or acknowledgement of risk.

If I were an OMM practicing person I would probably have it in all of my "new patient" forms.

I am sure it depends on the practice, but I can't imagine a physician performing OMT on a new patient without a discussion of the techniques, their risks and benefits, and obtaining verbal understanding and consent. Writing all that in the SOAP note would probably be sufficient the vast majority of the time.