The Alberta government ordered chiropractors to cease normal operations and limit care to urgent, critical and emergency cases only. Chiropractors are not permitted to provide any service that does not constitute urgent, critical or emergency care.
The ACAC was asked by some members to clarify what urgent, critical and emergency chiropractic care means.
This is defined for all chiropractors as follows:
Urgent neurological chiropractic care:
- This is defined as a pathology that could reasonably lead to a neurological deficit. The patient must be a demonstratable candidate for response to manual treatment, as delivered by a chiropractor; and if left untreated would result in the patient seeking urgent or emergency care at a medical facility. This must be established with a complete neuro/ortho/biomechanical assessment. No other form of assessment may be used to establish the need for care. Subluxation, wellness or functional care does not meet the criteria for urgent neurological chiropractic care in the context of what has been communicated by Alberta Health.
Urgent musculoskeletal chiropractic care:
- This is defined as a pathology that could reasonably be a musculoskeletal condition for the patient that does, or would incapacitate the patient’s ability to function in performing daily activities without immediate intervention; and if left untreated would result in the patient seeking urgent or emergency care at a medical facility. This must be established with a complete neuro/ortho/biomechanical assessment. No other form of assessment may be used to establish the need for care. Subluxation, wellness or functional care does not meet the criteria for urgent musculoskeletal chiropractic care in the context of what has been communicated by Alberta Health.
Relying on patient preference to receive chiropractic care is not currently acceptable in establishing the need for urgent, critical or emergency care. Any consideration for in-person care should begin with the assumption that in-person care is not necessary.
Patients should be thoroughly communicated with via a telephone or Telehealth consultation prior to a recommendation for a neuro/ortho/biomechanical consultation and assessment.
Remember that if you are consulting via Telehealth and deem that physical care is necessary, you cannot bill for Telehealth and in-person care on the same day. Demonstration of conservative management recommendations should be proven and documented prior to consideration for an invitation to a neuro/ortho/biomechanical consultation and assessment.
Patients should be screened for COVID-19 prior to the recommendation for an in-person consultation and they should be screened again prior to their arrival in your clinic. The acceptable screening criteria can be found here. This screening should be completely documented. Any positive answers in COVID-19 screening would indicate ineligibility for in-person care regardless of the patient’s urgent health-care needs. Patients who demonstrate positive answers in the COVID-19 screening should be advised to call 811 immediately.
Patients should have no physical interaction with other patients or staff during their time at your clinic.
Failure to comply with the orders from the Chief Medical Officer of Health to limit care to urgent, critical or emergency care may result in an investigation by the Chief Medical Officer of Health. This investigation may result in provincial penalties as well as disciplinary action from the ACAC.
The order from the Alberta government to close chiropractic clinics to all but urgent, critical or emergency care is significant, and all chiropractors are required to abide by the civic order to suspend all non-urgent operations. Alberta chiropractors have an ethical and fiduciary responsibility to support public health.
It is impossible for the ACAC to define how best to respond in each patient case that may be presented. Chiropractors are expected to use their professional discretion and experience in assessment and diagnosis to determine if patients meet the urgent, critical or emergency care threshold set by government. Chiropractors who provide care for patients meeting this threshold must understand there will be a high level of public and professional scrutiny while this civic order remains in place. It is essential that you document your decisions and delivery of care to clearly demonstrate that the patient met the threshold set by the government should those decisions be questioned.
Finally, regardless of the information contained in this update, the orders of the Chief Medical Officer of Health and the Government of Alberta will always supersede the directions and guidelines provided by the ACAC. This is a rapidly changing environment and we are committed to keeping our members as informed as possible. Please check our website for all communications regarding COVID-19.