WATCH WHAT YOU PROMISE!
Some ads create complaints
By Timothy J. Feuling

Chances are that you advertise. Nearly every doctor of chiropractic does. Whether you run a small display box in the yellow pages or large ads in the local newspaper, your advertising can be an important way to market your practice.

It can also get you into a lot of trouble with your state board if you aren’t extremely careful.

According to most boards of chiropractic examiners in the country, advertising is one of the top causes of complaints and investigations. A study of complaints filed with the Texas Board of Chiropractic Examiners during a three-year period showed that advertising was the third most common type of complaint, topped only by fee complaints and the vague “unprofessional conduct” category.

Penalties for advertising violations can range from a warning letter to revocation of your license. Since board complaints can cost you as much as, if not more, than a malpractice lawsuit, it’s vital to pay close attention to advertising content and placement in order to comply with state laws.

It’s also important to realize that your ads can be introduced as evidence in a malpractice case and used by a plaintiff’s attorney to show that you “promised” results or that you misled the patient.

Advertising can be a particularly risky endeavor for several reasons:

• Convoluted laws. One is that the laws can be complex, convoluted, vague, confusing, and even arbitrary.

The laws are often open to interpretation by board members who may have their own professional agendas or biases, as well as personal or professional animosities. To compound matters, laws differ greatly from state to state.

Some laws are highly general. For instance, the Alabama statute states: “Any chiropractor who disseminates or causes to be disseminated or allows to be disseminated any advertising which is in any way false, misleading, or which has the capacity or tendency to deceive, or mislead the recipient in any manner, shall be deemed to be in violation ...”

Others are very specific, such as the Kentucky law that mandates: “An advertisement must include the business name and address, chiropractor’s name, telephone number, expiration date if any, and suitable words or letters designating the particular doctor degree held by the chiropractor. ‘D.C.’ shall designate a doctor of chiropractic. Any deviation from this requirement must first be approved by the board.”

Before you place an ad, get a copy of your state’s latest regulations concerning advertising. These are usually available online at your board’s Web site. (To find your state board’s Web site, you can visit www.fclb.org and click on “chiropractic boards” for a list of online addresses.)

Make sure you have the most recently updated regulations, because they change frequently. In Texas, for instance, the law was changed concerning the use of the term “physician” or “chiropractic physician.” Unfortunately, the change went into effect after many DCs had submitted — and paid for — their yellow pages ad.

• Subjective interpretation. The second reason advertising can be so risky is that the interpretation of the laws can be very subjective. Most ads have an admonition against any language that can be construed as making “unsubstantiated claims” about chiropractic care.

The New York Board noted that it has seen “an increase in the use of advertisements that employ false or misleading statements that may deceive or defraud the public. These advertisements typically make unverifiable claims or cite studies from unreliable sources.”

The problem with these laws is the issue of who gets to decide what’s “misleading,” which claims are “unverifiable,” and which sources are “unreliable.”

If you state in your ads that you can reduce back pain in adults, you’re probably on safe ground since there is ample evidence to support that claim.

But if you state that you can cure asthma, you’re on thin ice and will probably be called up before your board to “prove” that claim.

In between the two extremes is a huge gray area that includes certain statements used by subluxation-centered chiropractors. Many ads drawing complaints discuss the benefits of subluxation correction.

Normally, while they don’t make direct claims about the power of chiropractic to “cure” or “treat” disease, they contain information on how vertebral subluxations can affect the nervous system and therefore compromise health.

By correcting these subluxations, many ads state, chiropractic allows the body to achieve a higher state of wellness.

The ads may also include statements noting that patients have reported improvement in various health issues.

Some doctors don’t think vertebral subluxation itself is a verifiable entity. Some of them serve on state boards. You can imagine how they view an ad that talks about subluxation correction’s ability potential to tap into one’s “innate intelligence.”

Ironically, the general public lodges very few complaints about ads. Most come from other chiropractors or from anti-chiropractic factions. Personal enmity or professional disagreements can spur DCs to file complaints against their colleagues and competitors.

A Texas Board staff member, for example, reported that two chiropractors were taking turns filing complaints about each other’s advertising. In most cases, the Board stated, the complaints are not substantive, or even legitimate.

WHAT TO DO?

In order to navigate the dangerous waters of advertising:

1. Think like your critics. Examine all your ad copy very carefully, looking at every statement the way your critics would. Can you substantiate the claims you make? Are you using the language prescribed in your state laws? Have you included anything that could possibly be misconstrued as false or misleading? Do you imply that you can “cure” anything or guarantee results?

2. Be able to substantiate statements. Compile documents that can be used to substantiate any statements you make, including even fundamental ones such as on the existence of subluxations or the use of chiropractic for wellness care.

3. Familiarize yourself with guidelines. The Council on Chiropractic Practice (CCP) guidelines can be used to validate many subluxation-based contentions.

Keep a file of documents relating to the validity and recognition of these guidelines. (A copy of the CCP guidelines and information about the CCP is available at www.ccp-guidelines.org.)

4. Stay informed. Maintain a file of research papers relating to chiropractic issues.

5. Check your malpractice insurance. Make sure your policy covers defense of board complaints. If you are called to defend yourself, you should be represented by counsel. Without proper insurance, this can be expensive.

Timothy J. Feuling is president of Chiropractic Benefit Services (CBS, www.cbsmalpractice.com) and a member of the Board of Directors of the World Chiropractic Alliance. You can contact him at 800-883-0412 or by e-mail at feuling@cbsmalpractice.com.