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Clinic Issues

Short Descriptive Title: Clinic Issues
Primary Parties Are: Student (Undergrad) and Administrator
Conflict Topic: Policy/Procedures
College/University Type: Medium-size Private Professional School

Description of the Issues in the Case:

This case involves three students in their graduating year at a chiropractic college. The students work independently in a clinic on campus that is open to the public. The three students are under review for using a technique in the clinic that they were not taught at the school. The technique is used widely by chiropractors in the field and is covered by health insurance plans. The students have been taking courses off-campus in the technique and plan on establishing practices incorporating the technique. The charges brought by the college include: using a technique in the clinic not taught at the school; failing to inform their supervisors that they were using the technique; and not documenting the procedure on patient treatment records.

Status of Intake/Intervention Efforts:

There is no mediation committee at the school. The students were compelled to get a lawyer from the outset. The lawyer managed to negotiate the school away from immediate expulsion to a one-year suspension and a repeat of their fourth year. The students instructed the lawyer to ask that the matter be taken to a disciplinary hearing, which is standard procedure. He was informed by the school's lawyer that if they went this route, they would likely be expelled. The students' lawyer, who has handled other cases of this nature, believes that a six-month suspension would be fair based on precedent. The students have completed all the requirements for graduation as well as passed their national and state board exams and would be eligible to practice upon graduation.

Special Issues or Challenges:

The technique used by the students is called "therapeutic touch" in layman's terms. A soft pressure is applied to the patient's body. It is considered a passive therapeutic technique. By way of example, the cancer society teaches its volunteers to use this technique on terminally ill patients to relieve pain. The documentation is the same for either the hard touch chiropractic adjustment or the soft touch technique. The students have admitted using the technique in clinic. Although the students will be able to use this technique in the field without restriction, the school wants to "make an example" of them to keep alternative therapies out of the school.

Questions for Reviewers to Address:

1) What do the students do now? 2) Does the school's diploma displayed on a chiropractor's office wall not imply to patients that the school has trained them in the techniques they employ? What is the school's obligation to make sure the practitioners they send into the field are fully trained? 3) How can the school, which has a history of severe disciplinary measures, regularly "making examples" of its students, be encouraged to offer mediation services on campus?


arrowarrow  Comments submitted by Carol Orme-Johnson on 9/13/02.

1. What bothers me about this case is that the outcome, so far, has been determined just by negotiations between the two lawyers. The school is not following its own process, and the students have not had a fair hearing. Perhaps a reasonable step at this point would be to see if both sides would agree to a hearing before the board which licenses chiropractors.
2. The school's diploma does not guarantee that the graduate has not learned other techniques elsewhere. In fact, since all medical practitioners are required to pursue continuing education, it is to be expected that a chiropractor will learn material and techniques from other sources.
3. It is a mistake to think of mediation as replacing disciplinary action. When a school policy has clearly been broken (that is implied but not explicit in this case), it most instances that will not be a case appropriate for mediation. Mediation is useful in situations where no policy governs the behavior complained of, but different interests conflict.

arrowarrow  Comments submitted by Catherine Morris on 9/13/02.

First of all, the question about the school's obligation to ensure that practitioners are fully trained is a question of law and policy and beyond the scope of what can be answered in this forum.

My first impression from the facts presented is that the writer of this case is seeing an actual or perceived power imbalance in favour of the school. I gather the students are afraid of a disciplinary hearing because they fear they may get a worse deal than they might through negotiation -- or as has been suggest in the case presentation, mediation.
The perception of power imbalance may be worth testing a bit. I'm guessing that the school's lawyer might be open to mediation if the school became concerned it might not do well in a disciplinary hearing, or if the school were concerned about reviews of the disciplinary hearing afterward, or if it were concerned about unfavourable publicity for the school.

What are the risks to both parties of not settling now, e.g. possibilities of appeal, publicity, etc. Is the school subject to the jurisdiction of a state ombudsman or human rights commission who might take jurisdiction to review a discipline process? What if the case ended up in the courts? Is the state a mandatory-mediation state that could compel mediation if the case were filed in court?

Is this dispute in the public eye? How publicly sympathetic is the case of the school and the students respectively? The students may have less to fear than the school if there were publicity (unless there are some adverse facts about the students, or if there are safety concerns that are not presented in this scenario.)

What are the views of various administrators in the school at various levels? Has the situation become controversial within the school? Would it be controversial if it became more widely known? What do other students think about it? Have they ever mobilized, or are they likely to mobilize? Are there interest groups outside the school who might be advocates on one side or the other? Possibly so, if there is a significant public discussion about alternative medicine (I thought chiropractic was an alternative approach?! It used to be...)

If there is a risk to the school from increased pressure or publicity, and if there is controversy about the situation within the school's academic and administrative ranks, mediation may be seen as attractive to prevent internal conflict within the school.

Has the idea of mediation been put forward to the parties? By whom? And how? Is there a possibility that a powerful administrator or other person within the system could propose mediation in a way that it might be considered?

Is there anyone in the situation who might help the parties do as thorough analysis with each of the parties, including risk assessment? The very fact that the school's lawyer is negotiating is a possible sign that the school's lawyer isn't sure what might happen if the students ratcheted up the dispute a few notches.


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