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Chiropractor Disciplined for Inappropriate Solicitation

Stephen Barrett, M.D.

Frank J. Amato, D.C., of Bellport, New York, has been disciplined for promoting unnecessary treatment to symptom-free patients. In December 2001, he was judged guilty of "unprofessional misconduct." His license was suspended for two months; and he was fined $7,000 and placed on probation for two years. He was also ordered to perform 100 hours of community service amd complete 36 hours of an approved college-level course in ethics and jurisprudence. The licensing board's summary states:

Licensee was found guilty of exerting undue influence on a patient for his own financial gain by placing pressure on the patient to bring family members into the office for examination, evaluation and treatment by him. Respondent was also found guilty of holding a "Patient of the Month" contest in which the patient who recommended the most new patients to the Respondent would win a color television set [1].

Public documents in the case provide a vivid account of what took place in Amato's office. Here's what the New York State Regents Review Committee concluded about what happened [2]:

FINDINGS OF FACT

  1. Respondent was authorized by the New York State Education Department to practice as a chiropractor in the State of New York.
  2. Respondent was duly served in this matter.
  3. At all times relevant in this matter, respondent was in private practice and maintained an office as a chiropractor in New York State.
  4. Patient S.M. sought chiropractic treatment from respondent for herself.
  5. After November 10, 1997, respondent informed patient S.M. about the fees that he would charge her if she entered into treatment with him. Respondent stated that S.M. could sign a contract for approximately 72 visits over a one-year period.
  6. In discussing the amount of his fee, respondent offered S.M. to take 15 percent off his fee. Respondent also offered her a 50 percent discount if her husband would enter into treatment with him. In addition, the total fee to S.M. would be reduced by 25 percent for each of her two children if they would also enter into treatment with respondent.
  7. S.M.'s husband and S.M.'s two children were all not experiencing back or neck problems. S.M. informed respondent that she was not interested in a fee plan involving the treatment of her husband or children.
  8. In November 1997, respondent began treating Patient S.M. for scoliosis. During the course of treating S.M., respondent gave a validation card to take home to screen her husband and sons for back problems. S.M. completed and returned the card and told respondent that none of her family members had any chiropractic problems. Nevertheless, respondent told S.M. that he wanted her to make appointments for her husband and sons to be evaluated by respondent. On different occasions, respondent told S.M. to bring her husband and sons in for examination by him. PS.M. declined to make appointments for her husband and sons to be seen by respondent.
  9. On various occasions when S.M. went for her appointments with respondent, she did not hire a babysitter for her nine year-old son, P.M. On these occasions when P.M. accompanied P.M. to respondent's office for S.M.'s visit, S.M. did not bring P.M. to respondent's office for the purpose of his being examined or evaluated by respondent.
  10. Although P.M. was not. respondent's patient and was not seeking to become a chiropractic patient, respondent asked P.M. various questions. Respondent specifically asked P.M., in the presence of his mother, "Do you play baseball?" "Do you want to hit a ball further?" "Do you want to jump higher?" "Do you want to run faster?" P.M. very active in sports. When P.M. responded yes to respondent's questions, respondent then said: "You talk to your mom about coming to see me and you can do these things." Respondent admits that he told P.M. that his performance in these areas would increase if he received chiropractic treatment by him.
  11. Respondent's secretary told S.M. that respondent "would like to know when" S.M. will be making an appointment for the children. Respondent's secretary also told S.M. that she had to ask S.M. when she will be making an appointment for P.M.
  12. Respondent told S.M. that everyone needed chiropractic care. Even though S.M. had not told respondent that she would bring her family in to his office or that she would make an appointment for any of them to see him, respondent kept pressuring S.M. to bring her family in for treatment by him. Respondent constantly asked S.M. when could she bring her children in to see him and when would she make an appointment for them.
  13. Respondent's efforts to get S.M. to bring her husband and children in to his office for treatment by him became more frequent over time. S.M. became very uncomfortable with these efforts to influence her and told respondent that she did not. feel it was necessary for her children or husband to be treated by a chiropractor.
  14. As a result of respondent's constant efforts, S.M. agreed for P.M. to be examined by respondent on July 1, 1998. Based upon his examination of P.M., respondent recommended that P.M. be x-rayed. Respondent did not make any diagnosis for P.M. at the time respondent recommended an x-ray.
  15. S.M. decided that x-rays were not to be taken for P.M. In view of S.M.'s.decision, respondent did not take any x-rays of P.M. Due to the absence of x-rays, respondent did not know if P.M. should be considered a chiropractic case.
  16. After examining P.M., respondent stated, in P.M.'s presence, that he saw certain particular problems in P.M.'s case, but did not indicate that P.M. had scoliosis. When P.M. went home from this examination and report by respondent, P.M. threw himself on a bed and cried because he felt he was deformed and that something was wrong with him.
  17. After he was convinced that S.M. would not agree to have her family be treated by him, respondent sent S.M. a letter dated September 21, 1998. In this letter signed by respondent, respondent indicated that his philosophy was to "educate and adjust as many families as possible toward optimal health using natural Chiropractic Care."
  18. In his letter, respondent asked S.M "how can we continue to have a truly healing Doctor-Patient relationship when you have no confidence in me or my healing philosophy". Respondent wrote, in view of his philosophy, that he "can't" continue adjusting S.M. "anymore."
  19. Respondent exercised undue influence on S.M, for his financial gain, by advising S.M. that he could not continue to treat her if he was not also treating her children.
  20. Respondent exercised undue influence on S,M., for his financial gain, by further advising S.M. that if P.M. did not receive chiropractic treatment, his health would be at risk.
  21. During the course of treating S.M., respondent had a "Patient of the Month" contest n which the patient who recommended the most new patients to the respondent would win a color television set.
  22. Respondent offered an inducement in a form other than a discount or reduction in an established fee or price for a professional service or product. Respondent's conduct constituted advertising or soliciting for patronage that is not in the public interest in violation of S. N.Y.C.R.R. §29.1(b) (12) (i) (e).

DETERMINATION

We unanimously determine that the first and second specifications of the charges have both been proven, by a preponderance of the evidence, and that respondent is guilty of both the first and second specifications of professional misconduct.

. . . The hearing panel finds Patient S,M, to be credible. Her testimony accurately described the key relevant events. Respondent is found to have exerted undue influence on this patient for his own financial gain. He exercised undue influence on S.M, by advising her that he could not continue to treat her without his also treating her family; and by further advising her that without chiropractic treatment her son's health would be at risk.

This hearing panel finds respondent's testimony to be incredible. Respondent was acting for his own financial benefit in placing pressure on S.M. to bring her son into the office for examination by him. He sought to gain financially by bringing P.M. into the practice as a new patient and by maximizing the number of patients he could bring into this practice.

Respondent attempted to overcome S.M. and her family's choice regarding whether they would seek professional services from him. The record demonstrates that respondent became obsessed with financial considerations beyond those appropriate in treating patient S.M. Contrary to his clams, respondent was not focusing solely upon his patient's interests. Respondent persisted in pressing his concerns on S.M., even though, as he testified, he had not determined, in the absence of x-rays and a full examination of P.M., whether P.M. should be treated as a chiropractic patient in his office. It was unprofessional for respondent to constantly apply pressure on S.M. against her wishes in order to pursue his gaining new patients.

Moreover, respondent acted inappropriately in suggesting to P.M. that he could run faster, jump higher, and hit a ball further if he would talk to his mother about his receiving chiropractic treatment from respondent. The questions respondent deliberately directed to this nine year-old boy needlessly upset him and caused distress.

Many chiropractors still cling to the belief that most health problems are caused by misaligned spinal bones ("subluxations") that can be corrected by spinal "adjustments." Although the disciplinary documents do not mention the word "subluxation," Amato appears to advocate that every spine should be checked and "adjusted" throughout life. The World Chiropractic Alliance (WCA), which is "dedicated to promoting a subluxation-free world," has sharply criticized the New York licensing authorities and issued a position paper stating:

Chiropractic care to detect and correct vertebral subluxations offers benefits for all people, including those who do not demonstrate symptoms of a disease or health condition. Therefore, the presence of symptoms and/or a medical diagnosis should not be a factor in determining the need for or appropriateness of chiropractic adjustments, nor should the presence of symptoms be required by any chiropractic board, insurance company or court of law to justify the rendering of chiropractic care to any patient [3].

The paper claims that checking for "subluxations" is analogous to periodic dental and blood-pressure check-ups. However, blood pressure and tooth decay can be objectively demonstrated, but the subluxations to which WCA refers can not [4].

According to a WCA report, Amato is appealing the action in court [5]. Do you think he will succeed?

References

  1. New York State Education Department Office of the Professions. Summaries of Regents Actions on Professional Misconduct and Discipline, December 20, 2001.
  2. Cohen SB and others. Report of the Regents Review Committee in the matter of the disciplinary proceeding against Frank J. Amato. No. 18075, Nov 8, 2001.
  3. Position paper on chiropractic for asymptomatic patients. World Chiropractic Alliance, May 15, 2002.
  4. Barrett S. Chiropractic's elusive "subluxation." Chirobase, Dec 25, 2001.
  5. N.Y. doctor censured for pushing family care. The Chiropractic Journal, April 2002.

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This article was posted on June 19, 2002.