COA: Chiropractors have no legal bar to give testimony, as long as scope is limited and foundation is laid

By Ben Solis
Gongwer News Service

A chiropractor has no legal bar to provide expert testimony on injury causation in the context of a motor vehicle crash as long as the proper foundation is laid and the testimony is limited in scope under the Public Health Code, the Court of Appeals ruled Thursday in a unanimous decision.

In a published opinion released Friday written by Judge Brock Swartzle, joined by Judge Kathleen Feeney and Judge Thomas Cameron, the panel in Infinity Physical Therapy LLC v. Meemic Insurance Company (COA Docket No. 365767) vacated the Wayne Circuit Court’s holding prohibiting a chiropractor from testifying in an auto no-fault benefits lawsuit.

The case involved a woman involved in a crash who was referred to physical therapy, which included separate chiropractic treatment. A second motor vehicle crash led to the assignment of benefits in question in Infinity Physical Therapy LLC.

The physical therapy provider sued the woman’s insurance company to recover no-fault benefits for the physical therapy treatment. During the course of the litigation, the insurance company moved to limit the therapists’ testimony regarding causation and whether the treatment was reasonable and necessary.

Infinity Physical Therapy argued that a chiropractor, as a licensed medical practitioner, could testify on causation. The defense counsel objected, noting the plaintiff needed to establish that the physical therapy was necessary, and that the chiropractor could not do so because they couldn’t legally bridge the gap on causation.

The trial court determined that the therapists could provide testimony, but the chiropractor could not testify about causation, medical diagnoses made by a medical doctor, the origin of any medical problem in the case, the relationship between medical treatment – out of chiropractic care – to the crash and the necessity of physical therapy in the matter.

Meemic sought summary disposition, arguing there was no genuine issue of fact without the physical therapists’ testimony on causation or the necessity of the treatment. The trial court acknowledged the argument about causation, but said that plaintiff had to show that the treatment was related to the collision and objectively reasonable. To that end, the trial court further noted that neither therapist was “qualified to offer an expert opinion on medical causation or a diagnosis,” or prescribe physical therapy.

Upon appeal, Swartzle and his colleagues found that Michigan’s rules of evidence did not limit medical expertise strictly to medical doctors and, under the Public Health Code, the making of a limited diagnosis is within a chiropractor’s scope of practice. The panel also found that a chiropractor’s diagnosis can be used to detect and correct the listed conditions and recommend patients seek treatment from other health professionals.

“Other states have addressed the expert testimony of chiropractors,” Swartzle wrote. “For example, the Nebraska Supreme Court has stated that ‘a duly licensed and practicing chiropractor is competent to testify as an expert witness within the scope of his or her knowledge according to his or her qualifications in the field of chiropractics.’”

In Infinity Physical Therapy LLC, the trial court abused its discretion with a broad limitation of the chiropractor’s testimony.

“Under the Public Health Code, (the chiropractor) was permitted to diagnose ‘conditions and disorders of the human musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions. These diagnoses shall be for the purpose of detecting and correcting those conditions and disorders or offering advice to seek treatment from other health professionals in order to restore and maintain health,’” Swartzle wrote while citing the Public Health Code. “The trial court properly determined that (the chiropractor) could not offer expert opinion about a diagnosis made by a physician, but it is proper for a chiropractor, with the proper foundation, to testify about a diagnosis within his or her practice as set forth in MCL 333.16401(1)(e)(i).”

Similarly, Swartzle added, a chiropractor, with the proper evaluation of a patient, “may testify about the cause of that condition or disorder to the extent that such cause can be reliably linked to a condition or disorder within the scope of (the Public Health Code).”

That said, Swartzle found the trial court did not err by prohibiting the physical therapist from offering expert testimony on causation.

“The Public Health Code’s provision of practice for a physical therapist specifies that the ‘practice of physical therapy does not include the identification of underlying medical problems or etiologies, establishment of medical diagnoses, or the prescribing of treatment,’” Swartzle wrote. “Accordingly, although the plaintiff also argues that the trial court erred by limiting (the physical therapist’s) testimony, the trial court properly limited his testimony to the services he provided and the reasons why he provided the treatment.”


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