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IN THE MATTER OF
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BEFORE THE STATE BOARD
STEVER HELSCHEIH
license no.S01146
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OF CHIROPRACTIC
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EXAMINERS
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95-BP-081
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Responden t
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NOTICE OF CHARGES AND CONSENT ORDER
UNDER THE MARYLAND CHIROPRACTIC ACT
The Maryland State Board of Chiroprac tic Examiners (the
"Board") hereby charges Steven Helschein (the "Responde nt"), with
violation of certain provisions of Md. Code Ann. Health
Occupatio ns §3-313 (1994).
Specifica lly, the Board charges the Responden t with
violation of the following provision s:
Subject to the hearing provision s of §3-315 of this
subtitle, the Board may deny a license to any
applicant , reprimand any licensee, place any licensee
on probation , or suspend or revoke a license if the
applicant or licensee:
(18) Practices chiroprac tic with an unauthoriz ed person
or supervise s or aids an unauthoriz ed person in
the practice of chiroprac tic;
(21) Commits an act of unprofess ional conduct in the
practice of chiroprac tic [.]
The Board, the Responden t, and the Office of the Attorney
General enter into this pre-charge Consent Order to resolve the
issues and to avoid further litigation .
FINDINGS OF FACT
The Board bases its charges on the following facts that the
Board has cause to believe are true:
1. At all times relevant to the charges herein, Responden t
was licensed to practice chiropr actic in the State of Marylan d.
2. Followin g the receipt of several complai nts to the Board,
the Board investig ated the complai nts and reviewed the treatmen t
records of twenty-f our (24) patients of the Respond ent.
Colonic irrigati on of Patient A
3. In or about October 1985 Patient A1 presente d to the
Respond ent's clinic with back pain due to an acciden t in 1977 at
Patient A's former place of employm ent. The Respond ent diagnose d
Patient A as having an impacted colon and recommen ded colonic
therapy.
Patient A was treated on approxim ately two hundred
forty-tw o (242) visits between 10/17/85 and 6/12/90.
During this
time period she had thirty-n ine (39) differen t diagnos es. Six of
these diagnose s were primary complai nts and the remaind er were
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variatio ns of these diagnos es.
Patient A received colonic
therapy, also known as "colonie s" or "colonic irrigati on" over
the next four (4) years.
4. The Respond ent admitted to the Board's investig ator that
Patient A was given colonic irrigati ons in his office over a
lengthy course of time. Patient A complain ed that the colonies
resulted in her having bowel and colon damage and dependen cy on
enemas.
5.
The frequenc y and duration of Patient A's colonic
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Patient names are confide ntial and are referred to by
letter in this documen t. The Respond ent may obtain a list of the
patient names which correspo nd to the letters by contacti ng the
adminis trative prosecu tor.
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irrigations by the Respondent is in violation of the Act in that
it is below the standard of care.
The recommended duration of a
course of colonies irrigation is six (6) weeks.
6.
The Respondent has stopped the use of colonic irrigation
in his office.
Additionally , the Respondent states that he has
instituted a more rigorous use of referrals to other medical
providers where he does not see an improvement of patient
symptoms after a specified period of time.
Further, at the time
that Patient A was a patient, the Respondent's office was a
multi-discip linary practice and according to the Respondent
allowed the patients a lot of freedom in the scheduling of
appointments and the practitioners that the patient saw on any
given day.
The Respondent stated that some patients over-used
some therapies and that he has dissolved the multi-discip linary
practice to prevent patients from over utilizing procedures.
Documentation
7.
Of the approximately two hundred forty-two (242) office
visits of Patient A only five (5) dates had narrative reports.
Two of these reports were for days when Patient A was not seen in
the office.
In addition, the Respondent dictated a comprehensiv e
medical report to Patient A's insurance company summarizing
Patient A,s medical treatments.
The Respondent's reports on
Patient A lacked sufficient detail regarding the history and
physical examination of Patient A to substantiate the number of
treatments rendered to Patient A.
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Further, the reports failed to
support the six (6) primary diagnoses or the variations of
diagnoses of Patient A.
The Respondent failed to sign or initial
the few reports which were typed with respect to Patient A.
8. Patient A filled out a personal history form on which she
indicated a number of conditions which were not addressed by the
Respondent in the few reports which he dictated.
Some of these
conditions were addressed while other Patient-reported symptoms,
which potentially could have had serious health consequences,
were not addressed.
The Respondent did not document that he
addressed these symptoms in an appropriate manner.
Additionally,
these symptoms could indicate contraindications for various
procedures such as spinal manipulation, colonic irrigation, and
various physiotherapy modalities and nutritional supplements,
which the Respondent prescribed for Patient A.
9.
The Respondent noted that there were positive
orthopaedic tests on Patient A.
However, he failed to fully
document the tests which were administered to Patient A.
Additionally, the Respondent failed to note the location and
severity of Patient A's pain.
At one time the Respondent stated
"physical therapy" as a plan for Patient A, without further
explanation of which area was to receive treatment or the extent
of the treatment which was to be rendered.
This note failed to
address the frequency of the physical therapy to be given to
Patient A.
10. On 5/19/87 Patient A presented with complaints relating
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to the neck and upper extremity areas.
According to the
treatment notes, there is no follow-up examinatio n, by the
Responden t, regarding these areas. The Responden t took very
little additiona l history according to the treatment note.
The
Responden t's treatment plan for Patient A on this date of service
addressed cervical treatment .
However, the Responden t assigned a
diagnosis code for this visit which did not reflect either
presenting complaint of the patient.
Patient A was also being
seen by occasion by other chiroprac tors in the Responden t's
office.
Patient A's treatment record for dates around the
5/19/87 reflect that treatment notes were recorded on the
superbill s which, in part 2 , addressed Patient A's complaint of
neck and upper extremity discomfor t.
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11. On 9/30/87 Patient A presented with complaint s relating
to the cervical area and the left arm.
The Responden t's
treatment note failed to document any additiona l history or
examinatio n of these areas.
The diagnosis the Responden t
assigned on this date does not relate to Patient A's presenting
complaint on this visit.
12.
On sixty-two (62) occasions the Responden t billed two
(2) insurance companies for care provided to Patient A on the
2
On occasion, Patient A's treatment record contains some
notations made by other personnel in the Responden t's practice.
While these notes are substanda rd, the Responden t is not being
charged with the failure of these individua ls with respect to
their documenta tion deficienc ies.
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same date.
For examp le, on November 30, 1987, Patien t A was
charge d for two office visits , both of which were billed
simul taneou sly to Patien t A's two insura nce carrie rs for the same
date. Respo ndent states that if the bills were simul taneou sly
sent to two compa nies, it was a resul t of antici pated
subro gation .
The remain ing record s review ed on Patien ts B3
throug h X did not demon strate double billin g occur ring in these
record s.
Accor ding to the Respo ndent, he did not inten tiona lly
receiv e overpa yment .
13.
The twent y-thre e (23) remain ing patien t treatm ent
record s conta in grossl y inadeq uate docum entatio n by the
Respo ndent to subst antiat e the diagno ses and/o r freque ncy of care
provid ed. Their treatm ent record s consi st almos t entire ly of
r)
nothin g more than bills.
14.
Addit ionall y, on occasi on, the Respo ndent' s dictat ed
repor ts which do appea r in the record s of Patien ts B throug h X
have the notati on "dicta ted but not read." The Respo ndent failed
to read over dictat ed notes which indica tes that the Respo ndent
did not meet the minimum standa rd of care, as readin g typed
dictat ion is an integ ral part of patien t care.
15.
The Respo ndent has taken steps to corre ct his level of
docum entatio n in the treatm ent record s and has expres sed his
willin gness to obtain additi onal traini ng in this area.
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x.
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Furth er,
These patien ts will be referr ed to as patien ts B throug h
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the Responden t states that he will counsel others in his office
regarding the level of documenta tion needed.
16.
The Responden t presented several recent treatment
records to the administr ative prosecuto r to demonstra te his
changes to the level of documenta tion that he now maintains .
(2) of these records were examined by the reviewer.
Two
The reviewer
stated that the treatment records were much improved, however,
there were several aspects of the Responden t's documenta tion
which still need improveme nt 4 •
The Responden t has agreed to work
in a mentoring relationsh ip to improve the quality of his
documenta tion.
Unauthori zed persons administe ring chiroprac tic treatment s
17. On treatment dates 12/14/87, 2/10/88, 2/18/88 and
6/20/88 Patient A's record contains the name "Kay" as the
treating health care provider and this person signed on the line
"Physician Signature ."
Three of these four signatures have the
initials "D.C." following the signature of Kay.
attended Life Chiroprac tic College.
Robert Kay
He reported to the Board's
investiga tor that he had taken the Maryland Chiroprac tic
Licensing examinatio n on three occasions , failing the licensing
exam each time.
According to the Responden t, at one point,
Robert Kay misrepres ented to the Responden t that he was licensed
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The reviewer found that the documenta tion shows
however, the Responden t needs training in "SOAP"
note content, needs to initial narrative reports, and the
patients need to initial acceptance of the treatment .
~mprovement,
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by the Board and the Respond ent then permitte d Robert Kay to
treat patients .
However, the Respond ent later learned that
Robert Kay had not been licensed by the Board and Robert Kay's
employm ent was immedia tely terminat ed •
18.
Accordin g to the Respond ent has correcte d this problem
by requirin g that each employee have in his or her personn el file
a copy of their license prior to assistin g in or providin g
chiropr actic care.
The chiropra ctors' licenses are displaye d on
the wall in the office where they can be seen by patients .
19. Between 12/12/95 and 4/17/96 the Respond ent employed Joo
Cha.
Joo Cha was permitte d to assist with patient therapy.
Joo
Cha's area of training is reported ly in the area of radiatio n
technolo gy.
The Respond ent permitte d Mr. Cha to adminis ter
ultrasou nd, heat treatmen t, and traction .
chiropr actic assistan t.
Mr. Cha was not a
Accordin g to the Respond ent, the
Respond ent obtained an applicat ion for Mr. Cha to become a
licensed chiropr actic assistan t.
The Respond ent also states that
he provided Mr. Cha with a list of the course work which was
required .
The Respond ent stated that he telephon ed the Board of
Physicia ns Quality Assuranc e regardin g the use of a "rad tech" to
perform ultrasou nd, and that based on the informa tion that he
received , he permitte d Mr. Cha to perform therapeu tic ultrasou nd.
Accordin g to the Respond ent he was under the belief that Mr. Cha
had become an applican t by mailing to the Board the applica tion.
Mr. Cha never mailed in the applicat ion and did not take the
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required courses.
The Respondent violated the Act by permitting
Mr. Cha to administer ultrasound when Mr. Cha was neither a
chiropractic assistant or an applicant.
20.
Eric Pierce was employed from about March 1988 until
and through January 1997.
Mr. Pierce was trained by the
Respondent and became licensed as a chiropractic assistant in
1995.
The Respondent permitted Mr. Pierce to perform range of
motion function tests and to make all preliminary arrangements
for the taking of patient X-rays, which included a comprehensiv e
set up of the patient prior to the actual exposure of the x-ray.
Under the Act, a chiropractor can only delegate those duties to a
chiropractic assistant which do not require the skill or
judgement of a chiropractor .
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Acts).
(See COMAR 10.43.07.09 Prohibited
The Respondent violated the Act by delegating duties to
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Mr. Pierce which required the skill or judgement of a
chiropractor .
CONCLUSIONS OF LAW
Based upon the foregoing Findings of Fact the Board finds
that the Respondent violated Md. Code Ann. Health Occupations
§§3-313 (18) and (21) by:
failing to properly document patient
treatment records; allowing unauthorized persons to administer
chiropractic care;
and over-utilizin g chiropractic treatment on
Patient A.
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ORDER
Based on the foregoi ng Finding s of Fact and Conclu sions of
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Law' it is this
.- ' I day of ' _,( ( (:.-.., v·lt ' 1998' by a
majori ty of the Board, hereby
ORDERED that Respon dent is REPRIMANDED; and be it furthe r
ORDERED that the Respon dent is assesse d a moneta ry penalt y,
in the amount of seven hundred fifty dollars ($750.0 0) for the
Respon dent's unprof essiona l conduc t in the practic e of
chirop ractic and the Respon dent's use of unauth orized person s in
the practic e of chirop ractic.
The moneta ry penalty is to be paid
by the Respon dent to the Board prior to conclu sion of the
probat ionary period . And be it furthe r
ORDERED that the Respon dent be placed on PROBATION for a
period of two (2) years, subjec t to the followi ng condit ions:
1.
The Respon dent agrees to cease the active practic e of
chirop ractic for a period of six (6) months beginn ing Decemb er 15,
1998.
The reprima nd, probat ion, and cessati on of practic e will
begin simulta neousl y.
During this six month cessati on period ,
the Respon dent shall not provide patien t care, shall not perform
any profes sional consul tation of patien ts, and shall not
superv ise clinic al staff.
On June 15, 1999, the Respon dent may
return to the active practic e of chirop ractic.
2.
During this six month cessati on period , the Respon dent
shall take a Board- approv ed course in docume ntation ,
3.
During this six month cessati on period , the Respon dent
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shall take a Board -appro ved course in risk manag ement.
4.
During this six month cessa tion period , the Respo ndent
shall shadow a Board -appro ved mento r for the purpos e of observ ing
the mento r's docum entatio n techni que in the follow ing manne r:
a.
After the Respo ndent has taken both the
docum entatio n course and the risk manag ement course , the
Respo ndent shall arrang e to spend two full office days observ ing
a mento r in a clinic al settin g;
b.
The mento r shall be select ed by the Respo ndent from
a list of three poten tial chirop ractor s provid ed and approv ed by
the Board .
c.
The Respo ndent is prohib ited on these two (2)
occas ions from rende ring chiro practi c care to the mento r's
patie nts. The only role of the Respo ndent on these two occasi ons
is to be that of an observ er of the docum entatio n techni que of
the mento r;
d.
It is antici pated that the mento r will expla in his
or her docum entatio n techni que throug hout the office day and that
the mento r will be paid by the Respo ndent for two (2) hours of
consu ltatio n on each date of shadow ing.
The mento r will be paid
a fee not to exceed $175.0 0 per hour.
5.
After the return to active chirop ractic practi ce on June
1, 1999, the Respo ndent shall
have~
two random record review s
during the proba tionar y period under the follow ing circum stance s:
a.
The Board 's invest igrato r will random ly selec t from
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the Respon dent's office calend ar, a date after the Respon dent has
comple ted the course in docume ntation referre d to in paragra ph 2
above and has returne d to active practic e;
b.
The Respon dent shall then have his office staff
copy all of the treatm ent notes of the patien t who are identif ied
as being seen in the office on that date;
c.
The review er shall be selecte d by the Respon dent
from a list of three potent ial chirop ractors approve d and
provid ed by the Board.
d.
The invest igator shall mail or delive r the
treatm ent notes to the review er;
e.
The review er shall read the treatm ent notes and
prepar e a report ;
f.
The report shall be forward ed simulta neousl y to the
Board and the Respon dent;
g.
The Respon dent shall pay the review er a fee not to
exceed $175.00 per hour for a reason able number of hours for his
or her time spent reading the treatm ent records and prepar ing the
report ;
h.
The Respon dent shall reimbu rse the review er for any
postag e fees incurre d as a result of returni ng the copied records
to the Board;
i.
A second review of the Respon dent's treatm ent
record s in the same manner detaile d in paragra phs S(a) through
S(h) above will occur subseq uent to the Respon dent's comple tion
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of the Board-app roved courses under paragraph s 2 and 3, and the
Responden t's completio n of the requireme nts under paragraph 4(a)
through 4(d) above.
6.
The Responden t shall provide a written statement of
understan ding to the Board on the proper use of chiroprac tic
assistant s;
7.
The Responden t shall continue to require the
presentat ion of all licenses of employees prior to the employee
rendering any patient care;
8.
At the end of the probationa ry period the Responden t
shall petition the Board in writing, to be released from the
probation ary condition s.
BE IT FURTHER ORDERED that in the event the Board finds for
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any reason that the Responden t has substanti ally violated any
provision of Title 3 of the Health Occupation s Article, Annotated
Code of Maryland or the regulation s thereunde r, or if the
Responden t violated any of the foregoing condition s of Probation ,
the Board, after notificati on to the Responden t, and an
opportuni ty to be heard, may take immediate action or impose any
lawful disciplina ry sanction it deems appropria te, including but
not limited to revocation or suspension of Responden t's licensee
to practice chiroprac tic; and be it further
ORDERED that the condition s of the Consent Order be, and the
same hereby are, effective as of the date of this Order; and be
it further
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ORDERED that for purpos es of public disclos ure, as permit ted
by Md. Code Ann. State Govern ment §10-617 (h) this docume nt
consti tutes the Board's Finding s of Fact, Conclu sions of Law, and
Order, resulti ng from formal discip linary procee dings.
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Howard F. Lewis, D.C.
Presid ent
CONSENT of Steven Helsch ein, D.C.
I, Steven Helsch ein, by affixin g my signatu re hereto ,
acknow ledge that:
1.
I am represe nted by an attorne y and have had an
opport unity to consul t with her;
2.
I am aware that withou t my consen t, my license to
practic e chirop ractic care in this State cannot be limited ,
except pursua nt to the provisi ons of §3-315
201 et
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of the Act and §10-
of the Admin istrativ e Proced ure Act, Md. Code Ann.
State Govern ment Article .
3.
I am aware that I am entitle d to a formal eviden tiary
hearing before the Board or an Admin istrativ e Law Judge.
4.
By this Consen t Order, I hereby consen t and submit to
the forego ing Finding s of Facts, Conclu sions of Law, and Order
provid ed the Board adopts the foregoi ng Final Consen t Order in
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its entire ty.
By doing so, I waive my right to a formal hearing
as set forth in §3-315
of the Act and §10-201 et seq. of the
Admin istrativ e Proced ure Act except on connec tion with any
alleged violati on of this Order.
I waive any appeal right under
Md. Code Ann. State Governm ent §10-22 2.
5.
I acknow ledge that by failing to abide by the condit ions
set forth in this Order, I may, after an opport unity to be heard,
suffer discip linary action , includi ng revoca tion of my
chirop ractic license in the State of Maryla nd.
6.
I unders tand that this Consen t Order is a public
docume nt, disclos able under Md. Code Ann. State Govern ment
Articl e §10-617 (h)(2) (vi).
7.
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I sign this Order withou t reserv ations, and I fully
unders tand its meanin g.
Steven Helse,~n, D.C.
/ !fp ~/f
DATE
STATE OF
CITY/COUNTY OF:
I
HEREBY CERTIFY that on this
day of
~_.c_·e_·,_n_b_._e_r____ , 1998, a Notary of the State of
_1)_.\
__
(City/C ounty) ,
c--...
:.>I e v P ''
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___-~}~_;-~,_·_L__
~---~\_..~_--_tL_·____ ,
--
person ally appeare d
-~~f~~:~~~~-<_i~~~~~~t_·~~-~------'
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~.:.t
D.c. Licens e No.
and
80114 6, and made oath in due form of law that signi ng the
foreg oing Conse nt Order was his volun tary act and deed, and
statem ents made herei n are true and corre ct.
AS WITNESS my hand and notar ial seal.
Notar y Publ1' c
My comm ission expir es:
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p.
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the