Notice to Members
March 23, 2020, 4 p.m.
COVID-19 update: member FAQs
Dear Colleagues,
Earlier today all regulatory colleges participated in a conference call with Alberta Health that included Dr. Deena Hinshaw, Alberta’s Chief Medical Officer of Health. The call confirmed that at this time our current positioning as communicated on Friday, March 20, remains the appropriate course of action. However, Dr. Hinshaw reiterated that this situation continues to rapidly evolve and its direction can change quickly. The ACAC remains in close contact with Public Health and AHS on developments and will update members with new information as it becomes available.
We do want to remind members to review their advertising and marketing, and to adjust it to be sensitive of the current environment. This is especially true if your marketing is automated through a content provider. We have received several complaints in the last few days from members of the public about messages such as “bring your children in now as they don’t have school” and “specials available as we are celebrating our clinic anniversary." Advertising and marketing messages of this nature are landing as tone deaf and undermining the profession’s credibility in the public eye.
Finally, the ACAC has moved to a remote work environment, effective March 23. While operations are ongoing, the ACAC building is closed to foot traffic.
Warmest regards,
Dr. Todd Halowski
Registrar
The ACAC received a number of questions on Friday, which we have answered below. Please contact the ACAC if you need clarity on any of these answers and we will do our best to respond to you in a timely manner.
- The ACAC used the words “strongly recommends that chiropractors suspend all chiropractic services except those limited to emergent care only.” The ACAC did not use the word mandate, so is this mandated?
A civil order at any level of government is the mechanism required to mandate full closure of operations. A civil order of this nature has not yet been issued provincially or municipally outside of Chestermere.
The exception is the practise of mobile chiropractic. The practise of mobile chiropractic is only allowable through approval by Council, and Council has suspended that approval effective Monday, March 23, 2020.
The strong recommendation to suspend all non-emergent care actively supports the public health measures being advised to slow the spread of COVID-19.
- Do I have to close my clinic?
If you practise mobile chiropractic, yes.
The ACAC strongly recommends that chiropractors suspend all chiropractic services except those limited to emergent care only.
- If I decide to ignore the ACAC’s strong recommendation and leave my clinic open for all care and not just emergent care, will there be any consequences such as disciplinary action?
The ACAC’s strong recommendation to suspend all non-emergent care actively supports the public health measures being advised to slow the spread of COVID-19. All regulated members are requested to follow these recommendations and any others that may follow.
If a regulated member opts to ignore the ACAC’s strong recommendation and remain open for all care and not just emergent care, all governing legislation and practice requirements remain applicable. Regulated members should be aware that deciding to remain fully open in contravention of the ACAC’s strong recommendation will likely invite scrutiny from the public and peers.
- Can I leave my clinic open if I continue doing all the cleaning and pre-screening? I would like to stay open for my patients, but I do not want to go against the ACAC.
Thank you for your conscientiousness regarding your professional responsibilities as a regulated member to the ACAC and to the profession as a whole. We all must do our part in these challenging times.
The ACAC understands the patient care implications resulting from the recommendation to limit care to emergent cases only. However, the ACAC’s strong recommendation to suspend all non-emergent care actively supports the public health measures being advised to slow the spread of COVID-19. All regulated members are requested to follow these recommendations.
When providing emergent care, the clinical requirements regarding infection prevention control, pre-screening and in-office social distancing all remain applicable.
- Your advice to clinics is putting us in a horrible position. Some clinics will continue treating patients and claim they are all urgent care. Those of us who suspend our practise risk losing patients to those offices.
The ACAC’s strong recommendation to suspend all non-emergent care actively supports the public health measures being advised to slow the spread of COVID-19. All regulated members are requested to follow these recommendations and any others that may follow.
These are unique times that require all members to operate at a high level of professional ethics and responsibility. We expect patients will be extraordinarily grateful and loyal to the clinics that follow the ACAC’s strong recommendation for providing emergent care only, as this is a clear demonstration of the clinic’s commitment to both safety of their patients and their community in slowing the spread of the pandemic.
- How does the strong suggestion to suspend all chiropractic services by March 23, 2020, affect a multidisciplinary clinic and other types of practitioners?
The decision as to how to proceed with other types of practitioners should be done in consultation between the clinic owner with those non-chiropractic practitioners. Please remember these other practitioners are required to follow direction from their respective regulatory bodies, so options may be limited.
- Should I close my clinic doors to all patients, or should I leave it open for only emergent care patients?
Each chiropractor has the discretion to decide to close for all patients or stay open for emergent care patients only.
- Do I have to tell my patients my clinic is closed, or can I leave a voicemail stating I am only able to see acute-care cases?
While we encourage proactive communication with patients, managing this activity is up to each clinic’s discretion. At a minimum, information on how to contact you should be easily accessible through phone and website messaging. Best practice in times of uncertainty is that more communication is needed, not less.
- What is the ACAC’s definition of acute care and sub-acute care in relation to emergent care?
Emergent care is defined by the ACAC as:
- The patient is in an acute condition where they would be severely physically limited from basic daily activities without chiropractic care.
- The patient is in a sub-acute condition that, if left untreated, would be vulnerable to an acute flare-up that could leave the patient severely physically limited from performing basic daily activities.
- If a chiropractor deems that the patient’s condition is emergent, are we still authorized to see them in the clinic?
If the chiropractor deems that the patient meets the ACAC’s definition of acute care or sub-acute care, yes, you are authorized to see them in the clinic.
- Is there a special informed consent form required to care for emergent patients during this time?
No, a special informed consent form is not required. Document the acute or sub-acute status of the patient’s condition in the clinical record as normal.
- Do I have to document differently when a patient requests emergent care?
No. You should document all clinical care to the same standard normally required.
- What does the ACAC consider a mobile clinic, and why is the ACAC ordering a suspension of all mobile services?
The ACAC defines a mobile clinic as in-person chiropractic care provided in locations other than a fixed, non-mobile clinic space.
Mobile clinics consist of the chiropractor providing care in an environment over which they have no control. Mobile clinics can be set up in locations such as homes, gyms, sports centres, or workplaces. Given the Alberta Health requirements for proper cleaning and disinfection of equipment and the surrounding environment, the ACAC considers mobile services a high-risk practice for exposure and possible transmission.
- I have a home practice set up as my satellite clinic. I want to make sure, in the case of urgent need requests, that I am still able to see patients in-person at my home-based satellite clinic. If so, would this be considered mobile care?
The registered satellite clinic is in a fixed location; it is not considered a mobile clinic. It would be appropriate to see patients requiring emergent care in this setting. When providing emergent care, the clinical requirements regarding infection prevention control, pre-screening, and in-office social distancing all remain applicable.
- If a chiropractor is treating WCB patients, what happens now?
We advise you to contact the patient’s WCB caseworker to seek their direction based on the patient’s current health status. WCB protocols and direction regarding patient care supersede the ACAC’s recommendation in this situation.
- If a chiropractor is treating MVA patients, what happens now?
We advise you to contact the patient’s insurance caseworker to seek their direction based on the patient’s current health status. MVA protocols and insurance caseworker direction regarding patient care supersede the ACAC’s recommendation in this situation.
- How am I supposed to be supplying continuing care to patients during this time?
Emergent care may still be provided to patients who meet the ACAC’s definition of acute or sub-acute status. When providing emergent care, the clinical requirements regarding infection prevention control, pre-screening, and in-office social distancing all remain applicable.
For patients who are eligible, Council has approved a temporary Telehealth permission.
- Will the ACAC advise members which clinics are open to accept their patients and which ones are closed?
The ACAC does not have the capacity to manage this coordination between clinics.
- How long out should I be rescheduling? Is this suspension going to last a couple weeks or will it be longer?
At this time we are unable to predict the duration. The ACAC remains in close contact with public health and will update you on changes as they are available.
- Do I tell my independent contractor (i.e. massage therapist) that they cannot work here anymore? What if they are treating acute-care cases?
First and foremost, independent contractors who are regulated must follow the direction from their respective regulatory body.
If your clinic will provide emergent care and the independent contractor is also allowed to provide emergent care, then they may continue to work.
- What type of help is available for associates? Do the clinic owners have any responsibilities to associates during the cease of patient care? Do they just get paid as per usual for work provided? Is it at the same pay scale as before?
The answers to these questions are specific to the terms of your contract. Please discuss this with the clinic owner to determine next steps in these extraordinary times.
Details on government program income supports for self-employed individuals are emerging daily. Links to these programs are provided in this update COVID-19 update: next steps.
- What do I do if I currently don’t have any work due to maternity leave and I can’t find a locum?
Details on government program income supports for self-employed individuals are emerging daily. Links to these programs are provided in this update COVID-19 update: next steps.
- How does closing a clinic apply to me getting EI?
Details on government program income supports for self-employed individuals are emerging daily. Links to these programs are provided in this update COVID-19 update: next steps.
- Our business insurance does not cover clinic closures unless we are forced to close. Why is the ACAC only making a strong recommendation instead of mandating to close?
A civil order at any level of government is the mechanism required to mandate full closure of operations. A civil order of this nature has not yet been issued provincially or municipally.
The exception is the practice of mobile chiropractic. The practice of mobile chiropractic is only allowable through approval by Council, and Council has suspended that approval effective beginning on Monday, March 23, 2020.
- Will the ACAC be following the CCPA and stopping any membership payments to help ease some of the financial stress during this time?
Monthly payments are not currently an option with the ACAC, so that scenario does not apply.
The ACAC is keenly aware and sensitive to the financial impacts that COVID-19 poses for chiropractors. Staff is currently working on options for Council’s consideration in helping members manage the upcoming renewal process. Details will be forthcoming.
- Please clarify the temporary Telehealth permission.
Please read the ACAC temporary Telehealth permission for a complete description of what is allowed. Chiropractors must receive permission from the Registrar before commencing temporary Telehealth consultations.
- Can patients who haven’t signed an informed consent form in the clinic within the last year verbally consent to a Telehealth consultation? Is there specific verbiage or PARQ that needs to be involved?
The informed consent regarding Telehealth consultations is verbal. Please review the ACAC temporary Telehealth permission page for more information regarding informed consent.
Please remember that you cannot commence temporary Telehealth until you have received permission from the Registrar.
- The information provided by the ACAC said that we can only provide Telehealth consultations to people who have had an examination in the last year. Does this mean if we haven't seen the patient for a year and a half, then we can't consult with them by video? Can we consult by a phone call to determine if they need to be seen in the clinic as an emergency treatment?
If you haven’t seen the patient for clinical care in the last twelve months’ they are ineligible for Telehealth consultations. You may consult by phone to determine if they need to be seen in the clinic for emergent care.
- Do we need to record the Telehealth consultations, or just take written SOAP notes as we would during an in-person treatment?
Please review the ACAC temporary Telehealth permission page for more information regarding this. All of the information to comply with the temporary Telehealth permission motioned by council is explained on this page.
- Are we obliged to do the Telehealth for continuity of care? I am unsure how I would manage this while I’m trying to learn to homeschool my children as well.
You are not obliged to do Telehealth. You may have phone conversations with patients, or you may stay connected via other digital means. The temporary Telehealth permission is offered as a tool for those members who choose to practise it, so that they have a regulated and ethical framework under which to operate.
Alberta College and Association of Chiropractors
11203 - 70 Street NW
Edmonton, AB, T5B 1T1
P 780.420.0932 | F 780.425.6583
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