When the Chiropractic Board of New Zealand receives a notification about you, it decides which route under the Health Practitioners Competence Assurance Act 2003 (the HPCA Act) the concern belongs on: competence, health or conduct. It writes to you with the concern, asks for your written response by a date, and then decides whether to close the matter, order a competence review, refer it to its health process or appoint a Professional Conduct Committee. While a matter is open it can suspend your practising certificate or place conditions on it. Call your indemnity insurer the same day, keep your notes, care plans, invoices and advertising as they stand, do not contact the patient, and reply before the date with a response written against the record, the Code of Ethics and the Board's standards.
Where a notification comes from
A notification about a chiropractor can come from a patient or their whānau, a colleague, a clinic owner, an employer, another health practitioner, ACC, a member of the public who has seen your advertising, the Health and Disability Commissioner or another agency. Two routes are mandatory under the HPCA Act. An employer must notify the Board when a chiropractor resigns or is dismissed for reasons relating to competence (section 34), and a practitioner or employer who believes a chiropractor may be unable to practise safely because of a mental or physical condition must notify the Registrar (section 45). The guide to a mandatory employer notification covers how the employment and Board processes run side by side.
Write the concern in the Board's letter out in one sentence of your own. That is the sentence your response has to answer.
The three routes
Competence. If the concern is that your practice may not meet the required standard, the Board can order a competence review under section 36 of the HPCA Act. Reviewers look at your notes, examination findings, imaging decisions, care plans and clinical reasoning, can interview you and observe you with patients, and report to the Board. The guide to what happens in a competence review covers the review and the competence programme that can follow it.
Health. If the concern is that a mental or physical condition may affect your ability to practise, the Board's health process applies. The Board can require an examination, accept voluntary undertakings and set conditions. The guide to the health process under the HPCA Act explains it.
Conduct. If the concern is about behaviour, the Board can appoint a Professional Conduct Committee under Part 4 of the Act. The Committee investigates, hears from you, and recommends an outcome to the Board or lays a charge before the Health Practitioners Disciplinary Tribunal. The guide to how a Professional Conduct Committee process runs sets out each stage.
What the Board measures you against
The Board assesses conduct against its Code of Ethics and the standards that sit with it, including the Professional Boundaries standard, and competence against the competencies for the chiropractic scope of practice. The Board's standards also set its expectations on matters such as informed consent, records and advertising. The Code of Health and Disability Services Consumers' Rights applies alongside them, including the right to be fully informed and to make an informed choice, and advertising is also subject to the Fair Trading Act 1986. Find the standard the allegation engages before you write, and answer in its terms.
The concerns a chiropractor can face
- Care plans and pre-payment. A long series of visits agreed at the first appointment, payment taken in advance, a plan not reviewed against progress, or a refund refused when the patient stopped. The Board reads the findings that supported the plan, what was explained about cost and review, and whether the payment arrangement shaped the clinical advice.
- Advertising claims. Claims about conditions treated or results that the evidence does not support, testimonials, comparisons and titles. This concern can arise without any patient complaint.
- Consent. A manipulation or other treatment started without the findings, the material risks, the other options and the cost being explained, or a change of technique without fresh agreement.
- Boundaries. A boundary with a patient or a colleague, including dual relationships with a patient who is a friend, a relative or an employee, personal messages, social media, gifts, and a relationship after care ends. The guide to a professional boundaries concern covers how the Board and the Tribunal treat these.
- Records. Notes that are missing, written late, repeated from visit to visit, or that do not show findings, reasoning and consent. The guide to a clinical records concern covers how a reviewer or Committee reads them, and the guide to an honesty or probity concern explains why a claim to ACC or an insurer that the notes do not support is treated as serious.
What happens, step by step
- The letter arrives. The Board sends you the concern, the material and a date. Call your indemnity insurer that day and gather your notes, care plans, consent forms, invoices, receipts and copies of the advertising concerned.
- You respond in writing. Facts from the record with references, your reasoning at the time, what fell short, what you have done since with evidence, and what you have understood, in the terms of the Code and the standards. The guide to how to write a response to a Board notification gives the structure.
- The Board decides the route. On your response, the records and any further enquiries, it decides whether to close the matter, write to you with advice, order a competence review, refer the matter to its health process or appoint a Professional Conduct Committee.
- The review or investigation runs. Reviewers report to the Board on competence. A Professional Conduct Committee gathers documents, can obtain an independent clinical opinion, can interview you and witnesses, and puts its concerns to you before it decides.
- You are heard before any order. Before the Board sets a programme, imposes conditions or makes an interim order, it tells you what it proposes and gives you the chance to respond.
- The outcome is recorded. The Board tells you its decision, what it has told your employer and what appears on the register. A charge laid by a Committee goes to the Tribunal.
Interim suspension and conditions
While a Professional Conduct Committee investigation is open, section 69 of the HPCA Act lets the Board suspend your practising certificate or place conditions on it if it is satisfied that is needed to protect the public. You are entitled to be heard first. A chiropractor who has stopped taking payment in advance, arranged for a named colleague to review care plans, and set that out in writing gives the Board a reason to prefer conditions to suspension. The guide to interim suspension and conditions on practice covers the risk test.
What you can do now
- Get advice the same day. Your indemnity insurer, your professional association if you are a member, or a lawyer, before you put anything in writing to the Board, your employer or the patient.
- Keep the records as they stand. Notes, imaging, care plans, consent forms, invoices, receipts, messages and copies of your advertising and website.
- Write against the record and the Code. Facts with references, reasoning at the time, what fell short, what you have done since, what you have understood.
- Start remediation before you reply. A revised consent and care plan process with review points, an audit of your notes and advertising with results, peer review, and courses completed with dated certificates. Completed steps are evidence; intended steps are promises.
The outcomes
After a competence review the Board can find the standard is met, set a competence programme or place conditions on your practising certificate, such as peer review of care plans or practice under supervision. On the health route it can accept undertakings or set conditions. A Professional Conduct Committee can recommend no further action, counselling, a competence review or conditions, or lay a charge before the Tribunal. The Tribunal can cancel or suspend registration (suspension for up to three years), impose conditions, censure, fine and award costs. The guide to a Health Practitioners Disciplinary Tribunal hearing describes what it weighs.
Where remediation fits
The part of a Board matter you control is what you have done since the concern was raised. Courses completed before your response goes, with dated certificates attached, are evidence that you have engaged with the Code. Ethics for Chiropractors and Professionalism for Chiropractors are written against the Chiropractic Board's Code of Ethics and standards, so a certificate from either answers a concern framed in the Board's terms. Insight for Fitness to Practise covers how to show the Board you understand what went wrong and why, and Remediation for Fitness to Practise covers the plan the Board reads when it decides whether conditions are needed.
Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to the Board or put in your remediation plan. The remediation courses for chiropractors facing a Chiropractic Board investigation are listed on one page, and the Council and Board investigation process explained shows where each course sits. The guide to showing insight and building a remediation plan explains how to present the certificates with the rest of your evidence, and the guide to what happens after a notification to any Council or Board gives the whole HPCA Act process.
Sources and further reading
- Chiropractic Board of New Zealand: the Code of Ethics, the Professional Boundaries standard and other standards, and the Board's pages on notifications, competence and health.
- Health Practitioners Competence Assurance Act 2003: sections 34, 36, 45 and 69 and Part 4 on Professional Conduct Committees and the Tribunal.
- Health Practitioners Disciplinary Tribunal: published decisions involving chiropractors, with the penalties imposed and the weight given to insight and remediation.
- Health and Disability Commissioner: the Code of Rights and how a complaint about a chiropractor is assessed and reaches the Board.
Frequently asked questions
A patient has complained about a pre-paid care plan. What will the Board look at?
The Board looks at whether the plan rested on the findings you recorded, whether the patient was told the options, the expected number of visits, the cost and the review points before agreeing, whether they could stop and receive a refund on fair terms, and whether the payment arrangement affected the clinical advice. Your response should show the examination, the reasoning, what was explained and agreed, and what you have changed in how plans are offered and reviewed.
Can the Board act on an advertising claim without a patient complaint?
Yes. A concern about advertising can come from a colleague, another practitioner, a member of the public or an agency, and the Board can act on it whether or not a patient has been harmed. It looks at claims about conditions treated or results, testimonials and titles. Remove or correct the material once you have taken advice, keep a dated record of what you changed, and show the Board the process you now use to check advertising before it is published.
What does the Board expect me to explain before a spinal manipulation?
The Board expects informed consent: the findings, what you propose and why, the material risks, the other options including no treatment, and the cost, explained so the patient understands before you start, with the patient's agreement recorded. Consent to a first treatment does not cover a change in technique or area treated later in the plan. Your response should show what you explained and recorded for this patient, at each stage.
What does the Chiropractic Board expect in my written response?
An account of the facts from your notes with references, your clinical reasoning at the time, a plain acknowledgement of anything that fell short, what you have done since with evidence, and what you have understood, written in the terms of the Code of Ethics and the Board's standards. Keep a level tone, make no comment about the notifier, and send nothing your adviser has not read. Where your account and the notes differ, the Board will rely on the notes.
Who should I contact first after a Chiropractic Board letter?
Your indemnity insurer, the day the letter arrives, and your professional association if you are a member. Either can tell you whether a lawyer should be instructed. Do this before you write anything to the Board, your employer or the patient. Where the concern alleges a breach of a boundary with a patient or a colleague, dishonesty, or conduct that could reach a Professional Conduct Committee or the Tribunal, ask about a lawyer in the first call.