Disciplinary Action against Timothy J. Young, D.C.
Stephen Barrett, M.D.
In 2004, Timothy Young, D.C., signed a consent order under which he agreed to pay a $5,000 fine, serve at least a years on probation and comply with requirements for monitoring and continuing education. The order (shown below) indicates that:
- Young used a "terms of acceptance" form that indicated that he did does not "offer to diagnose or treat any disease or condition other than vertebral subluxation and that, if "during the course of chiropractic spinal examination," a "non-chiropractic or unusual findings" are encountered, the patient would be advised to seek the services of another health care provider.
- In treating a patient who came with symptoms of back, shoulder, and neck pain, Young "adjusted" only the topmost vertebral joint and failed to record an assessment, a treatment plan, or progress notes.
- When the patient felt worse, he consulted another chiropractor who obtained an MRI that revealed significant back injuries that Young had failed to diagnose.
- When the board subpoenaed the charts of 11 more patients, it found a consistent pattern of inadequate record-keeping and inappropriate treatment.
Young completed his probation and was restored to full license privileges in 2005. Two years later, however, when faced with new allegations of substandard care leading to the death of a patient, he permanently surrendered his Maryland chiropractic license. He was also licensed in Virginia but had not practiced there. But the Maryland trouble led him to surrender his Virginia license in 2009.
IN THE MATTER OF
TIMOTHY J. YOUNG, D.C.
LICENSE NO. 01948
OF CHIROPRACTIC EXAMINERS
Case Number: 02-043C
FINAL CONSENT ORDER
Based on information received and a subsequent investigation by the State Board of Chiropractic Examiners (the "Board"), and subject to Md. Health Occ. Ann. § 3-101, et seq., (2000 Repl. Vol.) (the "Act"), the Board charged Timothy J. Young, D.C., (the "Respondent"), with violations of the Act. Specifically, the Board charged the Respondent with violation of the following provisions of § 3-313:
(a) Subject to the hearing provisions 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:
(9) Is professionally, physically, or mentally incompetent;
(19) Violates any rule or regulation adopted by the Board;
(28) Violates any provision of this title.
The Board further charged that the Respondent violated the following provision of its Act, namely §3-101:
(a) In this title the following words have the meanings indicated.
(f) (1) "Practice chiropractic" means to use a drugless system of health care based on the principle that interference with the transmission of nerve impulses may cause disease.
(2) "Practice chiropractic" includes the diagnosing and locating of misaligned or displaced vertebrae and, through the manual manipulation and adjustment of the spine and other skeletal structures, treating disorders of the human body.
(3) Except as otherwise provided in this title, "practice chiropractic" does not include the use of drugs or surgery, or the practice of osteopathy, obstetrics, or any other branch of medicine.
The Board further charged that the Respondent violated the following regulations:
Code Md. Regs. tit. 10 § 43.14.03 (January 9, 2000):
.03 Standards of Practice.
A. A chiropractor and chiropractic assistant shall concern themselves primarily with the welfare of the patient.
A chiropractor and chiropractic assistant shall:
(6) Practice chiropractic only as defined in the scope of practice set forth in Health Occupations Article, §3-1 01 (f) and (g), Annotated Code of Maryland;
The Board further charged that the Respondent violated the following regulations: Code Md. Regs. tit. 10 § 43.15.03 (February 23, 1998)
.03 Record Keeping.
A. The chiropractor shall maintain accurate, detailed, legible, and organized records, documenting all data collected pertaining to the patient's health status. (emphasis added)
C. The Patient Record.
(1) The chiropractor shall create a record for each patient.
(2) The chiropractor shall state the patient's name or identification number on each document contained in the patient record. (emphasis added)
(3) The chiropractor shall include the following information in the patient record:
- Chiropractor and clinic name identification;
- Patient history;
- Examination findings;
- (e) Treatment plan;
- SOAP notes;
- Financial records;
- Records of telephone conversations;
- Copies of correspondence and reports sent to other health care providers, diagnostic facilities, and legal representatives;
- Records and reports provided by other health care providers and diagnostic facilities; and
- The signed consent of the patient or the parent or guardian of a minor patient or incompetent patient.
The Respondent was given notice of the issues underlying the Board's charges by a letter dated March 1, 2004. Accordingly, a Case Resolution Conference was held on April 8, 2004, and was attended by E. Brian Ashton, D.C., and Jack Murray, D.C., Board members1, and Richard Bloom, Assistant Attorney General, Board Counsel. Also in attendance were the Respondent and his attorney, James B. Sarsfield, and the Administrative Prosecutor, Roberta Gill, Assistant Attorney General.
1Kay O'Hara, D.C., an oncoming Board member was present in an observational capacity only.
Following the Case Resolution Conference, the parties and the Board agreed to resolve the matter by way of settlement. The parties and the Board agreed to the following:
FINDINGS OF FACT
1. At all times relevant to the charges herein, the Respondent was licensed to practice chiropractic in the State of Maryland. The Respondent was first licensed on November 18,1999. The Respondent's license expires August 31, 2005.
2. In April 2002, Chiropractor A2 filed with the Board a written complaint against the Respondent. The complaint was based upon Chiropractor A's assessment that, as Patient A's3 subsequent chiropractor, he determined that the Respondent's provision of chiropractic services for Patient A was substandard in that the Respondent "failed to examine (ortho/neuro/xr),4 failed to dx,5 did not render appropriate treatment, did not maintain adequate records." Dr. A further complained that the Respondent "failed to treat/refer appropriately."
2The identity of the chiropractor is confidential for purposes of this document. The Respondent, however, is aware of his identity.
3The identities of patients are confidential but may be disclosed to the Respondent upon contacting the Administrative Prosecutor.
4These are abbreviations for the following: orthopedic, neurological and x-ray.
5This is an abbreviation for diagnosis.
3. Attached to a complaint was a letter addressed to the Board's Executive Director which contained the following information:
A. Patient A had been referred to Dr. A's office after being treated by the Respondent for low back pain.
B. On March 10, 2002, Patient A contacted Dr. A's office, complaining of severe low back pain with radiation down the back of his right leg.
C. Prior to examining Patient A, Dr. A referred him for a MRI, which revealed lumbar intervertebral disc protrusion at three levels, and a probable annular tear at the L4 disc level.
D. At his first visit, Patient A described the care provided by the Respondent, stating that the Respondent had done no orthopedic or neurological tests, nor had he discussed the need for imaging.
E. According to Patient A, the Respondent's care consisted of frequent adjusting at the Occipito-atlantic (C0-C1) level, and nothing more.
F. Furthermore, according to Patient A, after more than a dozen visits over the course of a few weeks, Patient A stated that he not only felt no relief, but, was getting worse in that what started out as severe low back pain had developed into right-sided pain and paresthesia in a sciatic distribution.
G. Patient A related that he had expressed concern over the appropriateness of his treatment to the Respondent who dismissed his concerns.
H. Dr. A contacted the Respondent on March 21, 2002 to obtain copies of his treatment notes or any x-rays that he might have taken of the patient's lumbar spine. The Respondent informed Dr. A that he had not taken any lumbar images, only cervical, as his practice was restricted to adjusting subluxations of C0-C1 only.
4. As a result of said complaint, the Board began an investigation, during which it conducted several interviews and obtained numerous patient records. Thereafter, the Board obtained the services of an expert to review all of the files it had obtained.
ALLEGATIONS SPECIFIC TO PATIENT A
5. Patient A first presented to the Respondent on August 24, 2001 for pain in the right cervical spine, shoulder, thoracic spine and side as a result of a car accident on July 2001.
6. Apparently, the Respondent took Patient A's history on a "Himes Case History" form, even though the identity of the individual recording the information is unknown, as the form is unsigned. On a form entitled "examination findings" (the reverse side of the Himes Case History), the Respondent recorded the readings of a "spinograph," or x-rays. However, the abbreviations, such as CM, TO, KVP, MA, and SEC are not standard or customary.6 The notations under these sections are merely documentation of x-ray techniques and settings, not findings.
6The Respondent had to supply Dr. A and the Board with an explanation of his patient charts, because it was indecipherable without it.
7. On August 24th, the Respondent also took x-rays: however, those x-rays are blurred and lack contrast. Thus, they are hard to read and are not fit for making a diagnosis.
8. On August 24, 2001, Patient A signed an "Office Policy" statement, which dealt with the fact that the Respondent did not accept insurance, charged a late fee for missed appointments, etc. Patient A also signed on that date a "Terms of Acceptance" form which explained certain terms such as "adjustment," and indicated that the Respondent does not "offer to diagnose or treat any disease or condition other than vertebral subluxation and that, if "during the course of chiropractic spinal examination," a "non-chiropractic or unusual findings" is/are encountered, the patient would be advised and a recommendation would be made that the patient seek the services of another health care provider. The Respondent's terms of acceptance did not explain that his adjustments would be limited to the C0-C1 area only, regardless of what the patient's problem is.
9. The Respondent provided treatment to Patient A for pain associated with his automobile accident on August 24 and 28, and September 1, 2001. The Respondent's notes are not in a SOAP format, nor do they contain SOAP information.7 Rather, the Respondent used graphs under the following headings: N.C.G., which the Respondent stated means "Neurocaligraph" or pattern analysis used to produce objective data regarding pre and post adjustment; "Chirometer", which the Respondent explained means a pattern analysis used to record pre and post adjustment; and "Spinal Balance", which the Respondent stated means supine leg checks or a pattern analysis to record pre and post adjustment.
7SOAP is an acronym for Subjective information, e.g., patient complaint; Objective information, e.g., patient's skin is red and warm; Assessment, which are examination results and history, used to form a diagnosis; and, Plan, based upon the above, what one plans to do regarding treatment.
10. Five months later, Patient A returned to the Respondent, on February 2, 2002, for low back pain. The Respondent failed to update his history of Patient A, although Patient A's back pain was not the result of the automobile accident of July 31, 2001. The Respondent failed to note that Patient A's pain began in mid-January and that he experienced pain sitting and standing, with symptoms felt more acutely standing. The Respondent further failed to note that Patient A's pain was relieved by lying supine. The Respondent failed to note that Patient A denied that trauma caused the pain, or that he had any bowel or bladder symptoms. The Respondent also failed to note that Patient A felt pain in the side of his right thigh and leg and failed to note what caused it to intensify, as well as what medications he was taking.
11. Rather, from February 2 until March 2, 2002, the Respondent provided Patient A with the same treatment, e.g., C0-C1 adjustment that he had provided for his neck and shoulder pain. The Respondent failed to note in his "remarks" column that Patient A stated that the pain radiated down his leg and that the Respondent's treatment was not helping. Further, after several sessions, the Respondent failed to take or refer for diagnostic imaging, such as x-rays or MRIs.
12. Because he was getting worse, Patient A returned to his primary care provider who referred him to Dr. A, who, based on the symptoms, ordered a MRI, which showed that Patient A was suffering from disc derangement at L3/4, L4/5 and L5/S1, with a small annular tear in the L4 intervertebral disc. Subsequent to the MRI, Dr. A treated Patient A, whose symptoms were greatly relieved.
13. The Respondent provided substandard care for Patient A in that he failed to, including but not limited to:
A. Obtain an adequate or appropriate health history at the date of Patient A's initial visit, in that he failed to include any information regarding allergies or medications;
B. Sign the history form;
C. Sign the treatment notes or include information thereon regarding the clinic where the treatment was rendered;
D. Put the patient's name on all graphs;
E. Use code and charts/graphs that were decipherable;
F. Put necessary information on Patient A's x-rays;
G. Interpret and record an x-ray report in the patient's file;
H. Obtain diagnostic quality x-rays;
I. Obtain and record an orthopedic and neurological examination, including palpitation, range of motion, provocative testing, reflex testing, or treatment plan;
J. Record a diagnosis;
K. Update Patient A's health history upon his return visit in 2002 for a different problem, including a listing of the onset of the new problem;
L. Obtain diagnostic images before treating Patient A's low back pain;
M. Record Patient A's subjective comments regarding his treatment, especially that Patient A's condition was worsening;
N. Maintain treatment notes with SOAP information therein on each visit.
O. Cease treatment when Patient A's symptoms were not getting better or recommend that the patient seek another health provider.
ALLEGATIONS WITH REGARD TO THE ELEVEN (11)
SUBPOENAED PATIENT RECORDS
14 Based upon the content of Patient A's file, the Board subpoenaed eleven (11) other patient files from the Respondent. The following was disclosed:
A. Each file contained a Himes Case History, which appeared to be completed by the same person, but lacked a signature of the person completing the forms;
B. The Respondent failed to complete the examination findings, other than a lower portion of the form. The form fails to disclose the patient's general health symptoms, such as blood pressure, heart rate, weight and respiration;
C. The Respondent failed to conduct range of motion evaluations, regarding the patients' complaints;
D. The Respondent failed to record the patients' subjective complaints, such as intensity or duration of the pain;
E. The Respondent failed to diagnose the patients, although the practice of chiropractic in Maryland involves a diagnosis;
F. The Respondent recorded his findings in such a manner that only he can understand them;
G. The Respondent used graphs on which there is no identifying patient information;
H. The Respondent failed to record objective findings, other than those of his specific technique;
I. The Respondent failed to record an assessment or treatment plan in order to understand the patients' status on each date of treatment and the overall plan for the patients;
J. Regardless of the patient's complaint, each chart contained four cervical spine x-rays;
K. The Respondent's x-rays are of poor quality and are not "flashed" with the patients' names, dates and where the films were taken;
L. The Respondent failed to interpret and record an x-ray report.
15. As a result of the above, a follow-up health provider would be unable to determine the patients' health status and necessity for care in that the Respondent failed to:
A. With regard to the history form, address the nature, character, duration and complicating factors that comprise the patient's chief or presenting complaint;
B. With regard to the history form, record familial history, medications/surgeries, allergies, etc.
C. With regard to examinations, record or document that complete examinations were performed that included a systems review, e.g., blood pressure, enabling one to understand the patient's condition and determine whether the patient could be safely and appropriately treated with chiropractic treatment, and to determine what risks or contraindications to treatment existed;
D. With regard to examinations, there is no evidence that any of the patients needed to be referred for additional diagnostic testing or consultation with another health care provider, as per the Respondent's "Terms of Agreement" form.
E. With regard to treatment notes, there is a lack of the basic components to document the patients' responses to treatment and are a violation of the regulations hereunder;
F. With regard to x-rays, no reports were recorded and were all of the cervical spine, regardless of the presenting problem.
16. As set forth above, the Respondent violated the Act and the regulations thereunder.
CONCLUSIONS OF LAW
Based upon the foregoing Findings of Fact, the Board finds that Respondent violated Md. Health Occ. Code Ann. § (a) (9), (19) and (28). In addition the Respondent violated Code Md. Regs. tit. 10 § 43.14.03.03 (January 9, 2000) and 10 § 43.15.03.03.
Based on the foregoing Findings of Fact, Conclusions of Law and agreement of the parties, it is this 10th day of May, 2004, by a majority of a quorum of the Board,
ORDERED that the Respondent is hereby placed on PROBATION for two (2) years, subject to the following conditions:
1. During the first year of Probation, he must be supervised by a Board-approved Mentor, who will review his practice thoroughly;
2. The Respondent shall take and pass a Board-approved records-keeping course;
3. The Respondent shall take and pass a course on the laws and regulations governing the practice of chiropractic in Maryland;
4. Upon completion of the latter course, the Respondent shall take and pass, at a percentage established by the Board, its jurisprudence examination;
5. The Mentor shall meet with the Respondent once a week for the first quarter of the Probation, and then quarterly thereafter;
6. The Respondent shall ensure that the Mentor submits timely reports to the Board after each mentoring session;
7. The Respondent shall timely pay any costs of carrying out the aforementioned mentoring and courses.
It is further ORDERED that the Respondent shall pay a monetary penalty of Five Thousand Dollars ($5000) to the Board, before the expiration of his probationary period.
ORDERED that the Consent Order is effective as of the date of its signing by the Board; and be it
ORDERED that should the Board receive a report that the Respondent's practice is a threat to the public health, welfare and safety, the Board may take immediate action against the Respondent, including suspension or revocation, providing notice and an opportunity to be heard are provided to the Respondent in a reasonable time thereafter. Should the Board receive in good faith information that the Respondent has substantially violated the Act or if the Respondent violates any conditions of this Order or of Probation, after providing the Respondent with notice and an opportunity for a hearing, the Board may take further disciplinary action against the Respondent, including suspension or revocation. The burden of proof for any action brought against the Respondent as a result of a breach of the conditions of the Order or of Probation shall be on the Respondent to demonstrate compliance with the Order or conditions; and be it
ORDERED that the Respondent shall practice in accordance with the laws and regulations governing the practice of chiropractic in Maryland; and be it further
ORDERED that, at the end of the first year of the probationary period, the Respondent may petition the Board to have the conditions of Probation lifted, provided that he can demonstrate compliance with the conditions of this Order. Should the Respondent fail to demonstrate compliance, the Board may impose additional terms and conditions for the remainder of the Probation, as it deems necessary. At the end of the Probation, the Respondent may petition to be reinstated without any restrictions on his license, if he has not violated the Act or the Order.
ORDERED that for purposes of public disclosure, as permitted by Md. State Govt. Code Ann. §10-617(h) (Repl. Vol. 1999), this document consists of the contents of the foregoing Findings of Fact, Conclusions of Law and Order and that the Board may also disclose same to any national reporting data bank that it is mandated to report to.
MAY 10, 2004
E. Brian Ashton, D.C., P.T., President
Board of Chiropractic Examiners
CONSENT OF TIMOTHY YOUNG, D.C.
I, Timothy Young, D.C., by affixing my signature hereto, acknowledge that:
1. I am represented by an attorney, James B. Sarsfield, and have been advised by him of the legal implication of signing this Consent Order;
2. I am aware that without my consent, my license to practice chiropractic in this State cannot be limited except pursuant to the provisions of § 3-313 of the Act and the Administrative Procedure Act (APA) Md. State Govt. Code Ann. §1 0-201, et seq., (1999 Rep!. Vol. 2003 Supp.).
3. I am aware that I am entitled to a formal evidentiary hearing before the Board By this Consent Order, I hereby consent and admit to the foregoing Findings of Fact, Conclusions of Law and Order, provided the Board adopts the foregoing Consent Order in its entirety. 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 APA, and any right to appeal as set forth in § 3-316 of the Act and §10-201, et seq., of the APA. I acknowledge that my failure to abide by the conditions set forth in this Order and following proper procedures, I may suffer disciplinary action, possibly including revocation, against my license to practice chiropractic in the State of Maryland.
Timothy Young, D.C.
This article was posted on August 16, 2015.