The random thoughts of a sceptical activist

To ‘protect the public’, apparently

Chiroquacktors frequently claim that they have never harmed anyone with their spinal manipulations. What’s the Harm and the parents of this little baby know better.

However, no doubt, as a cynical marketing exercise to allay public fears and show the sceptics amongst us that it really is safe, they have recently set up CPiRLS – The Chiropractic Patient Incident Reporting and Learning System.

It is:

an online reporting and learning forum that enables chiropractors to share and comment on patient safety incidents.

Well…OK so far as it goes. But it begs the question what they’ve been doing since the duty to properly regulate them was given to the General Chiropractic Council (GCC) under the 1994 Chiropractors Act. The GCC themselves say one of their duties is to:

protect the public

If this is the first proper system for reporting ‘incidents’, WTF have they been doing???

The CPiRLS domain name was registered on 11 February 2009, so it can only have gone live fairly recently.

Ah! There are other ways to report incidents…

Please note that reporting to CPiRLS is NOT a substitute for the reporting of patient safety incidents to your professional association and/or indemnity insurers.

Whew! At least incidents will still be reported to the proper authorities, who will take appropriate action. Won’t they?

Whatever. At least this new system will identify any unsafe practices and ensure any errant chiroquacktor is disciplined or re-trained as necessary to

protect the public

Sadly, that’s not the case.

CPiRLS is secure and anonymous. There is no known way that anyone reporting can be identified, nor do those running the system seek to identify you. For this security to be effective, you require a password to participate.

They emphasise anonymity:

Anonymity

When a report is submitted to CPiRLS, the website stores the information provided as fields within an underlying database. The website and the underlying database are hosted on a remote commercial server. The IP address of the computer from which the report was submitted is not stored to disk and the contents of the RAM cache that could carry this information is transient and rapidly flushed. Because of these measures, it is not possible for anyone to identify the individual who has submitted a report. This means chiropractors can feel confident in sharing incidents openly through the CPiRLS website.

So, there is no way whatsoever any incident – minor or serious – can ever be traced back to the perpetrator. Encouraging for chiroquacktors, but doesn’t do much to

protect the public

All chiropractors are provided with the same (regularly changed) username and password which helps to ensure that individual users cannot be identified.

They even thought about that. Any chiroquacktor can report an incident, in the sure knowledge there can be no comeback.

(Of course, it would be easy for one chiroquacktor to report an incident, perhaps with a few ‘innocent’ details of location or similar, that might just enable a local competitor to be identified and wrongly accused. Perish the thought that any of them would be so devious!)

Moving on…what are these incidents that might be reported?

An “incident” is defined as any type of patient safety event, error, accident or deviation from the norm that either:

actually happened – represented by CPiRLS as a red traffic light, or

nearly happened (‘near miss’) – represented by CPiRLS as an amber traffic light, or

has the potential to happen – represented by CPiRLS as a green traffic light,

regardless of whether it is considered minor or major, results in significant patient harm or leads to a patient complaint.

A trigger list has been designed to help you participate in CPiRLS by providing examples of incidents that you might come across and should report. Some may be fairly common and some extremely rare; the list is not exhaustive. The list provides categories/sub-categories of incident that match those provided in the electronic reporting form.

Not much of a clue as to what they consider an incident or its severity. Wait! Hover over the three levels of severity and a popup gives an example of each:

actually happened: E.g. Patient tripped over a trailing cable

nearly happened (‘near miss’): E.g. Patient was stopped before tripping over a cable.

has the potential to happen: E.g. Trailing cable noticed and remedied before it became a risk to patients.

WTF! Shouldn’t they be considering such incidents as part of normal Health and Safety duties?

But, more importantly, what about incidents where patients were harmed by their unnecessary spinal manipulations?

Well, I suppose some chiroquacktors may well report such incidents using this system, but what confidence does anyone have that this will result in their ‘profession’ being made any safer?

BTW, I wonder who set this up? Was it the GCC, who, remember, are charged with the duty to

protect the public

The GCC is based in London. The domain name (cpirls.org) is registered to a website company called Typeline, who are responsible for the websites of several chiroquacktors (eg here, here and here, all virtually identical).

Typeline are based in Reading. Oh! The British Chiroquacktic Association is also based in Reading…

And what about a way for their patients customers to report incidents?

This whole system is totally amateurish and smacks of a cynical attempt to make it look like someone is actively investigating incidents, but it’s not a patch on the NHS’ National Patient Safety Agency system, where both patients and staff can properly report incidents and know that they are going to be followed up with real concern:

We improve patient safety by enabling the NHS to learn from patient safety incidents.

The system for the public is anonymous, encouraging them to report incidents, but the staff reporting system is not, so that incidents can be properly followed up to ensure that appropriate actions are taken to minimise recurrence.

This is even more worrying now that the NHS is to promote chiroquacktic for back pain.

First posted: 24 May 2009

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