Disciplinary Action against Ty Ruddell, D.C.
Stephen Barrett, M.D.
In 2006, the Arizona State Board of Chiropractic Examiners issued a letter of concern to Ty Ruddell, D.C. about his management of two patients. The disciplinary order (shown below) states that Ruddell:
- Did not maintain an adequate record of what he had done
- Sent x-rays out to be read, but proceeded to treat the patients before the x-ray reports were returned to him
- Used a disclaimer form. signed by patients, which stated that he did not diagnose or treat any condition other than "vertebral subluxation"
- Submitted insurance claims for other services that were not documented in the patient's chart.
- Billed for adjusting five spinal regions per session without documenting the appropriateness or necessity for this
Ruddell was ordered to (a) serve on probation for one years, (b) take continuing education courses in chiropractic record keeping, billing, and (c) undergo at least two practice audits.
BEFORE THE ARIZONA STATE BOARD
OF CHIROPRACTIC EXAMINERS
In the Matter of:
TY S. RUDDELL, D.C.,
Case No. 2006-079
CONSENT AGREEMENT AND
In the interest of a prompt and judicious settlement of this case, consistent with the public interest, statutory requirements and responsibilities of the Arizona State Board of Chiropractic Examiners ("Board"), and under A.R.S. §§ 32-924, et seq., and 41-1092.07(F)(5), Ty S. Ruddell, D.C., holder of license number 6023 to practice chiropractic in the State of Arizona ("Respondent"), and the Board enter into the following Recitals, Findings of Fact, Conclusions of Law and Order ("Consent Agreement") as the final disposition of this matter.
1. Respondent has read and understands this Consent Agreement as set forth herein, and has been provided the opportunity to discuss this Consent Agreement with an attorney. Respondent voluntarily enters into this Consent Agreement for the purpose of avoiding the expense and uncertainty of an administrative hearing.
2. Respondent understands that he has a right to a public administrative hearing concerning the above-captioned matter at which administrative hearing he could present evidence and cross-examine witnesses. By entering into this Consent Agreement, Respondent knowingly and voluntarily relinquishes all rights to such an administrative hearing, as well as all rights of rehearing, review, reconsideration, appeal, judicial review or any other administrative and/or judicial action, concerning the matters set forth herein.
3. Respondent affirmatively agrees that this Consent Agreement shall be irrevocable.
4. Respondent understands that any part of this Consent Agreement may be considered in any future disciplinary action brought against him by the Board.
5. Respondent understands that acceptance of this Consent Agreement does not preclude any other agency, subdivision or officer of this State from instituting any other civil or criminal proceedings with respect to the conduct that is the subject of this Consent Agreement.
6. Respondent understands that this Consent Agreement deals with Board Investigation Case No. 2006-079 involving allegations of unprofessional conduct against Respondent. The investigation into these allegations against Respondent shall be concluded upon the Board's adoption of this Consent Agreement.
7. All admissions made by Respondent in this Consent Agreement are made solely for the final disposition of this matter, and any related administrative proceedings or civil litigation involving the Board and Respondent. Therefore, any admissions made by Respondent in this Consent Agreement are not intended for any other use, such as in the context of another regulatory agency's proceedings, or civil or criminal proceedings, whether in the State of Arizona or in any other state or federal court.
8. Respondent acknowledges and agrees that, upon signing this Consent Agreement and returning this document to the Board's Executive Director, he may not revoke his acceptance of the Consent Agreement or make any modifications to the document, regardless of whether the Consent Agreement has been issued by the Board's Chairman. Any modification to this original document is ineffective and void unless mutually approved by the parties in writing.
9. Respondent understands that this Consent Agreement shall not become effective unless and until adopted by the Board and signed by its Chairman.
10. Respondent understands and agrees that if the Board does not adopt this Consent Agreement, he will not assert as a defense that the Board's consideration of this Consent Agreement constitutes bias, prejudice, prejudgment or other similar defenses.
11. Respondent understands that this Consent Agreement is a public record that may be publicly disseminated as a formal action of the Board, and shall be reported as required by law to the National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank.
12. Respondent understands that any violation of this Consent Agreement constitutes unprofessional conduct under A.R.S. § 32-924 (A)(16) ([v]iolating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate any of the provisions of this chapter or any board order) and may result in disciplinary action under A.R.S. § 32-924.
DATED: 25 JULY 2006
Ty S. Ruddell, D.C.
FINDINGS OF FACT
By stipulation of the parties, this Consent Agreement is entered into for the final disposition of the matters described therein. Respondent admits to the following Findings of Fact:
13. On or about December 14, 2005, the Board received a complaint filed against Respondent's license alleging improper billing and record keeping. This prompted the Board to open an investigation.
14. The investigation did substantiate that Respondent failed to create an accurate record for continued patient care. The record's for patients A.H. and C.L. frequently failed to note accurate dates for patient care, failed to document the patients subjective complaints on multiple dates, failed to document the treating physicians name or initials on daily notes, failed to document examination findings, failed to document negative findings, and failed to document the parameters for treatment for traction and cold packs. Additionally, patient C.L. lacked a patient record for March 26, 2001.
15. The lack of accurate records failed to support all charges billed for treatment and examinations billed either directly by Respondent or indirectly through American Insurance Auditors. The record also failed to support the appropriateness or necessity for the charges for five area adjustments. However, the foregoing does not indicate intent to defraud.
16. Additionally, the x-rays for both patients were under penetrated and cut off portions of the x-ray view. Respondent also failed to document an x-ray report. Respondent sent the x-rays out to be read, but proceeded to treat the patients before the x-ray reports were returned to him. Respondent also billed for taking and reading the x-rays although they were not of diagnostic quality and Respondent had not produced an x-ray report.
17. The complaint filed in this matter alleged that Respondent used a disclaimer form, signed by the patient, which stated that he does not treat or diagnose any disease or condition other than "vertebral subluxation." Respondent then billed the patient's insurance company to treat a diagnosed condition other than subluxation. The disclaimer statement was misleading and failed to accurately reflect Respondent's intent to submit charges for diagnostic and treatment services other than vertebral subluxation.
18. Respondent also released confidential patient records to a person who claimed to represent a billing company, American Insurance Auditors. Respondent did not enter into a contract with American Insurance Auditors for the purpose of protecting confidential information, nor did he confirm and verify the qualifications of the individual who took possession of the patient information.
CONCLUSIONS OF LAW
19. Under A.R.S. § 32-900, et seq., the Board possesses jurisdiction over Respondent and this matter.
20. The conduct and circumstances described in the above Findings of Fact constitute unprofessional conduct under A.R.S. § 32-924(A)(5) ([u]nprofessional or dishonorable conduct of a character likely to deceive or defraud the public or tending to discredit the profession).
21. The conduct and circumstances described in the above Findings of Fact constitute unprofessional conduct under A.A.C. R4-7-902(3) ([f]ailing to create and maintain a patient record that includes the patient's health history, examination findings, diagnostic results, x-ray films if taken, x-ray reports, treatment plan, and notes for each patient visit. The notes for each patient visit shall include the patient's name, the date of service, the chiropractic physician's findings, all services rendered, and the name or initials of the chiropractic physician who provided services to the patient).
22. The conduct and circumstances described in the above Findings of Fact constitute unprofessional conduct under A.A.C. R4-7-902(13) ([v]iolating any federal or state law or rule or regulation applicable to the practice of chiropractic).
23. The conduct and circumstances described in the above Findings of Fact constitute unprofessional conduct under A.R.S. § 32-924(A)(15) ([a]ny conduct or practice contrary to recognized standards in chiropractic or any conduct or practice that constitutes a danger to the health, welfare or safety of the patient or the public or any conduct, practice or condition that impairs the ability of the licensee to safely and skillfully practice chiropractic).
24. The conduct and circumstances described in the above Findings of Fact constitute unprofessional conduct under A.R.S. § 32-924(A)(22) ([b]illing or otherwise charging a patient or third party payor for services, appliances, tests, equipment, an x-ray examination or other procedures not actually provided).
Based upon the above Findings of Fact and Conclusions of Law, IT IS HEREBY ORDERED:
25. Chiropractic License No. 6023, issued to Respondent to practice chiropractic in the State of Arizona, shall be issued a LETTER OF CONCERN and PROBATION for one year for the unprofessional conduct described above.
26. The terms and conditions of Probation are as follows:
a. Within and up to three (3) months from the effective date of this Order, Respondent shall complete four (4) hours of continuing education in chiropractic record keeping that is pre-approved by Board staff and shall provide Board staff with satisfactory proof of attendance within fifteen (15) days after completing the course( s). The four (4) hours of chiropractic record keeping are in addition to the mandatory hours of continuing education required of Respondent;
b. Within and up to three (3) months from the effective date of this Order, Respondent shall complete four (4) hours of continuing education in billing and coding that is pre-approved by Board staff and shall provide Board staff with satisfactory proof of attendance within fifteen (15) days after completing the course(s). The four (4) hours of billing and coding are in addition to the mandatory hours of continuing education required of Respondent;
c. Within and up to three (3) months from the effective date of this Order, Respondent shall complete four (4) hours of continuing education in x-ray positioning and technique that is pre-approved by Board staff and shall provide Board staff with satisfactory proof of attendance within fifteen (15) days after completing the course( s). The four (4) hours of x-ray positioning and technique are in addition to the mandatory hours of continuing education required of Respondent;
d. Four (4) months after the effective date of this Order, Respondent shall be subject to a minimum of two (2) chiropractic records audits by Board staff or its designee. The audits shall review records from the effective date of this Order to the date of the audit(s). Respondent shall fully and promptly cooperate with Board staff or its designee during these chiropractic audits and provide whatever assistance or resources they request;
e. Within ten (10) days from the effective date of this Order, Respondent shall personally meet with Board staff to discuss the terms and conditions of his probation and any other matters of concern; and
f. Respondent shall bear all direct and indirect costs of complying with this Order.
27. Respondent may petition the Board for early termination of his probation, after six moths, provided that he has completed or complied with Paragraphs 26a, 26b, 26c, 26d, 26e and 26f. Upon petitioning the Board, the Board shall have complete discretion to determine whether Respondent has complied with the required terms and conditions of the Order to grant termination of probation.
28. Respondent shall be affirmatively responsible for petitioning the Board to terminate his probation. Respondent's failure to petition the Board to terminate his probation shall cause his probation to continue beyond the one year period until he petitions for termination.
29. Respondent shall appear in person before the Board to respond to questions or concerns regarding his compliance with this Order when requested by the Board.
30. In the event Respondent moves out-of-state or ceases to practice chiropractic in Arizona, he shall notify the Board of these events in writing within twenty (20) days of these events; and the terms and conditions of this Order may be stayed by the Board until Respondent returns to the practice of chiropractic in Arizona.
31. Respondent shall obey all federal, state and local laws, rules, and regulations including those governing the practice of chiropractic in this State. Violation of this paragraph, in addition to being considered noncompliant with this Order, shall also be a separate violation of the laws, rules, and regulations governing the practice of chiropractic in this State.
32. This Order shall become effective as of the date stated below.
DATED this 15 day of August, 2006.
ARIZONA STATE BOARD OF
Craig S. Seitz, D.C., Chairperson
Arizona State Board of
This article was posted on August 18, 2015.