Bus Company Shut Down By Federal Motor Carrier Safety Violations

Are you thinking about taking a bus for your holiday travel plans.  If you are than you might want to know that bus companies are required to be in compliance with federal motor carrier safety standards.

A Comprehensive Safety Compliance Review by the Federal Motor Carrier Safety Administration (FMCSA)  resulted in a Pennsylvania-based charter bus company's revocation of its DOT registration.  RLT Tours, LLC was ordered to cease all intrastate and interstate passenger carrier operations.

The violations included hours-of-services requirements for drivers, insurance requirements, vehicle maintenance standards, and drug and alcohol testing compliance.

The company cannot resume its interstate and intrastate service until it corrects the violations and gets in compliance with the federal motor carrier safety regulations.  They also have to pay over $8,500 in fines.

Titolo Law Office is a personal injury litigation group. We only represent plaintiffs and consumers. Titolo Law Office and Timothy R. Titolo do not give specific legal advice in this blog. You should contact us with any questions you have regarding the subject matter of this blog or your specific case.

Titolo Law Office is a personal injury litigation group. We only represent plaintiffs and consumers. Titolo Law Office and Timothy R. Titolo do not give specific legal advice in this blog. You should contact us with any questions you have regarding the subject matter of this blog.

The U.S. Department of Transportation's Federal Motor Carrier Safety Administration (FMCSA) today took a major step toward improving commercial truck and bus safety with the launch of the Compliance Safety Accountability (CSA) program.  This program has been a topic of attention for those us interested in making safety a priority for drivers on the roads and highways used by bus and truck companies.
 Titolo Law Office is a personal injury litigation group. We only represent plaintiffs and consumers. Titolo Law Office and Timothy R. Titolo do not give specific legal advice in this blog. You should contact us with any questions you have regarding the subject matter of this blog.
The focus of CSA is the Safety Measurement System (SMS), which will evaluate all safety-based violations from inspections and crash data to determine a commercial motor carrier's on-road performance. The new safety program will allow FMCSA to cover more carriers earlier and use a range of corrective interventions to address a carrier's specific safety problems.

U.S. Transportation Secretary Ray LaHood says "The CSA program will help us more easily identify unsafe commercial truck and bus companies. "Better data and targeted enforcement will raise the safety bar for commercial carriers and empower them to take action before safety problems occur." In turn this will make the roads and highways safer for drivers.

The program also advances the Obama Administration's open government initiative by providing the public with safety data in a more user-friendly format. This will give drivers a better picture of those carriers that pose a safety risk. CSA was also tested in nine test states before the program was launched.

FMCSA Administrator Anne S. Ferro said "We worked closely with our partners in the motor vehicle community to develop this powerful new program....CSA is an important new tool that will help reduce commercial vehicle-related crashes and save lives."

The SMS uses seven safety improvement categories called BASICs to examine a carrier's on-road performance and potential crash risk. The BASICs are Unsafe Driving, Fatigued Driving (Hours-of-Service), Driver Fitness, Controlled Substances/Alcohol, Vehicle Maintenance, Cargo-Related and Crash Indicator. Under FMCSA's old measurement system, carrier performance was assessed in only four broad categories.

By looking at a carrier's safety violations in each SMS category, FMCSA and state law enforcement will be better able to identify carriers with patterns of high-risk behaviors and intervene to provide carriers the information necessary to change unsafe practices early on.

Safety interventions include early warning letters, targeted roadside inspections and focused compliance reviews that concentrate enforcement resources on specific issues identified by the SMS.

FMCSA will continue to conduct onsite comprehensive compliance reviews for carriers with safety issues across multiple BASICs. And, where a carrier has not taken the appropriate safety steps, FMCSA will invoke strong civil penalties.

To learn more about the new CSA program, visit http://csa.fmcsa.dot.gov/. To see the new SMS, visit http://ai.fmcsa.dot.gov/sms.

Doing the Right Thing

Doing the Right Thing for the Right Reason   By Tim Titolo
When the phrase "pro bono" is put into the Westlaw search engine under Law Review Journals, you are prompted to select the following "related terms:" Benevolence, Charity, Gift, Gratuity, Largess and Philanthropy. Microsoft’s Encarta Dictionary defines "pro bono" as "done or undertaken for the public good without any payment or compensation." In the legal profession, "pro bono" is typically credited to the provider of services by a third party like a state bar agency. However no credit is given for services provided without third party assignment. Of course the obvious problem of manipulating free services "gratuitously" to those who do not need it, verses indigent parties, is real; so may be the incentive to voluntarily decline helping someone without resources if it is not credited as "pro bono." The point is that doing the right thing for the right reason is always a good thing.
Some attorneys are very accomplished in particular and specific areas, others practice in a more general way. It may not be particularly helpful or wise for a real estate attorney to take on a large medical malpractice trial; and visa versa. It may not be wise for a lawyer with virtually no experience in tax law to represent a client in an IRS hearing. The examples here are many; but the point is made.
On the other hand, a tax lawyer would be very useful in doing free legal work for an individual with IRS problems who can not afford legal services. A criminal defense lawyer may be able to provide competent representation for an accused person without resources. A lawyer with specific training and experience in particular medical areas could readily provide representation to a victim of injury when compensation is unavailable. In fact this area is fertile for gratuitous service.
I have a personal injury litigation practice. I try to keep the majority of my effort in the areas of brain injury. I have spoken publicly about the 3 things all brain injury cases require: liability, Injury and coverage – " LIC - an acronym I created "
That said, I feel it incumbent on my practice to help severely injured people and their families whose cases lack insurance funds, when, for instance, that person is comatose in the Emergency Room and physicians simply do not know what to tell the family. I will sit at the hospital and wait with these people for a good sign. I will ask the physicians if the coma will result in permanent damage (which I know it will) and then I prepare the family for the reality of the impending death or, sometimes worse, so called recovery.
After the recovery (from coma) I try to help the family with government benefits, health insurance, if any, medical arrangements and care for the
injured family member. I do this in addition to obtaining confirmation of assets, lack of insurance, or recovery of inadequate insurance "limits" from a tortfeasor. I do not take a fee for my service.
Pro bono work is needed by indigents all over. As Christ said when his apostles questioned his motive for allowing Mary Magdalene to waste fragrance on him when they could have sold it and used the money to help others, "the poor will be with you always…" Not for profit groups, like churches, shift providing for individual needs from indigent families to itself and thus relieve the government (other people of the state) from providing them. Likewise, lawyers should, when appropriate, relieve the public’s need for legal service (funneled through government agencies) by providing legal service for no profit to folks who are not otherwise able to receive that service. This may shift part of the burden from the state agency to the not for profit provider – the lawyer. This in turn will promote meeting the needs of the state’s pro bono needs by lawyers qualified to provide those needs.
The butterfly effect provides that a fluttering of a butterfly’s wings on one side of the globe can cause a hurricane on the other. The interconnectedness of everything is supported by the latest knowledge in the fields of physics and the cosmos. Doing your part, however small or large, can benefit the greater good.
Neither Clark County, the State of Nevada or anyone, other then the family helped, formally realizes that services were provided "gratuitously." But no matter, doing the right thing for the right reason is reward itself. If getting a pat on the back for caring and doing is motive for doing, it may inhibit some from doing good things when no one is looking. Hopefully the moments when something good is done when no one is looking, in my or any lawyer’s life, helps make up for some of the shortcomings in other parts of our lives. I hope so.

Timothy Titolo is a personal injury trial attorney representing clients with brain and spine injury. He is a frequently invited speaker at various brain injury associations around the country. He is the recipient of the 2002 Aurora Award, 2003 Award of Excellence, 2004 Jade Award, 2005, 2006, 2007. 2008  and 2009 Aurora Award for brain injury cases he has been involved in. He is a member of the Million Dollar Advocates and has obtained the largest verdicts and settlements in Nevada for persons with mild to moderate brain injury.
http://www.titololawoffice.com/  info@titololawoffice.com

Overview of Catastrophic Cases

Overview of Catastrophic Cases

Timothy R. Titolo

What Constitutes a Catastrophic Injury?

For many, the term “catastrophic injury” needs no definition. Most know a catastrophe when they see one. Federal law defines “catastrophic injury” as an injury whose consequence permanently prevents an individual from performing any gainful work. 42 U.S.C.A. § 3796b.Moreover, Nevada law includes a serious illness or accident that renders the employee unable to perform his/her duties and is either life threatening or requires a lengthy convalescence as a “catastrophe” for purposes of a public employee who wishes to take "catastrophic leave".Nev. Rev. Stat.§ 284.362; Nev. Rev. Stat.§ 281.153.

Types of Catastrophic Injury

Although Nevada law does not specify the various types of catastrophic injuries, the following classification from Georgia statute provides a good overview of examples of catastrophic injuries:

(a) Spinal cord injury involving severe paralysis of an arm, a leg, or the trunk;

(b) Amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage;

(c) Severe brain or closed-head injury as evidenced by:

1. Severe sensory or motor disturbances;
2. Severe communication disturbances;
3. Severe complex integrated disturbances of cerebral function;
4. Severe episodic neurological disorders; or
5. Other severe brain and closed-head injury conditions at least as severe in nature as any condition provided in subparagraphs 1.-4.;

(d) Second-degree or third-degree burns of 25 percent or more of the total body surface or third-degree burns of 5 percent or more to the face and hands;

(e) Total or industrial blindness; or

(f) Any other injury that would otherwise qualify under this chapter of a nature and severity that would qualify an employee to receive disability income benefits under Title II or supplemental security income benefits under Title XVI of the federal Social Security Act as the Social Security Act existed on July 1, 1992, without regard to any time limitations provided under that act.

Ga. Code Ann., § 34-9-200.1.

Evaluating Liability and Damages

The Supreme Court of Nevada has held that damages in personal injury cases should be calculated based on modicum of rationality and not with mathematical precision. See Greco v. U.S., 893 P.2d 345, 418 (Nev. 1995). In Hill v. U.S, 854, F. Supp, 727 (D. Colo., 1994), the federal district court in Colorado considered the following facts in evaluating the economic damages in a catastrophic injury claim:

1.      Expenses for periodical medical care that is required during the lifetime of the injured with regard to the nature of injury suffered. See id. at 730.

2.      Expenses for present and future medication and supplies with regard to the nature of the injury suffered. See Id.

3.      Expenses for providing and facilitating required personal care to the injured depending upon the nature of the injury. See id.at 730-31.

4.      Expenses for providing psychological counseling to the family members of the injured to cope with the injured person’s demands and need and to assist them in providing care to the injured. SeeiId.at 731.

5.       Expenses for appointing case management professional to assist in the planning, coordinating and supervising the care of the injured depending upon the complexity of the medical and physical care services required by the injured. See id.

6.      Expenses for the special transportation facilities that the injured person’s physical impairment requires. See id.

7.      Expenses for developmental assessment to monitor the developmental progress and to access the injured person’s needs. See id.

8.      Expenses for rehabilitation services to give required physical therapy and other therapies such as occupational therapy, speech therapy etc., depending upon the nature of the injury. See id.

9.      Expenses for special equipments required for the injured. See id. at 732.

10. Expenses for home modification that is required by the family to modify the home to accommodate injured person’s special equipments and needs. See id.

Apart from the above, economic damages are also awarded on the basis of future loss in earning capacity. See id.

Evidentiary Issues

            I am writing from the perspective of a practitioner and have attempted to provide an overview of the evidentiary issues associated with litigating catastrophic injury claims, especially from the plaintiff’s perspective. My intent is not to provide an academic discussion that covers all aspects of this topic. However, for a deep and detailed discourse, please see 72 Am. Jur. Proof of Facts 3d § 363 (2007) which discusses these issues in the catastrophic brain injury context. I have used the foregoing resource as a reference point for organization and to identify key points.

Injury:

More often than not, in a catastrophic injury, particularly a traumatic brain injury, the injured person exhibits memory deficits. Even though such people cannot describe the situation exactly, the occurrence of the injury has to be ascertained by the circumstances surrounding the accident/incident. It is the duty of plaintiff's counsel to carefully analyze all available evidence about the accident and endeavor to integrate each of those facts into a cohesive narrative that shows the finder of fact that the defendant acted in a negligent manner. Plaintiff’s counsel should supplement the plaintiff’s deposition testimony with other prior statements if the plaintiff is unable to recall the facts of the accident. Counsel should be mindful, however, that such deposition testimony should corroborate rather than contradict the plaintiff's prior statements or testimony.

Elements to Establish:          

            The necessary elements to establish negligence by the defendant are long-established: a legal duty to the plaintiff, a breach of that duty, and damages proximately caused by the breach of duty. It is the plaintiff's ability to establish a prima facie case through circumstantial evidence which is of particular importance in claims involving traumatic brain injuries given the frequent inability of brain-injured clients to recall the specific facts surrounding their injuries. If the case is based on circumstantial evidence, the plaintiffs must present facts from which the defendant's negligence and causation of the accident by that negligence may be reasonably inferred.       

            Generally, causation of a medical condition and permanency of an injury must be established by testimony of medical experts. Such testimony must show that the indicators of a permanent disability resulting from the traumatic brain injury outweigh those to the contrary. Claiming damages for loss of earning capacity is generally recoverable when such loss is an immediate and necessary consequence of an injury.

Duty to plaintiff and the court’s view:

            In the context of a brain injury case, whether defendant has a duty to the plaintiff is a question of law that has to be decided by the court. Once the court determines that one party owes a duty to another, it is important to know the scope and extent of the duty, namely the standard of care that the defendant had to meet and the actual care that the defendant took. Once the court has determined the appropriate standard of care, the jury addresses the factual question of whether that duty has been breached.

            Further, there is no legal requirement that a jury make a damage award simply because liability is found. In determining the appropriate amount of compensation for such loss, the jury must consider the plaintiff's age and occupation, the nature and extent of the plaintiff's pre-injury employment, the value of the plaintiff's services and the amount of income that the plaintiff was earning at the time of injury. For ascertaining the damage, expert testimony is not certainly required, but it may be of assistance to the jury, especially on the issue of lost earnings. However, plaintiff's personal projection of future loss of earnings may be admitted where the future plans described by plaintiff are consistent with facts in evidence regarding his or her employment and educational history and where the plaintiff's projections are supported by expert medical testimony.

Damages:

A plaintiff may make a claim for money damages including actual damages, compensatory damages (including reimbursement for attorney fees and for retaining experts, compensation for medical injuries, subsequent injuries, disability, compensation for lost earning capacity, and plaintiff's personal projection of future loss of earnings). Any award of punitive damages is completely within the discretion of the fact-finder.

Plaintiff’s counsel should also be mindful of the duty to mitigate damages. In Nevada, the law regarding the mitigation of damages states that “[a] person who has been damaged by the wrongful act of another is bound to exercise reasonable care and diligence to avoid loss and to minimize the damages, and he may not recover for losses which could have been prevented by reasonable efforts on his part or by expenditures that he might reasonably have made.”Lublin v. Weber, 108 Nev. 452,454 833 P.2d 1139, (Nev., 1992); Silver State Disposal Co. v. Shelley, 105 Nev. 309, 774 P.2d 1044 (Nev., 1989). Defense counsel should, of course, explore any possible failure to mitigate by the plaintiff as a potential defense to avoid or reduce a damages award.

The Nevada collateral source rule prohibits the jury from reducing the plaintiff's damages on the ground that the plaintiff received compensation for his injuries from a source other than the tortfeasor. Nev. Rev. Stat. § 17.130;Bass-Davis v. Davis, 134 P.3d 103, 110-11 (Nev. 2006). Plaintiff’s counsel should be mindful to object to any attempts by the defense to introduce evidence of other sources of compensation for the plaintiff. Introduction of such evidence can lead to a new trial for the plaintiff. See Davis, 134 P.3d at 111.

Discovery and Investigation

            Generally, litigation discovery is governed by Fed. R. Civ. Pro. 26 for federal trials and Nev. Rev. Stat. Rule 16.2(b)(2) for Nevada state court litigation. However, my discussion is aimed at providing an overview of some of the specific discovery issues that arise in the catastrophic injury context. For a more detailed discussion, I refer you once again to 72 Am. Jur. Proof of Facts 3d § 363 (2007), which I have used to help organize this discussion and to identify salient points for this overview.

1)      Information to be obtained from the plaintiff prior to commencement of litigation:

The discovery methods in such cases require a thorough prior knowledge of all the previous incidents surrounding the plaintiff’s injury to maximize the results of the trial for the plaintiff. Discussion with the plaintiff about the mechanism of injury, resulting symptoms and long term effects serves as a primary source of information. Plaintiff’s counsel may obtain necessary information from potential witnesses such as the physicians who treated the plaintiff both prior and/or subsequent to the injury, information from the family members of the injured describing the affect, frustration, post-injury emotional distress, and information from the plaintiff’s employer, and co-workers about the changes they have noted in the plaintiff’s ability to work.

2)      Information to be obtained from medical expert.

The next step in the preparation of the discovery proceedings would be to consult the expert who will be called at trial as part of the plaintiff’s case. Besides obtaining the background information of the expert, the other important information to be obtained from the expert is his prior litigation history mentioning the percentage of cases in which the expert testified on behalf of the plaintiff and the defendant and also the educational and employment qualifications. Counsel should ask the expert regarding the date, location of the first contact with the plaintiff, the occasions on which the plaintiff will require treatment, tests performed (and the nature of the tests and their purpose and results), and the treatment provided to the plaintiff. Plaintiff’s counsel should pose questions to the expert regarding the expert’s opinion about the medical certainty that the plaintiff suffered an injury, cause of the injury, signs, symptoms, complaints, whether the problems exhibited by plaintiff were the result of that injury, and whether any pre-existing conditions have been distinguished from the injuries at issue.

3)      Information to be obtained from economist or other expert regarding special damages

Plaintiff’s counsel must collect necessary information from economists or other experts being called in support of the plaintiff’s claim of damages, especially in cases where the plaintiff has lost his earning capacity. Expert opinion as to the plaintiff’s lost earnings should address losses suffered as a result of plaintiff's inability to perform household tasks, plaintiff's future costs for medical care, reduction of such amounts to present value and methodology for calculating present value.

  

Conclusion

A catastrophic case should not be taken lightly.  There are ethical and legal considerations.  Damages must be explored and developed properly.  An inability to finance the development of damages may make an otherwise good case bad.  An astute lawyer will recognize her limitations and ask for a more experienced lawyer’s help.

Titolo Law Office is a personal injury litigation group. We only represent plaintiffs and consumers. Titolo Law Office and Timothy R. Titolo do not give specific legal advice in this blog. You should contact us with any questions you have regarding the subject matter of this blog.

How Doctor's Think

How Doctors Think is striking a chord with doctors.  Doctors' thinking processes, in particular, need attention, according to Jerome Groopman, MD, hematologist and oncologist. Groopman's 2007 book, How Doctors Think (Houghton Mifflin), called "a mix of science and soul" by New York Times reviewer William Grimes, has struck a chord with physicians, insurers, and others concerned about why so many medical errors occur and how to prevent them.
I find the latest advances in legal thinking and the use of heuristics is also cutting edge thinking in medicine. 
The following is an interview printed in Medical Economics by Leslie Kane MACC of Dr. Groopman:

Kane: You described three heuristics that doctors typically use—"the three As," as you call them. What are they?

Groopman: The first is anchoring. We quickly latch onto what we think the diagnosis is, and selectively accept or ignore information that corresponds with what we expect to find. This influences the questions we choose to ask, and how we ask them. That, in turn, tends to focus patients' answers. So we're more likely to find what we've already decided we're looking for.

The second heuristic is availability. That's the tendency to judge the likelihood of a diagnosis based on how readily relevant examples come to mind. During a flu epidemic, for instance, if you see 15 people with the flu, when the 16th person comes in saying he feels clammy and has a bit of fever, you automatically assume it's the flu. But it might be something else entirely.

Or if you've had a very dramatic case—which all doctors do—it imprints on your mind. When you see patients with similar physical findings, you superimpose that prior dramatic case on the one in front of you.

The third heuristic is attribution. We all hold stereotypes in our mind and are very quick to attribute complaints to a larger stereotype. If a patient is slovenly, hasn't shaved, has rum on his breath, and has an enlarged liver, he becomes alcoholic cirrhosis even if he says he doesn't drink much.

Kane: Doesn't everyone use heuristics to get through life? That's how people learn by experience, and make it through the day without having to evaluate every occurrence from scratch. How are doctors supposed to turn off these very human thinking mechanisms?

Groopman: You're correct. These kinds of mental shortcuts are wired in our brains. Physicians in particular invoke heuristics because we're working under conditions of time pressure and uncertainty, with limited data.

Kane: Given that heuristics are hard-wired, how can doctors overcome them?

Groopman: We need to remember that the three heuristics I mentioned are all traps. So you need to do metacognition—think about your thinking. To do that, ask yourself some simple questions when evaluating patients: "What else could it be?" Or "Am I being too quick to lump it all together?" Or "Can two things be going on at once?" Because maybe the person does drink, but that doesn't mean there can't be another problem that accounts for his enlarged liver.

These are the kinds of questions that when we were residents, we asked our attendings or the attending physicians asked us. But now that we're in practice, it becomes harder to ask these questions because we're working within our own heads.

Kane: With today's shorter patient visits, pay for performance, and evidence-based medicine, doctors are encouraged to use algorithms and decision trees to diagnose. The system doesn't encourage doctors to take more time for open-ended thinking. How can doctors find the time to think more and still make a good living?

Groopman: The system has gone headlong into checking off the boxes and following all the outcomes and decision trees. I believe medicine is still something that requires an understanding of the individual.

I've spent years in research for evidence-based medicine, and I'm very aware of the limits and deficiencies of how those data are used. They reflect a very, very cherry-picked group of patients. They use patients who aren't on seven medications, and they come up with statistical averages. How closely does the patient in your office correspond with the data-based medicine? Are you supposed to say to your patient, "Please leave my office, you don't fit the data"?

Kane: It sounds like there isn't really an answer to the situation. Hearing from doctors who are struggling with diminished reimbursements, I get the impression that the public expects doctors to be more altruistic than other human beings and not care about the financial end.

Groopman: I think this is a caring profession; it still attracts people who want to do good and people who are altruistic and dedicated. But that doesn't mean you shouldn't make a living. Being a doctor doesn't mean you're required to be a monk and give up the world. Physicians are being pushed to work ever harder, while at the same time the system is changing in ways that prevent profit from going to the people who do the work.

Kane: Any other wisdom or advice you'd give doctors?

Groopman: Learning how doctors think has helped me give better care, and has prevented me from making the kinds of mistakes I made in the past. I feel it has restored to me some degree of control because I know my mind better. And that control enables me to more effectively buck the system.

Groopman brings up important information about tuning into your own thinking. Doing so takes some attention and practice; and because thinking short-cuts are so human, it may be a challenge. But doctors have never been ones to take the easy path, especially when an activity can sharpen their expertise and enhance their patients' lives.

Groopman holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is Chief of Experimental Medicine at the Beth Israel Deaconess Medical Center. His earlier books include The Measure of Our Days (1997), which explores the spiritual lives of patients with serious illness; Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine (2000); and The Anatomy of Hope: How People Prevail in the Face of Illness (2005). He is also a staff writer at The New Yorker.

Titolo Law Office is a personal injury litigation group. We only represent plaintiffs and consumers. Titolo Law Office and Timothy R. Titolo do not give specific legal advice in this blog. You should contact us with any questions you have regarding the subject matter of this blog.

Chiropractic for Pain

Over the years, Chiropractors have taken a lot of heat about their brand of healing.  Insurance companies discredit their treatment everyday.  But Chiropractic care, in this emerging age of preventable care as a way to reduce health care costs, may be ready to make a grand re-entrance.

I previously blogged about a Seven Year Study that revealed Chiropriactic was an excellent care technique.

I work with Chiropractors in appropriate cases where client care can be managed by such a physician.  These doctors often refer patients on to other specialists if the needs arise.

Low-back pain sufferers can seek relief from any number of health professionals, orthopedists, physical therapists and osteopaths among them.

Many choose chiropractors, which typically combine spinal manipulation with such treatments as exercise, massage, heat or electrical stimulation. This approach is modestly  successful in reducing pain of recent onset and improving disability, at least for a few weeks, according to a new Cochrane review. However, the review found no evidence that chiropractic works significantly better than care provided by other clinicians.
Cochrane Reviews investigate the effects of interventions for prevention, treatment and rehabilitation in a healthcare setting. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting.
Low-back pain is one of the most common and costly musculoskeletal problems in modern society. About 80% of the population will experience low-back pain at some time in their lives. Many people with low-back pain seek the care of a chiropractor.

For Cochrane's review, chiropractic was defined as encompassing a combination of therapies such as spinal manipulation, massage, heat and cold therapies, electrotherapies, the use of mechanical devices, exercise programs, nutritional advice, orthotics, lifestyle modification and patient education. The review did not look at studies where chiropractic was defined as spinal manipulation alone as this has been reviewed elsewhere and is not necessarily reflective of actual clinical practice. Non-specific low-back pain indicates that no specific cause is detectable, such as infection, cancer, osteoporosis, rheumatoid arthritis, fracture, inflammatory process or radicular syndrome (pain, tingling or numbness spreading down the leg).
Twelve randomised trials (including 2887 participants) assessing various combinations of chiropractic care for low-back pain were included in this review, but only three of these studies were considered to have a low risk of bias.

This tells me that chiropractic care is a useful protocol in the effort of reducing pain and healing in many circumstances.