In North Carolina, when a chiropractor's patient was previously imaged at a public hospital, can the chiropractor get access to those existing diagnostic X-rays for treatment, or does the hospital get to refuse and force the chiropractor to take new images?
Plain-English summary
Representative Ramey Kemp asked the AG a clean question on behalf of constituents (most likely chiropractors and their patients): could a licensed NC chiropractor review the diagnostic X-rays of his patient when those X-rays were sitting in a public hospital's file room?
The 1977 General Assembly had amended G.S. § 90-153 to spell this out. The amended statute said: "A licensed chiropractor in this State may have access to and practice chiropractic in any hospital or sanitarium in this State that received aid or support from the public, and shall have access to diagnostic X-ray records and laboratory records relating to the chiropractor's patient." (The emphasized clause was added in 1977.)
The AG, through Special Deputy William O'Connell and Assistant AG Robert Reilly for AG Edmisten, gave a one-word answer: yes. The statute was clear. Access to "diagnostic X-ray records" was the right being given, and that included the X-rays themselves, not just the radiologist's interpretation report or any summary.
The AG identified three legislative purposes behind the 1977 amendment:
- Avoiding unnecessary costs in health care delivery (no double imaging).
- Preventing unnecessary patient exposure to radiation (no double dose).
- Enabling chiropractors to engage fully in the practice of chiropractic (no second-class status compared to MDs).
The opinion is short but the policy stakes were real. In the late 1970s, the chiropractic profession in NC was still fighting for recognition alongside conventional medicine. Hospitals were often reluctant to extend the same record-access courtesies to chiropractors that they routinely extended to MDs. The 1977 amendment to G.S. § 90-153, and the AG's 1978 endorsement of its plain meaning, settled the point at the state-law level: a hospital receiving public aid had to give a NC-licensed chiropractor the same access to patient X-rays that an attending physician would have, when those records related to the chiropractor's own patient.
Currency note
This opinion was issued in 1978. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here. The most significant later development is the federal Health Insurance Portability and Accountability Act (HIPAA), which took effect in stages starting in 2003 and now governs the disclosure of protected health information including medical imaging. Anyone working a current medical-records-access question must consider HIPAA's authorization requirements, the patient's own access rights under the HIPAA Right of Access (45 C.F.R. § 164.524), and any current state-law provisions including any updates to G.S. § 90-153.
Background and statutory framework
NC's chiropractic statutes have always granted licensed chiropractors the right to practice in the state, but the scope and conditions of that practice have evolved. Through the 1960s and 1970s, hospitals frequently treated chiropractors as outside the conventional medical team, denying them admitting privileges, denying them access to hospital diagnostic resources, and denying them the right to review records of patients they were treating.
The 1977 amendment to G.S. § 90-153 was part of a broader push to remove those barriers, at least at hospitals that received aid or support from the public. The "aid or support from the public" qualifier was the policy hook: a hospital benefiting from public funds had to extend its diagnostic resources to a publicly licensed provider whose patient had records there.
The AG's reading that "X-ray records" includes the actual films is consistent with the statute's three identified purposes. A radiology report summarizes findings but does not let a treating provider see the actual image; another provider might read the image differently, identify other features, or confirm a finding by inspection. The full benefit of avoiding duplicate radiation and unnecessary cost only accrues if the chiropractor can see the actual film.
The "relating to the chiropractor's patient" qualifier limited the access to records of patients the chiropractor was actually treating. It was not a general right of access to all hospital X-ray files; the chiropractor had to have a treatment relationship with the patient whose records he was asking to see.
Common questions
Could a private hospital refuse a chiropractor access under this statute?
The statute applied to hospitals or sanitariums "that received aid or support from the public." A purely private hospital that did not accept any form of public aid (no Medicaid, no Medicare, no public construction grants, no tax-exempt municipal bond financing, etc.) might have argued it was outside the statute's reach. In practice, that fact pattern was rare; most NC hospitals accepted some form of public aid.
Did the patient need to consent?
The statute didn't expressly require patient consent, but as a matter of medical-records practice in 1978, the patient's authorization was typically obtained before the records were transferred or accessed. After HIPAA, the patient's authorization (or compliance with a HIPAA-permitted use or disclosure category) became a federal-law requirement.
What if the chiropractor's reading of the X-ray differed from the hospital radiologist's?
That was a clinical disagreement, not a legal one. The statute gave the chiropractor access; it did not require any particular outcome from the chiropractor's review. A chiropractor who disagreed with a hospital radiologist would document the alternative finding and treat the patient accordingly, just as any second-opinion provider would.
Did this opinion give chiropractors hospital admitting privileges?
No. Admitting privileges are a separate, hospital-by-hospital credentialing question handled by hospital medical staff bylaws. G.S. § 90-153 spoke about practice access and records access, not about admitting authority.
Source
- Landing page: https://ncdoj.gov/opinions/health-chiropractors-access-to-x-rays-in-possession-of-hospitals/
Citations
- N.C. Gen. Stat. § 90-153
Original opinion text
Requested By:
The Honorable Ramey F. Kemp
Member of the House of Representatives
North Carolina General Assembly
Question:
Under current statutes may a chiropractor review the diagnostic X-ray records of his patient when such records are in the possession of a hospital which receives aid or support from the public?
Conclusion:
Yes.
As amended by the 1977 General Assembly, G.S. 90-153 provided as follows:
"A licensed chiropractor in this State may have access to and practice chiropractic in any hospital or sanitarium in this State that received aid or support from the public, and shall have access to diagnostic X-ray records and laboratory records relating to the chiropractor's patient." (Emphasis Supplied)
This statute clearly authorizes a chiropractor to review the records described in the question, which such entitlement including access to the X-rays themselves. It would seem that the intent of the General Assembly in enacting this legislation was threefold: (a) to obviate unnecessary costs in the delivery of health care; (b) to prevent unnecessary explosure of patients to radiation; and (c) to enable chiropractors to engage fully in the practice of chiropractic.
Rufus L. Edmisten
Attorney General
William F. O'Connell
Special Deputy Attorney General
Robert R. Reilly
Assistant Attorney General