Navigating the Telehealth Frontier

Navigating the Telehealth Frontier: Standards of Care and Expert Testimony

Wayne Bennett, DC, DABCC, DABCO

Telehealth has moved from a pandemic stopgap to a permanent fixture in modern healthcare. Unfortunately for providers—and fortunately for litigators—it has done so at a pace that outstrips the ability of law, regulation, and precedent to keep up. The result is a growing category of disputes where outcomes depend less on settled doctrine and more on how well an expert witness can explain what competent clinicians are expected to do when the patient is on a screen instead of an exam table.

At first glance, it seems obvious that certain aspects of care—such as chiropractic manipulation—cannot be delivered remotely. On that point, there is little room for debate. But once you step past what clearly cannot be done, the rest of the profession’s scope opens up considerably. History, triage, exercise instruction, care planning, follow-up, and patient education can all be delivered through telehealth. That is where the legal questions begin to multiply—quietly at first, and then all at once.

For attorneys, telehealth cases bring a familiar sort of frustration: novel facts, uneven guidance, and opposing counsel confidently declaring that “the standard of care is obvious.” In telehealth, that confidence is often inversely related to accuracy.

Most disputes revolve around questions that sound simple but tend to get complicated in a hurry. What constitutes an adequate examination over video—or asynchronously? When should a clinician escalate to in-person care? How much documentation is enough when you never laid hands on the patient? How certain does a diagnosis need to be before treatment is recommended? Were the right safeguards in place to protect patient data? And, inevitably, where did the care legally occur when the provider and patient were in different states—and which set of rules is riding shotgun?

These questions are rarely answered by pointing to a single study or guideline. Instead, they are resolved by looking at how the profession actually operates—guided by board expectations, professional policies, and regulatory frameworks that aim to preserve the standard of care while acknowledging the limits of remote tools. In other words, the rules exist, but they are still being worked out in real time—which is another way of saying the courtroom has become part of the drafting process.

That reality places expert testimony squarely in the middle of most telehealth litigation.

From an admissibility standpoint, telehealth cases tend to favor Frye-style qualification. Where peer-reviewed literature lags behind real-world adoption and credentialing remains inconsistent, courts often benefit more from testimony grounded in general professional acceptance than from trying to force telehealth practice into a Daubert framework built for controlled scientific validation. In these cases, the expert’s job is not only to identify the appropriate jurisdictional authority, but to explain how competent clinicians adapt traditional processes—history, triage, escalation, documentation, and follow-up—when the only thing between them and the patient is a Wi-Fi signal and a camera that may or may not be pointed in the right direction.

Expert testimony is increasingly central across several recurring areas of dispute: adequacy of the remote examination, formation of a valid clinician–patient relationship, telehealth-specific informed consent, documentation and continuity of care, and licensure or compact compliance. These are not checklist issues—they are judgment calls, and without context, they can look either entirely reasonable or completely indefensible, depending on who is telling the story.

The takeaway for attorneys is straightforward. Telehealth cases are rarely about hard science or published medical evidence; they are about accepted clinical processes operating in a regulatory landscape that is still catching its breath.

And if there is a practical lesson here, it is this: practicing telehealth without understanding the rules is a little like riding across open range without knowing where the fences are—you might be fine for a while, right up until someone else insists you have crossed a line you never saw. At that point, it helps to have someone who knows the terrain, can read the markers, and can explain—calmly and clearly—how you got there, and whether you actually wandered off trail…or if the fence just got moved after you passed through.