Hi,
Sorry for the delay in responding re point 3. I have moved into my new purpose built house and clinic this weekend, with many dramas over the last 4+ months. Still unpacking with patients starting to attend tomorrow.
Anyway re point 3. There is an ongoing debate regarding risk to patient, how much training a therapist should have prior to manip, the validity of pre-tersting to adequately screen for risks anyway, and how much insurance cover is valid anyway.
Damian makes a good point regarding different patient groups and their understanding of and willingness to accept risk. We all make these types of decisions everyday, even to the level of crossing the road. Some of us get it wrong and get run over by a vehicle, despite previous experience indicating it was safe.
Some of my patients have received chiropractic treatments for years, and expect me to give them the same treatment despite the fact that contraindications to manip of the cervical spine are obvious. (I do not manip!)

I also have patients that visit a chiro the same day or day previous to consulting me, as they see the treatments as different. As vertebro-basilar complications can take time to develop after a manipulation, I could find myself in court defending a case despite doing nothing wrong based upon an incorrect patient assumption of guilt. I am likely to successfully defend the case, but would not wish to be placed in this situation!
Patients may believe they understand the risks following disclosure by a therapist, however if something goes wrong, they can later deny that they were informed or that they did not understand the complexity (how could they when it is being debated at a professional level), and furthermore if a good legal person becomes involved, the advice would be to sue the therapist.
Despite the fact that some valid procedures are high risk, it is my personal judgement that it is not economically or legally prudent for me to perform the procedure of cervical manipulation.
I have had a couple of patients that have had CVA problems post chiropractic manip, and others that have had lumbar discal disease worsened with prolapse etc due to improper treatments by other therapists.
The writing is on the wall for all of us.
To fully inform a patient of cervical manip risks would take a long time, and to ask a patient to sign a lengthy document of technical nature (which it would have to be given the inherent dangers), could be seen as a waste of time the moment a lawyer picked the document to pieces or the patient stated that they did not understand it. I do not believe that a person is allowed to sign away their rights, and that if they do so, the document could be thrown out of court. The APA pre manipulation testing document is prohibitive in actual application, as the amount of time required to comply would make it uneconomic to implement - and whilst other methods may not be quite as effective they are deemed to be safer and quicker.
Hope the above clarifies my thoughts on the matter.
MrPhysio+