NSW Health has warned that any chiropractor working in a hospital without permission could put patients at risk, while the Australian Medical Association NSW says the behaviour is "outrageous". Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis - an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery. ''Another few millimetres and there would have been a devastating spinal cord injury and the baby would have either died or had severe neurological impairment with quadriplegia,'' he said. Dr Pappas complained to the Australian Health Practitioner Regulation Agency, which referred the case to the Chiropractic Board. Three weeks ago, he received a letter from AHPRA saying the case had been closed after the chiropractor committed to completing further education. Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it.

''I think they have put the chiropractor's interests before the interests of the public,'' Dr Pappas said. ''[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage.'' A review published in the Pediatrics journal in 2007 also found serious adverse events relating to spinal manipulations in children, including a brain haemorrhage and paraplegia. However, the president of the Chiropractors' Association of Australia, Laurie Tassell, says chiropractic treatment is as safe for children as it is for adults, and chiropractors should be able to treat patients in hospital, if authorised. "Chiropractic care can be remarkably gentle," he said. "Being a five-year, university-trained spinal health expert, a chiropractor will modify their adjustment techniques to suit the age and spine of each individual child." President of the Australian Medical Association Steve Hambleton said the board needed to either produce evidence supporting chiropractic treatments for children or rule out paediatric care. ''The AMA is not aware of any evidence that chiropractic manipulative treatment of infants and children offers any benefit at all,'' he said.

The Sun-Herald has seen Facebook conversations in which chiropractors discuss methods of sneaking into hospitals. Images, obtained by blogger Reasonable Hank, include one of a baby being adjusted in a hospital. AMA NSW head Brian Owler said it was "absolutely outrageous" for chiropractors to treat patients in hospital without permission. "None of us can go into an emergency department of a hospital and start treating patients without proper credentials and medico-legal coverage," he said. A spokeswoman for NSW Health said treating patients without notifying the hospital may be improper conduct and it could be reported to the Health Care Complaints Commission.