An expert in massage therapy and chiropractic treatments was needed to testify in a malpractice trial that contended a standard neck adjustment had led to a patient’s death. After experiencing lower back pain, a middle-aged male patient had gone to a chiropractor for a neck readjustment. One week later, he went to emergency services and was investigated for ischemic stroke. He was given an MRI scan, and doctors concluded that he had sustained a vertebral artery dissection, as the inner lining of the vertebral artery appeared to be torn. He was given a tissue plasminogen activator to facilitate the breakdown of blood clots, but his health declined despite continual treatment and he passed away soon after the stroke. It was alleged that the neck adjustment had torn the artery and facilitated the man’s stroke, and that he had been unaware that the chiropractic procedure could be harmful.
Question(s) For Expert Witness
- 1. Do you routinely perform neck manipulations?
- 2. Should patients be warned about the risks of neck manipulation?
Expert Witness Response E-009668
I currently teach full-time at a Chiropractic College where I teach students how to apply safe and effective neck manipulation, and routinely perform neck manipulation on colleagues and students. The issue of warning patients is complicated. Based on current evidence, the causal relationship between neck manipulation and stroke is still controversial. In the absence of specific risk factors, I do not believe the evidence supports the necessity of routinely warning patients of the risk of stroke from neck manipulation. However, if a patient presents with specific risk factors, then informed consent is necessary. This means a chiropractor must perform a thorough history and examination to rule out these risk factors. Many of these cases hinge on the thoroughness and appropriateness of the chiropractor’s pre-treatment evaluation. In this case, it is unclear whether this patient had specific neck-related complaints that would indicate the neck manipulation was appropriate. In the absence of any significant neck complaints, neck manipulation would not be appropriate. Since any benefit of neck manipulation would be unclear, I believe specific informed consent discussing possible risks would be required.
Expert Witness Response E-007260
A patient coming from a medical doctor’s or a chiropractor’s office after treatment has the same risk of a stroke, so chiropractors need to be equally aware of certain signs, known as the “6 D’s and 3 N’s.”.The 5D’s to be conscious of are: Diplopia, Double vision, Dizziness, vertigo Drop-attacks, sudden weakness Dysarthria, Dysphagia speech disorders, and Difficulty swallowing. The 3 N’s, meanwhile, are Nausea, Numbness, and Nystagmus. Another sign is involuntary eye movements, which are important to look out for.