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Court finds chiropractic negligence in manipulation

Source Tom Blackwell, National Post

A new court ruling has again called into question a widely used but controversial chiropractic treatment, concluding that a Newfoundland practitioner made a patient deaf in one ear and caused other debilitating injuries by performing a neck manipulation on him.

The judge in the civil suit found the chiropractor negligent and will decide later what compensation to award Abe Gallant, who says he had to leave his $80,000-a-year job because of the damage.

The decision follows a series of public inquiries and inquests that have blamed cervical manipulation for strokes, some of them fatal, and the filing of a $500-million class action suit in Alberta that targeted the allegedly dangerous chiropractic therapy.

” This is not something new … they’ve been maiming people all over the country,” Mr. Gallant said in an interview yesterday, suggesting the procedure be banned. “I’m lucky that I can talk about what happened. Most of them are dead or on respirators.”

The practice has generally continued unchecked, however, and chiropractors argue that the most recent scientific evidence indicates manipulations are fully safe.

“We had previously erred on the side of caution by saying there was a risk,” said Wanda Lee MacPhee, past president of the umbrella group for chiropractic regulators. “But that was prior to having the newer data…. It doesn’t appear that there is a causal relationship.”

Meanwhile, that Alberta class-action suit was actually thrown out last week.

In the Newfoundland judgement earlier this month, Justice Michael Harrington said Debbie Brake-Patten, a Stephenville, N.L., chiropractor, was negligent both for causing the injuries and failing to tell Mr. Gallant about the risks of the treatment so he could give informed consent.

She essentially misled him to believe the procedure was virtually risk free, the judge said.

Some experts testified the manipulation likely tore an artery in the patient’s neck, triggering a clot that blocked blood flow to his inner ear, leaving him partially deaf, constantly off balance and suffering from tinnitus.

Dr. Brake-Patten’s lawyer could not be reached for comment. The chiropractor had argued she did inform Mr. Gallant of the risks, while her experts said the injuries likely resulted from a virus.

Cervical manipulations involve a chiropractor rapidly twisting the neck, a treatment for a type of spinal ailment that practitioners call “subluxations.” Chiropractors blame subluxations for a variety of medical complaints, although the phenomenon has little scientific backing.

Most research on the issue suggests manipulation can cause strokes by unintentionally tearing arteries in the neck that send blood into the brain, injuries called dissections.

5 comments to Court finds chiropractic negligence in manipulation

  • Interesting case. Chiropractic started with the return of Harvey Lillard’s hearing in 1895. Skeptics have had a “ton of fun” maintaining that chiropractic could never have accomplished that. Now here’s a report of chiropractic taking someone’s hearing away. Where are the skeptics when we need them?

    It’s always a sad occurrence when someone experiences an adverse event like this, and my sympathy goes out to this man.

    But, based on what I’ve read in the literature (Beauty Parlor Stroke, or Bow Hunter’s Stroke), it’s certainly not unreasonable to ask whether this patient was a ticking time bomb, with high homocysteine levels and pre-existing vascular disease.

    Research has demonstrated that it takes a lot of force to tear a healthy artery, certainly an order of magnitude (10 times) more force than is associated with a standard rotary-style manipulation.

    Considering that the provider was a female, I am very skeptical that she could have provided the force necessary to damage a healthy vessel. And if the artery was unhealthy, no orthopedic test would have revealed that, and based on the literature, it could have happened with any other innocuous activity like turning their head to back their car out of a driveway. The cause was pre-existing disease, not anything that doctor did.

  • When I was in chiropractic school (1990-93) our profession agonized over reported instances of post-care stroke. However, since then, numerous studies have explored the relationship and found several things:

    1.   In reviewing 10 years worth of malpractice claims in Canada, filed against all 4500 of their chiropractors, it was determined that only 1 stroke was reported for every 5.85 Million cervical manipulations. [1]

    2.   The odds for having a spontaneous stroke while you are in a hospital is 10 incidences per million, or 50 times more likely than if you visited a chiropractor (if your only criteria is statistics)! [2] Does this mean we should close hospitals because of that increased risk?

    3.   The words “chiropractor” and “chiropractic manipulation” are frequently used inappropriately by biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury, when in fact, careful review of the sources of data reveals that the manipulations were actually delivered by other providers like MDs, PTs or even barbers! The most recent example is a review published in the Journal of Neurology titled “Vertebral artery dissections after chiropractic neck manipulation”, despite the fact that only 4/36 (11%) of the cases reportedly involved a care provider identified as a chiropractor. [3-4]

    4.   Please review this Table and article, which compares the risk of death from various causes, and you will see that the risks associated with chiropractic care are vastly lower than most “normal” human activities. [2] What really caught my eye is that you are 1200 times more likely to die from taking NSAIDs provided by your MD for that neck pain, than you are getting your neck adjusted!

    5.   A Task Force was formed by the Bone and Joint Decade study group. This group reviewed all the medical literature (thousands of peer-reviewed medical articles), and then it was published in the prestigious Spine Journal (the bible for orthopedic surgeons).

    Their findings were that “the increased risks of VBA stroke associated with chiropractic and PCP visits are likely due to patients with headache and neck pain from (an already existing) VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care, compared to primary care. ” [5]

    This is not a chiropractor’s opinion. This is a statement from a group of medical doctors, DCs and epidemiologists, after an extensive review of the literature.

    References:

    1. Sudden Neck Movement and Cervical Artery Dissection: The Chiropractic Experience
    CMAJ 2001; 165 (7): 905–906

    2. Cerebrovascular Accidents: The Rest of The Story
    International Spinal Trauma Conference; June 20, 2003

    3. Are German Orthopedic Surgeons Killing People With Chiropractic?
    ChiroZINE

    4. Inappropriate Use of the Title Chiropractor and the Term Chiropractic Manipulation in the Peer-reviewed Biomedical Literature
    Chiropractic & Osteopathy 2006 (Aug 22);   14 (1):   16

    5. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-control
    and Case-crossover Study

    Spine 2008 (Feb 15); 33 (4 Suppl): S176–183

  • Dr R Graham Hunt AM DC MCSc DipLS FICC FACC

    Dear Dr Painter,

    I like what you are doing.

    I would like to communicate with you regarding an International project with which I am involved as Head of our Companies Research Division. I would be inviting you to submit research reports and /or articles which will be acknowledged as original work by you and carried on GLOBinMED hub which I will explain to you once I have a direct email address to which I can send attachments.

    I am based in Malaysia which only has about 30 DCs at this stage. We are working on increasing that number. Australia, my home country, with about the same population as Malaysia has some 6000 DCs. The International Medical University here will commence it’s Chiropractic Course next month.

    I look forward to making direct contact with you.

    Best regards,

    Graham

    I can be reached at Frankp@chiro.org

  • As long as rumors about the safety of chiropractic exist, we must work to educate the general public that chiropractic is the safest and most effective health care system available. Thanks for providing all the references to support this!

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