A patient complains of the worst headache she's ever had, double vision, facial sagging, slurred speech and nausea. What happened when her ND missed the warning signs?
Posted in ND Insights Newsletter on Tuesday, December 10, 2024
Peggy Jones, age 47, loved her job. She traveled throughout the world purchasing fabric for a designer label garment manufacturer.
Upon returning home from an overseas purchasing trip, Peggy complained to her husband of a stiff neck “that she just couldn’t get rid of.” She also mentioned experiencing double vision and pain in her left eye.
On September 18, 2021, Peggy’s husband convinced her to see her naturopathic physician, Thomas Dubois, N.D. Dr. Dubois had been Peggy’s doctor for two years, assisting her with hypertension through diet, lifestyle changes, and homeopathy. However, Peggy had not followed Dr. Dubois’ advice to quit smoking or slow down her lifestyle.
That same day, Peggy visited Dr. Dubois, who performed a cursory physical examination. Finding no significant indications of cranial or vascular issues, he concluded that her complaints stemmed from a musculoskeletal problem. He prescribed a homeopathic remedy, Sanguinaria (1M, one dose), and advised her to return if her symptoms persisted. Additionally, he provided her with a low-potency homeopathic preparation (6x range) focused on promoting detoxification, which Peggy was to start the following day.
Worsening Symptoms and Missed Opportunities
On September 19, Peggy saw her optometrist, who found no gross abnormalities in her eyes. The optometrist advised her to consult a medical doctor if her blurred vision returned.
Three days later, Peggy awoke at 6:15 a.m. with the worst headache she had ever experienced, combined with increased neck pain, stiffness, and nausea. Her husband urged her to see Dr. Dubois again, but Peggy initially refused, expressing frustration that he would likely dismiss her symptoms as a remedy “aggravation” and repeat his advice to quit smoking.
By 8:15 a.m., Peggy’s symptoms had worsened. She vomited twice, had reduced neck motion, and experienced numbness and pain in her right arm. Her husband persuaded her to book an appointment with Dr. Dubois, which she managed to secure for 9:45 a.m.
At the appointment, Peggy’s headache was so severe that she had to lie down immediately. Despite a more thorough orthopedic examination, Dr. Dubois found no specific nerve impingement in the cervical spine. He attributed her symptoms to an aggravation from the Sanguinaria and the detoxification process initiated by the homeopathic remedy. He recommended Peggy return later that day for further evaluation.
Peggy left the office feeling lethargic and went straight to bed. When her husband woke her at 3:30 p.m. for her follow-up appointment, she struggled to dress due to severe pain and vomited again. He noticed her speech was slurred, but Peggy attributed it to the pain.
Alarming Signs Ignored
On the way to the appointment, Peggy observed her left eyelid drooping and numbness from her left cheekbone to her chin. She shared these symptoms with Dr. Dubois, who dismissed them as effects of sleeping all day. He did not address her complaints about feeling as if a vice was squeezing her head.
Without conducting additional examinations, Dr. Dubois modified her treatment, prescribing Gelsemium (200C) and advising her to return first thing Monday.
Medical Emergency
Early the next morning, around 2:45 a.m., Peggy woke up screaming “fire,” holding her head. Her speech was slurred, she staggered, and she had soiled herself. Unable to hold a glass of water, her husband called 911.
At the hospital, neurosurgeon Sam Conley, M.D., ordered an immediate CT scan, revealing a 7–8 mm aneurysm on the right middle cerebral artery. Peggy underwent emergency surgery, but her condition deteriorated due to a substantial subarachnoid hemorrhage. Over the next week, she required multiple surgeries, including a right frontal and temporal lobectomy.
Despite these efforts, Peggy suffered significant brain damage, leaving her unable to speak or move. She now resides in a nursing facility.
Legal Repercussions
Peggy’s husband filed a lawsuit against Dr. Dubois, Dr. Conley, and the hospital. Experts defending Dr. Dubois deemed his initial treatment on September 21 acceptable but criticized his failure to refer Peggy to a medical doctor when her symptoms worsened. Notably, his records mentioned a differential diagnosis of acoustic neuroma or brain tumor, yet this did not lead to immediate referral.
The case resulted in settlements totaling $3,250,000, with Dr. Dubois' liability insurance covering $500,000 of the damages.
Conclusion
This case highlights the importance of recognizing warning signs and prioritizing timely medical referrals. Delay in addressing critical symptoms can have devastating consequences, as seen in Peggy’s tragic outcome.
What Can We Learn?
New or recent onset of double vision is a clear red flag.
In this case, both the patient’s ND and her optometrist found no objective findings for her double vision. When symptoms occur that have no logical explanation, the ND should refer the patient to a specialist or consider additional diagnostic testing.
Do not assume previous practitioners were accurate in their assessments.
The onset of severe and unusual headaches, especially those associated with dizziness, nausea or vomiting and a stiff neck should raise suspicions of an intracranial bleed, such as a subarachnoid hemorrhage. These symptoms, however, may indicate a dissection of a vertebral artery in progress or an intracerebral hemorrhage. These conditions are potentially life threatening or can lead to severe neurological loss. They require immediate attention.
No improvement or especially worsening symptoms following treatment should be a sign to re-evaluate the patient and the therapeutic intervention.
In this case, the patient and her husband informed the naturopathic doctor that her symptoms worsened since beginning homeopathic treatment. The ND ignored the information and proceeded to again treat the patient the same way.
Some clinical signs warrant a “Stop-Look-Listen” approach.
“The worst headache I have ever had,” double vision, vomiting, facial and eyelid droop, and slurred speech all indicate a possible cerebro-vascular condition. If the N.D. would have stopped to re-evaluate, looked to determine any underlying issues and listened to the patient, the outcome may have been different.
Altered records create an impossible-to-correct impression.
When it comes to juries, altered records often result not in only a plaintiff’s verdict, but also in “punitive,” or punishing, damages.
Clinical records must also support even the most comprehensive of exams.
Dr. Dubois categorized his examinations as “comprehensive,” but they were not recorded that way.
Focus globally, treat locally.
There is nothing wrong with concentration on the treatment specialty. However, problems can result when the global picture is overlooked because of a doctor’s focus on one area. In this case, thinking about possible underlying conditions may have opened the door to the possibility of a subarachnoid hemorrhage, vascular dissection, brain tumor or other causes.