Patient Deteriorates Rapidly Following Cervical Spine Adjustment

Michelle Parker was looking forward to her chiropractic appointment. As a treat to herself for working so hard at her new job, she added an in-office massage therapy visit to immediately follow her chiropractic adjustment. Her new job required a lot of air travel and hotel stays and caring for her daughter as a single mom meant little time for self-care. Her neck had been stiff and sore for a couple of weeks and she had a headache that would not go away.

Posted in Examiner eNewsletter on Thursday, May 20, 2021

Parker arrived for her appointment with Eric Brockman, DC, and explained that she had persistent neck pain and a right occipital headache. Dr. Brockman briefly examined her and performed manual adjustments to various levels of Parker’s spine, consistent with adjustments he had previously performed.

The cervical adjustment was the last adjustment, and the first attempt was not successful. Dr. Brockman commented that Parker’s neck was being “grumpy”, and he tried again. Parker immediately felt a “whoosh” feeling that she had never felt before, and as she sat up on the chiropractic table, she felt dizzy and a tingling in her cheek. She told Dr. Brockman that she was dizzy, and he told her to take her time standing up.

Dr. Brockman called for the massage therapist to transfer Parker from the treatment room to the massage therapy room. Parker was struggling to maintain her balance and stumbled, using a nearby handwashing sink to steady herself. The massage therapist helped her to the massage therapy room, where Parker collapsed into a chair. She told the massage therapist she felt nauseous. The massage therapist handed her a trash can. The room was spinning and she couldn’t see, she said. The massage therapist tried to help her onto the massage table to lie down, but she could not support her own body weight.

The massage therapist struggled to get her on the table, but Parker could not move. Her arm was awkwardly pinned underneath her body as she was lying face down with her head hanging over the edge of the table. Vomit was on her clothes and in her hair. The massage therapist rushed to summon Dr. Brockman and he arrived right away.

Dr. Brockman was alarmed when he saw Parker. He crouched down and asked her to describe her symptoms. What she described sounded familiar—she was dizzy, the room was spinning and she was suddenly and violently nauseous. Dr. Brockman had the exact symptoms one week earlier when he was ill, and after 24 hours, the symptoms resolved. He explained this to Parker, and she told him that her 3-year-old daughter recently had the flu.

Dr. Brockman remembered Parker telling him during the visit that her brother had recently had a stroke. He asked her for more details about her brother’s condition, and Parker explained she had been genetically tested and “cleared” by her physician. Dr. Brockman concluded that Parker’s sudden deterioration was most likely due to the severe onset of flu symptoms. He told her not to drive and to seek medical attention. Parker asked Dr. Brockman to call her parents to drive her home. Dr. Brockman asked the massage therapist to make the call and left the room. Parker told the massage therapist to find her mother’s number on her cell phone. The massage therapist told Parker’s mother that she was sick, most likely with the flu, and needed a ride home. Parker’s parents arrived at the chiropractor’s office approximately 10 minutes later.

In that 10 minutes, Parker’s condition worsened with more bouts of vomiting and increased weakness. Parker’s parents were horrified when they saw their daughter and planned to take her to the emergency room. The massage therapist and a front desk employee helped Parker’s parents transport her from the massage therapy room to their vehicle via a wheelchair through the back door.

Parker’s parents drove her to a local hospital where she was later diagnosed with a vertebral artery dissection and stroke. That morning, Parker was a 33-year-old healthy, young, vibrant woman who walked into the chiropractor’s office seeking relief of neck pain and headache. Within 30 minutes of Dr. Brockman’s adjustment, she could not walk, communicate or hold her head up. She thought she was going to die.

Parker was hospitalized for one week and lived with her parents for several months following her hospital discharge as she recovered from the stroke. She could not work and required assistance from her family members to care for herself and her 3-year-old daughter.

A Lawsuit Ensues

A year later, Parker filed a lawsuit against Dr. Brockman and his practice. The early narrative from Parker’s lawyers was that Dr. Brockman and his employees had acted callously and conspired to conceal Parker’s medical event and condition from other patients. They argued:

• Dr. Brockman failed to perform a thorough examination.
• His adjustment caused Parker’s dissection and stroke.
• His failure to recognize the signs and symptoms of a stroke and call 911 was grossly negligent.

Parker’s lawyers also blamed Dr. Brockman’s employees for not calling 911 and failing to notify Dr. Brockman that Parker’s condition worsened after he examined her in the massage therapy room. Parker’s lawyers stated early on that they would accept nothing less than $1 million from Dr. Brockman and $1 million from the practice to resolve the case.

The legal defense team consulted with multiple experts early in the case to prepare the strongest defense possible. After gathering all medical evidence and consulting with renowned experts in the fields of chiropractic, genetics, critical interventional neurology and neuroradiology, it was clear that Dr. Brockman did not cause Parker’s dissection. Her dissection had most likely occurred 10 to 14 days before Dr. Brockman’s adjustment, which was when her neck pain and headache began. The defense was prepared to present compelling evidence that the stroke was attributable to the dissection and not Dr. Brockman’s care. Additionally, there was nothing in her presentation that contraindicated cervical adjustment.

However, the primary challenge of the case was not Dr. Brockman’s cervical adjustment. What was most concerning to the defense was his assessment of her severe symptoms as flu-related, and his failure to recognize the signs and symptoms of a stroke.

Dr. Brockman and his staff’s failure to call 911 became the central issue of the case when Parker’s parents testified that they had chosen to take her to the local community hospital because it was the only facility they had been to prior to that day. Across town, but equidistant from the chiropractic office, was a Level II trauma center with a neurologist on staff in the emergency department specifically trained to assess and treat strokes.

Had Dr. Brockman or his staff called 911, paramedics likely would have taken Parker to the larger hospital with resources devoted to the assessment of stroke. Instead, there was evidence that Parker’s diagnosis was delayed while the community hospital struggled to find a neurologist for a consultation. For that same reason, the administration of tPA was delayed for more than two hours. Parker’s lawyers used the refrain “time is tissue” over and over, arguing that millions of brain cells were lost during that time frame, causing permanent and irreparable damage to Parker’s brain. They argued that any reasonable chiropractor or chiropractic office employee should have known to call 911 for someone in Parker’s condition.

Parker’s lawyers also argued that Dr. Brockman’s was grossly negligent and sought punitive damages not covered by insurance. Litigation spanned more than three years. The defense team developed evidence that Parker and her lawyers concealed evidence regarding her recovery and condition after suit was filed and elicited testimony from Plaintiff’s experts conceding that:

1. Dr. Brockman’s chiropractic adjustment did not cause the dissection.
2. Parker most likely had a rare and previously undiagnosed condition, Ehlers-Danlos, that explained her genetic susceptibility to dissection.

Using this evidence to challenge Parker’s credibility about her actual damages at trial, the defense team successfully resolved the case for less than $500,000, an amount that was fully covered by malpractice insurance. The total legal costs for the defense lawyers and experts exceeded the amount of settlement due to the protracted litigation and complex medical issues in the case. The personal and professional toll of the years-long litigation was significant, and Dr. Brockman was relieved that the case could be resolved without the need for a two-week trial.

What Can We Learn?

Call 911 if your patient has a medical event.

It is in the best interest of the patient to call 911 so paramedics can safely assess and transport the patient for medical care, if necessary. Even when the patient refuses 911, the chiropractor must use good clinical judgment and override those wishes if the patient is suffering from a medical emergency. It is also in the best interest of the chiropractor to have their patient receive the most timely and appropriate care for any injury.

Do not leave a severely ill patient alone.

Dr. Brockman was heavily criticized for his decision to leave his clearly ill patient in the care of the massage therapist while he returned to his other patients. The massage therapist then left the patient alone in the room several times while she sought help from other staff members. If your patient becomes suddenly or severely ill, ensure that he or she is closely monitored and appropriate steps are taken to seek intervention.

Train your staff for medical emergencies.

The massage therapist and Dr. Brockman’s staff testified that they were unprepared to assist a patient in Parker’s condition, and they never considered calling 911 or that it might be dangerous for Parker’s parents to transport her to the hospital in their vehicle. They were deeply concerned for Michelle’s well-being and very upset by her deteriorating condition. As a result, they were not thinking calmly or clearly. While the office had a written policy instructing staff to call 911 in a life-threatening emergency, none of them were aware of the policy. Additionally, none of them considered Parker’s condition life-threatening, in large part because Dr. Brockman concluded it was the flu.