Personal Trainer Suffers Post-Adjustment Stroke

A personal trainer who regularly performed extreme weightlifting routines allegedly suffered a vertebral artery dissection immediately after a chiropractic adjustment.

Posted in Risk Management on Wednesday, September 16, 2020

The Situation

In September 2016, Tyler Ellingson, age 27, began treatment with Scott Bagby, DC, for complaints of neck and back pain, which he attributed to his strenuous fitness regime. After meeting at the gym and getting to know one another, Dr. Bagby and Ellingson struck an arrangement to trade services—personal training in exchange for chiropractic care.

During the first appointment, Dr. Bagby conducted an examination that showed no contraindication to chiropractic care. Dr. Bagby had an informed consent discussion with the patient and outlined the risks and benefits of chiropractic care but did not address any associated weight training risks. Ellingson provided his signed informed consent, and Dr. Bagby proceeded to adjust Ellingson with the diversified technique, which initially alleviated his discomfort.

Ellingson was several weeks into chiropractic treatment and was preparing for an upcoming weightlifting competition when he reported worsening neck pain and the onset of constant headaches. Dr. Bagby noted and documented the competition training but continued with his normal treatment as the patient had been improving. Ellingson attributed his symptoms to recent dietary changes and dehydration from his training.

To address the patient’s new and ongoing symptoms, Dr. Bagby treated Ellingson with the same manipulative therapy a total of 25 times. During these visits, the patient reported some pain relief. However, following Ellingson’s November 16, 2016, treatment, he said he felt lightheaded and dizzy. Dr. Bagby noted these new symptoms in the records but didn’t change his course of care.

Ellingson’s last visit was a typical session that took place on November 22, 2016. During this visit, the patient again became dizzy and thought he was dehydrated. He mentioned to Dr. Bagby that he experienced feeling similar sensations at the gym several weeks earlier but had refused medical care afterward.

Dr. Bagby gave Ellingson a protein bar and water, but the patient’s condition continued to deteriorate until he became unresponsive. The office staff immediately called EMS, and the patient was taken to an emergency room where he was diagnosed with a right-sided subacute vertebral artery dissection at C1–C2. He was then airlifted to a specialized medical facility.

The Case

In June 2017, Ellingson filed a lawsuit against Dr. Bagby alleging that he:

• Caused the patient to suffer a vertebral artery dissection 
• Was aware of the patient’s previously reported fainting spell that took place at the patient’s gym
• Did not conduct a new examination before providing treatment to rule out neurological issues in light of the patient’s new symptoms of dizziness following his November 16, 2020, appointment

As a result of the DC’s alleged negligence, the lawsuit claimed that Ellingson suffered vascular neurocognitive disorder, memory problems, attention deficit disorder, personality changes, impaired fine motor dexterity, mild depression, physical and emotional impairments, and medical bills totaling more than $100,000.

In preparing the case, the defense obtained several expert witnesses who were ready to testify that the doctor met the standard of care and his treatment did not cause the alleged injuries. The experts included a neurologist who would opine that the dissection took place before the treatment in question. Additionally, the defense team noted that Ellingson made a full recovery. 

The Outcome

Despite these strong points, there were concerns about the defense’s chances for success in this case because the plaintiff retained a local neurologist who was well-known for his anti-chiropractic sentiments and fear-mongering testimony. Additionally, the plaintiff was young and extremely likeable, which would likely make him sympathetic to a jury. Finally, the venue in which this case was held had a history of being unfavorable to doctors.

Therefore, following extensive evaluation, the NCMIC-retained defense counsel estimated there was a slightly better than 50/50 chance of prevailing in this case. Moreover, if the case was lost, there was a strong potential for a verdict above Dr. Bagby’s $1-million policy limits. Concerned that his assets could be exposed for any amount above his policy limits, Dr. Bagby asked his attorney to settle the case, and the defense team agreed this was the best course of action.

Although the opening demand during private mediation with Ellingson’s attorney was nearly $500,000, the defense team was ultimately able to resolve the case for $140,000. NCMIC spent nearly $150,000 in legal expenses and expert witness fees to support the DC during the entirety of the case, which ended in December 2018.

What Can We Learn?

Avoid becoming complacent about patient care. In this case, the doctor continued with the same treatment despite the patient’s changing symptoms. Along these lines, make sure to document in sufficient detail, avoiding repetition in the records.

It may be beneficial for doctors to be knowledgeable about a patient’s physical activity and provide them with information about the risks of those activities during the informed consent process. Ideally, Dr. Bagby would have discussed with the patient how weightlifting can strain the musculoskeletal system and affect the success of chiropractic care.

Conduct a new exam when new symptoms (e.g., dizziness) surface. In this case, the doctor was influenced by the patient’s self-assessment that he was dehydrated. Dr. Bagby could have delved deeper to determine the cause of the patient’s symptoms and whether they were due to dehydration, a potential VBI or something else.

Experts matter and NCMIC goes the extra mile to support its doctors with experts who are knowledgeable about chiropractic care and the latest in chiropractic research. In this case, the defense team’s experts had extensive knowledge to rebut the standard of care and causation allegations.