Will the DC who “does things right” and “does the right thing” prevail in a case where the medical community is quick to place blame for a bad patient outcome?
Posted in Case Studies on Wednesday, March 19, 2025
Dr. Timothy Tolver, DC, first saw 31-year-old Rita Brown in April 2016 for complaints of low back pain from lifting her one-year-old daughter. She also experienced pain radiating from the hip down the front of her leg.
Dr. Tolver’s treatment included:
- Taking a history
- Conducting a physical examination
- Performing X-rays of Rita’s full spine
After intermittent treatment with Dr. Tolver until November 2017, Rita discontinued treatment for unspecified reasons.
A Return Visit with New Symptoms
On June 17, 2018, Rita returned to Dr. Tolver’s office complaining of neck pain and decreased range of motion over the previous 24 hours.
Upon examination, Dr. Tolver observed:
- Limited range of motion in extension and right rotation
- Muscle spasms
- Tenderness in the cervical spinal region
- Subluxation complex
Dr. Tolver determined that Rita had a left-sided occipital restriction in extension and right rotation. However, as he was preparing to perform an occipital lift adjustment, Rita suddenly developed acute, severe upper cervical pain. Recognizing that proceeding with the adjustment would not be prudent, Dr. Tolver stopped the procedure and instead applied Bio-Freeze and an ice pack to relieve her pain.
At that moment, Rita’s speech became slurred and she lost her vision. Recognizing the potential stroke symptoms, Dr. Tolver immediately called 911. By the time the ambulance arrived, Rita’s sight had returned, but she remained incoherent.
Hospitalization and Diagnosis
At the emergency room, Rita presented with vomiting, weakness on her left side, slurred speech, and decreased vision. A neurosurgeon was called in, and a four-vessel cerebral angiography was performed, which revealed:
- A long area of segmental dissection in the distal cervical and craniocervical portions of the left vertebral artery
- A suspected thrombus and intimal flap
- Otherwise normal blood vessels
Rita was placed on anticoagulation therapy and admitted to the neuro-intensive care unit. Notably, both the ER records and ambulance report stated that Rita’s symptoms followed a neck adjustment by a chiropractor. The following day, an MRI scan confirmed:
- Bilateral cerebellar and occipital infarcts
- An infarct in the medial portion of the thalamus on the left side
- Retrograde flow in the distal portion of the left vertebral artery
Rita improved rapidly, was placed on Coumadin, and was discharged on June 29, 2018.
The Lawsuit
Shortly after her discharge, Rita filed a lawsuit against Dr. Tolver, alleging that his negligence caused her vertebral artery dissection and cerebellar stroke. Her claims included that Dr. Tolver:
- Performed an improper chiropractic manipulation
- Conducted an incomplete physical examination
- Failed to provide informed consent
- Neglected to assess whether she was at increased risk of stroke
Alleged Damages
Rita claimed that due to Dr. Tolver’s actions, she suffered serious, painful, and permanent injuries; endured mental distress; accumulated significant medical expenses; lost income and earning capacity; and became unable to care for her family.
At the request of Rita’s attorney, the hospital’s chief of neurosurgery, Dr. Thomas Daniels, M.D., drafted a report summarizing her hospitalization. In it, he suggested the stroke was precipitated by chiropractic manipulation or that it dislodged a thrombus from a pre-existing dissection.
Deposition Testimonies
During Rita’s deposition, she testified that Dr. Tolver had visited her in the hospital and apologized. According to her, Dr. Tolver admitted that she cried out in pain when he adjusted her neck. He allegedly attempted a second adjustment—a high-velocity occipital lift—but as he positioned her head, she lost her vision.
Dr. Daniels, during his deposition, revealed bias against chiropractors and lack of chiropractic knowledge. His report relied on second- and third-hand information. He presented two possible theories: that Rita had suffered a dissection in Dr. Tolver’s office or that Dr. Tolver’s head movements dislodged clots from a pre-existing dissection, causing a stroke.
Dr. Daniels admitted that a dissection and stroke could be separate events and that even minor head movements—independent of chiropractic treatment—could have caused her condition.
The plaintiff’s chiropractic expert alleged that Dr. Tolver:
- Failed to re-evaluate Rita after a 7-month treatment gap
- Did not perform basic screening tests (e.g., blood pressure, cerebrovascular auscultation)
- Didn’t document changes in her medical history
- Used an inappropriate chiropractic technique
- Did not follow proper emergency procedures
The plaintiff’s expert also asserted that either Dr. Tolver performed an inappropriate adjustment or he adjusted when he shouldn’t have, leading to the stroke.
The Defense Responds
The defense’s chiropractic expert countered each claim:
- While Dr. Tolver didn’t perform specific screening tests, his approach served as a functional screen. He stopped the adjustment when Rita felt pain, preventing further risk.
- The occipital lift technique is well-respected in chiropractic care and not associated with a higher risk of vertebral artery dissection.
- Dr. Tolver immediately called 911, which was appropriate and demonstrated his concern for the patient.
Additionally, a neurologist specializing in strokes testified that:
- Sudden onset of new neck pain can indicate an existing vertebral artery dissection.
- Rita’s stroke could have occurred with any neck movement, not just spinal manipulation.
- Chiropractic adjustments are not uniquely dangerous compared to other minor traumas.
- Dr. Tolver’s emergency response was appropriate and timely.
The Verdict
The trial lasted 11 days and involved multiple expert testimonies. Rita’s attorney sought $3,750,000 in damages.
After four hours of deliberation, the jury returned with a verdict in favor of Dr. Tolver. They found that he did not breach the standard of care, awarding Rita $0 in damages.
Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.