Feeling a "pop" during a chiropractic treatment is quite normal—but in the case of this patient, the sensation was caused by a ruptured breast implant. Was the DC to blame?
Posted in Case Studies on Wednesday, July 17, 2024
Incident
Mary Chase, 42, first saw Dr. Richardson on November 15, 2019, and complained of neck pain, thoracic pain, and right upper extremity paresthesia following a recent car accident the month prior. Dr. Richardson took X-rays, which were normal, and performed orthopedic tests and took a history. Of relevance, Dr. Richardson’s history revealed that Ms. Chase had a history of breast augmentation in 2013. She was also a nationally ranked CrossFit competitor who regularly trained six times per week for over two hours each day.
On this visit, Dr. Richardson performed a thoracic manipulation while Ms. Chase was laying prone on the table. Following the adjustment, the patient told Dr. Richardson that she heard a “pop” in her right breast and felt a burning sensation. She sat up and palpated her right breast, which was painful. She continued with the remainder of her treatment that day but did not return.
Dr. Richardson noted in his record that the patient may have ruptured a breast implant during the manipulation. Ms. Chase ultimately presented to her primary care physician, who referred her to an out-of-state plastic surgeon. The plastic surgeon diagnosed Ms. Chase with a ruptured breast implant and discussed the case with the implant manufacturer. Interestingly, the implant manufacturer agreed to cover the cost of the ruptured implant, but not the non-damaged implant, which needed to be replaced, too.
Lawsuit
Ms. Chase filed a chiropractic malpractice lawsuit against Dr. Richardson alleging that he utilized excessive force and performed manipulative therapy when it was contraindicated. As a result, Ms. Chase alleged that she suffered from a ruptured breast implant, will require future surgery, and lost wages due to her inability to compete in CrossFit at an elite level.
The Case
On behalf of Dr. Richardson, NCMIC retained a chiropractic and plastic surgery expert. The chiropractic expert saw no deviation from the standard of care and opined that chiropractors treat patients with breast implants on a regular basis. The fact that a patient has a breast implant is not in and of itself a contraindication to manipulative therapy. The chiropractic expert also opined that it is exceedingly unlikely that chiropractic manipulation would cause a breast implant to rupture. NCMIC also retained a plastic surgery expert who has extensive experience with breast implant surgeries. The plastic surgery expert opined that it would be unusual and very unlikely that a chiropractic manipulation would cause a breast implant to rupture. Rather, the plastic surgery expert opined that Ms. Chase’s rupture likely occurred due to normal wear of the implant combined with trauma of the car accident and Ms. Chase’s rigorous fitness routine.
Ms. Chase’s chiropractic expert testified that because of her history of implants Dr. Richardson's adjustment of Ms. Chase was a violation of the standard of care. Her plastic surgery expert also opined that the rupture was clearly due to the chiropractic adjustment performed by Dr. Richardson due to the timing of her pain and hearing a “pop” during the adjustment.
The Outcome
Due to the minimal damages alleged and the favorable expert reviews, it was determined that the best course of action was to pursue trial. The initial settlement demand was $75,000, which was rejected. After scheduling a trial date, Ms. Chase elected to drop her lawsuit against Dr. Richardson.
What We Can Learn
Timing of an injury does not automatically mean negligence. In this case, the patient clearly suffered from pain right after the adjustment occurred. This was also documented by Dr. Richardson. Once an appropriate expert was able to review the entire case and records, it was determined that Dr. Richardson’s adjustment was not the sole factor that caused the implant to rupture.
Always take a complete patient history. Not only does it help you have a more complete understanding of the patient's medical background and help you make informed decisions about treatment, it will also be crucial to prove that you did due diligence should a claim arise.
Informed consent is always important. Making sure the patient is aware of the risks of chiropractic care is essential in any case, but it's especially necessary when the patient's medical history reflects previous surgeries, health concerns, or medications that could pose additional risk. Verbally discuss with patients, then have them sign an informed consent form and keep it in your records.
Stand by your treatment. Just because you are sued does not mean that the case will end in a trial or a settlement payment. Many times, patient’s attorneys will file lawsuits to try and reach a “quick” settlement. This case was pushed to trial due to the strength of the defense experts and the patient’s attorney elected to drop the case.
About the Author
John Floyd, Jr. is a partner in the Nashville office of Wicker Smith. He regularly defends chiropractors in litigation and regulatory matters, including cases involving stroke, orthopedic injuries, boundaries, and audits and licensure matters. John is licensed in Tennessee, Kentucky, and Washington. He graduated from Sewanee: The University of the South and The University of Memphis School of Law. John resides in Nashville, Tennessee.
Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.