A patient suffers a medical emergency 20 minutes after an adjustment. Is the DC to blame?
Posted in Case Studies on Monday, September 9, 2024
Every patient offers a new opportunity, a new chance to provide proper care and treatment that will hopefully resolve the patient of their discomfort. Unfortunately, not all experiences can be positive.
Incident
After developing pain in her neck, shoulder and head, Katie Swanson made an appointment with Dr. Talia Gossard. She attributed her discomfort to having slept in an awkward position, triggered by an evening when her head was hanging off the side of the bed.
Dr. Gossard performed a thorough exam, documenting her findings in detail. She commenced a chiropractic treatment which included a cervical neck adjustment.
The patient found relief following the treatment, but a week later, returned with similar symptoms. During this appointment, Dr. Gossard opted not to perform a cervical adjustment, and instead, went with a range of motion stretching. Again, Dr. Gossard kept copious, detailed notes. The patient reported relief and left the office.
The Relief Was Only Temporary
A week later, on her final visit, the patient again reported that her headaches had returned, but not to the prior severity. Feeling comfortable with the improvement, Dr. Gossard performed comprehensive treatment, including electrical stimulation, stretching, and cervical adjustment.
Once treatment was completed, the patient stood up from the examination table, and immediately began feeling dizzy.
Dr. Gossard advised her to lay back down and provided an ice pack for her forehead. While Dr. Gossard was outside the door charting, the patient began vomiting blood and felt as if her throat was closing. Dr. Gossard immediately called EMS and the patient was rushed to the hospital.
While hospitalized, the patient underwent a series of tests and imaging studies that revealed she had suffered an ischemic stroke to the lateral medulla of the brain. Her neurologist reported that Dr. Gossard’s cervical manipulation caused the stroke to occur.
Lawsuit and Case
The patient decided to pursue a suit, filing a $3.6 million claim. Her legal team found experts who claimed that Dr. Gossard must have used improper force and rotation during the cervical adjustment, resulting in a devastating stroke that nearly destroyed half the patient’s medulla.
NCMIC'S Experts Weigh In
NCMIC consulted a chiropractic expert who noted that, based on Dr. Gossard’s detailed record keeping of the treatment given, the adjustments performed were well within the standard of care. The headaches the patient was experiencing were common symptoms that a chiropractor would normally treat.
A neurosurgeon also sided with Dr. Gossard’s treatment plan and added that the adjustment could not have caused the stroke, as the speed in which the stroke symptoms occurred happened too far from the time of the adjustment. He argued that clots travel at the speed of blood, so a clot breaking free would arrive at the brain in a matter of seconds. Dr. Gossard’s cervical neck manipulation had occurred just over 20 minutes prior to any symptoms appearing.
Upon review of the records, the neurosurgeon was able to determine that the clot in vertebral artery was likely between two to three weeks old prior to Dr. Gossard’s final treatment. It was determined that when the patient stood up after the procedure, it caused a change in blood pressure, which is known to cause clots to break free.
Previous Findings on Chiropractic Manipulation and Stroke
The defense team also relied on previous findings and studies, which concluded that there is no evidence of a causal relationship between chiropractic manipulation and stroke. Also, it has been shown that the amount of force required to compromise the integrity of the vertebral artery is over 15 times the amount of force applied during a properly performed chiropractic manipulation.
The Outcome
This case was pending for seven years, and during that time, the patient testified that the stroke had made her everyday life incredibly difficult. Due to the stroke, she said, she was forced to avoid social gatherings, large crowds, and many activities that she had previously enjoyed participating in.
Her social media painted a different picture. Despite saying she avoided social gathering and outings, she still posted pictures of her enjoying multiple international vacations, rock climbing, and trips to baseball stadiums.
The court ruled in favor of Dr. Gossard.
What Can We Learn?
Detailed notes and documentation can make all the difference. Having well-documented notes of each interaction with the patient is of incredible importance. These notes allow other experts to confirm your treatments were correct.
Experts are essential to the case. NCMIC's use of key, credible experts helped make the case that Dr. Gossard was not responsible for Katie Swanson's stroke.
Don't be afraid to call 911. Having an ambulance arrive at your office can be alarming, but if your patient is having a medical emergency, you shouldn't hesitate. Although it may feel less "scary" to call a spouse, friend, or family member to pick up a patient who is not feeling well, it's not always the right choice. Do what's best for your patient, always.
About the Author
Austin C. Monroe is a trial attorney handling cases in Illinois. These cases have included chiropractic, physician and other health care malpractice, trucking and automobile liability, construction and premise liability, and other claims for catastrophic injury. Mr. Monroe has been heavily involved in complex cases, from the filing of suit through trial.
Mr. Monroe has been named an “Emerging Lawyer” by Leading Lawyers, Law Bulletin Media, awarded to less than 2% of lawyers licensed to practice in Illinois. He has also been named a “Rising Star” by Super Lawyers, Thomas Reuters, an honor given to no more than 2.5% of lawyers in the state.