Free Care to Employee is Monkey on Doctor's Back

DCs must treat all patients, paying and nonpaying, equally—and fully investigate when indications of a potentially serious condition are present.

Posted in Case Studies on Friday, September 12, 2025

Ann Cruse was an employee of Rolo’s Back and Neck Care Center for only two weeks when she complained of neck pain and headaches to Ed Rolo, D.C. Dr. Rolo offered to treat Ann for free and asked her to complete the clinic’s patient data form.

The information Ann provided revealed her problems dated back to an automobile accident that occurred years earlier. Her symptoms had waxed and waned since the accident, and she rated her pain as a 7 or 8 on the 1–10 pain scale. She also noted on the body diagram that she had pain and spasms on the right side of her neck and on the right scapula area.

To further assess her condition, Dr. Rolo took X-rays with AP and lateral views of Ann’s cervical spine. According to Dr. Rolo’s records, he adjusted Ann’s cervical spine, though he didn’t record the levels adjusted or the techniques employed. Dr. Rolo later said he was sure he applied the Diversified technique because that’s the only treatment he uses on the cervical spine.

During the next month, Ann was treated on six occasions by three DCs at the clinic. She started to become annoyed when her appointments were moved around to fit in between other patients’ appointments and when she learned bills were being submitted to her medical insurance company for her supposedly “free” treatments.

Following each of the spinal manipulations, which Ann described as “rough,” along with low-voltage galvanic stimulation and heat, she complained of pain in her jaw and on the right side of her throat and tongue. Dr. Rolo’s records noted Ann showed signs of improvement after her third treatment, but that she continued to complain of symptoms on the right side of her throat and tongue.

Ann Sees Another DC

After being passed from doctor to doctor without favorable results, Ann became increasingly annoyed to the point of anger. As a result, she chose to seek chiropractic care from a different DC. However, Ann stayed on as an employee of Rolo’s Back and Neck Care Center.

Ann made an appointment with Dr. Ron Pardock, who reviewed the AP and lateral cervical X-rays taken by Dr. Rolo’s office. In reviewing these films, Dr. Pardock became concerned over a possible congenitally malformed odontoid process. Dr. Pardock took an AP open-mouth film, which reaffirmed a possible malformed odontoid process, a hypoplastic underdeveloped odontoid process or an os odontoideum.

Consequently, Dr. Pardock immediately referred Ann for an MRI, which confirmed an os odontoideum with an abnormal separation of the superior half of the odontoid process from the body of C2 and the base of the odontoid process. The MRI also revealed considerable abnormal instability of the C1–os odontoideum complex.

After the MRI, Ann underwent two cervical fusions at C1 and C2. According to her surgeon, Ann’s cervical spine had been stabilized following the second cervical fusion, but she was left with a 25 percent permanent disability.

Lawsuit Initiated

At that point, Ann Cruse decided to sue Dr. Rolo and Rolo’s Back and Neck Care Center. The complaint alleged Dr. Rolo and his clinic:

• Were negligent and careless in failing to diagnose her condition
• Failed to take a complete set of X-rays of her cervical spine
• Failed to properly interpret two X-rays of Ann’s cervical spine before beginning chiropractic adjustments

At the Deposition

During testimony at the deposition, Dr. Rolo stated he wanted to take an AP open-mouth X-ray, but Ann declined because she didn’t want to subject herself to radiation exposure. In response, Ann testified that she never refused to take an AP open-mouth X-ray.

Dr. Pardock was asked to provide his assessment of Ann Cruse’s condition in a written report. In this report, Dr. Pardock concluded she had a congenital os odontoideum, which he believed contraindicated treating her upper or general cervical spine with manual manipulative therapy. He further offered his opinion that Dr. Rolo and the other DCs in the clinic caused the instability of Ann’s upper cervical spine.

The Evidence Mounts

Dr. Pardock’s report concluded with a devastating blow to the defense. It stated os odontoideum, while uncommon, is taught by chiropractic colleges as being so dangerous doctors must always look for it, and failure to take an AP open-mouth X-ray is a departure from the standard of care when lateral or AP X-rays hint of an abnormality.

The case went further south when both Ann’s family physician and the surgeon who operated on her supported the conclusion that the manipulative therapy she received at Rolo’s Back and Neck Care Center caused the instability in her cervical spine.

After hearing this testimony, Dr. Rolo admitted his failure to take an AP open-mouth X-ray constituted malpractice. He also conceded that the Diversified manipulative technique was contraindicated in the treatment of os odontoideum.

Unfortunately, not a single DC or MD expert was willing to testify that Dr. Rolo took the proper course of action, making a defense verdict extremely unlikely. To compound the defense team’s challenge, Ann Cruse’s chronic disability was truly tragic and likely to generate an emotional response with the jurors. She literally had to hold up her head with one or two hands when seated or standing.

Dr. Rolo’s NCMIC-assigned defense attorney thought a jury would want to hold someone financially accountable for her plight, most likely with a large dollar judgment against Dr. Rolo and his clinic.

Negotiating a Settlement

With these facts in mind, Dr. Rolo’s attorney strongly recommended attempting to settle the case. He thought his chances for successfully defending it would be virtually nonexistent, and the best scenario would be to minimize the damages.

Understanding that a jury verdict against him was likely and could easily exceed his $500,000 policy limits (and that he would be personally liable for any amount in excess of the $500,000), Dr. Rolo quickly agreed to settle his case.

Using a structured settlement—a settlement where the injured party receives some of the money upfront and the remaining in installments—the case settled for his policy limit of $500,000.

_{Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.}