A patient suffered a stroke after experiencing neurological symptoms following a chiropractic treatment. What the DC did afterward made a significant impact on the outcome of his claim.
Posted in Case Studies on Wednesday, June 12, 2024
Incident
Carrie Nicholson, 35, first saw Dr. Schmidt on June 12, 2018, and complained of recent onset of pain in the posterior cervical region, left trapezius, upper thoracic and right posterior trapezius for about a week. Dr. Schmidt performed a maximum foramina compression bilaterally and a Jackson foraminal compression. The patient felt better after treatment. The cervical X-ray was normal.
The patient then returned to see Dr. Schmidt on June 14 and June 16, and the same treatment was administered. A few hours after the appointment on June 16, Ms. Nicholson called Dr. Schmidt and reported that her peripheral vision was fuzzy and she had a severe headache. She denied any other neurological symptoms. Dr. Schmidt informed her she should go to the ER for further evaluation. Dr. Schmidt called the patient later that evening to see how she was doing and she informed him that she decided not to go to the ER as she assumed it was a migraine.
She then returned to see Dr. Schmidt on June 18. At that visit she reported her neck and back pain had improved but had been experiencing a headache for a few days. The headache was located in the back of her head and top of her neck, or the occipital region. She believed it was this migraine that caused her blurry vision. Dr. Schmidt then administered the same treatment as he did on the previous visits. Immediately after the adjustment, the patient reported she felt dizzy, and this then worsened over the next several minutes. She attempted to keep her eyes open but was unable to and was also unable to respond to Dr. Schmidt’s questions. An ambulance was called, and Ms. Nicholson was taken to the emergency room. Dr. Schmidt contacted Mr. Nicholson to alert him to the situation. Dr. Schmidt went to the hospital after the ambulance left his office in order to provide any information that the ER physician may need in order to assist with the proper diagnosis and treatment.
Ms. Nicholson was diagnosed with a vertebral artery dissection and stroke, which was found to be remote infarctions in the medial occipital lobes bilaterally, and remote lacunar infarctions in the right and left cerebellar hemispheres. Ms. Nicholson suffered permanent vision and cognitive injuries. Several months after the stroke, Plaintiff underwent a neuropsychological examination that found significant memory and cognitive defects.
Lawsuit
Ms. Nicholson filed a chiropractic malpractice lawsuit against Dr. Schmidt alleging that a proper history and physical was not performed on June 12 and June 18. Specifically, the Plaintiff asserted that Dr. Schmidt should have determined that Ms. Nicholson’s neck pain on June 12 was potentially a dissecting vertebral artery for which medical care was required. Plaintiff also asserted that her blurry vision and headache on June 16 and 18 were neurological symptoms which made chiropractic treatment a contraindication until she had been cleared medically.
The Case
On behalf of Dr. Schmidt, NCMIC retained a chiropractic and a neurology expert. The chiropractic expert saw no deviation from the standard of care on the part of Dr. Schmidt and noted that the patient improved from the treatments administered on June 12 and 14, so there was no reason to believe a different treatment should have been provided on June 18. The chiropractic expert also opined that visual disturbances are not a contraindication to cervical adjustment. The Defendant’s neurology expert believed that Ms. Nicholson was experiencing a dissecting vertebral artery prior to presenting to Dr. Schmidt on June 12, the dissection was healing and formed a clot, and that the cervical adjustment performed on July 18 dislodged a clot that resulted in her stroke. The neurologist also believed that, in hindsight, the patient’s symptoms of headache and visual disturbances on June 16 were potential warning signs of a stroke and she should have presented to the emergency room.
The primary issue with the case was the cervical adjustment on June 18. Ms. Nicholson’s symptoms of blurred vision and severe headache should have alerted Dr. Schmidt that he needed to do additional testing and possibly consider a medical referral, in light of his previous suggestion for Ms. Nicholson to go to the ER following the treatment two days earlier.
The Outcome
Because of the significant damages suffered by Ms. Nicholson, it was determined that the best course was to settle the case rather than taking a chance at a large verdict at trial. The initial settlement demand was $1 million, which was Dr. Schmidt’s policy limit. This amount included past medical bills of $200,000 as well as significant non-economic damages in the form of permanent vision loss, memory deficits, and general cognition impairment.
While the defense experts did not believe Dr. Schmidt caused the vertebral artery dissection, a jury could have found that the cervical adjustment caused the stroke by dislodging a clot or that Dr. Schmidt should have done additional testing and made a referral during the June 18th visit.
The lawsuit was resolved via settlement in the amount of $225,000. This favorable outcome was achieved due to standard of care expert support, but also because Dr. Schmidt’s actions, which were thoroughly charted, showed his genuine concern for his patient and that he did all he could to ensure she received prompt and proper care.
What Can We Learn
New symptoms or significant changes require new testing. Any new symptoms or significant changes in current symptoms require an additional evaluation and testing by the provider. If the additional testing and examinations are inconclusive, a possible medical referral should be discussed with the patient before additional treatment is considered.
Care about your patients. When a patient experiences a complication while receiving care, it may seem like the best route is to pretend like it did not happen. The best practice is to recognize the complication and immediately take action, which in rare situations requires calling EMS. The value of this case was decreased dramatically because Dr. Schmidt not only did the right thing by immediately addressing Ms. Nicholson’s medical emergency that occurred in his office, but actually went to the ER to provide any information that may have been beneficial for diagnosis and treatment. A jury understands that unexpected outcomes occur in medicine and favor physicians who go above and beyond to help their patients.
About the Author
Dede K. Zupanci focuses her practice on health care defense litigation and regulatory matters, including: chiropractic professional liability, hospital premises liability, and hospital regulations and compliance. She has represented clients in Illinois and Missouri, including metropolitan and rural hospitals, as well as chiropractors and physicians. She is a graduate of Saint Louis University (J.D.) and Southern Illinois University – Carbondale and is a member of the Illinois Association of Defense Trial Counsel, Madison County Bar Association and St. Louis Area Health Lawyers Association. Dede resides in Edwardsville, Illinois.