Chiropractic neck manipulation linked to woman's death

Provided by: Globe and Mail

Written by: Gay Abbate

The Canadian chiropractic profession is preparing for lawsuits and a possible patient exodus after a landmark verdict Friday on the death of a woman who suffered two strokes after being treated for a migraine.

A coroner's jury in Toronto found that chiropractic neck manipulation was linked to the death of Lana Dale Lewis, a 45-year-old mother of three.

The chiropractic industry reacted with anger. When the inquest began in a blaze of publicity on April 22, 2002, chiropractors, especially those in Ontario, saw their patient billings drop by as much as 25 per cent.

Tim Danson, the high-profile Toronto lawyer hired by the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College, said his clients will appeal the jury's verdict to the Ontario Divisional Court. “This verdict and this inquest represents a travesty of justice,” Mr. Danson told reporters. “What was at stake at this inquest was the truth. The truth lost,” he said.

Ms. Lewis' family was elated with the verdict. Her four sisters burst into tears.

“The public will be better served by this in that they are going to have the opportunity to have more information out there, knowing the kind of treatment they're getting and the possible harm that could come of it,” said a smiling Jim Sweeney, Ms. Lewis's husband.

This was the second coroner's inquest in Canada to place the controversial practice of upper cervical manipulation under a microscope.

The first was held in Saskatoon into the death of Laurie Jean Mathiason.

She suffered a massive stroke on her chiropractor's table and died three days later on Feb. 4, 1998.

That jury, which sat for only four days, also concluded that neck manipulation caused the stroke.

The Lewis inquest, said Amani Oakley, the family lawyer at the hearing, is the first of its kind and is a landmark case watched carefully around the world.

The chiropractic profession went quickly into damage-control mode. An e-mail with the verdict was sent to all of Ontario's 3,000 practising chiropractors by mid-afternoon.

The e-mail also contained a directive not to talk to the media, but to forward all calls to the chiropractic association.

Mr. Danson said he hopes the country's 6,000 practising chiropractors will not lose patients scared off by the inquest result.

“I hope that people will see this [verdict] as being unrealistic and perverse and hopefully it will not have any more effect than it has had from the outset of the inquest.”

Dean Wright, a chiropractor in Newmarket, Ont., said the first slump was short-lived.

Patients discussed the case with their chiropractors and were reassured. What the impact will be now is difficult to determine, he said in an interview.

“When patients understand the parameters and the low risk in question, things should level off,” he said,

One of the jury's 17 recommendations is for patients to be given a form that spells out the risk of treatment. During treatment the neck is sharply twisted, sometimes producing a cracking sound.

Mr. Wright, who is also president of the Ontario Chiropractic Association, put the odds of suffering a stroke from a neck adjustment at around a million to one. Mr. Wright said he and most chiropractors already provide patients with a consent form that outlines the risk of injury.

About 4.5 million Canadians are treated by chiropractors annually.

Like all coroner's juries, the three women and two men at this inquest had five possible choices to determine by what means Ms. Lewis died. Homicide and suicide did not apply to this case, leaving jurors with natural causes, accident or undetermined.

A finding of accident means there was trauma associated with the death, said Ms. Oakley. The dead woman's health record showed no other injury, “not even a stubbed toe,” in the weeks before her death on Sept. 12, 1996.

The jury heard from more than a dozen experts who provided conflicting evidence.

Those supporting the Lewis family said she died when the upper cervical manipulation created a tear in the vertebral artery, causing a blood clot to form over the lesion. The clot can break off, travel to the brain and cause a stroke.

Experts appearing for the chiropractors testified that she died from hardening of the arteries. “She was a ticking time bomb,” Mr. Danson said.

Some members of the Lewis family have filed a multimillion lawsuit against her chiropractor, Philip Emanuele.

Ms. Oakley said the debate over neck adjustments will not be over soon.

She has filed six lawsuits against chiropractors and is preparing six others.

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