Top 25 Medical Malpractice Cases of a 25 Year Career – Chiropractic Manipulation
Medical malpractice cases are very complex.
In this series of articles BC and Alberta personal injury and medical malpractice lawyer Angela Price-Stephens describes her top 25 most notable medical malpractice cases of her 25-year career to date. Her selection of cases is a representation of the breadth of her experience, the complexity of cases, the twists and turns in the evidence and the dramatic benefit to her clients and their respective families by successfully pursing their claim with Angela and her team.
Angela Price-Stephens has litigated cases across Canada and England and Wales. The names and distinguishing details of the cases referred to in this series of articles have been changed to protect the client. In all cases of settlement for medical malpractice the lawyers for the defendant healthcare providers insist on a confidentiality clause in which the existence of a settlement (payout of money to the former patient, irrespective of whether an admission of liability was made) must remain a secret.
Angela has successfully secured settlements in cases of medical malpractice for up to $6.5 million in specific cases. Valuing a claim is a complex process in which many aspects of the client’s loss must be taken into consideration in the context of the evidence known at that time. The manner in which the evidence is secured and prepared for presentation to the court is a critically important factor.
Proving Causation – the Key to Medical Malpractice Claims
One of the factors that make claims of medical malpractice so challenging is the issue of causation. Paul Mitchell Q. C. explained causation in his article Medical Practice 101, The Top 7 Things You Need to Know About BC Medical Malpractice Cases – #5. Essentially, causation refers to proving, on a balance of probabilities, that a specific error (or omission) made by the defendant health care professional caused a worse outcome for the patient. Without proving causation there can be no compensation. This explanation is deceivingly (over) simplified. Causation, or the failure to prove causation, is where the majority of medical malpractice cases fail.
Chiropractic Neck Adjustment Causing Stroke
In the first of this series we review the case of Michael who suffered a stroke 18 days after a ‘routine’ chiropractic manipulation on his neck. The manipulation was part of a ‘wellness’, ‘routine maintenance’ visit, encouraged by the chiropractor.
The remarkable aspect of this ultimately successful claim was the delay between the last chiropractic manipulation (cracking the neck) and the stroke, which was caused by the dissection of the choroid artery. A dissection is a breakdown of the inner layers of the blood vessel, rather like a blistering, which impacts the smooth flow of blood to the brain. The narrowing of the blood vessel increases the risk of a blood clot to the brain that may cause a stroke, which may result in permanent brain damage. This is what happened in Michael’s case. The effects of the ischemic stroke were devastating for Michael and his family, preventing him from returning to work to support his young family, requiring ongoing care for his regular activities of living and leaving him with severely impaired speech and reduced comprehension. He also fatigued easily, a common symptom of the post-stroke condition, which impaired ongoing efforts to rehabilitate.
Junk Science and Chiropractic Care
This 18-day delay between chiropractic treatment and stroke allowed the chiropractor, through his professional association and lawyer, to argue that the manipulation was, on the balance of probability, not a cause of the stroke. As expected, they argued that there are many ordinary and everyday activities that can precipitate or cause a carotid artery dissection. These activities include strenuous exercise, anything that places pressure onto the neck (resting the neck onto a hairdresser’s sink to have one’s hair washed, for example), blunt trauma, whiplash and congenital disorders that may make one more vulnerable to developing dissections (such as a Ehlers-Danlos syndrome). Dissection may also happen spontaneously, with no apparent cause.
It was also argued that the scientific literature demonstrated no causal connection between chiropractic neck manipulation and stroke. In fact, the defendant argued that the pressure and velocity of a neck adjustment could not be sufficient to induce trauma, which was contrary to the argument that every day, innocuous activities such as running on a treadmill could trigger a dissection.
It was clear from the outset that establishing causation was going to be the most challenging aspect of this claim. Given the potential high value of the claim and the reputation of the chiropractic industry being at stake, it was also going to be fiercely defended.
By very careful review of both the literature and Michael’s clinical notes a clear and reasonable case theory emerged as to how the chiropractic manipulation was the most probable cause of dissection. The problem remaining was how to prove it on legal principles on a balance of probability.
Angela first challenged and undermined the credibility of the scientific evidence. It became apparent that the design of the experiments, in which the forces of a chiropractic manipulation were simulated on cadavers, was fundamentally flawed. By expert evidence she proved that the literature used by the chiropractic industry to assert the safety of neck manipulation was, at best, misleading.
Having debunked the literature, Angela was able to focus on the chronology of events for this client. This included the sudden onset of headache following the manipulation, which persisted until the stroke and the reported feeling and sound of “whooshing” in his ear, which was later characterized as pulsatile tinnitus by the expert neurologist retained for the claim.
With the right experts the risk to the defendant chiropractor of being found liable for the subsequent stroke was too great and the case was settled prior to trial.
Also of influence on the settlement, was the potential consequence an adverse judgment may have had on the chiropractic industry had the court recognized the risk of dissection inherent in neck manipulation and the flawed, if not misleading, scientific literature the industry continues to rely upon.
Angela Price-Stephens is an English and Canadian lawyer who focuses on serious personal injury arising from the negligence of others, mostly health care professionals. Of her 25-year career approximately half of that time has been spent defending health authorities, doctors and other healthcare professionals. That experience is now used exclusively for the benefit of injured patients.
For more information on this article, or for a confidential discussion of your claim, contact Angela Price-Stephens at 250 869 1124, or send her a confidential email at firstname.lastname@example.org.