Fact
Ms. Diane Lyon entered Dr. Edward Roberts' office on March 10, 1987. Her major complaint was low back pain associated with right sacroiliac pain. The pain had begun seven to eight months before, radiating around the groin area and down the right leg on the lateral and medial thigh. She attributed the pain to lifting a heavy bundle and said it felt like something had snapped in her right gluteal area. She was also experiencing neck and right shoulder pain, which had occurred two weeks before and had persisted. She experienced difficulty in walking, due to the right leg pain.
The patient noted that she had a history of cancer, and she stated she had been treated by her medical doctor. Under "operations," the patient did not list her left radical mastectomy surgery five years before, or any other surgery. Apparently, the patient felt that it was not important to tell the chiropractor about the surgery. The chiropractor did not ask any questions about her history of cancer.
Examination: The doctor did an orthopedic examination which consisted of a range of motion, skeletal exam, and an orthopedic exam. Specifically, he did a foramen compression test and a range of motion test, consisting of extension, flexion, and abduction. Flexion was 40%, extension was 50%, Patrick's Fabare was positive on the left; leg raise was bilaterally positive; Ely's Test was positive right and left; knuckle test was positive right and left; and Derefield's -- left short leg.
X-ray Examination
Views taken were an anterior/posterior and a lateral full spine. There was also evidence of an osseous change in the right symphysis pubis area. The doctor had noted the area. By the doctor's testimony, he did not know what it was but he knew something abnormal existed. There was no referral or pathological report.
Note: At this time, this doctor was running a separate x-ray facility out of his office under a different name.
Outcome: Patient died of metastatic carcinoma.
Prevention: In this case, the patient was terminal prior to reaching Dr. Roberts' office. But in the same vein, if Dr. Roberts' noted changes in the pubic area of osseous origin and did not know what it was, a consultation should have been initiated. If patient denies any conditions, symptoms, operations, or accidents, "denied" should be printed through that entire section. This helps to insure that adequate questioning on history has been observed.
During the doctor's deposition, the plaintiff's attorney revealed 10-15 health tracts the doctor was using in his office. Many statements contained in the health tracts the doctor could not justify. Make sure you are familiar with all the literature and patient information in your office.
This case study is provided from the claim files of the OUM Group Chiropractor Program. The study is based on actual incidents, however, circumstances have been changed.
Dennis Semlow, D.C.
Freemont, Michigan
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