Facts:
Marci Henney, a 45-year-old bookkeeper and business school instructor, first saw Dr. Sam Dunne in June 1985. A well-groomed woman of average build and weight, Henney complained of chronic upper back pain and stiffness.
Dr. Dunne asked her to complete a written medical history. Next, they discussed her history in detail. Henney told the doctor that she was on medication to regulate her heartbeat, but that her blood pressure was consistently normal. She denied any personal or family history of neurological or vascular problems.
Dr. Dunne diagnosed a subluxation of the 1st and 2nd vertebrae. He gave Henney a manual adjustment. The following week, the patient reported improvement. Dunne continued to manually adjust Henney on a regular basis for the next nine months. Henney assured the doctor that she felt better.
In March of 1986, Henney came to the chiropractor's office complaining of persistent headache along with back pain. Dr. Dunne adjusted her spine as usual, but the patient returned three days later, still complaining of a headache and upper back pain. Dr. Dunne performed various tests to verify proper neurologic and circulatory function, observed her eye movements, and took her blood pressure. All were normal. He documented his findings, and then adjusted her 1st and 2nd vertebrae.
Within seconds, Henney complained of dizziness and numbness. Dr. Dunne noted that her eyes were moving rapidly. He immediately called an ambulance. Dr. Dunne contacted the hospital later that day and learned that Henney had suffered a mild stroke, but was doing well.
Three months later, Dr. Dunne received a letter from Henney's attorney demanding $100,000 for emotional stress, financial loss, and permanent disabling injuries. Henney alleged that Dr. Dunne failed to perform adequate testing before the manipulations, and failed to refer her to a neurologist or cardiovascular surgeon, and that Dr. Dunne's manipulations caused the stroke.
Outcome:
Hospital records show that Henney had suffered a left occipital infarction, but that she had recovered very well. The patient complained of short-term memory loss, verbal dysfunction, and a right superior quadrant field cut (visual loss). However, the defense neurologist commented, "Except for her reduced field of vision, her present complaints are mostly subjective. She lost approximately 1/18th of her field of vision -- I seriously question whether this would cause any noticeable problems in daily living or normal activities."
Further, it was disclosed that in spite of her claims of memory loss and verbal dysfunction, she continued her bookkeeping activities and teaching at the business school. She also admitted to having "fast danced" at a local nightclub several times since the stroke. Other hospital records revealed that Henney had suffered a minor stroke one year prior to seeing Dr. Dunne, and several spontaneous strokes following the incident at Dr. Dunne's office. Old medical records chronicled her abuse of alcohol while using Premarin and Elavil, and revealed a history of high blood cholesterol and pre-existing vertebral basilar artery disease. Henney had neglected to inform Dr. Dunne of any of these conditions.
The defendant's chiropractic and neurological expert witnesses agreed that Dr. Dunne performed adequate testing before treating Henney. Both said that there was no way he could have foreseen the stroke given the patient's failure to disclose her medical history. According to the neurologist, "Only an angiogram would have been a more reliable indication -- obviously a risky, expensive, and impractical test that goes beyond the chiropractic standard of care."
"With the information Dr. Dunne had, I would have treated the patient that day," the defense chiropractor said.
Dr. Dunne kept excellent and thorough records. Not only were his medical records and x-rays clear and precise, but Dr. Dunne had documented his discussions with the patient about her condition and his treatments. When the plaintiff's attorney requested the patient's medical records and x-rays, Dr. Dunne wisely made copies of all requested documents, and kept the originals in his office.
Dr. Dunne's chances for winning the case were very good. When the plaintiff's attorney discovered that the defense had documentation to prove that Henney's statements and allegations were unfounded, he counselled her to drop the case.
Prevention:
Thanks to Dr. Dunne's careful record-keeping and documentation, the defense could convince the plaintiff's attorney that Henney's stroke was not caused by Dr. Dunne's negligence. The plaintiff dropped the case.
This case study is provided from the OUM Group Chiropractor Program's claims files. The study is based on actual incidents, however, circumstance and names have been changed.
