Facts:
Carl Bradford, a 35-year-old construction foreman, called Dr. Marvin Davidson complaining of low back and leg pain. This was the first time Bradford had experienced substantial pain in his lower back, though Dr. Davidson had previously treated him for a neck injury. Bradford first noticed the pain several days after he helped a neighbor move furniture.
On Bradford's initial office visit, the doctor performed several orthopedic tests, including Kemp's test, Bechterew's sign, and the Valsalva maneuver. No x-rays were taken.
Dr. Davidson diagnosed a sciatic neuritis, and he informed Bradford that a protruding disc was irritating the S-1 nerve root. Treatment consisted of pelvic adjustment using a blocking technique and sacral base adjustment with SOT blocks. Bradford was advised to come back to the office every three to five days for adjustments.
The following month, Bradford received seven adjustments. By the end of the month, Dr. Davidson felt that the protruding disc was receding. He asked the patient to come back for two more appointments.
The doctor noted continued improvement during the two follow-up visits, but Bradford returned several weeks later with new pain in his right thigh, calf, and hip.
Dr. Davidson assured the patient that more adjustments would relieve the pain. He did not take any x-rays or suggest that Bradford seek a second opinion. After three more adjustments, Bradford said he was unhappy with the treatment and had decided to see a physical therapist.
The physical therapist suggested a CAT scan, which revealed a prolapsed disc at the L5-S1 level. He referred Bradford to Dr. Lorraine Wilson, a local neurologist. Dr. Wilson performed a myelogram and suggested lumbar surgery. Bradford had the prolapse surgically repaired and was hospitalized for nine days.
Dr. Wilson had advised Bradford that recovery could be slow, but when he still felt lower back pain a month and a half later, he returned to the neurologist. More CAT scans were taken, and Bradford entered the hospital for exploratory surgery. Scar tissue was removed, but Dr. Wilson could not guarantee that Bradford would ever be absolutely pain-free.
Outcome:
Several months later, Bradford was still suffering from sporadic pain. He contacted his attorney and filed a malpractice suit against Dr. Davidson. The lawsuit alleged that Dr. Davidson had prolapsed Bradford's disc. Bradford claimed the following damages: $40,000 in medical bills, loss of his construction job, and emotional distress.
After reviewing the facts of the case, the medical investigator concluded, "Dr. Davidson is clearly at fault for failing to take any x-rays and failing to obtain a second opinion. He made no attempt to rule out tumor, aneurysm or fracture." The investigator also criticized Davidson's record-keeping, particularly with the presence of radicular symptoms.
Experts for the defense agreed that the case presented a substantial exposure to liability. The defense's chiropractic expert witness noted that an x-ray of the lumbar spine would have helped to correlate an accurate diagnosis and appropriate treatment. He added, "Moving heavy furniture could have easily damaged Mr. Bradford's disc, but without x-rays, Dr. Davidson has no defense."
The defense's expert neurologist said, "The chiropractor should not have assumed that a protruding disc was any less cause for concern than a possible prolapse." He also said that a consultation would have been advisable after the back and leg pain returned.
Dr. Davidson practices in an extremely liberal county, with a history of inflated malpractice awards. The magnitude of the plaintiff's medical bills, the medical investigator's findings, and the adverse opinion of expert witnesses would likely result in a substantial verdict for the plaintiff. Defense counsel felt that Brdford might be awarded as much as $350,00, an amount exceeding Dr. Davidson's $100,000 policy limits. With the best interests of the doctor in mind and in view of the doctor's exposure to liability in excess of his policy limits, the lawsuit was settled for $100,000.
Prevention:
Dr. Davidson diagnosed a condition and began a course of treatment without x-raying the lumbar spine. Had he taken other diagnostic tests, an appropriate diagnosis and/or referral could have been made.
The return of pain in Bradford's leg and lower back after a month of treatment should have alerted the doctor to the need for additional testing or second opinion. Finally, Dr. Davidson's incomplete records made it difficult for him to prove that he had conducted appropriate tests before making a diagnosis.
This case study is provided from the OUM Group Chiropractor Program's claims files. The study is based on actual incidents; however, circumstances and names have been changed.
Dennis C. Semlow, D.C.
Fremont, Michigan
