TORONTO - A coroner's jury ruled Jan. 16 that a patient's death, which occurred more than two weeks after receiving an adjustment to her neck, was an accident. While the five-member jury investigating the death of Lana Dale Lewis was unable to find any direct evidence linking chiropractic adjustments to a stroke she suffered six days after being treated, the ruling of "accident" suggests that the manipulation performed by Etobicoke chiropractor Philip Emanuele on Ms. Lewis may have played a part in hastening her demise, and allows Ms. Lewis's family to proceed with a civil suit against Dr. Emanuele.
Lana Lewis was admitted to Queensway General Hospital in Toronto on Sept. 1, 1996, six days after receiving an upper neck manipulation from Dr. Emanuele. Prior to suffering the stroke, she had seen Dr. Emanuele for approximately 18 months, primarily for treatment of migraine headaches and musculoskeletal pain. At Queensway, she was diagnosed as having suffered a minor stroke and was hospitalized briefly, then released. However, approximately 10 days after suffering the first stroke, she suffered a second, larger stroke that proved to be fatal. She was readmitted to Queensway, where she died Sept. 12. The initial coroner's report did not cite the adjustment as the cause of death, and at that time, the Toronto coroner's office decided not to hold an inquest into the cause of Ms. Lewis' death.
Nevertheless, more than three years later, in November 1999, the Lewis family called for an inquest to determine the cause of her death. In January 2000, the family also filed a $12 million civil lawsuit against Dr. Emanuel and a number of chiropractic organizations, citing that they had not advised the public properly about the dangers of neck adjustments. Representing the Lewis family at the time was Murray Katz, MD, a longtime opponent of the chiropractic profession and founder of the National Association of Chiropractic Medicine (NACM). In early 2001, however, Dr. Katz was removed from the case after threatening to end the professional career of a Canadian coroner, Dr. Murray Naiberg.
After the family's request for an inquest was denied twice, the coroner's office reversed its stance and decided an inquest could proceed. Even then, however, it faced a series of delays. In addition to Dr. Katz's removal from the case a second time, the Lewis family's original lawyer excused himself from the proceedings, and several dozen slides of Ms. Lewis' artery vanished, delaying the start of the inquest an additional six months.
The inquest into the cause of Ms. Lewis' death finally began in April 2002. The coroner's jury was charged not with assigning blame, but determining whether Dr. Emanuele's adjustment played a role in the death, and was given the option of five possible findings: homicide, suicide, accident, natural causes, and undetermined.
The position of the chiropractic profession was that Ms. Lewis died of natural causes, exacerbated by her poor overall health - being overweight, a heavy smoker and drinker, and suffering from high blood pressure - all of which put her at increased risk for stroke At the trial, several medical experts testified that Ms. Lewis' stroke was caused not by the chiropractic adjustment, but by advanced end-stage atherosclerosis that, in the words of Dr. Harker Rhodes, a neuropathologist at Dartmouth University Medical School, had "virtually completely destroyed" her left intracranial vertebral artery and blocked 70 percent of the right vertebral artery intracranially. Dr. Rhodes also stated "it was simply a coincidence" that Ms. Lewis received a neck adjustment a few days prior to her stroke.
Witnesses called by the coroner's office and evidence presented at the inquest provided differing testimony. One letter, signed by dozens of neurologists, stated that blood vessels such as the vertebral artery can tear if a person's neck is rotated improperly. Other witnesses testified that Dr. Emanuele's adjustment was "the probable source of injury" to Ms. Lewis, and that there was only minimal to moderate atherosclerosis in her vertebral arteries.
In addition to ruling Ms. Lewis' death an accident, the coroner's jury made 17 recommendations, including:
Lawyers for the CCA and the CMCC expressed disappointment with the jury's verdict, saying it "represents a massive miscarriage of justice." In a statement to the media, attorney Tim Danson said the chiropractic profession would appeal the decision on the grounds that there was "a complete failure of justice in the conduct of the inquest." He also alleged that the coroner's office suppressed evidence that would have helped the chiropractic profession's position.
"The public should know, as should the jury, that two of the most distinguished and respected neuropathologists in the world, Dr. David Graham of Glasgow, Scotland, and Dr. Francesco Scaravilli, of London, England, were prohibited from testifying at the inquest [even though] the coroner was aware that as leading world authorities, their opinions commanded great respect, and would have carried considerable weight," said Mr. Danson. "... Dr. Graham and Dr. Scaravilli formed the opinion that this was the clearest case they have ever seen of a person dying as a result of natural causes, and any other explanation would be grossly speculative and unscientific."
This decision marked the first time in Ontario, and only the second instance in Canada, in which chiropractic manipulation of the neck was the subject of a coroner's inquest. The first inquest examined the death of Laurie Jean Mathiason, a 20-year-old woman from Saskatoon, Manitoba, who died in February 1998, three days after suffering a stroke while being adjusted. The jury in that inquest ruled that more research was needed to determine the risks and benefits of neck adjustment, and that the public be better informed.
Even before the jury ruled the death of Lana Lewis an accident, however, Canadian chiropractors were beginning to feel the backlash of the inquest. According to an article in the Toronto Globe and Mail, the Lewis inquest "subjected the chiropractic industry to terrible publicity," and some practitioners have reported a drop in billings and the number of patients treated by more than 20 percent.
But the battle does not end here, as Mr. Danson made clear in his comments to the media: "We have instructed our counsel to bring an Application for Judicial Review before a three judge panel of the Superior Court of Justice (Divisional Court) to quash the verdict on the grounds that it is perverse, and on the grounds that there has been a complete failure of justice in the conduct of the inquest."
Resources
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
