A Quebec coroner has concluded that a chiropractic adjustment contributed to the death of a Montreal woman. Coroner Paul G. Dionne said the death of Pierrette Parisien, a 36-year-old mother of two, was accidental, but that the chiropractic neck adjustment she received "created damages to the blood vessels in her neck, leading to her death."
Parisien had been a regular chiropractic patient for nine years prior to her Feb. 20, 2006 appointment, when she went in for treatment after developing headaches and dizziness from acute neck pain. She had attended two previous appointments, on Feb. 6 and again on Feb. 7, before falling unconscious and slipping into a coma. She died two days later.
The coroner's report stated that Parisien went to her chiropractor on Feb. 6, complaining of neck pain and headaches. Her chiropractor found the pain points during examination and told her she needed an adjustment. The report found that he did not have her sign a release acknowledging that she knew of the risks. After suffering from dizziness, chills and pins and needles in her face and arm, Parisien returned to her chiropractor the next day, apparently telling him of her symptoms but also saying she did feel better. Her chiropractor gave her another adjustment, after which she stated that her neck pain had improved but that she still felt dizzy and suffered from a loss of sensation.
She returned again two weeks later, complaining of a stiff neck. According to the report, her chiropractor manipulated her spinal column, noting there was no cracking or popping, as usually occurs with a cervical adjustment. During the treatment, the patient complained of pain, headache and nausea, before losing control of her eyes and her ability to speak. Clinic staff called 911, and the ambulance arrived and administered oxygen. However, Parisien was pronounced brain dead two days later.
The official coroner's report makes a total of 15 recommendations, addressing the chiropractic, physiotherapy and medical professions in Canada. The Quebec Order of Chiropractors said it agreed with the coroner's findings in this case and believes the chiropractor misdiagnosed the patient. However, the organization argues that this was an isolated incident and that the majority of chiropractors are careful when diagnosing patients. The practitioner in this case was fined $6,000 and continues to practice chiropractic. He said he regrets the error.
Of course, this is not the first high-profile death of a chiropractic patient in Canada attributed to cervical manipulation. In January 2004, a coroner's jury ruled that a patient's death, which occurred more than two weeks after receiving an adjustment to her neck, was an accident. While the investigation showed no direct evidence linking chiropractic adjustments to a stroke Lana Dale Lewis suffered six days after being treated, the ruling of accident suggests the manipulation played a part in her death.
Lana Lewis was admitted to Queensway General Hospital in Toronto on Sept. 1, 1996, six days after receiving an upper neck manipulation from her chiropractor, Dr. Phillip Emanuele. Lewis had been a patient of Dr. Emanuele's for approximately 18 months prior to suffering the stroke, and had been complaining of migraine headaches and musculoskeletal pain. At the hospital, she was diagnosed as having suffered a minor stroke, was hospitalized briefly and released. Approximately 10 days later, she suffered a second, more severe stroke which proved fatal. The initial coroner's report did not cite the adjustment as the cause of death, and the coroner's office decided not to hold an inquest into the cause of death.
In the Lewis case, the chiropractic profession in Canada took the stance that Lewis died of natural causes, exacerbated by her poor health - being overweight, a heavy smoker and drinker, and suffering from high blood pressure - all of which put her at increased risk for stroke. In addition to its ruling, the coroner's jury made 17 recommendations at that time, some of which clearly were not followed in the Parisien case. For example, the Lewis recommendations state that practitioners should obtain written, informed consent from their patients prior to performing high neck manipulation, and that they provide patients with an information sheet outlining the possible risks associated with neck manipulation. The coroner specifically noted this was not done in the Parisien case.
Chiropractic has come under increasing scrutiny for the purported link between cervical manipulation and stroke. Connecticut has been battling several organizations, including one called neck911usa.com, founded by infamous anti-chiropractic MD, John W. Kinsinger. An article in the May 2007 issue of SELF magazine, "A Deadly Twist," profiles several patients who suffered strokes following chiropractic treatment. (http://www.chiroweb.com/archives/25/12/10.html).
The Association of Chiropractic Colleges (ACC) recently released a DVD titled, "Cervical Spine Adjusting and Vertebral Artery Issues." This DVD is the culmination of three years of work by the ACC to summarize research and clinical experiences on this topic. Life Chiropractic College West president and ACC board of directors member Dr. Gerard Clum, narrates the 105-minute lecture.
According to the ACC, this DVD was designed to accomplish several specific things, including increasing "The ability of the chiropractor to better recognize a patient in the process of an arterial dissection upon presentation." According to the ACC, "the information presented in this lecture [also] will provide the chiropractor with current information about the demographics and incidence data of Vertebral Artery Dissection (VAD) in general as it relates to the practicing chiropractor. Finally, this lecture will provide up-to-date information on the proper management of a patient who is experiencing a VAD to minimize morbidity, mortality and related issues of professional liability."
"It is very clear that procedures once thought to be helpful no longer provide clinically relevant value, and it is equally clear that the issue associated with chiropractic care has shifted from one of perceived causation to one of evaluation and recognition," Dr. Clum stated. "Every chiropractor, regardless of when they graduated, the school or college they graduated from, the techniques used or the type of patient population served, needs to review and understand this information."
As of April 2007, more than 50,000 advance copies had been ordered online (www.chirocolleges.org/cva_ordering.html), with most of those orders coming from chiropractic colleges and programs planning to make the information available to alumni, faculty and students.
"Chiropractors armed with this new data can proceed with greater confidence when providing chiropractic care. Patients' clinical presentations will be better understood with the new research findings and therefore, potential complications can be avoided," Dr. Clum said.
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