Health

Lethal treatment

The death of a patient puts chiropractic on trial

MARK NICHOLS September 21 1998
Health

Lethal treatment

The death of a patient puts chiropractic on trial

MARK NICHOLS September 21 1998

Lethal treatment

The death of a patient puts chiropractic on trial

Health

Laurie Jean Mathiason had been going to a Saskatoon chiropractic clinic for six months, mostly for treatment of lower back pain. On Feb. 4, the 20-year-old restaurant manager visited chiropractor Stacey Kramer for the last time. According to Mathiason’s mother, Sharon, she had seen Kramer the day before because of a sore neck. But after treatment, her neck pain seemed to worsen and she returned in the hope that Kramer could ease the discomfort. In the clinic, Kramer once again manipulated her patient’s neck. But according to testimony at an inquest last week, the treatment did not help. As Mathiason lay on the chiropractor’s table, she complained of pain—then lost consciousness and began convulsing. Rushed in a coma to Saskatoon’s Royal University Hospital, she was kept on life support for three days, then died on Feb. 7—as a resuit, according to an autopsy report, of ruptured vertebral artery. Testifying at the inquest, Sharon Mathiason told of being in Kramer’s office as her daughter exhibited all the signs of a stroke. Kramer assured her that everything would be all right, said Mathiason—and “I trusted her, she was a doctor.”

MARK NICHOLS

In effect, the inquest put the chiropractic profession on trial. The four-day hearing, before Saskatchewan’s chief coroner, John Nyssen, and a six-member jury in Saskatoon’s Court of Queen’s Bench, ended with the jury urging that provincial health ministries immediately fund research into the incidence of strokes associated with chiropractic manipulation of patients’ necks and spines. After deliberating for four hours, the jury made no suggestion that Kramer had performed the procedure incorrectly. But it said that literature outlining the risk of stroke should be made available in chiropractors’ offices. It recommended that health authorities try to find effective screening tests to identify patients who might be vulnerable to injury. And it proposed the development of standardized forms for patients to fill out providing details of their health and medical history. Sharon Mathiason told reporters that she hoped the jury’s proposals would be acted on, “so that nobody else will walk to their death like Laurie did.”

Chiropractors acknowledge that cervical (neck) and spinal manipulation can cause strokes. In fact, practitioners routinely require patients to read and sign a waiver

warning of the risk. And chiropractors were clearly concerned that the Mathiason case could shake the public’s faith in them. According to the Toronto-based Canadian Chiropractic Association, about three million people across the country pay an estimated 30 million visits annually to more than 5,000 licensed chiropractors. “We’ve got a lot of patients who have been unduly scared,” says association president David Peterson, a Calgary practitioner. ‘Yes, there is a risk involved in cervical manipulation. But it is extremely low.”

Yet testimony at the inquest raised disturbing questions. Sharon Mathiason, who works at a health food store just a few doors away from the chiropractic clinic, told the inquest she saw her daughter shortly before her Feb. 4 appointment. Soon after that, her daughter’s fiancé, Doyle Gertner, arrived at the store to tell her that Laurie Jean was in trouble. Mathiason rushed to the chiropractor’s office, where she found her daughter twitching and foaming at the mouth. Gertner and Mathiason testified that the only thing Kramer did to try to help was slap Laurie Jean’s face. “My daughter was dying before my eyes and nothing was happening,” sobbed Mathiason.

Kramer’s account was different. She told the court that

Kramer, with companion Mark Hornick; Sharon Mathiason and husband Al with a photo of daughter Laurie Jean (opposite): chiropractors say the risk of stroke from a treatment is very low

after she performed an adjustment to her patient’s neck, Mathiason began to cry, complaining that her neck hurt. “I had a gut instinct something was not right,” Kramer testified. “But I had nothing to base it on.” Kramer, 29, said that she subsequently examined Mathiason’s eyes and saw that the left one was moving “all wrong.” At that point, said Kramer, she told her receptionist to telephone for an ambulance. Kramer, who is still practising in Saskatoon, told the inquest that Mathiason’s death was the worst thing that had ever happened to her.

Dr. Robert Macaulay, who performed the autopsy on Mathiason, testified that the woman’s artery was probably torn during her Feb. 3 session with Kramer. When she returned the next day, said Macaulay, the additional neck adjustment probably dislodged a blood clot formed the day before, blocking the artery “like a cork” and cutting the flow of blood to the brain.

Chiropractors insist that strokes caused by their treatments are rare—their estimates range from one in a million to one in 3.8 million manipulations. That is considerably less risky, they argue, than taking ordinary over-the-counter painkillers like ASA and its cousins, which can burn and perforate stomach linings; a Seattle gastroenterologist estimated last year that about 76,000 Americans are hospitalized a year because of problems caused by the pills.

But when manipulation of the neck does damage blood vessels that run up the spine and into the head, resulting strokes can cause temporary or lasting impairment of speech, vision and other faculties—and sometimes death. What happened to Mathiason was “a tragedy—a family lost their daughter,” | said Dr. Alexander Grier, presd ident of the Chiropractors’ As| sociation of Saskatchewan. 2 “But you have to see it in the | perspective of the risks and « benefits involved in any kind of 1 treatment.”

Statistics on chiropractor-induced stroke are scarce. Physicians critical of chiropractic say that is partly because strokes usually happen a day or so after treatment, making it difficult to demonstrate a link. But in a 1992 survey by researchers at Stanford University in Palo Alto, Calif., 51 neurologists reported seeing evidence of strokes in 56 patients and other neurological problems in 46 patients treated by chiropractors in the previous 24 hours. According to the study, published in the journal Neurology, most of the patients were still experiencing problems three months later.

Chiropractic has come a long way since Daniel David Palmer, a Port Perry, Ont.-born schoolteacher, “adjusted” a bump on the spine of a deaf janitor in Davenport, Iowa, in 1895 and somehow restored the man’s hearing. Palmer later developed a theory that misaligned bones, or subluxations, hampered healing processes. Today, Canadian chiropractors are entitled to call themselves doctors—and they have respectable academic credentials. To qualify for the four-year training course at Toronto’s Canadian Memorial Chiropractic College—where Kramer graduated in 1996—students must first have three years of university education. And according to the college’s president, Dr. Jean Moss, students are required to make an intensive study of such subjects as anatomy and neuroanatomy, and are taught about the risks of stroke as a possible consequence of cervical manipulation.

Besides promoting themselves as specialists in joint problems, many chiropractors counsel patients on diet, exercise and lifestyle issues. “We believe that the body has the ability to heal itself,” says Peterson. “We do not believe the answer to better health is more drugs and more surgery—but we do not for one minute believe that chiropractic is a cure for everything.” When chiropractors encounter problems beyond their competence, adds Peterson, they are obliged to refer the case to medical doctors.

Still, critics claim that many chiropractors treat ailments that have nothing to do with the neck or spine. “I believe the overwhelming majority of chiropractors believe they can cure virtually anything,” says Dr. Ronald Slaughter, the Houston-based executive director of the National Association for Chiropractic Medicine, a breakaway organization with members in the United States and Canada who restrict their practices solely to problems involving the body’s joint structures. “And I believe that a sincere quack is more dangerous

than an out-and-out charlatan” who would know better than to treat conditions for which he has no training. In Canada, even chiropractors who claim to offer only research-based treatments say they can sometimes help with such disparate conditions as asthma, headaches, stomach upsets and colic in babies. “Infants with colic and children with learning disorders and bed-wetting problems are being treated by chiropractors,” says Dr. Murray Katz, a Montreal pediatrician and a long-standing critic of chiropractic. “It’s astounding and extremely dangerous.”

Katz, who testified at the inquest, told Maclean’s that in his view chiropractic “is snake-oil quackery—a monumental fraud.” Laurie Jean Mathiason died, he added, “because provincial legislation says that chiropractors can treat people by manipulating bones.” At the inquest, Saskatoon radiologist Dr. Brent Burbridge said he had seen neurological problems in about a dozen chiropractic patients. “I believe some patients derive some benefit from chiropractic treatment,” he said, but then added, “I would never have my neck manipulated by a chiropractor.” In the end, the inquest left a harrowing picture that may linger in some patients’ minds—of a healthy young woman whose treatment by an alternative health practitioner ended in death.

DAN ZAKRESKI

With DAN ZAKRESKI in Saskatoon