MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

On 19-30 April 2021 & 1-2 September, 2021 the Professional Conduct Committee of the General Chiropractic Council considered the case of Arleen Scholten, the chiropractor who treated John Lawler, the patient who died after her treatment. Details of the case can be found in the following posts:

The Committee considered there had been breaches of the Code, those breaches occurred as a result of Mrs. Scholten’s state of mind at the time and not as a result of a deliberate intention on her part to be inaccurate or misleading. In light of those circumstances, the Committee considered other members of the profession and fully informed members of the public would not consider her failings to be morally reprehensible or deplorable, but rather would consider them regrettable but understandable in the exceptional, albeit tragic, circumstances of this case. The Committee, therefore, agreed with the GCC’s expert witness Mr Brown and did not think Mrs Scholten’s conduct fell far short of the standard required of a registered chiropractor. The Committee was not satisfied, therefore, that her behaviour amounted to unacceptable professional conduct. Accordingly, the Committee found the allegation of UPC not to be well-founded.

How can this be right?

To remind us of the case, here is what I wrote about it previously:

The tragic case of John Lawler who died after being treated by a chiropractor has been discussed on this blog before. Naturally, it generated much discussion which, however, left many questions unanswered. Today, I am able to answer some of them.

  • Mr Lawler died because of a tear and dislocation of the C4/C5 intervertebral disc caused by considerable external force.
  • The pathologist’s report also shows that the deceased’s ligaments holding the vertebrae of the upper spine in place were ossified.
  • This is a common abnormality in elderly patients and limits the range of movement of the neck.
  • There was no adequately informed consent by Mr Lawler.
  • Mr Lawler seemed to have been under the impression that the chiropractor, who used the ‘Dr’ title, was a medical doctor.
  • There is no reason to assume that the treatment of Mr Lawler’s neck would be effective for his pain located in his leg.
  • The chiropractor used an ‘activator’ which applies only little and well-controlled force. However, she also employed a ‘drop table’ which applies a larger and not well-controlled force.

I have the permission to publish the submissions made to the coroner by the barrister representing the family of Mr Lawler. The barrister’s evidence shows that:

a. The treating chiropractor owed a duty of care to the Deceased, her patient;
b. That duty was breached in that:
i. After the Deceased reported loss of sensation and paralysis in his arms, the only safe and appropriate response was to:
1. Leave him in situ;
2. Await the arrival of the paramedic;
3. Provide an accurate history to the ambulance controller and attending paramedic;
ii. The treating chiropractor, in fact:
1. Manhandled the Deceased from the treatment bed into a sitting position on a chair;
2. Tipped his head backwards and gave “mouth to mouth” breaths;
3. Provided an inaccurate and misleading history to the paramedic and ambulance controller, causing the paramedic to treat the incident as “medical” not “traumatic” and to transport the Deceased downstairs to the ambulance without stabilising his neck.
c. The risk of death was a reasonably foreseeable consequence of the breach;
d. In the absence of the breach:
iii. The paramedic would have stabilised the neck, in situ, and transported the Deceased on a scoop stretcher;
iv. The deceased would have survived.
e. Having regard to the risk of death involved, the misconduct was grossly negligent so as to be condemned as the serious crime of manslaughter. The decision to intervene as she did, went beyond a very serious mistake or very serious error of judgment having regard to the fact that:
i. She held herself out as a provider of (quasi) medical treatment;
ii. She styled herself as “doctor”, (when she was not entitled to do so);
iii. She intervened without any understanding of the injury she had caused nor any training in how to intervene safely.
___________________________________

The chiropractor, Mrs. Scholten, had been accused by the GCC of unacceptable professional conduct. The exact text of the GCC reads as follows :

1. Between 31 July 2017 and 11 August 2017, you provided chiropractic care and
treatment to Patient A at Chiropractic 1st, 68 The Mount, North Yorkshire, YO24 1AR,
(‘the Clinic’).
2. On 11 August 2017 you provided treatment to Patient A which included:
a. a drop technique applied to the thoracic spine;
b. the use of an Activator applied to the thoracic spine;
c. the use of an Activator applied to the cervical spine.
3. Following the drop technique, Patient A indicated he was in discomfort and had lost sensation in his arms and you inappropriately continued treatment.
4. During the course of a subsequent 999 telephone call:
a. you told the call handler that Patient A had laid on the adjusting table and you had used the Activator on his midback;
b. you told the call handler that when you were using the Activator on Patient A’s midback he had said his hands had gone numb;
c. you told the call handler that as Patient A was elderly you had never used any manual adjustment on Patient A;
d. you omitted to tell the call handler that you had used a drop technique on Patient A;
e. you omitted to tell the call handler that Patient A had first expressed discomfort following the drop technique;
f. you omitted to tell the call handler that you had treated Patient A’s cervical spine.
5. When paramedics arrived at the Clinic:
a. you told them words to the effect that you had manipulated Patient A’s midback with the use of an Activator;
b. you told them words to the effect that Patient A had first complained of discomfort when you had been using the Activator on his midback;
c. you omitted to tell the paramedics you had used a drop technique on Patient A;
d. you omitted to tell the paramedics that Patient A had first expressed discomfort following the drop technique;
e. you omitted to tell the paramedics that you had treated Patient A’s cervical spine;
f. you demonstrated the force applied by an Activator on one of the paramedic’s arms.
6. In Patient A’s records for 11 August 2017:
a. you recorded that you had used the Activator on Patient A’s thoracic spine at T2/3 level;
b. you recorded that Patient A had directly said his arms felt numb;
c. you omitted to record that you had used a drop technique on Patient A;
d. you omitted to record that you had treated Patient A’s cervical spine.
7. Your comments and omissions as set out above at 4 and/or 5, and/or as recorded at 6 above, were;
a. inaccurate;
b. misleading;
c. dishonest in that you intended to mislead as to the precise details of the treatment you had provided Patient A

Mr Goldring, on behalf of Mrs Scholten, indicated that the following facts were admitted: Particulars 1, 2(a), 4(a), 4(b), 4(c), 4(d), 5(a), 5(b), 5(c), 5(f), 6(a), 6(b), 6(c) and 7(a) and (b), insofar as they related to the aforementioned admitted facts. The Chair therefore announced that those matters were found proved. Later in the proceedings Mr Goldring indicated that 7(a) and 7(b) were not in fact admitted in respect of 4(c) and 6(b), since it was Mrs Scholten’s case that she had not used any manual adjustment on Patient A, (Particular 4(c)) and the record that Patient A had directly said his arms felt numb was accurate, (Particular 6(b)). Accordingly, the Chair formally announced that position.

END OF QUOTES

I am totally baffled by this ruling.

  • What about the fact that the chiropractor’s treatment was not even indicated?
  • What about the fact that no informed consent was obtained?
  • What about the fear that the chiropractor moved her patient after the injury had happened and made an attempt of ‘mouth to mouth’ resuscitation which seems to have aggravated the injury?
  • What about the fact that she misled the paramedics which then caused them not to stabilise Mr. Lawlwer’s neck?

Is the GCC truly saying that, as long as a chiropractor panics, all these mistakes can be excused? I am at a complete loss trying to understand the GCC ruling and very much hope that someone can explain it to me.

 

46 Responses to Chiropractor found not guilty even though her patient, John Lawler, died after neck manipulation

  • An activator? Is that the clicky thing that does nothing? How would it rupture a disc and cause this issue? And how would treatment of the mid back cause an issue in the neck? Is that what the drop piece does?

  • 3. Following the drop technique, Patient A indicated he was in discomfort and had lost sensation in his arms and you inappropriately continued treatment.

    Ref. https://www.gcc-uk.org/assets/hearings/2021.09.02_-_Scholten_-_Final_Determination__.pdf

  • For those who might be unfamiliar with the use of an “Activator” tool or a “drop table” by a chiropractor, I think it’s more than helpful to see them in action. As an added bonus in this video, you get to hear the chiropractor explain what’s on their chiropractic mind when employing these devices.

    ADJUSTING THE JOINTS

    This 15 minute video from a Scientific American Frontiers episode titled Adjusting the Joints might help to flesh out the discussion here and elsewhere whenever “chiropractic” and chiropractors are mentioned. At least you’ll know a little bit more about what you’re looking at and become more familiar with the chiropractic meatball apologists we routinely see here who reflexively and ineptly attempt to defend what they think and do professionally.

    You really can’t make it up this good. See for yourself 🙂

    ~TEO.

    • I agree, it’s a good film

    • Now do a video with someone like Stephen Perle, Jan Hartvigsen or Gregg Kawchuk.

      • why?
        what is wrong with his?

        • His video, in general, served his purpose.

          However it was slanted in one direction, did not cover some topics very well and wasn’t based upon the current research (not sure when he did the video).

          Also, including someone like Chris Colloca who helped research the Activator and Joseph Pickar, who did neurophysiological research on spinal manipulation, would give a more balanced view.

          But I doubt that was John’s intent and probably why he focused on Life U folks.

  • “What about the fact that the chiropractor’s treatment was not even indicated?”

    “Not indicated”…?

    Mr Lawler was known to have ankylosing spondylitis – and had had spinal surgery for this.
    Any manipulation of any part of the spine was CONTRA-indicated.

    Was there no expert witness with expertise in spinal surgery provided to the GCC by Mr Lawler’s family?
    Only a chiropractor – who has never operated on a spine, and by whose account, had never seen an ankylosed spine manipulated.

  • The Committee, therefore … did not think Mrs Scholten’s conduct fell far short of the standard required of a registered chiropractor.

    So this ‘standard required of a registered chiropractor’ boils down to gross medical incompetence, and ineptness in recognizing let alone dealing with a medical emergency.
    Well, at least they implicitly admit that chiropractors are pretty useless with regard to healthcare.

    • “ Well, at least they implicitly admit that chiropractors are pretty useless with regard to healthcare.”

      Ah, so we are judging a whole profession on the actions of one chiropractor? Shall we do that with other healthcare professions?

      • Ah, so we are judging a whole profession on the actions of one chiropractor?

        No. We are judging the whole profession by the opinion of its disciplinary committee and thus its highest representatives. THEY found that this chiropractor acted in accordance with their ‘professional standards’, and was not to blame for the events. Which, given what happened, implies that these standards fall woefully short of those applying to real healthcare.

        • “ We are judging the whole profession by the opinion of its disciplinary committee…”

          One disciplinary committee. Do they represent all chiropractic committees?

          There are what, around 3300 chiropractors registered in England? Out of 100,000 chiropractors worldwide practicing in 100 countries.

          • oh dear; you are scraping the barrel and coming up with real idiocies again.

          • So you think one disciplinary committee in one country, that covers 3300 chiropractors, allows one to judge the whole profession?

            That is the claim

            “We are judging the whole profession by the opinion of its disciplinary committee and thus its highest representatives.”

          • not to my understanding:
            “its disciplinary committee” means the disciplinary committee of the GCC. therefore the context is the UK

          • One disciplinary committee. Do they represent all chiropractic committees?

            They should. And if they don’t, these ‘professional standards’ that they mention are just meaningless words to hide the fact that they don’t actually have any professional standards by which to judge the conduct of their members, and any incidents resulting from this conduct. Or, to put it in a more succinct way: quacks will never criticise or chastise fellow quacks.

            The facts are crystal clear: a completely preventable death has occurred as the result of multiple counts of very poor judgment on behalf of an alternative practitioner. This practitioner
            – should have known that spinal manipulation was contra-indicated for her customer’s condition;
            – should have been aware of the risks inherent in manipulating the cervical area;
            – should have recognized her customer’s condition immediately after the event as a potential medical emergency;
            – should have known what to do (and, more importantly, what NOT to do) in such emergencies.
            And no, the fact that the practitioner apparently panicked is not a mitigating circumstance – quite the contrary, as it indicates that this practitioner was not prepared nor competent in any way to deal with real medical problems.

            If this would have happened to a real doctor (and yes, they sometimes make similar mistakes), these real doctors invariably face disciplinary measures, up to and including losing their medical license in the more egregious cases. They are never just let off with a verdict of ‘did nothing wrong, case closed’.

          • “Whole profession”

          • yes, the whole profession regulated by the GCC

          • They should is not the equivalent of they do.

            As far the rest of your comments, that was not what I was challenging.

          • Fair enough.

            But I still think his generalization to other UK chiropractors based on the action of one chiropractor is unwarranted. But I have better use of my time.

  • The GCC only seems to call as expert witnesses other chiropractors. As in my case: https://majikthyse.wordpress.com/2020/07/28/infantile-chiropractic/

    Does anyone know what the legal position is re oversight of the GCC? Surely it can’t be the final arbiter.

    • I take it that the Lawler family could have called their own expert.
      I offered and wrote them a detailed critique of Chiropractor Brown’s ‘expert witness’ report.
      I heard nothing more.

      My review is available on request: richardrawlins2@gmail.com.

      The GCC (as the GDC, GMC and all regulators) are not the final arbiter and appeals can be heard by the courts – at a price!
      E.g: the GMC’s decision on Dr Hadiza Hawa-Gaba was successfully appealed (in this case, to have her being struck off by the GMC reversed). But she had much financial support from the profession, crowd funding etc.

      In the case of Mr Lawler, is the Daily Mail interested?
      if not, why not?

      • I see the Dail Mail has reported on 6th September 2021 – but hardly the investigative report this serious matter deserves – not least a challenge to the expertise of the ‘expert witness’ Ch. Brown.
        (Not a medical doctor, so not ‘Dr’ as he has at times styled himself – ‘Ch’ for ‘Chiropractor’. A profession of which I am sure he is proud.)
        Sigh

      • The family were not party to the GCC case, although I was the claimant and my mother was a witness of fact. We couldn’t call any witnesses, although we would have liked to have been able to.

        • I wonder what the Daily Mail thinks of a regulator denying any proper expertise was presented?

          If you decide to enter a civil claim for damages, let me know if I can help.
          Just because Ch Brown and the GCC determined Miss Scolten is fit to practice does not mean she is not liable for her failings.

          Most doctors who have to pay damages for clinical negligence are not even referred to the GMC, let alone determined to be worthy of discliplinary sanction.

          In a civil case, you would have a specislist spinal expert opining on the treatment.
          The fact that such an expert would not be a chiropractor is irrelevant – it is the treatment which would be considered, not the training the practitioner had (?) or their ‘qualification’.
          Bolam and Bolitho – “would a reasonable body of practitioners who treated ankylosing spondylitis have acted thus?”

          Even Ch Brown opined he had never before come across such a case!
          So, no! Res ipsa loquitur m’lud!

    • I’m not an expert on the legal situation but as the GCC is a public body, I would have thought their decision could be challenged via judicial review. See e.g. https://www.instituteforgovernment.org.uk/explainers/judicial-review

  • Some good points here.
    Plus AS is definitely contraindicated as RR states.
    Question for Edzard and those familiar with informed consent in the UK.
    Is informed consent a common law requirement in the UK for all health professions?
    Here in Australia the law was passed in 2000 and it is checked every year by the health regulator and by my PI insurance provider when I renew. I have been using informed consent with every patient since 1995.
    See here:
    https://www.alrc.gov.au/publication/equality-capacity-and-disability-in-commonwealth-laws-alrc-report-124/10-review-of-state-and-territory-legislation-2/consent-to-medical-treatment/
    and
    https://pubmed.ncbi.nlm.nih.gov/17987206/

    Additionally, Keith Simpson and Stan Innes discuss informed consent in regards to mythical subluxations and it’s legal implications with some high powered legal input here:
    https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00342-5
    “We argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered.”

    Informed consent cannot be a generic, done once form as well. It must be condition specific, the patient must understand and it must be updated regularly.

    • In my view no valid consent can be given by a patient with ankylospondylitis to have their spine manipulated.
      Chiropractor Brown (who has previously styled himself ‘Dr’) must be thanked for making it clear just what standards are appropriate for members of his profession.

      Caveat emptor.

      • @Richard Rawlins
        I have managed many patients with AS over the years. I do not do thrust manipulations (chiropractic is not a single technique) and instead do general range mobilizations, exercise, rehab etc and we discuss the importance of maintaining mobility and flexibility as long as possible. We also discuss that a day will come where AS will flare, no one knows what the trigger is and it can then progress rapidly. This is discussed with the patient during the consent. I also get their consent to contact their doctor to coordinate their care. Every patient has consented to this and every doctor has been supportive. It has also generated AS referrals from GP’s.
        @RR you know how AS progresses so you know when any manual therapy has utility and when it can no longer help.
        So there is a valid consent and it is very case specific.

        • @Critical_Chiro:
          Splendid, and how does that differ from treatment that could be offered by a physiotherapist?

          Why did you not train to be a physiotherapist, or doctor, or osteopath?
          What is unique about chiropractic which drove your vocation?
          Adjusting ‘subluxations’?

          And what do you think of Ch. Brown’s evidence that using a drop table technique and an Activator were appropriate treatments for a distraught elderly man whose thorac-lumbar spine had been stabilised by two steel rods?

  • The Professional Standards Authority reviews every fitness to practice decision made by the statutory regulators which bizarrely includes the GCC and the General Osteopathic Council https://www.professionalstandards.org.uk/what-we-do/our-work-with-regulators/decisions-about-practitioners

    The GCC uses different language from other regulators. It’s not clear if “unacceptable professional conduct” is the same as being unfit to practice. If it is, the PSA could have the decision reviewed in court if it feels that it doesn’t go far enough to protect the public.

    If not, the Lawler family could apply for Judicial Review of the GCC’s decision on the basis of the decision being irrational. Some law firms might do this pro bono. Crowdfunding would also be possible and it could well gain support from those critical of chiropractic.

  • Arleen Scholten, the chiropractor who panicked, and therefore wasn’t responsible for Mr Lawler’s death (according to the GCC), can be heard here talking about ‘Chiropractic, the Science and Philosophy and Why it Works!’
    https://www.pechakucha.com/presentations/chiropractic-the-science-and-philosophy-and-why-it-works

    Watch and weep. Knows all about how to deal with stress, apparently.

    • “We owe everything to these two lovely gentlemen on the right (screen photos) – the one in the centre is D. D. Palmer…”

      What? Is this the same D. D. Palmer who was araigned many times for being drunk and disorderly and for wife beating and child abuse?
      His son B. J. wrote that his sister had many wealts from the thrashings she received, and ran away from home.

      “… a lovely gentleman” Mrs Scholten?
      I think not. You have been mislead.

      • DD Palmer’s son, BJ Palmer (one of Arleen Scholten’s “two lovely gentlemen”), was just as bad, if not worse. He was ruthless businessman. A brief browse through this link https://www.chirobase.org/05RB/psc_catalog_1922.pdf [now broken, unfortunately] showed that he was a charlatan and a chancer:

        In 1910, he testified that, at the age of 11, that he had been “kicked from home, forced to make a living” (State of Wisconsin vs. S.R. Jansheki, December 1910).
        He spent years as a vagrant, living largely by hustling on the streets, and slept in dry-goods boxes, hotel kitchens, pool halls, etc. He was permanently expelled from school in the 7th grade, did jail time for petty thievery, and was well-acquainted with the red-light district of town. (Magner, G. Chiropractic: The Victim’s Perspective).
        In the preface to one of BJ’s books, a dean of Palmer College wrote, “The first 20 years of this boy’s life were spent in being educated to hate people and everything they did or were connected with”. (Hender H. Preface. In Palmer BJ. The Bigness of the Fellow Within. Davenport. IA: Palmer School of Chiropractic, 1949)
        Indeed, R.C. Schafer DC, a former director of public affairs for the American Chiropractic Association, reported that as a self-proclaimed ‘keeper of the flame’ BJ was suffocating and ruthless to anyone who dared oppose him, and he remembered him as a bigot and an outlandishly vulgar person. Apparently it was common knowledge that BJ openly supported Hitler in the 1930s (Schafer RC. The imbroglio of the professional greyhound. Dynamic Chiropractic 9(17)10, 1991.) and, like his father, BJ was afflicted by megalomania.
        His book titles revealed an enormous ego and he made many sweeping pronouncements about the nature of health, disease and the human body. His ignorance and ego also combined to discover a ‘duct of Palmer’ connecting the spleen with the stomach’(https://tinyurl.com/y4kmfkgg ) .
        During his pre-chiropractic years he worked with a mesmerist and in a circus – both of which may have honed his showmanship and salesmanship. From the beginning, BJ did everything possible to distance chiropractic from medicine and osteopathy. His views came to dominate the profession and he greatly expanded chiropractic’s metaphysical basis, which constituted a major part of chiropractic education. He described chiropractic as a ‘health serve-us’ (Palmer BJ. Selling Yourself. Davenport, IA: Palmer College Press, 1921)
        BJ also claimed “I do nothing. It is Innate that does the work’ (Bach, M The Chiropractic Sotr. Austell, GA: Si-Nel Publishing & Sales Co., 1968)
        On page 424 of his book ‘Answers’ (1952), BJ refers to Innate as the ‘other fellow’, or the ‘fellow within’, and the real originator of chiropractic.
        And in his book, ‘The Bigness of the Fellow Within’ (1949), he states that “Innate…has been building and running millions of bodies for millions of years” and he exhorted all chiropractors to harness this divine power. He also states: “One spark of Innate is greater than all the education, books, and libraries of man”.
        `
        BTW, it’s worth noting that, in 1901, six years after inventing chiropractic, BJ’s father, DD Palmer, wanted to discard it:
        https://www.facebook.com/204610332906631/photos/a.349152545119075/2047167945317518/?type=3&theater

  • I’m not a lawyer but my first thought reading this was that this tragedy shouldn’t be a professional misconduct hearing but a prosecution for manslaughter. I understand that gross negligence would be grounds for that. I hope the family’s legal team support them to seek a trial.

  • John wrote: “my first thought reading this was that this tragedy shouldn’t be a professional misconduct hearing but a prosecution for manslaughter”

    The police declined to prosecute her for manslaughter:

    “Paul Spencer, for Mrs Scholten, said there had already been a detailed police investigation – Operation Coriander. A number of experts had been consulted and there had been an independent review of the evidence by the Crown Prosecution Service. He added: ‘All these experts considered with North Yorkshire Police whether the test for Gross Negligence Manslaughter was met – and concluded it was not’.”

    Ref. https://www.dailymail.co.uk/news/article-7698089/Chiropractor-fatally-broke-80-year-old-ex-bank-managers-neck-blasted-family-inquest.html

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