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

This paper is an evaluation of the relationship between chiropractic spinal manipulation and medical malpractice. The legal database VerdictSearch was queried using the terms “chiropractor” OR “spinal manipulation” under the classification of “Medical Malpractice” between 1988 and 2018. Cases with chiropractors as defendants were identified. Relevant medicolegal characteristics were obtained, including legal outcome (plaintiff/defense verdict, settlement), payment amount, nature of plaintiff claim, and type and location of the alleged injury.

Forty-eight cases involving chiropractic management in the US were reported. Of these, 93.8% (n = 45) featured allegations involving spinal manipulation. The defense (practitioner) was victorious in 70.8% (n = 34) of cases, with a plaintiff (patient) victory in 20.8% (n = 10) (mean payment $658,487 ± $697,045) and settlement in 8.3% (n = 4) (mean payment $596,667 ± $402,534).

Over-aggressive manipulation was the most frequent allegation (33.3%; 16 cases). A majority of cases alleged neurological injury of the spine as the reason for litigation (66.7%, 32 cases) with 87.5% (28/32) requiring surgery. C5-C6 disc herniation was the most frequently alleged injury (32.4%, 11/34, 83.3% requiring surgery) followed by C6-C7 herniation (26.5%, 9/34, 88.9% requiring surgery). Claims also alleged 7 cases of stroke (14.6%) and 2 rib fractures (4.2%) from manipulation therapy.

The authors concluded that litigation claims following chiropractic care predominately alleged neurological injury with consequent surgical management. Plaintiffs primarily alleged overaggressive treatment, though a majority of trials ended in defensive verdicts. Ongoing analysis of malpractice provides a unique lens through which to view this complicated topic.

The fact that the majority of trials ended in defensive verdicts does not surprise me. I once served as an expert witness in a trial against a UK chiropractor. Therefore, I know how difficult it is to demonstrate that the chiropractic intervention – and not anything else – caused the problem. Even cases that seem medically clear-cut, often allow reasonable doubt vis a vis the law.

Apologists will be quick and keen to point out that, in the US, there are many more successful cases brought against real doctors (healthcare professionals who have studied medicine). They are, of course, correct. But, at the same time, they miss the point. Real doctors treat real diseases where the outcomes are sadly often not as hoped. Litigation is then common, particularly in a litigious society like the US. Chiropractors predominantly treat symptoms like back troubles that are essentially benign. To create a fair comparison of litigations against doctors and chiros, one would therefore need to account for the type and severity of the conditions. Such a comparison has – to the best of my knowledge – not been done.

What has been done, however – and I did previously report about it – are comparisons between chiros, osteos, and physios (which seems to be a more level playing field). They show that complaints against chiros top the bill.

19 Responses to Malpractice Litigation Involving Chiropractic Spinal Manipulation

  • These are very low numbers compared to the number of treatments givven over 30 years in the US. I think we can conclude Chiropractic is SAFE.

    Aside from that I have no doubt there are many more cases that were somehow not included

    • “I think we can conclude Chiropractic is SAFE.”
      I am sure you will! But actually, the paper was not about the safety of chiropractic.

    • I think you missed the class Mr. Almog, where you learn that the term safety involves two main parameters, risk and benefit.
      Just like the case with acupuncture, chiropractic (the original prescientific invention of HVLA “adjustments” or later theatrical additions that put apply abnormal and even injurious strain to the musculoskeletal structure) by DD Palmer et al.) would most likely long be withdrawn from the market due to safety concerns, were they a modern drug.

      • “… would most likely long be withdrawn from the market due to safety concerns, were they a modern drug.”

        And yet MDs keep putting SMT in clinical guidelines for some conditions.

        • ‘DC’ wrote “And yet MDs keep putting SMT in clinical guidelines for some conditions.”

          For which medical conditions do MDs put chiropractic spinal manipulation in clinical guidelines? Or was your comment yet another asinine off‑topic red herring.

          • I didn’t write “chiropractic spinal manipulation”. I wrote SMT which stands for spinal manipulation therapy.

            Read much?

          • You were, and still are, off-topic. You are commenting on:

            Malpractice Litigation Involving Chiropractic Spinal Manipulation

            NOT

            Malpractice Litigation Involving SMT

            Thank you for confirming that your comment was indeed “yet another asinine off‑topic red herring”.

          • Sigh, so if manipulation would have been withdrawn from the market it would not apply to PTs or DOs or MDs?

            If this is your main point Pete, that it is CHIROPRACTIC manipulation, it is silly in light of Bjorn’s comment.

            Once again you have shown to be a waste of time.

          • ‘DC’, Are you claiming that chiropractic spinal manipulation (performed by a Doctor of Charlatanry chiropractor, obviously) is, for all practical purposes, spinal manipulation therapy (performed by a qualified medical practitioner, such as a physiotherapist, obviously)?

            You mention SMT so frequently in your comments that you appear to be equivocating; misdirecting via wilful obscurantism, semantic filibustering.

            A chiropractor who claims to diagnose and/or treat an actual medical condition, would be making a bogus claim: a charlatan and a quack.

            Chiropractors are not medically qualified to even lance a boil and dress the wound.

            Thus, allow me to make a suggestion to chiropractors worldwide: Instead of continuing with HAPPILY PROMOTING BOGUS TREATMENTS, what about using the ‘chiropractic awareness week’ to raise awareness of the urgent necessity to research the safety of your treatments?
            — Edzard Ernst (2022-04-04)
            https://edzardernst.com/2022/04/chiropractic-a-safe-form-of-treatment/

          • Pete: A chiropractor who claims to diagnose and/or treat an actual medical condition

            Is a sprain/strain and “actual medical condition”?

          • Pete: ‘DC’, Are you claiming that chiropractic spinal manipulation is, for all practical purposes, spinal manipulation therapy

            Yes. It differs somewhat from osteopathic manipulation in that they tend to use a long lever manipulation vs chiropractors and PTs who tend to use a short lever manipulation.

          • So, you can answer “yes” only to a question that I didn’t ask.

            Physiotherapists are NOT quacks, and they do not treat patients with chiropractic spinal manipulation.

            Thank you for confirming, yet again, that your comment on Sunday 03 April 2022 at 16:29 was indeed “yet another asinine off‑topic red herring”.

          • ‘DC’ wrote “Is a sprain/strain and [sic] ‘actual medical condition’?”

            Are you trying to imitate an utter moron?

            Both of those conditions have a degree, they are not either/or conditions. E.g., if the degree is mild the usual treatment is conservative management; if the degree is severe then surgery could be the best treatment option.

            To accurately diagnose those conditions, evaluate their degree, recommend treatment options, obtain informed consent, and take responsibility for the patient, requires which of the following practitioners:
            • a physician (or a medical specialist)
            • a quack playing ‘Doctor’

          • Pete, you really are clueless about the chiropractic profession. I’m content with you remaining ignorant on the topic. Take care.

          • ‘DC’ wrote “Pete, you really are clueless about the chiropractic profession.”

            LOL! So are the chiropractic ‘professions‘.

            From comments I’ve read on this blog, chiropractic is defined essentially as ‘whatever an individual practitioner chooses’. Small wonder then that ‘official’ boards a consumer might normally expect to offer some sort of standards and regulation of the ‘profession’ turn out to be dissembling, weaselly worded shams that protect only the practitioners of this particular branch of Big Snakeoil.
            — Frank Odds

            If you are in doubt who to trust, the promoter or the critic of chiropractic, I suggest you ask yourself a simple question: who is more likely to provide impartial information, the chiropractor who makes a living by his trade, or the academic who has researched the subject for the last 30 years?
            — Edzard Ernst, Chiropractic: Not All That It’s Cracked Up to Be
            https://edzardernst.com/2020/08/chiropractic-not-all-that-its-cracked-up-to-be/

  • It would be interesting to know more about these 38 cases that weren’t included since that’s almost half of the 86 cases. What percentage of those cases involved SMT by a non chiropractor?

    “Query of the VerdictSearch online legal database for “chiropractor” OR “chiropractic” OR “spinal manipulation” within the 22,566 listed cases classified as “medical malpractice” yielded 86 cases. Of these, 48 cases met the inclusion criteria by featuring a chiropractic practitioner as the primary defendant.”

  • Malpractice insurance is much higher for medical doctors because they treat procedures that need surgical or immediate care that is life threatening. You don’t see a chiropractor for fusing a bone, treating meningitis , heart failure, cancer, or kidney failure. When is last time a chiropractor delivered a baby, stitched a open cut, prescribed medicine for actual infection?

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories