It has been reported that a woman who suffered a severe headache after injuring her neck during a workout died following a visit to a chiropractor. Joanna Kowalczyk, aged 29, declined a procedure at hospital for her injury and chose instead to try chiropractic. Her medical history showed she regularly suffered migraines and joint hypermobility issues. She also had an undiagnosed connective tissue disorder which made her susceptible to arterial dissections.
Ms Kowalczyk told the chiropractor that she had discharged herself from hospital. The chiropractor was unaware of her medical history but nevertheless manipulated her neck. It is thought Ms Kowalczyk suffered an arterial dissection when she injured her neck in the gym and that she suffered acute dissections to the same location when a chiropractor cracked her neck. She died on October 19, 2021, at Gateshead’s Queen Elizabeth Hospital several days after her chiropractic treatment.
Now her coroner has raised concerns that chiropractors aren’t required to check patient medical records after Ms Kowalczyk’s death. Specifically, the coroner’s report raised two matters of concern:
1. The evidence from the attending paramedic was that she was not aware that symptoms of a stroke can stop after a short time as clearly set out on NHS website and guidance, and that this was not part of her training. This was directly contrary to the Head of Operations’ evidence that this was part of both paramedic training and annual continuing professional development. This was a concerning feature given the accepted evidence of the time critical period to treat patients with symptoms potentially indicative of stroke.
2. The evidence on behalf of the treating chiropractor was that he did not consider it necessary to request GP records or hospital records, before assessment or treatment despite being informed about the Deceased’s recent hospital attendance, investigation which was recommended, and her discharge against medical advice. Even in the updated consent form I have been provided with, which was designed by the British Chiropractic Association, there is no prompt or question designed for the chiropractor to ask to consider obtaining medical records before assessment or treatment, and when this may be appropriate, and the only reference to medical records is a consent to communicate as deemed necessary for the treatment, and for a report to be sent to the GP after treatment. I am concerned that consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations has been undertaken.
Receiving a Regulation 28 (Prevent Future Deaths) report from the coroner, the GCC stated that the case may raise some concerns for chiropractors and their patients and published the following additional comment:
The chiropractor involved is subject to a GCC investigation, which was paused to allow for the coronial process. This is standard procedure.
It is not appropriate for us to comment further as it could prejudice proceedings. It is inappropriate and unprofessional for chiropractors to speculate publicly on the details of the case, or the identity of the individual involved.
All matters brought to the attention of the GCC are risk assessed and are considered by an Investigating Committee. More about the investigation process.
In her report, the Coroner has asked the GCC to consider the following concern.
(I am) “concerned that consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations has been undertaken.”
We will give full and careful consideration to her concern. Given the clinical matters involved, we are seeking expertise (from across the profession, and beyond) to consider the impact of such a step – including on the care and safety of all patients. The Registrar will be writing to the coroner in the next week to set out how her concerns will be considered, and the expected timing of that work.
We have been in contact with leaders from across the profession and are grateful to them all for their support of our proposed approach.
____________________________
The GCC’s main task is the protection of consumers. I have repeatedly pointed out that they seem to have forgotten this and seem to think it is to promote chiropractic in every way they can, e.g.:
- The UK General Chiropractic Council (yet again) protects the chiro rather than the patient
- The General Chiropractic Council “regulates chiropractors to ensure the safety of patients” … well, you could have fooled me!
- Hurray! The new professional standard by the General Chiropractic Council protects UK chiropractors
- Death of a chiropractic patient prompts a reaction by the UK General Chiropractic Council
- The UK General Chiropractic Council: fit for purpose?
- The GCC “seems to be a little self-regulatory chiropractic bubble where chiropractors regulate chiropractors.”
- The death of Mr Lawler highlights the scandals of chiropractic
Let’s hope the GCC takes the occasion of yet another tragic and unnecessary death as a wake-up call for finally getting its act together!
11 Responses to Following the death of a young woman, the UK General Chiropractic Council received a ‘Prevent Future Deaths’ report
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Let us hope the GCC considers all the evidence in the posts you reference – and asks you to attend and speak to those articles.
Why is the chiropractor not identified?
Any putative patients need to know of his/her standards of practise as from now.
But most importantly – why was Mrs K’s neck manipulated? What for?
Pain relief?
No – pain is a symptom.
What was the diagnosis?
What did the chiropractor think he/she was doing?
We must be told.
And is Mrs K’s estate considering civil action for compensation? Or even police action for manslaughter?
“If all you have is a hammer….” You should never be allowed to call yourself a “doctor”.
The DM picked up the story:
https://www.dailymail.co.uk/health/article-14372023/chiropractor-risks-death-warning-experts.html
Such a tragic situation.
What are the factors that would lead an adult concerned enough about health and fitness to be an active gym member, to reject advice of medically qualified persons with medical degrees that took years to obtain, and at great cost, in favour of a Chiropractor?
Is the mindset involved in such a decision a very widespread one? Does it represent average public perception?
Does it say anything about marketing?
In my experience the general public has no idea about the risks of chiropractic and just very simply think back or neck pain = need to see a chiropractor, much as a tooth ache = need to see a dentist to them. The chiro quacks have definitely marketed themselves well.
It certainly seems so…..
This is true. And they are well protected
This is going to be interesting
The General Chiropractic Council (GCC) has now published its initial response to coroner. See p.16 here for details:
https://www.gcc-uk.org/assets/council/CO250319-00_Council_Meeting_Pack_Mar-25.pdf
It has announced that ‘a small expert group’ has been convened comprising of leaders within the profession and others from outside the profession ‘to ensure that a broad perspective is obtained’. The group will meet on two or three occasions over the next few months, with the first meeting determining the focus of activity and commissioning of any reports or research. It is expected that progress will be reported to the June 2025 meeting of the GCC with final recommendations presented to the September meeting for approval. In its response (p.19) to the coroner, the Chief Executive and Registrar of the GCC declared that it was the Council’s ‘intention’ to carefully consider [your ]findings and ensure that any action that can be taken to prevent a further death or harm to patients in similar circumstances will be.
On p.21, the terms of reference of the review (Draft Review summary) state that the review will explore the technical and clinical nature of sensitive issues identified by the coroner, and in particular her request that we address ‘whether consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations have been undertaken’. It also states that ‘the review will need to consider the relationship between chiropractic treatment and arterial dissection’. It will consider the case for developing best practice guidance to be adopted by the profession, supporting the new Code of Professional Practice and its emphasis on a safety culture – potentially addressing areas such as high-risk patients, history taking and appropriate risk management.
Functions of the Group :
1. Respond to the issues raised by the coroner and determine whether any aspect of chiropractic care including diversified neck adjustments could potentially have caused or contributed to the patient’s death. Consider whether access to medical records would have changed the chiropractor’s approach to treatment (including not undertaking treatment) and/or referral decisions.
2. Consider whether to commission an expert to undertake an up-to-date review of the published research and evidence.
3. Make recommendations on the steps to be taken by the various stakeholders within the system of chiropractic, which is the GCC, professional associations, the Royal College of Chiropractors, and registrants.
4. Members of the reference group will contribute to the success of the review by:
• informing the approach and providing support for the review as a whole
• ensuring advice is available on the key issues
• advising on the quality, limitations and appropriate use of evidence and the quality of that evidence
• highlighting relevant practice and implementation issues relevant to the review signposting to relevant information
• ensuring a focus throughout on how the findings will be used and presented
• assisting in the development of GCC’s recommendations, ensuring they are realistic and based on a consensus
5. Members can expect the GCC to provide secretariat to the expert review group.
The members of the group are then named, complete with their bios.
The conclusion of the General Chiropractic Council’s expert group and the proposed actions for approval by Council has just been published. See pp 18-22 here: https://tinyurl.com/4wyb6psm
If approved, the actions will be undertaken (or committed to) and the GCC will write to the coroner accordingly. A final update on actions will become available at the December meeting of Council.
KEY ACTIONS
1. Material to help chiropractors understand the process for obtaining medical records (where they consider it appropriate), as well as reflect on the benefits and limitations of using (and not using) those records.
2. Material to help chiropractors and patients discuss rare, but catastrophic, events as part of shared decision making.
3. Material to help chiropractors (when taking a clinical history) identify patients who may be at a higher risk of a cervical arterial dissection stroke.
4. Material to assist chiropractors to identify and appropriately respond to a stroke in progress.
1. Material to help chiropractors understand the process for obtaining medical records (where they consider it appropriate), as well as reflect on the benefits and limitations of using (and not using) those records. The GCC will commission an article acknowledging that chiropractors will ordinarily consider medical history as a matter of course, but prompting registrants to consider if there are further approaches available to them: Does the registrant know how to obtain a medical report or imaging report from the NHS? Can they use the NHS app to access medical history? Are they reviewing medical history with the patient, or relying on completion of a form?
2. Material to help chiropractors and patients discuss rare, but catastrophic, events as part of shared decision making. The Royal College of Chiropractors (RCC) will produce a Chiropractic Practice Standard around risk and risk management. This will focus on a broad approach to risk and mitigation but will also look at some specific examples some of which would be relevant to this case. The RCC will produce a tool or tools to assist chiropractors and patients with shared decision making. The GCC will update the “patient portal” on the GCC website to include not only “what to expect” but also to identify reasonable expectations of the patient (to partake in shared decision making, to respect the clinical judgment of the chiropractor). This update will lean on materials produced by GOsC (General Osteopathic Council). The professional associations [trade bodies] will consider producing a “safety net” leaflet for their members for use when a patient has been identified as being at a higher risk of stroke following treatment.
3. Material to help chiropractors (when taking a clinical history) identify patients who may be at a higher risk of a cervical arterial dissection stroke. The group will publish a letter to registrants following this case. The letter will avoid questions of causality but, following the precautionary principle, will ask registrants to reflect on their knowledge of stroke. The letter will highlights reputable sources of information on the risk factors for stroke – specifically NICE guidance 128 (Stroke and transient ischaemic attack in over 16s: diagnosis and initial management) and the Stroke association website: https://www.stroke.org.uk/professionals. The letter will address the areas of poor understanding and lack of evidence identified by the group, namely: some types of stroke mimic neck pain and headache and can therefore bring patients to seeking care; symptoms of a stroke in progress can appear to improve; there is a lack of evidence of the risk of stroke in individuals with connective tissue disorders.
4. Material to assist chiropractors to identify and appropriately respond to a stroke in progress. The GCC will (as part of 2025-26 CPD focus on Safety and Quality within Principle B of the Code of Professional Practice) produce newsletter articles prompting registrants to consider: Their own knowledge in recognising and first aid of a stroke in progress – including FAST and the importance of calling 999. Identifying which hospitals local to them have an Integrated Stroke Delivery Network or similar dedicated stroke pathway. The RCC (in conjunction with LSBU – London South Bank University) is updating the emergency referral form (which would be used in case of a stroke or other emergency). All parties will promote the updated form to their constituents. The GCC registrar will write to the Royal College of GPs and Royal College of Emergency Medicine highlighting his expectation that a referral from a chiropractor be given appropriate consideration. The group will seek to persuade the major clinic management systems to develop the emergency referral form as a standard feature.
5. A response to the coroner’s letter, (agreed by GCC Council) which explains the group’s approach and agreed outputs. This fifth output (a response to the coroner) will be sent to the coroner once the registrar is satisfied by the progress made. This will be a letter outlining the process, progress and sharing materials as appropriate. The registrar will also invite the RCC and professional associations to contribute details of any activities that they may have independently carried out in response to the case.
I had TMJ swallowing choking issues after chiropractic adjustment. After 1year of investigation GCC decided its due to anxiety. It’s inhuman how they protect chiropractors.
hear, hear!