Uncategorized October 21, 2016

Chiropractic Malpractice Insurance – Katie May Stroke Response

Hi, I’m Dr. Stu Hoffman, president of Chiro Secure, and we want to talk to you a little bit today about something that’s in the news right now. We’re dealing with a stroke conversation. Katie May, who was an actress and a model, almost a year ago had a fall during a photoshoot. She subsequently went to the emergency room, from what we understand, and later on decided to go seek treatment from a chiropractor. Afterwards, she wasn’t feeling so well, went to the emergency room, and later that day, she wound up dying. Well, what does that tell us?

We have to be able to respond to this news, and all of these segments that are out in the public right now, about the association between chiropractic and strokes. As many of you know, Chiro Secure has been on the leading edge of doing this research, and we have uncovered so many things to help our doctors, to not only defend them, but for the doctors to actually be able to educate their patients. Rather than being reactive, they can be constructive in instructing their patients.

My suggestion, to start off with, in responding to these allegations about the cause and effect of Katie May’s death is to not argue or debate whether or not the chiropractor actually caused this dissection, leading to stroke, which eventually she died from. That’s a losing argument. Just as the coroner probably doesn’t have enough evidence to determine that exact nature either. What we do want to ask is, what did the hospital find when she went there? What diagnostic tests were run that allowed them to send her home in the first place? Did they do any imaging? In fact, there’s a ton more questions that are out there, including from the coroner, when did this actual dissection occur? Was it before she even saw the chiropractor?

All of these are loose ends, but we want you to have enough information to be able to discuss this in a comfortable and calm and respectable and professional manner with each and every one of your patients that this comes up, or even in your community. With us today is Dr. Jerry [Clum 00:02:37], who is one of our experts and he is certainly an expert in this particular area. I want to actually welcome you, Dr. Clum, and ask you if you can help address this from a doctor’s perspective, on this particular situation.

Dr. Clum:

Thanks, Stu. I appreciate it, and I appreciate the opportunity to chat with you about this and perhaps put some perspective on this for our colleagues. First thing I would tell everybody is, take a deep breath and relax, and sit back and think about this for just a little bit, and not try, as Dr. Hoffman said, to come up with a defensive statement or anything of that nature. We need to approach this as a specific individual situation, and to manage it accordingly.

The problem for us right now is that we don’t know anything for a fact. The information that we have comes to us by way of news stories, of social media posts, things of that nature. As Dr. Hoffman said, we don’t know what hospitals were involved, what diagnostic testing was done, who the woman was seen by, anything of that nature. We don’t know the timing of everything that’s going on. Until the coroner’s report is widely available and we are given an opportunity to review that report, we’re not really going to have any specifics to be able to talk about relative to this case.

One of the important things, a couple important things that we need to keep in mind, is that it took the coroner’s office about nine months to generate their report. I’m not that familiar with how long it takes for a coroner’s report to come out, but to me, that seems a little bit excessive, and I’d wonder why that is. The second consideration is a comment from the coroner himself, saying that this was the first type of case of this nature he had ever seen in his career. I’m sure the gentleman’s very experienced, I’m sure he’s very capable, I’m not questioning his knowledge whatsoever, but this is a very nuanced area, and unless you’re familiar with the whole concept, unless you’re familiar with the literature behind it and the epidemiology associated with it, you could easily jump to conclusions that are wrong, and are very misleading.

I would suggest to you as a practictioner that you do several things. First is, I would refer back to the Chiro Secure informed consent packet. In that packet are write-ups of the key literature associated with this subject, that include the Cassidy study from 2008, the [Kosloff 00:05:22] study from 2015, and the Church study from 2016. All of these share in common the similar conclusion that there is no causal link between a cervical spine adjustment and the development of an arterial dissection and stroke. There clearly is a temporal link, and again, we come back to this whole question, this chicken and egg question, as to whether or not the person dissected. The dissection produces neck pain and headache. They seek care for the neck pain and headache, and the person goes on to stroke at a given point. The literature indicates that they go on to stroke at a rate equal to or greater than when they see a medical doctor versus seeing a chiropractor. We make the presumption that the medical doctor is not adjusting cervical spines, so if the incidence rate under medical care is higher than the incidence under chiropractic care, and the medical doctor doesn’t provide chiropractic care, then it’s logical to say that the chiropractic care was not involved in that.

Now, we can say that until the cows come home. This is a person who had a very high profile on social media. She was a very young woman, she was in the prime of her life, has a young child. It’s a very sympathetic story, it’s a very sad story. Don’t take anything away from that, for sure, and we sympathize with her family and offer our condolences to them for their loss. We’re very sorry to have to have had that happen in their life. The problem that we’re left with is dealing with the facts of this situation in the absence of the facts. Over the next few days to weeks, we’re going to get the copies of the coroner’s report, and then we’ll conduct a complete analysis of that, and be able to give you specifics on this case as you go forward.

In terms of managing how you would approach feedback from patients, first thing is, I wouldn’t be defensive. I wouldn’t minimize this. I would relate to it as a tragic outcome, about which we know very, very little, and even though the coroner may have arrived at a conclusion at this point, we don’t necessarily know if the facts support his conclusion or not, and we need to wait until we get those. You can assure your patients, as soon as those are available, you’re going to study them. You’re going to have them reviewed, and you’re going to be able to brief them on anything that’s learned out of this unfortunate situation. Whether the chiropractor was involved, whether the chiropractor was incidental to it, whether that if she’d gone to a Starbucks and wound up with the same problem. We don’t know that at this point, so we need to give it a little bit more time, let it mature out a little bit more, and again, no need to be defensive. Be factual, be sincere, be honest about the information. Use the data in the reports that Dr. Hoffman’s provided through Chiro Secure for you, and let us know if you’ve got any questions specifically that we can help with, and we’ll try and do our best to answer those questions.

Dr. Hoffman:

Thank you, Dr. Clum. I appreciate the words of wisdom, and especially in discussing how the doctors should relate, and including minimizing this, to their patients. It is one individual circumstance, it just happens to be a high-profile one that is getting air play. In two, three weeks, it’s going to be gone, and we have to remember that it’s still important for us as professionals to understand the data and the research that we have available to us so that we can educate our patients properly.

One of the things that we’ve been lecturing all over the country about is informed consent, because informed consent was designed to allow patients to have enough information about any given procedure to make informed choices. I believe that’s appropriate. One of the sidebars to an informed consent is that it actually does protect the doctor as well, and I can tell you that with all of the people that we’ve had working to create an informed consent as we have done, in a user-friendly way for both the doctor, and educational for the patient when it comes to this type of a situation. I think that you’ll be in great shape by implementing it if you haven’t already.

I really want to review one thing, because one of the things that we’ve talked about previously when it comes to this stroke issue is the basis of our argument. One of the things that we have said is that while the weakest form of scientific evidence, which is case studies, does establish an association between the chiropractic adjustment and stroke, that association is common to almost a hundred trivial movements that are part of everyday life, and we’ve done all the research to uncover this. Yet causation not only remains unproven, the inverse has been established. Biomechanical and epithemiological studies, which are known as the strongest form of scientific evidence, have disproven a direct causative relationship.

I want you all, as Dr. Clum said, to be calm and educated about this topic, and you’re going to get questions. I want you to be able to respond in an appropriate way, but being defensive is certainly not that. Get your information, discuss this with your patients as need be, and be able to move on. From Chiro Secure, in the next day to two days, we’re going to have an additional response to you, so stay tuned, whether it be to the Chiro Secure website or to our Facebook page, but stay tuned, because we’re going to have more information as we get and obtain more information.

If you want to learn more about this, you can get information about our show that we did on how to educate the public, including your patients, which we called Changing Public Perception. It’s all about the stroke issue. You can get the transcript for that or Dr. Clum’s insight into the stroke issue by emailing info@chirosecure.com. If you’re gonna email us and request that, including our informed consent packet, we’re happy to share it with any of you, whether you’re already insured with us or not. What we ask is when you email to us, that request, please include your name and your phone number, and the state that you’re located it. We’ll be happy to share any of this information with you.

As I said earlier, we’ll keep up on this on your behalf, because that’s what we do, and we will keep you informed, and any other additional information and/or communication tools that we have available, we’ll be sharing with you, and I want to thank Dr. Clum for participating on your behalf with us today. Anything that you need, Chiro Secure will be here to help and be part of the team along with you. Thank you.