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    Death in Saskatoon after chiropractic neck manipulation - Inquest into death of Laurie Jean Mathiason

    Copyright 1998 Micromedia Limited
    Canadian Business and Current Affairs
    Copyright 1998 Maclean Hunter Ltd.
    Maclean's (Toronto Edition)
    September 21, 1998
    SECTION: v.111(38) S 21'98 pg 70; ISSN: 0024-9262
    CBCA-ACC-NO: 4295520
    LENGTH: 1582 words
    HEADLINE: Lethal treatment: the death of a patient puts chiropractic on trial
    [Laurie Mathiason case in Saskatchewan]
    BYLINE: Nichols, Mark
       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 result, according to an autopsy
    report, of a 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.''
       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 fiance, 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 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,
    president of the Chiropractors' Association of Saskatchewan. ''But you
    have to see it in the perspective of the risks and benefits involved in
    any kind of 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.