Christa Heck, Chiropractic Stroke Awareness Organization

Testimony Submission, Declaratory Ruling – Chiropractic Informed Consent

Prepared for Connecticut State Board of Chiropractic Examiners Public Hearing

January 5-6, 2010

Issue: Whether to require chiropractors to warn patients about a possible risk of stroke from neck manipulation

In November 2003, my life changed forever. I nearly lost my life to two brainstem strokes that occurred just after undergoing a chiropractic upper neck manipulation.  Minutes after leaving the chiropractor’s office, I felt nauseated and dizzy.  I quickly pulled my SUV into the parking lot of a local convenience center.  As I shifted into park, I suffered a full-blown stroke.  At that time, I had no idea what was happening, but it felt dismal and I did not believe I would survive it.  No longer able to control my body, I slumped over the center console, my head resting on the passenger seat.  Everything was spinning and I was paralyzed.  I lay there, unable to move or focus, believing I was going to die.  I thought of my daughter, my stepdaughters, my husband and my parents.  I wondered how they would cope with my death. I felt badly that they would have to experience the loss of a loved one.  I would find out later that I had suffered a vertebral dissection, resulting in clots that shot up into my brain causing two strokes.  I would also learn later that this is a known risk factor of chiropractic neck adjustments.

Prior to that moment, November 14th was a day like any other.  Returning home from work, I stopped at my chiropractor’s office for a quick adjustment like I had for many years.  I was a 39 year-old, healthy, fit, active woman, successful in my profession and in managing a large family of 6.  I had used chiropractic for nearly 20 years as a means of health maintenance, and to relieve minor aches and pains in my shoulders, back and neck.  I believed chiropractic was an overall healthy and positive thing to do for my body and trusted that it was a safe healthcare service.  Never, during all those years of chiropractic treatment, was I advised by my treating chiropractors of any stroke risk associated with upper cervical manipulations. In fact, as my symptoms diminished somewhat in the parking lot of the convenience center, I theorized that I may be suffering from an inner ear infection, which caused the intense vertigo leading to the other symptoms I experienced.  Since I had never been informed of the stroke risk associated with upper cervical manipulation, and I was young and healthy, I did not know that I had just survived a major stroke.  After this event, I went home and directly to bed to rest.  The next morning I awoke to find my right side numb, my left eye sagging, the right side of my face drooping and my speech was slurred and unintelligible.

At that time, I sought medical help.  After a myriad of brain scans, I was diagnosed by neurologists at a metropolitan medical center as having a 4.5 cm dissection (or tear) in my vertebral artery.  This dissection caused bleeding within the artery, which formed a thrombus (similar to a scab on a wound).  The thrombus broke into smaller pieces (or emboli) that shot up into the pathways of my brain, blocking the blood flow.  Essentially, parts of my brain were destroyed…permanently.  I was utterly shocked.  Seeing my dismay, one of my treating neurologists said, “We’ve known about this for years”.  Barely able to speak due to severely slurred speech I asked, “Who has known?” He replied, “The neurological community, other physicians…chiropractors”.  I asked why chiropractic patients are not aware of this risk and I am still waiting for that answer, which brings me here today.

The doctors told me I was lucky to have survived.  I am lucky to have survived considering the horrible adverse outcomes experienced by others who have suffered from chiropractic induced strokes. Quite frankly, it is a miracle and a blessing that I lived and am not paralyzed.  I hoped and prayed that all would be as before, that I had inexplicably made a full recovery from an often debilitating or deadly stroke.  At the time of my stroke, I was the sole financial provider for my family; my husband was completely disabled and we had four young children.   I was successful in my career as a pharmaceutical representative.  In fact, I was in the top tier in market growth within my company, both regionally and nationally.  My future looked bright and I had just purchased a new home (one month prior to suffering my stroke); a fixer-upper that I was in the process of renovating.  My company selected me to participate in the management training program.  I assisted my District Manager in interviewing all new representatives, provided training and mentoring to new representatives, as well as existing representatives who were experiencing difficulties within their respective territories.  I prepared comprehensive reports and presentations for national sales meetings, in addition to maintaining top-quality service, and consistently increasing product share, within my own territory. In order to achieve this success, I had worked very hard to understand and disseminate detailed information from scientific studies on the efficacy, indications, contraindications and possible side effects of my product, as well as the extensive information on the clinical trials and mechanism of action as summarized in the FDA approved product insert pamphlet.  Additionally, I possessed comprehensive knowledge of all competing products and insurance reimbursement for my product and competitors’ products, specific to each physician’s practice.  I had created a call routing plan that ensured optimal timing of my office calls and efficient time management, in order to effectively service approximately 200 physicians.  Essentially, my experience, keen memory, intellectual and communication abilities allowed me to successfully fulfill my many familial and career obligations.

After I suffered my strokes, I returned to work as quickly as possible for fear of losing my job, being unable to support myself and my family and losing my home. Still suffering from right-sided numbness, I struggled with balance and coordination.  I changed my hairstyle in an attempt to camouflage my facial droop and used make-up to reduce the obviousness of my sagging eye, also known as Horner’s Syndrome.  Still suffering from slurred speech, I kept communication to a minimum.  In addition to the residual physical symptoms, I realized that my cognition had dramatically declined.  I felt a sense of ‘otherness’ from my prior self; as if the ‘real me’ had died and an entirely different person had overtaken me.  I experienced intense fatigue, often falling asleep in the parking areas of the physician offices I was scheduled to visit.  When I would awaken, I could not remember where I was or what client I had planned to meet.  Daily, I became lost while driving, despite having driven the routes many times prior to the stroke.  I was unable to maintain in my mind, my current location, the intended destination and the route to get there.  Frequently, I would pull off the road, fold over the steering wheel and sob uncontrollably.  I felt overwhelmed, incompetent, confused, anxious and depressed, as well as irritable, exhausted and impatient; feelings and behaviors that were foreign to me prior to suffering the stroke.

Later I would hear terms like ‘permanent brain damage’, ‘severe short-term memory deficit’, ‘chronic neurological fatigue’, ‘severe depression and anxiety’ and ‘attention deficit disorder’, but at that time I was just dazed, confused and crumbling. There were many people relying on me, expecting me to be the woman I was before the stroke and, deep inside, I knew that ‘she’ was dead.  Each and every day I cried privately, mourning the loss of former self, unsure of what to do…how I would function even minimally.  I was riddled with fear; fear of dying and fear that something horrible may happen to my children.  After all, I had suffered a near-deadly consequence from a health care service that I believed was healthy and safe.  My cognitive dysfunction and physical disabilities greatly adversely affected my job performance.  My market share percentage plummeted, as well as my ranking.  Eventually, it became clear that I was no longer able to perform my job responsibilities.  The career success, which had taken more than half my life to achieve, was over; along with it my sense of identity, self-esteem and hope.  I felt completely and utterly defeated.

It has been nearly 7 years since my stroke and the loss I have experienced is very difficult to effectively convey. Simply put, I am no longer the woman I was for the first 39 years of my life and, each and every day, I am forced to face that fact.  I have worked very hard through cognitive rehabilitation to compensate for the many deficits that remain.  I struggle to cope with the loss of my former self and am striving to accept the person I am now.  Needless to say, it has been an arduous journey.  Ultimately, I found that one of the only avenues of solace is in connecting with others who have also endured chiropractic induced strokes and the ensuing destructive consequences, as well as with family members coping with the heart-breaking loss of the stroke victims who did not survive.  For this reason, I founded The Chiropractic Stroke Awareness Organization, which offers a confidential online support group to stroke victims and family members from across the United States, and other countries as well.

Within the virtual walls of this sanctuary, and due to my own experience, I have witnessed firsthand the devastating aftermath of strokes induced by neck manipulations.  If we were lucky enough to have survived strokes, we live on as ‘broken’ people.   Some victims suffer complete or partial paralysis; which can result in ‘Locked-in Syndrome’.  The National Institute of Neurological Disorders and Stroke defines this syndrome as a, “…neurological disorder characterized by complete paralysis of voluntary muscles in all parts of the body except for those that control eye movement…Individuals with locked-in syndrome are conscious and can think and reason, but are unable to speak or move. The disorder leaves individuals completely mute and paralyzed. Communication may be possible with blinking eye movements…”¹  It has been described as the closest thing to be being buried alive.

Other victims may improve physically, but struggle with significant cognitive dysfunction or ‘Traumatic Brain Injury’ (TBI).  The National Institute of Neurological Disorders and Stroke defines Traumatic Brain Injury as, “…a form of acquired brain injury, [that] occurs when a sudden trauma causes damage to the brain….Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.   A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheaded, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.  A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.” ²  With regard to treatment and prognosis for TBI, the Institute notes, “Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury…Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support….Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the individual. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness). More serious head injuries may result in stupor, an unresponsive state, but one in which an individual can be aroused briefly by a strong stimulus, such as sharp pain; coma, a state in which an individual is totally unconscious, unresponsive, unaware, and unarousable; vegetative state, in which an individual is unconscious and unaware of his or her surroundings, but continues to have a sleep-wake cycle and periods of alertness; and a persistent vegetative state (PVS), in which an individual stays in a vegetative state for more than a month. ²

For the stroke victims who, through rehabilitation, are able to recover most physical function, many do not regain cognitive function.  This can be referred to as ‘The Unseen Injury’.  It is often permanent and life-altering.  “Individuals with a mild brain injury generally “look fine” physically, but often say they “feel different” and experience difficulties in thinking, behavior and emotions that prevent them from functioning day-to-day with the same success as before the injury….The difficulties may not be obvious initially, but become more apparent when the person returns to the demands of work, school or home…These difficulties can have a profound impact on the ability to function and the quality of life.  For example…Impaired memory…Slowed thinking…Difficulty organizing…Over sensitivity to noise and visual output…Confusion…Impulsivity…Difficulty with judgment and reasoning…Difficulty with new situations or change…Difficulty with language or words…Inflexibility of thought…Attention and concentration…Lack of initiation…” ³

Many survivors of stroke within our group suffer from permanent or chronic dizziness, vertigo and lack of balance and coordination (vestibular impairment), diminished ability to speak (i.e., slurred speech and/or stuttering) and swallow (without choking), chronic pain, headaches and fatigue, body temperature fluctuations, insomnia, hearing loss and visual disturbances, decreased, or loss of, smell, taste and appetite, psychological and emotional impairments such as, anxiety, depression, thoughts of suicide, irritability and restlessness, dis-inhibition and impulsiveness, extreme changes in emotion, loss of self-esteem and social ability.  Equally disturbing is the universal claim of all participants of our support group that they were not advised by the their treating chiropractors of the risk of stroke associated with neck manipulation; that they trusted that their chiropractor was held to the well-known, fundamental, health care policy of Informed Consent.  Currently, the omission of this vital health care axiom within the chiropractic arena results in patients undergoing chiropractic without ever knowing they are at risk of being permanently maimed or dying.  Our awareness of this issue and the need to address it as a public health safety concern is heightened because we have suffered strokes from upper neck manipulations.  Since there is no mandatory, standardized Informed Consent process for stroke risk from cervical manipulations, the patient is not protected from a potentially deadly outcome, or even aware of the stroke risk, and, therefore, may not report their adverse outcome, so there is currently no way to accurately quantify the risk.  Thus, chiropractic induced strokes are under-reported despite the risk being acknowledged. ⁴ We believe that all patients should have the right to consider risk versus benefit when undergoing any and all treatments.

I would just like to now share with you the horrific stories of just a few victims that are members of our organization.  In order to maintain the integrity and anonymity of our online support community of chiropractic stroke victims and their family members, I am including only a general and brief synopsis.  Please note that these people possess medical data supporting their diagnoses of arterial dissections and strokes, which occurred after undergoing chiropractic upper cervical manipulation.

Survivor ‘A’ was a healthy 29-year-old athlete and artist who sought chiropractic treatment for a headache.  After undergoing neck manipulation, she suffered two strokes and lapsed into a coma.  Initially, she suffered from Locked-in Syndrome and was hospitalized for months.  After two years of intense rehabilitation, she is ambulatory only via wheelchair, and with the use of a walker for only short periods of time.  She suffers from a significant facial droop, slurred speech and she must wear braces due to extreme limb contraction.  She is incapable of living independently.

Survivor ‘B’ was a 32- year old professional singer and dancer enjoying a successful career in theatre and television.  After an upper neck manipulation, she experienced nausea and vomiting, severe headache and left-sided numbness.  She had suffered a stroke.  She was hospitalized for six weeks; unable to walk for six months, unable to read for nine months and still today, many years later, suffers from vestibular issues and cognitive dysfunction.  Her career and life as she knew it ended that day.

Survivor ‘C’ was an active, fit, 52-year old male with an established career as executive manager of a major metropolitan retailer.  After a chiropractic adjustment, he suffered multiple strokes. No longer able to maintain his position or financially support his family, he suffers from unilateral deafness, vestibular and cognitive deficits, as well as chronic neurological fatigue and depression.  Also, he, as are most other stroke survivors, is plagued with fears of sudden death and shortened lifespan due to suffering strokes.

Survivor ‘D’ was a master’s trained professional in a successful career in academia, who sought chiropractic treatment for shoulder and neck soreness.  After an upper neck adjustment she suffered a stroke and Wallenberg’s Syndrome.  She was confined to a wheelchair, then walker for several months.  Years after her stroke, she still suffers from chronic vertigo and balance dysfunction, inability to swallow without risk of choking, slurred speech, body temperature abnormalities and visual disturbances.

Victim ‘A’ was a 25-year old male who visited a chiropractor for shoulder pain. The chiropractor performed many upper neck manipulations over the course of five months.  After the final cervical manipulation, he suffered a stroke minutes after leaving the chiropractor’s office, while pulled over in a parking lot.  He was rushed to the hospital, where he remained unconscious until he died a few days later, never able to speak to his family again.  He left behind his wife and infant son.

Victim ‘B’ was a 24-year old medical office administrator who consulted a chiropractor for sinus headaches. During her second visit, she suffered a stroke immediately after the chiropractor manipulated her neck. She died three days later, one day before her 25th birthday. The autopsy revealed that the upper neck manipulation had split the inside walls of her vertebral arteries, causing the walls to balloon and blood clots to form, blocking the blood supply to her brain.

Victim ‘C’ was an active, healthy 59-year old woman who utilized chiropractic care as a health maintenance tool.  Minutes after undergoing upper cervical manipulation, near the parking lot of the chiropractor’s office, she suffered a major stroke.  A few days later, she lapsed into a coma and died, leaving behind two young adult daughters.

For medical doctors, virtually all states recognize, either by statute or common law, the right to receive information about one’s medical condition, the treatment choices, the risks associated with the treatments, the possible outcomes and prognoses.  This is a mandatory, fundamental standard of practice for physicians, as well as other health care providers.  In fact, the American Medical Association incorporated the concept of Informed Consent in its Medical Code of Ethics, as part of the Patients Bill of Rights movement in 1972. 5 “It is mandated that this medical information must be in plain language and easily understood so the patient is able to make an “informed’ decision about his or her health care.  If the patient is competent to make decisions and receives this information, this is called ‘informed consent’.  If the injury or harm was a foreseeable complication or risk, but the possibility of its occurrence is not communicated to the patient in advance, there is a lack of Informed Consent.  A medical doctor who fails to obtain Informed Consent for non-emergency treatments may be charged with a civil and/or criminal offense.” ⁶

Faden and Beauchamp ⁷ state that the practice of Informed Consent “…began as a mandate by the federal government as a reaction to the large volume of medical malpractice cases from the 1920’s through the 1970’s.  In the early 1970’s, due to the symbiotic efforts of the Department of Health and Human Services (HHS), the Joint Commission of Accreditation of Hospitals (JCAH), the American Hospital Association (AHA) and the American Medical Association (AMA), the medical landscape in this country changed from paternalist, or authoritarian, to a ‘correlative’ one, where the patient became an active participant in his or her medical treatment. The Medical Malpractice Reform Act of 1975 called for mandatory Informed Consent.  State legislatures therefore began to include informed consent provisions in liability-limiting specifications…Twenty-five states enacted informed consent legislation from 1975 through 1977.  The replacement of the common-law path to informed consent by statute in so many states – 30 states by 1982 –reflects both the doctrine’s high social visibility and the political influence of physicians on state legislatures…” (p139).

In 1983, the President’s Commission for the Study of Ethical Problems and Medicine and Biomedical and Behavioral Research again addressed Informed Consent as its main issue, in the volume entitled, ‘Making Health Care Decisions; The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship’. ⁸ In 1997, The Advisory Commission on Consumer Protection and Quality in the Health Care Industry was appointed by President Clinton to ensure quality health care and value.  The Commission drafted a ‘consumer bill of rights’ where information disclosure was addressed, stating that “Consumers have the right to receive accurate, easily understood information in making informed health care decisions about their health plans, professionals and facilities.” ⁹ The Bill of Rights emphasizes the health care consumer’s right to fully participate in all decisions related to their health care and, specifically, defines informed consent.  The document states, “In order to ensure consumers’ right and ability to participate in treatment decisions, health care professionals should:  Provide patients with easily understood information and opportunity to decide among treatment options consistent with the informed consent process; specifically; discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all…discuss all risks, benefits, and consequences to treatment or non-treatment..” (p4).

According to The Journal of Chiropractic Medicine, the issue of informed consent was addressed in an article entitled, ‘Should the chiropractic profession embrace the doctrine of informed consent?” ¹⁰ This article ‘provides a narrative review of the literature focusing on the use of a health care informed consent process in the United States…[They] review the current positions of the World Medical Association, American Medical Association, American Chiropractic Association, Wisconsin and New Jersey State Courts, US Federal Government Office of Health Policy and Clinical Outcomes.” (p107). After reviewing the information, the article notes that “…the results suggested that the chiropractic patients were not provided an appropriate informed consent process because of the paternalistic concepts of the chiropractors.  The doctors determined that the safety of the routine discussion of major risk unnecessary…[which]…suggests that a patient’s autonomy and right to self-determination may be compromised when seeking chiropractic care.  Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.  (p109).

The article specifically addresses the state of Connecticut, stating that, “All health care providers in Connecticut should implement the use of the informed consent process to comply with the current case law, which protects and respects the rights of all individuals seeking medical treatment…The Connecticut consent issues are detailed in a legal digest, which attempts to explain the health care provider responsibilities in the “Constitution State”.  The article cites the legal digest, stating, “In the case of adults, Connecticut case law has established a common law right of bodily self determination entitled to respect and protection.  Health care providers have no common law right or to thrust unwanted medical care on a patient who, having been sufficiently informed of the consequences, competently and clearly declines that care.  As long as a patient is sufficiently informed of the consequences of her decision, is competent to make such a decision, and freely chooses to refuse treatment, the health care provider is required to respect her choice.” [p110]   The article concludes by stating that “…doctors of chiropractic are ethical health care providers but many are unaware of the value placed on the informed consent process by health care consumers.  A rational profession must consider the pursuit of cultural authority and improved patient safety as pragmatic strategies…” and that they “…recommend that the chiropractic profession in the United States comply with the Federal and State regulations and laws, which attempt to improve patient safety through the implementation of an informed consent process.” [p113].  It is imperative to note that the stroke risk of chiropractic neck manipulation is a dire potential risk that must be specifically and clearly stated in a written Informed Consent document, as well as discussed verbally with the patient before treatment.  Also, considering that strokes from upper cervical manipulation may occur hours or days after undergoing this practice, all chiropractic patients must have written Discharge Summaries, outlining signs and symptoms of stroke so they may seek medical care immediately.  This practice can save a patient’s life, and at the very least, can greatly improve the prognosis of recovery of functionality.

Informed Consent is a doctrine that is an important practice that has been embraced and incorporated into all areas of health care.  It is an essential communication tool between patient and provider, which promotes the formation of an effective, quality treatment plan, as well as the safety and well-being of the patient.  For example, recently my daughter and I contemplated whether she should receive the meningococcal vaccine.  She was about to begin her freshmen year at college and would be living in a dormitory, where she may be at higher risk of contracting meningitis.  Her physician provided us with an informational form from the U.S. Department of Health and Human Services.  It provides detailed information on the disease, as well as the vaccination, including the risks associated with the vaccination stating that the vaccination “…is capable of causing severe problems, such as severe allergic reactions…or death”.  Additionally, the sheet provided a listing of symptoms to look for that may indicate a serious adverse reaction, as well as emphasis on the need to seek medical care immediately.  Also, the form provides contact information to obtain further information and to formally report any adverse events experienced as a result of the vaccination. ¹¹ The prominent use of formal, standardized Informed Consent is mandatory practice in hospitals and medical centers.  Hartford Hospital’s Patients’ Bill of Rights states, “…You must be given all the information you need to make decisions about your healthcare.  No one else can make those decisions for you…It is no longer acceptable for doctors and others to hide facts from you…Doctors and other healthcare professionals may recommend a particular course of action, but you must be informed of all other options and be given the opportunity to carefully consider those options before proceeding.” ¹²  Furthermore, Informed Consent is also a mandatory practice within the physician’s office.  For example, when a patient is undergoing a sigmoidoscopy, which is “…a procedure performed to examine the inside of the colon, or large intestine.” ¹³  This Informed Consent form, requiring the signature of both patient and physician, also lists the possible risks associated with the procedure, including “…possible death”. ¹³

As a chiropractic induced stroke survivor and a facilitator of a support group for other stroke victims and family members, I have witnessed the destructive consequences that can occur from upper cervical manipulations and personally experienced these consequences.  In fact, this submission was made possible due to the concerted effort of some stroke survivor participants and their family members. If not for their unending, widespread assistance and support, I would not have been able to create this submission, as my cognitive dysfunction severely limits my abilities.  Honestly, it was a painful process, provoking many tears and much anxiety, as I struggled with writing and presenting this submission, while being fully aware that this was a task I excelled in prior to the stroke.  I sadly miss the abilities possessed by the woman I was and wish that I had known I was risking this consequence and more, from undergoing chiropractic neck manipulations.  It is my hope that, ultimately, no one else will have to go through what I, and so many others have; especially without ever knowing that these treatments were putting us in grave risk.  If I had known and I had received a written discharge summary, I would have recognized the signs and symptoms of stroke and would have sought emergent medical care.  This would have allowed for a very different outcome, that is, possibly a full recovery.

We have provided this information from recognized primary sources within the legal, health care and chiropractic arenas.  After careful review of the research, as well as my own personal experience and the detailed accounting of other patients of chiropractic who have suffered tragic outcomes from upper cervical manipulations, it is evident that many people are being horribly injured from neck manipulations, and the Informed Consent process is not consistently offered, specifically addressing the stroke risk, to patients of chiropractic care.  Additionally, the lack of the Informed Consent doctrine within chiropractic is completely contradictory to specific, comprehensive declarations and mandates by federal and state government regulatory agencies, including Connecticut’s ‘Legal Digest’, as well as those of all health care providers and medical institutions in the United States.  This Declaratory Ruling proceeding provides a vital opportunity for chiropractors to fully integrate their practices into the ethical and legal codes of conduct of medical doctors, hospitals and most other health care practitioners.  Most importantly, implementing an Informed Consent standard emphasizes patients’ rights to make decisions about their own health care, and may prevent irreparable and sometimes life-threatening outcomes. Mandatory Informed Consent policy within chiropractic practice would ensure open communication between patient and provider; allow chiropractic patients to have full knowledge of their diagnosis, treatment, alternative therapies and risks of treatment, which promotes a safer health care environment, as well as encouraging critical, early intervention for potentially life-threatening adverse outcomes. To fulfill this goal, it is imperative that all chiropractic patients receive a written Discharge Summary listing signs and symptoms of stroke, in order to recognize that they may be having a stroke so they may seek immediate medical care. This would make a monumental, positive difference in chiropractic patient outcomes.  For these reasons, all chiropractors should integrate a standardized Informed Consent process, clearly stating the stroke risk of upper cervical manipulations, as well as written Discharge Summaries delineating specific and comprehensive signs and symptoms of stroke, into their office practices.

Additional Testimonies:

• Testimony of Michael McCormick
• Testimony of Janet Levy
• Testimony of Susan Hoffman

CITATIONS:

1.  National Institute of Neurological Disorders and Stroke. “NINDS Locked-In Syndrome Information Page.” 2007. Office of Communications and Public Liaison. 20 Oct. 2009http://www.ninds.nih.gov/disorders/lockedinsyndrome/lockedinsyndrome.htm.

2.  National Institute of Neurological Disorders and Stroke. “NINDS Traumatic Brain Injury Information Page.” 2009. Office of Communications and Public Liaison. 20 Oct. 2009 http://www.ama-assn.org/ama/no-index/advocacy/8152.shtml.

6.  Encyclopedia of Everyday Law. “Informed Consent.” 2009. 16 Oct. 2008

http://www.enotes.com/everyday-law-encyclopedia/informed-consent

7.  Faden, Ruth R. and Beauchamp, Tom L. A History and Theory of Informed Consent. New York. 1986

8.  Report of a U.S Presidential Commission United States. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions – The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Volume One: Report. The Commission.1983.

9.  Report of a U.S. Presidential Commission United States. President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Consumer Bill of Rights and Responsibilities. Appendix A. The Commission.

10. Lehman, DC, MBA, DABCO, James J. and Conwell, DC, DABCO and Sherman, Paul R., DC. “Should the chiropractic profession embrace the doctrine of informed consent?”. Journal of  Chiropractic Medicine. 7 (2008): 107-114.

11. U.S. Department of Health and Human Services. Meningococcal Vaccine – What You Need To Know.  Washington. Government Printing Office, 2003.

12. Hartford Hospital. The Patient Bill of Rights: Your Right to Respect and Good Care.
Connecticut. 2008.

13. American Family Physician. “Informed Consent Form – Flexible Sigmoidoscopy,” Vol. 63, Number 7. 2009