Testimony of Susan Hoffman, widow of John Hoffman

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

My husband John Hoffman was an active and healthy 39 years old man. He was the type of guy who would be willing to try any type of sport or activity and put 100% in to doing it the best he could. John also suffered from chronic lower back pain. Since he was a carpenter by trade and extremely active in sports having this pain seemed like it should be expected.

In late March, early April of 2004 John came across an ad in our local weekly newspaper that claimed “New Breakthrough” treatment for chronic lower back pain and all you had to do was call the toll free number for information. When John called the number a recording asked you to provide your name and address so the information and study findings could be sent to you in the mail. In less then a week from the time of that call we were being inundated with literature and special offers from a chiropractor’s office. We began receiving letters and flyers from this chiropractor as much as 3 to 4 times a week. So on May 5, 2004 John had his first appointment with Timothy Young. John’s treatment started with x-rays taken by the chiropractor. The film was then displayed and the alleged “subluxation” was diagnosed and a treatment plan of 2-3 visits per week for the next 12 weeks was prescribed. John was told that if this treatment plan was followed his lower back pain would be gone forever.

On the night of August 5th I came home a little late from work. I hadn’t talked to John all day but that was the norm for us. We’d been together for 21 years and married for over 17 of them so not to talking during our work day wasn’t unusual unless we needed something. When I opened the front door to our home that night I clearly heard a dragging sound. My first thought was that John must be moving something. I came into the house, put down my bags and turned to go down the stairs to the family room to let John know I was home. As I did I found John sitting upright on the landing conscious but disoriented. When I asked him what happened all he could say is “I don’t know” in a slurred voice. I asked him if he needed and ambulance and again all he said was “I don’t know”. I ran to the kitchen and grabbed the phone and dialed 911. As I spoke to the dispatcher I went to the top of the stairs so I could see John and noticed that the front of his shorts were wet from losing control of his bladder. He looked so scared and confused. As soon as I hung up with 911 I called my neighbor Vivian and asked that she come over immediately. I left John briefly to go open the front door and when I returned to the stairs with my neighbor I noticed that the left side of Johns face had begun to droop. Vivian noticed this too and sat down next to John and asked him what was wrong. Again his reply was “I don’t know”. Then she took his right hand and asked him if he could squeeze it and he did. Then she took his left hand and asked him to squeeze it and nothing happened. At that point Vivian and I carried John up the stairs and while I held him up she grabbed a chair for us to sit him in. As we sat him down the ambulance crew arrived and began examining him and asking him questions. All of which he answered with a slurred “I don’t know”. While they were loading John on the stretcher one of the EMT’s asked me to walk him through everything including taking him down to the family room where we found the TV on. Then we came up the stairs and I showed him where I found John and what position he was in.

By the time I returned up stairs the first ambulance crew had loaded John into the ambulance and were pulling away. My neighbor had told them that we would be following behind.

After arriving at the Emergency Room at Shady Grove Hospital I was told that they were running some tests. When the results of the C.A.T. scan were noted, I was asked if John had recently been a car accident or received a head injury. Without hesitation my answer to both questions was no. I was then informed that it appeared that he had suffered a stroke and treatment was dependant on determining the time the stroke had occurred. Since I had gotten home late I started calling neighbors to see if any of them had seen John when he got home from work and if they did had he acted any differently. Two neighbors had seen him after he got home and had talked to him, none noticed him acting differently but no one knew the exact time they saw him. So then I tried logical deduction from what I knew of Johns schedule and what I had observed when I got home. First, John got off work usually at 5:00pm. In traffic and without any stops that would put him home around 5:45. Then, going by observation, John had changed out of his work clothes into shorts and a tee shirt. On the tee shirt were smudges of clay dirt which meant that John had been outside working on his garden landscape as he had been doing on previous evenings. I also noticed a dirty pan on the stove which meant that he had cooked and ate dinner. And last was an empty cup sitting on the coffee table in front of the TV in the family room that the EMT had brought to my attention and asked what had been in it. It was an orange liquid that smelled like peaches so I knew that he had also blended a batch of Fuzzy Navels.

It was during this time that someone from admissions came into the room and asked for John’s insurance card. I had been given Johns wallet when I arrived so I pulled it out of my purse, opened it and when I went to pull out the card I found the Chiropractors appointment card. The card said that he had had an appointment that day at 5:00pm. I was so excited to find this card because it meant I was closer to determining the time of John’s stroke so I pulled it out and showed the doctor. The doctors reaction and response to this information is something I will always remember. His exact words to me were, “your husband was seeing a chiropractor?” I said yes so this means we’ve narrowed down the time and as he began shaking his head in disbelief he said “Everyone knows you never let them near your neck”, and he left the room.

For the next few days John struggled to be normal and would become agitated and frustrated when even the simplest of tasks like being able to tell someone what he was feeling couldn’t be done. The only words John could say were “No” and “I don’t know”. I was told by the speech therapist that this was called reflex speech. In Johns mind he knew what he wanted to say but when he tried to speak only reflex words no and I don’t know would come out. It was after one of these days when John became very agitated and had stopped cooperating with the Occupational Therapists that the doctors came to me and told me that I needed to sit down and tell John what has happened to him and what was needed to help him get better. Everyone left the room and I took Johns hand. From the way he had been reacting to visitors and situations it was clear that he was fully aware and could comprehend what was going on. I started the conversation by going over the signals to let me know that he understood. Squeeze my hand once for yes and twice for no. Once I made sure we were on track I told him that he had had a stroke and that he was at Shady Grove. I asked if he understood and he squeezed once. I told him that he needed to make sure he did everything the doctors asked him to even if he didn’t want to. I told him he was going to be sent to the rehabilitation center next door and I needed him to work as hard as I knew he could. I asked if he would do that, he said “I don’t know”. I asked “do you think you can do this” he squeezed my hand twice for no. I knew at that point John was already feeling defeated. So I told him that the stroke wasn’t the result of him being in bad health or anything that he did. They believed the stroke was caused by the chiropractor. As soon as I said that John’s eyes got really big, he leaned forward and started squeezing my hand so hard it was painful. Then he said to me in a slurred voice “I will survive”. After that John agreed he would work as hard as he possibly could to get himself better.

On August 11, 2004 my husband of 17 years passed away at the age of 39. On October 16, 2004 the Maryland State Medical Examiners Office in Baltimore Maryland released the final death certificate with the following classification;

Manner of Death: ACCIDENT
Due to: CERVICAL MANIPULATION

After John’s death I was at a loss. How could this have happened? Why didn’t the chiropractor warn us? Why haven’t I heard more about this before now? All of my questions led me to the internet.

What I found through my research is that John’s sudden and premature death was not an isolated incident. I’ve learned that these cases occur dozens if not hundreds of times each year in our country. Chiropractors claim that the incidence rate is only one in a million, yet concerned medical doctors have stated that the incidence rate could be as high as one in every 5,000 neck manipulations. Ultimately, for me and all the other victims I’ve associated myself with, finding out the exact rate of occurrence isn’t as important as getting the word out to the public that this CAN OCCUR, it DOES OCCUR and being informed, educated on the risks and consenting to treatment may prevent others from suffering similar fates.

Reading all the information that is out there and available if you really look is what also led me to other victims. Finding these victims and hearing their stories is what motivated me and other victims of chiropractic strokes to form a non-profit organization named V.O.I.C.E.S. – Victims Of Irresponsible Chiropractic Education and Standards. Our goal is to educate the public and lobby to get informed consent laws passed and to ensure every person is given the right to decide. In an effort to accomplish our goal we have advertised on billboards, buses, in newspapers, at bus stops and tops of taxis across the Southeastern U.S.

Everyday, I am amazed and sickened at the number of people who contact me who have been injured in some way by what they thought was a simple safe chiropractic treatment. I recently met Dora a 23 year old woman from Kentucky who suffered a stroke 3 weeks after her neck manipulation. Her test results after being admitted to the hospital showed 8 separate tears in her vertebral artery consistent with pinching by the spine. She’s now left with severe neurological disorders and unable to hold either of her 2 small children.

And then there was Kim, a 32 year old wife and mother of 3 young children who went to a chiropractor because she was suffering from sinus headaches. I say was because Kim suffered a stroke and died within days of visiting her chiropractor.

Unfortunately, there are so many more victims and unbelievably heartbreaking stories. In my communications with these victims they all have said the same thing. “I didn’t know this could happen” – “I (he/she) was never told there was a risk by the chiropractor” – “I thought I was doing something healthy for myself”. So after suffering their illnesses and/or losses all of these uninformed people are also struggling with guilt that they somehow should have known this could happen, but the reality is, they should have been informed. It is the obligation of all health practitioners to tell their patients of the risks no matter how large or small. It is the right of every patient to be told of the risks and give their consent to move forward or opt to walk away. In addition, something that could have helped and still can is for patients to be sent home with a Discharge Summary after treatment. A simple informational sheet listing the signs of stroke or adverse reactions along with instructions on what to do in the event you begin to show symptoms could prevent many unfortunate outcomes. A Discharge Summary given to chiropractic patients has the potential to save so many people from suffering needless injuries that can be SERIOUS, PERMANENT, OR FATAL.

There’s not a day that goes by that I don’t think about John and what our future was supposed to be. There’s also many days when I get so sad thinking about the hell he must have lived for 6 days. I think about this vibrant and active man who loved to laugh and joke around being fully aware of his surroundings yet living inside a body that’s no longer functioning like it should. Trying to communicate to the doctors, trying to tell them what he’s feeling, trying to hug his sister, or even trying to tell me he loves me, and he’s unable. Then comes the anger and the “what if’s”. What would have happened if John had been told about the risk of stroke? If he started to feel a little strange would he have called for help? If so, would the doctors have known exactly when the stroke had occurred and been able to treat him? Would John be alive today if he had been told by the chiropractor that there was a risk of stroke and consented to treatment? These questions make me angry because I believe the answer to all of these questions is a resounding YES. But the chiropractor never told him and John is no longer here for me to ask.

It astounds me to think that the chiropractic community would not want to do what’s best for their patients. They are supposed to be healthcare providers. Why wouldn’t they want to protect their patient’s health especially when there’s risk of serious and permanent injuries? By informing their patients, obtaining their consent, and then providing a simple piece of paper advising them on what to look for and what to do can only be a win/win situation for all.

During John’s first visit with the chiropractor he was guaranteed the lower back pain would be gone forever. Johns forever happened August 11, 2004. While it may be too late for John, it’s not too late to stop others from unknowingly risking their lives.

Additional Testimonies:

• Testimony of Michael McCormick
• Testimony of Janet Levy
• Testimony of Christa Heck