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Malpractice defense: Chiropractic adjustment allegedly caused Bell’s Palsy

Posted Aug 13 2013 1:27pm

I’m the former chairman of the board of Advanced Practice Strategies (APS) and I always find their malpractice defense cases to be fascinating.

Illustrated Verdict
by APS

APS’ Demonstrative Evidence Group shares case examples from our archives to show how a visual strategy can support the defense effort. We hope that it is of value in your practice as you develop your defense strategies on behalf of health care providers. Please feel free to forward it to colleagues or clients.About Us
APS is a leading provider of demonstrative evidence for the defense of medical malpractice claims. Our team of medical illustrators consults with defense teams to educate the lay jury audience about the complexities of medical care. We do this by developing a visual strategy with expert witnesses including high-quality case-specific medical illustrations, x-ray enhancements, and multimedia presentations. APS receives judgment for the defense in over 94% of the cases we participate in, as compared to the national average of 73%. Additionally insurers who supply us with their trial list enjoy a win rate of up to 97%.
To learn more, e-mail us or call 877.APS.4500.
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I.V. Library
Click to view other editions:

Pregnancy and Delivery:
Fetal Assessment
2009v1
Shoulder Dystocia 2009v3
MVA Leads to Fetal Demise 2010v4
Fetal Descent Stalled 2010v5
Shoulder Dystocia / Erb’s 2011v4
Fetal Tracings / Hypoxic Injury? 2013v1

Heart Coronary Artery Disease 2009v5
CAD / Recurrent MI 2010v1
Aortic Valve Replacement 2011v1

Lungs Stroke After Lung Surgery 2009v2
PE / Infection 2010v3
PE Following Roux En Y 2012v1
Intubation / Macklin Effect 2012v4

Female Pelvis Hysterectomy / Fistula 2011v9
Hysterectomy / Ureter Injury 2010v2
Hysterectomy / Kinked Ureter 2010v8
Diag Lap / Bowel Injury 2012v3
Cervical Cancer 2013v3

Male Pelvis Bladder Cancer 2013v2

Digestive System Gastric Bypass 2009v6
Recurrent Hiatal Hernia 2009v8
Right Colectomy / Leak 2010v7
Gastric Bypass / Volvulus 2011v2
Nissen Fundoplication 2011v3

Abdomen Spleen Injury and Bleed 2009v4
Bleed Following Lithotripsy 2012v2
Lap Cholecystectomy 2012v5

Orthopedic Partial Hip Replacement 2010v6

Vasculature tPA Infusion 2009v7

Head and Neck Bell’s Palsy 2013v4

Judgment for the Defense
Chiropractic Adjustment Allegedly Caused Bell’s PalsyA 42-year-old man was in relatively good health until December 2000, when he slipped on a step and developed lower back strain. He was seen by a chiropractor who performed a neck manipulation (rapid rotation of neck) . During the maneuver, he felt a “pop” sensation and developed pain on the left side of his head. He saw the chiropractor again the following day when the chiropractor repeated the maneuver. His pain worsened within thirty minutes and left-sided facial palsy along with left hand weakness and tingling developed. He went to the ER and was treated with medication. Initially, the palsy was severe, but then started to improve by Feb of 2001. He had both MRIs * and MRAs * (pictures of blood vessels inside the body) of the brain which were all said to be normal. He also had an MRI of his cervical spine * that showed left-sided C5/6 disc and osteophyte impingement on C6 left nerve root. In 2002, he underwent a surgical fusion of C5/6 and discectomy, which resulted in significant improvement of his left arm. However, he continued to have issues with his lower back.

PLAINTIFF’S CLAIM:

Plaintiff claimed that the chiropractic manipulation of his neck caused Bell’s palsy.

DEFENSE’S ARGUMENT:

The defense experts believed and set out to prove that there was no possible relationship between an adjustment of the cervical spine and Bell’s palsy. The defense experts helped the jury to understand that anatomically, this does not make sense because the facial nerve enters directly into the skull, so it would not be affected by manipulation.

VISUAL STRATEGY:

Collaborating with the defense attorney and experts, APS’ Demonstrative Evidence Group created a visual strategy that helped explain that the defendant’s actions were within the standard of care.
We created illustrations that helped demonstrate the path of the facial nerve . Specifically where it enters into the skull and what portions of it are within the skull .
The next diagram demonstrated how Bell’s palsy appears with the distribution of the facial nerve .
The fourth diagram was normal anatomy of the cervical spine , which was used to demonstrate a healthy spine.
The fifth diagram illustrated the spinal issues that the plaintiff had at C5/6 based on a description of the MRI reports in July 2001.
Then another diagram was created from MRI reports from January 2007 to show the extent of his disease and the surgical fusion he had done on his cervical spine in 2002.
The seventh diagram was normal anatomy of the lumbar spine (lower back) .
The next diagram helped to demonstrate the lumbar spinal issues he presented with in January 2007 .
The final diagram was used to explain some of the issues that the plaintiff experienced throughout the years , which were not related to the original chiropractic manipulation of his neck.
This series of visuals helped the defense successfully convey the following key points to the jury:

  • It was impossible for the facial nerve to have been injured with a neck manipulation based on its anatomical location in the skull and the path to the face.
  • The plaintiff’s symptoms of left arm weakness and numbness that developed at the same time of the palsy were attributed to the cervical spine issues of the C5/6 osteophytes and disc issues.
  • The plaintiff had a history of back and spine problems that were all attributed to spinal issues and did not have any relationship with the original chiropractic manipulation done in 2000.

RESULT The arbitrator found in favor of the defense. 

“The jury returned a defense verdict on Wednesday after two hours of deliberations. Many thanks for all your help!”

- Attorney Bernard Guekguezian, Esq., Adler, Cohen, Harvey, Wakeman and Guekguezian LLP, Boston, MA

*Films are examples and not case specific.


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