As there is malpractice insurance for doctors of medicine, malpractice insurance carriers also serve chiropractors.
Chiropractic manipulation, include neck manipulation, is generally safe for most patients. Chiropractic neck injuries are rare. Chiropractors are careful about treating patients with certain issues. In particular, strokes may be caused by VAD, or Vertebral Artery Dissection, which is quite rare. While VADs can be said to be “’associated’ with cervical manipulation”, it can occur from coughing, visiting the hairdresser, archery, and rotating the head while driving. Rotation or extension of any kind of the cervical spine could trigger this underlying VAD condition. Yet, although over 90% of chiropractors use manipulation, VAD only accounts for “1 out of 3 million manipulations”. Therefore, until “identification of ‘high risk’ populations improves”, chiropractors should make sure to provide all patients with “informed consent” about any potential risks. Chiropractic adjustments are generally low-risk procedures, and “a causative relationship between chiropractic manipulation and stroke is unlikely”. The reason for the association made between chiropractic manipulation and stroke is related to the fact that people choose to seek relief of stroke-related symptoms with chiropractic care. Chiropractors need to check patient history for physical trauma, drugs/medications, connective tissue diseases, nervous system issues, or cardiovascular problems, and make sure that any patients with sudden or new headaches, neck pain, or face pain are examined closely. Any patient suspected of having a stroke should seek emergency medical care, and the chiropractor should not perform the manipulation. The signs of stroke include the “5 D’s and the 3 N’s”: diplopia (double vision), dizziness, drop attacks (sudden weakness), dysarthria (trouble speaking), dysphagia (difficulty with swallowing), ataxia of gait (problems with walking), nausea, numbness, and nystagmus (“involuntary rapid eye movements”).1
Chiropractic Malpractice Insurance
A chiropractor risks, just by treating patients, getting sued for malpractice. There are two kinds of chiropractor malpractice: failure of the doctor to diagnose medical conditions that need immediate care and “damage from manipulation of body parts that have been weakened by disease or previous trauma”.2 Malpractice insurance is extremely expensive for medical doctors, but much less so for chiropractors. Malpractice rates have remained steady for chiropractors and “the number of malpractice cases has declined slightly” in recent years, according to the president of NCMIC Chiropractic Solutions. This does not mean that chiropractors are safe from lawsuits, however, even though there are fewer “frivolous cases”. In general, “failure to diagnose, failure to refer, disc herniation, (and) other miscellaneous complaints, such as burns” are the “same broad claims” used in lawsuits. Informed consent is crucial. Despite publicity about neck stroke, or CVA, and spinal manipulation, “there has been no increase in the numbers of CVA cases” nor any causative relationship between CVA and manipulation.3 NCMIC not only offers malpractice insurance, but it provides practitioners with a Risk Management Library that can help chiropractors “avoid a claim or board complaint” by examining case studies, common mistakes in documentation, staff practices, and more.4 Chiropractors need to “document, document, document,…stay on the cutting edge,…(and) focus on the doctor-patient relationship”.5 According to Keith Overland, DC, “neck manipulation is associated with many fewer stroke deaths than other common medical treatments for neck pain”, such as NSAIDs, narcotic medications, and spinal surgery. Chiropractic care is often a safer treatment option.6
3, 5 https://www.acatoday.org/content_css.cfm?CID=1967
Find out more about chiropractic and stroke.