|If Lana Dale Lewis' fatal stroke was caused by a chiropractic neck manipulation, it will be the first time in medical history a patient's left neck artery has been injured by treatment on the opposite side, an inquest has heard.Paul Carey, an expert witness and president of the Canadian Chiropractic Protective Association — the profession's insurer — testified yesterday that the left vertebral artery in the neck cannot be injured by adjustments on the right side.A key theory the coroner's jury is considering is that the 45-year-old woman's left vertebral artery was injured as a result of a neck manipulation by chiropractor Philip Emanuele. The Etobicoke chiropractor only treated her right upper neck, never her left, according to his testimony and records of her treatments.Tim Danson, lawyer for the Canadian Memorial Chiropractic College and the Canadian Chiropractic Association, asked Carey: "Would this be the first case in the world where a right-sided neck adjustment produced a left vertebral artery injury?""Yes it would," Carey replied.Lewis was admitted to Queensway General Hospital with a stroke six days after her last visit to Emanuele on Aug. 26, 1996. She died of a second stroke on Sept. 12. The inquest is examining whether her death was as a result of that neck adjustment or her other medical problems.When you add all the risk factors Lewis had, such as high blood pressure and a build-up of plaque in her arteries, chiropractors are acting responsibly by taking the position that neck adjustments had no connection with her death, said Carey, who is also president of the World Federation of Chiropractic.Carey testified that reports by neurologists "exaggerating" the danger of strokes caused by chiropractic treatments have scared away so many patients that some practitioners have been forced to leave the profession. Others chiropractors report they are losing from 15 to 30 per cent of their incomes, Carey testified. The impact has cost Canada's 6,000 chiropractors an estimated $100 million in the last 18 months, he said."There is a tremendous amount of anger and hurt out there" about reports that have put the number of strokes as high as one in 5,000 treatments, he said. The real risk is, at its worst, one in a million adjustments, likely lower, he said.Chiropractic is generally considered a very conservative treatment, he said. "It would be hard to find any health procedure that has a better safety record," he said, adding, "I think that it's safer than taking an Aspirin."The Canadian Chiropractic Protective Association emphasizes and re-emphasizes to its members that they must obtain informed consent to treatment from patients, preferably in written form, Carey said."Written, informed consent, we believe, is being done somewhere between 75 and 80 per cent" of the association's members, Carey said. The inquest continues.