Inquest to probe chiropractic link in death

Family of Lana Lewis believes neck manipulation killed 45-year-old
From Canadian Press
Toronto Star - May 4, 2002

A long-awaited inquest into the death of Lana Lewis, a woman who suffered two strokes following a neck manipulation by her chiropractor, is expected to begin Monday.

Lewis, 45, died in 1996, 17 days after receiving the adjustment by Toronto chiropractor Philip Emanuale as treatment for her migraine headaches.

Critics of the practice have warned that it can trigger strokes by damaging the lining of an artery supplying blood to the brain.

The inquest is expected to explore the relationship between the chiropractic neck manipulation Lewis received and the stroke that killed her, said Dr. Bonita Porter, deputy chief coroner.

The probe is also sure to bring to light the often antagonistic relationship between chiropractors and the traditional medical community.

Amani Oakley, the lawyer representing the Lewis family, said she hopes the inquest will help educate people about the potential risks.

"Most people, if properly informed, would not choose to get rid of a migraine at the risk of a stroke."

Lewis's family has long maintained that damage found in the woman's left artery during a post-mortem examination was a dissection.

They have even launched a lawsuit against Emanuale.

Although arterial dissection is considered a critical link between neck manipulation and strokes, it can also be caused by any number of activities that stretch the neck.

Pathologists had initially reported the damage in Lewis's artery was not conclusive evidence of dissection and did not link the chiropractic treatment with her death.

Lewis, a heavy drinker and smoker, suffered from health problems that included high blood pressure, severe headaches and a weight problem.

The chiropractic community has repeatedly said upper-neck manipulation poses very little risk. The Canadian Chiropractic Association cites the risk of stroke or stroke-like symptoms in just one or two of every million treatments.

"People who are chiropractic patients are pretty content and trust their chiropractic physicians," said association spokesperson John Tucker.

Estimates vary, but Tucker said about 13.4 million Canadians receive upper-neck adjustments each year.

In a recent study led by Toronto neurologist Dr. John Norris of 178 strokes due to dissection, 20 per cent of the cases were linked to chiropractic manipulation.

"We were quite surprised to find such a high percentage of patients," said Norris.

The results of the study have not yet been published and Tucker said research in the area is problematic.

"The difficulty with this kind of research is the risk is so rare it's like a lottery. It's very difficult to get a clear picture," he said.

Ontario's chief coroner had initially consulted with the Lewis family and members of the chiropractic community before announcing there would be no inquest. That decision was reversed in May 2000 after the family appealed.

Since then, the inquest has faced numerous delays. Last year, Dr. Murray Katz, a vocal critic of the chiropractic profession, was barred from representing the family over what a lawyer for the Canadian Chiropractic Association called "gross impropriety" and ``breach of professional rules."

Then last fall, the inquest was delayed again after new evidence was found. A doctor reviewing pathology slides at the family's request discovered evidence of dissection.

The coroner's office was also investigating the disappearance of tissue samples that were part of the investigation.

A 1998 coroner's inquest into the death of a 20-year-old Saskatoon woman following two chiropractic adjustments marked the first death conclusively linked to upper-neck manipulation in Canada.

The inquest jury looking into the circumstances of Laurie Mathiason's death made a series of recommendations among them, to ensure patients were well-informed about possible risks to their health before undergoing treatment.

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