| The chiropractor who treated Lana Dale Lewis 17 days before she died of a stroke says no alarm bells went off in his mind as she walked normally from his office after her last treatment."She had all of her senses," Philip Emanuele told an inquest into her death yesterday."She walked out fine," he said, recalling her visit on Aug. 26, 1996. "She was better than when she came in."Six days later, Lewis, a 45-year-old Etobicoke mother of three, was admitted to Queensway General Hospital after suffering a stroke. She died on Sept. 12, having had another stroke. The inquest is trying to determine if the upper neck manipulation she received on that final visit caused the stroke or whether she died, as chiropractors contend, from ongoing health problems.Emanuele testified he never had her sign a consent form that would prove he had informed her of various risks — including the possible dangers of stroke associated with upper neck manipulation — even though the Canadian Chiropractic Protective Association, his insurer, was making a "firm suggestion" to all practitioners that it be done. Emanuele said he was never taught to seek written consent when he trained at Canadian Memorial Chiropractic College between 1978 and 1982, though he was told to explain the risks to patients. Whether to have patients sign a consent form before beginning treatment was at the discretion of each individual chiropractor, he said. "I feel more comfortable without throwing a paper in front of them to sign," he said. "Looking back, I should have used it." But Emanuele insisted he has a clear recollection of having verbally warned Lewis of the risks on Feb. 2, 1995, her first visit. Emanuele testified he tells all his patients that manipulating the top two vertebrae of the spine can cause a tear in the artery, leading to a stroke."I tell them the risk factor is one in a million to one in 1.5 million cervical adjustments," he told Tom Schneider, counsel for coroner Dr. Barry McLellan.He only started seeking written consent when he was slapped with a $12 million lawsuit by Lewis' family, he said. "I thought, `Wow, I'm being sued.' I thought, if I have to prove anything I better start using it."Emanuele said he treated Lewis 24 times. During 21 of those treatments he said he did upper neck adjustments, but only on her right side. Schneider asked him if he routinely contacted a new patient's family doctor to see if there are any "contra-indications" for treatment.He replied no, that he only contacts their doctors if he finds something abnormal. In previous testimony, Lewis' husband, Jim Sweeney, said she had complained to him that on Aug. 26 Emanuele had reached over the treatment table and cracked her neck rather than moving over to the other side, as he usually did. But yesterday Emanuele testified he always placed himself directly behind the patient to adjust their upper neck. The inquest continues.
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