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ChiroWatch | Laurie Jean Mathiason |
Death in Saskatoon after chiropractic neck manipulation
- Inquest into death of Laurie Jean Mathiason
Copyright 1998 Micromedia Limited
Canadian Business and Current Affairs
Copyright 1998 Maclean Hunter Ltd.
Maclean's (Toronto Edition)
September 21, 1998
SECTION: v.111(38) S 21'98 pg 70; ISSN: 0024-9262
CBCA-ACC-NO: 4295520
LENGTH: 1582 words
HEADLINE: Lethal treatment: the death of a patient puts chiropractic on trial
[Laurie Mathiason case in Saskatchewan]
BYLINE: Nichols, Mark
BODY:
Laurie Jean Mathiason had been going to a Saskatoon chiropractic clinic for
six months, mostly for treatment of lower back pain. On Feb. 4, the
20-year-old restaurant manager visited chiropractor Stacey Kramer for the
last time. According to Mathiason's mother, Sharon, she had seen Kramer
the day before because of a sore neck. But after treatment, her neck pain
seemed to worsen and she returned in the hope that Kramer could ease the
discomfort. In the clinic, Kramer once again manipulated her patient's
neck. But according to testimony at an inquest last week, the treatment
did not help. As Mathiason lay on the chiropractor's table, she complained
of pain--then lost consciousness and began convulsing. Rushed in a coma to
Saskatoon's Royal University Hospital, she was kept on life support for
three days, then died on Feb. 7--as a result, according to an autopsy
report, of a ruptured vertebral artery. Testifying at the inquest, Sharon
Mathiason told of being in Kramer's office as her daughter exhibited all
the signs of a stroke. Kramer assured her that everything would be all
right, said Mathiason--and ''I trusted her, she was a doctor.''
In effect, the inquest put the chiropractic profession on trial. The
four-day hearing, before Saskatchewan's chief coroner, John Nyssen, and a
six-member jury in Saskatoon's Court of Queen's Bench, ended with the jury
urging that provincial health ministries immediately fund research into
the incidence of strokes associated with chiropractic manipulation of
patients' necks and spines. After deliberating for four hours, the jury
made no suggestion that Kramer had performed the procedure incorrectly.
But it said that literature outlining the risk of stroke should be made
available in chiropractors' offices. It recommended that health
authorities try to find effective screening tests to identify patients who
might be vulnerable to injury. And it proposed the development of
standardized forms for patients to fill out providing details of their
health and medical history. Sharon Mathiason told reporters that she hoped
the jury's proposals would be acted on, ''so that nobody else will walk to
their death like Laurie did.''
Chiropractors acknowledge that cervical (neck) and spinal manipulation can
cause strokes. In fact, practitioners routinely require patients to read
and sign a waiver warning of the risk. And chiropractors were clearly
concerned that the Mathiason case could shake the public's faith in them.
According to the Toronto-based Canadian Chiropractic Association, about
three million people across the country pay an estimated 30 million visits
annually to more than 5,000 licensed chiropractors. ''We've got a lot of
patients who have been unduly scared,'' says association president David
Peterson, a Calgary practitioner. ''Yes, there is a risk involved in
cervical manipulation. But it is extremely low.''
Yet testimony at the inquest raised disturbing questions. Sharon Mathiason,
who works at a health food store just a few doors away from the
chiropractic clinic, told the inquest she saw her daughter shortly before
her Feb. 4 appointment. Soon after that, her daughter's fiance, Doyle
Gertner, arrived at the store to tell her that Laurie Jean was in trouble.
Mathiason rushed to the chiropractor's office, where she found her
daughter twitching and foaming at the mouth. Gertner and Mathiason
testified that the only thing Kramer did to try to help was slap Laurie
Jean's face. ''My daughter was dying before my eyes and nothing was
happening,'' sobbed Mathiason.
Kramer's account was different. She told the court that after she performed
an adjustment to her patient's neck, Mathiason began to cry, complaining
that her neck hurt. ''I had a gut instinct something was not right,''
Kramer testified. ''But I had nothing to base it on.'' Kramer, 29, said
that she subsequently examined Mathiason's eyes and saw that the left one
was moving ''all wrong.'' At that point, said Kramer, she told her
receptionist to telephone for an ambulance. Kramer, who is still
practising in Saskatoon, told the inquest that Mathiason's death was the
worst thing that had ever happened to her.
Dr. Robert Macaulay, who performed the autopsy on Mathiason, testified that
the woman's artery was probably torn during her Feb. 3 session with
Kramer. When she returned the next day, said Macaulay, the additional neck
adjustment probably dislodged a blood clot formed the day before, blocking
the artery ''like a cork'' and cutting the flow of blood to the brain.
Chiropractors insist that strokes caused by their treatments are
rare--their estimates range from one in a million to one in 3.8 million
manipulations. That is considerably less risky, they argue, than taking
ordinary over-the-counter painkillers like ASA and its cousins, which can
burn and perforate stomach linings a Seattle gastroenterologist estimated
last year that about 76,000 Americans are hospitalized a year because of
problems caused by the pills. But when manipulation of the neck does
damage blood vessels that run up the spine and into the head, resulting
strokes can cause temporary or lasting impairment of speech, vision and
other faculties--and sometimes death. What happened to Mathiason was ''a
tragedy--a family lost their daughter,'' said Dr. Alexander Grier,
president of the Chiropractors' Association of Saskatchewan. ''But you
have to see it in the perspective of the risks and benefits involved in
any kind of treatment.''
Statistics on chiropractor-induced stroke are scarce. Physicians critical
of chiropractic say that is partly because strokes usually happen a day or
so after treatment, making it difficult to demonstrate a link. But in a
1992 survey by researchers at Stanford University in Palo Alto, Calif., 51
neurologists reported seeing evidence of strokes in 56 patients and other
neurological problems in 46 patients treated by chiropractors in the
previous 24 hours. According to the study, published in the journal
Neurology, most of the patients were still experiencing problems three
months later.
Chiropractic has come a long way since Daniel David Palmer, a Port Perry,
Ont.-born schoolteacher, ''adjusted'' a bump on the spine of a deaf
janitor in Davenport, Iowa, in 1895 and somehow restored the man's
hearing. Palmer later developed a theory that misaligned bones, or
subluxations, hampered healing processes. Today, Canadian chiropractors
are entitled to call themselves doctors--and they have respectable
academic credentials. To qualify for the four-year training course at
Toronto's Canadian Memorial Chiropractic College--where Kramer graduated
in 1996--students must first have three years of university education. And
according to the college's president, Dr. Jean Moss, students are required
to make an intensive study of such subjects as anatomy and neuroanatomy,
and are taught about the risks of stroke as a possible consequence of
cervical manipulation.
Besides promoting themselves as specialists in joint problems, many
chiropractors counsel patients on diet, exercise and lifestyle issues.
''We believe that the body has the ability to heal itself,'' says
Peterson. ''We do not believe the answer to better health is more drugs
and more surgery--but we do not for one minute believe that chiropractic
is a cure for everything.'' When chiropractors encounter problems beyond
their competence, adds Peterson, they are obliged to refer the case to
medical doctors.
Still, critics claim that many chiropractors treat ailments that have
nothing to do with the neck or spine. ''I believe the overwhelming
majority of chiropractors believe they can cure virtually anything,'' says
Dr. Ronald Slaughter, the Houston-based executive director of the National
Association for Chiropractic Medicine, a breakaway organization with
members in the United States and Canada who restrict their practices
solely to problems involving the body's joint structures. ''And I believe
that a sincere quack is more dangerous than an out-and-out charlatan'' who
would know better than to treat conditions for which he has no training.
In Canada, even chiropractors who claim to offer only research-based
treatments say they can sometimes help with such disparate conditions as
asthma, headaches, stomach upsets and colic in babies. ''Infants with
colic and children with learning disorders and bed-wetting problems are
being treated by chiropractors,'' says Dr. Murray Katz, a Montreal
pediatrician and a long-standing critic of chiropractic. ''It's astounding
and extremely dangerous.''
Katz, who testified at the inquest, told Maclean's that in his view
chiropractic ''is snake-oil quackery--a monumental fraud.'' Laurie Jean
Mathiason died, he added, ''because provincial legislation says that
chiropractors can treat people by manipulating bones.'' At the inquest,
Saskatoon radiologist Dr. Brent Burbridge said he had seen neurological
problems in about a dozen chiropractic patients. ''I believe some patients
derive some benefit from chiropractic treatment,'' he said, but then
added, ''I would never have my neck manipulated by a chiropractor.'' In
the end, the inquest left a harrowing picture that may linger in some
patients' minds--of a healthy young woman whose treatment by an
alternative health practitioner ended in death.
