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    Sharon Mathiason's letter to the OMA about the Ontario Chiropractic Association campaign to Ontario doctors - Ontario Medical Review - Oct. 99. This letter is not on their web site.

    Chiropractic statement to Ontario physicians "inaccurate, misleading"

    Dear Editor:

    Earlier this year, family physicians and neurologists in the province of Ontario received a letter from the president of the Ontario Chiropractic Association in which the death of my daughter, Laurie Jean Mathiason, is discussed.

    The death of my 20-year-old daughter has been very painful, but to have her death discussed with the medical profession of Ontario, without giving me any notice or ability to comment, has been an additional source of anguish.

    Furthermore, the letter contains some inaccurate statements which I feel must be corrected and, perhaps more importantly, fails to communicate to physicians the important clinical practice lessons which may be learned from the death of my daughter.

    Prominent in the communication with physicians is the statement that this is the first death following chiropractic treatment in Canada. The letter fails to mention evidence produced at the inquest that there had been a case of death following chiropractic manipulation the year before in Toronto. Furthermore, the jury pointed out that one reason we don't know the true incidence is that there is inadequate research to gather the numbers.

    A second inaccuracy is that physicians are told that the cause of death was a tear in the vertebral artery, In fact, the coroner's jury in Saskatoon stated that the cause of death was "traumatic rupture of the left vertebral artery."

    In my opinion, this shift in the language of the description of injury minimizes the impression of what really happened in Laurie's death. It is in keeping with other statements which I believe mislead readers,

    For example, the Canadian Chiropractic Association has provided a release which says, in part, "the jury did not make a finding that chiropractic treatment was the cause of this tragedy." Indeed, the jury accurately put the cause of death as a "traumatic rupture."

    It is the courts which find fault, not a coroner's jury. But the fact remains that after her last chiropractic manipulation, she suffered sudden neck pain, and within minutes became unconscious, and within days was dead from the effects of the traumatic rupture.

    In the letter to Ontario physicians, the risk of chiropractic therapy is belittled by comparing it with the risk from therapy with medications or spinal surgery. It seems to me that the risk of chiropractic should be explained on its own. For example, the risks of spinal surgery have little to do comparatively with the risk of chiropractic manipulation, since spinal surgery on the neck would not be used for a condition even remotely similar to that for which chiropractic manipulation of the neck was used.

    My daughter's death and subsequent events have led me to believe that physicians may not be sufficiently aware of the fact that chiropractic manipulation may cause the cervical vertebrae to strike the arteries and result in a stroke whether or not there is a rupture. They may also be unaware of how effective early recognition and anticoagulation therapy can be, although it could not have helped my daughter.

    Looking at the above facts, I would like to make two recommendations to the physicians of Ontario, If these two recommendations became part of your thinking, then my daughter's death would not be completely in vain.

    First, I would like to have every doctor remember that "Every stroke which is not otherwise specifically explained should automatically result in a question as to whether the victim had chiropractic manipulations."

    Only by being alert and aware can physicians have the opportunity to intervene quickly enough to benefit the patient with anticoagulent therapy and prevent further tragedy.

    I know that from time to time physicians refer patients to chiropractors for various back problems. When you do that as a physician, the patient takes great stock of the fact that you have referred them to a chiropractor, and willingly transfers their trust and confidence to that practitioner. Although stroke is not frequent, nevertheless, the effect upon an individual patient is catastrophic and therefore the risk must be considered to be significant.

    This brings me to my second recommendation: "When physicians refer patients to a chiropractor for therapy they should inform patients that they should be subjected to cervical manipulation there is a risk of a catastrophic stroke."

    As Laurie's mother, I have been distressed that the Ontario Chiropractic Association would undertake a direct mailing to physicians without contacting or consulting me and asking my permission to use her name.

    I have no ability to match the resources required to do that, however, I am grateful to the Ontario Medical Association for printing my letter to the editor so that those doctors may receive this information.

    At the same time, I hope to be of service to other patients and to physicians through my recommendations, which I believe can serve the best interests of the practice of medicine and the health of the people of Ontario.

    Sharon Mathiason, Saskatoon, Saskatchewan