Source: MIL-OSI Submissions
Source: Health and Disability Commissioner
The man sought treatment by the chiropractor for hip pain. There is some disagreement as to what occurred at the initial appointment, due to insufficient note taking by the chiropractor. According to the notes the chiropractor discussed lumbar spine manipulation with the man, but did not discuss the associated risks other than the potential for a stroke. At a second appointment the chiropractor also carried out a cervical spine manipulation, without any prior information provided to the man.
Following several appointments with the chiropractor the man experienced pain and issues with his neck and difficulties with his sight. His condition deteriorated to the extent that he went to the Emergency Department of a public hospital where he reported a six-week history of neck and scalp pain following neck manipulation by a chiropractor. He was discharged and referred to his GP who prescribed him medication and referred him to a neurologist.
Dr Caldwell found a number of shortfalls in the care provided by the chiropractor.
“The chiropractor failed to provide the man with sufficient information regarding lumbar spine manipulations and cervical spine manipulations. As a result the man was not in a position to give informed consent for the procedures,” said Dr Caldwell.
She noted that a patient must have all the information a reasonable person would expect in the circumstances, including the associated risks, possible side effects, and options available, to be able to make informed choices and give informed consent. In this case this did not happen.
Dr Caldwell also considered that the chiropractor’s record-keeping did not comply with professional standards. During the investigation it was noted that only minimal patient history and visit history notes were recorded.
Dr Caldwell made adverse comment about the clinic’s lack of policies and procedures in place at the time of events. She also made adverse comment about the quality of care the man received from the chiropractor during his final appointment.
- provide evidence of attending informed consent and documentation courses;
- re-familiarise himself with the New Zealand Chiropractic Board’s professional standards and code of ethics;
- undertake further training on the clinical issues raised in the case;
- notify HDC of his completion of the diploma of orthopaedics for chiropractors; and
- apologise to the man.
She recommended that the Chiropractic Board consider undertaking a review of the chiropractor and arrange a mentor to review his informed consent processes.
Dr Caldwell also recommended that the clinic arrange a chiropractor recommended by the Chiropractic Board to review its cervical spine treatment policy and procedures, and adverse events policy and procedures, and report back to the board on whether they comply with accepted standards.
