January 2004

Canadian 'stroke' inquest enters final week

The final week of a lengthy inquest into the death of a chiropractic patient began on Dec. 8, 2004, with the outcome still in doubt.

The inquest was originally ordered in 2000 to investigate the 1996 death of Lana Dale Lewis of Ontario, Canada. Lewis suffered from migraine headaches and regularly consulted a chiropractor in the 18 months prior to her death. Seventeen days after her final chiropractic appointment, during which she received a neck adjustment similar to those she had received on previous visits, she died.

The Lewis family, along with a number of chiropractic opponents, alleged that the adjustment led to an arterial dissection in her neck, which resulted in her death.

Following several delays, the inquest began on April 22, 2002. The legal proceeding pitted chiropractic researchers, educators and experts against chiropractic critics and brought the issue of chiropractic's alleged link to strokes to the media's attention. Numerous news articles and broadcasts have been distributed since 2000, keeping chiropractic organizations busy dispelling unfounded rumors and countering inaccurate information on the issue.

With testimony completed, each party with standing was granted a maximum of three hours to present final summaries of their cases to the jury.

Tim Danson, one of the attorneys representing the chiropractic profession, addressed the jury first. Quoting from the inquest transcripts, Danson accused the opposition of fear mongering, noting that Dr. John Norris, a Canadian neurologist from the Canadian Stroke Consortium ‑‑ whose original testimony was considered extremely damaging ‑‑ later retracted many of the statements he had made under oath.

Norris admitted that the Consortium's SPONTADS study, used as evidence against chiropractic, was "speculation," "sheer guesswork," "way‑off," and "irrelevant" to the inquest. He also retracted statements he had made on national television and radio that exaggerated the risk of stroke associated with neck adjustment and confessed that he used results to spread fear and misinformation in the media. When asked to explain to the jury why he had lied to the media he responded, "I can't explain that to the jury. I'm sorry."

Danson also reminded the jurors that Dr. John Deck, one of the two pathologists who worked on the case from the coroner's office, had no knowledge of chiropractic neck adjustments. Although Deck testified in April 2002 that it was a "90 percent" certainty that Lewis' death was caused by the chiropractic manipulation, he later admitted that his findings were nothing but speculative opinion. Danson reiterated statements by Dr. Jim Cairns, the Deputy Chief Coroner, Investigations, for the Province of Ontario, that Deck's work in this case was incompetent.

The jury was also given a summary of the extensive information on the biomechanics of neck adjustments they'd heard during the inquest. Danson told the jury that only one expert, Dr. Walter Herzog, professor and Associate Dean of Research in the faculty of Kinesiology at the University of Calgary, was qualified as a witness in biomechanics.

During his testimony, Dr. Herzog stated that chiropractic did not cause strokes. He said that during every day activities, the vertebral artery is stretched more ‑‑ often twice as much ‑‑ as it is during a neck manipulation. The quarter‑billion neck adjustments that are performed each year in North America are within the natural range of motion and are safe because our bodies are built to move this way, he testified.

Danson ended his summation by asking the jury to find that Lewis died of natural causes and to be fair and practical when making their recommendations.

Next, Brian Foster, counsel for Lewis' chiropractor, Dr. Philip Emanuele, stood before the jury and told them that the inquest was actually a simple case made to appear complicated by testimony based on opinion, speculation and conjecture as opposed to the facts. He urged the jurors not to allow themselves to be confused and encouraged them to objectively assess the big picture, to examine the facts, and to make decisions on what made sense.

In debunking the supposed link between chiropractic and strokes, he noted that chiropractic neck manipulation had been thoroughly examined and that an attempt had been made to find a causal link between SMT and stroke. He reminded them that more than 260 exhibits had been presented during the inquest and encouraged the jurors to look for the disclaimers in these reports and to use common sense when evaluating them since none of them established a causative link.

He also recalled for the jury that, while witness after witness admitted they had no knowledge of chiropractic theory or practice and no training in its mechanics or outcomes, they continued to offer opinions related to the safety of chiropractic and its alleged causation of stroke.

At press time, summations from the College of Chiropractors of Ontario and the Lewis family attorneys were yet to be held.

Complete information on the inquest, including details of the testimony given throughout the proceedings, is available from the Canadian Chiropractic Association at www.ccachiro.org.