The claimant, a 42-year-old female, was originally seen by Dr. Jones on June 14, 2007. She complained of back pain and low-back muscle spasms that started several days prior.

No specific precipitating incident, such as a fall, was identified in the history the doctor took.

Her prior medical history indicated she had a skiing accident two years ago, which resulted in acute back pain and limited range of motion. She was treated by a chiropractor for that condition, with favorable results.

Following a thorough examination that included instrumentation with surface EMG but no x-rays, Dr. Jones diagnosed the patient with multiple subluxations and ordered chiropractic adjustments twice per week, in addition to ice/heat applications.

The patient came in for six treatments. On the seventh visit, following the routine re-examination, one of the patient’s children, who were in the adjusting room, created a disturbance during the thoracic adjustment that distracted Dr. Jones at the exact time of a high-velocity thrust procedure.

This distraction caused a misdirection of the thrust, away from the intended spinal contact point, and caused a mild fracture of the sixth rib just anterior to its angle.

Dr. Jones’ records did not include an informed consent form or documented discussion about the risks of chiropractic adjustment/manipulation procedures.

Dr. Jones responded to the misdirected thrust with an immediate x-ray and arranged a referral to confirm his findings of a rib fracture.

The patient alleged his negligent manipulation caused a fracture of one rib, which resulted in considerable discomfort and limited mobility, and

prohibited her from conducting normal functions, including child care, for five weeks.

Despite the circumstances of the accidental fracture, the patient held Dr. Jones singularly and fully responsible for the injury and proceeded to seek damages.

WAS DR. JONES RESPONSIBLE?

Defense experts, including a chiropractor and orthopedic specialist, opined that the thoracic adjustment was the sole cause of the injury. Dr. Jones did not dispute those findings, based on the facts of which he was uniquely aware.

Regarding the informed consent issues, defense experts stated they could defend Dr. Jones’ informed consent, even though it is not documented in the patient’s chart, based upon his testimony that it was performed verbally for “adverse events.” However, this was disputed by the patient.

Based upon the issues surrounding this case — the patient’s documented injuries and negative expert reviews — the defense counsel opined this was a case of probable liability and estimated the chance of verdict in favor of Dr. Jones at less than 15 percent.

Defense counsel also estimated that a potential adverse verdict value could be in excess of $100,000, based on settlement data for a number of similar incidents in the preceding two years.

This matter was ultimately settled for an amount under the estimated jury award, without litigation.

Stuart E. Hoffman, DC, FICA, is the president of ChiroSecure. He is an experienced chiropractor and licensed insurance broker who advises based on his knowledge of both the insurance world and the chiropractic world. He can be contacted at 866-802-4476 or through the Web site, www.chirosecure.com.