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Vertebral artery dissection following neck manipulation by osteopath (03HDC09752)

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(03HDC09752, 25 May 2004)

Osteopath ~ Standard of care ~ Neck manipulation ~ Rights 4(1), 4(2)

A woman consulted an osteopath about a severe headache and problems with her lower back. She returned for treatment of her lower back later that week. At this consultation, the osteopath asked about her neck, which was still painful. He conducted a series of standard tests for potential risk factors (including a blood pressure check), then proceeded to manipulate the woman's neck. During the manipulation, the woman experienced pain in her head, which she described as a "loud banging". She told the osteopath, who stretched her neck, stopping the noise. When the woman attempted to stand, she found that her right-sided vision was impaired and she had pins and needles down her right arm and leg - symptoms of a stroke. The osteopath re-checked her blood pressure, which was elevated, then rang her general practitioner and arranged to take her to hospital. The woman subsequently complained that the osteopath conducted an inappropriate manipulation and massage of her neck, which resulted in dissection of an artery. She experiences ongoing problems as a consequence of this.

It was held that the osteopath did not breach the Code. Although the neck manipulation was likely to have caused the stroke, there is nothing to indicate that the osteopath's technique was performed incorrectly. Stroke is a recognised, though rare, complication of neck manipulation, and it was accepted that the osteopath appropriately reviewed the woman's history regarding risk factors, and performed the appropriate physical tests before commencing treatment. Accordingly, he provided treatment with reasonable care and skill.

It was noted, however, that the osteopath's notes did not detail what his standard tests included; it was his normal procedure to record specific tests only when a risk was identified. Detail on the tests was provided in a later attachment to the notes. The need for better record-keeping as part of the osteopath's standard practice was stressed.

Additionally, the woman was left alone in the hospital Emergency Department despite the fact that she could not walk and had trouble communicating. It would have been considerate for someone to sit with her until she was seen by the medical team, or a family member arrived.