John Lawler inquest

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The John Lawler inquest was an inquest into the death of John Lawler in 2019. In August 2017, the death of 80-year-old John Lawler, who died following a chiropractic treatment in York, England led to a coroner's inquest. Lawler visited the clinic of York chiropractor Arleen Scholten in August 2017 seeking relief for back pain, but during a spinal manipulation session, he suffered severe complications that led to his hospitalization and eventual death the following day. [1] [2] Coroner Jonathan Heath led the inquest, examining whether Scholten’s actions contributed to Lawler’s death. Although the coroner acknowledged a link between the treatment and Lawler's death, Scholten was not found criminally negligent. The case led to a prevention of future deaths report by the Judiciary of England and Wales. [3]

Contents

Background

John Lawler, aged 80, visited Arleen Scholten’s chiropractic clinic in York on August 11, 2017, for relief from chronic back pain. During the session, Scholten performed spinal manipulations, which soon caused Lawler to experience serious medical complications. He was subsequently hospitalized and died the next day. The 2019 inquest investigated whether Scholten’s treatment was appropriate for Lawler’s condition and if it directly caused his death. Though the spinal manipulation was found to be a factor in Lawler's demise, Scholten was cleared of wrongdoing after the inquest. [4] [5]

Incident and investigation

Following Lawler’s death, a coroner’s inquest was launched to determine whether Scholten’s treatment directly contributed to the fatal outcome. The inquest examined the appropriateness of the chiropractic procedures performed and whether they were executed in accordance with standard medical practices. [6] Medicine watchdog website Science-Based Medicine criticized the regulatory body General Chiropractic Council for not taking action against Scholten after Lawler’s death. [5]

The coroner's report emphasized that Lawler's spine was more fragile than expected due to calcification, a condition common in older patients, which made his spine more prone to injury. The inquest also noted that no X-rays were taken before treatment, which may have revealed the severity of Lawler’s condition. [7] [8]

Coroner's inquest

The inquest, held in 2019, examined whether Scholten's spinal manipulations were responsible for Lawler's death. The coroner, Jonathan Heath, heard testimony from experts who outlined the risks associated with high-velocity spinal manipulations, particularly in patients with conditions like Lawler's. Testimony from Lawler's widow detailed how he expressed discomfort during the treatment, including complaints of severe pain and numbness. [8] [9]

The coroner criticized the lack of pre-treatment imaging, which could have informed Scholten of Lawler's condition, and noted that Scholten’s handling of the emergency, including the misleading information given to paramedics, was concerning. However, the inquest concluded that Lawler’s calcified spine contributed significantly to the severity of the injury and that there was no intent of wrongdoing on Scholten’s part. [10]

Verdict and outcome

After reviewing the evidence, the coroner concluded that Lawler’s death was due to complications from the chiropractic treatment but did not attribute criminal negligence to Arleen Scholten. The inquest resulted in a narrative verdict, meaning no charges were brought against her. However, the case prompted calls for stricter regulations within the chiropractic profession, including the recommendation that chiropractors conduct pre-treatment imaging, such as X-rays, on patients with similar medical histories. [11]

Aftermath and impact

The inquest into John Lawler’s death had a significant impact on the chiropractic profession and public awareness of the risks associated with spinal manipulations. It led to renewed discussions on the importance of thorough patient assessments, particularly for elderly patients with pre-existing spinal conditions. Professional chiropractic associations emphasized the necessity for clearer communication between chiropractors and their patients, ensuring that all potential risks are fully understood. [12]

Related Research Articles

<span class="mw-page-title-main">Chiropractic</span> Form of pseudoscientific alternative medicine

Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It is based on several pseudoscientific ideas.

Inquests in England and Wales are held into sudden or unexplained deaths and also into the circumstances of and discovery of a certain class of valuable artefacts known as "treasure trove". In England and Wales, inquests are the responsibility of a coroner, who operates under the jurisdiction of the Coroners and Justice Act 2009. In some circumstances where an inquest cannot view or hear all the evidence, it may be suspended and a public inquiry held with the consent of the Home Secretary.

<span class="mw-page-title-main">Vertebral subluxation</span> Chiropractic concept

In chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action or makeup. Chiropractors claim subluxations are not necessarily visible on X-rays.

<span class="mw-page-title-main">Spinal adjustment</span> Chiropractic technique

Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease.

<span class="mw-page-title-main">Spinal manipulation</span> Intervention performed on spinal joints

Spinal manipulation is an intervention performed on synovial joints of the spine, including the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. It is typically applied with therapeutic intent, most commonly for the treatment of low back pain.

<span class="mw-page-title-main">Disc herniation</span> Injury to the intervertebral disc

A disc herniation or spinal disc herniation is an injury to the intervertebral disc between two vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatments may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including good posture.

<span class="mw-page-title-main">History of chiropractic</span>

The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samuel H. Weed coined the word "chiropractic" by combining the Greek words cheiro (hand) and praktikos.

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.

Manipulation under anesthesia (MUA) or fibrosis release procedures is a noninvasive procedure to treat chronic pain which has been unmanageable by other methods. MUA is designed not only to relieve pain, but also to break up excessive scar tissue. Scar tissue frequently builds up after orthopedic surgery, impeding movement of soft tissue and joints, so MUA is valuable in re-establishing optimal range of motion. The patient normally goes through a series of examinations, including imaging tests and laboratory work, before undergoing MUA. These tests are necessary to precisely identify the targeted area and to ensure the patient's able to benefit from the procedure. MUA may be performed by a number of different types of medical professionals, but only those who have studied MUA and received certification in the technique.

<span class="mw-page-title-main">Activator technique</span> Chiropractic treatment method and device

The Activator Method Chiropractic Technique is a chiropractic treatment method that uses a device created by Arlan Fuhr as an alternative to manual manipulation of the spine or extremity joints. The device is categorized as a mechanical force manual assisted (MFMA) instrument which is generally regarded as a softer chiropractic treatment technique. The method purports to use the device to identify and remove vertebral subluxations and correct "pelvic deficiency", defined as an "'apparent' difference in leg length, not an anatomical difference". These claims have been criticized.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

Throughout its history, chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. Internal divisions between "straights," who adhere strictly to Palmer’s original philosophy, and "mixers," who incorporate broader medical practices, have further complicated the profession’s identity. A 2003 profession-wide survey found "most chiropractors still hold views of Innate Intelligence and of the cause and cure of disease consistent with those of the Palmers". A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation.

<span class="mw-page-title-main">Veterinary chiropractic</span>

Veterinary chiropractic, also known as animal chiropractic, is chiropractic for animals – a type of spinal manipulation. Veterinary chiropractors typically treat horses, racing greyhounds, and pets. Veterinary chiropractic is a controversial method due to a lack of evidence as to the efficacy of chiropractic methods. Contrary to traditional medicine, chiropractic therapies are alternative medicine. There is some degree of risk associated with even skilled manipulation in animals as the potential for injury exists with any technique used. The founder of chiropractic, Daniel David Palmer, used the method on animals, partly to challenge claims that the placebo effect was responsible for favorable results in humans. Chiropractic treatment of large animals dates back to the early 1900s. As of 2019, many states in the US provide statutory or regulatory guidelines for the practice of chiropractic and related treatments on animals, generally requiring some form of veterinary involvement.

Sports chiropractic is a specialty of chiropractic. It generally requires post-graduate coursework and a certification or diplomate status granted by a credentialing agency recognized in a practitioner's region.

Osteomyology is a multi-disciplined form of alternative medicine found almost exclusively in the United Kingdom and is loosely based on aggregated ideas from other manipulation therapies, principally chiropractic and osteopathy. It is a results-based physical therapy tailored specifically to the needs of the individual patient. Osteomyologists have been trained in osteopathy and chiropractic, but do not require to be regulated by the General Osteopathic Council (GOsC) or the General Chiropractic Council (GCC).

<span class="mw-page-title-main">Spinal disease</span> Disease involving the vertebral column

Spinal disease refers to a condition impairing the backbone. These include various diseases of the back or spine ("dorso-"), such as kyphosis. Dorsalgia refers to back pain. Some other spinal diseases include spinal muscular atrophy, ankylosing spondylitis, scoliosis, lumbar spinal stenosis, spina bifida, spinal tumors, osteoporosis and cauda equina syndrome.

<span class="mw-page-title-main">Diffuse idiopathic skeletal hyperostosis</span> Medical condition

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by abnormal calcification/bone formation (hyperostosis) of the soft tissues surrounding the joints of the spine, and also of the peripheral or appendicular skeleton. In the spine, there is bone formation along the anterior longitudinal ligament and sometimes the posterior longitudinal ligament, which may lead to partial or complete fusion of adjacent vertebrae. The facet and sacroiliac joints tend to be uninvolved. The thoracic spine is the most common level involved. In the peripheral skeleton, DISH manifests as a calcific enthesopathy, with pathologic bone formation at sites where ligaments and tendons attach to bone.

Primary spine practitioners are health care professionals who are specially trained to provide primary care for patients with spinal disease.

Clarence Selmer Gonstead was an American chiropractor. He created the Gonstead technique. He established a large chiropractic facility in Mount Horeb, Wisconsin.

<span class="mw-page-title-main">Cervicocranial syndrome</span> Medical condition

Cervicocranial syndrome or is a combination of symptoms that are caused by an abnormality in the cervical vertebrae leading to improper function of cervical spinal nerves. Cervicocranial syndrome is either congenital or acquired. Cervicocranial syndrome may be caused by Chiari disease, Klippel-Feil malformation, osteoarthritis, and physical trauma. Treatment options include neck braces, pain medication and surgery. The quality of life for individuals suffering from Cervicocranial syndrome can improve through surgery.

References

  1. ↑ Bean, Dan (October 14, 2017). "Woman Arrested on Suspicion of Manslaughter After Man, 80, Dies Following Visit to York Chiropractor Clinic". The Northern Echo . ProQuest   1966169798.
  2. ↑ Sandeman, George (October 16, 2017). "Chiropractor Arrested Over Patient Death". The Times . p. 13. ProQuest   1951146416.
  3. ↑ "John Lawler: Prevention of Future Deaths Report". Judiciary of England and Wales . November 26, 2022.
  4. ↑ "Family Urge 'Unlawful Killing' Verdict Over Chiropractic Death". BBC News . November 15, 2019.
  5. 1 2 "Another serious complication from chiropractic cervical manipulation: Vertebral fracture leading to paralysis and death | Science-Based Medicine". sciencebasedmedicine.org. 2019-11-25. Retrieved 2024-07-02.
  6. ↑ Laycock, Mike (September 6, 2021). "Chiropractor Cleared of Misconduct Over Treatment of Patient Who Died". The Northern Echo .
  7. ↑ "Plea for New Guidelines on Chiropractors". The Times . November 19, 2019. p. 19. ProQuest   2315457145.
  8. 1 2 Ball, Tom (November 12, 2019). "Chiropractic Patient Died After Treatment Broke His Neck, Inquest Told". The Times . p. 17. ProQuest   2313496116.
  9. ↑ "Elderly Patient Died After Session With the Chiropractor Left Him 'Like a Rag Doll". The Daily Telegraph . November 12, 2019. p. 11. ProQuest   2313469282.
  10. ↑ "Bank Manager Died After He Was Left With Broken Neck Following Session With Chiropractor, Inquest Hears". The Daily Telegraph . November 11, 2019. ProQuest   2313438427.
  11. ↑ "Chiropractors Urged to Take X-rays First to Prevent Deaths". The Daily Telegraph . November 19, 2019. p. 9. ProQuest   2315371046.
  12. ↑ "Family tribute to 'much-loved' John Lawler, 80, after inquest". York Press. 2019-11-18. Retrieved 2024-07-02.
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