Chiropractic Patients Need To Know Treatment Risks

Published: 2009-05-06 14:11:30
Author: Rick Green | Hartford Courant | March 17, 2009

If you have received a flu shot, you signed a piece of paper that included, buried in the fine print, a warning like this: In approximately 5 percent of the cases a permanent or even fatal form of paralysis may occur.

This is known as "informed consent," and the idea is to make the patient aware of the risks. Most of us ignore this and get on with the injection.

Again this session, this seemingly simple, ethical concept has legislators tied in knots over whether it should be extended to a specific spinal adjustment procedure performed by chiropractors.

"It's dangerous when you try to make law on individual isolated situations," said state Sen. Jonathan Harris, chairman of the legislature's public health committee. "We are working on getting both sides of this issue together to come up with a meaningful solution that offers protection to the public that doesn't single out a profession."

I'm for that. But I'd also like to know there's a chance — however unlikely — that neck manipulation by a chiropractor could cause a stroke.

State chiropractors are fighting the proposed informed-consent law. The chiropractors say they are all for doing this, but they want it to apply to anyone who performs a procedure involving the neck, such as hairdressers. This is an obvious smoke screen.

Still, the chiropractors have a point: The chance for a disaster is very remote. I'm not sure, though, why this means they shouldn't be required to inform patients of the potential risk from the procedures they perform, including "a discharge summary" of all potential side effects.

"The research shows that this type of treatment is the safest for neck pain or headache," said Dr. Matthew N. Pagano, a Winsted chiropractor. Mandating informed consent creates "an inference that this type of treatment is dangerous."

"The risks associated with this procedure are so low that if the legislature is going to contemplate mandating written informed consent it should be done for all professions with respect to all medical procedures that have a higher risk."

The chiropractors say they believe in the concept of informed consent. Many do it voluntarily. But the state has no business singling them out, they argue.

"It's tough for me to reconcile as well," said state Sen. Len Fasano, sponsor of legislation that would require chiropractors to tell patients about all the risks. "The first story you get is we do informed consent, anyway. The second story we get is why are you picking on us?"

Fasano has modified his proposal to say that any physician who performs neck manipulation must practice informed consent. The chiropractors say this still singles them out.

"The chiropractors are all over this. It's a lot of pressure," Fasano said. "Legislators are getting called left and right. They are very vocal. They are saying things that are not quite accurate, like we are singling out chiropractors and there is no such thing as a stroke" caused by cervical manipulation.

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