Dutch court issues historic ruling on causation in chiropractic SMT case

Haarlem, February 21, 2022: Chiropractor cleared of causing grievous bodily harm during treatment

The Noord-Holland Court has passed its judgment in relation to a chiropractor alleged to have caused serious physical injury to a patient, who became unwell during a treatment on January 26, 2016 in his practice in Haarlem.

On January 22, 2016, the patient presented to the chiropractor complaining of head and neck pain. The symptoms had arisen on January 17, 2016 and on January 19, 2016, the GP referred him to a physiotherapist or chiropractor. During the first treatment, the chiropractor adjusted the patient’s cervical spine bilaterally. A follow-up appointment was made.

The second treatment took place on January 26, 2016, during which the chiropractor adjusted the patient’s neck again. During this treatment, the patient became unwell. He lost consciousness, was resuscitated and taken to hospital by ambulance. At the hospital, it was determined that the patient had suffered a brainstem infarction due to oxygen deficiency as a result of an arterial dissection. As a result of the brainstem infarction, the patient developed various neurological deficits, including paralysis of the limbs, speech disorders and visual disturbances. Over time, some function has returned, but the patient remains severely limited by neurological deficits and is to a large extent dependent on care.

In this case, a number of experts investigated whether the injury was caused by the cervical manipulation that the chiropractor performed on the patient. The experts’ reports indicated several possible causes for a dissection of the artery resulting in a brainstem infarction and that there are circumstances where a dissection is already in progress but only manifests later. The experts concluded that there is no scientific evidence demonstrating a causal relationship between cervical spine manipulation and the occurrence of a dissection and that the medical facts in this case could not determine what caused the dissection in the patient.

The Court took note of a report from a neurologist who, on the instructions of the liability insurer, investigated the patient’s complaints and limitations. The neurologist expressed the view in his report that the dissections were caused by manipulation of the neck. However, the Court rejected this conclusion on the grounds that the neurologist had not sufficiently substantiated the basis on which he established that the dissections were caused by manipulation of the neck.

The Court ruled that it has not been legally and convincingly proven that it is the fault of the chiropractor that the patient suffered serious physical injuries during the treatment on January 26, 2016. Specifically, in view of the experts’ conclusions, it cannot be established beyond reasonable doubt that the arterial dissection was the result of the treatment performed by the chiropractor on the patient.

The Court ruled that the chiropractor adhered to the professional standards of the Netherlands Chiropractors’ Association. Prior to the treatment, he took sufficient steps to identify possible contraindications to cervical spinal manipulative therapy. In the absence of such contraindications, the Court found there was no reason for the chiropractor to forgo the treatment.

The Court ruled that the chiropractor was not under a duty to inform the patient that dissection was a possible risk of the treatment. The experts’ reports indicated that the current state of knowledge cannot identify arterial dissection as a potential risk of cervical manipulation. Moreover, a dissection of an artery after cervical spine manipulation resulting in a brainstem infarction was considered a extremely rare occurrence.

The full and detailed text of the ruling is in Dutch but will be available in translation shortly.