Got Consent?

A recent Wisconsin Supreme Court ruling brings up an important issue: Should chiropractors be required to inform patients of the possible health risks associated with their treatment?

The ruling involved a man who suffered a stroke shortly after receiving a neck adjustment from his chiropractor.

According to the June 29, 2005 decision in Gary Hannemann v Craig Boyson, DC, “A patient of chiropractic has the same right as a patient of medical practice to be informed of the material risks of the proposed treatment or procedure so that he may make an informed decision whether to consent to the procedure or treatment.”

This case also brings up the question of whether DCs should require patients to sign a consent-to-treat form that discloses these risks. I believe that the benefits of having patients sign such a form far outweigh the negatives.

Kenneth S. Ross, who is a chiropractor, lawyer, and Chiropractic Products editorial advisory board member, agrees. He says that having a consent-to-treat form is an important part of risk management, and that the DC, not staff, should also explain it verbally to patients. “The ramifications in legal cases are great for chiropractors and all doctors treating patients,” he says.

In fact, at least one chiropractic malpractice insurance company requires its DC clients to have such forms. A representative from the National Chiropractic Council, a malpractice insurance company in Santa Ana, Calif, said the company has about 20,000 clients, and they are all required to have their patients sign a consent form that warns of possible side effects. DCs who would like a general form to use as a template can call the council for a free copy. Des Moines, Iowa, chiropractic malpractice insurance company NCMIC supports, but does not require, policyholders to provide informed consent, and teaches that the process involves doctor-patient interaction, not just a form. According to NCMIC, the steps involved include discussing the treatment, the material risks of treatment, alternatives to the proposed treatment, and potential consequences of going without treatment. NCMIC says that these communications should be updated any time the treatment plan is changed.

Although most of the DCs that I have talked to tend to agree that some kind of consent-to-treat form is necessary, the other side of the argument is that these agreements only serve to scare the patient. One DC said that until a direct correlation between the adjustment and stroke is proven, the agreement will just prevent patients from getting the chiropractic care that they need.

That is actually the reason Boyson gave for not disclosing the risk of stroke. He testified that, to his recollection, at the time of the treatment in 1997, no definitive correlation existed between chiropractic adjustments and stroke. Today, that correlation still appears to be minuscule. The American Chiropractic Association cites the Canadian Medical Association Journal in stating that the risk of stroke following a cervical manipulation is 3 per 10 million manipulations.¹

Both sides of the issue have good points, but you can never be too careful when it comes to informing your patients.

Daryl Lubinsky
dlubinsky@ascendmedia.com

Reference
1. Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. Can Med Assoc J. 2001;165:905–906.