Chiropractors, Cancer, And Medical Malpractice

Are chiropractors qualified to diagnose cancer? If they fail to diagnose cancer, are they liable for medical malpractice? A case from the Second Department last week illustrates that it is probably unwise to even ask your chiropractor if certain symptoms could be cancerous. The case was Patrella v Atlantic Chiropractic Group, 2007 NY Slip Op 05710. In that case, the plaintiff had been treated by a chiropractic group for approximately a month. As part of the treatment, one chiropractor had taken X-rays of the plaintiff's spine, which he used to diagnose a narrowing of vertebral discs. When he was reviewing the X-ray film, the plaintiff asked the chiropractor if certain abdominal pain she was feeling could be cancer. The chiropractor responded that there was nothing on the X-ray film to indicate the presence of cancer. The plaintiff was subsequently treated by a neurologist and several other physicians, none of whom diagnosed her with cancer. She finally was diagnosed with cancer of the appendix approximately a year later. The plaintiff then commenced a medical malpractice action against her chiropractors.

At trial, a chiropractic expert for the plaintiff testified that the defendants departed from good and accepted chiropractic practices by attempting to diagnose cancer, and by failing to refer the plaintiff to an internist or general surgeon. A chiropractic expert for the defendants characterized the idea that the defendants were attempting to diagnose cancer as "absurd," and testified that they did not depart from accepted practices. In addition, an oncologist who testified as an expert for the plaintiffs, admitted that there was no evidence of cancer on the X-ray films, but also testified that X-rays are not used to diagnose cancer.

A jury returned a verdict for the defendant chiropractors. The Second Department affirmed the jury's verdict stating there was a valid line of reasoning by which the jury could have concluded that the defendants did not depart from good and accepted chiropractic practice, and that the jury was entitled to credit the testimony of the defendants' expert over that of the plaintiffs' expert.

This case raises interesting questions of whether a chiropractor can be found liable for failure to diagnose cancer, or at least failing to refer a patient to specialists, if the type of cancer falls more within a chiropractor's knowledge. Chiropractors typically examine such structures as the spine and pelvis to see if they are in alignment, and use x-rays to check such structures. What if, instead of the cancer being in the appendix (where apparently nothing would show up on x-rays), something suspicious showed up on one of the bony structures of the spine or the pelvis? Under these circumstances perhaps a more credible argument could be made that since a chiropractor is more familiar with such bony structures, anything that looked suspicious should be referred to a more qualified physician or oncologist.

Another question that arises is: In Patrella, should the chiropractor have simply responded to his patient - "I am not qualified to diagnose cancer, you should seek the opinion of an oncologist." Perhaps. But this is probably not realistic given that all medical providers want to provide their patients both with accurate information and some degree of comfort in responding to patient questions. This is all that the chiropractor in Patrella seems to have done, and it appears that the jury's verdict recognized this.

Comments

[Marlene Patrella]

I'd liked to clarify that the X-rays were not only of the spine, but also of the pelvic area. Tissue tumors do not show up on X-rays. On the witness stand the Doctor admitted that he used the X-rays to reassure me that I did not have cancer. This is clearly a violation of the Ed Law and the Doctor should have had some disciplinary action for going outside the scope of his profession. He openly admitted at trial, quote, "I don't know if you can diagnose cancer on a plain X-ray".
Yet he took my life in his hand and I had incurable cancer for his failure to refer me to a medical doctor.