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Herman Praszkier
Attorney At Law



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Chiropractor Case Gets Attention Of Attorneys
$118K Verdict Shows Malpractice Is Viable

Missouri Lawyers Weekly
By Anne C. Vitale

A recent $118,000 malpractice verdict against a chiropractor could ignite interest in a cause of action usually ignored by plaintiffs' attorneys, according to the patient's lawyer.

Herman Praszkier, who represented Leslie Krieger in her St. Louis City case, said remarks made by the jury panel during voir dire revealed that chiropractic malpractice could be a fertile area for litigation.

One panel member believed chiropractors perform "hocus pocus," Praszkier said, a comment that was seconded by many others on the panel.

Such an attitude makes chiropractor litigation less forboding than most other med-mal cases, he said.

"In normal medical malpractice cases, the attorney has to overcome juror bias against the plaintiff for bringing the case. But in this case, it was not the plaintiff against the medical community, but rather the plaintiff against a chiropractor.

"Here, those in the medical community who view chiropractors with suspicion were our allies. Therefore, the hurdles we had to overcome were not so insurmountable."

Thomas Smith, who represented Dr. Leonard R. Suiter, said the defense has the task of separating facts about chiropractic treatment from fiction. "Some jurors will have a great deal of familiarity with chiropractic treatment and some jurors will have very little knowledge of chiropractic treatment," Smith said.

"It's important to start as early as possible during jury selection to learn what opinions potential jurors bring into the courtroom about chiropractors and chiropractic treatment," he said. "Secondly, it is important to educate the jurors about chiropractic treatment."

According to Smith, the verdict is being appealed.

A report on the Feb. 21 verdict in Krieger v. Suiter appeared in the March 10 issue.

Treatment

Krieger initially went to Dr. Suiter on Feb. 7, 2001 complaining of hip pain and numbness in her fingers. The first five treatments, during which Dr. Suiter manipulated her spine, seemed successful, but she then began to have pain in her neck. She continued to receive spinal manipulations from Suiter, but her pain grew worse.

Complaining of severe pain, she saw Dr. Suiter on March 2. He manipulated her spine again, but this time Krieger said she felt a "pop." The pain diminished for a few hours, but returned that evening and began to increase. By March 5, Krieger was experiencing partial paralysis, evidenced by her inability to move or get out of bed.

At that point, Krieger's husband took her to the emergency room at St. Luke's Hospital in Chesterfield.

After X-rays and an MRI, Dr. Alexander Marchofsky, a neurosurgeon, diagnosed a herniated or ruptured disc, which he believed was caused by Dr. Suiter's manipulation on March 2. Marchofsky said the herniated disc was pressing on Krieger's spinal cord, causing the paralysis. Krieger underwent surgery to remove the disc on March 16.

Dr. Suiter denied any negligence, claiming that Krieger suffered from a severe degenerative disc and joint disease. He said that she ruptured her disc attempting to roll out of bed on March 5.

Krieger argued that Dr. Suiter should have reevaluated her treatment and referred her for a neurological consult when the manipulations caused her pain to increase. She also said his manipulation had caused her disc to rupture, and that Dr. Suiter had not diagnosed any disc degeneration while she was under his care. Dr. Marchofsky said the X-rays showed no evidence of disc degeneration.

Experts

Praszkier said he incorporated several different strategies in his case against Dr. Suiter. First, he solicited expert testimony from some of the country's top chiropractic, biomechanic and neurosurgery experts to dispute Dr. Suiter's theory that chiropractic manipulation cannot cause traumatic injuries such as a ruptured disc.

Similarly, Prasz-kier cited numerous studies from both the medical and chiropractic communities stating that chiropractic manipulation can cause traumatic injuries such as paraplegia, quadriplegia, and the tearing of vertebral arteries resulting in strokes.

By studying the Mercy Guidelines of Chiropractors, he discovered that chiropractors use varying methods of record-keeping and documenting a patient's history - which can lead to problems with treatment.

"Some chiropractors don't do a thorough enough analysis to determine whether the patient is suffering from an orthopedic or a neurological problem, which deviates from the standard of care and pinpoints where many chiropractors get into trouble," he said.

According to Praszkier, when Krieger began to develop neurological problems - numbness, pain, and tingling - Dr. Suiter failed to recognize these problems and reevaluate Krieger's treatment.

"Suiter didn't even follow the minimum level of evaluation for determining neurological complaints. In this case, he should have stopped manipulating and reevaluated by sending her to a neurologist for an MRI," Praszkier said.

Finally, Praszkier explored the differences between chiropractors and medical doctors. "Chiropractors and neurosurgeons use different terminology in describing injuries, which causes confusion," he said.

"For example, 'herniation' and 'rupture' have different meanings to a chiropractor, but these terms are synonymous to a neurosurgeon. Moreover, a chiropractor might think he can manipulate either a herniation or a rupture, but a neurosurgeon would say neither should be manipulated."

There are also differing approaches to treatment, he said. "What a chiropractor thinks is abnormal, a medical doctor will tell you is perfectly within normal limits - where a chiropractor will want to provide a remedy, a medical doctor will think treatment is unnecessary."

In this case, "while Suiter's technique may have been correct, [the treatment] should not have been done" once Krieger developed neurological symptoms.

According to Praszkier, "when treating someone like Krieger, it is critical for chiropractors and medical doctors to be on the same page. When they are not on the same page, it is more difficult to recognize a problem before it progresses to an injury." Here Praszkier claimed that the failure to recognize Krieger's developing neurological problems resulted in the ruptured disc injury.

Hostility

During voir dire, Praszkier said he discovered significant hostility against chiropractic treatment on the part of some members of the jury panel.

"It's a longstanding battle - some medical doctors and some people believe in chiropractors and some don't," said Praszkier. He said one person in the jury pool, who is an X-ray technician for an orthopedic surgery group, stated that she shared the view of some in the medical community who think chiropractors practice nothing more than "hocus pocus."

Praszkier said he encountered a wide spectrum of opinions from potential jurors. "Some in the jury pool claimed they needed surgery after a chiropractor ruptured a disc, some thought chiropractors ran up their bills by scheduling unnecessary visits and treatment, and some didn't like chiropractors because they only wanted to know what type of insurance they had and how many visits the insurance company would pay.

"But others viewed chiropractors on the same footing as physicians who have helped them immensely. What was interesting is that people from the medical community were the most opinionated, and the most vocal against chiropractors."

According to Praszkier, many injured patients do not realize they have a potential chiropractic malpractice case when surgery occurs after chiropractic treatment. And many chiropractors are distressed over his verdict.

"I've already received phone calls from chiropractors who are upset about the potential impact of this case on their business," Praszkier said. "They are worried it will leave a bad taste in peoples' mouths about chiropractors."

He also thinks some auto accident defense attorneys might begin to look into whether chiropractic malpractice sometimes makes an injury worse.

"I've also received calls from defense attorneys who think that in some of the cases they've handled where an insured has been in an accident, the person's initial injury may not have been as bad, but treatment from a chiropractor made the injuries more severe because they believe the chiropractor ruptured a disc."


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