Academy of Chiropractic

Quickie Podcast 1297
Clinical Information 298 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

Managing a Missing Fragment by a Radiologist

 

 

Speaker 1:

This is being recorded with permission. Good morning. Good morning. Okay, so we're going to kind of start not from way beginning, but tell me about the patient and how long you've been treating them and what the, um, complaints event, um, I'm treating the patient for about two years, uh, after they were in a car accident, they presented with pain in their low back with some ridiculous symptoms into her, their right leg. Um, after some conservative treatment, there was some relief, um, but Kara was kind of inconsistent. Uh, but when the patient would come in, it would be debilitating pain to the point where it was hard to walk.

Speaker 1:

I referred for MRI consultation and they all just reported what they reported, uh, with a moderate, um, disc herniation at the L five S one without any neural impingement. And then she's been treating for two years on and off and coming in during exacerbation periods? Yes. Okay. And how often does the patient come in? Once a month? Once a week, once every six months. Uh, when they are symptomatic, we'll be, uh, one or two times a week for a few weeks, then they get better and then it will be a couple months probably. Okay. And now the insurance company wants an MMI letter from you saying what's the prognosis and why? Yes. So, and that's when you call me, what do I say? And then I want to look at the MRI. Now you're relatively new in the program. You've only been in about two weeks, so you're just being indoctrinated into the world of, of, of really what's going on.

Speaker 1:

So I'll pick it, I'll pick it up from here. So, um, I just looked at your MRR, which you're not trained yet and, and looking at, and it appears there is a disc fragment. That's now S from L five, it looks like it broke off and it's sitting below S one and the kata is severely pinched off between that disc fragment between the fragment and which looks like the ligaments and flies at the back of me. And the quota is down to maybe seven or eight millimeters. We're above it. It's maybe 50 millimeters or more. So let me tell you about what happened to me Mark. In 1989, I treated the case face. She came in, she had low back pain, um, and she was hurting and I treated her. She came in from the ER, she had seen a neurologist who diagnosed her with ms.

Speaker 1:

And that's a reasonable diagnosis for chiropractor to treat for people to help. So I started treating her and she got a little better, got a little worse. I got him back to work. She was back, um, directing a play. Uh, I mean she had little kids. She was taking care of her kids, but she would flare up periodically on and off on and off on and off, she would flare up exactly as your patient identical. Well, she went to a neurosurgeon because she got worse. And the neurosurgeon said you have cervical myelopathy from it, from an extruded disc in your neck. The surgeon slipped in the operated on her, the surgeon slipped and seven her spinal cord. Um, as a result of that, she ended up she's in a wheelchair, but since you know, it's 21 years already, she's in a wheelchair, uh, which I feel horrible about, but everyone was sued.

Speaker 1:

Quoting me. The radiologist got off. It was a reasonable misdiagnosis for the time the surgeon got off because the patient signed something that the, um, it's a reasonable, um, complication during surgery. The chiropractor me was held to grow. Smith was found to have gross misconduct on my license for not ordering the second MRI IQ training and not understanding what was on the MRI with the understanding that even a 1989 MRI was not available for chiropractors to refer to. So I treated this patient for months and because I didn't take that patient and seek that second opinion or order another MRI when I didn't have the ability to, but the great state of New York said that well, and they, they ruled on this in the year 2000, 11 years. I fought them for 11 years, but they ruled that I should have done this and have a misconduct against my license.

Speaker 1:

And they tried to take my license away. I did let them, and we negotiated that out. Um, but this is the exact same scenario. So what you need to do right now is you need to get the patient to a neurosurgeon immediately. Um, and this, this, this doesn't fall on you because you're not supposed to understand what's going on with this patient because the radiologist's report was incorrect. Um, have, did you refer the patient out to any other specialists during the intervening time? I referred her to TCO. What's TC twin cities, sorry, sorry. Twin cities. Orthopedics. Yes. I did refer a general orthopedists to a spine surgeon. I referred her to a spine specialist. And what did that spine specialist say? Um, they were recommending injections at the time and she declined to get a epidural. Okay. Um, and I'm curious if they looked at this cause this, uh, I don't know, you got to get it to work.

Speaker 1:

They probably did not look at this. Yeah, you did the right thing. So from a licensure perspective, you're protected because you did get the, you did refer her out to the orthopedic surgeons who in fact was going to do this. But the only thing I would have done differently is when the patient is in this type of acute scenario, uh, did you speak to the spine surgeon? And I, I promise you that maybe they would have seen a general surgeon, but, um, my question to you is, did you speak to the surgeon? No, I did not. Okay. That's the only other thing I would have done. Um, but that doesn't make you culpable because you did all the right things. You did the MRI, you send them out to an ortho surgeon, a spine surgeon, theoretically. So use it all the right things. So from a licensure perspective, you know, you're okay. But from a patient perspective, she needs to see a neurosurgeon. Okay. Yes. Okay. Any more questions? Cause I'm good to go. You should be also that's it. Okay. Have a great day. Bye-bye.

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