Coroner’s Inquest or a Script for a Hollywood Movie?

The Coronial Inquest into the cause of death of a Canadian woman in 1996 is beginning to sound more like a Hollywood movie script . The plot involves nearly all the necessary ingredients for a good movie; an unfortunate death, conspiracy theories, cover ups, possible witness collusion, misrepresentation of scientific literature, brown paper envelopes full of evidence, media manipulation and grandstanding attorneys.

The main players are, in order of appearance: Ms. Lana Dale Lewis, the deceased, aged 45 years; Dr. Philip Emanuele, Ms. Lewis’s chiropractor; Drs. Deck and Pollanen, neuropathologists; Dr. Norris, neurologist, Dr. Murray Katz, noted anti-chiropractic crusader; Ms. Amani Oakley, council for the Lewis family; Mr. Brian Foster, counsel for Dr. Emanuele; Mr. Tin Danson counsel for the Canadian Chiropractic Association (CCA) and the Canadian Memorial Chiropractic College (CMCC).

The story line reads something like this: Ms. Lewis, with a medical history of poorly controlled hypertension, migraine headaches, smoking, cardiovascular problems and elevated cholesterol, consults her local chiropractor, Dr. Emanuele, on 26th August 1996 for the treatment of persisting headaches. Ms. Lewis is treated with spinal manipulation to the cervical spine. Five days later she presents at a local hospital emergency department complaining of severe neck pain, orientation problems and headache. The attending physician examines Ms. Lewis and views a CT scan of the head and neck. The physician concludes that Ms. Lewis has suffered a stroke. Ms. Lewis is treated with blood thinning agents and anti-hypertension medication and after observation is discharged. On September the 10th 1996 Ms. Lewis is transported to hospital by ambulance and a further CT scan confirms a second stroke to the left posterior region of the brain. The following day Ms. Lewis is pronounced brain dead.

An autopsy conducted by two neuropathologists, Drs. Deck and Pollanen, concluded that Ms. Lewis died of a vertebral artery dissection resulting from the neck adjustment she had received from Dr. Emanuele on 26th August 1996.

Enter the man wearing the big black hat, Dr. Murray Katz, Toronto paediatrician and anti-chiropractic crusader. Katz is well known for his ferocious attacks on chiropractic and his push to have cervical spine manipulation banned. In 1978 the New Zealand Commission of Inquiry into Chiropractic reported that Dr. Katz had indulged in a “deliberate course of lies and deceit ... without any appearance of shame” and charged him with “plainly fraudulent conduct” with regard to his appearance before that Commission. According to one witness, Dr. Katz heard of the Lewis case from someone in the Coroner’s office and contacted the Lewis family offering his help and to act as their legal agent.

However, Dr. Katz has been prevented from appearing at the inquest, and disqualified as an agent by the Coroner after sending a threatening letter to Coroner Naiberg. Katz also sent a letter on 18th December 2000 to Dr. Pollanen, one of the two neuropathologists who performed the autopsy, requesting a meeting with him. Dr. Pollanen said that he refused to meet with Dr. Katz because he was not certain that Dr. Katz had any standing with the inquest. Dr. Pollanen explained that Dr. Deck, the other neuropathologist involved in the autopsy, had thought very highly of Dr. Katz and had apparently intended meeting with him to discuss the case. When Dr. Deck became ill he turned over the case to Dr. Pollanen who thought it unusual for a pediatrician to express opinions on vertebral artery pathology.

Enter another “black hat” Dr. John Norris, neurologist at Sunnybrook Health Sciences Centre, Head of the Canadian Stroke Consortium and co-author of the SPONTADS study. You may recall this study, the preliminary results of which were released on 3rd February, 2002, and which sent alarm bells ringing throughout the medical and chiropractic fraternities when it quoted that the risk of stroke from cervical spine manipulation was 1:5000.

However, under cross examination at the inquest, Dr. Norris admitted that the SPONTADS figures was incorrect and “sheer guesswork” and that the true risk from the SPONTADS study showed a risk of 1:2.2 million. When questioned on how he arrived at the 1:5000 risk factor he said he could not recall his reason for announcing such a figure. Subsequently the Coroner ruled any reference to the SPONADS study at the inquest be considered inadmissible.

Now it appears that Dr. Norris and Dr. Katz are good friends, first meeting in the fall of 1999 and subsequently meeting on four occasions, once with a lawyer. At the first meeting, discussions were held about forming a team of experts to testify at the inquest, including an anatomist, histologist, epidemiologist, pathologist, geneticist, and a neuroradiologist. As well as these meetings there was a voluminous amount of correspondence between the two, including an email from Dr. Norris to Dr. Katz in August 2000. The email, which “came to light” included the phrases “Your remarks about the chiros indicate a high degree of panic! We’ve got them on the run!” Dr. Norris under cross-examination, during the inquest, indicated that Dr. Katz had asked him to do things that he didn’t want to do and had refused to do. In January 2001, Dr. Norris prepared a medical/legal report for this inquest, which connected Ms. Lewis’ stroke to a chiropractic adjustment.

In what appears to be another media stunt Dr. Norris testified that he had arranged for Dr. Katz to speak on the topic of chiropractic stroke to the medical staff of Sunnybrook Hospital in April 2000 and despite the fact that he had already extended an invitation to Drs. Sil Mior and Howard Vernon of CMCC, to present at this venue, he withdrew the invitation at Dr. Katz’s request. Dr. John Edmeads, Chief of Sunnybrook’s Department of Medicine and Dr. Norris’ direct superior characterized Dr. Katz’s presentation as a “rambling and savage sandbagging of chiropractic.”

At two press conferences, in 1997 and 1999, both Katz and Norris were present with the Lewis family to announce that Ms. Lana Lewis died as a direct result of a vertebral dissection, caused by the cervical adjustment delivered by her chiropractor Dr. Emanuele. Further, at the 1999 press conference the family announced a $12 million lawsuit against Ms. Lewis’ chiropractor, CMCC, Dr. Jean Moss, the Canadian Chiropractic Protective Association (CCPA), Dr. Paul Carey and the College of Chiropractors of Ontario (CCO) Dr. Jaroslaw Grod, then Deputy Registrar. At the inquest when asked why he had appeared at the press conference Dr. Norris replied “I was there to give support to the family,” as well as attest to the possibility that neck manipulation can cause a dissection of the vertebral artery and lead to a stroke”. Strangely enough, at the inquest when Dr. Norris was questioned about how he concluded that Ms. Lewis died as a result of the manipulation, he replied that at the time of the press conference he had never reviewed Ms. Lewis’ medical records and knew nothing of her medical history when he wrote his opinion. Even more damming was his admission that he possibly relied on information supplied by his buddy Dr. Murray Katz and what he had read in the newspapers. Now that’s what I call good science.

In March 2000 The Superior Court of Ontario ruled that there is no basis in law for the inclusion of the laws suit against the chiropractic bodies CMCC, CCPA, CCO, and Drs. Moss, Carey, and Grod and to date the claim against Dr. Emanuele has not proceeded.

Undeterred, “the big black hat” pushed for a Coronial Inquest, even after two previous decisions by the Coroners office found that the evidence did not warrant an inquest, however in November 2000 the request for the inquest was granted and began on 22nd April 2001.

The inquest to date has focused primarily on evidence relating to on the events leading up to Ms. Lewis’ death and various expert testimonies on the autopsy findings and neuropathology of stroke and, in general, stroke related to spinal manipulation.

Dr. Norris’ expert testimony on the causal relationship between the cervical manipulation and Ms. Lewis’ stroke took a further battering during cross examination by one of the “white hats”, Mr. Tin Danson counsel for the CCA and the CMCC. At one point during the day Mr. Danson asked Dr. Norris “Given the preponderance of probabilities in this case would you agree that Lana Dale Lewis’ death was a result of a natural disease process?” to which he agreed. Evidence to date has indicated that Ms. Lewis first complained of neck pain on 31st August, five days after the adjustment. This time delay between the onset of neck pain and the manipulation is crucial. If an arterial dissection was to occur from the manipulation then, as Dr. Norris agreed, the pain had to be within a few hours or the same day in order to conclude that the explanation was chiropractic manipulation and if not he would have to look for an explanation beyond chiropractic manipulation. Furthermore, Mr. Danson suggested that a chiropractic neck adjustment delivered on August 26, 1996 could not produce an intracranial dissection on or about September 10, 1996, to which Dr. Norris agreed. He also agreed that trauma was not needed to cause damage to the arteries either intra or extracranially

Enter another white hat, who was formally a black hat, Dr. Pollanen, one of the two neuropathologists who performed the autopsy of Ms. Lewis. In two previous reports Dr. Pollanen concluded that Ms. Lewis’ stroke was related to the cervical manipulation. However, after finding and reviewing several histology slides, which were not reviewed in forming the first two opinions, he concluded that Ms. Lewis died of natural causes due to an advanced case of atherosclerosis. “We were wrong,” Dr. Pollanen told the Coroner’s Inquest, “In retrospect, our conclusions were erroneous.” Dr. Pollanen emphasised his belief that the intracranial portion of the vertebral artery contained severe atherosclerosis, which led to the formation, over a period of time, of a thrombus. This thrombus grew down into the extracranial portion of the vertebral artery as well as towards the basilar artery. Eventually, this led to Ms. Lewis’ strokes and death.

Further appearances of white hats, Dr. Scott Haldeman, chiropractor and neurologist, and widely respected neurosurgeon, Dr. Richard J. Moulton and Dr. Hamilton Hall, orthopaedic surgeon, testified that Lana Lewis died of natural causes and firmly rejected any association between her death and her chiropractic treatment.

The inquest is now in recess and will resume on 9th September 2002.

From my interpretation of the proceedings, the evidence to date, overwhelmingly exonerates chiropractor Philip Emanuele of any blame in the death of Ms. Lewis. What is most disturbing and of great concern to all chiropractors worldwide is the well planned and obviously well funded campaign against chiropractic by Katz and Norris. If one assumes that there a concerted effort by certain sections of medicine to, at the very least, see a banning of cervical manipulation by chiropractors, who is funding this effort? Can it happen here in Australia? You bet your sweet a…. it can.

John Reggars