MDLinxLargest ER Malpractice Payout in Georgia History Slams Two Doctors

A $75 million malpractice verdict in Georgia highlights critical diagnostic delays in emergency stroke management following chiropractic cervical manipulation. The case involved a 32-year-old patient who developed locked-in syndrome after brainstem stroke went undiagnosed for over 24 hours, establishing the largest ER malpractice award in state history.

⚕️ Key Clinical Considerations ⚕️

• High-risk chiropractic procedures: High Velocity, Low Amplitude (HVLA) cervical manipulation can cause vertebrobasilar artery dissection, requiring immediate CT angiography with IV contrast for suspected cases.
• Stroke protocol activation: Emergency departments must implement rapid assessment protocols for post-chiropractic patients presenting with neurological symptoms, weakness, or sensory deficits.
• Diagnostic imaging urgency: Vertebrobasilar dissection requires immediate CT with contrast; delayed diagnosis significantly worsens prognosis once neurological symptoms manifest.
• Legal accountability standards: Court precedent establishes clear expectations for timely stroke diagnosis in emergency settings, with significant financial liability for diagnostic delays.
• Risk stratification protocols: Most chiropractic patients lack proper medical clearance before manipulation, creating increased vulnerability for those with predisposing vascular risk factors.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Counsel patients seeking chiropractic care about vertebrobasilar dissection risks, particularly with cervical manipulation techniques, and advise immediate emergency evaluation for post-treatment neurological symptoms.
• Practice Integration: Establish clear triage protocols for post-chiropractic patients, ensuring rapid stroke team activation and neuroimaging capabilities are readily accessible for suspected vascular emergencies.
• Risk Management: Document thorough neurological assessments and imaging decisions for all post-manipulation presentations to meet evolving legal standards for emergency stroke care.
• Action Items: Train staff on recognizing vertebrobasilar dissection presentations and implement standardized imaging protocols for suspected cases to minimize diagnostic delays.

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