Lessons from the Kowalczyk Case: Chiropractic Risk Management in High-Stakes Cases

Originally published: 2025-02-01

Introduction

The case of Joanna Kowalczyk underscores the critical role chiropractors play in risk management and patient safety, particularly when patients present with a history of prior medical visits and undiagnosed vascular conditions. While chiropractors have a limited scope compared to medical doctors, they are responsible for triaging patients, recognizing red flags, and ensuring that treatment is safe.

1. Never Rely Solely on Patient Self-Report

Key Lesson: Patients cannot be relied upon to provide accurate or complete assessments of their own medical condition, prior evaluations, or ongoing risks.

✅ Best Practice:

Always verify a patient’s medical history through direct communication with healthcare providers—especially when they disclose a recent ER visit.
If a patient states that a doctor recommended further testing but they self-discharged, assume that critical issues were left unresolved.
Use structured intake forms that ask about recent hospital visits, tests performed, and whether the patient was officially discharged with clearance for chiropractic care.

🚨 In Joanna’s Case:

She told the chiropractor that she had undergone a CT scan and had been recommended further testing, but the chiropractor did not request records or call her physician to confirm details.
Assumption: That her discharge meant she was "cleared" for care.
Risk Management Failure: Chiropractors should never assume that a prior medical visit means ominous conditions have been ruled out.

2. Always Obtain Medical Records Before Treating High-Risk Patients

Key Lesson: Chiropractors should not proceed with treatment in cases where vascular or neurological pathology is suspected without a full medical history review.

✅ Best Practice:

Implement a mandatory protocol for requesting and reviewing medical records before adjusting patients with recent ER visits or neurological symptoms.
If immediate access to medical records is not possible, contact the referring physician or ER department for a verbal report before proceeding.
If records cannot be obtained, defer treatment until clearance is established.

🚨 In Joanna’s Case:

The chiropractor did not request medical records before treatment.
A call to her doctor could have confirmed that vascular complications had not been ruled out.
This failure to verify put the chiropractor at significant risk of liability and potentially worsened the patient’s outcome.

3. Never Assume a Prior Medical Visit Means the Patient is Safe for Adjustment

Key Lesson: Just because a patient saw a doctor does not mean they were given a clean bill of health.

✅ Best Practice:

Treat every patient as a new clinical case and assess red flags independently rather than assuming clearance from previous providers.
Be aware that vascular events can be missed in emergency departments, particularly vertebral artery dissections, which are not always immediately symptomatic.
Document explicit reasons for determining that a patient is safe for an adjustment, rather than assuming clearance.

🚨 In Joanna’s Case:

The chiropractor proceeded with treatment despite knowing that the hospital recommended further testing.
A more conservative approach would have deferred treatment until medical clearance was confirmed.

4. Recognize and Act on Stroke Symptoms Immediately

Key Lesson: Chiropractors are well-trained to recognize emergent neurological events and should never delay emergency action.

✅ Best Practice:

Implement a zero-tolerance policy for stroke symptoms—any patient exhibiting:
- Dizziness
- Double vision
- Tingling/numbness
- Speech difficulties
- Loss of balance or coordination
  … should be transported to a hospital immediately.
If a patient refuses to go to the hospital, call emergency services anyway and document the refusal.
Never allow a patient with neurological symptoms to leave the clinic without documented medical evaluation.

🚨 In Joanna’s Case:

She exhibited classic stroke symptoms immediately after the adjustment.
The chiropractor relied on her temporary improvement and allowed her to rest instead of calling an ambulance.
A delayed stroke diagnosis contributed to the fatal outcome.

5. Consider the Rising Risk of Vascular Events Since COVID-19 and the COVID Vaccine

Key Lesson: Chiropractors must recognize that post-COVID vascular events and vaccine-related complications have become an increasing concern.

✅ Best Practice:

Screen for recent COVID-19 infections or vaccinations in patient history.
Be aware that COVID-related vascular inflammation and post-vaccine clotting risks could predispose certain individuals to arterial dissections and stroke.
If a patient has a history of COVID-related symptoms or vaccine side effects, extra caution should be exercised before performing cervical adjustments.

🚨 In Joanna’s Case:

There was no mention of whether she had a recent COVID infection or vaccination.
Given the documented rise in vascular complications post-COVID, this should have been considered as a contributing factor.

6. Implement Strict Documentation and Communication Policies

Key Lesson: In high-risk cases, thorough documentation is critical for legal protection and patient safety.

✅ Best Practice:

Document all patient-reported symptoms and decisions in detail—especially when patients refuse recommended emergency care.
If a patient refuses transport, obtain a signed refusal of emergency care and call their primary physician immediately.
Always communicate with other healthcare providers in suspected stroke cases.

🚨 In Joanna’s Case:

The chiropractor gave her a handwritten note advising her to seek emergency care instead of making a direct call to a hospital or physician.
A formal communication protocol with the ER could have ensured earlier hospital intervention.

Conclusion: The Gold Standard for Risk Management in Chiropractic Care

Joanna Kowalczyk’s case serves as a critical reminder that chiropractors play a key role in patient safety and must adopt proactive risk management strategies to mitigate liability.

📌 Key Takeaways for Chiropractors:
✔️ Never rely on patient self-reports—always verify medical history.
✔️ Obtain medical records before adjusting high-risk patients.
✔️ Do not assume prior medical visits mean the patient was cleared.
✔️ Recognize and act on stroke symptoms without hesitation.
✔️ Take a leadership role in coordinating emergency care.
✔️ Document all critical interactions thoroughly.

By implementing these best practices, chiropractors can protect their patients, their license, and their profession while ensuring optimal safety and care in high-risk situations.

Click Below for the other articles in this series that break down the case: