SMITH V YOHE Supreme Court of Pennsylvania 10-9-63
Background: Mr. Smith, an aged man, was seen by orthopedist Yohe for hip pain. He neglected to take x-rays. Mr. Smith subsequently died from complications of a hip fracture. Yohe and an associate (Galey, who was later absolved) were sued for negligence. Defense argument was that Yohe erred in judgment by not taking x-ray, and thus no civil damages were indicated. Plaintiff argued that this was not an error of judgment but negligence, requiring damages Case went to State Supreme Court. Court found that x-rays especially in the case of geriatrics patients with hip pain, were necessary and common practice. Failure to perform indicated negligence not error of judgment. Here is the courts ruling;
"If a physician, as an aid to his diagnosis (i.e.: his judgment) does not avail himself of the scientific means and facilities open to him for the collection of the BEST factual data upon which to arrive at his diagnosis, the result is not an error of judgment but negligence in failing to secure and adequate factual basis upon which to support his diagnosis or judgment"
Cockburn's Commentary: WOW! The case of Smith V Yohe, while possibly not applicable in every state, is non-the-less a supreme court ruling with tremendous implications in chiropractic.
The x-ray mensuration and or x-ray digitizing argument comes to mind. Regardless of consensus opinion and the politics of same, imagine what could happen in a chiropractic malpractice case with the following scenario:.
A patient comes to chiropractor Lillard with complaints of headache following a major auto accident. Dr. Lillard takes a seven view Davis Series, notices a kyphotic reversal of the cervical curve, diagnosis a whiplash injury, agrees with the radiologists impression that the reversal is due to muscle spasm, and then orders a course of therapy to include spinal manipulation, supported with the use of hydrocollator, ultrasound, intersegmental traction and home use of mineral ice.
A week later, the patient is seen at the ER for transient ischemic attacks, dysphagia, dysarthria and disorientation. The head is held in a dependent position and he can not move without assistance. Intake x-rays reveal a dislocation of the C4-5 segment at 5.4mm's.
Suit is filed alleging that Dr. Lillard adjusted a severe dislocation and caused damage to the vertebral artery and spinal cord. Plaintiff alleges further that had Dr. Lillard measured the intersegmental instability he would have precluded force technique to this region. Plaintiff indicates that a subluxation might have existed that could have been measured and the failure to mark and measure the x-ray caused the dislocation, obviously the patient did not have such neurological findings prior to being manipulated, even though he had a significant C.A.D. injury.
In his defense Dr. Lillard states that he was taught in chiropractic college that you can not see a subluxation on an x-ray, and that lines of mensuration are meaningless.
Plaintiff has the x-rays digitized by two independent x-ray digitizing companies, one owned by a DACBR and one owned by a medical radiologist, both of which independently demonstrate a subluxation at C4-5 pre treatment of 4.3mm's (dislocation range.)
Now re-read the courts decision in Smith v Yohe and examine the implications in your own practice. also see Willet V Rowekamp