Largest ER malpractice payout in Georgia history slams two doctors
Key Takeaways
Industry Buzz
“There are many patients who come to the emergency department after manipulation from a chiropractor, but not all of them have vascular catastrophes.” — Ken Perry, MD, FACEP, emergency medicine attending physician
“If you seek chiropractic treatment, you should not let [chiropractors] ‘manipulate’ your neck because there is a high risk of serious injury and stroke.” — Ryan Marino, MD, emergency physician and associate professor at Case Western Reserve University School of Medicine
When 32-year-old Jonathan Buckelew saw his chiropractor for neck care in October 2015, he didn’t know he’d be involved in what would become the largest emergency room malpractice verdict in Georgia’s history. []
Buckelew collapsed during his chiropractic visit and was taken to North Fulton Hospital, where matters only got worse, Radiology Business reports.
While his physician failed to make an appropriate diagnosis until his second day in the hospital, Buckelew suffered a brainstem stroke, leading to “locked-in syndrome.” []
Locked-in syndrome is a catastrophic diagnosis where a patient has the complete ability to synthesize thoughts but has no way of communicating beyond using their eyes, according to Ken Perry, MD, FACEP, an emergency physician.
“It is classically taught to be the result of an ischemic stroke within the basilar artery,” Dr. Perry says. He highlights The Diving Bell and the Butterfly, a memoir and movie about living with locked-in syndrome.
Read more about malpractice:
About the malpractice lawsuit
Flash forward to a March 25, 2025, statement from Buckelew’s legal team, which stated that the physician and radiologist’s gross negligence led to the jury awarding Buckelew $75 million in damages, with $40 million attributed to the physician. []
“The Court of Appeals has made it clear that emergency room physicians must be held accountable when their actions—or inaction—lead to catastrophic harm,” the statement read. “This case highlights the critical importance of timely and accurate stroke diagnosis in emergency medicine.”
Ryan Marino, MD, an emergency physician and associate professor at Case Western Reserve University School of Medicine, agrees with that assessment. “Rapid stabilization and diagnosis are important so that people can undergo any needed treatments or interventions as soon as possible,” he says.
Risks of chiropractic treatment
Emergencies following chiropractic adjustments aren’t uncommon, Dr. Perry says. “There are many patients who come to the emergency department after manipulation from a chiropractor, but not all of them have vascular catastrophes. If the patient has symptoms of stroke, such as weakness or sensory deficits, many hospitals will have protocols to get a workup for a possible stroke.”
Unfortunately, a specific type of chiropractic manipulation of the neck, known as High Velocity, Low Amplitude (HVLA), is known to cause dissection or tearing of the small vertebrobasilar arteries in the neck,” according to Jared Ross, MD, an emergency physician and assistant professor at the University of Missouri.
“If that is suspected, a patient should immediately have a CT scan with IV contrast dye performed to confirm the diagnosis," Dr. Ross says. "For patients with vertebrobasilar dissection, treatment can be started to decrease the risk of stroke. Unfortunately, once patients have started experiencing neurological symptoms, their prognosis becomes very poor.”
Dr. Marino offers up some advice: “If you seek chiropractic treatment, you should not let [chiropractors] ‘manipulate’ your neck because there is a high risk of serious injury and stroke.”
According to an article in Biomedical Research and Reviews, “spinal manipulation, a hallmark practice of chiropractic providers and a practice occasionally utilized by physiotherapists, osteopaths, and physicians, is often viewed as a controversial and potentially dangerous procedure without good evidence supporting its use … Most patients are never cleared medically for manipulation, which can be devastating for those few who are at increased risk for dissections.” []
Related: What to do when facing a malpractice lawsuit