Upholding the Standard of Care: The Chiropractor’s Appropriate Emergency Referral in the Tragic Case of Jonathan Buckelew
Written by: James Demetrious, DC, DABCO
The tragic outcome of Jonathan Buckelew’s vertebral artery dissection and subsequent locked-in syndrome is a sobering reminder of the vital importance of the timely and accurate diagnosis of cerebrovascular events. While this case culminated in a $75 million jury verdict, it is essential to clearly distinguish the roles of each healthcare provider involved.
Notably, Dr. Michael Axt, the chiropractor who rendered care on the day of Buckelew’s acute deterioration, fulfilled his professional obligations by recognizing the emergency and promptly referring the patient for advanced medical evaluation. The legal and clinical record affirms that Dr. Axt did not breach the standard of care; rather, the catastrophic lapse in this case was due to subsequent failures by the emergency room physician and radiologist at North Fulton Hospital.
The Chiropractor’s Appropriate Emergency Response
On October 26, 2015, Jonathan Buckelew sought care from Dr. Michael Axt for persistent neck pain and other symptoms, including tinnitus and visual disturbances. These symptoms, while concerning, are not uncommon in musculoskeletal complaints and can present in the absence of serious pathology. Nevertheless, Dr. Axt adjusted Mr. Buckelew’s neck, during which time Buckelew became disoriented and then lost consciousness. Immediately recognizing the severity of the situation, Dr. Axt called emergency medical services. Paramedics arrived and transported the patient to North Fulton Hospital for further evaluation.
This sequence of events illustrates Dr. Axt’s adherence to the chiropractic and general healthcare standard of care in emergency situations. The standard requires that providers:
- Monitor for adverse reactions,
- Recognize signs of serious neurological compromise, and
- Initiate emergency referral when warranted.
Dr. Axt reportedly did all three. Importantly, he did not attempt to manage the patient beyond his scope, nor did he delay care. The speed and decisiveness of his emergency referral ensured that Buckelew was placed in the hands of emergency medical professionals without delay.
No Liability Assigned to the Chiropractor
In the resulting malpractice litigation, Dr. Axt was originally named in the lawsuit. However, he was dismissed from the case prior to trial following an “amicable resolution,” and ultimately the jury found no negligence on his part. The court’s actions validated that Dr. Axt had complied with the expected standard of care. His timely referral removed him from the chain of liability in the tragic outcome that followed.
It is critical to recognize that the law, as well as medicine, evaluates culpability based on whether a provider’s actions met the expected standard given the information available at the time. In this instance, Dr. Axt met and arguably exceeded that threshold by taking immediate life-saving steps.
Medical Missteps: Breach of Standard of Care by the ER Team
While Dr. Axt did what was clinically appropriate, the same cannot be said for the emergency room team that received Mr. Buckelew. The jury ultimately found two providers at North Fulton Hospital liable for Buckelew’s catastrophic outcome:
- The emergency room physician, Dr. Matthew Womack (60% liability), and
- The radiologist, Dr. James Waldschmidt (40% liability).
Their collective failure to recognize and appropriately act upon the signs of vertebral artery dissection constituted a clear breach of the standard of care.
Vertebral artery dissection (VAD) is a time-sensitive vascular emergency. Patients may present with non-specific symptoms such as neck pain, headache, dizziness, or visual disturbances as exhibited by Buckelew. Guidelines from both neurology and emergency medicine emphasize the need for high clinical suspicion in the setting of acute neurological change, particularly when accompanied by posterior circulation symptoms.
In Buckelew’s case, the treating ER physician allegedly failed to relay the full clinical picture to the consulting neurologist and radiology team. Furthermore, the radiologist failed to identify a vertebral artery dissection on imaging studies. These combined failures resulted in a catastrophic delay in diagnosis and treatment, allowing the dissection to progress into a brainstem stroke, which left Buckelew permanently locked-in, mentally intact but unable to move or speak.
The breach was not merely a missed diagnosis; it was a systemic breakdown in the interpretation and communication of clinical information. This is why the jury, after hearing extensive expert testimony, returned a verdict assigning 100% liability to the hospital’s providers, completely exonerating the chiropractor.
Conclusion: Recognizing Proper Standards Across Disciplines
In evaluating complex malpractice cases, it is imperative to assess each provider’s actions within the context of their training, scope, and immediate circumstances. The chiropractor, Dr. Michael Axt reportedly identified a medical emergency, responded appropriately by calling 911, and ensured Mr. Buckelew was transferred for emergent care. His role ended with that transfer, and the legal system rightly acknowledged his compliance with the standard of care.
Conversely, the emergency room physician and radiologist at North Fulton Hospital failed to meet their own standards of diagnostic vigilance and inter-provider communication. The tragic outcome of this case underscores not only the need for better acute stroke recognition protocols in emergency settings but also the importance of fairly attributing liability. The legal dismissal of Dr. Axt and the jury’s verdict affirm that accountability rests where the true breach occurred, in the emergency department, not in the chiropractic office.
Disclaimer
The information presented in this article was developed using publicly available sources, including legal filings, media coverage, and medical literature. It is intended solely for educational and informational purposes and does not constitute legal or medical advice. While every effort has been made to accurately represent the facts as reported, the author makes no warranties regarding the completeness or accuracy of third-party information. The author, Dr. James Demetrious, expresses his deepest sympathy for Jonathan Buckelew and his family. The inclusion of this case is not intended to diminish the tragic nature of the events, but rather to provide constructive insights into professional standards of care, emergency response, and system accountability in hopes of preventing similar outcomes in the future. Readers are encouraged to consult legal counsel or medical professionals for guidance specific to their individual circumstances.
Disclosure
The information provided in this article and all PostGradDC coursework should not be considered standards of care. We offer this information for educational purposes only. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding medical conditions or treatment. Seek the opinion of your legal representative.
Conflict of Interest Statement
Dr. James Demetrious is a board-certified chiropractic orthopedist and the founder and owner of PostGradDC (PostGradDC.com), a privately operated provider of chiropractic continuing education. He develops and delivers postgraduate coursework on clinical examination, diagnosis, patient safety, and risk management, including content related to cervical artery dissection and informed consent. Dr. Demetrious has published peer-reviewed research on these topics and provides consultation services to chiropractic physicians, attorneys, and professional organizations. This commentary was written independently and without external funding. While his educational and advocacy activities promote evidence-based chiropractic practice, the views expressed herein are his own and are based on interpretation of the current scientific literature.
PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a distinguished board-certified chiropractic orthopedist, educator, author, and editor.
© 2025 – James Demetrious, DC, DABCO. Open Access. Unrestricted use, distribution, and reproduction are allowed in any medium, provided you give appropriate credit by citing the original author and source: Demetrious J. PostGradDC. Upholding the Standard of Care: The Chiropractor’s Appropriate Emergency Referral in the Tragic Case of Jonathan Buckelew. PostGradDC.com; 2025.
