A coroner is calling on Quebec to regulate the osteopath industry “as soon as possible” following the death of a woman who sought treatment for chronic neck pain. Huguette Papineau, 80, died on May 17, 2024, 13 days after going to the emergency room at Charles-Le Moyne Hospital on Montreal’s South Shore. Coroner Annie Nadon concluded that she died from complications of a stroke, “but the cause—whether spontaneous or traumatic—remains undetermined.” However, according to the leading theory from hospital physicians, the cause was “bilateral vertebral dissections, likely caused by trauma following osteopathic cervical manipulations,” the report stated. The coroner’s report, dated Sept. 16, said Papineau had a long history of neck pain and headaches and in July 2023, she received physical therapy, which didn’t help her condition. She was then referred to an osteopath and received seven treatments between March and May 2024. Her condition worsened during this time, leading to vision problems and extreme fatigue. In the nearly two weeks she spent in hospital before her death, her neurological condition deteriorated rapidly and she experienced balance problems, speech difficulties, headaches, decreased sensation on the right side of her face, loss of strength, weakness, and paralysis on the right side of her body. Various tests revealed she suffered strokes before receiving palliative care. Nadon explained in her report that vertebral artery dissection is bleeding that occurs in the artery wall and tears it without rupturing it, which can trigger a stroke. It can be caused by several factors, from something as minor as a sneeze or hyperextension, and can be minor or fatal. “Similarly, certain osteopathic treatments, depending on the patient’s predisposition, the technique used, and the force applied, could be a contributing factor,” she said. “The totality of the evidence indicates that Ms. Papineau died from medical complications of multiple vertebrobasilar strokes following bilateral vertebral dissections,” Nadon said. “Although osteopathic care is provided as a contemporary treatment, in the context of preexisting neck pain and headaches, the available information does not allow us to determine whether the dissections were spontaneous or traumatic in origin. Nor can it confirm or rule out whether a cervical movement, physical exertion, or osteopathic treatments contributed to the dissections and the onset of the strokes.” Recommendation for a professional order In her report, Nadon noted the growing popularity of osteopath treatments, citing a 2020 Leger survey that showed one in four Quebec adults seeking osteopath treatment. Ostéopathie Québec estimates that two million osteopathic sessions are provided each year in Quebec, which now has more than 3,000 osteopaths. In June 2026, the Government of Quebec announced that osteopaths would be integrated into the Order of Chiropractors, but the province’s Office of Professions has struck a committee that is still ironing out the details to ensure a smooth transition, which could take several months to complete. Coroner Nadon acknowledged integrating into an existing professional order presents some culture and governance challenges regarding but nonetheless, “It is desirable that this work proceed expeditiously and allow for recognition of the specific characteristics of osteopathic practice,” adding that “certain treatments may carry risk.” “Certain specific cases and risk factors call for vigilance, particularly the presence of neurological symptoms and/or care involving the cervical spine. Some of the activities performed by osteopaths are similar to those of professionals whose practice is regulated,” Nadon added. In a statement to CTV News, Ostéopathie Québec said it has been calling for osteopaths to be regulated by a professional order for years. “We have always maintained that a clear professional regulatory framework is the best way to ensure public protection, establish uniform standards of practice, and adequately recognize the competencies of osteopaths and their contribution to public health,” said spokesperson Catherine Lafortune. “The working committee for the integration of osteopaths into the Order of Chiropractors has now been formed; its work has just begun, and we hope that the professional regulation of the profession will be finalized as soon as possible.”
