Infectious Disease – Pediatrics

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CASE: Infectious Disease – Pediatrics

FACTS: This is a wrongful death medical negligence case brought pursuant to RSA 556:12. The decedent was four months and eight days old when seen and treated at the defendant hospital for a respiratory illness. She was diagnosed as suffering from RSV and bronchiolitis. Over the next 5 and 1/2 days, she had been gradually improving, however, she developed coughing to the point of vomiting, decreased urinary output, decreased feeding and a fever of 103°. As a result, she was brought by her father to the defendant hospital’s emergency room for treatment at 2 a.m.

At the defendant hospital, she was seen by the hospital’s nursing staff and the defendant emergency room physician. Assessment revealed an elevated pulse and an elevated respiratory rate with mild expiratory grunting. Despite those findings, no oxygen saturation rate was taken. Her weight was either not taken or not recorded, no blood tests were ordered, no chest x-ray was ordered, no urinalysis was ordered and no treatment was prescribed.

The decedent’s father was reassured that there was nothing worrisome about her condition and that he should have her seen by her primary care physician “today or tomorrow.” Approximately 36 hours later she was seen by her PCP (at the first available appointment) where the severity of her condition was recognized. Despite prompt hospitalization and aggressive treatment she died of multiorgan failure secondary to bacterial superinfection.

DEFENSE: General denial. The defendants met the applicable standards of care and a lack of causation.

INJURIES: The decedent suffered from an acute bacterial infection, dehydration, respiratory distress, cardiovascular and renal failure, enormous physical and emotional pain and suffering, loss of enjoyment of life, loss of earning capacity, and death.

SPECIAL DAMAGES: Medical bills: $75,967.00; The economic loss to the estate was estimated at $570,000 to $1,000,000.

SETTLEMENT: The parties agreed to settle the case for a confidential amount.

PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law PLLC)

NAMES/COUNTY: Anonymous v. Anonymous

CASE: Osteomyletis

FACTS: In May of 2012, Plaintiff was an active and healthy 13 year old. On Saturday May 26th, she participated in a weekend soccer tournament without incident or injury. She woke up Sunday, May 27th, with pain in her left thigh that prevented her from finishing the tournament. On Monday, May 28th,  she saw her pediatrician because of her leg pain. He took x-rays of her pelvis and hip, which were read as normal, diagnosed her with “left thigh pain”, told her to use crutches and prescribed Tylenol and Motrin. 

Plaintiff had. school field trip to Washington, D.C. scheduled for that week, which sh was eager to join. Her pediatrician approved of her taking that trip. During the four days of that field trip, Plaintiff’s pain became severe and she was unable to get around except in a wheelchair. Despite taking Tylenol and Motrin as instructed, she was in excruciating pain for the duration of the trip. 

Upon her return from the field trip Plaintiff’s mother took her to the emergency room for evaluation of her severe pain. She was seen by the Physician Assistant. The PA noted the history of a week of severe pain, the required use of a wheelchair, her inability to lie on her back or sit and uncontrolled pain despite 400mg of ibuprofen every three hours. The physical exam revealed a pulse of 135, a swollen left buttock and “exquisite” pain to either gluteus maximus, or hamstring and Plaintiff denied any trauma or injury. 

Additional pelvic x-rays were ordered along with an ultrasound of the left buttock. Despite Plaintiff’s denial of any trauma or injury, the clinical history the PA conveyed to the radiologist was “sports injury” and “sport injury to the left gluteal region.” The radiology interpreted both imaging studies as negative for fractures and hematoma, but included in his reports was a recommendation for an MRI if there was a suspicion for a hamstring or muscle tear. The PA did not follow the radiologist’s recommendation despite her impression that the source of the Plaintiff’s extreme pain was “left hamstring/gluteus maximus tear”, nor did he order any blood work. 

Instead, the plan for Plaintiff’s care was pain management, including Tylenol with Codeine, ibuprofen, ice and crutches. Nowhere in the PA’s notes, order or other records concern the the June 3rd vista to the emergency department did she make any mention of reference to, or suggestion that she considered infection as a possible cause of Plaintiff’s prolonged, severe and disabling pain. 

Two days later, Plaintiff had not improved, and her mother was able to get her an appointment with Defendant Orthopedist. His.her physical exam reveal a healthy appearing “markedly distressed, crying and at times hysterically sobbing” patient. Plaintiff was noted to have difficulty moving and able to stand only by “leaning on her mother in a crouched position.: She reported an inability to lie supine and complained of pain in the proximal half of the posterior thigh. The counter of the hamstring appeared normal and “gentle log rolling” did not cause pain. 

Defendant Orthopedist’s diagnosis was “gluteus and hamstring muscle spasm.” His/er differential diagnosis consisted of muscle spasm (gluteus and hamstring) and deep infection. The orthopedist acknowledged that deep infection would be a serious medical problem if it were the cause of Plaintiff’s presentation, but he/she decided against pursuing further investigation. Accordingly, no blood work or imaging was ordered to investigate a possible deep infection. In fact, vital signs were not even taken at the time of the office visit. 

Two days later, Plaintiff returned to the Defendant Hospital Emergency Department. The physician who saw her recognized the possibility of a deep infection and ordered an MRI. However, Plaintiff was in so much pain she needed anesthesia to undergo the MRI so she was transferred to a hospital in Boston where she could receive that care. An urgent MRI of the Hip and Pelvis was performed at the hospital in Boston for probable pyomyositis and possible septic hip and osteomyelitis. That MRI was interpreted as showing: “Extensive left pelvic inflammatory process which most likely initiated osteomyelitis… This is now complicated by extensive pyomyositis with and extremely large fluid collection, likely abscess…” 

Plaintiff was confirmed to be suffering from pelvic abscess, left pelvic/hip osteomyelitis, septic arthritis and fulminous sepsis. She underwent numerous surgeries to deal with her critical illness during her initial three week hospitalization at Boston Children’s Hospital. She spent extensive time in the ICU for resuscitation and sepsis management. 

DEFENSE: General denial. 

INJURIES:  Plaintiff required critical care for two weeks followed by a year of rehabilitation. Her doctors told her that she would eventually require a hip replacement because the infection had caused her to develop extensive arthritis in the hip. At the age of 19 the Plaintiff had a hip replacement. She lives with chronic pain due to the arthritis in the area of the hip and pelvis. 

SPECIAL DAMAGES:  Total medical expenses: $317,285.67  Estimated future medical expenses: $162,239.25

SETTLEMENT: The parties agreed to settle for a confidential amount. 

PLAINTIFF’S COUNSEL:  Randy Reis and Kimberly Kirkland (Reis & Kirkland, PLLC) 

NAMES/COUNTY: Anonymous v. Anonymous