Legal Review & Commentary-Failure to promptly diagnose viral meningitis: $7.3 million settlement
News: Four days after a child was first presented at the hospital, her meningoencephalitis was diagnosed. Failure to make a timely diagnosis caused a delay in administration of the appropriate medication, which led to her brain damage. A $7.3 million structured settlement was provided on the first day of trial.
Background: The 6-year-old child first went to the hospital one afternoon, complaining of fever despite having taken Tylenol and Motrin as prescribed at a primary care clinic the day before. Her mother said the child had been sleeping excessively, was generally less active, and had not eaten well for the past three days. After waiting five hours in the emergency room, she was seen by the emergency room physician and discharged home with a diagnosis of a viral upper respiratory infection, possibly bronchitis.
The following evening, she was brought back to the hospital because her fever had persisted and her face was numb. The staff doctors noted that she was lethargic and dehydrated. When she was given fluids, she was unable to swallow. Early the next morning, a pediatrician was called in, and he performed a spinal tap. Based on the results, the consulting pediatrician diagnosed meningitis and dehydration. Believing she had bacterial meningitis, a staff pediatrician admitted her to the hospital, where she was treated with antibiotics.
Over the next two days, her condition worsened. By the end of the second day, she was comatose. One of the attending medical residents noted that the spinal tap reading was an indication of viral rather than bacterial meningitis. She was not started on Acyclovir until the day she was transferred to a neighboring city's children's hospital. By the time she had arrived at the children's hospital, irreparable brain damage had occurred.
In preparation for trial, the children's hospital's pediatric neurologist stated that the initial hospital had been negligent in its failure to have the staff physicians make the diagnosis of meningoencephalitis. On the trial's first day, a $7.3 million structured settlement was reached with the hospital and the county responsible for hospital operations.
What this means to you: Although the facts in this instance are similar to those posed in the case described on p. 2, the fault and subsequent liability fell squarely on the hospital and the county that owns it. In this case, the physicians were employed by the hospital and had contractual arrangement to care for such patients. "When the hospital has a contractual arrangement with the attending physicians, risk managers must become more involved with protocols," says Michele Bellmore, senior risk management consultant at Sinai-Grace Hospital in Detroit.
Bellmore says the emergency room physician should have consulted with a pediatrician or pediatric neurologist during the first emergency room visit and should have worked the child up for sepsis. Bellmore also says it does not appear the patient was discharged with appropriate instructions. During the second visit, there was additional delay in care when the child was not seen until the next morning by the pediatrician. Finally, the hospital was slow to treat even after viral meningitis was diagnosed.
In summary, hospital nursing appears to have failed to note the child's symptoms, react appropriately, or notify the physician so appropriate steps could be taken, Bellmore concludes.
Reference
Merly Tapia v. County of Kern and Kern Medical Center, Bakersfield County (CA) Superior Court, Case No. 234387 SPC.
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