By Stacey Kusterbeck
When the plaintiff in a malpractice claim is a child or a child’s family, the ED’s preparedness for pediatric emergencies will become a central focus of the case. “Providing emergency care for children is highly specialized, and differs from adults. Children are not just small adults,” underscores Robert W. Derlet, MD, a professor emeritus of emergency medicine at UC Davis School of Medicine.
Many large, urban EDs maintain separate areas for children staffed by pediatric emergency physicians (EPs). “But most community hospital EDs do not have separate pediatric areas or pediatric emergency physicians,” Derlet notes.
Derlet says during litigation involving pediatric care in the ED, plaintiff attorneys will scrutinize whether the EP had immediate access to a pediatric consult by phone or in person. The attorney also will ask whether the ED had made available appropriate supplies specific for pediatric patients (e.g., medications for sedation, procedure kits for lumbar punctures). Plaintiffs will search for evidence indicating whether the ED had plans in place to transport pediatric patients who need a higher level of care.
Elsewhere, attorneys will want to know if the EP was board-certified in emergency medicine, how many hours of training in pediatric emergency medicine the EP received during residency training, and how much continuing medical education (CME) in pediatric emergencies the EP received in the past several years. If the EP’s training occurred years earlier, or the EP had not undergone any CME involving emergency pediatrics, attorneys could use these facts to argue the clinician was inadequately trained.
How experienced was the EP in treating pediatric patients? Plaintiff attorneys will examine factors such as the annual pediatric volume in the ED to which the plaintiff presented, the number of pediatric intubations performed in the ED, the number of pediatric patients admitted from the department, and how many pediatric patients are transferred to another facility for a higher level of care. If those numbers are low, the attorney can make an issue of the fact the EP rarely cared for pediatric emergencies.
What about training for nurses? If the suit concerns a dosage error made by nurses, plaintiffs will examine whether they had undergone specialized pediatric training, along with the volume of children in their care. “Most medication doses for kids are in mg/kg. Errors made in calculating doses are more frequent,” Derlet notes.
Litigation will center on training, experience, and facility resources.
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