The most award winning
healthcare information source.
TRUSTED FOR FOUR DECADES.
News: A 10-year old girl died as a result of complications due to pneumonia after doctors mistakenly diagnosed her with the flu. The child’s mother had taken her young daughter to the hospital for symptoms that included fever, vomiting, and respiratory difficulties. Upon evaluation by the late night clinic physician, it was determined that the child was suffering only from a viral flu. She was sent home with her mother without any course of treatment or medication. The following day the woman rushed her ailing daughter to the hospital where the child was pronounced dead as a result of the pneumonia. The parents brought suit against the hospital for medical negligence; however, prior to trial, the hospital made the decision to settle with the family for $265,000.
Background: After complaints of difficulty breathing, fever, and vomiting, a mother took her 10-year-old daughter to a local hospital’s after-hours urgent care clinic for evaluation. Due to the time of night, the child was one of the last patients evaluated by the late-night staff before closing. The physician evaluated the girl but only gave her a basic evaluation. Despite noting the young girl’s fever, complaints of vomiting, and respiratory distress, the physician dismissed the symptoms as merely a result of a common viral flu. The doctor decided not to order a chest X-ray or even conduct basic diagnostic procedures such as taking the girl’s blood pressure readings. The doctor opted not to provide a prescription for a standard course of antibiotics because the doctor was confident the child suffered only from a viral flu.
Pneumonia, while generally treatable, can pose deadly threats if not adequately addressed by physicians. Currently, pneumonia is the eighth leading cause of death in the United States, according to the National Center for Health Statistics. Infants, the elderly, and patients with compromised immune systems are most susceptible to serious cases of pneumonia. If not treated quickly, patients of any age will begin to suffer respiratory failure due to excess fluid in the lungs.
Another important concern that can prove to be fatal is sepsis. Once the infection spreads to the patient’s bloodstream, a drastic drop in the patient’s blood pressure often leads to cardiac arrest.
Tragically, in this case, the young girl was suffering from a serious case of pneumonia that required immediate treatment. Throughout the night, the mother closely monitored the girl; however, her condition was becoming progressively worse. By the following morning, the woman found her daughter gravely ill. Despite rushing the girl quickly to the hospital, the girl died in the emergency department that morning after succumbing to undiagnosed and untreated pneumonia. An autopsy later confirmed the tragic diagnosis. Sadly, the girl likely was suffering from pneumonia five days prior to her passing.
The parents brought suit against the hospital for negligence for failing to adequately evaluate the young girl despite the seriousness of the symptoms she presented with. Due to the medical caps in California, the family was likely only expecting a maximum of $250,000 for non-economic damages (pain and suffering) based on the Medical Injury Compensation Reform Act. Nine months after the suit was filed against them, the hospital decided to settle with the family for $265,000.
What this means to you: The facts of this case are as simple as they are heartbreaking. The doctor did not adequately evaluate the young girl when she presented with serious symptoms that required additional inquiry and immediate medical attention. As is all too often the case, neglect by medical facilities to establish and/or implement protocols incorporating differential diagnosis techniques resulted in tragedy. In this case, instead of ensuring that each and every patient received a thorough examination, the doctor provided the child with only a cursory medical exam and neglected serious red flags along the way. It should not matter if the child was the last patient to be admitted to the urgent care clinic that evening. It was the hospital’s responsibility to ensure that their physicians provide, to each and every patient, care meeting the required standard.
Another consideration for hospitals is the need to ascertain the right course of action. Often, medical protocols and standards take time to be established, and they might be burdensome or costly to implement. Nonetheless, hospitals should be forward-thinking, and they should aspire toward a higher standard of care than what might be the simple bare minimum. Lawsuits often require the medical community to evaluate the mistakes and pitfalls of other hospitals and physicians because their actions fell below the current required standard of care. Instead, medical professionals should strive to provide the best standard of care possible given the current medical knowledge and treatments. At the very least, however, hospitals must ensure that the established standard of care is met for each and every patient who walks through the hospital’s doors.
This case also raises the issue of caps on medical malpractice damages. California law, like other states that implement medical caps for the recovery of damages, severely limits recovery for medical malpractice as further detailed below. That limit creates a serious obstacle for clients and their families who seek compensation for the severity of damages suffered. However, these medical caps can be advantageous to medical facilities as the cap limits the amount the hospital is required to compensate for damages, even though these medical caps are often small in comparison to the lifelong funds frequently needed to adequately care for plaintiffs’ permanent injuries.
The history of medical caps in California dates back to 1975 with the enactment of the Medical Injury Compensation Reform Act of 1975 (MICRA). As originally intended, the legislation was supposed to ease the "crisis" created by rising insurance premiums. By setting a limit for amount of recovery of medical malpractice damages, California legislators hoped to encourage physicians to remain in California and to postpone early retirement. Fast-forward almost 40 years later. Some argue the unintended effect of this legislation has been that plaintiffs are less likely to bring medical malpractice lawsuits because of the minimal recovery amount. Since 1975, other states have adopted similar legislation including Indiana, Kansas, Louisiana, Mississippi, Nevada, Oklahoma, West Virginia, and Wisconsin. It should be emphasized that the current California legislation does not place a cap on the amount of money plaintiff’s may receive to compensate their medical care, including past and future care. Lost wages or loss of the plaintiff’s ability to hold gainful employment as a result of the medical malpractice also are completely recoverable and are not part of the cap amount.
Opponents of the medical caps in California argue that MICRA is preventing juries from awarding a meaningful recovery for the plaintiffs. As it now stands, MICRA limits the amount of recovery for damages, specifically pain and suffering, loss of quality of life, at $250,000. MICRA does not limit the amount a plaintiff is able to recover for medical bills and economic losses, however. Because the cap did not include provisions allowing the limit to be adjusted based on inflation, the current value of $250,000 is only $58,000 in 1975 dollars. If the legislation had included a provision to index the cap based on inflation, the cap would have increased to $1. 1 million, which is the adjusted cap California lawmakers will need to consider. Additionally, trial attorneys also argue that the current cap on damages makes it financially impossible to take on these cases, which often are prolonged and require expensive experts to prosecute correctly. Thus, there is a movement in California to advance a ballot measure that would not only increase the amount plaintiffs may receive for pain and suffering, but also require for doctors to do each of the following:
• use a drug tracking database before prescribing controlled substances;
• undergo random drug and alcohol testing;
• undergo mandatory drug and alcohol testing after a death or injury occurs that was unexpected;
• be required to report any medical negligence or substance misuse they observe by other physicians;
• be put on a mandatory automatic suspension if they test positive for drugs or alcohol.
• report any positive drug or alcohol test results to the California Medical Board.
Physicians from all jurisdictions should closely monitor developments in California as a potential harbinger of similar developments nationwide.