Return and the End of the Case

Yes, I have returned. It's been crazy here and my time was better spent off line. Anyway, so much has happened; in the world and locally.

Locally: The trial is over for now. There were 3 defendants: 1 female Dr. and 2 males. The case was medical malpractice related to the death of a child. It was one hell of a case. The female Dr. had a judgment rendered in her favor the rest was a mistrial. This was also the second time this case has been to court. The Judge will retain the case. I think it's nuts to try it again. Let me give a synopsis of the case.

The death of a 10 year old girl from Crohn's disease, DIC...she bled out because of severe internal rupture of GI system. Now, the case was sad but unfortunate and I don't believe these Doctors could have done more than what they did with the information they were given and the time line involved.

Time line:

Mother goes to regular Pediatrician for check up in Nov. 2001 ( female and male Dr.'s), no complaints. Mother next takes daughter to Peds Docs in March of following year for school check-up and says during this time that child had blood in stool. CBC done and manual exam done. No frank blood seen. Hgb (hemoglobin) comes back normal for child's age (12.1, all other signs normal: pulse, resp., BP, weight, etc.) If any signs recur to contact Dr.

Next medical contact is August of that year in the ER. ER Dr. (1 of the defendants) sees child...he's never seen her previously. Mother says child has had blood in stool for a year and has abdominal pain. BP normal, pulse:110, Resp. 20...Now pulse and resp and high but could be attributed to child being scared and in pain (these 2 factors can raise these values...in a perfect world a second set of vitals would have been done...we don't live in a perfect world). Stool culture done and was normal...no occult or frank blood. Blood work shows child's Hgb now at 10.3 which is very low for a normal 10 year old...could indicate internal bleeding. Child shows no pain upon exam. Mother told to contact regular Dr. or the Hospital's Pediatrician if problems recur. Child released to parent.

Next contact is Nov. when Mother takes child to regular Peds Doc and says blood in stool and abdominal pain. Makes no mention of ER visit in August. Dr. exam negative for blood in anal canal/stool /pain but indicated weight loss of 13 lbs. since previously seen in March.. Writes order for blood work but lab is closed so Mother comes back in 2 days, gets blood drawn and results sent to Dr. Child's blood work again shows Hgb of 10.3. Dr. spends 2 days leaving messages and playing phone tag with Mother. He's not sure what's going on but asks her to bring child in again for further exam. He doesn't hear from Mother that weekend and by Monday child is dead.

Autopsy shows Crohn's disease and DIC are cause of death. Mother sues on behalf of child's estate.

Ok, this case is a heart breaker. However, part of good medicine is parents giving appropriate info and taking action immediately, not months later. At the final Dr. visit this Pediatrician had no idea there had been an Hgb level of 10.3 since August. The Mother didn't mention it and no test results were forwarded to the regular Dr. This was his first time seeing this. Had he seen it previously, he would've taken different action. For me there was too much time between child being seen and bouts of blood in stool. Keep in mind that Crohn's disease has flare ups and remissions and is not easy to diagnose in a child. The child should have been seen by her Dr. the day the Mother saw the blood in stool or if unavailable, taken to ER and regular Dr. contacted immediately. None of that was ever done.

Now, the female Peds Doc was not seeing this child regularly and so a judgment was rendered, in her favor, that removed her from the case. As far as the ER Dr., he had no other info than what the Mother gave him. He did tell her to see her regular Dr. or the Hospital's Peds Doc if problems recur. Now he (or the nurses) could have taken another set of vitals. He could have referred her to a Pediatric GI Doc or even called in a Peds GI Doc but ER's being what they are that didn't happen. He did what many Er docs do...refer to regular Pediatrician.

The regular Peds Doc was at a loss for information. He had never seen the child's Hgb at 10.3 previously, had no info from the ER visit, didn't even know she went to the ER in August(there was no process in place at the time to forward the ER info to the regular physician) and did call the Mother when he got results for further exam. He was really being sued because he didn't have a crystal ball that could tell him the past and possible future outcome.

It was a tough case but this happens in many medical malpractice cases...they sue everyone possible hoping someone pays up prior to going to court. I seriously doubt this case will be heard again in court. According to the Mothers' statements there were many occurrences of bloody stool for which she did not have the child seen. My question was that if she told the ER Dr. that this had been going on for a year then why was there basically no documentation to support that anywhere.(One instance back in March but nothing previously and since she saw the Er Dr. in August that would presume the child had these occurrences since the previous August but that was not the case according to the records.) I hate to say this but if it isn't documented it wasn't done is a pretty cardinal rule in medicine. While the loss of a child is horrific it is incumbent upon parents to take action immediately and give all relevant info to the physician.

The problems with Crohn's disease are that the remissions may be long and while seen in younger children it usually occurs in the early teens. There are so many symptoms that may be confused with other diseases. Doctors are not God.

Pediatric Crohn's disease, definition, symptoms, treatment

DIC (Disseminated intravascular coagulation)definition