Legal Community & Review-Misdiagnosis results in death, $1.1 million verdict

News: A child was taken to the emergency room with a high temperature, rapid respira -tion, and elevated heart rate. She was seen by a physician's assistant and allegedly by the emergency room physician and discharged home, where she died the next day from meningitis. The jury awarded a verdict of $1.1 million to her parents.

Background: The mother took her 6-month-old child to the emergency room complaining that her baby was panting, breathing with difficulty, and had not been eating well for the past few days. The baby was examined by a physician's assistant who had recently received her PA degree. The physician's assistant noted in the medical record that the baby had a respiratory rate of 60 and an inflamed ear.

The emergency room physician signed off on the chart, allegedly having seen the child, and sent the child and mother home with the diagnosis of an ear infection. Additional diagnostic tests were not ordered, despite the elevated respiratory rate.

Thomas Cardaro, attorney for the plaintiff, says that "the physician's assistant was not properly supervised and that too much reliance was placed on her assessment of the patient. It appears that the child's high respiratory rate was not given full consideration. A simple diagnostic test could have been performed, and the child would be alive today."

What this means to you: Stephen Trosty, JD, MHA, director of risk management and loss control for Mutual Insurance Corporation of America in East Lansing, MI, says, "Proper supervision, sufficient protocols, and systematic methods for drawing attention to situations that a physician should review could have had a profound impact on the situation. First, it does not seem that either the physician or the physician's assistant were aware of any institutional or statutory parameters regarding their professional interaction. The physician's assistant noted what she detected, but she did not appear to have flagged any of her findings for further inquiry by the physician."

The physician seems to have relied on the physician's assistant's conclusions without asking any questions, Trosty says. Physicians must be educated and advised as to their responsibility for supervising physician's assistants in all settings, particularly the emergency department, he explains.

Computerization may have helped

Further, once physicians sign off on the physician's assistant's medical chart, it is generally assumed they have personally reviewed the case and have assumed liability for medical decisions based on that chart.

"A computerized system, if used properly, could have been of tremendous benefit in this instance," Trosty says. "Abnormal findings could have been identified, and recommended courses of action could have been suggested. Protocols, clinical guidelines, and practice parameters do exist, particularly for pediatric emergency situ ations. Even without computerized systems, methods can be devised to highlight abnormal findings in order to draw the attention of the medical personnel. Regardless of which system is used — manual or computerized — protocols could have been adopted as the standard of care."

Essentially, the failure to properly supervise the physician's assistant and completely review the medical record resulted in an adverse outcome, Trosty notes. The problem could have been mitigated or avoided with knowledge of the supervisory requirements and the institution of emerg ency room protocols, he says.


Yulanda Hall, Pers. Rep. of Mariah Makle v. Aseem Chaudhry, MD, Prince George's County (MD) Circuit Court, Case No. CAL96-21868.