Legal Review & Commentary

$10 million settlement in toddler amputations

Group A Streptococcus care delayed 5 hours

News: A 2-year-old patient presented to the emergency department (ED) with a high fever, skin discoloration, and weakness. Despite her parent's numerous requests for treatment, the patient waited for five hours before being evaluated by medical staff. By the time she was evaluated, her condition had worsened. She was flown to another hospital, where she was diagnosed with septic shock. She lost both of her feet, her left hand, and part of her right hand as a result of the shock. The hospital has agreed to a $10 million settlement.

Background: The parents of a 2-year old little girl brought her to the ED of a local hospital with a high persistent fever, skin discoloration, and weakness. The parents reportedly begged the doctors and nurses to see the girl as they watched her condition deteriorate. After a five-hour delay in care, the treating physicians determined that her condition required treatment at another medical center.

Upon arrival at the academic medical center, physicians diagnosed her with septic shock secondary to an aggressive strain of Group A Streptococcus bacteria that had entered her bloodstream. Surgeons had to remove the patient's feet, her left hand, and part of her right hand. She spent three months in the hospital and later was transferred to another hospital in the area. She continues to undergo therapy and will need expensive medication, custom prosthetics, special garments, and wheelchairs for the rest of her life.

The patient's family filed a lawsuit against the hospital and medical staff. They sued for compensation for their daughter's past, present, and future medical bills. The hospital and physicians have agreed to a $10 million settlement.

Commentary: Septic shock occurs most often in the very young and very old. There are many types of bacteria that can cause septic shock. The toxins that are released by the bacteria can cause tissue damage and result in poor organ function and/or death. In some instances gangrene can occur, possibly leading to amputation.

The symptoms of septic shock differ in children and can be difficult to diagnose. It is one of the most common and often life-threatening conditions in infants and children. The incidence of septic shock is highest among children with special healthcare needs, and this special population of children continues to expand.

While our body of knowledge on septic shock continues to grow, our overall recognition of pediatric septic shock by healthcare practitioners remains low. To improve outcomes for these children, there must be early recognition and treatment. The treatment must be aggressive and goal-directed. Each additional hour of persistent shock increases the mortality risk twofold. Healthcare practitioners need to become aware of the warning signs of pediatric septic shock. They should be aware of changes in key vital signs such as age-appropriate heart rate, respiratory rate, and blood pressure. The signs and symptoms include fever, tachycardia, altered mental status, and poor perfusion to extremities noted by cool skin or decreased capillary refill. The occurrence of hypotension would be a late finding.

In this case, the child presented to the ED with a high fever, skin discoloration, and weakness. The background states that they waited five hours before the treating physician determined that her condition required treatment at a facility that could deliver a higher level of care.

The use of treatment protocols and strategies that include the delivery of rapid, aggressive fluid resuscitation and early antibiotic and oxygen administration could have improved her outcome. The ED failed to assess and take action when the child presented with all the symptoms of septic shock. The skin discoloration was a prime indicator that there was a decrease in circulation and should have been further assessed. There was a clear delay in treatment, which resulted in the loss of tissue and ultimately the loss of both feet, her left hand, and part of her right hand.

The $10 million settlement the providers and the patient agreed upon is reasonable. While $10 million is a significant sum, the patient is only 2 years old and will require ongoing care, expensive prosthetics and a great deal of therapy in the future.

SELECT REFERENCES

1. Hutchison C. Parents sue hospital, claiming its delay in treating daughter's strep resulted in amputation. ABC News. Feb. 16, 2011. Accessed at http://abcn.ws/e48W5a.

2. The Huffington Post. Family of Malyia Jeffers, whose limbs were amputated after long ER wait, settles with Methodist Hospital. Oct. 28, 2011. Accessed at http://huff.to/x5J0dN.

3. Hubert C. Family of Sacramento girl who needed amputations after ER delay is awarded $10 million. The Sacramento Bee. Oct. 28, 2011. Accessed at http://bit.ly/umvCbd.