Case # 4009: Medical Negligence Resulting In Infant Brain Injury
At 10:30 a.m. on March 26, the 7 month old Infant Plaintiff presented with his father to the Defendant Hospital’s emergency department reporting two days of diarrhea, the fact that the baby could not sit up for a matter of days, and fever in the range of 102°F to 104°F. He further explained that the baby had not responded to Tylenol. The triage nurse noted the Infant Plaintiff to have a rectal temperature of 104.72°F, a pulse of 130, a respiratory rate of 28, and a blood pressure of 98/47, and liquidy-yellow stool and administered Tylenol.
Upon examination, the physicians noted that the Infant Plaintiff resisted movement of his thighs and knees bilaterally, and had a history which included the fact that the baby would not sit up. Blood studies were ordered which revealed a white blood cell count of 14.46. The emergency department physician diagnosed the Infant Plaintiff with “febrile illness” — in addition to probable bilateral hip dysplasia based on a questionable x-ray. The Infant Plaintiff was discharged to home with instructions to take Tylenol and follow-up subsequently. The Plaintiff alleged that the Defendant negligently failed to perform a neurological examination or perform a lumbar puncture.
On March 27, abnormal blood cultures were returned to the Defendant Hospital by the lab. Hospital personnel called the Infant Plaintiff’s contact number but were unable to reach the family. Accordingly, hospital personnel sent a mailgram advising the family to return. The Plaintiff alleged that the Defendant negligently failed to contact the authorities for direct, immediate contact with the family for the Infant Plaintiff’s return.
At 9:30 p.m. on March 28, the Infant Plaintiff re-presented to the Defendant Hospital’s emergency department with a 102.8°F fever, right arm and right sided trembling, and the appearance that his eyes were rolling back into his head.
A work-up, including lumbar puncture, confirmed the presence of Group A streptococcus. Enhanced CT scan of the head confirmed infarction/cerebritis of the temporal, parietal, and occipital lobes. An MRI of the brain confirmed extensive infarction of the cerebrum bilaterally (right greater than left), and extensive abnormal leptomeningeal enhancement — consistent with extensive encephalitis. Despite treatment with antibiotics, the Infant Plaintiff suffered global, massive and irreversible brain injury, requiring around-the-clock care for the remainder of his life.
The Defendant denied all allegations of negligence, asserting that a complete exam was conducted and the infant did not appear ill enough to warrant a spinal tap.