Microsoft word - 05-case study#2 _2_.doc

Jacobs vs. Our Charitable Sisters of Mercy Hospital, et al. Whether the MDs responded appropriately to infant John’s history of tick exposure, rash and fever Whether the nurses responded appropriately to infant John’s clinical deterioration Hospital records – Both hospitals and transport records Pediatric records from birth Labor and delivery records Medical bills Rocky Mountain Spotted Fever (RMSF) Criteria for admission to ICU Antibiotic administration Consults 2004-2007 Vickie Milazzo Institute, a division of Medical-Legal Consulting Institute, Inc., Houston, Texas. All Rights Reserved. American Medical Association American Academy of Pediatrics American Nurses Association Pediatric Nursing Standards Authoritative textbooks and journal articles AAP – Infectious Disease Pediatric texts Rocky Mountain Spotted Fever Antibiotics Viral enteritis DIC Scrotal hydrocele Drugs This is a case about a failure to presumptively diagnose RMSF and treat RMSF in the presence of the triad of symptoms This resulted in the death of infant John This is a case about an atypical presentation This is a case about a very ill infant who unfortunately would have died no matter what we did Hospital #1 – Our Charitable Sisters of Mercy Hospital Hospital #2 – Mission Children’s Hospital Corporate owner Dr. Bringham Young (pediatrician) Dr. Mike Robe (infectious disease consult) Dr. Hank N. Round (ICU physician) Physician’s associate group Staff nurses 2004-2007 Vickie Milazzo Institute, a division of Medical-Legal Consulting Institute, Inc., Houston, Texas. All Rights Reserved. [9] Healthcare facility #1 [9] Corporate owner [9] Physicians [9] Physician’s associate group [9] Nurses [9] Other healthcare providers [ ] Residents or students [ ] Medical or nursing school [ ] Other negligent parties [? ] Plaintiff Healthcare facility #1 – Our Charitable Sisters of Mercy Respondeat superior – RNs and employees Direct corporate liability Inadequate staffing Inadequate policies and procedures Hospital #1 – Our Charitable Sisters of Mercy Hospital Negligently disregarded history of tick exposure Failed to make a presumptive diagnosis of RMSF Failed to examine daily Failed to timely transfer to ICU Failed to timely transfer to second hospital Conflicting notes Failed to diagnose and recommend treatment for RMSF No note for May 23 Inadequate communication Delay in 1st dose of Chloramphenicol Inadequate ventilatory support 2004-2007 Vickie Milazzo Institute, a division of Medical-Legal Consulting Institute, Inc., Houston, Texas. All Rights Reserved. Failed to timely transfer to second hospital Failed to do complete assessments every shift Failed to timely notify Dr. Young of deteriorating condition Delay in administering Chloramphenicol (6 hrs) Delay in administering Chloramphenicol (6 hrs) Failed to get ABGs Negligent transport Other healthcare providers – Pharmacy Delay in administration of Chloramphenicol Timeliness of bringing to doctor Tick attachment Repeated exposure to ticks Death from RMSF Was full recovery achieved? [ ] Yes [9] No Did the negligence cause the injuries complained of? [9] Yes [ ]No High mortality rate Delay in seeking treatment Finger-pointing among defendants Pediatrician ÅÆ Infectious Disease consult Dr. Round ÅÆ Both doctors Nurses ÅÆ Doctors Possible Defenses (Not Already Addressed Above) Appropriately diagnosed viral enteritis Fever and rash nonspecific symptoms Serum sample for RMSF was negative Relied on infectious disease consult 2004-2007 Vickie Milazzo Institute, a division of Medical-Legal Consulting Institute, Inc., Houston, Texas. All Rights Reserved. Called back Done a punch biopsy Ordered Chloramphenicol Both doctors were negligent I got dumped with a mess Did the best I could given the deteriorated condition of the infant Missing Records or Evidence of Tampering [9] Yes [ ] No Missing records – No progress notes for 3 days by Dr. Young No progress notes for May 23 by Dr. Robe Negative serum sample could confuse the jury Pediatrician Pediatric infectious disease specialist Pediatric nurse Pathologist PICU nurse Intensive care MD In my opinion, this case is meritorious because there was a failure to presumptively diagnose and treat for RMSF in the presence of the triad of symptoms The significant deviations caused the infant’s death Locate expert witnesses Research SOC Write detailed report 2004-2007 Vickie Milazzo Institute, a division of Medical-Legal Consulting Institute, Inc., Houston, Texas. All Rights Reserved.

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