Botched meningitis treatment leaves boy with brain injury
Meningitis requires fast treatment, but doctors and nurses repeatedly fumbled
As a Houston, Texas medical malpractice lawyer, I have handled many cases where a patient was severely injured because of poor communication among healthcare providers.
This is such a serious problem that the Joint Commission, and an accrediting agency for hospitals, coined the term “hand-off communications.” Think of it like a team relay race, where one runner passes the baton to a teammate, who then continues the race. Unfortunately, in healthcare settings, doctors and nurses too often drop the baton.
This situation reminds me of a pediatric meningitis case where a little boy had a devastating brain injury caused by the negligence of the doctors and nurses involved in his care.
Generally speaking, meningitis is a medical condition characterized by inflammation of the brain and spinal cord membranes (called meninges), typically caused by an infection. Without treatment, meningitis can be life-threatening.
A 2-year-old boy had a bout with an ear infection that had been treated with antibiotics. Around a week later, the little boy had a fever, pain, and was vomiting. He was taken to a hospital emergency room, where the triage nurse described him as lethargic (sleepy and with no energy), with his eyes closed, having no response when his rectal temperature was taken, a fever of 104 degrees, and a stiff neck.
Emergency room triage levels
Triage nurses are registered nurses who are assigned by the hospital to perform an initial assessment of patients when they present to the emergency room. Most hospitals require their triage nurses to use the Emergency Severity Index (ESI) to describe how quickly a patient needs to be seen.
There are five different ESI numbers that the triage nurse can assign. The lower the number, the worse the situation is for the patient.
An ESI of 1, for example, requires immediate life-saving intervention. An ESI of 2 is a high risk situation, or the patient is confused/lethargic/disoriented or in severe pain/distress.
Mistake after mistake by doctors and nurses
In the case I was describing above, the triage nurse assigned the 2-year-old boy to a triage level of ESI 2. This is baffling to me, considering that the patient’s symptoms included a stiff neck, which is a classic, textbook sign of meningitis.
But the handling of the patient after that triage mistakes only goes downhill. Next, the triage nurse did not even alert a physician. As a result, three patients of lower acuity (meaning higher triage ESI scores, who did not need to be seen as quickly) were seen before this little boy. It ends up taking a full two hours for the patient to be seen by an emergency room physician, who then proceeds to call in a pediatrician, and then never sees the patient again.
Thirty minutes later, the pediatrician arrives, sees the patient, and then orders a CT scan. It takes another two hours to have the CT scan completed. After that, almost two and one-half hours pass before a lumbar puncture is done. At that point, the pediatrician writes an order for two powerful antibiotics, ceftriaxone and vancomycin.
The bungling is not over, though.
Instead of writing the antibiotic orders on the emergency room chart, the pediatrician wrote it on an orders page in the hospital admission record. As a result, over two hours pass before the nurses started the patient on ceftriaxone, and an additional 90 minutes from then pass before the vancomycin is started.
By the time the antibiotics are started, the patient is essentially unresponsive. Tragically, the little boy is left with permanent intellectual disabilities, and experts believe it is unlikely that he will develop beyond the mental capacity of a two-year-old.
We are here to help
I think that anyone who has worked with others in a job setting would agree that if no one is assigned responsibility for something, then no one takes responsibility. Unfortunately, this is also true when it comes to healthcare.
The standard of care requires physicians and registered nurses to exercise diligence and deliver individualized care to their patients, which includes making sure that the baton is passed to the next doctor or provider. If not, there can be devastating consequences. In the sad case of the little boy, practically everyone involved with his care dropped the baton—the triage nurse, the emergency physician, the pediatrician, and the hospital nursing staff.
The medical malpractice lawyers at Painter Law Firm, in Houston, Texas, are experienced in reviewing complex medical malpractice cases and know how to get answers. If you or someone you care for has been seriously injured in a hospital setting, call us at 281-580-8800, for a free consultation concerning your potential case.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He files medical malpractice and wrongful death lawsuits against doctors, surgeons, anesthesiologists, and hospitals, like those in the Memorial Hermann or Houston Methodist systems.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine