My fellow doctors hurt my child

My fellow doctors hurt my child

After misdiagnosis led to a serious operation for her daughter, the author wondered: Should I sue?

By Dorothy C. Greco, MD
Internist/St. Louis

The summer from hell, as my daughter calls it, is over.

Julie is now eight weeks post-op and steadily regaining a 14-year-old's usual strength and vigor. But she's not as quick to smile, and her deep blue eyes now harbor a hint of distrust. For the rest of her life, the 5-inch scar on my youngest child's abdomen will bring back to her a flood of frightening memories. And in the next several years, she'll continue to ponder the question she asked me just before her surgery: "Will this affect my ability to have babies?"

I am a member of the profession that let her down. During the 21 years I've been a mother, I've been ever mindful of the saying that "doctors' kids get the worst medical care." I've actively sought to prove this adage wrong. When necessary, I've been willing to ask specialists for help, and to let them do their jobs without having to trip over a doctor-mom, because true professionals respect each other's areas of expertise.

So what went wrong?

One evening, Julie developed upper-abdominal pain, which intensified throughout the night. By daybreak, when she went to the bathroom to vomit, she could barely make it back to her bed because it hurt so much to walk.

After consulting with the on-call pediatrician, my husband and I took Julie to the emergency room to have her admitted for an appendectomy. By then, the pain had moved to her lower abdomen. Her white count was 20,000, with 86 percent neutrophilic forms.

A pediatric surgeon with more than a quarter-century of experience examined Julie's abdomen, recommended an intravenous pain medication, and ordered a CT scan of her pelvis. He returned later to say that the CT scan was negative, thus ruling out surgical pathology. He suggested a gynecology consult and left. The gynecologist, after a urinalysis and vaginal exam, ruled out both urinary tract and gynecologic causes for Julie's pain.

Julie was admitted to the pediatric floor for observation, IV fluids, and pain control. During the next 48 hours, her temperature spiked to 102 and 104; she had chills, rigors, and drenching sweats.

She was treated with acetaminophen, ibuprofen, and a pain medication. In all that time, she was examined only once by a physician, a young house officer I summoned in the middle of the night when Julie was having rigors.

The surgeon never returned, although we were told several times he was coming. The pediatrician of record stopped by three times, but never laid a hand on her. Not one of the 10 doctors involved in Julie's care—eight pediatricians, a gynecologist, and a pediatric surgeon—thought to consider pelvic appendicitis, let alone perform the rectal exam that would have diagnosed it.

A week after her trip to the ER, a repeat CT scan showed a pelvic mass, and laparoscopy the following day confirmed a pelvic abscess. A surgeon re-moved Julie's gangrenous appendix and drained the abscess in a two-and-a-half-hour procedure. She spent five more days in the hospital, receiving IV antibiotics while a 5-inch, open-ended surgical incision allowed the pelvic infection to drain.

Julie's physical recovery was medically uneventful. After six weeks, she began a graded exercise program, and she later returned to physical education classes at school. Her emotional recovery is another issue. If you think adolescent girls are hard to figure out in normal circumstances, you should try to assess one after an experience like Julie's.

Looking for answers about what had occurred, I wrote to several of the doctors. A month after receiving my letter, the admitting pediatrician wrote back, telling me that his decisions had been made "with Julie's best interests at heart." He had not re-examined her, he said, because he didn't want to "traumatize" her.

The surgeon wrote that no one had told him Julia had been admitted; he thought she'd gone home. He justified his initial decision not to operate by saying that, in the past five years at the hospital, there hadn't been a single case of pediatric appendicitis where a CT scan of the pelvis was negative. The radiology department would back him up on that, he wrote.

Faced with the flabby, disgracefully unprofessional excuses her doctors had offered, I struggled to decide whether, as a physician and parent, I owed it to Julie to seek damages. My child had received bad care, and I'd seen it myself. She'd suffered unnecessarily, and she could have died. And there is still the unanswered question of her future fertility. This time, the expert I consulted was a lawyer.

I had good grounds for a malpractice suit, the attorney assured me. Serious, unforgivable errors had been made, and I would probably win.

But he asked me to consider my objectives. Bringing suit would put Julie through a time-consuming legal process. Because it was not yet clear whether her fertility was affected, damages would be limited to the suffering she'd experienced before and after surgery. And given Julie's ultimate recovery, the settlement would probably be too small to cover the treatment she might need if she later proved infertile.

Suing would enable me to chastise my colleagues and make them endure the consequences of a lost malpractice suit. But the lawyer cautioned against revenge as a motive for legal action. Instead, he said, I could pursue the issues of substandard care through the avenues provided by the medical profession and the state's Board of Registration for the Healing Arts. Through them, I could perhaps get the closure I wanted—and perhaps make enough of an impact to prevent such a nightmare from happening again.

So the quintessential professional in this entire sorry experience turned out to be a lawyer!

 

Carol Pincus, ed. Dorothy Greco. My fellow doctors hurt my child. Medical Economics 2000;8:85.