Several incidents of death from meningitis have been in the news this month. It is imperative that risk managers prepare policies and procedures to avoid liability or mitigate damages in litigation concerning meningitis diagnosis and treatment.
A four-year old died at a local hospital after falling ill with meningococcal meningitis group B after being diagnosed only 24 hours earlier. The child had first fallen ill a couple of weeks previously. The child was taken to the hospital when she started having seizures, and even though the child was put into an induced coma and on a ventilator, the child died.
In another situation, a school district learned from the county public health department that a student had been hospitalized with bacterial meningitis, and later died. School district officials sent a letter to parents notifying them of signs of the illness, thoroughly cleaned the school campus with hospital-grade disinfectant, and fogged all spaces. Classes resumed two days later.
According to the Centers for Disease Control and Prevention, death occurs in about 10 to 15 out of every 100 people infected with meningococcal disease. About 11 to 19 out of every 100 survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage. See: Centers for Disease Control and Prevention, Meningococcal Disease: Technical and Clinical Information.
In litigation involving the untimely testing and treatment of a patient’s streptococcus pneumoniae meningitis the jury awarded $7.5 million in compensatory damages. Expert witness testimony and evidence from the hospital’s website proved persuasive. The Superior Court of Pennsylvania determined that expert witness testimony and the hospital's website were evidence on the causation issue that the failure of the hospital and physician to use proper testing methods prevented the timely treatment of the patient's meningitis, resulting in brain injury. A board-certified pediatric emergency medicine physician with 25 years' experience testified that, had the physician performed any bloodwork at all, it probably would have led to the patient’s admission, observation, and intervention. A chief of pediatric infectious disease with over 31 years' experience testified that, had tests been performed sooner, they would have suggested a serious bacterial infection that would have required, at a minimum, administration of antibiotics intravenously in the hospital. Another expert was qualified under the Medical Care Availability and Reduction of Error Act to provide limited standard of care testimony on the issue of whether antibiotics should have been administered after the bacterial meningitis diagnosis. This expert was a board-certified neurologist surgeon and otolaryngologist who had practiced pediatric otolaryngology for over 20 years, was a professor of otology and laryngology at Harvard Medical School, was an active otolaryngologist and surgeon at two hospitals and an eye and ear center, and had extensive knowledge and experience regarding the results of a failure to diagnose bacterial meningitis. The court also determined that the hospital and physician “opened the door” to rebuttal evidence from the hospital's website stating that effective treatment of bacterial meningitis involved early antibiotic treatment. The jury's $7.5 million compensatory damages award was found not excessive, since there was significant testimony on the patient’s brain injury and disabilities. See: Tillery v. Children's Hospital of Philadelphia, 156 A.3d 1233, 2017 PA Super 50 (Pa.Super., Feb. 28, 2017), reargument denied (Apr. 24, 2017), appeal denied, 172 A.3d 592 (Pa., Oct. 10, 2017).
This alert provides analysis and “what this means to risk managers” information you can’t get anywhere else.
A Physician Insurers Association of America (PIAA), November 2000, report on meningitis claims focused on malpractice claims in which the adverse outcomes were associated with untimely diagnosis and/or improper treatment of meningitis. The intent of the study was to improve patient care and minimize malpractice loses. Included in the report were recommendations, including some of the following.
Action Recommendations for Risk Managers to Prevent Liability or Mitigate Damages
- Health care providers must listen carefully to the caregiver, such as a parent or spouse, of a sick person with restricted communication abilities, such as young children or handicapped persons, regarding changes the caregiver has observed that may indicate meningitis.
Risk managers should consider implementing training for health care providers on listening and questioning skills for all patients in order to key in on signs and symptoms that indicate the patient may have meningitis.
- Health providers must provide clear follow-up care instructions, both verbal and written, to include the signs and symptoms of meningitis that warrant immediate medical attention.
Risk managers should consider implementation of a form to reinforce provider verbal instructions, which contains standard meningitis instructions and instructions specific to the patient.
- Health care provides must use lay terms instead of medical jargon when talking with a patient or caregiver about meningitis.
Risk managers should consider providing to healthcare providers documentation of lay terms that can replace medical jargon. In addition, training for health providers on how to talk to patients, including how to apologize if a bad outcome results, should be considered.
- Health care providers must document completely in the medical records all patient complaints, provider observations, and provider actions regarding possible meningitis. The documentation must include recommendations for subsequent diagnostic testing and follow-up treatment. This information must be recorded in a timely and accurate manner and not altered.
Risk managers should consider how their medical records are compiled and if this process has been successful. Revisions to the current process should be made to ensure effective and accurate medical records, such as including a checklist of recommendations for subsequent diagnostic testing and follow-up treatment when meningitis is suspected.
- Health care providers must routinely follow up with physician or other consultants when any observations or laboratory tests indicate meningitis.
Risk managers should consider implementing a coordination program between health care providers, lab and other testing entities, and consultants to ensure that a meningitis diagnosis is not missed and that treatment is provided as early as possible.
- Health care providers must evaluate, refer, and/or admit a patient presenting with any signs or symptoms indicating meningitis until this diagnosis is ruled out of the provider’s differential diagnosis.
Risk managers should consider providing guidance on the actions to be taken when meningitis is suspected, including what differential diagnosis should be considered, what testing should be completed, whether admitting the patient to the hospital is needed, or whether referring the patient to a specialist is a proper next step.
Medical Risk Law: Meningitis: The Swelling Risks of Litigation provides in-depth law and medical information when you want and need it.
Expert Analysis in the above Medical Risk Law, the monthly report on specific medical litigation topics:
What Can Risk Managers Do to Avoid Liability for Delayed Diagnosis of Meningitis?
Bill Kanich: Chief Medical Officer, The Institute, MagMutual
How Important Is the Meningitis Vaccination for Teens and Young Adults?
Leslie Maier: President, National Meningitis Association
What Evidence Should be Evaluated to Prove Malpractice Involving Meningitis?
Robert W. Painter: Painter Law Firm PLLC
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