Failure to Provide Causation Expert Results in No Liability for Death from Meningitis

A 29-year-old woman went to the emergency room (ER). She complained of a severe headache that had started the previous morning, as well as nausea and dizziness. A CT scan of her brain showed no abnormalities. The woman was diagnosed with a migraine headache, given some pain medication, and told to return to the ER if her condition worsened or changed.


Two days later, the woman returned to the ER complaining of shortness of breath and vomiting, as well as a severe headache that was not relieved by the headache medicine. A second-year family-practice resident from a university medical center treated the woman. The woman was a nursing student and was concerned she may have caught the flu interacting with patients. She was given a flu swab. The test was negative. The woman was discharged with antibiotics to treat a possible upper respiratory infection and pain medication for the migraine headache.


The following day, the woman went to the university medical center’s ER complaining that her headache was worsening and her vision was blurred. She also complained for the first time that her neck was stiff. A physical examination revealed pain and loss of movement in her neck. She had a temperature of 102 degrees, but her other vitals were normal. Due to these symptoms, physicians performed a lumbar puncture, which confirmed a diagnosis of meningitis. Because of the woman’s white blood cell count and elevated protein in her cerebrospinal fluid, the test results were consistent with bacterial meningitis. The woman was administered antibiotics, steroids, and pain medication. She was admitted to the internal medicine ward in the general hospital at the university medical center early the following morning in stable condition.


Later that morning, the woman continued to suffer from an extreme headache and neck pain and could not get comfortable. She was given IV pain medication. At some point her pain subsided, but at 1 p.m. it returned. She was given more pain medication and fell asleep. At 3 p.m., the woman told nurses she was in so much pain that she requested medication to “just knock [her] out.” A hospitalist, who was board certified in internal medicine as well as infectious diseases, examined the woman. She told him that “when she closed her eyes, she saw people.” Her head ached, and her neck was still stiff. The hospitalist noted that the woman probably had viral and not bacterial meningitis. His treatment plan was to continue treating her with antibiotics and await clinical responses. The physician ordered a morphine IV, and the woman was noted as sleeping at 6:50 p.m. The woman continued to be given antibiotics for bacterial meningitis.


The following morning a nurse recorded that the woman still complained of neck stiffness and headache, but nothing further. The woman was given morphine through her IV for the pain. She told the medical staff her throat was hurting, her vision was blurred, and one arm was tingling. A third-year resident who had been treating the woman was notified of these symptoms and she was among a group of physicians who examined the woman. An attending physician in that group ordered another CT scan of her brain. The woman’s vital signs did not change significantly until late in the afternoon, shortly after she was administered morphine, when her temperature rose to 102 degrees, and her blood pressure dropped to 91 over 58. About an hour after those vitals were noted, the nurse caring for the woman found her nonresponsive and called a code blue. Medical personnel unsuccessfully tried to resuscitate her, but the woman was pronounced dead about 25 minutes later.


An autopsy reported the woman’s cause of death was cerebral edema secondary to meningitis. The woman did not die directly from meningitis because her meninges did not rupture. The CDC analyzed a sample of the woman’s tissue and found no evidence that a bacterium or virus caused the meningitis.


The woman’s mother sued the hospital, five physicians, and university medical center for medical malpractice. The complaint alleged that the hospital, five physicians, and university medical center failed to exercise the appropriate standard of care, which resulted in the woman’s death. Specifically, the complaint alleged that the second-year family-practice resident’s failure to diagnose the woman’s meningitis at the hospital’s ER, and the university medical center’s inadequate care and treatment by numerous hospital physicians and nurses during her hospitalization, negligently caused the woman’s death.


The mother designated a board-certified ER physician as an expert. He was not an internal-medicine or infectious disease specialist. He opined that the woman’s death was caused by the failure to send her to the university medical center’s intensive care unit (ICU) where she would have been more closely monitored, unlike the internal medicine ward.


The Hinds County Circuit Court, First Judicial District, found the university medical center liable under the Mississippi Tort Claims Act for the woman’s death. The trial court awarded the woman’s mother the maximum statutory-damage award of $500,000.


The Court of Appeals of Mississippi reversed. The court held that the trial court’s judgment was not based on substantial credible evidence because the mother failed to provide competent expert testimony on the issue of causation.


The trial court’s judgment was not based on substantial credible evidence because the mother failed to provide competent expert testimony on the issue of causation. The mother’s expert ER physician was the only expert witness on causation. Because the specific cause of the woman’s meningitis was unknown, the mother’s expert ER physician could not establish, except through impermissible speculation, what the university medical center’s staff could have done to save her life. The court reasoned that because the mother’s expert ER physician could not identify which possible complication of meningitis caused the woman’s heart to stop, his opinion that the ICU would have saved her life was mere speculation and insufficient to establish causation. He failed to establish, to a reasonable degree of medical probability, the causal link between the hospital’s failure to properly care for the woman and the cause of the injury. To prove causation, the mother’s expert ER physician needed to testify as to what procedures would have saved the woman’s life from cardiac arrest and that there was a fifty-one percent or greater chance she would have had a better outcome had those procedures been performed.


The Court of Appeals of Mississippi reversed the trial court’s entry of judgment in favor of the woman’s mother.


See: The University of Mississippi Medical v. Littleton, 2016 WL 5793241 (Miss.App., October 4, 2016) (not designated for publication).


See also Medical Law Perspectives, June 2016 Report: How Risky Is Going to the Hospital? The Dangers and Liabilities of Healthcare-Associated Infections