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Teenager dies of undiagnosed pneumonia.

A 16-YEAR-OLD GIRL was taken to the emergency room with diarrhea, fever, a nonproductive cough, chest pain, and rhinorrhea. The pediatrician and nurse who examined her found no abnormalities of the lungs, respiration, or oxygenation. A viral syndrome and/or infection of the upper respiratory tract was diagnosed. The girl was discharged with instructions to see her primary physician and return to the ER if her condition worsened.

The patient saw her pediatrician 3 days later after becoming increasingly weak. The pediatrician noted abnormalities in her respiration. He diagnosed a virus but prescribed antibiotics, and told the girl to return if her condition became worse. The girl didn't return and died 3 days later. Her death was attributed to pneumonia.

PLAINTIFF'S CLAIM The pediatrician and nurse in the ER should have diagnosed pneumonia. The differential diagnosis in the ER should have included pneumonia, and the patient shouldn't have been released until pneumonia had been ruled out. The patient's pediatrician should have given IV antibiotics and ordered a chest radiograph and white blood cell count.

DOCTORS' DEFENSE The patient's symptoms were characteristic of a viral infection and not typical of a bacterial infection. The pneumonia originated after the patient was last seen and was an aggressive form.

VERDICT $3.9 million New York verdict reduced to $500,000 under a high/low agreement.

COMMENT Our worst nightmare: treating a patient appropriately by withholding antibiotics (in the case of the emergency room staff) followed by a catastrophic outcome. This case is a great example of why we practice defensive medicine and what's wrong with our tort system.

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Article Details
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Title Annotation:WHAT'S THE VERDICT? Medical judgments and settlements
Author:Susman, Jeffrey L.
Publication:Journal of Family Practice
Article Type:Brief article
Geographic Code:1USA
Date:Jan 1, 2010
Words:265
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