On May 14, 2009 at 8:30 a.m., the plaintiff presented to St. Anthony's Medical Center Emergency Department after being ill with what the patient and her daughter described as flu-like symptoms for three days. She had been to her PCP (and former co-defendant) the day before and been sent home with a diagnosis of flu, but her condition had worsened the morning before she arrived in the ED when she started throwing up repeatedly. The ER doctor, who was represented by Evans & Dixon, saw the patient within ten (10) minutes of arrival and began a thorough work-up. Two hours later, the patient's mental status changed abruptly and she was diagnosed with bacterial meningitis. The patient became unconscious before being transferred to the floor and died a few days later. Plaintiffs were the children of the deceased patient, who claimed the ER physician failed to timely diagnose and properly treat the patient.
Specifically, plaintiffs alleged that the defendant failed to perform an adequate history or physical examination which would have revealed the patient had a headache, neck pain, mental status changes, and that she had taken Tylenol which resulted in the patient being afebrile during her initial presentation to the ED. Plaintiffs claim that had these been done then meningitis should have been on the top of defendant’s differential diagnosis which would have resulted in her ordering antibiotics sooner than she had. Plaintiffs also allege that once the patient had a change in mental status, antibiotics and steroids should have been immediately ordered and administered which would have resulted in the patient having a better outcome.
Defendant maintains her history and exam met the applicable standard of care. Her examination as well as the examination done by both the triage nurse and ER nurse didn’t reveal any signs or symptoms consistent with meningitis. Once the patient had an abrupt change in her mental status, a stroke or bleed were at the top of defendant’s differential diagnosis and she appropriately ordered a CT scan to assess for those conditions. Once those were ruled out, the patient’s condition continued to change and once defendant found out decedent had spiked a temperature, meningitis became a concern and she timely ordered antibiotics as well as a lumbar puncture. While defendant was not required to have ordered antibiotics any sooner than she had if they were given any earlier it would not have changed the patient’s outcome. The patient’s family acknowledged that decedent had been ill for 3-4 days before the ED visit and during that time period, her symptoms waxed and weaned and she had the classic triad of meningitis (fever, headache, neck pain, and mental status changes). Given the long timeframe of decedent’s symptoms had she received antibiotics even when she hit the ED floor it would not have change her outcome.
The care at issue occurred over a three (3) hour period in the Emergency Department. The case was filed in St. Louis County and over the years saw the co-defendant hospital and PCP settle out, as well as serial bankruptcy filings by the plaintiffs. The jury returned a unanimous verdict in favor of the ER doctor. Stephanie Preut and Brian Niceswanger tried the case, with the amazing support of the E&D litigation team, Beth Crosser, Ryan Cox, Dave and Mitchell Wilson.