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In early February of 2001, 45-year-old Ms. Doe sought treatment from her family doctor, Dr. Blank, for a headache, sore throat, and other cold symptoms. Her symptoms continued for more than seven weeks while Dr. Blank treated her with an antibiotic, a pain reliever and other medications in accordance with his diagnosis of her condition as cluster headaches, acute rhinosinusitus (runny nose), and otitis media (an ear infection) and by mid March vertigo (dizziness).
On March 27, Ms. Doe was again seen at Dr. Blank’s office. Later that same day, the police found her staggering outside Dr. Blank’s office and she was taken to the hospital by ambulance. Ten days later, Ms. Doe was dead from cryptococcal meningitis, a fungal infection of the brain and the spinal cord. Ms. Doe’s family and her Estate claim that Dr. Blank failed to investigate her continued and persistent symptoms and failed to timely diagnose the cryptococcal meningitis at a time when it was still treatable. They have brought claims of wrongful death and malpractice against Dr. Blank.
Ms. Doe worked full time as a meter reader for the water department for several years, which required her to find water meters that are typically outside of a home in a hidden-away area. Her job sometimes caused her to come into contact with bird droppings found around the outside of houses and buildings and occasionally on the water meters themselves.
Cryptococcal meningitis is a fungal infection of the brain and the spinal cord. Persistent headaches are the key symptom of meningitis. It is typically contracted from contact with bird droppings and it can be assumed that Ms. Doe came into contact with droppings as part of her job as a water meter reader.
Dr. Blank’s Treatment of Ms. Doe
Dr. Blank is a Family Practitioner who was Ms. Doe’s primary care physician for several years. On February 5, 2001, Ms. Doe came to Dr. Blank’s office complaining of a headache, sore throat, and other cold symptoms. Dr. Blank examined her and made a diagnosis of cluster headaches, acute rhinosinusitus (runny nose), and otitis media of the right ear (inflammation of the middle ear). He prescribed an antibiotic and a pain reliever with codeine.
Ms. Doe’s symptoms persisted and on February 10, Dr. Blank renewed the prescription for the pain reliever. On February 12 and 13, she had additional lab tests, including a CT scan of the brain but these were inconclusive.
Dr. Blank saw Ms. Doe again on March 6, and he refilled her prescription one more time on March 14. On March 19, she returned to his office and was examined again. This time, Dr. Blank prescribed an anti-inflammatory, Decadron, a steroid preparation that is administered as a nasal spray. Despite the fact that six weeks had passed since Ms. Doe’s initial complaints, he refused to consider or investigate other
possibilities or explanations for her persistent symptoms. He continued to diagnose her with acute rhinosinusitus and otitis media of the right ear, but he now added vertigo to his list of diagnoses. He recommended that Ms. Doe rest and eat plenty of soup.
Just eight days later, on March 27, the police department found Ms. Doe staggering in the street outside of Dr. Blank’s office. An ambulance was called and she was taken to the hospital. When she arrived at the hospital, she was drowsy, disoriented, her grip was weak, and she complained of a headache. Her vital signs, including her blood pressure and respiration, were weak. She also showed a lack of muscle
Hospital reports indicate that on the day that Ms. Doe was found in the street, she reported to the hospital staff that she had been at Dr. Blank’s office earlier in the day. Her son agrees with this statement, and Dr. Blank conceded as much in his hospital notes. Yet, there is no record of a visit that day in Dr. Blank’s office notes.
The hospital conducted numerous blood tests, as well as, a chest x-ray, which showed no heart or lung disease. She was also given another head CT scan in the Emergency Room. The head CT scan now showed signs of a possible stroke. Since Dr. Blank was out of town, a physician’s assistant in the Emergency Room consulted with another physician who was covering for Dr. Blank. The covering physician agreed that Ms. Doe should be admitted as a new cerebrovascular accident (CVA, or stroke) patient. At that point, the CVA diagnosis was only considered to be a possible diagnosis.
On Sunday, April 1, when Dr. Blank returned, he suggested to Ms. Doe’s two adult sons that their mother’s symptoms might be psychological, and suggested a consult with a mental health facility. Ms. Doe’s sons adamantly rejected the idea and refused.
Dr. Blank’s notes on the next day, April 2, indicate that Ms. Doe suffered from a “bad headache, lethargic, not eating, not improving, with general condition downhill. Mild fever to 100.8. Assessment, headache. Comment general downhill course.”
By this time, Ms. Doe’s two adult sons were seriously worried about the lack of a diagnosis from Dr. Blank and their mother’s deteriorating condition. Ms. Doe was transferred to another hospital, but the reason for this is in dispute. Her sons say that they contacted another doctor, a neurologist, regarding their concerns about their mother’s condition and Dr. Blank’s lack of success in treating it, and that the neurologist authorized the transfer. Dr. Blank contends that he contacted the neurologist, and that he was simply referring Ms. Doe to a specialist. The neurologist’s records, however, show that the family requested the transfer.
The Diagnosis of Cryptococcal Meningitis
At the time of Ms. Doe’s transfer, on April 2nd, she was no longer following commands and could make no verbal response. During the next two days, she had another chest x-ray, and another doctor [?SPECIALTY] was called in for consultation, and she was given an EEG, which is a brainwave test. The EEG results were abnormal and a spinal tap was ordered to determine the cause of the abnormalities. The spinal tap was performed the next day on April 4. The preliminary results of the culture from the spinal tap arrived the following morning, indicating that she was suffering from cryptococcal meningitis. Unfortunately, Ms. Doe’s illness had already progressed too far, and she died less than an hour later.
The Negligence of Dr. Blank
From the very onset of her symptoms — almost two months before her death — Dr. Blank failed to properly diagnose Ms. Doe’s condition. He identified an ear infection, runny nose and “cluster headaches” but utterly failed to further investigate their cause — particularly when the symptoms persisted and failed to respond to treatment.
This failure to look further for the root cause of Ms. Doe’s medical condition was ongoing throughout Dr. Blank’s care. By March 6, four weeks after Ms. Doe’s first complaints, Dr. Blank should have taken some affirmative steps to find out what was causing her illness. Instead he continued the same futile course of treatment — refilling the same prescriptions that had been ineffective for four weeks.
Not surprisingly, Ms. Doe was back at Dr. Blank’s office on March 19, however, he continued to diagnose her with acute rhinosinusitus and otitis media of the right ear with the single addition of vertigo to the diagnosis. Moreover, the nasal spray, Decadron, that he prescribed, is a steroid that is known to worsen
fungal diseases, and this may have exacerbated her condition. If he had identified cryptococcal meningitis — even as a possible diagnosis — the use of Decadron would have been contraindicated and another medication prescribed. This basic elementary practice of identifying all possible causes of symptoms before prescribing medication could have prevented the condition from worsening as it did eight days
later, leading to her death.
Ms. Doe had now suffered through seven weeks of persistent symptoms, but Dr. Blank still could not see beyond his original diagnosis other than the addition of vertigo. Had he diligently sought the true medical cause, it would have been found and proper treatment would have saved her life. Instead, he paid little attention to her continuing complaints of persistent headaches, which is the classic symptom of meningitis. He discounted the seriousness of her symptoms and took the easy way out recommending rest and plenty of soup.
After she was found staggering in the street outside his office and had been admitted to the hospital, Dr. Blank shockingly suggested that Ms. Doe’s symptoms were psychological. Even at this critical stage, he failed to look for an alternative medical cause. Finally, as her condition continued to deteriorate and they lost faith in Dr. Blank, Ms. Doe’s family stepped in and removed her from his care and transferred
her to another hospital. Within 48-hours with proper care and appropriate testing at the new hospital including an EEG (brainwave test) and a spinal tap, the correct diagnosis of cryptococcal meningitis was made. Unfortunately, these results came too late and she died less than an hour later.
Dr. Blank has impeached his own professionalism and veracity throughout this case. Dr. Blank’s apparent habit of poor record keeping is a testament to his lack of professionalism. His office record doesn’t even reflect that he had seen Ms. Doe on the day she was found staggering in the street, though it is indisputable that he did so, by his own hospital notes. As to the transfer between hospitals, Dr. Blank contends that he arranged the transfer by contacting the neurologist at the other hospital and that he was simply referring Ms. Doe to a specialist. However, her sons say that they contacted the neurologist regarding their concerns about their mother’s condition and Dr. Blank’s lack of success in treating it, and that the neurologist authorized the transfer. Furthermore, the neurologist’s records show that the family requested the transfer.
Dr. Blank failed at every step of the way to identify and properly treat Ms. Doe’s condition. He failed to seek proper consultation when symptoms persisted and did not respond to medication. He failed to order appropriate testing to confirm his diagnosis. He failed to rule out alternative causes of Ms. Doe’s symptoms and to take those possible causes into consideration when prescribing medications. He failed to refer the case to a specialist to provide medical care that was apparently beyond his abilities. Ms. Doe Jackson trusted Dr. Blank to provide reasonable medical care. He failed. His failures constitute malpractice and caused the wrongful death of Ms. Doe Jackson.
Before her death, Ms. Doe was a 45-year-old African-American divorced mother of two adult sons. Her two sons were especially close to her, coming to her for advice, comfort, emotional support, and occasional financial assistance. On weekends, she would often take care of her nine grandchildren, all under age 9. She loved to go shopping with them, take them to McDonalds or out for ice cream, and to the movies and playgrounds. She also had two sisters, two brothers and her mother. Her family was very close and all of them visited each other quite often.
Ms. Doe lived with her mother until just three months before her illness when she was able to buy her own house giving her more freedom to entertain her grandchildren. Ms. Doe continued to regularly provide financial assistance to her mother, giving her money from each paycheck, and also took her to church, restaurants, shopping and on visits to other family members. Her mother relied on her both financially and for companionship.
For relaxation, Ms. Doe enjoyed playing Bingo 3 or 4 times a week, and occasionally tried her luck at a riverboat casino. She was very active in her church, served as chairperson of the Building Fund Committee and was a fixture at every Sunday service.
Ms. Doe’s family is seeking in excess of $1.3 million in compensation for her pain and suffering, medical expenses, lost earnings, and their loss of her society and companionship and her wrongful death. Her medical expenses were approximately $20,000. Assuming that at age 45, she would work at least another 20 years at her current salary of approximately $25,000 a year, she would have earned a minimum of $500,000.
Additionally, from the time that she first felt the symptoms of her illness, Ms. Doe’s quality of life deteriorated dramatically. She suffered physical pain and discomfort, fatigue, loss of concentration and mental anguish. She was, often, unable to work, and her family members frequently found her bedridden during their many visits.
Because of Dr. Blank’s negligence, Ms. Doe’s two adult sons will no longer have the support of their mother and best friend. Ms. Doe’s surviving mother has lost a daughter who provided love and assistance, both financially and emotionally. Her young grandchildren have lost decades of the love and attention of a very involved grandmother. And finally, her extended family has lost a vital member.
Facts and Arguments for Defendant(Dr. Blank)
Dr. Blank was Ms. Doe’s family doctor for several years and he too is saddened by her death. He denies, however, that he acted negligently or that he deviated from the standard of care during the course of her illness. Her complaints of cold-like symptoms and headaches came during the peak of the cold and flu season and masked the serious nature of her condition. He took reasonable steps to help her, including prescribing antibiotics and a pain reliever. When her symptoms did not dissipate following her first visit on February 5, he appropriately ordered a CT scan and lab tests that did not suggest that she was suffering from a more serious condition. He took proper and sensible steps to identify other possible
problems considering the symptoms presented.
Ms. Doe’s continuing complaints of headaches did not appear to increase in seriousness for several weeks. Patients can contract one cold virus after another without diminished symptoms and individual cold viruses often linger for long periods of time and associated headaches are not uncommon. Rhinosinusitus is often accompanied with sinus headaches and otitis media can also produce headache symptoms. The lab and CT scan results had been negative. So, considering all the factors, Dr. Blank had no reason to suspect that a very serious illness was progressing.
Contrary to plaintiffs’ contentions, physicians are not required to seek out all possible causes of symptoms before ordering medication, but only reasonable explanations. When Dr. Blank prescribed a nasal spray and anti-inflammatory to attempt to relieve the persistent symptoms on March 19, he had no reason to expect that Ms. Doe’s condition was deteriorating. At this point in time, she continued to present with
nothing more than persistent cold symptoms and there was nothing indicative of a serious illness. He advised rest and plenty of soup as is common under these circumstances.
It was not until shortly before she was admitted to the hospital that serious symptoms began to present themselves. This in itself indicates that Ms. Doe may not have contracted the cryptococcal meningitis until late in March.
When she was admitted to the hospital, Dr. Blank continued to perform various tests in an attempt to diagnose her mysterious condition. While it is very unfortunate that her cryptococcal meningitis was not diagnosed until shortly before her death, it is unfair to accuse Dr. Blank of not doing everything reasonable to help her. Cryptococcal meningitis is a rare disease that unfortunately shares many of the
same symptoms as are caused by colds and the flu. Doctors cannot, however, be expected to order an EEG and a spinal tap for all patients with cold or flu-like symptoms who complain of headaches. Prior to the time when Ms. Doe was admitted to the hospital, it was reasonable for him to consider her symptoms as not serious enough to warrant more invasive testing or a referral to a neurologist.
It was not until Ms. Doe’s symptoms became very serious at the hospital that the tests that ultimately discovered the meningitis were ordered. In fact, Ms. Doe was in the hospital and under the care of other physicians who were covering for Dr. Blank for four days between March 27 and April 1, and no one ordered an EEG or spinal tap or made a diagnosis of cryptococcal meningitis. The EEG was only done when Ms. Doe stopped following commands and would make no verbal responses. And it was the abnormal results of the EEG that led to the spinal tap being ordered to determine the cause of those abnormalities and ultimately the discovery of the meningitis.
Also, it is not certain when she actually contracted the meningitis or if an earlier diagnosis could have saved her life. Even if the cryptococcal meningitis was found earlier, it is very possible she might not have survived.
Dr. Blank acted within the standard of care throughout his care of Ms. Doe. Hindsight is 20-20, and he cannot be expected to have discovered the cryptococcal meningitis considering the symptoms he was presented with at the time. Even the neurology specialist took two days in a hospital environment to finally discover the meningitis and it is questionable whether even he would have made that discovery without the serious symptoms that led to the EEG and ultimately the spinal tap.