Defense Verdict in a Case of Appendicitis in a 3 ½-year old Girl.
PRI obtained a defense verdict on behalf of a pediatrician, a pediatric physician assistant (PA), and an urgent care facility in a case involving the alleged failure to diagnose appendicitis in a 3 ½ year old girl.
The events of the case began on December 3rd at 11:30 PM when the patient was brought to the urgent care facility by her mother. The patient was seen by the PA. The chief complaint was periumbilical pain for the past 2 hours. The mother reported that her daughter felt feverish but had normal energy and no changes in appetite. On exam, the patient was afebrile with an elevated pulse. Her abdominal exam was normal, along with the rest of the exam. The PA diagnosed early gastroenteritis vs. viral illness. The care of the child was not discussed with the supervising pediatrician. The mother was instructed to bring the patient to the ED if there was any nausea, vomiting, change in appetite, or worsening abdominal pain. Twenty-one hours later, the girl was brought to the ED with right lower abdominal pain and lethargy. She was found to have a perforated appendicitis and surgery appendectomy was performed. Following discharge, the patient developed a pelvic abscess requiring hospital readmission and long term IV antibiotic therapy. Two years after the visit in question, the parents filed suit against the PA, the pediatrician, and the urgent care facility.
During trial the plaintiff’s attorney tried to show that the defendant PA was negligent in not sending this patient to the emergency department where blood work and imaging studies would have allowed the diagnosis of appendicitis to have been made earlier on, thereby decreasing the chance of appendiceal rupture and subsequent formation of an intra-abdominal abscess. Furthermore, according to the plaintiff’s attorney, the PA should have consulted with the attending pediatrician present at the urgent care center. Had this occurred, according to the plaintiff’s case, the pediatrician likely would have better recognized the signs and symptoms of appendicitis. In response, PRI’s defense team showed that the medical record, as documented by the PA, revealed that she obtained a thorough history including diet and bowel habits. The defense was able to demonstrate to the jury how the medical record clearly delineated a thorough abdominal exam including “negative McBurney’s point tenderness”. This documentation reflected that the PA appropriately considered and evaluated for appendicitis. PRI’s expert witnesses explained to the jury that appendicitis is less common in children of this age and that the condition is an evolving process. At the time of the encounter, the appendicitis was very early, yielding a benign exam which warranted no further workup other than supportive care and parental observation. The patient’s mother was given appropriate discharge instructions, informing her that if there was fever, change in appetite, or if the pain worsened or moved to the lower right abdomen, she should bring her daughter to the emergency department. After considering the argument on both sides and reviewing all the evidence, the jurors determined that PRI’s defendants had not departed from the standard of care, and a verdict in favor of the defense was rendered.