This case involved a 6 month old girl who died from peritonitis induced sepsis seven days post colostomy take down relating to the surgical treatment of the child’s congenital Hirschprung’s disease. Three days following January discharge from the hospital, the child developed fever. The parents reported the fever to the defendant, pediatric surgeon who, upon telephonic inquiry, was satisfied that the fever was not surgically related and referred the parents to the child’s pediatricians. The first of our two pediatrician clients was paged on a Saturday evening and directed that the child be seen and evaluated in the office that evening at 10:30 PM. Examination at that time reported a rectal temp of 103.5 but no associated abdominal symptoms or findings. The baby was described to be alert and playful. She was observed to be eating, voiding, and passing stool and gas. Exam revealed normal bowel sounds without any abdominal distension or tenderness. The colostomy closure wound site showed no evidence of discharge or inflammation. The baby did have some mild congestion and it was the pediatrician’s assessment that the baby most probably had a viral illness and concurred with the opinion conveyed by the surgeon to the parents that the fever was not surgically related. The next day, Sunday, three telephone exchanges occurred between the mother and our second pediatrician client wherein the only reported change in the baby’s condition was one episode of vomiting. By all accounts, the baby continued to feed, void and pass stool with a soft, non-distended and non-tender belly. On each occasion, the doctor offered to see the child for further assessment but the mom elected to wait until the next morning. By the parent’s account, the baby was fed at around 11:00 PM and laid to bed “pleasant and smiling”. The mother woke the next morning to find that the baby had died.
Autopsy findings revealed a small abscess adjacent to a suture at the site of the bowel anastomosis. The abscess had apparently leaked e-coli from the bowel into the peritoneal cavity and blood stream resulting in peritonitis and sepsis which was determined to be the cause of death. Plaintiffs contended that the standard of care in evaluation of fever post abdominal surgery demands the performance of radiographic abdominal studies and blood work and that had a CT scan been obtained, the anastomosis site abscess would have been detected for timely treatment to have been rendered. Plaintiffs asserted that they were falsely reassured by the doctors. They contended that our second pediatrician should have insisted on seeing the baby rather than merely offering to see her. The defense presented cogent pediatric and pediatric infectious disease experts who testified that in the absence of clinical findings or symptoms pointing toward the abdomen as the likely source of fever, the indiscriminate ordering of tests is entirely inappropriate. Moreover, the defense experts asserted that, given the description of the baby up until the moment she was laid to bed, it was most likely that the anastomotic leak developed while the baby slept and that she succumbed rapidly to the septic effects of the virulent e-coli bacteria. After a two week trial, a York County jury found in favor of the three defendant physicians.
The case was prosecuted on behalf of the plaintiffs by Frank Collern from the Collern Firm. The defendant pediatric surgeon was represented by Jeff Lewis from Eckert Seamens. The two named defendant pediatricians and their group were represented by Margolis Edelstein’s, Michael M. Badowski.
Michael M. Badowski
NBTA Certified Civil Trial Advocate
Direct Dial 717-760-7500