NP and PA misdiagnosis leads to 1 year old death and $3M lawsuit awarded

[wamcp]

https://www.kansascity.com/news/nation-world/national/article252446403.html?fbclid=IwAR1peZVxp-6bYeUwUuQUKOL2495uJrWbRAwGMpXDgBP4RZsKRPwQZGA_aqw

When Kyler was 5 months old, he was seen at a primary care clinic at CoxHealth after suffering a persistent fever for 10 days. A nurse practitioner diagnosed him with pneumonia, though he didn’t exhibit other signs of pneumonia, attorneys said. Kyler had actually been suffering from Kawasaki disease.

The Missouri mom took 1-year-old Kyler George to an urgent care clinic at CoxHealth Hospital Branson in June 2017.
Kassie McAtee knew something was wrong with her toddler son.
He was pale, cold, clammy and acting lethargic.

There, a physician’s assistant diagnosed him with an earache and sent them home without conducting a complete examination.

Three hours later, Kyler died.

In a statement, CoxHealth told KOLR it believes appropriate care was provided in Kyler’s case.

Mom awarded $3.2 million, adjusted to $1.8 million due to Missouri laws.

As an internist, I ask: Would this have been easily recognized by an attending pediatrician?

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[SurfingDoctor]

First. Why are all your posts on here about misdiagnosed of advanced practitioners. Does that make you feel good or something?

Second. The child died 3 hours after seeing the PA. Given the quick decline, its hard to say whether anything would have made a difference. There's clearly details missing here as I guess the jury thought it was a clear mistake, but if my child was pale and lethargic, I would probably take them to the ER, not an urgent care clinic. Again, though, none of us were there so it's all pointless conjecture.

 

[WheezyBaby]

https://www.kansascity.com/news/nation-world/national/article252446403.html?fbclid=IwAR1peZVxp-6bYeUwUuQUKOL2495uJrWbRAwGMpXDgBP4RZsKRPwQZGA_aqw

When Kyler was 5 months old, he was seen at a primary care clinic at CoxHealth after suffering a persistent fever for 10 days. A nurse practitioner diagnosed him with pneumonia, though he didn’t exhibit other signs of pneumonia, attorneys said. Kyler had actually been suffering from Kawasaki disease.

The Missouri mom took 1-year-old Kyler George to an urgent care clinic at CoxHealth Hospital Branson in June 2017.
Kassie McAtee knew something was wrong with her toddler son.
He was pale, cold, clammy and acting lethargic.

There, a physician’s assistant diagnosed him with an earache and sent them home without conducting a complete examination.

Three hours later, Kyler died.

In a statement, CoxHealth told KOLR it believes appropriate care was provided in Kyler’s case.

Mom awarded $3.2 million, adjusted to $1.8 million due to Missouri laws.

As an internist, I ask: Would this have been easily recognized by an attending pediatrician?

Hard to answer these things without seeing the kid or at least having more complete information. 10 days of fever would universally at least lead to entertaining the idea of a KD diagnosis. The optics are obviously not great of a kid dying 3 hours after a health professional assessed them in a sick visit and thought they were good to go home

First. Why are all your posts on here about misdiagnosed of advanced practitioners. Does that make you feel good or something?

Second. The child died 3 hours after seeing the PA. Given the quick decline, its hard to say whether anything would have made a difference. There's clearly details missing here as I guess the jury thought it was a clear mistake, but if my child was pale and lethargic, I would probably take them to the ER, not an urgent care clinic. Again, though, none of us were there so it's all pointless conjecture.

One of the recent transfers I accepted the OSH described as "pale and lethargic" planning to transport by private vehicle

 

[SurfingDoctor]

Hard to answer these things without seeing the kid or at least having more complete information. 10 days of fever would universally at least lead to entertaining the idea of a KD diagnosis. The optics are obviously not great of a kid dying 3 hours after a health professional assessed them in a sick visit and thought they were good to go home



One of the recent transfers I accepted the OSH described as "pale and lethargic" planning to transport by private vehicle

View attachment 339786

Medicolegally, that's a terrible idea. What that the family's request?

 

[WheezyBaby]

Medicolegally, that's a terrible idea. What that the family's request?

I didn't get into it with them. I strongly advised alternative transport and they came ALS. It's usually not too much an argument when it's something like this. Sometimes it's more an argument for an ICU transfer where the transferring wants to use their crew (quality ranging from "acceptable" to "I would rather drive them to the hospital in my sedan") and I want to use ours, which is generally excellent, but ultimately they're responsible for choosing transport obviously

 

[robellis]

First. Why are all your posts on here about misdiagnosed of advanced practitioners. Does that make you feel good or something?

Second. The child died 3 hours after seeing the PA. Given the quick decline, its hard to say whether anything would have made a difference. There's clearly details missing here as I guess the jury thought it was a clear mistake, but if my child was pale and lethargic, I would probably take them to the ER, not an urgent care clinic. Again, though, none of us were there so it's all pointless conjecture.

Why wouldn’t it make him feel better? If physicians aren’t better at diagnosing then what is all our training for? So yes, we feel better when the APPs are shown to be inferior

 

[SurfingDoctor]

Why wouldn’t it make him feel better? If physicians aren’t better at diagnosing then what is all our training for? So yes, we feel better when the APPs are shown to be inferior

Umm… Alright.

 

[VA Hopeful Dr]

Why wouldn’t it make him feel better? If physicians aren’t better at diagnosing then what is all our training for? So yes, we feel better when the APPs are shown to be inferior

I get satisfaction from a job well done, not from being better than anyone else.

 

[robellis]

I get satisfaction from a job well done, not from being better than anyone else.

I bet you wouldn’t feel that way if NPs were doing a better job than you

 

[deleted941485]

I get satisfaction from a job well done, not from being better than anyone else.

Im sure you'll be satisfied when the midlevels are doing a job well done that you will be pretty much redundant.

 

[VA Hopeful Dr]

I bet you wouldn’t feel that way if NPs were doing a better job than you

I don't compare myself to anyone else, so I'd never know if they were or not.

I have 6 physician partners, no idea how they practice or how good they are at it. Why would NPs be any different?

 

[robellis]

I don't compare myself to anyone else, so I'd never know if they were or not.

I have 6 physician partners, no idea how they practice or how good they are at it. Why would NPs be any different?

That’s not normal human behavior but to each their own

 

[VA Hopeful Dr]

That’s not normal human behavior but to each their own

As I'm one of the apparently rare physicians that enjoys my job, doesn't freak out about midlevels, and would recommend the profession to my kids seems like maybe I have the right idea.

 

[oldbearprofessor]

As I'm one of the apparently rare physicians that enjoys my job, doesn't freak out about midlevels, and would recommend the profession to my kids seems like maybe I have the right idea.

Are you sure you're rare? I meet those three criteria and have >1 physician children. I'm also way more interested in babies getting good care than who makes a diagnosis and do not find any satisfaction in a missed diagnosis regardless of who makes it, especially if it harms a child. I've been working with nurse practitioners and PAs since 1985 (yes, we had a neonatology PA in 1985) and greatly appreciate what they add to the neonatal care teams.

 

[Iamnew2]

https://www.kansascity.com/news/nation-world/national/article252446403.html?fbclid=IwAR1peZVxp-6bYeUwUuQUKOL2495uJrWbRAwGMpXDgBP4RZsKRPwQZGA_aqw

When Kyler was 5 months old, he was seen at a primary care clinic at CoxHealth after suffering a persistent fever for 10 days. A nurse practitioner diagnosed him with pneumonia, though he didn’t exhibit other signs of pneumonia, attorneys said. Kyler had actually been suffering from Kawasaki disease.

The Missouri mom took 1-year-old Kyler George to an urgent care clinic at CoxHealth Hospital Branson in June 2017.
Kassie McAtee knew something was wrong with her toddler son.
He was pale, cold, clammy and acting lethargic.

There, a physician’s assistant diagnosed him with an earache and sent them home without conducting a complete examination.

Three hours later, Kyler died.

In a statement, CoxHealth told KOLR it believes appropriate care was provided in Kyler’s case.

Mom awarded $3.2 million, adjusted to $1.8 million due to Missouri laws.

As an internist, I ask: Would this have been easily recognized by an attending pediatrician?

I'm not even a Pediatrician and within about 5 seconds of reading your first sentence I thought Kawasaki disease! For the second one, a pre-med could have diagnosed that. This is why I think the next big thing in law is midlevel lawsuits. Reason why if they "practice independently" it might be the best thing for medicine. They will soon realize how little they know.

 

[SurfingDoctor]

😐

 

[VA Hopeful Dr]

Are you sure you're rare? I meet those three criteria and have >1 physician children. I'm also way more interested in babies getting good care than who makes a diagnosis and do not find any satisfaction in a missed diagnosis regardless of who makes it, especially if it harms a child. I've been working with nurse practitioners and PAs since 1985 (yes, we had a neonatology PA in 1985) and greatly appreciate what they add to the neonatal care teams.

Probably not, SDN effect (I hope).

 

[Katheudontas parateroumen]

I'm no pediatrician either but 10 days of fever... 10 DAYS. That has got to raise some alarms. I didnt think of KD but I would have definitely be more alarmed and sought further assessment. The problem is APP don't know what they dont know. If I don't know something I am willing to send off for more investigation. Not just chalk a TEN DAYS hx of fever in a 5month of just to PNA or Ear ache especially if they had no signs/symptoms of either. I am sure anyone can make a mistake but the issue is people just making a diagnosis just for the sake of making one. Do not just chalk something if the things don't add up. It's okay to not know what is going on and admit it! That's more wise than just coming up with some diagnosis.

 

[SurfingDoctor]

I wonder how many other posts will start off “I’m not a pediatrician BUT”…

 

[SurfingDoctor]

Update: I had this question on my MOCA today.

"A 4-year-old girl is evaluated for daily fever for 2 weeks. Her mother has a journal showing temperatures to 41°C each day, mostly in the evenings, though occasionally at different times on the weekends."

Now, you're not suppose post board questions so I won't give you the answer, other than to say that none of the answers were "Kawasaki's Disease"... just for those non-pediatricians in the room. Actually all of the answers were relatively benign.

Also, FYI, 25% of the respondents (who are board-certified pediatricians BTW), got it wrong. So... they clearly must have been all NPs prior to their MDs... so says the armchair experts.

 

[robellis]

Update: I had this question on my MOCA today.

"A 4-year-old girl is evaluated for daily fever for 2 weeks. Her mother has a journal showing temperatures to 41°C each day, mostly in the evenings, though occasionally at different times on the weekends."

Now, you're not suppose post board questions so I won't give you the answer, other than to say that none of the answers were "Kawasaki's Disease"... just for those non-pediatricians in the room. Actually all of the answers were relatively benign.

Also, FYI, 25% of the respondents (who are board-certified pediatricians BTW), got it wrong. So... they clearly must have been all NPs prior to their MDs... so says the armchair experts.

Were you a nurse before or something? Jeez I’ve never seen such a sellout before

 

[SurfingDoctor]

Were you a nurse before or something? Jeez I’ve never seen such a sellout before

Ha. Sure, why not. If that makes you feel better.

 

[Stitch]

Were you a nurse before or something? Jeez I’ve never seen such a sellout before

You are welcome to your opinions about NPs and PAs, but there's no need or place for the pot shots at other members like this. Keep it civil.

 

[robellis]

Ha. Sure, why not. If that makes you feel better.

So you were a nurse?

 

[SurfingDoctor]

So you were a nurse?

Why does it matter?

 

[robellis]

Why does it matter?

Lol.

 

[Stitch]

I think this thread has run its course. For what it's worth it's certainly reasonable to discuss scope of practice and concerns with comparative training, however anecdotes like this one, where the details of the case are unknown, are seldom helpful, and can be used in either direction.