Something seems off about this case to me. Opinions? (Mt Druitt child death)

[Ceke2002]

I really don't want to link to the news article regarding this case, because it contains images of a dying child hooked up to 'life support' (mainly out of respect for the deceased).

About a week ago in Mt Druitt Sydney there was the death of a 15 year old boy from what I'm gathering was a brain infection. The parents are trying to go after Paramedics and ED staff for lack of proper care leading to their sons death, but some of what they've said in interviews just doesn't add up to me. Not being a Doctor myself I thought I'd see what others opinions were on this case.

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According to the mother:

15 year old boy with a blocked/runny nose lasting 3 days, began feeling worse and vomited (didn't say how many times) on the night of June 23rd.
Child initially presented to GP (date of first visit not given), and was allegedly noted to be experiencing confusion with a temp of 40C, low heart rate and low blood pressure. GP informed parents their child did not belong there (at the GP clinic) and sent them to the local hospital with a letter saying he needed to be seen straight away because he "looked very unwell" and "confused".

Parents then claim they waited for 1 and half hours at the hospital, and were told to take their son home to rest and given panadol. They also claim they were told there were 60 other patients in front of them and if they decided to wait it would be about 9 hours before they could be seen by a Doctor, and that the triage Nurse told them it was likely to be a stomach bug or the flu. At this point they claim their son's eyes were rolling back in his head, he didn't know what was happening, and that he was confused and in a daze. At the same time they also claim that their 'dazed, confused and doesn't know what's happening' 15 year old son was apparently able to communicate his own desire to not wait at the hospital.

Once they got home the boy started vomiting again and kept exclaiming, "I don't feel well, my head, my head". The mother then applied a cold compress to help with her son's fever, but says that she noticed he had chills so knew he had an infection. Child could barely eat, and experienced headaches throughout the evening.

The following day the child began complaining about loss of movement in one leg. At 4.37 am June 26 the family were awoken by the sound of their son screaming. He told his parents his head and stomach hurt, and he was vomiting. An ambulance was called at which point it is alleged that paramedics were skeptical of the seriousness of the situation, and suggested the teenager just needed to drink plenty of fluids. They then allegedly informed the parents that their son likely had a stomach bug or the flu and "if we take him down to hospital he will get other bugs". The mother then says she noted the boys pallor, and that she 'knew her boy' and something wasn't right. She allegedly told paramedics there was something wrong with her son's brain, only to be dismissed again when paramedics told her, "No that's how you act when you've got the flu" and that the child in question was probably being 'overdramatic'.

The boy's condition worsened throughout the day and into the following evening, with his parents allegedly noting body aches, head swelling and vomiting of blood. At one point the boy stated that it felt like his head was going to explode. An Ambulance was called again at 9.10am on June 27, and the child was transported to hospital where he quickly became unresponsive. The mother then follows with a dramatic description of her screaming her son's name and overhearing ED staff saying, "we're going to lose him".

The teenager was placed into a medically induced coma, put on a ventilator and given antibiotics to help kill the infection. CT scans then showed he had fluid on the brain so he was rushed into surgery to remove a portion of his skull so his brain could swell and drain fluid. The parents claim they were told that when their son was opened up his head was "full of pus from infection". Two more operations followed, including a sinus drilling and removal of a front portion of the boy's skull. The family was then allegedly told that some of their son's brain was dead and that he'd never recover. The surgeon allegedly told the parents "there was nothing we could do", and all the nurses began crying because they don't normally treat children.

The boy had also apparently suffered a stroke between the time the first Ambulance was called, and allegedly dismissed the child's symptoms, and the time of the second ambulance arriving.

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Maybe it's just the way it's being reported, but the alleged wording of the Doctor's note, the dismissive of hospital staff towards what sounds like a clearly sick child, the changing story between 'the child had no idea what was going on' to 'the child was cognisant enough to refuse to wait at the hospital' during the first visit, the further dismissiveness of paramedics when allegedly faced with a 15 year old boy who is screaming in pain from his head and vomiting, the mother's description of all the nurses starting to cry because they never treat children, something about this whole case just doesn't sound right to me.

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[comp1]

One of the tragedies of medical cases that make the media is that you only ever get one side of the story unless a lawsuit actually progresses to trial, which is fortunately very rare as that is its own tragedy for everyone involved. This really prevents the public from learning about actual medicine and the problems and successes seen in it. It just becomes another sad story. This is not entirely on the family. The reporters might even be accurately reporting their perspective on things, but it is just that. It's a limited, one sided perspective, potentially horribly twisted by grief. No one's memory is perfect and people in horrible distress have some of the worst memories for specifics of what is said or done. I'm not sure what the solution is. I'd like to see more medical records released publicly in cases like this, but I don't see that happening. I did learn that acetaminophen is called Panadol in Australia at least. Also, I don't think the OP has to worry about shielding EM providers from seeing someone intubated, although I do agree it's quite a manipulative use of the image by the journalists.

 

[ERMudPhud]

I could see it happening. In fact we have cases every year in the US of kids being sent home then getting dramatically worse and dying. Makes the news here too. Usually they were told something like, "it's just the flu" It thankfully isn't common but it happens. During flu/RSV/COVID respiratory season you see literally countless kids with fever, runny nose, congestion, headache, vomiting, lethargy, feel like crap, not eating or drinking etc... Almost all of whom get better with fluids and tylenol. That's the flu. It's easy to get lulled into a false sense of security that every kid you see during that time is on the same trajectory. Recognizing the 1 kid in a million of those who has meningitis or sepsis and is about to fall off a cliff is the art and science of what we do but we aren't perfect at it. Sounds like their hospitals must be overwhelmed right now if they are seeing 9 hour wait times. I will say there are three important differences here. First, most of my community docs would call me and give me a heads up if they are worried, not write a note to send with patient, and I would tell the triage nurse to watch out for the patient. Second no one gets turned away from our ED's by a nurse saying its going to be a 9 hour wait. They might give up and leave on their own but it would be an EMTALA violation to announce to the waiting room or even tell individual patients in the waiting room, "Its going to be a 9 hour wait why don't you all go home, take some tylenol, and see how feel tomorrow" Third, our medics don't generally have the discretion to choose not to transport. If you call them and want to go to the ED except in very rare cases you are going.

 

[Rendar5]

Unfortunately, you will not be able to get a sense of what actually happened unless you review the medical records. media reports are notoriously inaccurate as are legal complaints filed. I’ve reviewed legal cases where I think I know exactly what happened until I actually take apart the records themselves. And even then will sometimes get surprised by what I find out in deposition since medical records themselves are not always detailed enough to get a sense of what was going on in the ED that day.

Im guessing the diagnosis was Pott’s Puffy Tumor. Never seen that in real life. A paramedic or nurse would typically have 0 clue as to what it was or how dangerous it is.

 

[ERMudPhud]

Im guessing the diagnosis was Pott’s Puffy Tumor. Never seen that in real life. A paramedic or nurse would typically have 0 clue as to what it was or how dangerous it is.

I've seen Pott's once. Seen severe meningitis from sinusitis, otitis, or mastoiditis a few times

 

[MechEDoc]

Improbable things happen and otherwise healthy people suddenly die even if you do everything right, thankfully it's very rare.

 

[TelemarketingEnigma]

m guessing the diagnosis was Pott’s Puffy Tumor. Never seen that in real life. A paramedic or nurse would typically have 0 clue as to what it was or how dangerous it is.

Sounds to me more like a bacterial sinusitis complicated by intracranial extension/empyema since it sounds like they did a craniotomy. I’ve seen a handful of both so far in residency (at a large peds hospital)- Potts can be fairly impressive on exam and I think less likely to be missed as stomach flu than infection hiding inside the skull. Of course, impossible to know for sure without medical records

Edit: jk I read it more closely after I posted and saw the mention of head swelling which does sound like Potts! Maybe complicated by intracranial infection as well

 

[Ceke2002]

One of the tragedies of medical cases that make the media is that you only ever get one side of the story unless a lawsuit actually progresses to trial, which is fortunately very rare as that is its own tragedy for everyone involved. This really prevents the public from learning about actual medicine and the problems and successes seen in it. It just becomes another sad story. This is not entirely on the family. The reporters might even be accurately reporting their perspective on things, but it is just that. It's a limited, one sided perspective, potentially horribly twisted by grief. No one's memory is perfect and people in horrible distress have some of the worst memories for specifics of what is said or done. I'm not sure what the solution is. I'd like to see more medical records released publicly in cases like this, but I don't see that happening. I did learn that acetaminophen is called Panadol in Australia at least. Also, I don't think the OP has to worry about shielding EM providers from seeing someone intubated, although I do agree it's quite a manipulative use of the image by the journalists.

The hospital is investigating so won't release any sort of official statement for that reason (which is fair enough). I'm very interested to read the coroner's report on this case, assuming there'll be one. Agree with the 'I'd like to see more medical records released publicly' statement, because the one sided reporting on this seems heavily biased.

I definitely don't think I have to protect EM providers from seeing a photo of a child intubated. I believe the parents took the photo themselves to use on their go fund me page and I just find that incredibly distasteful. I don't know if a 15 year old boy's last wishes would have been, "please take a photo of me as I lay dying, and post it to the internet."

 

[Ceke2002]

I could see it happening. In fact we have cases every year in the US of kids being sent home then getting dramatically worse and dying. Makes the news here too. Usually they were told something like, "it's just the flu" It thankfully isn't common but it happens. During flu/RSV/COVID respiratory season you see literally countless kids with fever, runny nose, congestion, headache, vomiting, lethargy, feel like crap, not eating or drinking etc... Almost all of whom get better with fluids and tylenol. That's the flu. It's easy to get lulled into a false sense of security that every kid you see during that time is on the same trajectory. Recognizing the 1 kid in a million of those who has meningitis or sepsis and is about to fall off a cliff is the art and science of what we do but we aren't perfect at it. Sounds like their hospitals must be overwhelmed right now if they are seeing 9 hour wait times. I will say there are three important differences here. First, most of my community docs would call me and give me a heads up if they are worried, not write a note to send with patient, and I would tell the triage nurse to watch out for the patient. Second no one gets turned away from our ED's by a nurse saying its going to be a 9 hour wait. They might give up and leave on their own but it would be an EMTALA violation to announce to the waiting room or even tell individual patients in the waiting room, "Its going to be a 9 hour wait why don't you all go home, take some tylenol, and see how feel tomorrow" Third, our medics don't generally have the discretion to choose not to transport. If you call them and want to go to the ED except in very rare cases you are going.

If Sydney is anything like Melbourne at the moment, then yeah I can imagine hospitals might be a tad overwhelmed. Covid, Pertussis, RSV and Mycoplasma Pneumonia out breaks are rife in the community.

What you said about Doctor's sending patients in, ED nurses not just telling patients to go home the wait will be too long, and decision to transport generally holds true here in my experience as well, or at least it does in the 2 States I've lived in (South Australia and Victoria). I've been on the receiving end of some genuinely poor care in the ED (long story short after multiple complaints and 3 patient deaths from treatable causes, the Health Department was required to step in), but I've never literally been told "the wait time is X hours, why don't you come back later" (I don't recall one single time visiting the ED where wait times were given unless you specifically asked), I've never known a GP to send a patient they think is an emergent case off to hospital with a vaguely worded letter (again just my own experience, but they tend to ring ahead and let the hospital know exactly why they are sending the patient in) and whilst you do have the right to refuse transport the majority of the time if something looks even remotely dodgy then Paramedics are going to do their darndest to get you to hospital.

 

[southerndoc]

Thread is locked as this borders on medical advice/legal issues and this thread may be discoverable.