Question

My daughter got bacterial meningitis and is now severely injured. We're devastated and my wife is blaming herself. Our daughter went to the pediatrician twice and to the ER, but I can't console her. The doctors said nothing could have prevented what happened, but a good friend said that wasn't necessarily true. We live in Illinois and just want to know the truth.

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Answer

I’m sorry for what you’re going through. As a parent myself, I know how helpless and sometimes guilty we feel when our children get sick. I don’t know everything that happened in your case, but I can say with absolute confidence that nothing you or your wife did caused the outcome. I know this because I know that bacterial meningitis, especially in children, can look and act like a bad flu and the only one who knows how to tell the difference is a trained doctor (or nurse). Which is the real question here: did your doctors (or nurses) miss the bacterial meningitis? It is certainly possible, especially since your daughter was seen twice by your pediatrician. But let me answer your question by starting with some basics about the disease.

Bacterial meningitis is a bacterial infection in the lining of the brain (and spinal cord) called the meninges; thus its name. In the vast majority of cases, the bacteria get into the meninges by first getting into the bloodstream and then hitching a ride into the brain. But sometimes the bacteria can directly invade the brain from an ear or sinus infection (areas that are very close to the brain). The bacteria that cause bacterial meningitis typically find their foothold in our nasal passages, ear canals, and respiratory system, and, while there, cause what we would describe as the flu or flu-like symptoms, or earaches. In most cases the body’s immune system fights off these infections before they can cause serious illness, and starting in 2005, vaccines for many common and dangerous meningitis bacteria became part of pediatric immunizations. As a result, most of the time when our children get infected with the bacteria that cause bacterial meningitis we never know it because the body’s immune system, especially when boosted by a vaccine, successfully defeats the bugs.

In the un-immunized, however, there are times when the bacteria overwhelms the body’s defense system, or the bacteria travel to a place where the body has problems fighting them off, like the brain and spinal cord. In such cases, antibiotics are mandatory and if given in a timely manner will, in the vast majority of bacterial meningitis patients, lead to a recovery without serious injury. The key concept is, of course, timeliness. What this means in practical terms is that patients suspected of having bacterial meningitis must get antibiotics within an hour of their arrival to the emergency department or the doctor’s office. Any delay in administering antibiotics beyond this hour is medical malpractice (medical negligence). Because delay in treating bacterial meningitis is always life-threatening, doctors aren’t even allowed to wait for test results before giving antibiotics. The rule of thumb is that the moment a doctor thinks of bacterial meningitis is the moment he must start treating it. Nothing is allowed to delay the giving of antibiotics. A simple analogy may help you understand why this is so. 

Consider a house that gets invaded by termites. At first the infestation is small, and the house owner doesn’t pay them much mind, but before long the number of termites double and have begun to spread to all parts of the house. Now if the owner still does nothing—that is, he chooses to delay treating the infestation after its begun to grow—the termites will keep doubling in number until there are too many to control and the house begins to collapse. The same thing happens with bacteria that are allowed to grow untreated in a patient with bacterial meningitis. In such cases, the bug will keep doubling in number and after a point will cause the brain to swell until the patient dies or is seriously injured. This is why the only way to successfully treat bacterial meningitis is to get antibiotic treatment as early as possible, while the bacteria are still few enough in number to be controlled.

To ensure that treatment isn’t delayed, nurses and doctors are carefully trained to recognize the signs and symptoms of bacterial meningitis. In children under the age of two the signs and symptoms of bacterial meningitis can be subtle, but include irritability, high pitched crying, poor feeding, fever, vomiting and something called a “bulging fontanelle” (which is the soft spot in the baby’s skull). They may also have a stiff neck (a painful turning of their head) but this is not a very common sign in babies. In older children and young adults, signs and symptoms of bacterial meningitis may include high fever, severe headache, stiff neck (painful turning), light sensitivity, vomiting, nausea, lethargy, confusion, and in advanced cases, loss of consciousness. In a certain type of bacterial meningitis, there may also be a rash. 

Of all the signs and symptoms, the ones that stand above the others as bright red flags of warning are lethargy, headache, and stiff neck, with lethargy being the single most important sign. (Lethargy is extreme tiredness, sluggishness, or lack of energy or involvement. Parents often describe lethargy with phrases like this: “just lying around,” “not herself,” like a ragdoll,” or “won’t do anything.”) The rules of medicine, also known as the standards of care, say that when a doctor has a pediatric patient with any one of these signs he must presume it is bacterial meningitis until proven otherwise, and must administer antibiotics immediately.

Now, with that background, let’s look at the various opportunities where the negligence of a doctor or nurse could have caused injury to your daughter from bacterial meningitis. If you were to contact our law firm, Cirignani, Heller & Harman (www.cirignani.com) about your daughter’s case, the first things we’d review are her pediatrician records to see if proper immunizations were given. If your child should have been vaccinated, but wasn’t, this is medical malpractice. (By the way, you can do this yourself but you really don’t have to. My partner, Stan Heller, is a lawyer who is also a doctor, and he’ll review your medical records and talk to you about what he’s found free of charge, and without you having to hire us or make any other commitments). 

The second thing we’d do is determine whether your daughter showed signs or symptoms that should have triggered the thought of bacterial meningitis when your wife brought her to the pediatrician. If so, then the doctor had a duty to immediately treat your child with antibiotics. Understand, this is not something your wife could have possibly known—it was and is the doctor’s job. If, for example, your daughter was lethargic, feverish, and throwing up, her pediatrician should have immediately suspected bacterial meningitis, given her antibiotics, and sent her to the emergency department to be worked up for possible bacterial meningitis. Failure to do these things is medical negligence.

Similarly, the third thing we’d do is examine closely the care your daughter got at the emergency room. Did the triage nurse recognize the possibility of bacterial meningitis and give her a high acuity rating (a rating that says she was an emergency case that needed a doctor’s care right away)? If not, it is nursing negligence. Even if the triage nurse acted correctly, we’d still check to see if your daughter was seen by a doctor and given antibiotics quickly. As I mentioned earlier, unless there are unusual circumstances (like an over-busy ER), the standard of care required your daughter to get antibiotics within an hour of her arrival to the ER (this is sometimes referred to in the medical business as the “golden hour.”). Any unjustified delay in the giving of antibiotics is medical negligence. 

Finally, we’d look to see if the doctors chose the proper treatment once they suspected bacterial meningitis. There are four common types of bacteria that cause most cases of bacterial meningitis. One of them, Streptococcus pneumoniae, has developed a strain that is resistant to many common antibiotics. Doctors know all about this resistant strain, and must therefore administer an antibiotic to cover that strain. Failure to give the proper antibiotic is medical malpractice.

In sum, while bacterial meningitis is a very serious disease, appropriate vaccinations, and prompt recognition and proper treatment almost always leads to good results. I cannot know without looking at the medical records and finding out the details of your daughter’s course, but with three different doctors examining your daughter I cannot help but be suspicious that someone somewhere missed what is inexcusable to miss.

(Note, while this question is technically a hypothetical one, it is based very closely on a real case handled by our law firm).

Answered 08/02/2013

Disclaimer: This answer was provided by an attorney selected to Super Lawyers, and is intended to be an educated opinion only. This answer should not be relied upon as legal advice, nor construed as a form of attorney-client relationship.

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