Doctors in emergency situations have a responsibility to act accordingly based on a patient’s symptoms upon arrival. Especially in pediatric patients, it is essential for a physician to take abnormalities seriously because illnesses in pediatric patients may appear differently than in adult patients.
It is also of the utmost importance for physicians to act diligently in diagnosing patients who are demonstrating an accumulation of abnormal symptoms to prevent further deterioration. The more quickly an accurate diagnosis is reached, the faster the patient can receive proper treatment, which in the most serious cases can be life saving.
Failure to follow these steps in patient care ultimately leads to careless mistakes. An inattentive doctor can cause loss of life, and that is exactly what happened in this case.
The Townsley Law Firm won this case in a settlement with the defendant, in which they agreed that negligence occurred. A settlement over $550,000 was awarded to our client in this case.
Table of Contents
What Happened: Two Medical Encounters. Two Failures. One Preventable Death.
The Pediatrician’s Office
Our client, a 13-year-old girl, was brought to her pediatrician’s office with a combination of symptoms that, taken together, pointed toward a serious cardiac problem: chest pain accompanied by coughing, shortness of breath, and markedly cold hands.
Cold extremities in a young patient are not a benign finding. They indicate reduced peripheral circulation, a sign that the heart may not be pumping effectively. Combined with chest pain and shortness of breath, this presentation demanded a thorough evaluation.
The nurse practitioner who saw our client did not conduct a proper medical history. She did not perform a thorough physical examination. She ordered no chest X-ray. She ordered no lab work.
Without confirming her diagnosis through any objective test, the nurse practitioner concluded that our client had influenza. A diagnosis she reached without proper testing (an influenza test). Our client was sent home with a prescription for cough medicine, Zofran (an anti-nausea medication), and an inhaler.
This was the first, and most critical, missed opportunity to save her life.
The Emergency Room
Less than 36 hours later, our client was brought to the emergency room. Her original symptoms had not improved. In fact, they worsened.
In the ER, clinicians observed a young girl who was:
- Tachycardic: heart rate dangerously elevated
- Tachypneic: respiratory rate dangerously elevated
- Hypoxic: oxygen levels falling below safe range
- Diaphoretic: drenched in cold sweat, a classic sign of shock
- Extremely cold hands: persistent, worsening peripheral vascular compromise
This was not a child with the flu. This was a child in cardiogenic shock. Her heart was failing to circulate blood adequately to her body. Every one of these signs, in combination with her initial complaint of chest pain, pointed directly to a cardiac emergency.
The emergency room physician failed to recognize this. Rather than treating this as a potential cardiac crisis, the ER team administered high-volume fluid boluses, a treatment appropriate for many types of shock, but potentially dangerous in a patient with a failing heart, where flooding the circulatory system places additional strain on cardiac muscle that is already overwhelmed.
Critically, the medical team never obtained arterial blood gases (ABGs), which is a standard diagnostic test that would have revealed the severity of her respiratory and metabolic failure and indicated the need for urgent cardiac intervention. Other essential cardiac diagnostic tests were also not performed.
Our client continued to deteriorate. As physicians watched her condition become unstable and critical, the decision was made to transfer her to another facility. The ER physician placed the child on a ventilator prior to transfer and made two more critical errors. He failed to notify the accepting physician about the need for the ventilator, and he ordered the wrong ventilator settings, which worsened her condition.
She was transported by ground ambulance, not air transport, despite her critical condition.
En route or shortly after arriving at the receiving hospital, she suffered a fatal cardiac arrhythmia. She died before she could receive the care her condition had required from the very beginning.
What the Clinicians Were Required to Do — and Did Not Do
Both the nurse practitioner at the pediatric office and the emergency room physician failed to meet the standard of care Louisiana law requires of medical professionals.
At the pediatric office, the nurse practitioner was required to:
- Obtain a complete and thorough patient history
- Perform a physical examination adequate to assess the significance of chest pain, respiratory symptoms, and cold extremities in a child
- Order appropriate diagnostic testing, and at a minimum, an influenza test before diagnosing influenza; a chest X-ray and basic labs given the combination of symptoms
- Consider cardiac causes of chest pain in a child before concluding a respiratory diagnosis
She did none of these things.
At the emergency room, the physician was required to:
- Recognize the constellation of tachycardia, tachypnea, hypoxia, diaphoresis, and cold extremities as signs of a hemodynamic emergency
- Conduct a cardiac workup including ECG, troponin levels, and chest X-ray
- Obtain arterial blood gases to evaluate the severity of respiratory compromise
- Recognize that fluid boluses may worsen cardiac output in a patient with myocarditis
- Arrange appropriate transport, including consideration of air transport, for a critically ill pediatric patient
He did none of the essential steps.
Miscommunication between doctors and nurses and the failure of physicians to listen to patients and get accurate histories are some of the top causes of medical errors and patient harm in hospitals.
This case was resolved in a settlement, in which compensation was secured for our client’s surviving family members.
What Is a Nurse Practitioner’s Legal Duty of Care in Louisiana?
In Louisiana, nurse practitioners are licensed advanced practice registered nurses authorized to diagnose conditions, order and interpret diagnostic tests, and prescribe medications. In exercising these functions, nurse practitioners are held to the standard of care applicable to a reasonably competent nurse practitioner practicing in the same specialty under similar circumstances.
This means a nurse practitioner who conducts a clinical evaluation is legally required to perform that evaluation thoroughly including gathering adequate history, performing an appropriate physical examination, and ordering the diagnostic tests a reasonably competent clinician would consider necessary. The failure to perform an influenza test before diagnosing influenza, and the failure to consider cardiac causes in a child presenting with chest pain and cold extremities, both constitute departures from that standard.
Louisiana law allows patients, and in wrongful death cases, their surviving family members, to hold nurse practitioners and the healthcare facilities that employ them accountable for negligent care.
What Viral Myocarditis Is — and Why It Is Survivable When Caught in Time
Viral myocarditis is an inflammation of the myocardium, the muscular tissue of the heart, caused by a viral infection. The condition is most commonly triggered by common viruses, including enteroviruses, adenoviruses, and others that circulate widely in the community.
In many cases, viral myocarditis presents with symptoms that mimic respiratory illness: chest pain, cough, shortness of breath, and fatigue. This overlap is precisely why a thorough evaluation, including an ECG, cardiac enzymes (troponin), chest X-ray, and consideration of echocardiography, is essential when a young patient presents with chest pain alongside respiratory symptoms.
When viral myocarditis is identified, treatment focuses on supporting the heart, managing arrhythmia risk, and in severe cases, providing mechanical circulatory support. The condition is survivable with appropriate care. The medical literature and expert testimony in this case established that had our client’s cardiac condition been identified at any point in her two medical encounters, routine diagnostic and therapeutic interventions would more likely than not have prevented her death.
She did not die from viral myocarditis. She died from the failure to diagnose and treat it.
