When dealing with pediatric patients, doctors have a responsibility to recognize the differences in how an illness can present in a child versus an adult. Symptoms for an illness can be different in younger patients, which makes it essential for doctors to fully consider every possibility when determining a diagnosis and treatment plan.
Sepsis is an example of a medical emergency that may present differently depending on a patient’s age. However, in both adult and pediatric patients, the treatment protocol for sepsis is time-sensitive and well-established: identify it early, administer antibiotics promptly, support circulation, and monitor for deterioration. Any delay in treating sepsis in a pediatric patient increases the risk of organ failure, brain damage, and death.
In emergency situations, when a doctor does not act diligently and efficiently, delays and poor judgement calls occur. That is what happened in this case – systemic failures at every level of emergency care.
The Townsley Law Firm presented its case to the defendants, who acknowledged their negligence. A settlement of over $2,500,000 was agreed upon for our client’s family.
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What Happened: A Missed Sepsis Diagnosis and a Chain of Preventable Failures
The Pediatrician’s Office
A family brought their one-year-old son to his local pediatrician because he was fussy and not acting like himself. The pediatrician evaluated him and diagnosed him with an ear infection and an upper respiratory infection. He was sent home.
A few hours after returning home, the child began vomiting and developed a fever. His parents recognized that something was seriously wrong and brought him to the emergency room. They were right to be concerned. The symptoms their son was showing, including fever, vomiting, and a recent infection, are recognized warning signs of sepsis in pediatric patients.
The Emergency Room
The medical team in the emergency department wasted over eight hours before making a diagnosis and treating the infant’s sepsis, causing the infant to quickly deteriorate.
The ER physician then delayed transferring the child to another hospital with a higher level of pediatric care until it was far too late.
The Improper Transfer
When a critically ill pediatric patient requires inter-facility transport, the method of transport is a medical decision that must account for the patient’s current condition and the urgency of their need. A child who has been deteriorating for more than eight hours, whose sepsis has not been properly treated, requires rapid transfer.
In cases of that severity, air transport is the standard, but this child was transported by ground ambulance. Not only does ground transport take longer, it provides fewer resources for managing a deteriorating patient mid-transport.
Due to the additional time in transit, by the time the ambulance arrived at the receiving hospital, the child had become hypoxic and had stopped breathing altogether. The hospital initiated CPR and the child was resuscitated, but the delays in diagnosing and treating his condition along with the prolonged transfer time between facilities caused permanent damage to his brain.
He suffered an anoxic brain injury, a condition that occurs when the brain is deprived of oxygen long enough for brain cells to begin dying.
How The Townsley Law Firm Proved Negligence
The Townsley Law Firm presented their evidence to the defendant and proved, through medical expert testimony and a detailed review of the records, that multiple failures occurred and that each failure contributed to this child’s permanent injury.
We established that:
- The emergency room team – including hospital staff and contracted physician providers – failed to timely recognize and diagnose the child’s sepsis, despite having more than eight hours and documented symptoms consistent with a pediatric sepsis presentation.
- The failure to administer appropriate sepsis treatment within the recognized treatment window was a direct breach of the standard of care.
- The decision to transfer the child by ground ambulance rather than air transport, given his clinical condition at the time of transfer, was a separate and independent departure from accepted emergency medicine standards by the hospital staff, contracted physician, and ambulance service.
- The anoxic brain injury the child suffered was a direct and foreseeable consequence of these failures, and would not have occurred had the standard of care been met.
The Townsley Law Firm collected over $2,500,000 from the defendants for our client’s family. Recoveries like this one matter, not only for this family, but as a statement about the standard every pediatric patient in an emergency room deserves.
What Is the Legal Standard for Pediatric Emergency Care in Louisiana?
Emergency room physicians in Louisiana are held to the standard of care of a reasonably competent emergency medicine physician practicing under similar circumstances. For pediatric patients, this includes the duty to recognize presentations consistent with serious illness, including sepsis, and to initiate treatment within accepted time parameters.
Louisiana’s medical malpractice framework also addresses the standard applicable to transfer decisions. A physician who transfers a patient is required to ensure that the transfer is appropriate given the patient’s condition and that the mode of transport is medically suitable. Transferring an unstable, critically ill child by ground ambulance when air transport was available and clinically indicated can constitute a breach of that standard.
The hospital and its medical staff can be held jointly liable when nursing staff, physicians, and administrative decisions each contribute to a pattern of failures that results in patient harm.
Why Ground Transport Was a Critical Error
The decision to transport a critically ill pediatric patient by ground rather than air is not simply a logistical choice. It is a clinical decision governed by the patient’s condition and the anticipated time-sensitivity of their deterioration.
In emergency medicine, air transport is indicated when a patient’s condition requires a level of speed and in-flight clinical capability that ground transport cannot provide. A pediatric patient who has been in an emergency room for over eight hours with an untreated systemic infection, who is visibly deteriorating, meets that threshold.
Ground transport in this case extended the time between the ER and the receiving hospital. It limited the resources available to manage the child if he decompensated mid-transport. And because he had not received appropriate stabilizing treatment before transport, he was not stable enough to survive the journey without further deterioration.
The decision to use ground transport, in this child’s condition, was a departure from the standard of care. It was one of several failures in a chain of decisions that resulted in his brain injury.
What Is Sepsis and Why Does It Progress So Quickly in Infants?
Sepsis is the body’s extreme and dysregulated response to an infection. Instead of fighting the infection locally, the immune system begins attacking the body’s own tissues and organs. In infants and young children, this process can accelerate rapidly because their immune systems are still developing and their physiological reserves are smaller than those of adults.
The early signs of sepsis in infants include fever or abnormally low body temperature, irritability or unusual fussiness, rapid breathing, rapid heart rate, decreased urine output, and poor feeding. These are not obscure or rare findings. They are the standard criteria emergency medicine physicians and pediatric nurses are trained to recognize and act on immediately.
The “Sepsis Six” and pediatric sepsis bundles in emergency medicine exist precisely because the medical community understands that rapid, protocolized treatment saves lives. When an emergency room allows a septic infant to sit without appropriate treatment for more than eight hours, that is not a judgment call. It is a failure to follow established medical standards.
What Is an Anoxic Brain Injury and What Causes It?
An anoxic brain injury occurs when the brain is completely deprived of oxygen, causing brain cells to begin dying within minutes. It is distinct from a hypoxic brain injury, which involves reduced but not completely absent oxygen supply, though both can cause permanent damage.
In this case, the anoxic brain injury resulted because the child stopped breathing during transport, a direct consequence of his sepsis not being treated during the eight hours he spent in the emergency room. Had his sepsis been identified and treated appropriately, his condition would not have deteriorated to the point of respiratory arrest.
The effects of an anoxic brain injury vary depending on how long the brain was without oxygen and which regions were most affected. They can include cognitive impairment, motor disabilities, seizure disorders, speech and language deficits, memory problems, and difficulties with attention and executive function. For a one-year-old child, these deficits carry consequences across an entire lifetime.
