Malpractice case highlights competing forces in medicine

A Massachusetts mother is suing a pediatrician for failure to diagnose her daughter's disabling case of viral meningitis, pointing to the physician's notes as the "smoking gun" that prove the doctor did not follow the standard of care--and highlighting the conflicting pressures on doctors to reduce defensive medicine on one hand and unnecessary care on the other.

According to two reports from the Lowell Sun, in Aug. 2005, Stacy Phillips took her then-eight-year-old daughter Amber to pediatrician Michelle Lock with headache, sore neck and slight fever. Lock's notes from the encounter acknowledged that there were six possible reasons for the symptoms, including migraine, allergies and viral meningitis.

After examining Amber and gathering information from Phillips, the doctor sent the pair home with allergy medication and instructed Phillips to keep a "headache diary to rule out migraines. As for meningitis, the doctor's notes stated "no evidence upon exam."

While the newspaper reports don't indicate whether Lock's notes provided further detail supporting her decision to rule out meningitis, current results from the Physician Quality Reporting Initiative suggest that physicians' documentation nationwide is in need of improvement. It isn't clear in this case whether more detailed notes would affect the lawsuit, but in general, better documentation and better communication can help defend against malpractice claims.

In the Massachusetts case, Harry Webster, a specialist in brain damage in children at the Floating Hospital for Children in Boston, testified last week that meningitis is such a potentially dangerous illness that doctors cannot afford to miss. Lock "violated the standard of care by failing to do a lumbar puncture," he said.

Countering this argument, the jury is expected to hear from a defense-paid pediatric infectious-disease expert that there is no treatment for what Amber was later diagnosed with: viral meningoencephalitis.

"Dr. Lock complied with the standard of care," her attorney, John Mulvey, said in his opening statements. "In this case there was no indication that a lumbar puncture (spinal tap) should be done. There was no basis to do it and there [are] risks to the procedure."

To learn more:
- read the coverage from the Lowell Sun here and here

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