The case takes place in Maryland and involves a young girl who presented to the ER with complaints of fever and sinus congestion. She was diagnosed with the Flu some time before her ER visit by the family physician. She was given a course of Tamiflu, which she completed. Some time later, the girl presented to the ER again complaining of new symptoms. Testing performed at the hospital revealed several suspicious findings, including an elevated white blood count, however the patient was discharged from the hospital with a prescription for a basic antibiotic. The next day, the patient was again rushed to the emergency room exhibiting signs of respiratory distress. The patient died shortly after being admitted to the hospital, at which time a significant bacterial infection of her lungs was discovered.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case? Please explain.
- 2. Do you believe this patient may have had a better outcome if the care rendered had been different? IE: antibiotic therapy?
- 3. Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.
- 4. Please tell us why you're qualified to serve as an expert reviewer of this case.
Expert Witness Response E-005391
I have taken care of many children with similar presentations. It appears that this infant presented with Influenza and was appropriately prescribed Tamiflu. As is not uncommon with influenza, it then appears that this child had a bacterial superinfection with Pneumococcus and was appropriately prescribed antibiotics (an antibiotic that would have activity against Pneumococcus) when he arrived at the ED. Unfortunately, this child succumbed to a bacterial superinfection. Possibilities for this poor outcome could be an unusually resistant Pneumococcus (as Augmentin should normally have activity against this organism) or a delay in presenting the ED on February 16th. I have served in a previous case of a teenager who passed away from Influenza. The family was concerned that he never was prescribed Tamiflu upon initial presentation. That case was different from this case as he had no underlying risk factors for severe influenza. As this current child had underlying congenital cardiac disease, it was appropriate that he received Tamiflu when he did. As I routinely see children hospitalized with viral and bacterial infections, I believe I am qualified to serve as a reviewer of this case.
Expert Witness Response E-009637
I do routinely treat patients similar to the one in the case. I am the Director of Infectious Diseases at one of the largest children’s hospitals in the country. We have a very large and active cardiac surgery service and we routinely care for children with congenital heart diseases. Also, I am quite familiar with the epidemiology, clinical features, treatment and preventive strategies for Streptococcus pneumoniae. Whether or not antibiotic therapy, etc. would have helped in this situation depends on the antibiotic susceptibility of the bacterial strain isolated that was isolated, but I believe that more aggressive initial treatment was warranted and would likely have resulted in a better outcome. Another variable to consider is whether the patient had received the pneumococcal vaccine and if so, which one?