Physician Assistant Fails to Diagnose Bacterial Meningitis in Child


Physician Assistant Expert WitnessThis case involves a young girl who began complaining of a sore throat. The next day, she reportedly slept most of the day, and exhibited a fever, which became progressively worse on the next day. She was brought to her pediatricians office where she was seen by a physician assistant. The girl was falling asleep in the pediatrician’s office, and her lethargy was so significant that she was not responding well to questions. Nevertheless, the girl was sent home from the pediatrician’s office with a prescription for antibiotics. Later that day, she was not improving and began to show signs of confusion. She was taken to the emergency room where a lumbar puncture was described as yielding cloudy fluid. She was transferred to a larger medical center at where she was pronounced brain dead.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients like the one described above?
  • 2. Do you have familiarity with the subject matter described above?
  • 3. Have you ever had a patient develop the outcome/complications noted above?

Expert Witness Response E-035146

I have been engaged in healthcare in various roles for 35 years including emergency medicine, surgery, family practice, and PA education. I have encountered numerous patients such as the one described as a practicing physician assistant and continue to see patients such as this today. I have seen patients with the presumed infectious processes described suffer from sepsis, septic shock, and death. Immediate administration of broad spectrum IV antibiotics in an inpatient setting, or even administration of intramuscular antibiotics may have prevented this negative outcome.

Expert Witness Response E-035073

Expert-ID: E-035073

I see patients like this in my practice. I am familiar with meningitis. I’ve never had a patient die from complications of this nature. Lethargy in a febrile child should make you suspicious of a systemic problem. It is important to distinguish sleepiness from lethargy. Her lack of response to questioning is somewhat concerning, it suggests a change in cognition. As PA’s we are capable of making medical decisions under these circumstances and this PA should have been able to make more appropriate recommendations for care. I have 19 years of experience in primary care. I worked 6 years in general pediatrics mostly seeing acute care patients. The remainder of my work has been in family medicine where I see about 40% children.

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