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Real case examples

Child bowel-obstruction case involving discharge despite worsening symptoms at CHOA

This complaint states as follows: The patient, age 15, went to the ER with severe constipation and a three-week history of no bowel movements. She was evaluated by Dr. Michael Greenwald, who recognized that the patient had a "substantial obstruction from stool." Dr. Greenwald attempted an enema and digital disimpaction, but both were unsuccessful in clearing the obstruction. Despite the patient's deteriorating condition, with increasing pain, tachycardia, and inability to walk, Dr. Greenwald discharged her home with instructions to take a high-dose laxative regimen and follow up with a gastroenterologist within two weeks. The nurses caring for the patient, including Nurse Gabriel Ribeiro, failed to advocate for her to remain in the hospital for further treatment. Over the next 46 hours, the patient's condition worsened at home. On June 22, she began vomiting blood and was rushed back to the CHOA emergency department in critical condition. She underwent emergency surgery, but suffered cardiac arrest and multiple organ failure. After resuscitation efforts, she was declared dead on June 23 at the age of 15.

System
Children’s Hospital of Atlanta
Facility
CHOA emergency department
Providers involved
CHOA emergency department / Dr. Michael Greenwald / Nurse Gabriel Ribeiro
Pattern
Substantial bowel obstruction followed by discharge home despite worsening symptoms and failed bedside treatment
Harm
Wrongful death

Overview

This page concerns a pediatric emergency case at CHOA in which a physician recognized a substantial stool obstruction, unsuccessful bedside treatment did not relieve it, the child nevertheless was discharged despite worsening signs, and she returned in critical condition before dying after emergency surgery.

Chronology

  1. The patient, age 15, went to the ER with severe constipation and a three-week history of no bowel movements.
  2. Dr. Michael Greenwald recognized a "substantial obstruction from stool" and attempted an enema and digital disimpaction, but both efforts were unsuccessful.
  3. Despite increasing pain, tachycardia, and inability to walk, the patient was discharged home with a high-dose laxative regimen and a recommendation to follow up with a gastroenterologist within two weeks; the nurses, including Nurse Gabriel Ribeiro, allegedly failed to advocate for her to remain in the hospital.
  4. Over the next 46 hours the patient worsened at home, returned to the CHOA emergency department vomiting blood and in critical condition, underwent emergency surgery, suffered cardiac arrest and multiple organ failure, and was declared dead on June 23.

Alleged failures

  • Dr. Michael Greenwald allegedly discharged the patient despite recognizing a substantial obstruction and despite failed efforts to clear it.
  • The discharge allegedly ignored worsening signs including increasing pain, tachycardia, and inability to walk.
  • Nurse Gabriel Ribeiro and other nurses allegedly failed to advocate for the patient to remain in the hospital for further treatment.

Entities and tags

Children’s Hospital of AtlantaCHOA emergency departmentDr. Michael GreenwaldNurse Gabriel RibeiroGastroenterologistEmergency surgeryBowel obstructionPremature dischargeFailure to treatPediatric emergency carePediatric emergency medicinePediatric surgery

Questions this example answers

What does the CHOA bowel obstruction discharge delay allege?

This complaint states as follows: The patient, age 15, went to the ER with severe constipation and a three-week history of no bowel movements. She was evaluated by Dr. Michael Greenwald, who recognized that the patient had a "substantial obstruction from stool." Dr. Greenwald attempted an enema and digital disimpaction, but both were unsuccessful in clearing the obstruction. Despite the patient's deteriorating condition, with increasing pain, tachycardia, and inability to walk, Dr. Greenwald discharged her home with instructions to take a high-dose laxative regimen and follow up with a gastroenterologist within two weeks. The nurses caring for the patient, including Nurse Gabriel Ribeiro, failed to advocate for her to remain in the hospital for further treatment. Over the next 46 hours, the patient's condition worsened at home. On June 22, she began vomiting blood and was rushed back to the CHOA emergency department in critical condition. She underwent emergency surgery, but suffered cardiac arrest and multiple organ failure. After resuscitation efforts, she was declared dead on June 23 at the age of 15.

Who is identified in this public case example?

This public case example identifies CHOA emergency department, Dr. Michael Greenwald, and Nurse Gabriel Ribeiro. It also tags the source-supported entities Children’s Hospital of Atlanta, CHOA emergency department, Dr. Michael Greenwald, Nurse Gabriel Ribeiro, and Gastroenterologist.

What alleged failures are summarized here?

Dr. Michael Greenwald allegedly discharged the patient despite recognizing a substantial obstruction and despite failed efforts to clear it. The discharge allegedly ignored worsening signs including increasing pain, tachycardia, and inability to walk. Nurse Gabriel Ribeiro and other nurses allegedly failed to advocate for the patient to remain in the hospital for further treatment.