CHOA Scottish Rite complaint alleges ED sepsis-workup failures before a 17-year-old patient’s death

The complaint alleges that a 17-year-old patient went to an urgent-care center with fever and abnormal vital signs. She was sent to a hospital emergency department, where her vital signs did not improve. An emergency physician attributed her condition to a rhinovirus infection, canceled ordered lab tests, and discharged her overnight. A procalcitonin result of 36.05 returned after discharge and was not reported to a physician. She returned later that morning with altered mental status, vomiting, and fever, became unresponsive, and died that afternoon.

System: Children’s Healthcare of Atlanta
Facility: Children’s Healthcare of Atlanta Scottish Rite Hospital
Providers involved: Thomas J. Abramo, M.D. / Pediatric Emergency Medicine Associates, LLC / Children’s Healthcare of Atlanta, Inc.
Pattern: Alleged failure to work up a bacterial infection and reconsider a rhinovirus diagnosis in a feverish, tachycardic, hypotensive patient before emergency-department discharge
Harm: Alleged undiagnosed bacterial infection, sepsis, and death

Overview

This page concerns a public complaint alleging that an emergency-department physician and hospital staff did not properly work up a worsening bacterial infection. It alleges they discharged a feverish, tachycardic teenager who died hours later.

Chronology

The complaint alleges as follows:

The patient, 17, was seen at an urgent-care center on September 28, 2021 for fever and ear pain. She was sent to Children’s Healthcare of Atlanta Scottish Rite Hospital’s emergency department for abnormal vital signs.
She arrived at the emergency department at 10:41 p.m. Her initial vital signs, recorded at 12:41 a.m., showed a temperature of 39.2, a heart rate of 138, and blood pressure of 104/82.
An emergency physician ordered lab tests at 1:36 a.m., including a procalcitonin level. Ferritin, LDH, and DIC tests he ordered at 1:40 a.m. were discontinued a minute later. Her vital signs remained abnormal overnight.
Around 3:02 a.m. the physician attributed her condition to a rhinovirus infection, and she was discharged home around 3:40 a.m.
A nursing note at discharge described her as alert and at her baseline, though she had continued chills and needed help reaching the car.
Her procalcitonin result came back at 36.05 at 4:08 a.m. but was not reported to a physician.
She returned around 11:03 a.m. that morning with altered mental status and fever. She became unresponsive at 12:05 p.m. and died at 1:15 p.m. despite resuscitation. Blood cultures drawn before her death grew Neisseria meningitidis.

Alleged failures

The complaint alleges the following failures:

The treating physician prematurely settled on a rhinovirus diagnosis and did not adequately work up the more likely diagnosis of a bacterial infection and sepsis.
The physician canceled lab tests that more likely than not would have shown evidence of a worsening bacterial infection and sepsis.
The treating nurse did not note or alert a physician that the patient’s vital signs had not improved and that she had developed diarrhea.
The nurse documented a discharge assessment the complaint alleges was inaccurate.
Hospital staff did not report the elevated procalcitonin result to a physician after it returned following the patient’s discharge.
The filing alleges the physician’s and nurse’s deviations were gross negligence, and that the defendants’ negligence directly and proximately caused her death. The complaint pleads medical malpractice, wrongful death, survivorship, and vicarious liability, and attaches expert affidavits under O.C.G.A. § 9-11-9.1.

Entities and tags

Children’s Healthcare of AtlantaChildren’s Healthcare of Atlanta Scottish Rite HospitalPediatric Emergency Medicine Associates, LLCThomas J. Abramo, M.D.Neisseria meningitidisSepsisProcalcitonin testDeKalb CountyDelayed or missed diagnosisPremature dischargeCommunication or follow-up failureWrongful deathPediatric emergency medicineEmergency nursingInfectious disease