The plaintiff, age four, was seen at a hospital emergency room in July 2006 after developing a fever and rash with pustules in her mouth. The emergency room nurse documented a small pustule rash to the extremities and tongue.

After triage the child was seen by a certified physician assistant (PA-C). The plaintiff had a fever of 103.1. The nurse had originally written “petical” rash and crossed it out and had written “pustular.” A petechial rash looks like little red dots on the skin and a pustular rash is like a vesicle filled with pus. The PA-C described a “macular/papular rash.” A macular rash includes flat, small red patches on the skin and a papular rash is raised without pus. The PA-C did not note the rash in the mouth.

The parents described the child as having a brick-red type of skin color with little red dots. The parents raised the child’s shirt and the father was able to write his name into the child’s back by pushing on it. The child was discharged with instructions to follow up with a pediatrics clinic, but no instructions on whom to see or when to go and there were no written instructions given for fever control.

The child’s condition worsened the next day and she was taken to another emergency room and then transferred to another hospital where she was diagnosed and treated for staph sepsis. The child required amputation of portions of both hands and amputation of both feet. She was fitted with prosthetics with which she is able to walk and run.

The plaintiff claimed that the defendants were negligent in failing to diagnose bacterial infection and that the PA-C’s examination had been deficient and without proper orders for testing. The plaintiff also claimed that a physician should have seen the child, not a PA-C.

The defendant argued that the examination of the child was proper and that the type of rash observed was consistent with a viral infection. The defendant also claimed that the infection the child was later diagnosed with was extremely rare and that the parents should have returned the child to the emergency room earlier.

According to a published account a $3 million settlement was reached.

With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.