The plaintiff mother took her fourteen-month-old son to a clinic in January 2007 due to a one-week history of a painful abscess on his buttock. He also had a fever. The physician’s assistant assigned to the clinic examined the infant, who had a temperature of 100.8 a pulse of 147 and a respiratory rate of 28.

The infant had an area of redness on his right buttock with an area of central induration, but no exudate. The child was sent home on antibiotics with instructions to have warm compresses applied to promote drainage. The mother was told that the abscess would likely require incision and drainage if the compresses and antibiotic did not work. Less than six hours later the mother returned with the child and was again seen by the clinic’s physician's assistant.

The child’s pain seemed increased and the child now had a temperature of 105.6, a pulse rate of 206 and a respiration rate of 64. At this visit the right ear was found to be red, bulged cloudy and not mobile and the left ear was pink grey retracted clear/cloudy with questionable mobility. After an hour and one-half the child’s temperature had dropped to 101. The child was sent home with Motrin and Tylenol and instructions to continue the antibiotics. Over the next two days the child slept more and cried only when awake. He ate very little and took fluids only through a syringe.

The abscess grew in size and no longer had a shape or center. The mother then returned to the clinic. He had a temperature of 99.8, a pulse of 170 and a respiratory rate of 28. A different physician’s assistant examined the child and contacted a pediatrician. The mother and her son were transported to the location of the pediatrician. When the child was seen upon arrival his temperature was 99.2, his pulse was 146 and he had a respiration rate of 56. He was given IV fluids and the IV antibiotic, Vancomycin, with Tylenol an Morphine. An aeromed was ordered and transferred the child again. Upon arrival at this facility the child was somewhat alert upon arrival, but became less responsive within an hour. His blood pressure had fallen to 70/40 and his pulse was 190. He was found to be in septic shock. The child was intubated due to respiratory failure and placed on a ventilator. Intravenous fluids and medications were administered to treat poor perfusion. Surgery was performed at bedside to incise and drain the abscess on the right buttock.

The child was admitted to the pediatric critical care unit with the diagnoses of cellulitis/abscess, right buttock/thigh; septic shock; cardiovascular failure insufficiency that developed into failure; respiratory failure; and acute renal failure. A blood culture grew Staphylococcus hominis, and a wound culture grew MRSA. The child was in critical care for fifteen days. He was maintained in a medically induced coma for twelve days. He was on the general pediatric floor for an additional two weeks. When the child was discharged from the hospital in favor of outpatient care, the mother stayed in a motel in the area and the child’s wounds were periodically repacked by a nurse who visited him daily.

After two weeks only one of the wounds was still open, the child had no fevers and was eating and drinking well. The child, however, suffered brain damage with static encephalopathy manifesting in developmental delay and behavioral problems. The plaintiff claimed that the problems were caused by the sepsis resulting from the abscess. The child had to be weaned off morphine, which caused tremors during the process.

The mother claimed that the abscess on the buttock should have incised and drained by the physician’s assistant during the initial visit. The defendant claimed that not every abscess requires incision and drainage and that warm compresses are a proper first treatment. The defendant also claimed that the sepsis did not case the child’s neurological disorder and that the child did not suffer brain damage.

According to a published account a $133,939 bench verdict was returned for the child and the mother was awarded $100,000. The award included $88,939 for the Medicaid lien for the child’s care. In post-trial matters, the plaintiff’s counsel was awarded $33,227.12 for costs associated with arguing liability as sanctions against the defendant for failing to admit negligence.

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