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The case was filed in the Court of Common Pleas of Summit County, Ohio on April 27, 2005, against a local hospital as well as a local pediatric group.
One evening a child, ten (10) months of age, became ill. His parents called their pediatricians telephone triage line (after hours) to get advice as to what to do for the child’s illness. The 10 month old child at that point had a fever and was not acting as himself.
The Pediatric group’s telephone triage line is a means by which calls are handled after regular office hours. The triage call line is staffed by nurses with pediatric experience who will listen to a patient’s complaint and recommend a disposition for that patient. Disposition may include for the patient to be seen urgently at the emergency department, to be seen during physician office hours or to be given advice on home care. As a result of the telephone triage call, the parents were not required to take their child to the emergency room or take him to the pediatricians office the following day. Rather, the parents were provided instructions by the nurse who responded to their call for home care for their child. Over the next several days The child continued to have a fever and continued to exhibit signs and symptoms of not being himself. He began vomiting. In addition, the child had an episode in which he was not responding to his parents. As a result, the child’s father again called the telephone triage for the pediatric group (since it was again after hours) who again advised the father on home care and did not refer the child to the emergency department of the pediatricians office.
Thereafter the child remained ill. The next morning the child had a seizure. The child’s parents called the telephone triage line for the pediatric practice a third time (again after hours) and, at this point, were told to take the child urgently to the emergency department at the local hospital by the triage nurse.
At the emergency department, the child was eventually diagnosed as suffering from a viral illness known as Herpes Symplex Encephalitis (HSE) and was started on the anti-viral drug called Acyclovir. HSE is the only viral illness that is treatable with anti-viral medication. Once prescribed the Acyclovir, the virus was treated and the child was able to leave the local hospital within 3 weeks. However, as a result in the delay in treatment, the child was left with brain damage and an inability to speak.
It was our position in this case that the 10 month old child should have been referred urgently to the emergency department by the triage nurse once the child was not responding to his parents This was neurological symptom that required urgent care and was first reported on the telephone triage line. It was our position that had the child been referred to the emergency department immediately upon having a neurological symptom, he would have been started on Acyclovir within eight (8) hours, been provided treatment for his condition three (3) days earlier, and the child would have had minimal neurological deficits from his illness, and not have lost his ability to speak.