Pediatric MVC [Tibia Fracture Allegedly Missed]
Case #93
A 5-year-old boy was playing on a scooter in a parking lot.
The child had previously been diagnosed with developmental delay, particularly affecting his speech.
He was struck by a pickup truck, and ended up under the vehicle.
911 was called and he was taken to a nearby academic children’s hospital.
He had diffuse abrasions and mild burns, affecting his trunk and all 4 extremities.
X-rays were ordered where he had pain.
Fortunately no fractures or serious injuries were identified.
The child was discharged.
Several days later he followed-up with his pediatrician.
His parents reported that he seemed to be having right leg pain.
X-rays were ordered that showed a “probable non-displaced fracture of his right distal tibia”.
He had follow-up appointments with ortho, who documented that they were unsure if this was truly a fracture or simply a nutrient channel.
Nonetheless he was placed in a cast for several weeks.
He did not suffer any long-term disability.
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The family filed a lawsuit against the driver who hit the child, GEICO (the driver’s insurance company) and the owner of the parking lot where this occurred.
They settled with all 3 of these defendants.
It appears that the family was also upset about the way they were initially treated at the pediatric ED.
The attorney wrote that the ED physician “failed to respond to [the child’s] parents’ concerns that [his] right leg was in severe pain”.
The lawsuit claims that their concerns about his right leg pain were ignored and dismissed while in the ED.
They hired an attorney to bring a lawsuit against the ED physicians and hospital.
A pediatric EM expert wrote the following opinion:
The plaintiff offered to settle the case for $20,000.
The plaintiff withdrew the lawsuit in January 2022.
There is no record of a settlement.
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MedMalReviewer Analysis:
The plaintiff’s attorney is a fool for agreeing to this lawsuit. This was a waste of his time and money. It appears that the lawsuit was either withdrawn or possibly settled for a very small amount.
I suspect that there is more to the story than can be determined from the legal documents. My suspicion is that the family was extremely upset with the ED staff, and demanded that any attorney who took the entire portfolio of lawsuits (against the driver, the insurance, and parking lot operator), also sue the ED. Even though the plaintiff’s attorney knew that the malpractice lawsuit was doomed to failure, it was the price he paid to land them as a client.Communication with parents of children with developmental disability is critical. They know their child extremely well and their concerns need to be taken seriously (especially when they can be addressed with a test as simple and cheap as an x-ray). The defendants in this case certainly knew this as PEM doctors who deal with these situations on a daily basis. This lawsuit is a good reminder about communication and rapport with patients and their families, even though the doctors ultimately prevailed.
When a patient is discharged, return precautions and follow-up instructions are critical. It is wise to advise a patient that even though they have negative x-rays now, if their pain is not improving they should have a recheck appointment. Specifically warning them about rare instances in which a follow-up x-ray can reveal new findings makes it much more palatable when it occurs, rather than surprising them.
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