Top 25 Medical Malpractice Cases of a 25 Year Career – Fungal Meningitis
Medical malpractice cases are very complex.
In this series of articles BC and Alberta personal injury and medical malpractice lawyer Angela Price-Stephens describes her top 25 notable medical malpractice cases of her 25-year career to date. Her selection of cases is a representation of the breadth of her experience, the complexity of cases, the twists and turns in the evidence and the dramatic benefit to her clients and their respective families by successfully pursing their claim with Angela and her team.
Angela has litigated cases across Canada and England and Wales. The names and distinguishing details of the cases referred to in this series of articles have been changed to protect the client. In all cases of settlement for medical malpractice the lawyers for the defendant healthcare providers insist on a confidentiality clause in which the existence of a settlement (payout of money to the former patient, irrespective of whether an admission of liability was made) must remain a secret.
In this article we review the unusual case of Valerie who suffered a devastating brain injury as a result of a missed diagnosis of fungal meningitis. In fact, not only was the diagnosis missed, she was misdiagnosed and treated with steroids which likely exacerbated the extent of her brain injury.
Valerie was a 34-year-old mother of one young daughter (aged 4). She was single and worked full time in engineering. She had a headache for several days before the headache become so bad she took herself to emergency at 2 am. She was examined by the emergency room physician who diagnosed migraine. She was given Maxalt and sent home.
The pain improved for a few hours but the second dose of Maxalt was not effective. The pain became too much to bear and so she returned to the emergency department. Her diagnosis of migraine was reaffirmed by a different emergency room doctor and she was given IV morphine for immediate relief and given a prescription for more Maxalt and naproxen.
Over the course of the next 4 weeks Valerie attended the emergency room another five times. Her signs and symptoms increased to include nausea and vomiting and photophobia. Over the course of the seven emergency room visits her records documented that she had been prescribed or administered IV morphine, IV Demerol, Maxalt, naproxen, Frova and Zomig to treat her migraine. Not one doctor recognized that this pattern of migraine or repeated attendance at emergency was highly unusual for this patient.
On the seventh visit to emergency Valerie was told again that she had a migraine and that she was simply ‘doing too much’ and ought to consider cutting back her hours, or taking time off work. The migraine was due to stress. By this time Valerie was so desperate for help, so worn down by the unremitting pain that she was tearful. She was told she was depressed and anxious and a referral was made to a psychiatric outpatient clinic and sent home with more painkillers.
Valerie’s mother, Dorothy, very concerned about her daughter, flew across the country to be with her. Shortly after Dorothy arrived, Valerie collapsed and was taken to hospital by ambulance. Dorothy attended at the hospital and essentially demanded that her daughter be admitted and tests run to find out what was wrong. Valerie was admitted. She was not offered a lumbar puncture and a CT scan (which was the standard of care) but sedated and visited at the bedside by the on-call psychiatrist.
On day three of her hospital admission Valerie suffered blurred vision, a stiff neck and a likely seizure. She was then diagnosed with meningitis and treated with a combination of intravenous drugs, including a steroid to reduce the swelling on her brain.
Still no lumbar puncture or CT scan was performed.
Valerie’s condition appeared to improve with the course of treatment, which was regarded as confirmation of the correct diagnosis. What actually happened was that the steroids were effective in reducing the swelling on the brain which reduced the head pain. What the steroids also did however was to suppress Valerie’s immune system and permitted the, as yet undetected, fungal infection in her brain to advance at a faster rate.
Valerie was discharged from hospital after a 10-day admission. She collapsed within 24 hours of discharge. Fortunately for Valerie her mother was with her and it was Dorothy who insisted her daughter be taken to a different hospital. On arrival it was recognized Valerie’s condition was critical. The first test that was undertaken was an emergency CT scan which demonstrated brain pathology, followed by a lumbar puncture. The lumbar puncture had a high opening pressure and the CSF fluid was cloudy and orange (rather than clear and colourless).
Testing on the CSF fluid confirmed the relatively unusual diagnosis of fungal meningitis and the appropriate treatment was commenced. Unfortunately given the advanced stage of the disease Valerie had already sustained permanent brain damage.
During examinations for discovery, the doctor who diagnosed meningitis stated that he had assumed it was viral meningitis and wanted to spare Valerie a lumbar puncture. Meningitis is the inflammation of the lining, or meninges, between the brain and the skull. The inflammation can be used by a virus, bacterial or fungal (and other rarer infections such as parasitic). A bacterial meningitis would have already proved fatal. A fungal infection was never considered.
Over the next two years Valerie required more than 60 lumbar punctures to monitor the status of the fungal infection. The damage sustained also interfered with the body’s natural mechanism to produce and drain CSF which caused regular bouts of increased intracranial pressure which caused severe headaches. Valerie later had a shunt placed to allow the CSF to drain.
Fungal meningitis in Canada is relatively rare. Angela used her connections to locate a world expert on fungal meningitis based out of Australia, who just happened to be at a conference in Toronto at the time of her call. The expert was able to confirm that had a timely diagnosis been made Valerie would have likely made a full recovery with only a modest requirement for follow up in the 6 months post treatment to confirm the infection had been eradicated. It was also confirmed that the fungal infection does not have to be extensive to be detected in the CSF through a lumbar puncture. An early CT and lumbar puncture would have made a definitive diagnosis and ensured appropriate treatment.
The nature and the extent of losses sustained by Valerie as a result of the wrong diagnosis was devastating. The brain damage impaired her ability to live independently and parent her child. She was unable to return to work and is likely never to work again.
Valerie’s claim was settled at mediation.
Angela Price-Stephens is an English and Canadian lawyer who focuses on serious personal injury arising from the negligence of others, mostly health care professionals. Of her 25-year career approximately half of that time has been spent defending heath authorities, doctors and other healthcare professionals. That experience is now used exclusively for the benefit of injured patients.
For more information on this article, or for a confidential discussion of your claim, contact Angela Price-Stephens at 250 869 1124, or send her a confidential email at firstname.lastname@example.org.