Comments on: Infant meningitis and the LP: Did this ER physician exaggerate risks? http://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html Tue, 14 Feb 2012 23:00:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73586 Anonymous Tue, 03 Apr 2007 12:05:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73586 Interesting issue with adult consent on behalf of minors.The law permits the latitude of surrogacy automatically to the parent, even if the parent might not be the most qualified person to judge the best interests of the child. Yet while the consent is given by the surrogate, the liability does not follow the same course. The liability still remains open until the child reaches legal majority and then usually for a prescribed time after. That seems unreasonable, given that the right to decide is awarded to a person presumed to be a competent adult at the time consent is given. Laws that permit liability in pediatric medical encounters to extend as they do appear to stand that notion on its head, suggesting perhaps that right to consent isn't really being given to the adult after all. Interesting issue with adult consent on behalf of minors.The law permits the latitude of surrogacy automatically to the parent, even if the parent might not be the most qualified person to judge the best interests of the child. Yet while the consent is given by the surrogate, the liability does not follow the same course. The liability still remains open until the child reaches legal majority and then usually for a prescribed time after. That seems unreasonable, given that the right to decide is awarded to a person presumed to be a competent adult at the time consent is given. Laws that permit liability in pediatric medical encounters to extend as they do appear to stand that notion on its head, suggesting perhaps that right to consent isn’t really being given to the adult after all.

]]> By: Blog, MDhttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73585 Blog, MD Tue, 03 Apr 2007 11:17:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73585 This topic is covered (on the adult side) in a nice piece in today's NY Times. Click <a HREF="http://www.nytimes.com/2007/04/03/health/03essa.html" REL="nofollow">here</a>. This topic is covered (on the adult side) in a nice piece in today’s NY Times. Click here.

]]> By: Michael Rack, MDhttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73584 Michael Rack, MD Tue, 03 Apr 2007 09:52:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73584 "A recent Idaho federal court ruling shows doctors should tread carefully when considering whether to get the state involved"<br/>The legal system keeps the final authority, but dumps the responsibility back on the doctor. “A recent Idaho federal court ruling shows doctors should tread carefully when considering whether to get the state involved”
The legal system keeps the final authority, but dumps the responsibility back on the doctor.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73570 Anonymous Mon, 02 Apr 2007 23:55:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73570 Well once again the lawyers/courts f@#$ed up again. Are you surprised. This is what happens when the judiciary which has a total lack of understanding of potential medical emergencies is making 20/20 hindsight decisions. <br/>PS: I personally saw someone DIE of meningitis/septic shock over the course of six hours so that JD IDIOT who stated there was plenty of time HAS NO GODDAMN CLUE WHAT HE IS TALKING ABOUT. Well once again the lawyers/courts f@#$ed up again. Are you surprised. This is what happens when the judiciary which has a total lack of understanding of potential medical emergencies is making 20/20 hindsight decisions.
PS: I personally saw someone DIE of meningitis/septic shock over the course of six hours so that JD IDIOT who stated there was plenty of time HAS NO GODDAMN CLUE WHAT HE IS TALKING ABOUT.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73568 Anonymous Mon, 02 Apr 2007 23:43:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73568 Parents have NO right in ANY country to "opt out" of care deemed potentially lifesaving by a physician - what utter nonsense.<br/>Parental rights are superceded by the duty of physicians to treat children appropriately nad protect their welfare despite parental objections.<br/>This kind of verdict is complete rubbish and gives a big boost to the rabid anti (insert lifesaving , evidence based Rx of choice here) lunatics.<br/>Glad I don't work in the US!<br/>I am allergic to the paint needed to paint the target insignia on my forehead! Parents have NO right in ANY country to “opt out” of care deemed potentially lifesaving by a physician – what utter nonsense.
Parental rights are superceded by the duty of physicians to treat children appropriately nad protect their welfare despite parental objections.
This kind of verdict is complete rubbish and gives a big boost to the rabid anti (insert lifesaving , evidence based Rx of choice here) lunatics.
Glad I don’t work in the US!
I am allergic to the paint needed to paint the target insignia on my forehead!

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73566 Anonymous Mon, 02 Apr 2007 23:13:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73566 Who was there to act in the child's best interests? A 5 week old cannot give consent at all, much less informed consent. Given the risk both medically and medicolegally, this physicians bent over (forwards, unfortunately) to do what he deemed best for the patient. I hope he is able to recover in a countersuit, but my guess is that this is just the usual extortion act, without any harm done, looking for a quick settlement. Who was there to act in the child’s best interests? A 5 week old cannot give consent at all, much less informed consent. Given the risk both medically and medicolegally, this physicians bent over (forwards, unfortunately) to do what he deemed best for the patient. I hope he is able to recover in a countersuit, but my guess is that this is just the usual extortion act, without any harm done, looking for a quick settlement.

]]> By: DrGwennhttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73564 DrGwenn Mon, 02 Apr 2007 22:46:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73564 The internet does us no favors with parents for medical procedures. I often find they've stumbled upon a forum or discussion board or relying on faux-science. <br/><br/>I'm also with gasman. This doc did no service to informed consent. If we do our job as docs and explain the choice, most times parents have a right to opt in or out. <br/><br/>Sam raises an interesting point. I can only imagine what our medical records being to look like if we have to have parents literally document their choice legally. Not sure there is enough RAM on most computers for what will occur. The internet does us no favors with parents for medical procedures. I often find they’ve stumbled upon a forum or discussion board or relying on faux-science.

I’m also with gasman. This doc did no service to informed consent. If we do our job as docs and explain the choice, most times parents have a right to opt in or out.

Sam raises an interesting point. I can only imagine what our medical records being to look like if we have to have parents literally document their choice legally. Not sure there is enough RAM on most computers for what will occur.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73557 Anonymous Mon, 02 Apr 2007 18:53:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73557 "She concluded from her own research that the procedure's risks outweighed the chances that her daughter had meningitis, records show."<br/><br/>Published and peer reviewed, we may presumed. Most of the time when my patients tell me about their "research" it means that two other people at the beauty parlor told them something. “She concluded from her own research that the procedure’s risks outweighed the chances that her daughter had meningitis, records show.”

Published and peer reviewed, we may presumed. Most of the time when my patients tell me about their “research” it means that two other people at the beauty parlor told them something.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73554 Anonymous Mon, 02 Apr 2007 17:47:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73554 Please explain why if the parent thought that a child's fever was serious enough to take the child to the emergency room--where presumably qualified expertise is available-- why the parents felt qualified to second guess the treating physician. Exactly what were the criteria these parents used to decide they didn't want to give consent to the LP? <br/><br/>I have been in the position where I have had to threaten the same kind of action (in my case in a suspected Tylenol poisining), and I completely agree that the ER doctor<br/>should at least have been given the benefit of the doubt. If the federal court can't establish the facts against the doctor are present, how then should they find against him? And just how much information should the parent be given, if they do not show an adequate capacity to understand even an elementary amount of reasoning? It isn't the doctor's responsibility to compensate for every parent's deficiency in reasoning or education, especially in an emergency setting. The patient is the child, not the parent. Suing because 1. the parent doesn't like the idea of an LP and 2. the LP might appear to have been "unnecessary" because it was "normal" is still a frivolous action. Was harm done? Doubtful. Was informed consent given? The patient is incompeternt by minority, and the parent is not reasonable. Show me how the action of the doctor is still in the wrong. You can bet if the kid wasn't tapped at the request of the parent and there was a bad outcome, the family would be suing because, you guessed it, the doctor failed to provide the right kind of pre-procedural consent. Please explain why if the parent thought that a child’s fever was serious enough to take the child to the emergency room–where presumably qualified expertise is available– why the parents felt qualified to second guess the treating physician. Exactly what were the criteria these parents used to decide they didn’t want to give consent to the LP?

I have been in the position where I have had to threaten the same kind of action (in my case in a suspected Tylenol poisining), and I completely agree that the ER doctor
should at least have been given the benefit of the doubt. If the federal court can’t establish the facts against the doctor are present, how then should they find against him? And just how much information should the parent be given, if they do not show an adequate capacity to understand even an elementary amount of reasoning? It isn’t the doctor’s responsibility to compensate for every parent’s deficiency in reasoning or education, especially in an emergency setting. The patient is the child, not the parent. Suing because 1. the parent doesn’t like the idea of an LP and 2. the LP might appear to have been “unnecessary” because it was “normal” is still a frivolous action. Was harm done? Doubtful. Was informed consent given? The patient is incompeternt by minority, and the parent is not reasonable. Show me how the action of the doctor is still in the wrong. You can bet if the kid wasn’t tapped at the request of the parent and there was a bad outcome, the family would be suing because, you guessed it, the doctor failed to provide the right kind of pre-procedural consent.

]]> By: Blog, MDhttp://www.kevinmd.com/blog/2007/04/infant-meningitis-and-lp-did-this-er.html#comment-73551 Blog, MD Mon, 02 Apr 2007 16:47:00 +0000 http://clients.emmense.com/kevinmd/2007/04/infant-meningitis-and-the-lp-did-this-er-physician-exaggerate-risks.html#comment-73551 I completely agree with gasman. In this case, I would have someone in the room to witness my discussion of the risks/benefits of proceeding (or not) with the LP as part of a full septic work-up, and if the family still refused, I'd document the hell out of it in the chart (name of witness, direct quotes from parents regarding their reasons why to not LP, details of discussion and facts you provided, etc.). <br/><br/>I wonder if we're moving to a point where physicians will begin asking patients to document their choices that run counter to standard of care (e.g., having parents who choose not to vaccinate sign a statement acknowledging the risks). The AAP has such a form for parents who refuse to vaccinate. I completely agree with gasman. In this case, I would have someone in the room to witness my discussion of the risks/benefits of proceeding (or not) with the LP as part of a full septic work-up, and if the family still refused, I’d document the hell out of it in the chart (name of witness, direct quotes from parents regarding their reasons why to not LP, details of discussion and facts you provided, etc.).

I wonder if we’re moving to a point where physicians will begin asking patients to document their choices that run counter to standard of care (e.g., having parents who choose not to vaccinate sign a statement acknowledging the risks). The AAP has such a form for parents who refuse to vaccinate.

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