But the student was not in the mood for joking. His headaches and lethargy had continued, and now he was complaining about new symptoms, vomiting and photophobia. After a short discussion of his symptoms and a brief physical examination, Ms. R diagnosed Mr. J as having migraines. She prescribed an anti-migraine medication and recommended that he see a neurologist on Monday if the symptoms continued. The student thanked her, took his prescription, and left. Ms. R noted the diagnosis in his chart and filed it away.
The next morning, the student was found dead in his dorm room. After an autopsy, the medical examiner determined that the cause of death was bacterial meningitis.
Mr. J’s devastated parents knew that he had been to the school’s health clinic for the headaches, and they sought the counsel of a plaintiff’s attorney to decide whether they might have a case. The attorney, after having the medical records reviewed by an expert, told the parents that he believed they did have a case, and he recommended suing the practice that employed the NPs and the physician who was supposed to be overseeing the work of the NPs.
Ms. R was not personally sued, but because the case was based on her alleged negligence, she was called as a witness and had to give a deposition prior to the case going to trial. During the deposition, she was asked why she had not referred the student to a hospital emergency department for head imaging when he returned a week later still complaining of severe headaches. Ms. R had no answer.
Her supervising physician was questioned about why he had not intervened, and it became apparent that he had not even looked at the notes from the second visit before the patient died. The case was ultimately settled prior to trial, out of court, for an undisclosed amount.
Although Ms. R committed the actual negligent act in this case, it was her employer that was sued. This is common in cases against physician extenders, although that is starting to change. In general, the physician or practice will have deeper pockets (and better professional insurance) than an NP, and so the practice or supervising physician is often the one sued in such cases, particularly, as in this case, where there should have been more supervision.
Although Ms. R was not personally sued, once the case was settled she was let go from her employment based on what had happened to her patient.
Because the early symptoms of meningitis can resemble something less threatening, such as the flu, it can easily be misdiagnosed. Bacterial meningitis requires early diagnosis and treatment, or there can be tragic consequences. The three main symptoms—sudden fever, severe headache, and stiff neck—only all occur together in less than half of bacterial meningitis cases, meaning that if 1 of the 3 symptoms is present, it is worth ruling out meningitis because the consequences of the disease are so great.
In addition, Ms. R should have considered the setting in which she was practicing. Outbreaks of meningococcal disease, particularly those caused by Neisseria meningitidis, tend to spread where large groups of people are living together in close quarters, such as college campuses. Even if Mr. J’s first visit had not been enough to cause Ms. R to consider meningitis, his second visit should have. Vomiting and photophobia are also signs of meningitis, and those combined with his severe and long-lasting headaches should have prompted Ms. R to refer him to the emergency department immediately for further screening. Her supervising physician should have given her better instruction on recognizing the signs of meningitis—particularly considering the setting that she was working in.
Ms Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, NY.