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Koehler v. Neighbors

June 01, 2001

COLIN KOEHLER, A MINOR, BY HIS MOTHER AND NEXT FRIEND JANE KOEHLER, JANE KOEHLER, AND MICHAEL KOEHLER, PLAINTIFFS-APPELLEES,
v.
DAVID NEIGHBORS, M.D., DEFENDANT-APPELLANT.



Appeal from the Circuit Court of Clinton County. No. 94-L-19 Honorable John P. Coady, Judge, presiding.

The opinion of the court was delivered by: Justice Kuehn

David Neighbors, M.D., appeals from the trial court's final order entered on March 28, 2000, denying his motion for a new trial. We affirm.

Colin Koehler was born on April 2, 1992. After Colin's birth, the doctors in the office of David Neighbors, M.D., were designated as his pediatricians, and so Dr. Neighbors and his partner provided Colin's medical care from his birth.

On May 16, 1992, Dr. Neighbors examined Colin in the emergency room at St. Joseph's Hospital in Breese, Illinois. Six-week-old Colin presented to the emergency room with a 102-degree fever. Following the physical exam, Dr. Neighbors ordered blood tests, x rays, and a lumbar puncture to assist in diagnosing the cause of Colin's fever. Based upon the examination and the test results, Colin was diagnosed with viral pneumonia and questionable cardiomegaly.

On Friday, June 5, 1992, when Colin was nine weeks old, he developed another fever. In the morning, the fever was low. Colin's father, Mike, stayed home with him while his mother, Jane, went to work. Later that morning, Mike determined that the fever was much worse. He called Jane at work to tell her that Colin's fever was over 104 degrees. Jane called Dr. Neighbors' office, but she learned that Dr. Neighbors' office was closed on Fridays. She then contacted St. Joseph's Hospital, and a representative provided her with the necessary information to reach Dr. Neighbors at home.

Ultimately, Jane was able to talk to Dr. Neighbors later in that afternoon. She informed him that at that time Colin had a 104-degree temperature. She asked for guidance. Dr. Neighbors asked some questions, and Jane answered them, advising Dr. Neighbors that she and Mike had not observed any other abnormal symptoms. Dr. Neighbors prescribed infant Tylenol and asked Jane to contact him immediately if she should notice any abnormal symptoms. Otherwise, Dr. Neighbors wanted to see Colin in his office on Monday morning if the fever persisted through the weekend.

Over the next 48 hours, Mike and Jane followed the instructions given and made efforts to lower Colin's body temperature. Neither parent slept much because of these ongoing attempts. Despite their efforts, Colin's temperature never fell below 102 degrees. At 4 a.m. Sunday morning, Colin began grunting. At one point early Sunday morning, Jane thought that Colin's head looked somewhat enlarged, but when she and Mike looked closer under the light, they decided that she had been mistaken. During this same time frame, Jane noticed that on one occasion Colin's left arm stiffened. For most of Sunday, Colin's behavior was not terribly unusual, although he did sleep more and eat a little less than usual.

At 4 p.m., Colin began staring blankly and his breathing quickened. At that time, his parents took him to the emergency room at St. Joseph's Hospital. He was admitted to the hospital at approximately 4:45 p.m. The emergency room physician notified Dr. Neighbors of Colin's admission. After dropping his son off at their home, Dr. Neighbors made the 15-minute drive to the hospital, and he immediately went to examine Colin. The physical examination revealed an abnormal blood pressure, a temperature of 105 degrees, a distended abdomen, and a bulging anterior fontanel. Dr. Neighbors later testified that after seeing Colin on that date, he believed that Colin could have meningitis. He noted the abnormal breathing pattern and the grunting, and he testified that Colin's condition implied that he was experiencing seizures. Additionally, Colin was non-responsive to verbal stimuli, and he thought that perhaps Colin's neck was stiff. In his professional opinion, if Colin did not receive immediate care, Colin would not be expected to live. Dr. Neighbors performed a spinal tap, noting that the spinal fluid was cloudy, another meningitis indicator. Colin was started on intravenous antibiotics to fight the infection and steroids to help prevent any central nervous system damage. After the diagnosis of bacterial meningitis was made, Dr. Neighbors arranged for Colin's airlift transport to Cardinal Glennon Hospital in St. Louis, Missouri, as Colin was far too ill to be cared for at St. Joseph's Hospital.

Colin remained at Cardinal Glennon Hospital until June 23, 1992. He was discharged with seizure disorder, hearing loss, cerebral palsy, and mental retardation. For months after coming home, Colin experienced pain and would not allow anyone other than his mother and sister to touch him. Since that time he has undergone several surgical procedures. Colin is severely limited in his mobility and communicative skills. Colin's conditions are permanent and have required constant care and education.

At the trial, two pediatric experts testified on behalf of Colin and his parents. They both agreed that if an infant is less than three months of age with a history of previous illness and presented with a 104-degree temperature with no other symptoms, then a doctor should examine the infant and order diagnostic testing to determine the fever's source. If the diagnostic tests showed no obvious cause of the fever, then antibiotics should not necessarily be prescribed. These physicians provided opinions that Colin had occult bacteremia in his bloodstream on Friday when Jane initially contacted Dr. Neighbors. The occult bacteremia later progressed to bacterial meningitis. One of these physicians specifically testified that if Dr. Neighbors had ordered diagnostic tests on Friday, the results would have revealed abnormalities indicating the necessity of antibiotics. Both physicians testified that if Dr. Neighbors had examined Colin and started him on antibiotics on Friday, Colin would not have developed bacterial meningitis and suffered its consequences.

Expert physicians also testified on Dr. Neighbors' behalf. One of these experts testified that he believed that Colin was already suffering from insidious onset meningitis and that, therefore, a prescription of antibiotics on Friday would not have helped. Both of these experts also testified that an automatic physical examination and diagnostic testing in an infant presenting with a 104-degree temperature would only occur in infants less than two months of age. In other words, since Colin was nine weeks old, and thus older than two months of age, his temperature alone did not necessitate an examination and testing. Both physicians testified that Dr. Neighbors did not deviate from the appropriate standard of medical care.

From the testimony of all of the physicians, it became clear that there is a split of authority on when an infant with an elevated temperature must undergo a thorough physical examination and diagnostic testing. Dr. Neighbors and his experts cited authority for their position that such treatment is not required when an infant is more than two months of age. The physicians who testified on Colin's behalf provided authority for their positions that such treatment is required until an infant reaches three months of age.

Colin and his family also presented expert testimony to the jury on the issue of damages. One expert presented an extensive life-care plan for Colin. This life-care plan only extended to the age of 45 and began at the age of 21, and depending upon whether Colin lived in a nursing care facility or in a home, the cost ranged from $1.7 million to $2.1 million. Another expert testified as to the present cash value of Colin's care and his earning potential. The present cash value of Colin's earning potential if he completed high school was $864,061, and if he completed college, it was $1,161,402.

The parents testified to Colin's ordeal, including his pain and suffering upon his discharge from the hospital and ...


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