Jude Ward was born on April 19, 2015, in the presence of a nurse midwife. Parents refused Vitamin K injection but did accept oral Vitamin K. Parents were aware that oral vitamin K required 3 doses. During 1st office visit with the pediatrician on April 22, parents recall discussion with MD regarding additional doses of Vit K. Dr commented that his office did not stock oral vit K but that it would be ordered. 2nd office visit on May 14, there was no discussion regarding Vit K. On May 20, 2015, Jude presented to the ER with seizure activity. CT revealed subdural hematoma and emergency craniotomy performed.
Physicians diagnosed Vitamin K deficiency bleeding.
Did the pediatrician have a responsibility to recommend injectable Vitamin K if oral K was not available?
Files:
No questions yet!
Do you believe there might have been medical error?
There is no form of oral vitamin K that is licensed by the FDA in the United States. The physician probably should have mentioned that oral vitamin k is not available in the US rather that rather than state that it would be ordered. Even in countries where oral vitamin K is available it is clear that there are treatment failures as opposed to no treatment failures with injectable vitamin K. The child's bleed is the parents fault for refusing injectable vitamin K.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The only person responsible for this child's bleed is the parent who refused the injectable vitamin K dose at birth.
What makes you a good expert for this case?
I have been seeing newborns for 21 years
How often do you encounter cases similar to this one in your practice?
Never -- I would never allow my patient to skip vitamin K and if they refused I would tell them to find another physician.
Do you believe there might have been medical error?
1. Injectable vitamin K is recommended 2. If oral vitamin K is used —as a substandard alternative— and is unavailable, then the argument is not whether the physician has the obligation to recommend injectable vitamin k be used. That recommendation has already been made; with the presumed risks of not using it already having been discussed 3. The baby suffered the bleed because of the parents ill-advised decision not to use the recommended preventative measures which have zero risk factors. The parents chose to risk this outcome and forego a ‘procedure’ that had only benefit to be gained; and which is widely available, especially given the unavailability of the substandard alternative. 4. Even if the baby got ALL the oral doses, the oral regimen is substandard. Only IF the physicians recommended oral, as a safe and equally effective preventative measure as the injectable, would s/he bare any responsibility and or negligence. 5. The standard of care is to recommend the standard of care: injectable. The parents and the parents alone chose to breach this standard of care and the parents alone should be held responsible. 6. It is my belief that foregoing this safe and harmless procedure is child medical neglect.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
No medical error. No causation.
What makes you a good expert for this case?
25 years of experience Academic pediatrician Prenatal visits when these issues are discussed. Have become an advocate insisting that home births by midwives and local birthing centers specifically recommend injectable vitamin k; and avoid offering or presenting it as an OPTION Ongoing cme on the subject.
How often do you encounter cases similar to this one in your practice?
Regularly at prenatal visits, questions such as these come up.
Want to open a case or submit response?
Comments from similar speciality or otherwise pertinent to the case may also be accepted.