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Medical Forum / Diseases and Disorders / Sinusitis / July 2007When It's Not Sinusitis After All
Posted Online: Posted online: July 5, 2007 9:10 PM Print publication date: 07/06/2007 Suit alleges Geneseo doctor misdiagnosed teen By Stephen Elliott, selliott@qconline.com A Geneseo physician is facing his second medical malpractice lawsuit in four years -- this time over the acute meningitis-related death of a patient. The six-count lawsuit against Dr. Randall Mullin and Trinity Family Medical Associates seeks damages of more than $300,000 for the May 2006 death of Kyle Robert Malufka, 16. It was filed in Henry County Circuit Court in June by the teen’s parents, Charles and Davette Malufka of Annawan. The lawsuit alleges negligence on Dr. Mullin’s part, claiming he misdiagnosed the teen’s symptoms when he came to Hammond-Henry Hospital’s Emergency Department on May 13, 2006, for a severe migraine. The lawsuit alleges Dr. Mullin discharged the teen the same day with a diagnosis of headache/migraine and a prescription for pain medication. The lawsuit alleges that on May 15, 2006, Davette Malufka contacted Dr. Mullin about her son’s continued headache, fever and decreased appetite. Dr. Mullin ordered blood tests and a computerized tomography, or CT, scan of Kyle Malufka’s brain at Hammond-Henry Hospital, according to the lawsuit. The teen was admitted to the hospital that day with a diagnosis of sinusitis, according to the lawsuit. He continued to have a significant fever, severe pain and stiffness in his neck, according to the lawsuit. On May 17, 2006, he was evaluated by another physician and was transferred to OSF St. Francis Medical Center in Peoria. He died the following day of acute bacterial meningitis and related periventriculitis, according to the lawsuit. Matthew Smith, a Peoria attorney representing Dr. Mullin and Trinity Family Medical Associates, could not be reached for comment Thursday. Michael Warner, a Rock Island attorney representing the Malufkas, said he could not comment on the case. http://qconline.com/archives/qco/display.php?id=345098 [ You would think that the stiff neck would be a clue that it might be meningitis rather than sinusitis. And meningitis is serious enough that when this symptom is present as it is in most cases of meningitis, the doctor MUST check for meningitis. ]  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > You would think that the stiff neck would be a clue that it might be > meningitis rather than sinusitis. And meningitis is serious enough that > when this symptom is present as it is in most cases of meningitis, the > doctor MUST check for meningitis. > ] What makes you think it wasn't both, possibly? One of the things I've been reading a lot about lately, with a likely transsphenoidal endoscopic pituitary surgery likely in my future, is about the meningitis that's a somtime complication when sinus bacteria breach the opening. Pituitiary tumors sometimes extend into the sinuses, too. The boy may've had a complicated sinus infection that caused his meningitis. Susan >The boy may've had a complicated sinus infection that caused his meningitis. Sounds probable. A similar experience prompted my interest, and sense that all is not right with medical knowledge of the whole subject. The day that I was informed that all the cultures and tests had come back negative I had a drilling headache, fever, stiff neck, and delirium. This prompted both my curiosity as to the sensitivity of the cultures, and my adventures with rose fungicide. About 7 hours after swabbing with the fungicide finger size yellow green globs started to detach and I nearly choked before I could get rid of them. Evidently the stiff neck was caused by something stuck in the vicinity of my vocal cords, because when that peeled off, I could breath, and my neck was not stiff any more, but I could not talk for three weeks. No one should have to do this stuff for themselves. I felt like I was preforming surgery on myself on the hospital steps because the tests are not what they are cracked up to be. Subquently I have read of a number of instances where the patient presents with a headache, is sent home several times and dies of meningitis . > x-no-archive: yes > [quoted text clipped - 14 lines] > The boy may've had a complicated sinus infection that caused his > meningitis. I thought about that. But either way, regardless of the origin, the meningitis is so much more urgent than the sinusitis that immediate investigation is necessary. I once got a bad asthma attack from a sinus infection. I had to go to the ER. They didn't waste time treating my sinus infection, even though that was the root cause--they immediately hooked me up to the nebulizer to treat my acute asthma attack! SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. One of my favorite patients is in her early 50's, in excellent health, got a bad cold last summer, it became an ear infection, she was sent home from the ER twice, and finally admitted with mastoiditis and bacterial meningitis. She survived, after a protracted course. The ENT's just say she had eustachian tube dysfunction. We treat her colds aggressively now. Is that overuse of antibiotics? Judy > > x-no-archive: yes > [quoted text clipped - 28 lines] > Email: sdlit...@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. > One of my favorite patients is in her early 50's, in excellent health, > got a bad cold last summer, it became an ear infection, she was sent > home from the ER twice, and finally admitted with mastoiditis and > bacterial meningitis. She survived, after a protracted course. The > ENT's just say she had eustachian tube dysfunction. We treat her colds > aggressively now. Is that overuse of antibiotics? As a patient with her history, I still wouldn't take the antibiotics unless/until a cold became worse, not better, and had clearly evolved into a sinus/ear/bronchial infection. Susan The spot the phycian is in is really tough. The tests are not sensitive, so false negatives abound, if they treat and the patient gets better they can be slammed for inapproperate antibotic and antifungal use and messy side effects. If they don't treat and the patient dies, then they get sued. HELLO working for your malpractice insurer and EXACTLY following guideline protocol (even if it does not work) to cover your butt. The one time that antibiotics CAN kill bacteria is while they are free swimming. Colds kill cilia, if allowed bacteria will move in. When it gets worse, it is too late. Current antibiotic protocol is very infrequently successful at clearing a biofilm once it is formed. They can scrape it off of most places but they play hell scraping it out of tiny tiny tubing. By the way, I developed those symptoms after I had had the goo for 6 months and while I was TAKING predisone and Leviquin. I was at the end of a one month course and could not make the ENT believe that it was getting worse with predisone, not better, or to look at the smears stained for fungus, which seemed to me the only thing left. He was all hot to operate, but I could not figure out how they preposed to control post operative infection, or what they were going to "correct", since whichever side I slept on shut down and showed opaquified. Later I found out that failure to diagnose fungus is the most frequently misdiagnosed cause of death. The wife of a coworker died of Cryptococcal meningitis and he found that it is usually only diagnosed at autopsy. > One of my favorite patients is in her early 50's, in excellent health, > got a bad cold last summer, it became an ear infection, she was sent > home from the ER twice, and finally admitted with mastoiditis and > bacterial meningitis. She survived, after a protracted course. The > ENT's just say she had eustachian tube dysfunction. We treat her colds > aggressively now. Is that overuse of antibiotics? This is EXACTLY the mistake I made with my own life, and I warn everyone not to repeat my mistake: IMHO (and speaking as a layperson), if antibiotics are the sole treatment each time, then it represents a *misuse* of antibiotics. If her colds are constantly turning into secondary bacterial infections, then in the absence of discovering and treating the cause of those complications, the antibiotics are a Band-Aid that may be covering up a worsening chronic problem, and (every time oral antibiotics are taken) helping to breed resistant strains of bacteria such as staph. In fact, all you are doing is allowing Darwinian evolution to select which strains of bacteria will infect her next--namely, the ones most resistant to the particular antibiotic you have prescribed for her. The answer to recurrent infections is to aggressively identify and treat the cause, not throw antibiotics at it. If I had known that 20 years ago, I might have prevented my recurrent sinus infections from becoming chronic. Antibiotics had knocked down my acute infection each time; but the underlying sinus disease was progressing silently, month after month, till it eventually reached a point that it became chronic and the antibiotics stopped working. No one else should make the same mistake I did. Finally, repeated doses of antibiotics run the risk of having your patient's immune system get angry and cause an allergic reaction, which will then mean that antibiotic can't be easily prescribed anymore. That's an especial problem with the penicillins and cephalosporins that have more than their share of allergic reactions. There is even some evidence that during a viral infection, you are more prone to a maculopapular rash from cephalosporins than at other times (check this for yourself). Hence if you're going to try to prevent secondary infection anyway, at least don't prescribe antibiotics from these two classes. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. All valid points: in the year since she nearly died, she's gotten one course of antibiotics for a protracted viral illness that appeared to have developed a secondary sinusitis. I agree about the constant barrage of antibiotics for intractable sinusitis: I was in the same situation myself, and began to develop allergic reactions to them--again you're right about viral rashes (if you give someone with mono ampicillin they WILL get a rash, and it is not allergy.) Judy > > One of my favorite patients is in her early 50's, in excellent health, > > got a bad cold last summer, it became an ear infection, she was sent [quoted text clipped - 44 lines] > Email: sdlit...@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. On 7/8/07 5:14 AM, in article 1183896891.640557.230160@o61g2000hsh.googlegroups.com, "judy.n" > One of my favorite patients is in her early 50's, in excellent health, > got a bad cold last summer, it became an ear infection, she was sent [quoted text clipped - 3 lines] > aggressively now. Is that overuse of antibiotics? > Judy She should be checked for a dehiscence of the roof of the mastoid. A CT of the mastoid might show it. WE have seen these in previously very healthy persons. She's had multiple CT's of her infected mastoids: and has seen two ENTs. At this point, they're finally clear. Surgery was considered early in the acute illness, but the decision was made to treat with prolonged IV antibiotics (by ENT consult). Myringotomy tubes were suggested, and agreed to, but the ENT changed his mind and just did a one time myringotomy incision. She then did see the ENT who had seen her in the hospital (it's not clear how the second ENT became involved--he was not involved in the acute hospitalization) and he felt no further surgery was required. What would you do about a dehiscence of the roof of the mastoid? Her infection was h. flu meningitis and mastoiditis, felt to be secondary to otitis media. Judy > On 7/8/07 5:14 AM, in article > 1183896891.640557.230...@o61g2000hsh.googlegroups.com, "judy.n" [quoted text clipped - 10 lines] > the mastoid might show it. WE have seen these in previously very healthy > persons. |
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