Delay in Diagnosing Kidney Failure in 18-month old - Povrzenich
The Povrzenich Case
Facts & Allegations
From when Lacey was 18 months old to when she was 10, she suffered repeated and recurrent urinary tract infections. During this time, Lacey was treated by pediatrician Dawn McCracken, who prescribed antibiotics for her infections. From ages 4 to 8, Lacey had blood tests that showed abnormally high creatinine levels, markers for an abnormal kidney function, which went undetected.
When Lacey was 11, she had moved and came under the care of pediatrician Jennifer Ripepi for a period of six months. During that time, she had two urinary tract infections, which Dr. Ripepi attributed to dehydration and prescribed antibiotics. Lacey’s lab work again showed high creatinine levels, which Dr. Ripepi allegedly ignored. In 2008, while under Dr. Ripepi’s care, Lacey had an abdomen CT scan that was interpreted as normal by radiologist Frank Diettinger.
In March 2009, after having moved again, Lacey, 13, began seeing a physician’s assistant at Mon Valley Community Health Services. There were two abnormal blood-pressure readings that were allegedly abnormally high. In May 2010, a blood-pressure reading was again high, recorded as 183 over 124, which was missed by the physician’s assistant.
Two weeks later, Lacey was taken to an emergency room after having difficulty going to the bathroom. She was initially diagnosed with dehydration, but after fluids failed to improve her condition, she was transferred to Children’s Hospital, where she was diagnosed with renal failure.
On behalf of Lacey a lawsuit was filed against Dr.McCracken, Dr. Ripepi, Dr. Diettinger, Mon Valley Community Health Services and Monongahela Valley Hospital where the labs were interpreted, alleging claims of medical malpractice.
After several years of extensive discovery involving depositions of the doctors nurses and physicians assistants, a trial was scheduled in Washington County Pennsylvania.
At trial we had an expert in pediatric nephrology who testified that Lacey’s recurrent urinary tract infections were red flags that Dr. McCracken and Dr. Ripepi failed to heed and respond to accordingly. He also added that having urinary tract infections at such a young age, and at such a frequency, should have had the pediatricians further investigate, and that they should have correlated Lacey’s abnormally high creatinine levels to kidney impairment or failure, and they improperly relied upon the incorrect blood work readings by Monongahela Valley Hospital.
Further, our pediatric nephrologist testified that the hospital negligently based Lacey’s lab results on adult values. Her values ranged from 0.9 to 1.8. A normal value for a child under 10 years old is 0.3 to 0.7; a normal adult value is 0.7 to 1.3. Most of Lacey’s results were double the normal, yet Monongahela Valley Hospital posted the results as adult values, and failed to communicate that these were adult and not child values to Dr. Ripepi and Dr. McCracken.
Our pediatric nephrologist further faulted the physician’s assistants at Mon Valley Community Health Services for failing to properly treat Lacey’s bouts of hypertension, which she experienced when she had her blood pressure taken, in March 2009 and 2010.
We also had a radiologist testify that Lacey’s February 2008 CT scan showed findings suggesting kidney scarring and ureter problems. These two conditions indicated severe kidney damage that should have been detected, the expert opined.
At trial, in her defense, Dr. McCracken testified that she did not believe Lacey’s urinary tract infections and creatinine levels indicated kidney damage or warranted any further investigation.
At trial, Dr. Ripepi’s counsel argued that the pediatrician’s care of Lacey also met good and acceptable standards, and argued that Lacey was under Ripepi’s care for only six months, and that she properly treated Lacey’s urinary tract infections with antibiotic medications.
Monongahela Valley Hospital’s counsel argued that the hospital was a small-community hospital that did not have the requirement to report individual ages of patients’ blood tests; instead, it reports on the majority of the area’s population, which is primarily comprised of adults, and the care was within the standard of care.
Mon Valley Community Health Services’ counsel asserted that Lacey’s March 2009 blood pressure was not that abnormal, and was most likely the result of her being sick with an earache at the time and experiencing fear of the doctor’s office, otherwise known as white coat syndrome/hypertension. Moreover, repeated abnormal blood pressures are not indicative of kidney failure, the defense argued. As to the May 2010 visit, the physician’s assistant testified that she did not remember the exam with Lacey.
The radiologist had an expert in radiology who testified that the 2008 CT scan showed no evidence of kidney scarring and ureter problems.
In May 2010, plaintiff Lacey Povrzenich, 14, underwent a kidney transplant after having been diagnosed with end-stage renal failure, in Pittsburgh.
Lacey’s mother donated her kidney to her daughter. Both of Lacey’s kidneys were damaged, with her right kidney more injured. She then underwent six months of dialysis. Lacey came under the care of a nephrologist, whom she continued to see at the time of trial. Additionally, she continued to have urinary tract infections. In 2014 and 2015, Lacey underwent ureterectomies to bypass her ureters in order to provide relief for her kidneys. Also in 2015, Lacey had her two kidneys removed after they had reached the point of irrevocable damage. At the time of trial, Lacey continued to see her physicians every three months and take 30 medications per day.
Our pediatric nephrology also testified that Lacey will most likely need a future kidney transplant. Her current kidney function is hovering around 30 percent, which is sufficient, but if her function decreases below 20 percent, she will need a transplant, the expert opined.
Lacey further treated with psychological counseling after being diagnosed with anxiety. Due to the third kidney, which was placed in her abdomen, Lacey had a protrusion in her abdomen that caused her peers at school to make fun of her and bully her. In 2013, Lacey stopped taking her kidney medication in a veiled attempt to commit suicide. Lacey’s psychologists discussed the emotional distress that she sustained, and related it to the bullying in school.
Lacey testified about the bullying and the emotional toll it had on her. She also discussed how every morning and night, at 6 a.m. and at 7 a.m., and at 6 p.m. and 7 p.m., she has to take 15 pills, which totals 30 a day as a result of her renal failure. Lacey stated that the only effects she experiences is occasional abdominal pain. She testified that she is in constant fear that something will happen to her kidney, further jeopardizing her health. Lacey sought damages for past and future pain and suffering.
The jury found Dr. McCracken 85 percent liable and Mon Valley Community Health Services 15 percent liable. No liability was found against Dr. Ripepi, Dr. Diettinger or Monongahela Valley Hospital.
The jury awarded Lacey $242,573 in past medical expenses, $1,000.000 in past pain and suffering and $3,000,000 in future pain and suffering for a total verdict of $4,242,573.