Facts

On Jan. 13, 2004, Jacob-Zachary Konn-Zurcher, then age six, presented to his pediatrician, Chrystal de Freitas, M.D., with complaints of stomach cramps, vomiting and diarrhea. The patient did not improve and on Jan. 15, he returned to see Dr. De Freitas with complaints of seven out of ten abdominal pain, fever and vomiting for two days. Dr. De Freitas suspected appendicitis and instructed the patient's mother, plaintiff Jeana Konn-Zurcher to take her son to Children's Hospital's emergency room.

At the ER, both the ER physician and pediatric surgeon, defendant Nicholas Saenz, M.D., examined the patient and suspected perforated appendix. Dr. Saenz took the patient to surgery. Instead of finding appendicitis, Dr. Saenz found an ileocecal intussusception. (Intussusception is an invagination or telescoping of a segment of intestine into the adjacent bowel.) Attempts at reducing the intussusception were unsuccessful and Dr. Saenz resected the necrotic bowel and performed a primary anastomosis.

Over the next six days, while the patient remained in Children's Hospital recovering from his surgery, he generally seemed to be recovering, although he did have a low-grade fever for the first four and a half days and on the fourth post-operative day developed scrotal edema. The plaintiff testified that her son also developed scrotal erythema (redness); however, other physicians or nurses did not see this. The patient had bloody and loose stools throughout his hospitalization, which Dr. Saenz and the nurses noted were not unexpected in light of the bowel resection and anastomosis and the loss of his ileocecal valve.

By Jan. 21, the patient was afebrile for 24 hours. He was on a regular diet, but only eating small amounts. He was also stooling, but it was all loose stools. Around 6 p.m., the patient's I.V. had become nonfunctional and the nurse paged Dr. Saenz. Dr. Saenz asked how the patient was doing. The nurse stated that he was doing well. Dr. Saenz asked whether decedent was febrile. The nurse confirmed that he had been afebrile for over 24 hours. Dr. Saenz also confirmed that the patient was not on an I.V. and that he was able to ambulate and tolerate a regular diet and that his discomfort was being controlled with Tylenol. Dr. Saenz then asked to speak with the plaintiff. Dr. Saenz offered the plaintiff mother the opportunity to take the patient home and the plaintiff agreed and the patient was discharged around 7 p.m.

The patient did well at home for two and a half days. On Jan. 24, the patient developed abdominal pain and later vomiting. He was taken to Tri-City Medical Center and then transferred to Children's Hospital.

It was determined that the patient had an anastomotic leak. He was taken to surgery where he underwent lysis of adhesions, bowel resection and ileostomy. Dr. Hilfiker, who did the surgery, noted copious amounts of infected fluid within the abdomen and a small anastomotic leak.

The patient did not respond to treatment and after an initial short period of apparently doing well, he became more septic with decreased venous return and no urine output and ultimately septic shock, anasarca and multi-system organ failure. The doctors tried AV extracorporeal membrane oxygenation, but to no avail. The patient died after life support was withdrawn at the request of the family on Jan. 31.

PLAINTIFFS' CONTENTIONS:
The plaintiffs contended that Dr. Saenz failed to recognize the signs and symptoms of an anastomotic leak while the decedent was hospitalized between Jan. 19-21. The plaintiffs also contended that Dr. Saenz should have ordered a CT scan or ultrasound to rule out an anastomotic leak. The plaintiff contended that the decedent's leak was causing the scrotal edema, erythema and pain.

DEFENDANT'S CONTENTIONS:
The defendant contended that Dr. Saenz, in all respects complied with the standard of care. The defendant contended that the scrotal edema was not at all related to the anastomotic leak, which did not occur until Jan. 24 shortly before the decedent started complaining of abdominal pains and then began vomiting. The defendant also contended that the scrotal edema was due to third spacing of fluid following the decedent's peritonitis and abdominal surgery and vigorous rehydration with I.V. fluids.

Settlement Discussions

The plaintiffs made a C.C.P. section 998 demand of $100,000. The defendant made a C.C.P. section 998 offer for zero dollars and a waiver of costs.

Specials in Evidence

$16,868 (medical lien).

Damages

Approximately $1,800 (funeral/burial expenses).

Result

Defense verdict.

Deliberation

40 minutes

Poll

12-0 (for Dr. Saenz)

Length

eight days