Medical Malpractice Insights: Transfer ASAP. Explain why.

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians, and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here.

Chuck Pilcher, MD, FACEP

Editor, Med Mal Insights

Transfer ASAP. Explain why.

9-year-old dies of ruptured AV malformation

Facts: A 9-year-old female is taken by ambulance to a local ED after a sudden loss of feeling in her face, weakness in her legs, and a headache. She begins seizing on arrival but remains able to localize pain. She is evaluated by the emergency physician, and a CT scan is ordered. The result is transmitted to the ED a little over an hour after the patient’s arrival and shows an intracerebral hemorrhage with suspicion of increased intracranial pressure. A pediatrician is consulted about 2 hours after arrival. An hour later, the patient has a cardiac arrest and is resuscitated. Just over 4 hours after arrival she is transferred to a pediatric hospital with neurosurgery capabilities. She arrives there with fixed, dilated pupils, and brain death is confirmed. Autopsy reveals a ruptured AV malformation. All but the emergency physician either settle or are dismissed before trial. The EP’s case goes to trial.

Plaintiff: The CT scan early on showed a condition which you and your hospital were not equipped to treat. You never gave her any medication to reduce the swelling. You should have transferred her immediately when you got the CT report. You never told us what she had or why she was being transferred. All you told us was that she was being transferred. By the time we got to the other hospital, she was dead. Your delay caused her death, and your failure to communicate with us will cause us lifelong grief.

Defense: Your death was the result of a pre-existing condition. My care was appropriate and consistent with the medical standards. I called a pediatrician to take over the case and he was the one in charge, not me. [The pediatrician settled before trial.] The transfer was delayed because the receiving hospital at first refused to accept you. And the ambulance with whom our hospital contracts was delayed. It’s not my fault.

Result: After a 9 day trial and 2 days of jury deliberation, the plaintiff was awarded $497,686 in damages. That award was reduced by half to $248,843 because the death was 50% attributable to a pre-existing condition. The pre-trial settlement amounts against other defendants were not disclosed.


  • When you and your hospital are unable to treat a problem, expeditious transfer is key.
  • Communicate early, clearly, and often with the patient and/or family about your findings, the gravity of the situation and your plans.
  • Juries favor injured kids more often than injured adults. A tearful mother on the stand with photos of a now-dead child is inherently risky for a defendant.
  • The award seems small, given that the case involves the death of a 9-year-old girl. This might indicate jury awareness that others were more directly responsible, like the pediatrician who settled before trial.
  • That the defense was unable to mitigate this case on “causation” is rather shocking, especially when arguing over a delay of 1-2 hours in a critically ill patient with a catastrophic condition.

Source: Verdict Search, New Jersey.


Prescription for successful patient engagement:
Lead with curiosity.
Embrace uncertainty when it exists.
Reassure honestly.
Communicate effectively.

Dan Berg

Patient Advocate and Founder of Patient Power

Dan lost his 15-year-old daughter to multiple medical errors.


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