Medical Malpractice Insights: Failure to detect child abuse results in $45 million verdict

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. Stories of med mal lawsuits can save lives. If you have a story to share click here.

Chuck Pilcher, MD, FACEP

Editor, Medical Malpractice Insights

Failure to detect child abuse results in $45 million verdict

Femur fracture missed; no imaging follow-up system in place 

Facts: A 2 ½ month old infant is brought to the ED by his mother because he is not moving his right leg and cries every time it is touched. The ED physician orders an x-ray of the leg. It is read by a tele-radiologist as normal. The child is discharged with conservative treatment and advised to follow up as needed. The following morning the film is over-read, and a possible femur fracture is reported. The ED is notified that further imaging is recommended, but the family is not informed so it is never done. A month later the child returns with seizures and altered mental status. Workup reveals a skull fracture, intracranial bleeding, and healing rib and right femur fractures. He is left with significant disability and requires long term support. A lawsuit is filed against the radiologists, ED physicians and group, the hospital, and the abusing father, who is later convicted of child abuse and sent to prison.

Plaintiff: You missed my son’s broken femur and sent us home. You never called us when you were notified of the fracture the next morning. If you had done what the radiologist recommended, my son would be normal today.

Defense: Radiologists: We told the ED about this and recommended further imaging. ED: We never received any report from the radiologist. Hospital: The doctors are not our employees. We aren’t responsible. Even so, everyone met the standard of care. The first ED doc property managed your son based on the radiologist’s original report.

Result: After a 4-week trial and 6 hours of deliberation, the jury rendered a plaintiff verdict for $45 million. This was attributed 60% to the abusing father, 35% to the ED physician responsible for notifying the family, and 5% to the ED physician who first saw the patient.


  • Have a low threshold to suspect child abuse.
  • Have a system in place to send, receive and act upon lab and x-ray reports that are only available after patient discharge.
  • ED physicians should at least lay eyes on the actual imaging and use their knowledge of clinical context when ordering imaging.
  • As previously discussed in this newsletter, 4 (or 6) eyes are better than 2.
  • Please see results of an earlier MMI survey on ED physician practices with regard to viewing diagnostic imaging results ordered.

Reference: Child Abuse. Magana J, Medscape eMedicine, updated Jul 24, 2018.

Source: Thanks to attorney and EM attending Nicole Chicoine-Mooney, MD, JD for this case. Dr. Chicoine-Mooney lectures regularly on medical-legal matters. Further details of case available at

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