25-year-old man died from infection six days after misdiagnosis — $793,803.86 verdict

Type of action: Wrongful death; medical malpractice

Injuries alleged: Wrongful death of a 25-year-old man

Name of case: Young v. Kletzing

Court: Roanoke County Circuit Court

Case no.: CL19-1067

Tried before: Jury

Name of judge or mediator: Judge Charles N. Dorsey

Date resolved: 8/24/2021

Special damages: Medical and funeral expenses

Verdict or settlement: Verdict

Amount: $793,803.86

Attorney for plaintiff (and city): Devon J. Munro, Roanoke

Description of case: The case involved the treatment of a 25-year-old man from Hillsville, who presented Aug. 13, 2017, to Pulaski Community Hospital’s emergency department with severe, constant pain in his shoulder, tachycardia and tachypnea, but no fever. The plaintiff claimed that during the 3 ½- hour visit, the emergency physician misdiagnosed the decedent with a general musculoskeletal injury, and improperly discharged him home to follow up the next day with orthopedics. The decedent was actually suffering a “deep space” MRSA infection that had seeded in a subscapularis (shoulder) muscle and was developing an abscess (pyomyositis).

This was a rare case of community-acquired MRSA, with no history of trauma or known source of its introduction, no IV drug use, etc. The plaintiff’s experts testified that the physician would not be expected to divine this rare presentation or pathogen, but should have suspected potential infection and kept the decedent for additional tests for inflammatory markers, followed by a CT with contrast of the shoulder.

Much of the expert debate centered upon whether the presentation so closely mimicked a musculoskeletal disorder or repetitive use injury that the misdiagnosis complied with the standard of care, or was instead so atypical that it required suspicion of a systemic inflammation and further testing. Also, the physician obtained a blood panel with only a slightly elevated WBC, with neutrophilia and lymphopenia. The plaintiff’s experts opined that these results suggested inflammatory illness consistent with bacterial infection, and the defense experts opined that they were instead most consistent with a pain and stress response.

Complicating both standard of care and causation evidence was the unusual timeline following the discharge. The decedent reported to an orthopedic physician assistant the next day for a prescheduled appointment. She performed a more limited exam but also discharged the patient home without the correct diagnosis. That night, the decedent returned to the PCH emergency department in septic shock, with multisystem organ failure, acidosis and septic emboli in both lungs causing respiratory distress. Subsequent providers recognized the sepsis, but did not identify the shoulder as the source of infection or image the abscess until Aug. 15. The young man died Aug. 19, devastating a close family of two parents and two brothers.

After a weeklong trial, the jury deliberated for 16 hours. They worked late Friday evening and resumed Tuesday after three days’ break, when they returned a plaintiff verdict.

[021-T-122]