Failure to treat plagiocephaly in a timely manner

by Olga Maystruk, Designer and Brand Strategist; and
Emma Louise, Risk Management Representative
 

Presentation

‍On July 16, 2012, a woman brought her 10-month-old son to Pediatrician A’s office for evaluation of reported head asymmetry and earache. Pediatrician A had been the patient’s treating physician for several routine well-child visits since birth.

Physician action

 ‍During the physical exam, it was documented that the patient was well developed, well nourished, and had a normal appearance. There was no ear shift and there was only a slight right flattening of the baby’s occiput. The physician diagnosed the patient with an allergy and a slight plagiocephaly. The physician advised the mother that head asymmetry due to positioning often disappears with age.

During the next six-month period, Pediatrician A saw the patient six times for well checks. According to the records, no further discussion of the patient’s head shape occurred. 

On April 8, 2013, when the patient was 19 months old, the mother took him to a plagiocephaly specialist where the patient was diagnosed with significant plagiocephaly. The mother was informed that it was too late for head banding. She then made a distressed phone call to Pediatrician A who apologized for perhaps not treating the patient more aggressively. Pediatrician A offered to help her find another pediatrician and recommended an evaluation by a cranial surgeon. 

One week later, the mother took her son to Pediatrician B’s office, who noted cranial asymmetry and mild facial asymmetry.  

The patient saw Pediatrician B six more times for well checks over the next two years. Medical records indicated no skull molding during two of those visits. No other issues or head shape discussions were noted.

Additionally, the patient was seen by a cranial surgeon who advised against surgical intervention because the plagiocephaly was not life threatening and it was not affecting the patient’s face. The surgeon noted that the condition is not likely to get worse or improve significantly with time.

Allegations‍

‍A lawsuit was filed against Pediatrician A. Allegations included failure to:

• provide adequate medical treatment;
• assess and evaluate the patient adequately; and
• refer to a specialist.

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Legal implications

Expert consultants for the defense were mostly supportive of Pediatrician A’s general course of treatment. However, the consultants noted a possible deviation from the standard of care due to Pediatrician A not diagnosing plagiocephaly until the patient was 10 months old. Had the physician noted head asymmetry sooner, the patient may have been referred to a specialist for cranial molding orthosis therapy. 

Additionally, the various consultants considered the actual severity of the patient’s head asymmetry and the effectiveness of potential treatments. The differing opinions illustrated the difficulty in predicting the outcome of the case.

The plaintiff’s consultant stated Pediatrician A breached the standard of care by failing to recognize the “persistence, progression, and/or severity” of the patient’s plagiocephaly over several office visits. The consultant also criticized Pediatrician A for not adequately documenting his treatment for the patient (repositioning) at the July 16 visit, and the patient’s progress with treatment over the next six visits. 

Disposition

This case was settled on behalf of Pediatrician A.

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More on diagnostic errors.
Risk management for pediatricians.
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