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Publication Date: Wednesday, October 01, 2003

Stanford, Medical Clinic hit by $70 million judgment Stanford, Medical Clinic hit by $70 million judgment (October 01, 2003)

Jury found that institutions failed to diagnose child's condition

by Nisha Ramachandran

A San Francisco Superior Court jury awarded more than $70 million to Michael Cook, a 9-year old child who suffered brain damage as a result of a delayed diagnosis and treatment by Stanford Hospital and the Palo Alto Medical Clinic

The $70,939,959 award in the case compensates Cook for economic damages, which are not limited and include future medical care, rehabilitation and lost earnings for not diagnosing a rare metabolic disease that prevents the body from breaking down protein.

The verdict comes in the middle of a nationwide debate about limiting the awards for damages in medical malpractice suits. Proponents of such bills to cap damages argue that excessive jury awards have driven up the cost of malpractice insurance, driving doctors out of high-risk specialties.

The jury awarded roughly $14 million to compensate Cook for his lost earning potential and $56 million for future medical needs, according to David Baum, a plaintiff's attorney with Baum & Blake.

"The sum is so high because of the future care that Michael requires. He requires future medical care, special education, rehabilitation therapy and has a full life expectancy." said Cook's lawyer David Baum, an attorney with Baum & Baum. "Michael is 9 years old now and will live at least 66 years longer."

According to David Sheuerman, an attorney with Sheuerman, Martini and Tabari in San Jose, who represented Stanford Hospital, however, the $70 million figure is "illusory." Sheuerman said the real amount that will be paid out by the two defendants is closer to $8 million, with Stanford University responsible for 35 percent and the Palo Alto Medical Clinic responsible for the remaining 65 percent. The $70 million is based on inflation over 66 years, he said.

Cook, who was born in September 1994 at Stanford Hospital, suffers from phenylketonuria (PKU). If left untreated, protein can build up in the body of a PKU patient, attacking both the central nervous system and brain. This effect however, can be controlled through a strict diet.

By state law, all newborns must be tested for PKU through a blood test before they are released from the hospital.

The validity of the test results however, depend on when blood is drawn from the newborn. It takes at least 12 hours for newborns to develop a metabolic system of their own, distinct from their mother's cord blood. If blood is drawn too early from a newborn, the test may not accurately reflect the condition of the child's system.

In Cook's case, Stanford University performed the PKU test on blood that was drawn four hours after birth. His test results were reported as normal.

According to Sheuerman, the hospital should not bare any responsibility for Cook's condition.

"Stanford performed this test the same way other hospitals were at the time. It was a state mandated test and state accepted the test at the time it was done, and they didn't reject it but the state is immune to liability," Sheurman said.

At three months, however, Cook began showing developmental delay. He missed a number of subsequent milestones in the next few months and was unable to grasp objects and keep his head up.

Dr. Richard Greene, Cook's pediatrician at the Palo Alto Medical Clinic, dismissed the delays as normal.

"Dr. Greene didn't think it was anything," said Cara Cook, Cook's mother. "We had two other boys then and he thought we were just comparing Michael to our other sons."

According to Baum, Greene's inaction constituted as negligence.

"The state not only mandates that the test be done properly at hospitals but that the clinic/pediatrician check the newborn screening to see if it's done property," he said. "And when a previously normal baby showed signs of development delay, he failed to do further metabolic tests and as a result the enzyme that was out of control built up in the child's brain and caused brain damage."

When Cook was 2, his parents switched his care from the Palo Alto Medical Clinic to UCSF. Although their new pediatrician made a note to order a urine test, which would have revealed the PKU, she did not carry out the order.

USCF was also cited as a defendant in the lawsuit, but settled with the Cooks three weeks into the trial for $500,000.

"According to experts, the damage had already been done before UCSF and for that reason we arrived at a minimal settlement," said Baum.

Cook was eventually diagnosed with PKU by a neurologist at UCSF when he was 5.

"When he was finally diagnosed, the child was at the point where he would not live independently and could not work because he had severe brain damage," said Baum.

Cook has been on a protein-restricted diet since his diagnosis in 1999. His mother said that since her son has been treated, he has shown some improvement in his coordination and language.

"He said his first four word sentence the other day and we were in tears," she said. "He tries so incredibly hard, he's our hero and has a spirit that doesn't give up."

Despite these improvements, the damage caused by the delay in treatment cannot be reversed. Cook's mother said her primary reason for filing the lawsuit was to make sure her son would be taken care of in the future.

"The brain damage is permanent and irreversible; it's a lifetime of needs," she said. "There is no question that Michael deserves every break he gets. I can't put into words -- the hardest thing about trial was how easily diagnosed PKU was."

The jury also awarded Cook $500,000 for non-economic damages but according to state law, this figure will be reduced by half. Currently, the state of California caps non-economic damages, such as pain and suffering, in such cases at $250,000.

Sheurman said that Stanford Hospital did not have any plans to appeal the decision.

The Palo Alto Medical Foundation declined to comment on this story.

Nisha Ramachandran can be e-mailed at nramachandran@paweekly.com A version of this story ran Monday on PaloAltoOnline.com.


 

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