Bill Bradford: Roberta’s life could not be saved

Published 10:19 am Thursday, October 22, 2009

bradfordBrenda carried her 3-year-old daughter Roberta into the Lee Memorial Hospital emergency room on a Sunday in August.

Daughter Roberta had been ill for a week with increasing fever.

Now she was lethargic and irritable and vomited occasionally. After 10 days of  hospitalization with ampicillin administration she appeared much improved; fever down and eating food.

Three days after Roberta was sent home from Lee Memorial, Brenda carried her into the ER at Borgess hospital in Kalamazoo.

Roberta’s symptoms were back in full force and she had muscle aches;  her heartbeat was rapid with occasional irregularities. When Roberta passed a round worm in the bathroom she was prescribed anti-worm medication and sent home.

Five days later Brenda carried Roberta into Bronson Methodist Hospital. Roberta was in and out of consciousness and gasping for breath.

A CAT scan of her head showed she had a very large brain abscess. After three head surgeries and 10 months in the hospital Roberta died.

Roberta’s parents engaged a Grand Rapids law firm to represent them in a wrongful death suit against three hospitals and several physicians, claiming $50 million in damages.

Two physicians with pediatric  academic credentials wrote separate expert witness testimony totaling hundreds of pages about this case.

They were in agreement that if Roberta had been promptly diagnosed and properly treated, she need not have died.

Would the careers of several physicians now be ruined by this case?

Would the hospitals suffer significant financial damages?

The consult by a pathologist with expert training in tropical medicine turned the case on its head.

Most brain abscesses result from middle ear infections.

Each of the examining physicians had looked for ear infection and not found it.

Most brain abscesses are caused by one, or at most two, bacterial species.

When the clinical laboratory had cultured the fluid from Roberta’s brain abscess it found seven different kinds of bacteria present.

Five of the species are normal and common to the intestinal tract. But in other tissue locations those five bacteria are abscess-forming.

How had these five species traveled together from the intestine to Roberta’s brain?
The answer lies in the life cycle of the round worm, Ascaris lumbricoides. Eggs of this worm are swallowed. In the stomach, acid takes off their tough outer shell. Passed into the small intestine, the eggs hatch into larvae.

The larvae burrow into a blood vessel and are carried to the liver and then to the lungs.
In the lungs, these developing worms wriggle up to the throat and are swallowed.

Back in the intestines again, they develop into mature worms. That is the usual route these worms take. But occasionally they may take a wrong turn in the blood stream and end up in some other tissue. In Roberta’s case, that other tissue was the brain. A larval worm carried intestinal bacteria into the brain.

In this case, with seven different species of bacteria in her abscess, there was no way she could survive. She was doomed from the start.

The clinical laboratory provided key information when it cultured and identified the bacteria. An adult female round worm produces 200,000 eggs per day for five to seven years.

The case was settled by the hospitals, helping to defray medical expenses. This case is described in more detail in the April 1990 issue of the Saturday Evening Post.

Bill Bradford retired to the rigors of a small farm in Pokagon Township.
He has served as director of clinical laboratories in physician group practices and hospitals.