Cromer v. Children's Hosp. Med. Ctr. of Akron

2012 Ohio 5154
CourtOhio Court of Appeals
DecidedNovember 7, 2012
Docket25632
StatusPublished
Cited by7 cases

This text of 2012 Ohio 5154 (Cromer v. Children's Hosp. Med. Ctr. of Akron) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cromer v. Children's Hosp. Med. Ctr. of Akron, 2012 Ohio 5154 (Ohio Ct. App. 2012).

Opinion

[Cite as Cromer v. Children's Hosp. Med. Ctr. of Akron, 2012-Ohio-5154.]

STATE OF OHIO ) IN THE COURT OF APPEALS )ss: NINTH JUDICIAL DISTRICT COUNTY OF SUMMIT )

SETH NILES CROMER, et al. C.A. No. 25632

Appellants

v. APPEAL FROM JUDGMENT ENTERED IN THE CHILDREN'S HOSPITAL MEDICAL COURT OF COMMON PLEAS CENTER OF AKRON COUNTY OF SUMMIT, OHIO CASE No. CV 2008 07 4775 Appellee

DECISION AND JOURNAL ENTRY

Dated: November 7, 2012

CARR, Presiding Judge.

{¶1} Appellants, Melinda Cromer, individually; and Roderick Cromer, Jr., individually

and on behalf of their late son Seth; appeal from a judgment entered on a jury verdict for

Children’s Hospital Medical Center of Akron on the Cromers’ claims against it, which alleged

that their son’s death was caused by medical negligence of the hospital’s employees. Because

the trial court incorrectly stated the law when it instructed the jury about the hospital’s standard

of care, this Court reverses and remands for a new trial.

I.

{¶2} This case involves the death of five-year-old Seth Cromer during the early

morning hours of January 14, 2007, while he was being treated as a patient in the pediatric

intensive care unit (“PICU”) at Children’s Hospital. Seth had been diagnosed with an ear

infection by his pediatrician several days earlier and, although he had been taking antibiotics and

had shown signs of improvement initially, his condition worsened after several days. Seth’s 2

parents brought him to the hospital emergency room because he had developed a stomach ache

and fever, and was clammy, cold, and listless.

{¶3} Because many of the specific details about Seth’s treatment at the hospital are

disputed by the parties, this Court will confine its recitation of facts primarily to those that are

not disputed. Due to an unexplained failure of the hospital to document what transpired in the

first exam room, an error in which another patient’s information was noted on Seth’s medical

records, and apparently because the hospital staff became too busy with the hands-on treatment

of Seth, Seth’s hospital records include incomplete details about the progression of his symptoms

and the treatment he received while in the emergency room. Therefore, most of the evidence

about the time Seth spent in the emergency room came from the conflicting recollections of

witnesses.

{¶4} It is not disputed that, at approximately 10:44 p.m., shortly after his arrival at the

hospital emergency room, Seth was assessed by a triage nurse, who noted that he was pale, had a

tender abdomen, and had a fast heart rate. Although Seth had no fever at that time, his parents

stated that they had given him Advil a few hours earlier. The nurse assigned Seth a triage level

of “urgent,” which indicated that he needed to be seen by a physician quickly.

{¶5} Seth was initially assigned to exam room 18 and remained in that room for

approximately 30 minutes. At some point, a doctor assessed Seth and concluded that he was in

shock because he was dehydrated, had an elevated heart rate and elevated respiratory levels, and

his blood pressure was decreasing. At approximately 11:20 or 11:30, the doctor ordered that

Seth be moved to exam room 3, which had more equipment to monitor his vital signs and was

closer to the nurses’ station. 3

{¶6} The doctor ordered that Seth be given normal saline fluids intravenously. Due to

an error by one of the nurses, however, Seth was given D5 ½ normal saline, which was not the

correct or optimal fluid to treat his dehydration. The evidence is disputed, however, about how

much of that incorrect fluid Seth received and what, if any, negative impact it had on his

condition. When the emergency room doctor realized the error, he ensured that Seth began

receiving normal saline solution through his IV. At some point, epinephrine was added to Seth’s

intravenous fluids, in an attempt to increase his blood pressure. The epinephrine was later

increased to a high dose, although the exact dosage is disputed. The negative or positive impact

of the epinephrine was also disputed by the parties.

{¶7} Shortly after midnight, Seth was transferred to treatment room 1. While in that

room, Seth seemed to show some signs of improvement because he was more alert and was

talking. In hindsight, however, given some of his other symptoms, experts agreed that Seth was

actually in compensated shock, meaning that his body was attempting to compensate for the

shock. Although his physical condition might have appeared in some ways to be improving, it

was actually getting worse. Because the emergency room doctor apparently recognized that Seth

was in compensated shock and believed that he was in critical condition, Seth was transferred to

the pediatric intensive care unit (“PICU”) at approximately 1:14 a.m.

{¶8} Shortly after Seth arrived in the PICU, the critical care doctor assessed him and

also determined that he was in shock. Suspecting that Seth’s shock had progressed to the point

that he had acidosis, the doctor believed that he would probably need to intubate Seth and place

him on a ventilator. Ventilation would help reduce the acidosis by decreasing the carbon dioxide

levels in the blood. The doctor first placed a central venous line to establish stable intravenous

access to continue administering the epinephrine and other medications, if needed. He then 4

placed an arterial line to draw blood for testing, which revealed that Seth was suffering from

significant acidosis. The doctor intubated Seth at approximately 2:15 - 2:25 a.m., and then

ordered an echocardiogram. During the echocardiogram procedure, at approximately 3:45, Seth

went into cardiac arrest and a code blue was called. Cardiopulmonary resuscitation was not

successful and Seth was pronounced dead at 4:05 a.m.

{¶9} The Cromers filed this action against the hospital and several individual

defendants, alleging that Seth’s death was caused by the negligent medical care that he received

at the hospital. The individual defendants were later dismissed and case proceeded to trial

against the hospital. At trial, although there was disputed evidence about some of the treatment

that Seth received, particularly while in the emergency room, the primary dispute between the

parties was the cause of Seth’s death. All experts agreed that Seth died due to coronary failure.

The dispute involved whether his heart failure was caused by an unknown, pre-existing heart

defect or the hospitals’ failure to properly treat the septic shock that had developed from his viral

infection.

{¶10} The Cromers’ medical expert, Dr. Margaret Parker, testified that, although Seth’s

autopsy revealed that he had a pre-existing narrowing of his left coronary artery, that condition

did not cause his death. Instead, she opined that Seth died due to septic shock that had not been

appropriately and timely treated at the hospital but was allowed to progress to severe cardiac and

respiratory failure. She explained that, when Seth arrived at the hospital, he was suffering from

septic shock, which, if not quickly treated and reversed, can lead to cardiac shock. She further

explained that untreated shock can lead to acidosis, which if not treated will ultimately cause

death. Dr. Parker pointed to evidence that Seth developed both respiratory and metabolic

acidosis while in the emergency room.

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Related

Cromer v. Children's Hosp. Med. Ctr. of Akron
2017 Ohio 5699 (Ohio Supreme Court, 2017)
Cromer v. Children's Hosp. Med. Ctr. of Akron
2016 Ohio 7461 (Ohio Court of Appeals, 2016)
Cromer v. Children's Hosp. Med. Ctr. of Akron (Slip Opinion)
2015 Ohio 229 (Ohio Supreme Court, 2015)
O'Loughlin v. Mercy Hospital Fairfield
2015 Ohio 152 (Ohio Court of Appeals, 2015)

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