After Child’s Death, Stony Brook Hospital Uses New System

After the <"">death of a six-year-old Mastic Beach boy last September, the Stony Brook University Medical Center is implementing a pediatric early warning system in its emergency department.  Children now being treated in the Stony Brook University Medical Center’s emergency department are now evaluated by this system.

Earlier this month, the state Department of Health cited Stony Brook University Medical Center for not correctly diagnosing William Gonzalez, the six-year-old boy.  William died from heart complications on September 11, 2007, after it was discovered, too late, that he had an enlarged heart.  The state cited Stony Brook University Medical Center for its failure to consider other causes for the boy’s symptoms.  The prior month, William’s parents took him to Brookhaven Memorial Hospital when he began vomiting, was tired, and was unable to keep food down.  He was diagnosed with reflux at Brookhaven Memorial and was referred to Stony Brook.  William was seen at Stony Brook three times and each time he was seen, was treated reflux.

In its correction plan, which the state accepted October 20, Stony Brook said it initiated a process known as the “Watchful Eye Algorithm” in its emergency department.  “This algorithm of Pediatric Early Warning Scores (PEWS), adapted from Cincinnati Children’s Hospital, is a method of categorically assessing and addressing patient status … to treat those patients at risk of significant clinical deterioration,” the plan said.

The PEWS system measures breathing, heart rate, pulse and behavior, according to the Cincinnati Children’s Hospital Website.  Also, nurses regularly check patients to update their score.  If a child’s score increases, doctors are called.

William’s father, Daniel Gonzalez, said he was pleased by the plan, “especially if my son’s death at Stony Brook was not in vain and if this hopefully will not let another child or adult die.”

In a prepared statement, hospital spokeswoman Lauren Sheprow said, “Clearly this case was a tragedy, and we express our deepest sympathies to the Gonzalez family.  We initiated a review of this case a year ago in September, and actions were already in place well before the plan of correction was drafted.”

Stony Brook University Medical Center was also cited by the health department because an abdominal X-ray four days before his death revealed that William’s heart was enlarged.  The diagnosis of an enlarged heart suggests there should have been a follow-up chest X-ray, which would have shown an enlarged heart.  But, the state said, that step was never taken.

In the plan of correction, Stony Brook hospital maintained that “an enlarged cardiac silhouette is a common distortion on abdominal … films … Thus this finding is not alarming” and would not require “immediate physician notification.”

 Regardless, Stony Brook hospital admitted that it now requires the radiology department to inform doctors if such a finding arises.

An enlarged heart may be due to damage such as heart attack, congestive heart failure, and dilated cardiomyopathy, whereas gastroesophageal reflux disease—GERD or acid reflux—is a condition in which the stomach’s liquid content regurgitates—backs up or refluxes—into the esophagus.

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