Blatant Negligence in Untreated Jaundice Case Ends With $46.5M Settlement

In March of 2017, one of the largest medical malpractice settlements in the history of the state of Arkansas was recorded after completion of a two week trial addressing the alleged medical negligence of a toddler who suffered permanent brain damage as an effect of untreated newborn jaundice. The family of Kara Smalls, a two year old condemned to a life with severe disabilities, was awarded a $46.5M settlement for economic and non-economic damages when a jury determined that the family's physician, Dr. Jonathan Lewis, along with Ouachita County Medical Center in Camden, AR failed to provide an adequate level of care to baby Kara. Unfortunately, Kara was made an example of what happens if jaundice is not treated.

Warning Signs Blatantly Ignored

Kara Smalls was born in June 2014 at the Ouachita County Medical Center in Camden, AR where she and her mother had been under the medical care of Dr. Jonathan Lewis. During the first day of Kara's life, a nurse noticed signs of mild jaundice which was confirmed by an initial test indicating the child was at risk of developing dangerously high bilirubin levels. Kara and her mother also had a maternal-infant blood incompatibility, further increasing the likelihood that the baby would develop extreme jaundice. Despite these observations and disconcerting facts and test results, no treatment was performed and the family was sent home without instructions to watch for signs of progressing jaundice. Three days later, the child's mother, Candice Smalls, called with concern over the condition of her baby, who was admitted to Arkansas Children's Hospital later in the day and treated with phototherapy. Unfortunately by that point, kernicterus had already set in as an effect of high bilirubin levels, leaving Kara with permanent brain damage.

Devastating yet Preventable Complications of Jaundice

As a result of the kernicterus which resulted in severe brain damage after Kara's bilirubin levels continued to increase for the first three days of her life, this young girl has been left with a brain that is cognitively normal yet confined within an incapacitated body. Although she displays normal emotions for a child her age, she will require the use of a wheelchair throughout her life and is unable to talk, feed or dress herself without assistance. Because her condition is not expected to improve, she will require 24 hour care along with expensive medical treatments. At best, Kara's family has hope that she will learn to use a technological device similar to the one used by Stephen Hawking which will, hypothetically, allow her to communicate with those around her. This all could have been avoided if Kara's jaundice hadn't gone untreated. Even more upsetting is the fact that babies with jaundice are common and usually easily treated.

Complete Disregard for Human Life?

How is it that a physician with access to all the technology, staff and training to properly diagnose and treat the common condition of newborn jaundice could ignore such glaring indications of a developing problem? Infant jaundice is easily treated with phototherapy and Kara should have received such treatment before her initial discharge. For some reason, however, Dr. Lewis failed to utilize the standard charting strategy which would have clearly indicated the need for phototherapy treatment based on the newborn's bilirubin level. To make matters worse, medical caregivers failed to inform Kara's parents of the dangers of jaundice, or suggest that Kara's parents carefully watch her condition and return to the facility if certain symptoms were to arise or worsen. When Mrs. Smalls' own concerns prompted her to call the doctor's office three days later, she was first instructed by a nurse to call back the next day, in spite of the fact that Kara was extremely lethargic and seemed to be in pain. Mrs. Smalls thought better of the suggestion to wait and insisted on coming in for an appointment; signs of jaundice were again noted by staff and blood was drawn in mid-morning,  yet Dr. Lewis sent the family home once again. It was not until later in the afternoon, when Kara's bilirubin test results showed dangerous high levels, that Dr. Lewis finally instructed the family to take Kara directly to the hospital. Dr. Lewis had even been aware that Mrs. Smalls had given birth to another child with a similar condition...was this a complete disregard for human life?

The Shockingly Cold Defense Argument

In perhaps one of the most shocking defenses recently presented in a court of law, defense attorneys claimed that physicians in Southern Arkansas are not bound by the national patient safety guidelines. These guidelines were created in 2004 with the intention of ensuring every individual's right to receive a minimal level of medical care. Stuart N. Ratzan, head of the plaintiff's team of attorneys, claims that the defense even went so far as to state:

"South Arkansas doctors and hospitals are free to ignore the patient safety rules and do what they want..."

Ratzan also went on to explain that the defense believed it was perfectly acceptable to maintain a lower standard of care than that found in the rest of the country.

Economic and Non-Economic Damages Awarded

Although the pain and suffering Kara and her family will inevitably experience from her untreated jaundice cannot be undone, they will at least not have to worry about how they will pay for the child's medical care. The settlement figure was calculated by estimating the total economic damages Kara and her family will be forced to live with, along with a significant amount for pain, suffering and emotional damage. Kara's lifelong care expenses were estimated at $33.7M, since she will require a number of medical treatments along with around the clock care. Additionally, Kara's lost earnings potential, based on the hypothesis that she would have achieved a similar status in life as her parents, was tallied at $3.2M. Finally, nine out of 12 jurors agreed that $9.5M was a completely justifiable figure to compensate Kara and her family for "non-economic" damages such as physical and emotional pain. All told, these combined damages total $46.5M and amount to one of the largest medical malpractice settlements in the history of Arkansas.

A Disconcerting Proposed Constitutional Amendment

Fortunately for the family of Kara Smalls, justice has been served and Kara will be able to receive the care she needs and deserves throughout her life. Kara's case, however, and its high non-economic settlement of nearly $10M, has inspired talk of a proposed constitutional amendment to limit non-economic damages in future medical negligence cases to $500,000. Placing a monetary value on the pain and suffering of a family is always challenging, yet opponents to this amendment express concern that limited settlement amounts will only encourage further acts of medical negligence. Holding providers accountable for their actions is a critical step towards shifting the medical industry towards more genuinely patient centered care.