Pediatrian failed to diagnose

What is the name of your state?NJ

I am looking for some advice regarding my 2 1/2 year old son Michael who is currently receiving speech therapy for Apraxia of speech which is a neurological disability.

The pediatrician failed to acknowledge Michael's speech delay at his 19 month check up and basically said in not so many words that he'd catch up. Their biggest concern at that appointment was the fact that I was refusing the MMR vaccine until I was clear as to what was causing Michael's delay and even threatened that they have the right to ask me to find a different Pediatrician if I don't vaccinate. During the months that followed Michael showed no improvement. In June, Michael was now 26 months old, I stumbled upon some brochures at an audiologists office while having my newborn daughter's hearing tested. I asked the Dr. what Early Intervention was all about and she advised me that the Pediatrician's refer you if they see any developmental delays.

I called the pediatrician and they insisted that Michael been seen immediately at which time they gave me the referral. Michael was evaluated in July and it was determined that he is 33% deficient in his expressive speech. To put it more clearly he was talking at a level of approx. 12 - 15 mos. The good news was that Michael did qualify for the program however, Early Intervention is provided for children 18mos.to 3 years and Michael would only recieve therapy for about 6 months. I wasn't too upset that we were late in getting help for him until his first Therapy appt. when the Therapist informed me in a matter of minutes that Michael has Apraxia of speech. This was something much bigger than a typical speech delay. Children with this disability do not out grow it. I left several messages at the pediatrician's office to discuss this and to find out how I can get a clinical diagnosis for Insurance purposes as his therapy is costing roughly $100.00 per session and also to find out if we should be referred to a Neurologist. Four days went by and still no return phone call. The Therapist along with the Early Intervention Team all questioned why the Pediatrician didn't refer me when I expressed my concerns when Michael was 19 months old. because so much time has been lost during such a cruicial stage of his life. My question to you is do you feel that I could possibly have a case against the pediatrician? I feel that I let down my son by just listening to the "Good Doctor" and fear for what may lie ahead for his future. Therapy can help him but as I stated in this situation Time is of the essence and 10 months of treatment has been lost. I am angry with the pediatrician for missing this and for not even calling me back to discuss his condition. Please help!

You need to do some research

I am a Chiropractor in Michigan. I suggest you do some research...not only to find out what the laws regarding immunizations in NJ are, but you should read up on the immunizations themselves. In most states, it is the parent's choice as to wether or not a child gets immunized. There are things called religious and philosophical exemptions that schools have to honor. Immunizations have been linked to numerous neurological, psychological and physiological syndromes and diseases. For instance the only polio virus contractions that occur in the US each year occur in children who have recently received the immunization. I read all about vaccines, and found that there is more bad than good said about them...and the majority of the bad stuff being said comes from the mouths of Medical Docs...even the ones who helped develop the things in the first place. I chose not to immunize my son, because immunizations really can weaken the body's natural immune response in the event of exposure. One good reading I would suggest is "The Vaccination Dilemma" by Christine Murphy. This book has been supported by several MD's....the list goes on and on. I am not telling you to stop with the immunizations, I am simply telling you that you should do some research, and then decide how you feel about it.....my son is almost 8 years old, and he has not been sick since he was 2 years old....not even a cold in the winter time when all his classmates are sick and missing school.

One more thing

I meant to tell you this because it is in direct regards to your immediate problem. You should check to see what the scope of Chiropractic is in NJ. In several states, Chiropractors are Primary Care Physicians, and could get you the referrals and help that you need. It is worth checking out.

Diagnosis of CAS: Medical malpractice?

I'm so sorry for the problems you are facing regarding your son's developmental disability. Determining whether or not you have a viable medical malpractice claim would require much more information than you have included in your post - but my opinion would be: very doubtful. Laws vary some from state to state, but in general the following applies:

First: The first step in a medical malpractice action is proving that the healthcare provider was negligent in that he or she deviated from a reasonable standard of care. Two important points here: for the purposes of proving malpractice, patients are entitled to reasonable care: not good care; not excellent care. Reasonable care. What that reasonable standard of care is - or is not - is the meat of a med mal action. But for example, a pediatrician who is board-certified by the American Academy of Pediatrics would be held to a higher standard of care than a GP who sees children as a part of his or her practice. It's a gross over-simplification - but gives you some frame of reference.

Once the determination has been made that there was a deviation from a reasonable standard of care, there are potatos that go with the meat of a medical malpractice claim: 1) Did the healthcare provider know, or should have known, that the care provided was likely to result in significant damage or injury to the patient? 2) Was the deviation from the reasonable standard of care the proximal cause of the significant damage or injury? 3) Did the healthcare provider have the patient's informed consent for the treatment administered or the care provided? And 4) if such warnings as to deem the consent "informed" not given, could a reasonable person be expected to agree to the treatment or care despite their absence?

And the buffet of vegetables, side dishes and desserts is almost endless.

How does this all apply to your situation?
You don't say what the status of your son's speech was at that 19 month check-up. The American Academy of Pediatrics' guidelines for assessing speech development are very broad because, in fact, children develop differently - often drastically so. For instance, the AAP's position is that a child making no effort to speak at 24 months, so long as s/he is healthy and active; understands you and communicates non-verbally is still possibly within the category of "late talkers".

Very, very little is known about CAS - including what causes it. Research is still in its infancy. Regardless of what your speech therapist told you, the consensus of opinion in recent papers published by researchers on the front line seems to be that children younger than 24 months are incapable of the cooperation necessary for a definitive diagnosis.

I strongly suspect that the referral you received when your son was 26 months old was timely and well within a reasonable standard of care. Which doesn't solve your problems, but perhaps may assuage any guilt you feel for not pursuing the issue more aggressively.

Which brings me to another observation: while refusing the MMR vaccine for your son is certainly within your rights - as is opting for non-invasive treatment instead of surgery, for example - your refusal obviously put you in an adversarial position with your pediatrician. Adversarial relationships do not make for good communication - which is crucial to good healthcare. The pediatrician's "threat" to discharge responsibility for your child's care because of your refusal to permit vaccination - which he is completely within his right to do - clearly demonstrates the scope of his philosophy on withholding childhood vaccines and I have to wonder why you did not -at the very least - immediately seek out a second opinion and from there, find a pediatrician whose views on vaccinations would not put you at odds immediately each time you entered the office. I hope, for both you and your children, that you have now found healthcare providers with whom you feel satisfied.

I'm assuming that your concern with the age limitations of Early Intervention have to do with a lack of insurance coverage? Contact your state's Department of Children and Families for possible state-sponsored insurance programs for children. It is also possible that your child may qualify for Social Security Disability -and therefore Medicare. Social service agencies are the best sources for this kind of information.

And as an end note: the last thing a child with a developmental disability needs is a chiropractor.

I wish you and your children the best. Good luck.

lggmoney
Well, you've certainly received some interesting information.

For a male child to be slow in talking, "behind" in his speech, at the age of 19 months is not that unusual.

Apraxia is the result of an immature central nervous system and in no way did the pediatrician cause the immature central nervous system; the child was born with it.

Many times a child with apraxia begins to receive speech therapy once a week while in pre-kindergarten. In NC, speech therapy is available in daycares that accept state-funded payments. If I recall correctly, the speech therapy evaluation is not done until the child reaches the age of three and actual therapy begins after the evaluation of all factors.

I think to label a 2 1/2 year old child as having a "neurological disability" because of slow speech development is cruel. Whoever came up with that one should be ashamed.

In my opinion, no area of malpractice or negligence exists (regarding the failure to diagnose apraxia).

As for the vaccination issue, the pediatrician is within his rights to refuse to continue to accept your child as a patient if you refuse to consent to the vaccinations. I imagine if the pediatrician honored your request and your child developed rubella with a high fever and lost his sight and, or his hearing, you would be wanting to sue the pediatrician for not explaining the risks and the astute recommendations for the vaccination.

Please treat your child as if he is completely normal or he will grow up with more problems than having a speech impediment.

EC

Doesn't need a Chiropractor?

ResIpsa, what is your career? Are you a qualified primary health care practitioner? You should do some research, also. Chiropractic is a very effective intervention to many developmental conditions in children. I am not saying that Chiropractic cures these things. Chiropractic enables the body to deal with these things at an optimal capacity. Like everything else, sometimes it works and sometimes it doesn't. I personally have seen Chiropractic care of children be so successful that parents were able to take them off allergy medications, asthma treatments and even ADHD medications. I was just offering up an alternative, that could very well be successful, or not....but there is nothing to lose. Furthermore, I was suggesting a Chiropractor as a solution for the referrals that this mother needs. A Chiropractor could take this child undercare and help her with referrals, from an unbiased point. Typically, in the event that another type of health care specialist is warranted, a Chiropractor is more than willing to give the proper referral. Enuff Said.

Have you also had thorough audiological exams? Hearing deficits, even the transitory type that kids with frequent ear infections experience CAN negatively impact speech development.

FYI- MY daughter was severely delayed due to a combo of sterile institutional environment preadoption and hearing problems that ebbed and waned with every cold and recovery period, so it was not obvious. At 25 months, she had absolutely NO receptive or expressive speech. After ear surgeries and adenoidectomy, therapies, and five years with us, at 7 she is almost totally caught up and in a challenging regular second grade.

And no, I would not give up her ADD meds, she is able to learn and focus because of them.

I agree to label a child at this age is horried you dont know what is totally going on and yes get the hearing checked first because we did the route that you are going just to find out that our son was losing his hearing.

I empathize with your situation. My 5 1/2 year old daughter suffers from severe autism. She is for the most part non-verbal. Very few words w/ no actual communication. I had the same problem w/ our pediatrician. I voiced my concerns w/ her delay in speech but I kept being put off. My daughter at one time had speech but hit a downfall after a series of 3 vaccines containing Thimerosal(mercury preservative used in vaccines; although it is said that these Thimerosal containing vaccines are now off the shelves w/ the exception of the flu vaccine and, I believe, HepB). She rcvd these shots in Nov 2000 and by Christmas we knew something to be severly wrong. Her speech was gone, she acted deaf. Soon thereafter she started self injurious behaviors. I called the dr who didn't appear to be concerned at all. He said she was just acting out by not talking. He wouldn't give us a referral for a hearing screen, since she had, at one time, been talking. He kept saying if she doesn't start talking by the time she goes into K that the school would evaluate her.(We heard this from 18 mos until age 2 yrs) I was appalled! I found out about First Steps(early intervention for kids birth thru 3 yrs.) They also couldn't believe this. Needless to say we were referred to a our children's hospital and she was eventually diagnosed w/ autism. You should check a childrens hospital in your area and get in to see a developmental pediatrician. Note: a dev ped does not replace a primary care physician.
To answer your malpractice and negligent Q:
Because of the TH in vaccines and my daughters nuerological condition, I have obtained an atty who is working on my daughters case. I also had some Qs about the dr.-

Drs were notified by the APA(sometime in 1999) that there was a possible link between nuero dis and TH. I felt I should've been asked to sign a release indicating that I was aware of this and made the choice to proceed. I was not given that info nor that choice. I felt dr to be liable- my atty said NO. TH was not proven to be a health hazard, YET. There are many contradictory studies where some say it is, others say it isn't.
There are many "secret" and confidential studies such as the Eli Lilly study that was done before TH was ever even put on the market.(I believe this study was done in the 1940's) These studies show the link(go figure). At any rate the jury is still out!

I also wanted to know if the dr was negligent by not following through w/ repeated requests concerning speech. I was told since her overall health was fine and he wasn't denying well care visits, it would be extremely hard to prove negligence.

I would still see an atty in your area though. Just wanted you to know our outcome and that you're not alone...
Hope this helps.
GOOD LUCK!

Pediatrician failed to diagnose update

WOW! There certainly are a lot of people really getting off my subject here. I do appreciate, however, all of your time. Since my original post a few weeks ago I have switched Pediatricians and have an appointment with their neurologist next week. My son has had several therapy sessions and is making some progress. When we first began addressing As for the poster who stated that I had "Labled" my son, I don't "Lable" my children as they are all unique and have many wonderful qualities. I used the term neurological disability because Apraxia like dislexia and other disorders alike are disabilities of varying degrees. And because this is a disability Insurance does pay for therapy thank goodness because otherwise I'd be paying approx. $400.00 per month. This is a very complex disorder as I am learning and while some children with Apraxia commonly have Cerebral palsy and Brain Tumors there are those who have no other conditions as is the case so far with my son. I do know that with therapy my son may improve. To what extent we aren't sure and it may take months or years until we know for sure if he will have problems with reading and writing as some Apraxic children often do. We have great hope that my son will make great progress through the resources available to him such as Early Intervention, Speech Therapy and even FREE Pre-School programs for children with developmental delays. My little boy is an Angel with many gifts and is extremely bright. I only "Lable" this little guy as a true gift from God.
My original question regarding the Pediatrician dropping the ball and not addressing my sons obvious situation was answered by one of you who gave me informed, intelligent info. And I thank you. I have overcome the anger towards the Pediatrician and don't blame anyone for his Apraxia. The lesson learned here is, When it comes to the health and well being of our children we should never just sit back and ignore the gift of Maternal Instincs regardless of what anyone says. A second opinion can never hurt!

Thanks to you all.