DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Case Reference:

Traveler Malaria Fatality:

Failure to Properly Treat Malaria — Death —$23.1 Million Gross, New York Verdict.

After deliberating for three days at the conclusion of a two-week trial, the jury allocated fault 40% to the medical center, 40% to the physician and 20% to decedent.

Gross damages of $23.1 million were assessed.

 

Keywords:

malaria, Liberia, prophylactic, preventative medication, chloroquine, antimalarial, doxycycline, quinidine, fatal progression, noncompliance

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Case Overview

A thirty-three-year-old man who recently visited Liberia for work as a cinematographer presented to a medical center with flu-like symptoms.

 

Before his departure, he was prescribed prophylactic medications to prevent the transmission of known contagious diseases in the Liberia region, such as malaria, but did not take the preventative medications.

 

The medical center initially prescribed oral chloroquine but proved ineffective because of the severity. 24 hours later, he received intravenous administration of two different antimalarial medications, doxycycline, and quinidine.

 

The medications could not reverse the effects of malaria, and the man died.

Chloroquine as Treatment for Advanced Malaria?

During the trial, the plaintiffs stated that chloroquine was an outdated drug and ineffective due to the advanced progression of the disease, and doxycycline and quinidine should have been the first choice to treat malaria during the beginning hours of hospitalization.

Importance of Accurate Recent Travel Record

The proper medication to treat malaria depends on many factors, including the severity, presenting symptoms, the infecting parasite, and the location where the disease was acquired.

 

The patient was educated about his responsibility and risk of not using preventative medications before traveling to known areas of specific contagious diseases, such as malaria.

 

Although preventative medications are recommended and not required before travel, each person is liable for their healthcare when given adequate measures to prevent disease.

 

The resident responsible for the patient's treatment communicated that the patient recently visited Libya rather than Liberia, an area known to be a leader in malaria mortality.

 

However, miscommunication by the resident as to where the patient recently visited prevented the patient from receiving the proper medication, in addition to other factors that facilitated the fatality.

Symptoms & Seeking Timely Treatment

Possible symptoms of malaria, methods of transmission, and risk factors are typically included during patient education when discussing preventative medications. With that knowledge, the patient should have sought medical treatment with early onset of symptoms.

 

When testing the patient for identification of the cause of their symptoms, all cases of malaria must be evaluated for potential drug resistance for successful treatment of the disease.

 

Knowledge of a clearly defined area provides the physician with proper information to choose the appropriate medication by eliminating possible “regional” drug resistance.

 

The defense stated that the patient's death was a result of late treatment of symptoms, which promoted the fatal progression of malaria and noncompliance of using prophylactic medications before visiting Liberia.

Drug Efficacy & Regional Resistance Testing

Although chloroquine is an older antimalarial drug, its effectiveness is dependent on the progression of malaria, and whether the infecting parasite has developed resistance to the medication. Chloroquine has more instances of drug resistance than other malaria drugs.

Patients who present with severe malaria symptoms or rapid progression must be treated promptly with aggressive intravenous antimalarial medications regardless of the infecting organism.

 

Due to the patient's hesitation to seek treatment and noncompliance with prophylactic medications, his physician should have treated the symptoms of malaria aggressively intravenously before any of the three medications administered.

 

Doxycycline is a slow-acting antimalarial medication which is not efficacious until after the first 24 hours of administration and not appropriate for severe cases of malaria. More potent drugs are available to better treat malaria in cases such as this, where the patient did not participate in prophylaxis and sought treatment late.

 

The defense stated that the patient's death was a result of late treatment of symptoms, which promoted the fatal progression of malaria and noncompliance of using prophylactic medications before visiting Liberia.

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Do you have questions about a medical case or need help understanding treatment plans and options?

Cardio Med Legal Dr. Jasdeep Dalawari

(804) 500-0685 - info@cardiomedlegal.com

Jasdeep Dalawari MD

About Jasdeep Dalawari MD

Experienced General and Specialist Physician with a demonstrated history of working in the medical practice industry. Skilled in Interventional, Endovascular, Vascular, and General Cardiovascular Medicine; Emergency Medicine; Healthcare Consulting, including Peer Review, Expert Witness, and Utilization Review; and Medical Education. Strong healthcare services professional with an MS focused in Health Administration from Virginia Commonwealth University.