Saturday, July 25, 1998

By Jason Montiel
and Leslie Mladinich

STAFF WRITERS

When Linette McCan's 7-year-old son Gregory came to her complaining of a stomachache last Saturday, she never dreamed her child would be dead the next morning.

She says doctors in the emergency room at Kaiser Permanente's Walnut Creek hospital ignored Gregory as he suffered from what turned out to be meningococcal sepsis, an infection that led to his death Sunday morning.

But Kaiser officials insist that the San Ramon boy was seen by a doctor within 15 minutes of arriving in the hospital's emergency room at 2 p.m. Saturday. They say the child received the best care possible as doctors tried to diagnose his illness.

State Department of Health Services officials are reviewing the case, looking at what happened from the time the boy arrived at Kaiser to when he was pronounced dead at 7:36 a.m. Sunday after being transferred to Children's Hospital Oakland.

The state's evaluation is not due out until late next week at the earliest, but a Kaiser spokeswoman said an initial report showed "no major care issues."

The death investigation is the latest in a string of state queries into patient deaths, emergency room delays and other problems at Kaiser facilities in the East Bay.

"I can't believe this," Linette McCan said Friday, weeping as she recalled watching her son slowly die as she stood by helpless at the Walnut Creek hospital. "It is like losing the eyes on my face."

Dr. Walter Keller, chief of pediatrics in Kaiser's Diablo Service Area, defends staff at the Walnut Creek emergency room. He said meningococcal sepsis, a bacterial infection that is difficult to diagnose, kills up to half of children infected within 24 hours.

"We feel very saddened and unhappy about this," Keller said Friday. "I feel we gave excellentand appropriate medical care. It is a condition that is difficult to diagnose and is rapidly fatal. I really don't think we could have done anything different."

"There could be a reason, and there could not be a reason," Gil Martinez, district manager of the State Department of Health Services, said. "It is hard to say whether there are any violations or problems."

Martinez said his department receives an average of 100 complaints a year of inappropriate health care at hospitals.

In March 1997, the state investigated Kaiser's Richmond facility following the deaths of two patients after they were transferred from the emergency room to other hospitals.

Martinez said he could not comment on the McCan case until the state issues its report to Kaiser next week.

Linette McCan, a single mother, said she first worried about Gregory at about 5 a.m. Saturday when he woke her up complaining of pain in his left lower abdomen. The boy had a fever, so she gave him a Tylenol pill and called Kaiser to set up an appointment.

She brought Gregory to Kaiser's Pleasanton clinic shortly after 10 a.m., where a doctor suspected the boy might have appendicitis. Blood and urine test were taken, as well as X-rays. The doctor sent them to Kaiser's Walnut Creek hospital, which operates an emergency room and pediatric unit.

The Pleasanton doctor, McCan said, said he would call ahead to alert the Walnut Creek emergency room about the case. McCan said once she arrived at the Walnut Creek facility at about 2 p.m., her son was put into an observation room. Then, she said, the waiting started.

"I told the nurse that the doctor (in Pleasanton) told us to come right away," McCan said. "The doctor was supposed to be waiting."

But Keller says a doctor evaluated Gregory within 15 minutes of his arrival. "The child was seen rapidly," Keller said. "The plan was that the child needed to be further evaluated."

McCan disputes Keller's claim, stating that the first doctor she saw visit her son was a pediatrician who arrived about 6:30 p.m.

Keller said another doctor also visited the boy, with a surgeon dropping by for an evaluation at 6:50 p.m. "The surgeon did not think it was appendicitis, but he was not certain," and asked for more observation, he said.

At about 10 p.m., the boy was transferred from the emergency room to the pediatric unit. "By the time he got to the pediatric ward, he had no fever," Keller said. "There was no sign of serious illness until literally hours before he died."

McCan said she noticed her son's worsening condition first. "I noticed a rash (on him)," she said. "I called the nurse, and she said it must be from something (Gregory) ate."

Keller said the medical staff noticed a rash on the boy around midnight, suggesting that he was not suffering from appendicitis. The staff ordered more tests. Antibiotics were administered about 2 a.m. "Sometime between 1 a.m. and 3 a.m., it was clear the child was getting sicker," Keller said.

These hours were the worst time, said Linette McCan, who stayed by her son's side. Gregory began having serious trouble breathing, a side effect of meningococcal sepsis.

Keller said sometime between 3 and 4 a.m., Kaiser officials called for help from Children's Hospital, which sent a doctor, nurse and respiratory therapist to the Kaiser facility to help Gregory. Children's Hospital spokeswoman Carol Hymen said Kaiser did not call for help until 4:30 a.m.

But Keller said Gregory went into cardiac arrest about 4 a.m., with hospital staff administering CPR to revive him.

Keller said the Children's Hospital team arrived in Walnut Creek about 6 a.m. and took the boy to the Children's Hospital intensive care pediatric unit by ambulance. Gregory was pronounced dead shortly after arriving at Children's Hospital.

"Our family from here on will be very empty," said grandmother Ruby McCan, also of San Ramon. "Gregory was a very gregarious child. He brought a lot of love."

Gregory, who is survived by his 8-year-old brother Tony McCan, was planning to attend second grade at Murray Elementary School in Dublin this fall. He loved swimming, skating and bike riding. A funeral is planned for Gregory at 11 a.m. Monday at C.P. Bannon Mortuary at 6800 E. 14th St. in Oakland.