CONCORD — Three Concord Hospital physicians have been sanctioned for professional misconduct involving the treatment of a teenage girl who showed up at the hospital emergency room and later died of an undiagnosed brain tumor, the New Hampshire Board of Medicine announced Thursday.
The physicians treated the unnamed patient for what they believed was a migraine headache and eventually admitted her to the hospital, but they did not order an emergency CT scan, which would have discovered the tumor, according to the settlement agreements the three reached with the board.
The agreements followed a board-initiated investigation and ended further actions against the three physicians.
All three — Ashley Fox, Elizabeth Hoffman and Joseph Toshach — agreed to a reprimand, to take continuing-education courses that focus on headaches and to pay fines and investigative costs that total $3,000 for each physician.
Concord Hospital is preparing a statement to address the settlements, said spokesman Jennifer Dearborn.
The board said Fox and Hoffman practice medicine at Concord Emergency Medicine Associates/Concord Hospital. It provided no information about Toshach’s employment.
According to the reprimands, the unnamed patient arrived at the hospital emergency room on May 1, 2016, with her father complaining about a migraine headache, which she had been experiencing on and off for a week.
This headache was persistent, but symptoms were similar to previous headaches. Hoffman ordered Compazine, Benadryl and Toradol, which is usually used to treat migraines and can cause sedation.
The pain improved, but the patient remained sleepy. Hoffman did not repeat a neurological exam but ordered an MRI within three days after discharge, according to the reprimands.
At 4 p.m., Hoffman handed the patient off to Fox. The patient remained sleepy and needed help using the restroom.
Fox did not order an emergency CT scan, take a neurological exam or take history from the girl or her parents. The patient was admitted to the pediatric unit at 10 p.m.
Within an hour she had dried blood on her nostrils and was non-verbal, though she responded to commands.
At 1:30 a.m., she went into cardiac arrest. It was then that an emergency CT scan discovered the tumor, according to the reprimands.
“A consulting neurologist was called in, and he was of the opinion that it was too late to reverse the damage the tumor had caused,” reads the Toshach settlement agreement.
The patient underwent brain surgery at Dartmouth-Hitchcock Medical Center but never regained consciousness. She died a few days later.
The victim’s parents are suing the three doctors, the settlement agreements say.