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Health: Jury hears testimony in cancer death of WHS student

By Jackie R. Broach
Coastal Observer

A Murrells Inlet doctor will take the witness stand again today as a jury tries to determine if she was at fault in the death of a former patient, Waccamaw High School graduate Ashley Gaines.

Dr. Amanda Drosieko, founding pediatrician at Inlet Pediatrics, is being sued for medical malpractice by Gaines’ parents, David and Melanie. Ashley was treated by Drosieko and other health care providers at Inlet Pediatrics for about six months before she was diagnosed with non-Hodgkin’s lymphoma in April 2007. She died in June the following year due to complications related to treatment for the disease at Morgan Stanley Children’s Hospital of New York-Presbyterian. She was 18.

The parents’ attorneys argued in court this week that the failure of Drosieko’s practice to diagnose Ashley’s cancer earlier played a role in her death. Drosieko and another pediatrician at her practice, Melissa McCabe, as well as a nurse practitioner, Dawn Fox, have testified they met the standard of care and did everything they reasonably should have for Ashley based on the information they had at the time. They took the time to listen to Ashley, they said, and even in retrospect, said she received quality care.

Drosieko, McCabe and Fox all treated Ashley between October 2006, when she started complaining of symptoms including abdominal pain, fatigue, a sore throat and vomiting.

In the course of the trial, the defense has raised questions about whether Ashley’s parents followed medical advice they were given regarding Ashley and whether they and Ashley adequately and accurately described what was going on with her health while she was a patient at Inlet Pediatrics.

Drosieko was questioned by Kevin Dean of Motley Rice law firm, an attorney for the Gaineses, on Wednesday afternoon. She will take the stand again this morning to answer questions for her own attorney, Hugh Willcox Buyck of Willcox, Buyck and Williams.

Melanie Gaines is also expected to take the stand today. Her husband has already testified, as have Fox and McCabe. Ashley’s doctor from Morgan Stanley, Mitchell Cairo, testified as an expert witness on Tuesday. He is a pediatric oncologist and hematologist.

If the cancer had been picked up earlier, perhaps in January instead of April, “she could have been alive today,” he told the court. He thinks she would have been cured, he said. The cure rate for the kind of cancer Ashley had is about 85 to 90 percent if it’s caught early, he said.

Ashley had Stage 3 cancer by the time tumors were detected in her chest and abdomen and Cairo gave her a “less than 50 percent chance” of survival. Illustrations shown to the court gave the jury an idea of the size of the tumors. The one in her chest, described by Cairo as “mega giant,” appears to take up about two-thirds of her chest.

Over the last two days Drosieko, McCabe and Fox have been questioned extensively about policies and procedures for how patients are seen at Inlet Pediatrics, Ashley’s medical records and why x-rays and scans that could have picked up the tumors weren’t performed earlier.

Dean questioned whether Ashley’s level of care was decreased by the fact she saw three care providers instead of the same one at every visit, and why her weight loss — between 15 and 20 pounds — didn’t raise more of a red flag.

Fox, who also lived across the street from the Gaines family during the time Ashley was being treated, was the first to be called up and was on the stand for hours on Tuesday. Information about symptoms provided by the patient and parents has an important role in diagnosing pediatric patients, Fox said. Pediatricians rely heavily on that as they may only have 10 or 15 minutes in the room with a patient, she explained.

“If they don’t tell us what’s going on, we have no way of knowing,” she said.

According to testimony, Ashley might have had symptoms her health care providers weren’t made aware of. Reference was made to Melanie Gaines finding her daughter sleeping on the bathroom floor after being ill. Drosieko and her colleagues said they had been unaware of that. The seriousness of Ashley’s symptoms might have been downplayed based on testimony from the health care providers.

McCabe recalled an office visit in which she asked for a follow-up with Ashley in two weeks. She also requested a stool sample which was never delivered. Melanie Gaines called Inlet Pediatrics about a week and a half later to ask for a note for school, McCabe said, but Ashley didn’t return for the follow-up office visit McCabe said she intended.

The next time McCabe saw her it was in March, near the time of her diagnosis and for that reason, McCabe said, she remembers the visit in detail, down to which room Ashley was in. She said Ashley was talkative, seemed in good spirits and “looked perfect.” Medical records show her condition was recorded as well-developed and well-nourished.

The visit also stands out, because it struck her as a bit odd, she said. Ashley told her she vomited “randomly” and for up to seven hours. However, she might be fine for days after an episode. She also said she hadn’t eaten in 24 hours and McCabe said she sent her out for food before Ashley came back to continue the visit.

McCabe said she was struck by how low the level of concern in the room seemed. She felt there should have been more concern, she said.

“The whole thing was so odd,” McCabe said. “There was no sense of urgency.”

A stool sample was again requested, but McCabe said she was told it would have to wait as Ashley was leaving for spring Break in Key West.

She considered an eating disorder and Ashley, at the request of her mother, was referred to a pediatric gastroenterologist at the Medical University of South Carolina, where her cancer was discovered.

Drosieko wasn’t aware of the severity of Ashley’s symptoms and the instance where she was found on the bathroom floor when she gave her deposition. Now that she is, she still told the court she didn’t want to use the word “criticism” in relation to the actions of Ashley’s parents.

“I just wish I had known more about what was going on in between visits,” she said.

She’ll talk more about her role in Ashley’s treatment today, before Melanie Gaines tells her side of the story.

During the course of treatment at Inlet Pediatrics, Ashley was also diagnosed with several ailments including viral pharyngitis (the most common cause of a sore throat), mononucleosis and lactose intolerance. She was also tested for strep throat and pregnancy, and treated for a soccer injury that was the cause of one of her four visits to Inlet Pediatrics between October 2006 and her diagnosis with cancer.

A physical exam and palpitation of the abdomen during doctor visits didn’t turn up anything abnormal.

Cancer crossed the minds of McCabe and Drosieko, but there were other illnesses with the same symptoms that were much more likely.

While several diagnoses were made, Cairo pointed out that none were confirmed. “They never followed up,” he said. “The dots were not being connected here.”

Ashley’s weight loss has been brought up frequently this week but Drosieko and her colleagues said it’s not uncommon for a girl that age, with an active lifestyle and who had also been recently ill. Ashley was an athlete who played soccer and tennis. Additionally, the weight loss was incremental over several visits and records show she had slightly gained weight at one visit.

The way weight and other information is recorded on some of the medical files has also come under scrutiny. Based on handwriting, Dean questioned whether a receptionist might have made some medical notes on the chart, but McCabe said that was extremely unlikely. It’s more likely the information is in the same hand as that where a receptionist normally writes because a nurse went up front to help.

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