Coroner says common bacteria killed Antioch girl

Experts at the federal Centers for Disease Control and Prevention in Atlanta have discovered what killed 7-year-old Jessie Geyer of Antioch.

Jessie died from a group A streptococcal infection that spread throughout her body.

A CDC fact sheet describes it as a common bacterium that doctors treat with antibiotics.

Although her parents rushed Jessie to a pediatrician and a hospital emergency room two days before her death, no one gave her antibiotics or did a blood culture at that time, according to forensic pathologist Kelly Arthur, who performed the autopsy.

Jessie's mother says a doctor at John Muir Medical Center in Walnut Creek told them that Jessie probably had a flu-related virus. He sent them home.

Now her parents agonize over a critical question: Might Jessie have survived, or at least had a fighting chance, if doctors had correctly diagnosed her?

Her parents maintain that Jessie's death highlights flaws in the American health care system.

"Jessie got taken to the doctor and over the next 65 hours, she fell through the cracks," said her father, Mark Geyer. "Nobody followed up correctly."

Unable to find a cause, the pathologist sent tissue from Jessie's major organs to the CDC for analysis.

Experts there identified the streptococcal organisms in blood vessels in many of Jessie's organs.

Initially, no one told her that when Jessie was seen in a second emergency room the night she died, the team at Sutter Delta Medical Center in Antioch gave her antibiotics as they struggled to save her life.

Often, when this happens, the antibiotics inhibit the growth of microorganisms in a blood culture, resulting in false-negative readings, Arthur said.

Compounding the tragedy for the Geyers is their belief that they took all the proper steps to protect their daughter.

"We just simply took her to the doctor for something that she had that didn't seem to be life-threatening," Mark said. "There was nothing remarkable about this."

Group A streptococcus often appears in the throat and on the skin. Many people carry it without getting sick.

It is spread through direct contact with mucus from the nose or throat of an infected person, or through contact with infected wounds and skin sores.

The bacteria can cause strep throat and other mild illnesses. Nearly 10 million such infections occur annually in the United States.

But on rare occasions, Group A streptococcus can lead to life-threatening diseases. That happens when the bacteria evade the body's defenses and become widespread. A break in the skin, for example, may enable bacteria to enter tissue directly.

The Geyers have wondered if a scrape on Jessie's left leg from a rollerblading fall 10 days before she became ill could have been an entry point.

But Arthur did not find widespread infection in the knee wound or in Jessie's tonsils. There was no sign she had strep throat.

In 10 percent to 20 percent of such cases where bacteria spread throughout the bloodstream, experts never find a source of infection, Arthur said.

Jessie is not alone in getting severely ill from the bacteria. Each year, nearly 9,000 people in the United States develop invasive group A streptococcal infection.

When the bacterium infects the blood, muscle or lungs, it can lead to life-threatening streptococcal toxic shock syndrome, which causes blood pressure to drop rapidly and the kidney, liver, lungs and other organs to fail.

Because Arthur could not obtain a positive blood culture, it is unclear if Jessie went into toxic shock.

Even the best medical care does not always prevent death when toxic shock occurs, according to the CDC. It estimates that nearly half of people die in such cases.

Early treatment with antibiotics is key to prevent an infection from spreading, notes a CDC information sheet. That is what upsets the Geyers.

"Jessie didn't get a break one step of the way," said her mother, Michelle Geyer.

Forensic pathologist Arthur declined to speculate about whether early antibiotic treatment could have saved Jessie. But she did say: "The kind of infection that she had is very treatable with antibiotics."

Two days before her death, their healthy daughter awoke with a temperature of 103 or 104 and such severe pain in her right leg she could barely straighten it or walk. The knee scrape was on her other leg.

Her mother carried her into her pediatrician's office. Jessie complained about missing the Halloween parade at John Muir Elementary School, where she was in second grade.

After a brief exam, Dr. James Evans told Michelle to rush Jessie to the John Muir Medical Center emergency room. He called John Muir and asked them to rule out septic knee, according to medical records. That refers to an infection localized in the knee.

Arthur would later conclude that Jessie died of "septic syndrome" resulting from a streptococcal infection that had spread throughout her body.

John Muir employees took X-rays of Jessie's leg and did blood tests. But they did not do a blood culture that might have revealed if she had a streptococcal infection, Arthur said.

John Muir's Dr. Mark Slomoff wrote in his medical records that his examination of Jessie's right knee, which was slightly warm, revealed no accumulated fluid.

Michelle Geyer says Slomoff told her Jessie probably had a flu-related virus that should last three or four days.

He gave her Motrin and sent them home, with instructions to see the pediatrician the next morning and to return if Jessie worsened.

The medical records do not mention a flu-related virus. For his diagnosis, Slomoff wrote "possibly viral synovitis," which refers to an inflammation of a knee membrane.

"I had a discussion with her pediatrician who felt that he would prefer that she not be started on antibiotics at this point in time," Slomoff wrote.

Antibiotics are generally considered useless for treating viruses such as a cold or the flu. Health officials in recent years have sought to reduce antibiotic use out of concern that overuse will foster drug-resistant germs.

Evans, Slomoff and John Muir officials declined to comment. Both physicians have a clean record in the California Medical Board database.

"Our sincere sympathies go out to Jessie's parents," said John Muir spokeswoman Barbara Hepner. "But it's the policy of our (emergency room) physicians not to discuss cases in the press."

On Thursday, the day after seeing Dr. Slomoff, Jessie still had a fever and leg pain. Michelle Geyer called Dr. Evans and told him the John Muir physician said Jessie had a flu-related virus that should last three or four days.

On Friday morning, Michelle Geyer called Evans again, telling him Jessie still had a fever. Could he prescribe something more for her pain?

Evans suggested Michelle bring Jessie back to his office. Believing that Jessie had the flu, Michelle asked what he would do differently than when he had seen her two days before. When he didn't have an answer, Michelle Geyer said, she told him she would bring Jessie in the following day if she wasn't better.

"Moving her was very, very painful for her," Michelle said this week. "She would shake."

That night, Jessie's fever broke and her leg began to swell. The Geyers called an advice nurse at an after-hours clinic, who said they appeared to be doing everything right. She set an appointment for 9 a.m. Saturday.

A short while later, Jessie called, "Mommy." Michelle Geyer rushed upstairs and discovered Jessie had become very cold. Her lips started turning blue and she had trouble holding up her head.

Her panicked parents rushed Jessie to the Sutter Delta emergency room, where a team fought to save her life. They pronounced her dead at 1:21 a.m.

The Geyers say they realize hindsight is perfect. But they criticize a health care system in which, they say, overworked doctors can rush through examinations, patients get little information, follow-up is minimal, and insurance companies pressure medical officials to keep costs down.

Although Jessie was in the John Muir emergency room for more than three hours while tests were performed, the Geyers say Dr. Slomoff spent about five minutes with Michelle and Jessie.

"It's not like it was when we were children," Michelle said. "You'd go in and you'd see a doctor and you'd get to know him. Now you're a number."

Because Slomoff declined to be interviewed, Contra Costa Newspapers could not confirm the Geyers' account.

Mark Geyer added that no one took the time to explain to them what was going on or discuss the best- and worst-case scenarios for Jessie.

"There was no interaction between the doctor and the parent," Mark Geyer said. "(Slomoff) didn't go over the panel tests with her. I mean, it would have taken another two minutes."

The Geyers urge other parents to push harder and to question medical decisions. They wish they had insisted that John Muir admit Jessie for observation.

"These days, you've got to be your own advocate," Mark Geyer said. "You don't take no for an answer and you don't let them push you around."

As the days pass, the Geyers find ways to cope with their grief over the little girl who loved pink and purple, arts and crafts and hugs with her classmates.

They try to provide a stable home life for Jessie's brothers, 5-year-old Jordan and 3-year-old Jamison.

The Geyers remain grateful for an outpouring of flowers, cards and phone calls from strangers after a Contra Costa Newspapers story about Jessie's death in early January.

"I am overwhelmed by how many wonderful people are out there," Michelle Geyer said. "I am just blown away by the response. That's a gift."

These days every little illness can jar nerves. When Jordan caught a cold recently, the Geyers took turns staying up with him all night. He nervously asked his parents: "Am I going to die?"

The entryway to the Geyers' home remains filled with memories of Jessie - photos from a family vacation, a card from her last birthday party, a heart drawn by a Scout troop after her death.

Although they cry when they hear it, the Geyers cannot bring themselves to remove Jessie's voice from their answering machine.

"Hi," she says. "You have called the Geyer family. We can't come to the phone right now, so please leave a message."

Years ago, my then 4 year old had similar sickness. When my wife took her to the doctor, he sent her straight to the hospital, ordered IV and antibiotics. Took about 48 hours to find a drug that would work. She's a healthy 16 year old now, but I often reflect on what might have happened if we waited or the doctor didn't send her to the hosptal.

"Because Arthur could not obtain a positive blood culture, it is unclear if Jessie went into toxic shock."

It's clear to me that's what killed her.

I'd have done a CBC on the kid - her white count should have either been sky high or super low - depending on which stage of septicemia she was in when the test was done. The pediatrician should have insisted on a CBC when the mom called him back the next day after having been to the ER that night. After all, he suspected a septic knee. Those are the kinds of cases that used to keep me awake at night - and I'm only a vet.

This is such a tough, sad case. Overuse of antibiotics is not good, but this is an example of why a doctor will prescribe it if there is no definite diagnosis.

When I lived in Hawaii a few years back, a lot of my friends would get strep if they went swimming with any kind of scratch on their leg. There are just too many visitors and Maui's sewerage system basically consists of dumping everything into the Pacific.

I've been fighting MRSA Staph from a leg wound myself for the last two months with Vancomicyn--a tough drug for a tough bug.

in my life, I have had much better results from vets than I have from MDs.

The vet could come out to the ranch and without a single word from the dogs, cows, calves, bulls, or even the cutting horses, he would determine what bug was running through the herd, prescribe the treatment and poof within a few days blood counts are back to normal.

How many MDs can successfully treat a patient in one visit, without any verbal conversation today? NONE! I have had much better care from vets than MDs with personal health problems also......unofficially of course. LOL Most of the time I even had the medicines on hand too.

About MD's - my husband is an MD, and he is a good diagnostician. He diagnosed his cousin with pneumonia over the phone, when an emergency room physician and the man's own personal physician missed it, and told him his shortness of breath, increased heart rate and fever was probably caused by something like ephedra in the supplements he was taking! He checked the labels of everything he was taking - no ephedra. And fever? Please. After speaking with him for a few minutes, hubby just said to him, "Hey, you've got pneumonia!". He was shocked at the emergency room physician's lack of diagnosis. Anyway, after starting to take antiobiotics, he rapidly started improving. The next problem came because he had been inactive for a period of time, and his leg started to swell. His own physician said it was nothing, not to worry about it. Well, he ended up in the hospital with a deep vein thrombosis (DVT) and nearly died because a chunk of it went to his lungs. My husband said his standard procedure in such an instance would have been to order an MRI because he would have been immediately suspicious of a DVT given the circumstances of the illness, swelling and period of inactivity.

Given all of the horror stories I've heard from people who have been misdiagnosed, I'm glad that my husband is around to keep an eye on me!

These days, you've got to be your own advocate

A friend lost his wife several years back to a bacterial infection missed by the Mt Diablo Hospital next door to the hospital mentioned in this article. Similar to Jim Henson. It seems bacterial infection is not suspected soon enough, and in people with low blood pressure, antibiotics do not get into the infected areas fast enough.

I had a similar problem in my leg when a teen many years ago. I was active in sports and the first doctor suspected trauma to the thigh bone. X-rays were negative, so I was told to ice the leg and go home until it got better. The pain was so severe I couln't sleep for several days. I was finally hospitalized and diagnosed with DVT. Icing the leg actually makes such a condition worse.

When the little girl complained of leg pain, that doesn't match a diagnosis of "Flu".

Your husband is A-Number 1. You should be very proud of him. He is truly practicing medicine as it was meant to be practiced.

Most physicians are good physicians. From the info posted above, I can't tell if her pediatrician is a good guy who missed something he sure shouldn't have, or if he's a lousy doc. He sure didn't use good judgement with her.

Sadly, docs have to see more and more patients in less and less time because medicare is killing them on decreased reimbursements. Things can, just due to the numbers involved, fall through the cracks. You hope it's the little things like the splinter in the finger and not the big stuff.

I admire people like your husband who stay in medicine as tough as it has gotten to make a living. The years he put in to be a doctor, the hours he puts in at the office, the hours on call, the responsibility for lives, the sacrifices you and your family make, are in no way compensated monitarily anymore. Thanks to you both for doing what you do.

I work with a lot of docs (MD's) and I see their frustrations with where medicine is going. It's only going to get worse with socialized medicine. We are so fortunate to have the quality of medical care we have today.

Sorry for the rant. -- E

Thanks for your compliments towards those in my profession. I honestly think working with animals is a gift. When I was younger (and quicker) I did a lot of herd work and horse work. There's so much to consider when you arrive at a farm - it's really detective work that sometimes involves considering more than just the one animal. It's fun. I miss it. I'm too old and slow now to practice large animal, and small animal never much appealed to me.

I am one of those kooks that believe in Colloidal Silver. A teaspoon a day taken orally would most likely have prevented this. Or at least gave her immune system a little help.

You are a fool if you wait untill you are on your death bed before asking for a second opinion. ...and most doctors rate right up there with insurance salesmen, telemarketers and lawyers.

Wanna know more about Colloidal Silver? Freep mail me.

The half dozen vets I've worked with in my life, all on reccomendations from other ranchers of course, were great people and all became close family friends. Being a good vet is a gift that few have, so true.

I'm sure you are proud of your accomplishments. You've undoubtably saved more herds with your experience than the average person could imagine.

I've actually seen my regular doc for less than 10 minutes - hardly gave me the time of day. Most of them do this now because of the capitated HMO system. They hate to see the patients in the capitated system come in - they can't make any money on them. They want the patients that are the fee for service.

I too have had much better experiences with vets than with MDs: Detailed explanations of test results, discussion of possible diagnoses and treatments, and so on.

I think it boils down to the fact that in the relationship with the vet I am the one paying the bill and thus I am in total control. If we were able to restore our human medical system to one in which the patients are paying the bills and in control (along the lines of medical savings accounts), many of the current problems would correct themselves rapidly.

Its the wise doctor who does not automatically prescribe antibiotics for a pt with fever and other symptoms....

drug resistance is a huge problem....one brought on because too many docs have ordered blindly, ususally to appease the sick pt or his family....

In this case, it might have been wise to order blood cultures or to lance the knee and do a culture from the fluid....

hindsight is a wonderful thing, though.....

Nineteen years ago, it was my child. My 2 year old son's pneumonia did not respond to IV antibiotics. Once septicemia, toxic shock, and disseminated intravascular coagulation set in, he died within 24 hours. He was diagnosed post mortem as having an inherited immune deficiency, which could have been diagnosed with a $25 test, was referenced in his pediatrician's notes in a dismissive way, and was never discussed with his mother and me.

Take nothing for granted. Inform yourself as best you can. Question everything. The potential consequences of failing to do so are immense.

"there is one thing right after another popping up"

Is your family doctor dropping in on her for evaluations? You might ask him to, and or to give you reccomendations you might suggest to the hospital drs.

Have you asked the doctor what he is expecting from each treatment? Sometimes one treatment will cause something else to come forward. Ask if he is prepared for these situations or is he just waiting to see what happens.

Many times the 'something else' will show up in eight hours, so if he is only making daily visits to examine her, request that they be changed to twice daily.

When any of my family goes to our family doctor, I usually have a suggestion or two to make. Generally it is nothing more than a CBC, complete blood cell count, before taking any medicines.

That gives you a line of where to start from. If the white cells are too high or too low and you don't see a correction with the medicine then it's the wrong treatment.

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