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."

I am a 27year old female. In December I was stricken with sever pain in right limb within 24 hrs I was unable to walk. I visited local ER twice in 2 days. I was sent home with pain medication ans was told I had sprained my foot and put too much pressure on calve at the first visit. Second visit and different doctor ordered dopplars on my legs thinking their could be a clot. Negative for clots. was sent home both times. Within 72 hrs I had visited the Er, local family doctor and was sent to orthopedic surgeon. Had 2 more dopplars and was eating pain pills. At this point I was not eating and was in a wheel chair. The orthopedic surgeon after having negative dopplars sent me home and said to prop my legs 4-5 pillows and come see him that following Monday which was 5 days later if I was not feeling better. Thankfully a friend took me to a hospital an hr away who admitted me with my white blood cell count at 32,000. They admitted me immediately and started antibioctics. Infectious Diseases was in my room within hrs and I had massive swelling to limbs and was very ill. I had a faciotomy within 2 days to relieve swelling...and almost died from the infection. I was very blessed...for I have 2 small kids to raise and I need them. I was close to dying and the ignorance of physicians...in a small community almost allowed me to die. I am thankful that I was treated in time. Recovery was 6 weeks...walking was something that took time. I have a scar to remind me of how close death was. I am sorry for your loss. More people need to be trained...and not walk away prescribing meds for the "unknown" their job is to find out the cause not simply treat a symptom.

I take offense to calling us a fool by waiting to take her to the Er the second time. With know signs of any symptom's until the am of the 29 of October of 2003 she suddenly woke up with an extreme fever and unable to walk. I rushed her to the pediatrician and after a brief exam he told me to rush her to the ER. He even called to tell them we were on our way. When we got their, no one would even look at us for hours. Then we I was told "JESSIE IS FINE. SHE JUST HAS THE FLU AND THE TESTS CAME BACK NEGATIVE FOR SEPTIC AND THAT IT SHOULD ONLY LAST 3 TO 4 DAYS. Bed rest and Motrin were prescribe. The nest day I was told to call her pedi and tell him what they said and confirmed "THAT SOUNDS ABOUT RIGHT" The following day I called again asking for something for her leg pain, still believing she just had the flu, never given information that something could be serious or even worse death! I told him Jessie symptoms again, nothing had changed. The that horrible Halloween night Jessie's fever broke and we were so happy, thanking God. You will never understand what happened when she suddenly called my name after going to bed for about 20 minutes, and as I went to her she was completely cold, within minutes she turned colors and went limp. We rushed her to the ER thinking maybe she is dehydrated, I mean she just has the flu! The we watched in horror as she died right before our eyes. We faced a cover up. No one would tell us what happened. We then found out she died of septic syndrome and the doctors lied to us about doing the tests and she could have survived because early detection is the key, with culture and antibiotics. Animals get treated better then 7 year old little girls. So before you make such an arrogant statement, you should put your self in our shoes, and I am positive you would not be so quick to judge.
Heart broken and forever changed.
I love you Jessie.
Mommy

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.

I am still an avid believer in Colloidal Silver and all that I personally know that it can do for anyone who chooses to use it.

New paragraph = New subject.

You are a fool if you wait until 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.

This is a blanket statement not only to you, but more emphatically to everyone expressing my lack of trust for the medical profession in general. I have three girls myself and have had more than my share of visits to hospitals and emergency rooms. I know doctors are completely fallible and even negligent in there duties on a daily basis. I also know that doctors can and do perform miracles on a daily basis as well, but I am not going to take the word of a doctor who may well have graduated doctor school with a D- to be the end all decision of a person that I care enough to trade my life for.

I feel for you for having to go through the horror of loosing a loved one. I apologize for what you have taken as a personal slam. I wasn't said in that context. I was no more calling you a fool than any other reader of this board.

My only advice to you would be to pray for the loving kindness and forgiveness of our Lord Jesus Christ and courage from the Holy Ghost to carry on until you can be rejoined with your child.

Short of that I would find the most blood thirsty lawyer I could and hold those accountable for the negligence in your daughters case.

Welcome to Free Republic.

Dont let this be your one and only post.

I am not sure what you mean by calling me a troll. We had no intention of sueing, but we had no choice, we need to know what happened. Money was not an issue until we found out about the MICRA law. I will be you don't even know what that is. If you do then I am very surprised. When it became clear that gross negligence was involved I finally did call an attorney, and one after the other turned us down say "I am so sorry Mrs. Geyer you have an excellent case, but because she is a little girl and not a wage earner she is not eligible for actual damages. The law focuses on who the person is rather than the negligence involved. That includes stay at home moms, children, elderly or a single person with no one to support but them selves, and since they are dead, the 30 year old law denies people the right to a fair trial by a jury of there peers. You can find out more if you want to educate your self to have a decent debate. Put her name in any search engine Jessie Geyer and learn. Here is a website too. http://home.comcast.net/~geyerinc/Jessie.html

Point Taken.
I now realize your "fool" reference was not personal.
However, it's a little too easy for people to second-guess those of us who learned the hard way that things can go very, very badly, very suddenly. Most of the time, we hear of "just misses" when the family goes through an incredible string of bad results, followed by a long, but successful recovery and ultimately, a happy ending. We've heard many of them.
But our story does not end happily. We did not get that "near-miss" second chance. 2 different doctors were too casual about a serious diagnosis. Neither explained the risks of being wrong or talked of other options. They didn't know each other either. The pedi simply escalated to the nearby ER, then apparently did not think again about it because the ER doc called him and said it was negative, but only did panel blood tests, but no cultures. We actuallly found out later that the panel tests did show reason for concern, but was evidently rationalized with the Flu diagnosis.To this day, we still have not heard why they collectively decided not to perscribe antibiotics.
This is all water over the Dam. Just trying to point out that our biggest mistake was trusting the wrong professionals at just the wrong time. No one should be second-guessed for that -- simply because we will spend the rest of our days doing that to ourselves.

My heart aches for you, as you I have learned in the worst possible way that words cannot ever do justice to describe what we feel in our heart. When Jessie died a part of me went with her, but my love for her stays with me. Our health care is in a complete decline and the priorities unfortunately are motivated by the all mighty dollar. We need to speak out to make a change, she no longer has a voice, but I will do all I can to continue to shed light on the chasm of failure buried by blackness, and laws in place that keep the handful of bad doctors protected, making it unfair to all the good ones. The system is broken, and we all know it, but have come to accept that, it is just the way it is. Many may read this and say I am glad that did not happen to me, but let me tell you, It could. I still feel like I am caught in some kind of nightmare or movie you see on Lifetime. I pray for someone to wake me up, but no one has. I will remember your son........very sincerely Michelle

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