Doctor's Name

LOYOLA UNIVERSITY OF CHICAGO STRITCH SCHOOL OF MEDICINE

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Other infractions/accusations: Failure to comply with CANRA mandatory reporting.

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• 1/11/2019—ACCUSATION FILED.

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Excerpt from Accusation dated 1/11/2019:

FIRST CAUSE FOR DISCIPLINE
(Unprofessional Conduct: Gross Negligence and/or Repeated Negligent Acts; Failure to
Comply with CANRA Mandatory Reporting)

11. Respondent Melissa Kelly Egge, M.D. is subject to disciplinary action for unprofessional conduct through gross negligence and/or repeated negligent acts under Business and Professions Code section 2234, subdivisions (b) and/or (c), and/or through failure to file a mandatory report under California Penal Code section 11166, as described herein.

12. On or about July 2, 2015, Patient A, a boy of about two-years-of age, was seen at the Emergency Department ("ED") of O'Connor Hospital ("O'Connor") in San Jose. The patient complained of right elbow pain and was diagnosed with a right supracondylar fracture and buckle fracture of the right distal radius. The examination of the left upper extremity was normal. The parents reported that Patient A fell backward while running on a tile floor. The patient's right arm was splinted and follow-up was arranged with orthopedics.

13. The next day, on July 3, 2015, Patient A returned to the ED at O'Connor with a complaint of left arm pain and swelling of the left upper extremity. The parents said that they were not aware of any new falls and that the left arm swelling had developed about 20 minutes before they arrived at the hospital. The diagnosis was a left supracondylar fracture. A skeletal survey x-ray (a 10-view battered child series of x-rays of the chest, legs, skull) was obtained.

14. Patient A was transported by ambulance from O'Connor to Santa Clara Valley Medical Center ("SVCMC") for pediatric orthopedic care. It was reported that physicians at O'Connor were also concerned about the possibility of non-accidental trauma ("NAT").

15. On or about July 3, 2015 at about midnight, Respondent received a call from a pediatric physician at SCVMC who examined Patient A and reviewed the case for orthopedic care and for further assessment of the possibility of a non-accidental trauma. Respondent was the on-call child abuse expert for the hospital. After reviewing the patient's known history by telephone, Respondent opined that Patient A's injuries were not likely to be non-accidental trauma, that the described mechanism of fall was consistent with the injuries, and that no report needed to be filed with Child Protective Services ("CPS").

16. Respondent did not adequately document the details of this telephone consultation.

17. Patient A was admitted overnight to the hospital for surgical repair. Repeated x-rays of the bilateral upper extremities were ordered at SCVMC.

18. Prior to Patient A's discharge on July 4, 2015, a SCVMC pediatric hospitalist reviewed the patient's history and contacted Respondent's SCAN team partner, who was the on-call child abuse expert at that time, for another telephone consultation about possible NAT. The other SCAN team physician concluded that Patient A's injuries were most likely accidental trauma and that a CPS report was not recommended. The patient was discharged home with orthopedic followup scheduled. No report was filed with Child Protective Services.

19. On or about July 7, 2015, a SCVMC physician was notified by a radiologist that Patient A's skeletal survey x-rays from O'Connor showed a "late subacute fracture deformity in the distal metaphysis of the left femur." The radiologist noted that: "Combination of acute and late sub-acute or chronic fractures in the pediatric skeleton suspicious for non-accidental trauma. Recommend clinical correlation."

20. On or about July 7, 2015, the SCVMC physician sent an e-mail to the other SCAN team physician regarding concerns about the multiple fractures and about the newly reported femur fracture.

21. On or about July 7, 2015, the SCVMC ED physician called and spoke with the other SCAN team physician, who was the on-call child abuse expert. The advice given by the other SCAN team partner was that, although the femur fracture was not as characteristic an injury for the fall described, he still had an overall low index of suspicion for non-accidental trauma and did not feel that a CPS report was warranted. He recommended that lab studies and screenings be done to test the patient's bone fragility. The labs were ordered and drawn and the results did not raise any concerns.

22. Sometime in or about July 2015, Respondent learned, during a discussion with the other SCAN team physician, about Patient A's additional femur fracture discovered by the radiologist.

23. On or about November 16, 2015, the Chairman of the SCVMC Pediatrics Department informed Respondent of concerns raised by orthopedic physicians about Patient A's case, the combination of known treated injuries, and the possibility of NAT, and asked that Respondent perform a chart review.

24. On or about November 17, 2015, Respondent reported, after her chart review, that it was her opinion that a report to Child Protective Services ("CPS") was warranted. Respondent discussed the case by email with her SCAN team partner and it was agreed that Respondent's SCAN team partner would file the CPS report. Respondent was told by her SCAN team partner that he would "follow up tomorrow" with the report to CPS about Patient A.

25. On or about November 17, 2015, Respondent notified the Chairman of the Pediatrics Department that her SCAN team partner would report Patient A's case to CPS.

26. On or about December 22, 2015, Respondent discovered that her SCAN team partner had not filed a CPS report on Patient A. Respondent asked the physician to enter a note in the patient's chart.

27. On or about December 24, 2015, Respondent's SCAN team partner posted a note in Patient A's chart in which he stated that "there was a low expectation of non-accidental trauma in this case." He did not mention the occult femur fracture, which had raised concerns and had prompted subsequent review of the case.

28. Neither Respondent or her SCAN team partner filed a report with Child Protective Services about suspected child abuse of Patient A.

29. On or about January 16, 2016, Patient A was found dead at home as the result of a suspected homicide with evidence of physical and sexual abuse.

30. Respondent is guilty of unprofessional conduct through gross negligence and/or repeated negligent acts, under Business and Professions Code sections 2234, subdivisions (b) and/or (c), as follows:

a. Respondent failed to make a mandatory report to the appropriate agency under California Penal Code section 11166 when she had a reasonable suspicion to suspect child abuse or neglect.

b. Respondent failed to follow-up to make sure that a CPS report was filed with regard to Patient A and/or failed to file a CPS report after she became aware that a report had not been filed by the other SCAN team physician.

c. Respondent failed to adequately document her communications and/or consultations regarding Patient A.

SECOND CAUSE FOR DISCIPLINE
(Unprofessional Conduct: Failure to Maintain Adequate and Accurate Records)

31. Respondent Melissa Kelly Egge, M.D. is subject to disciplinary action for unprofessional conduct under section 2266 for failing to maintain adequate and accurate records with regard to Patient A. Paragraphs 11 through 30 are incorporated herein by reference as if fully set forth.

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#PATIENTdeath
#FARCE—This story came to be in May of 2016 and the medical board failed to act until January 2019. 

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