The Case of Legge vs. Lees: Tylenol Toxicity, Impaired Metabolizers, Respiratory Depression, & the Death of Two Three-Year-Old Twins
Tonsillectomies have often been considered routine childhood surgeries; they are in fact, one of the most commonly performed surgical procedures for children in the United States today. When such surgery is recommended for children, generally it is for two primary reasons:
- Sleep Apnea – tonsils or adenoids become enlarged, creating difficulty breathing while asleep;
- Chronic Infection of the tonsils.
In most cases, a tonsillectomy is done as an outpatient procedure, meaning the patient is able to return home the day of surgery. However, if complications arise during the course of surgery, it is generally recommended that the patient remain at the hospital. The cut-off for this option in young children is generally three years and younger, as studies have seemed to suggest that complications are more apt to occur to those under the age of three.
In the case of Legge vs. Lees, (despite hospital/insurance policy regarding the age cut-off for inpatient/outpatient procedure following a following a “routine” adenotonsillectomy, which is the removal of both adenoids and tonsils), the mother of three-year-old twin boys requested that her sons be kept overnight. Routine or not, she was feeling particularly anxious at the thought of having such young children at home directly following surgery. However, the insurance company refused to authorize an overnight stay and the surgeon was adamant that it was neither possible nor necessary for them to do so, even when she offered to pay for it herself.
The twins were discharged and sent home, and through the course of monitoring the twins during the evening, she discovered one child to be unresponsive, limp and pale. She called 911, and they were transported to the hospital. Unfortunately, by the time they arrived, the child had passed away. Within hours, the second son experienced similar symptoms, was also rushed to a hospital and died a few days later. The family, reeling from shock and tragedy, then attempted to find answers. The answers were ultimately found, but only after they found someone as committed to obtaining the truth as they were-Attorney Gerry Leeseberg.
The truth lying at the heart of the tragedy would open up new understanding regarding how differently people metabolize drugs; it would also cast a greater light on the field of genetic mutations/variations while simultaneously casting doubt on what is deemed an appropriate “standard of care” in very young children. Sadly, it would also affirm the truth of what every mother or every parent knows about their child-follow your instincts and don’t let anybody talk you out of them. In the words of Ralph Waldo Emerson, “Trust instinct to the end, even though you can give no reason…”
Ultimately it was determined that the boys suffered from a well-known complication following airway surgeries-respiratory depression due to swelling and physiological collapse of the soft tissues shortly after surgery. Had they been kept overnight-as the mother wanted but the insurance company refused to authorize-“Pulse Oximetry Monitoring” would have detected the respiratory depression (regardless of the cause) and allowed nursing personnel to resuscitate the boys.
In Gerry’s words, “This was one of the most fascinating, difficult, complex, and tragic cases I have ever worked on. After the verdict, I actually worked with the defense expert to modify his manuscript to accurately describe what happened to these boys, in order to help educate the medical profession. At the same time, we basically forced the defense experts to acknowledge that their opinions as to the pediatric otolaryngology “standard of care” was in reality dictated by the insurance industry’s refusal to authorize payment for in-patient surgeries on children three years and over, despite the fact that the risk of airway collapse was only reduced a miniscule amount before and after a child’s third birth date. However, insurance companies remain impervious to this problem. They simply refuse to reimburse for in-patient charges, placing the onus on surgeons to advise patients of the risk, and forcing patients’ families to cover the costs out of pocket, and exposing surgeons to risk if procedure is done as an outpatient and patient dies. Just another example of how the insurance industry, and not malpractice attorneys, is the real threat to physicians.”