Longform

Missed Diagnosis

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Schmitt's report on June 19 noted that Greg was showing a "failure to thrive." The baby's placement on the growth chart--by now he was in the third percentile--"seems to be due to poor appetite and inadequate intake," Schmitt wrote. Children's Hospital also found that Greg had suffered "developmental delays with central hypotonia," or muscle weakness.

On June 23 Randel phoned the Boulder psychologist who had contacted her a few days earlier. "I am very concerned about the fact that you question a mom's worry without clinically checking out her baby," Randel recalls telling her. "I am very angry now! Do you want to help me with this new feeling?"

Today a smiling, tow-headed two-and-half-year-old, Greg still walks a bit wobbly and must take all of his nutrition through a tube inserted in his stomach, since he cannot yet eat solid foods. In and out of hospitals since his first operation, Greg now undergoes physical, occupational, feeding and speech therapy four days a week. His family sees him gaining strength and hopes his physical developmental delays will soon vanish.

At the famed Mayo Clinic in Minnesota, a pediatric neurologist noted that Greg's problems were caused "if not completely, in part by the malnutrition caused by the GI [gastrointestinal] problem he has suffered since birth." Still, it's not absolutely certain that Greg's continuing inability to eat normally and other medical problems could have been avoided by earlier intervention by his pediatrician.

The Randels spent months convincing their insurance company to cover Greg's testing, treatment and therapy costs dating back to the start of his medical troubles. In August 1997, at the suggestion of a physician friend, the Randels filed a complaint with the Colorado Board of Medical Examiners, the government-appointed body that both licenses and disciplines physicians.

By December 1997, an inquiry panel for the board took the uncommon step of forwarding Greg's case to staff members for a formal investigation. Ten months later, the investigation results were sent to the Colorado attorney general's office "for the commencement of formal proceedings against Dr. Fries' license to practice medicine," according to a letter the Randels received from the board.

But in April--a full twenty months after they sent their original letter--the Randels learned that the complaint against Fries had been dismissed. "Dr. Fries has obtained three pediatric experts who are willing to testify on his behalf that his care of your son was not substandard," the board wrote. "In light of the fact that numerous physicians with impressive qualifications were willing to testify in this regard," the board's attorney decided to ask another "well-respected pediatrician" and previous boardmember to look into the matter. That doctor did not feel she could "testify under oath that it was substandard...The panel felt it did not have the necessary legal basis to go forward in prosecution of this case."

The letter also noted that "the Panel still has very strong and serious concerns regarding Dr. Fries' care and treatment of your son which have been directly communicated to him." However, as in all cases, it was the panel--not the attorney general's office--that made the final decision to dismiss the Randels' complaint.

Bound by the rules of physician/patient confidentiality, Fries cannot comment on the specifics of Greg Randel's case. But he reiterates that four pediatricians--including Dr. Schmitt--responded to the medical board's query on his behalf, stating that Fries's "care was appropriate and did not deviate from the standard of care," he says.

It's not uncommon for anxious parents to worry that their child is too thin or not growing fast enough, Fries explains; the physician must take into consideration both the child's weight and height to determine if they're proportionate. Some children--and adults--are simply destined to be smaller than others.

But the anger that Sharon Randel told the Boulder County psychologist about has not subsided. Although she had trusted him with her children's health for a dozen years, Fries "was clearly not listening to a mother," she says. "What concerns me was that I went to a pediatrician as a baby's caregiver. I go in with these observations and they're repeatedly dismissed. Greg was clearly going downhill and not a single test was done. Is this the type of care we want for our children?

"This is the most critical time in a baby's life," she adds. "Our child paid a very big price in his infancy."

Until now, only neighbors and close friends have known what the Randels went through. "It was traumatic for the family. You didn't know what condition you're going to find the baby in in the morning," says Randel, whose older children are now seven and fourteen. Randel has not resumed her job as a residential designer because of her son's medical needs. And although they are now seeing a new local pediatrician for routine health care, the Randels often consult out-of-state specialists for Greg because their confidence in Colorado doctors has plummeted.

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Gayle Worland