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Nurse disputes events in death at Children's

Thirteen-month-old Taylor McCormack waited all night at Children's Hospital with excess fluid building up in her brain partly because no operating room was available for surgery that might have saved her life, medical residents directing her care told investigators in 2001.

Now, nearly three years after the child's death, an operating room nurse who was on duty that weekend night at Children's Hospital has said that an operating room was available. If a senior neurosurgeon had come to the hospital, he could have performed surgery to relieve the swelling in Taylor's brain, according to the nurse's deposition in the McCormack family's lawsuit against the child's doctors. A copy of the deposition was provided this week to the Globe.

But the residents never reached the neurosurgeon responsible for Taylor that night, Dr. Craig van Horne, nor did they call in an alternate surgeon. And van Horne's supporters now say the residents didn't try very hard to find him.

Van Horne's lawyer and another person who knows him personally, interviewed by the Globe, said he was home all night, but that the residents never called him at home or on his cellphone. The residents tried only his pager, which van Horne has told investigators he did not hear because he muted it while grocery shopping and never turned it back on.

The new documents in the McCormack case suggest a chain of miscommunications and finger-pointing that some observers say is similar to the problems revealed in the death in May of a patient with epilepsy during seizure monitoring at the world-renowned hospital.

The death of the 5-year-old with epilepsy has triggered a federal review of the hospital's eligibility for Medicare and Medicaid funding after investigators found that numerous doctors and nurses failed to intervene to stop the boy's severe seizure even though they were concerned that the treatment wasn't aggressive enough. Most of the medical personnel failed to call their supervisors to raise questions.

Children's has vowed to make changes to address the problems. But John McCormack, Taylor's father, says the latest case shows the hospital's leaders did not do enough after public health officials said systemic problems with communication and monitoring at the hospital contributed to her death. Subsequently, the hospital also found that communications problems may have contributed to two more deaths at the hospital in August 2002.

"It's just like in my case," McCormack said yesterday. "They promised the public changes after my daughter's case. Even after [the two August 2002 deaths], they were in the middle of changing policies, but it was too late."

Department of Public Health officials say the Taylor McCormack case differs from the recent incidents. They ruled that van Horne and the residents all agreed that McCormack was stable enough to wait overnight, a medical judgment that in hindsight may have been wrong. And they said the communication problem was that a senior doctor was unreachable, not that he wasn't called. On the other hand, the state medical board issued the residents a "letter of concern" for not trying to reach another attending doctor -- as well as giving van Horne a harsher warning for not answering the page. Rosemary Gibson, author of "Wall of Silence," a book on medical mistakes, said that the two deaths illustrate problems that arise when junior doctors are not in close enough contact with supervisors -- whether it is because they are afraid to speak up when they doubt a plan of care, or because they are overconfident and don't think they need advice.

After the McCormack case, Children's Hospital canceled its practice of having Brigham and Women's surgeons take responsibility for their patients on some nights to improve oversight of residents. Van Horne and Dr. Adel Malek, the senior resident, were Brigham doctors, specializing in adult, not pediatric, neurosurgery.

But at issue in the McCormack case -- which is pending in Suffolk County Superior Court -- is not just whether or not the residents could reach a senior surgeon. To John McCormack, the key is that resident Dr. Tien Nguyen told Taylor's mother that night that there was no operating room available for Taylor until the next morning.

Nguyen wrote the same thing to the state medical board: "I was informed that the first available time for surgery was 8 a.m."

But in her deposition, operating room nurse Bertha Terlecki says that at around 11 p.m., when Nguyen first contacted her to ask for an operating room, she gave him two choices.

She said she told Nguyen he could either have a definitely scheduled room at 8 a.m., or put Taylor on the equivalent of an airline standby list -- the girl could go in for surgery during the next gap in scheduled cases, probably around 3 or 4 a.m.

When Nguyen agreed to take the 8 a.m. time, Terlecki said in the pretrial discovery, she "told him to call his attending [van Horne], make sure that was fine with him and call me back." Terlecki said didn't hear from Nguyen, but she beeped him again later, after midnight. An anesthesiologist and a standby team of nurses would be available after their last case of the night, which ended at 1:19 a.m. Before letting them go home, she wanted to make sure he was comfortable with the 8 a.m. time.

But Nguyen said he would stick with the later time. Malek, the resident above him in the hierarchy, has said he agreed with that decision. They never consulted with van Horne or another senior physician. Around 6 a.m., Taylor stopped breathing. She never woke up.

McCormack believes they put off the surgery either because van Horne could not be reached or because they didn't want to bother another senior doctor.

"If [Nguyen] was forthright with me and my wife that night, saying there's nobody available, how many hospitals are around there? I would have brought her to one of them, maybe she would be alive today," said McCormack.

Nguyen's lawyer, William J. Dailey Jr., said his client believed Taylor was medically stable enough to wait, adding that he has "great sympathy" for the McCormacks.

In another case of dueling accounts, attorney George Jabour -- whose use of private eyes and phone records reflects his experience as a Quincy special prosecutor and filer of police brutality lawsuits -- has also challenged van Horne's version of events.

He argues in court that phone records suggest van Horne was not at home that night.

"He was at home, it's as clear as day," responds van Horne's attorney, Douglas Morgan. He noted in a statement that public health officials found "Taylor McCormack's surgery was not delayed by the unavailability of Dr. van Horne."

The other person who knows van Horne said he is talented, cares about his patients, and empathizes with the McCormacks, adding "This is something he lives with every day." Offering an explanation of a longstanding mystery in the case, this person revealed what van Horne says is the reason he muted his pager in the grocery store: In Brookline, where he lives, so many doctors are shopping that etiquette demands they keep their pagers quiet in the vegetable aisles.

Anne Barnard can be reached at abarnard@globe.com.

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