A Circuit Court jury will continue deliberations today on the fate of a Davidsonville doctor accused of negligence in the death from a brain hemorrhage of a 9-year-old girl four years ago.
Catherine "Katie" Gillespie died eight hours after arriving at Johns Hopkins Hospital on Nov. 2, 1987 -- the day before her 10th birthday. Just five days before, the girl was diagnosed with a blood disorder, called idiopathic thrombocytopenic purpura.
ITP is characterized by an abnormally small number of platelets, the part of the blood responsible for clotting.
Katie's parents say the specialist, Dr. Robert G. Graw Jr., failed to hospitalize the girl or take other reasonable steps that would have prevented her death.
"If inappropriately treated, the results can be fatal, primarily because of the risk of intracranial hemorrhage," court papers say.
But Graw's attorney, in closing arguments before the seven-woman, five-man jury, said the girl's bleeding wasn't severe enough on the two days he saw her to warrant hospitalization. And since a hospital wasn't necessary, Graw took appropriate action in sending the girl home and prescribing steroids.
Katie's troubles began Oct. 28, 1987, when her mother, Cynthia Gillespie Kirby, who lives in Severn, noticed that the girl's body was covered with red blotches, spreading from her mouth to her chest, legs and arms.
The complaint says Kirby took her daughter to her regular doctor, who diagnosed her condition asITP. He referred the girl to Graw, who saw her the same day. Graw agreed with the original diagnosis.
Gary I. Strausberg, the attorneyrepresenting Katie's parents, said Graw sent the girl home and prescribed prednisone, a steroid. The mother took the girl back to Graw two days later when her condition did not improve.
The complaint says the girl was sent home again. Two days later, Katie had a severe headache. The next morning, Katie was unresponsive and Kirby called 911. The girl was flown to Johns Hopkins Hospital, where she died.
Katie's parents, who are divorced, say Graw was negligent because he failed to hospitalize Katie and advise them to watch for signs of a headache, which suggests the onset of a hemorrhage.
During his closing arguments, Strausberg said Graw knew the girl was suffering from a large amount of bleeding because the day after he first saw her, he wrote a letter to another doctor saying he saw "severe bleeding."
But Strausberg said Graw, on the witness stand, tried to mitigate thatby suggesting he really meant to write "old blood" and that he did not thoroughly proofread the dictated letter.
"He is not a country doctor or a family doctor who didn't knowwhat to do," Strausberg said. "He's a specialist who should have known what to do. . . . It is always sad to hear about the loss of a child. What makes this even moretragic is that this death could have been avoided."
Both lawyers agreed that in cases where children with ITP are bleeding severely, they must be hospitalized. But in cases where the bleeding is minimal,the attorneys agreed there is debate on treatment among the nation's500 pediatric hematologists.
But Graw's attorney, Roy B. Cowdrey Jr., said the girl was not bleeding when Graw saw her, making the doctor's treatment reasonable. He also said the doctor warned the motheron her firstvisit about the headaches.
"You have been looking at one case backward for a week, and that is not how life works," Cowdrey told the jurors. "There was an array of acceptable choices. I am asking you to give a second opinion in this case."
Judge Warren B. Duckett Jr. told the jurors that they must base their decision on whata reasonable and competent doctor in a similar practice would have done in a similar situation.
An arbitration panel, made up of a lawyer, a doctor and a lay person, already has cleared Graw in the case.The parents, who are each asking for between $400,000 and $500,000, are appealing that decision in Circuit Court.