A $275,500 award against a Highlandtown pediatrician, who failed to order a lead-poisoning test for an 18-month-old boy later found to have toxic levels in his blood, could spur doctors nationwide to do more screening, specialists said.
"If I were a pediatrician, it'd get my attention," said Don Ryan, executive director of the Washington-based Alliance to End Childhood Lead Poisoning.
He and others said the award this week may be the first of its kind in the United States.
Despite new federal guidelines recommending that almost all children be screened, Mr. Ryan said, many doctors think the problem is limited to ghetto youth. Only about 1 in 10 children across the United States is now tested. In Maryland, that figure is 1 in 5.
Dr. Melvin S. Stern, legislative chairman for the group representing Maryland's pediatricians, said the ruling "is unquestionably" going to increase testing for the metal, which can blunt intelligence, slow growth and damage hearing.
The Baltimore youth has suffered permanent brain damage, his lawyer said.
But Dr. Stern said blanket screening of children might strain limited resources. And lead-poisoning awards also could make the cost of medical care and housing more expensive. "Is it going to change behavior beneficially? I'm not sure," he said.
A three-member panel convened by the Maryland Health Claims Arbitration Office issued its decision Wednesday night, after eight days of hearings.
The panel -- composed of a doctor, a lawyer and a layman -- ordered Dr. W. Duncan McCleary to pay Bruce Foehrkolb Jr., now 7, $250,500 for his medical and rehabilitation costs and suffering. Panel members also awarded his mother, Judy Shell, $25,000 for her suffering.
Both sides said the case would be appealed to Baltimore Circuit Court, the next step in major malpractice cases.
Kathleen Howard Meredith, Dr. McCleary's lawyer, said he "did everything he should have done in the case of this child."
Edward C. Bacon, the attorney for Ms. Shell and Bruce, said the award would not repay his clients, who now live in the city's Hamilton neighborhood, for their losses. "We don't think the finding of the arbitration panel adequately reflected the evidence the lead poisoning would have on this child's life," he said.
The dispute focuses on a series of examinations Dr. McCleary conducted during the spring of 1986 -- the last just three months before the child was hospitalized at Johns Hopkins University's Kennedy Krieger Institute with severe lead poisoning.
Ms. Meredith said Dr. McCleary, who treated Bruce for earaches, had no reason to suspect the child was at risk for lead poisoning.
She also said the doctor's expert witnesses found no sign of lead-related illness.
Mr. Bacon, whose office is in Landover, said the doctor essentially failed to ask the right questions.
If he had, Mr. Bacon said, he would have learned that the child put dirt and other objects in his mouth and lived in an old house with peeling paint.
Lead-based paint is a major source of contamination among children.
The child has difficulty reading and spelling, he said, and suffers from an attention deficit disorder.
Both sides agree that Dr. McCleary wrote "needs blood lead," referring to the screening procedure, in the child's medical file after an April 1986 visit.
Ms. Meredith said Dr. McCleary, for medical reasons, had wanted to postpone the test until the child recovered from a series of ear infections he suffered that spring.