- University of Iowa will pay $1.2 million to the family of a City High teen who died during the height of the COVID pandemic after providers misdiagnosed her with the virus and not a pulmonary embolism
- The teen was taking Gianvi, an oral birth control medication with the potential side effect of blood clots, including pulmonary embolism
- More than a half dozen doctors attributed her symptoms of shortness of breath and tightening chest to COVID-19, despite negative tests or no testing at all
- UIHC claimed immunity via the state's 'COVID-19 Response and Back-to-Business Limited Liability Act'
IOWA CITY — University of Iowa Health Care will pay $1.2 million to the parents of a 17-year-old Iowa City High School senior who died unexpectedly in July 2020 after several UIHC providers mistook her symptoms of a developing pulmonary embolism as COVID.
“The potential exposure, should a jury return a plaintiff’s verdict, would be substantial,” according to Deputy Attorney General Jeffrey C. Peterzalek’s $1.2 million suggested settlement to the State Appeal Board, which approved it unanimously Wednesday.
Given a new claim-coverage agreement between UI Health Care, its governing Board of Regents, and the Iowa Department of Justice that caps UIHC’s coverage per claim at $6 million and its coverage per year at $15 million, UI Health Care will pay the full $1.2 settlement, which Peterzalek called "very reasonable under these tragic circ*mstances.”
‘So frustrating’
Emma Nugent, heading into her senior year at City High in Iowa City, on July 6, 2020 collapsed in her bedroom at home after trying on outfits for her senior pictures — following weeks of reports to and conversations with doctors about her symptoms of shortness of breath, tightening chest, dizziness, and difficulty sleeping at night.
Although Nugent never tested positive for COVID and repeatedly reported taking Gianvi — an oral contraceptive with the potential side effect of blood clots, including pulmonary embolism — multiple doctors diagnosed her with “suspected COVID.”
“Despite that, she was not tested for COVID,” her parents reported in their November 2022 lawsuit about an April 28, 2020 visit with the fourth doctor she had seen for the same symptoms since first reporting her concerns via a UIHC telehealth visit on April 26, 2020.
In that first virtual visit, according to the lawsuit, Nugent reported she was taking Gianvi and also reported no known contact with any positive COVID cases, as well as “no cough, sore throat, runny nose, change of taste or smell, or abdominal symptoms.”
With her “suspected COVID” diagnoses, Nugent followed up the next day with a different telemedicine doctor, who “did nothing to rule out or treat pulmonary embolism.”
On April 28, Nugent saw two doctors who noted she had been experiencing “seven days of chest pain with no improvement.”
Finally seen in clinic, Nugent that day received a suspected COVID diagnosis — although she wasn’t actually tested for the virus, according to the lawsuit. On April 29, the teen saw two more telemedicine doctors, neither of whom addressed the possibility of pulmonary embolism.
Although symptoms abated, on June 21, Nugent told her mom the problems had returned and she again was seen virtually. For the first time, a nurse practitioner connected the teen’s symptoms to her use of an oral contraceptive.
Still, the nurse determined low concern for pulmonary embolism and again diagnosed her with COVID. When a COVID test came back negative the next day, the family was told to contact their doctor.
Reaching out to UIHC Pediatric Associates, Nugent’s mom — Carmen Nugent — was redirected back to the UIHC COVID clinic.
“Carmen explained that the UIHC had referred them, but they refused to see Emma,” according to the lawsuit. “This was so frustrating to both Carmen and Emma that Emma texted her best friend, ‘No one wants to see me and my mom is having to keep calling around to get me in somewhere’.”
Two days later, Nugent was seen at Pediatric Associates — where the family reported testing her again for COVID because the doctor “felt that Emma’s negative COVID test was a false negative.”
Carmen Nugent reported asking for more tests — like blood work and X-rays — which the doctor determined weren’t necessary “because even if the COVID test came back negative, (she) believed it was actually COVID or another infection that would resolve on its own.”
The COVID test did come back negative, and Nugent collapsed in her bedroom a week later. She was rushed to the hospital on July 6, 2020, where she was pronounced dead that afternoon, according to the lawsuit.
‘Preventable’
An autopsy determined Nugent died from “pulmonary thromboemboli” and that 80 percent of cases involve at least one risk factor.
“A particularly important acquired risk factor in younger female populations is the use of oral contraceptives, which studies have shown can increase the odds,” according to the lawsuit.
“Emma Nugent’s death was preventable,” the family wrote in their lawsuit. “Had University of Iowa employees timely and appropriately considered, evaluated, diagnosed and treated Emma Nugent to prevent or treat her pulmonary embolism, she would have been placed on lifesaving medication that would have saved her life.”
In sharing about their daughter in the lawsuit, Nugent’s parents said she played flute in the Wind Ensemble at City High, was a section leader in the marching band, and made varsity on the volleyball team. She also played tennis, loved art, and was active in her church’s youth group, according to the lawsuit. She had been inducted into the National Honor Society.
Her parents sued for negligence and wrongful death, specifically “giving undue weight to COVID-19 as the possible cause of Emma Nugent’s shortness of breath and chest pain, without sufficient objective supporting data and symptoms to justify that unconfirmed diagnosis.”
They also accused the providers of recklessness for “recklessly failing to consider the important increased risk factor that Gianvi posed to the possibility that Emma Nugent’s shortness of breath and chest pain could be due to pulmonary emboli.”
UI defense
In offering a defense and asking the court to dismiss the case in its favor, UI and state attorneys argued the Nugent claims are barred under a "COVID-19 Response and Back-to-Business Limited Liability Act” that provides “complete immunity to the defendant in this matter.”
That act protects health care providers from being sued related to the death or injury of someone "as a result of the health care provider’s acts or omissions while providing or arranging health care in support of the state’s response to COVID-19.“
Specifically, the legislation applied to injuries or deaths resulting from "screening, assessing, diagnosing, caring for, or treating individuals with a suspected or confirmed case of COVID-19”; prescribing, administering, or dispensing drugs to treat patients with suspected or confirmed COVID; and acts or omissions while caring for someone unrelated to COVID ”when those acts or omissions support the state’s response to COVID-19.“
The family, in response, said, “The allegations of fact related to COVID are incidental to the allegations of negligence, which would apply to any physician under any circ*mstances before, during, or after the COVID-19 pandemic.”
“The issue of whether (providers) were ‘providing or arranging health care in support of the state’s response to COVID-19’ at the time they made critical decisions that caused the death of Emma Nugent are questions of fact for the jury to decide,” according to court documents.
Additionally, according to the family, the statute is unlawfully retrospective and the Legislature did not intend to abrogate all common law claims, just common law claims related to COVID-19, or unrelated to COVID-19 but “in support” of the state’s response.
Vanessa Miller covers higher education for The Gazette.
Comments: (319) 339-3158; vanessa.miller@thegazette.com
