Three of the Concord Hospital doctors who were named in a wrongful death suit on behalf of Molly Banzhoff have been reprimanded by the state Board of Medicine.
Emergency room doctors Ashley Fox and Elizabeth Hoffman and pediatric doctor Joseph Toshach engaged in professional misconduct and will be reprimanded and required to attend continuing education courses, according to Board of Medicine settlement agreements. They will also pay a $3,000 fine each.
The punishment follows the case of a 13-year-old patient who came into the hospital complaining of headaches and later died from a brain tumor in May 2016, the settlements say.
Molly is not specifically mentioned in the settlement agreements for each doctor, but the timeline and medical descriptions match those in a lawsuit filed by her family in January 2017. Molly’s parents settled with Concord Hospital in October 2018. Hoffman, Fox and another doctor, Dolly Courtemanche, were named as defendants in that suit.
Molly’s mother, Barb Higgins, referred comment to her lawyer Mark Abramson, who wasn’t immediately available Thursday.
For months leading up to her death in early May, Molly’s pediatricians and emergency room doctors did not perform diagnostic brain imaging, even as she repeatedly complained of severe migraines, nausea, problems with her vision and tongue numbness, which are “classic signs of a pediatric brain tumor,” according to the now-settled suit filed by Higgins and Molly’s father, Kenny Banzhoff.
Even after Molly was admitted to the emergency room on May 1, 2016, doctors at Concord Hospital did not perform an emergency CT brain scan until after Molly was unresponsive and had stopped breathing twice, the lawsuit stated. At that point, the tumor growing in her brain was so large that it caused fluid to build up and massive pressure that “destroyed all neurologic function,” according to the suit.
Days later, Molly was removed from life support at Dartmouth-Hitchcock Medical Center in Lebanon, surrounded by her family members.
“Not only did they endure a loss that no family should have to endure, they watched helplessly as Molly needlessly suffered before her death,” the suit states. “They were forced to make the difficult decision to remove Molly from life support. After doing so, they laid with Molly, listening to her heartbeat slow and eventually stop.”
When Molly arrived at Concord Hospital’s emergency room on May 1 complaining of headaches, she was diagnosed with a migraine by Hoffman, an emergency room doctor, and given pediatric doses of migraine medications, which she said improved her headache. She said she also felt sleepy after taking the medications.
A known side effect of the medications – Compazine, Benadryl, and Toradol – is sedation, and Hoffman and Toshach, a pediatric doctor called in for a consultation, agreed that the sleepiness was from the medications. Hoffman and Toshach also said the teen’s condition could be “behavioral.”
Hoffman left the hospital at the end of her shift, and a new emergency physician, Fox, took over Molly’s care. The settlement says that Fox was told of Molly’s history of migraines by Hoffman, and that the doctors’ plan was to allow Molly to rest in the emergency department and allow her medications to wear off.
After the medications wore off, Fox was instructed by Hoffman to check Molly’s condition, and if her mental status was back to baseline, discharge her with the plan to have an outpatient MRI in the next one to three days. If Molly was still sleepy, Fox was to admit her for further evaluation and monitoring.
After continued monitoring and no improvement, Molly was eventually admitted into pediatric care – 10 hours after her arrival at the hospital and six hours after Fox’s shift started. In that time, Molly had not improved.
Nursing notes made shortly after her admittance into pediatric care indicate that was Molly had dried blood in both nostrils and was non-verbal, but was able to squeeze the nurse’s hand and open her eyes when requested. Three hours later, her pupils were unequal, and she was less responsive.
At one point, Molly went into cardiac arrest, and was revived. An emergency CT scan ordered by Toshach revealed the presence of the brain tumor. Although emergency treatment to reduce the pressure in Molly’s brain was undertaken, and she was transferred to Dartmouth Hitchcock for brain surgery, she died a few days later.
As a result of their settlement agreements, Hoffman and Fox will be required to undergo eight hours of continuing medical education in the areas of history taking, and evaluation, assessment, and diagnosis of, the headache patient, and history taking and assessment of the emergency room patient. Toshach is required to undergo four hours in the area of evaluating and assessing the headache patient.
They will each pay $3,000 to the state board of education.
Molly was a beloved member of the community and friend to many. She was a student at Rundlett Middle School who often performed in school plays, and she danced at Concord Dance Academy, where she had been a student since age 3.
Hundreds of family and friends paid tribute to Molly, attending a community-wide celebration of life and Molly B: The Musical, held at the Capital Center for the Arts in Concord, which included tributes and performances. There is now a stone on the walking path outside the Capital Center named in Molly and her sister Gracie’s honor.
Fox and Hoffman continue to work at Concord Hospital, while Toshach no longer works there, hospital officials said Thursday.
However, Concord Hospital had no official statement on the discipline by the Board of Medicine, saying it does not comment on “any lawsuit, litigation or settlement.”