Volume 32 • Number 6 • June 2011
Children who travel outside
of U.S. at risk for measles
Pediatricians and the Law
by Kathryn M. Edwards, M.D., FAAP, Jane Seward,
M.B.B.S., M.P.H., FAAP, and Tiffany Bailey, M.A.
Although measles was eliminated in the United States
in 2000, it continues to be common in many developed
and developing countries. This includes Western Europe,
a common destination for U.S. travelers. Unvaccinated
U.S. travelers, especially infants and young children,
are at risk for being exposed to measles. Infected U.S.
residents returning from international travel or infected
foreign visitors to the United States put others at risk
for measles, leading to outbreaks.
Beware the harbingers
by Robert A. Mendelson, M.D., FAAP
of a possible lawsuit
Recent reports from the Centers for Disease Control
and Prevention (CDC) of measles in young children
emphasize the need for physician awareness of the risks
of measles acquired during international travel and of
the importance of early vaccination.
In January and February, seven cases of measles were
reported in 6- to 23-month-old U.S. children who
recently had traveled internationally. Four of them experienced complications so severe that they were hospitalized. Although all seven children were eligible for
vaccination before travel, none had received the measles,
mumps and rubella (MMR) vaccine.
A measles outbreak also was confirmed in Hennepin
County, Minn., and 13 epidemiologically linked measles
cases had been identified as of April 1. Most involved
young children, and eight were hospitalized. The index
patient was an unimmunized 30-month-old who developed measles after returning from Kenya. Vaccination
status was known for 11 patients; five were too young
to have been vaccinated, and six were unvaccinated.
Signs and symptoms of measles
Measles is highly contagious and is spread by contact
with an infected person through coughing and sneezing.
After an infected person leaves the area, the virus remains
contagious for up to two hours in the air and on surfaces.
In 2008, an unvaccinated child with measles infected four
other infants and children during a visit to his pediatrician
in San Diego. One of the infants required hospitalization.
Signs and symptoms of measles are characterized by
the “ 3 C’s”: cough, coryza (or runny nose) and conjunc-
tivitis and include high fever and maculopapular ery-
thematous rash. The rash appears two to five days after
One day you might receive a letter from an attor-
ney requesting a copy of a patient’s medical records.
It hits you — a lawsuit may be in your future.
See Measles, page 11
Swimmer’s ear a mild but burdensome illness
Be on the lookout for ‘incidents’
An incident is an event that suggests even the
possibility of a medical liability lawsuit. How you
handle the incident is of the utmost importance.
Your first reactions to an incident can be critical
to the outcome of a potential or actual lawsuit. You
need to know what obligations your professional
liability policy places on you. Usually, you will be
required to notify your carrier as soon as a claim is
made or suspected. Early action affords your insurance company the opportunity to begin collecting
facts and evaluating the case, which improves the
chances of a successful defense should a claim
Following are incidents that may signal a potential lawsuit:
Complication: An unexpected outcome during
Dissatisfaction: Complaints or expressions of
dissatisfaction with an outcome or quality of care
delivered. Instruct your staff to report patient complaints in a timely manner. Sometimes, reassurance
that you care about the patient and have attended
to his or her concerns may keep a misunderstanding
or complaint from escalating into a claim.
Dissatisfaction with hospital staff also should be
See Lawsuit, page 6
by Sarah Collier, M.P.H., Michael Beach, Ph.D.,
and Michael Brady, M.D., FAAP
Acute otitis externa (AOE), known as “swimmer’s
ear,” is a common problem encountered in primary care
practice, particularly in the summer months. Although
AOE generally is a mild illness, it is responsible for a
substantial burden in terms of health care dollars and
As a conservative estimate, 2. 4 million U.S. health
care visits result in a diagnosis of AOE annually ( 8.1
visits/1,000 population), affecting at least one in 123
persons each year. In 2007, one in 324 emergency
department visits and one in 481 ambulatory care clinic
visits resulted in a diagnosis of AOE. In addition, non-
hospitalized visits for AOE cost more than $489 million
in direct health care costs.
Causes, symptoms of AOE
AOE is inflammation of the outer ear canal characterized by redness, swelling, pruritus, occasional exudate
In this issue
2011 AAP National
Exhibition, Oct. 15-18,
We’ve got it all. From education sessions and registration
to travel and hotel recommendations, get connected to all
of the details of this year’s meeting. Pages 22-23
AAP president-elect candidates
share their thoughts on MOC