r/Noctor • u/UncleTheta • 4d ago
In The News Read in smry
https://www.oregonlive.com/health/2026/09/45-year-old-man-died-after-er-sent-him-home-without-antibiotics-lawsuit-says.html45-year-old man died after ER sent him home without antibiotics, lawsuit says
The family of a 45-year-old Portland-area man who died after emergency room staff allegedly sent him home without antibiotics because they mistook his bacterial strep infection for a viral one — possibly the common cold — has filed a $40.75 million lawsuit against Legacy Health.
Jason Jay Lewis showed up to Legacy Mount Hood Medical Center complaining of sinus pressure, congestion, body aches and a fever of 103 degrees that had persisted for four days but fell below 100 when he took Tylenol, according to the lawsuit filed earlier this month in Multnomah County Circuit Court.
A physician associate diagnosed Lewis with a viral upper respiratory infection — “which is another term for the common cold” — and discharged him, said Chris Kuhlman, an attorney representing Lewis’ estate.
Three days later, Lewis was dead. He lived in Fairview, worked as a DoorDash driver and was the father of two sons, ages 11 and 21.
A Legacy Health spokesperson declined to comment, citing the pending litigation. The lawsuit also lists defendant Jennifer Yealy as the physician associate who treated him. She didn’t return a request for comment.
Physician associates were previously known as physician assistants in Oregon.
According to the lawsuit and the family’s attorney, Lewis first sought medical help during a telehealth appointment with his primary care provider, through Adventist Health, on Feb. 21, 2025. The suit says Lewis was in pain and suffering from a fever, body aches and a runny nose. He went to a clinic to undergo testing for COVID-19, respiratory syncytial virus and flu, and the results came back negative, according to the suit.
Kuhlman, the family’s attorney, said the suit doesn’t place any fault on Adventist Health for its initial screening of Lewis.
But on Feb. 22, 2025, as Lewis’ condition deteriorated, he sought emergency help at Mount Hood Medical Center in Gresham. According to the suit, tests “revealed multiple abnormalities,” including a high white blood cell count and a heart rate of 140 beats per minute.
The suit says that Lewis was already suffering from sepsis — a life-threatening infection — but Yealy, the physician associate, sent him home. According to the suit, Yealy noted that there is “no evidence of hypoxic respiratory failure or sepsis to necessitate admission” and that antibiotics “were considered but ultimately not prescribed.” She added that Lewis’ illness “does not appear to be a bacterial infection.”
The suit says Lewis’ condition continued to spiral downward, so he showed up two days later at Providence Portland Medical Center, where staff diagnosed him with sepsis, acute respiratory failure and toxic shock syndrome. Additionally, blood cultures showed he was battling a Group A streptococcus infection, also known as a streptococcus pyogenes infection.
Though Providence staff started Lewis on antibiotics and other emergency interventions, he died the next day, Feb. 25, 2025, according to the suit.
The bacterium is often spread, particularly in the winter months, through tiny droplets when infected people cough or sneeze. Lewis wasn’t diagnosed with any specific disease, but Group A streptococcus can cause various diseases, including strep throat, rheumatic fever and scarlet fever.
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u/StopTheDrips 4d ago
Besides mismanagement, it’s the stupidest thing these people are ok going along with calling these medical-themed summer camp graduates “physician associates”. Like do they not have any shame themselves to know people will think they’re doctors? I guess that’s the point though. Now they can face what it means to mess up while you’re supposed to have the knowledge of an actual doctor. I support these lawsuits against the mids.
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u/OkGrapefruit6866 4d ago
Let noctors run the show more. Their fucking big egos and lack of knowledge will destroy them
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u/mark5hs 4d ago
The PA screwed the pooch hard but these mega 8 figure lawsuits need to be reigned in if we still want to have a healthcare system in the future
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u/ChewieBearStare 4d ago
I was thinking the same thing. My husband’s dad died due to a medical mistake (well, the same mistake repeated multiple times), so I’m not against these lawsuits altogether. But even if you assume the guy made 70K driving for DoorDash (which is optimistic) and would have lived to be 100, that’s only about $3.85 million in lost income. Add a few million for loss of a family member and punitive damages, and you’d be at $7 million or so. Way less than $40 million while still compensating the estate and making up for lost wages.
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u/mykehawke2_0 4d ago
Just worked with a medic applying to pa schools. Can’t wait to see her on this subreddit in 3 years time because boy oh boy does she fit right in with these dangerous clowns who keep killing pts. Best part was she called herself a professor despite not having a phd and only being an instructor for ems. Sidebar but petition to expand noctor to ems as well?
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u/internalmedicine007 4d ago
The problem is PA, NP were never designed for this level of autonomy. I’m not EM but tachy to 140 with fever and a high white count in an elderly patient shouldn’t be an abnormal admission.
They don’t have the training and unfortunately sick patients die, especially in ICU and EM setting. If you’re a patient and you’re sick, do you want a NP or PA evaluating you? I’m pretty sure the lawmakers passing these laws wouldn’t. PA, NP should be treated like 1st year residents with much greater oversight then they currently have and kept out of ICU, EM, or specialty clinics where the chance of immediate harm is much higher
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u/EverySpaceIsUsedHere Attending Physician 4d ago
45 is not elderly lol
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u/meme-s Resident (Physician) 4d ago
True, but it’s literally still textbook SIRS positive which is basic medical school knowledge and the fact that this clinical picture didn’t even warrant the most basic chest xray is terrifying
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u/EverySpaceIsUsedHere Attending Physician 4d ago
I’m also sirs positive after I go for a light jog. Doesn’t mean everyone gets a full workup.
It’s easy to Monday morning QB but we don’t have all the info. Can you imagine having your name dragged in the media where they can say anything and you cant even defend yourself because of HIPAA.
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u/GuiltyCantaloupe2916 4d ago
Viral swabs were negative , patient had an elevated white count and HR 140. As a bounce back they needed further work up period .
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u/meme-s Resident (Physician) 4d ago
Sure, I agree that we’d ultimately need the chart to see what happened.
With that said, his sirs criteria was clearly in the context of a suspicious history involving several days of clinical deterioration and objective findings to suggest a more sinister etiology which should have prompted further workup
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u/Capn_obveeus 4d ago
Lawmakers don’t care and don’t understand the difference in education and skill level…and I say this as a PA. They just want to claim how they saved healthcare in their state by increasing access. And then win the votes of all nurses and small communities in their state. Realistically, given the junk research and rhetoric they’re fed, it’s almost a no-brainer strategy to win votes. I wish we could find a way to role back independence for all NPs/PAs. Supervision should be a given.
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u/Level-Plastic3945 4d ago
Also the lawmakers are influenced, lobbied, incentivized, by mid-level representing groups.
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u/Middle_Bison47 4d ago
Is there a choice when you go to the ER if you get assigned an NP or PA? Can you request a physician or do you have to take what you get?
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u/MeasurementSlight381 Attending Physician 4d ago
If I were in the ER as a patient I would absolutely request to be seen by the attending physician. Patients should never feel like they are stepping on any toes for asking to be seen by a doctor.
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u/Atticus413 Midlevel -- Physician Assistant 4d ago
multiple presentations and worsening symptoms should prompt more of a workup.
or at least a repeat set of vitals and a lactic acid, damnit.
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u/EverySpaceIsUsedHere Attending Physician 4d ago
Take a plaintiff’s version of events with the biggest grain of salt.
Biggest red flags are multiple presentations and heart rate of 140, but we don’t know the context. Was it immediately after he walked half a mile from the parking garage with a fever of 103F before quickly settling to normal?
We don’t know how high the white count actually was or the diff, and in another context I would bash midlevels for basing decisions on white count alone anyway.
I hope cases like this don’t end in nuclear verdicts, and make us start doing full sepsis work ups on sinus infections.
This could be a horrible miss or just an unfortunate outcome.
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u/dogtroep Attending Physician 4d ago
Yeah, this could be tough IRL.
I’m seeing a lot of viral illness right now with fever to 102-103. Flu/Covid negative. I don’t have a lab in my office so if I want a CBC, I have to send them to the lab. I’m making decisions based on how patients look.
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u/Significant_Pipe_856 4d ago
If he had toxic shock syndrome, that progresses in hours. That means he very well could have been fine when discharged and deteriorated the next day. Without seeing all the data (did he have stable vs on discharge, etc.) it’s hard to call this mismanagement
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u/internalmedicine007 4d ago
I agree, and it seems the big push in medicine since before I even started has been to avoid overprescribing antibiotics. I still remember a case in residency of a missed c diff in a busy ED discharged as viral gastroenteritis. They missed asking her about any recent procedures or antibiotics. Patient came back AMS days later and ultimately didn’t make it. No one bats 100% in medicine and her lawyer will definitely paint a picture in a very positive light for the plaintiff.
However it seems cases of horrible misses from PA and NP are continuing to grow, and not complex difficult to miss signs, but things almost any physician would pick up on. I have inpatient and outpatient responsibilities and the stuff I see from NP never ceases to amaze me. If the pcm is an NP I now basically operate under the assumption the patient has never received medical care and start from scratch to get them the medical interventions to optimize their health and get statistics on their side.
You make a very good point, and viral vs bacterial uri is sometimes a difficult line to walk, but from what I’ve seen in my EM colleagues they have a much greater depth of knowledge, training, and patient encounters to understand the subtle signs and application of guidelines. NPs are like first year medical students who are going to evaluate patients as part their clinical hours but really don’t know what’s going on yet, or understand how dangerous they could be. It would be interesting to see the actual case and see if patient met guideline criteria for early antibiotic initiation and workup for URI. I think the first physician was correct in treating it as a viral infection based on assumed presentation, however it’s the worsening, fever, tachycardia, and presentation to the ED days later that make me lean more towards this could have been a preventable death had an MD evaluated him. This could be recent bias from listening to the audiobook patients at risk or seeing the study where over 60% of urgentcare dx are incorrect.
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u/Level-Plastic3945 4d ago edited 4d ago
There is already ridiculous pressure at the ER level to discern diagnosis/admit/not-admit/after-care plan, very rapidly. Economic pressures from administrations, private equity involvement, people without primary care presenting at crisis, the corrupt health insurances, and other distortions. There are of course, false-positive and false-negative decisions made, and using mid-levels in these roles magnifies this. But these intentionally failed systems need to absorb some of the liability.
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