A 3-year-old in SE Minn. died. Who should be held responsible for his death?
The parents point to the hospital; the medical center says the father was negligent
ROCHESTER — Andreja Pavlovic woke up on Valentine's Day in 2022 to find her son, 3-year-old D-Angelo Pavlovic Pitchford, lying on the floor of her bedroom, curled up in the fetal position. He was stiff to the touch. He had died in the night.
The night before, the boy's father, Darius Dwayne Pitchford, 34, brought the child to Olmsted Medical Center's Emergency Department around 11 p.m. for recurring medical problems that presented as nausea and vomiting.
It wasn't Pitchford's first trip to the ER with D-Angelo, and after another diagnosis that he felt would not benefit his son, Pitchford would decline medical care, disregard warnings from hospital staff, and bring D-Angelo home.
Now, the court system will determine who, if anyone, holds responsibility for D-Angelo's death.
From family accounts, D-Angelo loved being a big brother to his younger sister and could be found playing with his best friend, the family cat, or his favorite toys, which included Chase and Marshall from the children's TV show "Paw Patrol," according to an obituary posted shortly after his death .
"He came into this world with his eyes wide open ready to explore this life, learning so many things before being taught. He was much smarter than his years. As his angel came down and held his hand guiding him onto his next journey, we are left with a hole not only in our hearts but a space in our family that could never be filled. He will be missed deeply," the obituary reads in part.
Pavlovic filed a lawsuit against Olmsted Medical Center and the doctor who treated her son, Dr. Luke Hunter, a little more than a month after D-Angelo's death. The lawsuit claims the hospital and Hunter had an obligation to report Pitchford to police for failing to heed doctor's warnings that D-Angelo could die.
The lawsuit is currently taken under advisement by a district judge, who is deciding if Pavlovic's case can move forward.
The Olmsted County Attorney's Office charged Pitchford with felony neglect of a child related to his son's death a month after Pavlovic filed her lawsuit. Pitchford is expected to appear March 28, 2023, for his next hearing.
"I miss my baby boy so much not a day goes by where I don’t think of you speak of you cry for you I would give anything just to have you back I will always miss and love you more then life it self til we meet again may you rest in paradise see you on the other side son," Pitchford commented on his son's obituary.
Pavlovic is suing the medical center and the doctor who treated her son for failing to intervene and help save her son's life. Pitchford's criminal charge alleges something similar, though the state has placed the blame squarely on his shoulders.
In motions to dismiss the lawsuit against the hospital, attorneys for Hunter and OMC don't argue the facts regarding the timeline of events during D-Angelo's visit to OMC. Instead, they deny Pavlovic's claim that the doctor or the center were required to report suspected abuse or neglect to law enforcement in this case.
The Minnesota statutes Pavlovic cites in her lawsuit mention possible criminal, but not civil, liabilities for failures to report. Pavlovic argues that common law, or laws based on court decisions as opposed to codes or laws, gives her the right to seek relief due to the hospital's failure to report. Hunter and OMC dispute that claim, as well.
Pavlovic, Pitchford and lawyers for the Olmsted Medical Center, Mark Solheim and Kevin McCarthy, did not respond to multiple requests for comment for this story. Pavlovic's lawyer, Elham Haddon, declined to comment for this story.
Valentine's Day 2022
There were several moments over the course of D-Angelo's final days in which somebody could have intervened and saved his life. The sequence of events so far is largely undisputed by the parties in the two cases, and come clear in the Post Bulletin's examination of the court documents.
This is what happened:
D-Angelo had a history of medical issues that presented as nausea and vomiting. His parents brought him to OMC several times over the course of his short life.
Around 2:30 a.m. on Feb. 13, 2022, Pitchford said he heard feet tramping upstairs in their northwest Rochester home. He found D-Angelo in a fetal position grabbing his stomach.
"Oww, my tummy," D-Angelo said to his father.
For the next three hours, until 5:30 a.m., D-Angelo remained awake. He had some water but spit it up. Around 11 a.m., Pavlovic would leave for work and D-Angelo threw up again.
When Pitchford left for work around 4 p.m. that day, he noted that D-Angelo was sitting with his head rolling around. His dehydrated, purplish lips were trembling.
Pitchford came home from work that night around 10 p.m. to find Pavlovic cleaning up D-Angelo's vomit. Pavlovic called a nurses' line earlier that day and was told that D-Angelo should be taken to the emergency room.
Pitchford filled a syringe with the vomit and took D-Angelo to the hospital. Pavlovic was usually the one who took D-Angelo in, but Pitchford said he wanted some answers regarding his son's continued medical problems.
At OMC, Hunter examined D-Angelo and noted, in written notes described in the civil complaint, that he was "in acute distress," and "appeared lethargic, pale and ill appearing," with "abdominal tenderness."
During their time at the medical center, Pitchford would refuse further testing for D-Angelo beyond a blood draw.
The blood work showed abnormalities that signaled possible kidney failure and dehydration. Hunter urged Pitchford to agree to further testing, but Pitchford refused.
Pitchford said he was being lied to and that D-Angelo was not dehydrated.
Hunter wanted to do further interventions on D-Angelo, including IV fluids, an EKG, abdominal imaging and a urine analysis. He told Pitchford that it was his right to leave, but such a decision could result in catastrophe — a permanent medical condition or even death for D-Angelo.
At some point during the visit, Pavlovic talked to medical personnel through Pitchford's phone, and was told that X-rays had been ordered for D-Angelo.
At 2:26 a.m. on Feb. 14, 2022, roughly two hours after they arrived, Pitchford signed a release form acknowledging he was taking his son home against medical advice.
Pitchford told a nurse at the medical center that if there was an issue, he was going to take D-Angelo to a different hospital or the boy's mother would bring him back because, "I am not going to come sit back here and deal with this nonsense."
No X-rays or further interventions were performed on D-Angelo.
Discharge paperwork notes: "Return to the ER as soon as possible. Your child may die."
The pair returned home around 2:30 a.m. D-Angelo took off his coat and asked for a cup of water, taking a few sips. When Pitchford asked D-Angelo if he was OK, D-Angelo's eyes started to roll.
He began to moan, and Pitchford brought his son upstairs to Pavlovic. D-Angelo then lay on the hallway floor and vomited up "brown stuff." The parents gave him some nausea medication, but he threw that up, too. Pitchford went downstairs after handing off his son to Pavlovic.
D-Angelo fell asleep in his parents' upstairs bedroom that night, his head lying on his mother's arm.
At about 5:18 a.m., Pitchford heard D-Angelo rolling around on the floor crying for his mother.
About an hour later, Pavlovic woke up to the sound of her phone ringing and noticed D-Angelo wasn't in bed. A moment later, Pitchford heard Pavlovic screaming that D-Angelo was dead.
An investigator with RPD would find a vomit-soaked pillow on the floor of the bedroom, along with a white T-shirt, also covered in brown vomit.
"My poor baby was only 3 years old. Not to mention I spoke to Dr. Hunter and thanked him because he was going to help my son," Pavlovic wrote on a Google Maps review for Hunter . "They failed to treat my son accordingly after even bringing a sample of the coffee ground vomit he had that night."
What did D-Angelo die of?
An autopsy showed that D-Angelo died due to complications of a paraduodenal hernia. The hernia would have been seen on a X-ray and would have required immediate surgery, Hunter told law enforcement.
"Paraduodenal hernias are rare types of hernias which result from incomplete rotation of the midgut. They may cause acute abdominal pain, chronic digestive disorders, and nonspecific or mild symptoms such as nausea and vomiting," according to a medical research paper by Karim Ibn Majdoub Hassani et. al. published in the National Library of medicine .
Timely surgical intervention helps minimize the chances of death or complications related to the hernia, according to the paper.
Why is Pitchford charged?
Being responsible for a child's death is one of the most serious accusations in our society, so why is Pitchford charged with neglect as opposed to manslaughter or murder?
"In a case like this we are very conscientious about the nature of the charges selected," Olmsted County Attorney Mark Ostrem wrote in an email to the Post Bulletin. "Here, the allegation is that the level of neglect was 'willful' and resulted in the death of the child, essentially leaving the hospital against medical advice with clear warning of the significant dire condition and need for additional examinations."
In order to file more significant charges, his office would need to prove that Pitchford acted with the intention of causing D-Angelo's death, he wrote.
"Proof beyond a reasonable doubt is a high burden and at the current stage of the investigation, 'willful neglect' better fits the evidence we believe we can prove beyond a reasonable doubt," Ostrem wrote.
A toddler died due to a potentially treatable condition; now the courts are left to decide who, if anyone, is responsible.
What is a paraduodenal hernia?
According to an article published in the American Journal of Gastroenterology, here are the key elements of paraduodenal hernias:
- The condition is rare and congenital, meaning it presents from birth.
- The condition presents a wide array of symptoms, which can make it difficult to diagnose.
- Delayed diagnosis is common due to chronic symptoms.
- Doctors being aware of the condition and having the ability to identify it prior to testing.
- Reliable medical imaging and prompt surgical intervention are key to successful treatment.
A timeline of D-Angelo's last days