By Karenlyn Barone
When he took the stand on Monday to testify on his own behalf, Dr. Clifford Butterman stood by his diagnosis that the girl suffered from the flu when she was brought to his East Rockaway office, despite a barrage of questions from the prosecution's attorney.
Agoado, of Lynbrook, went into cardiac arrest on Dec. 31, 1999, as a result of complications of bacterial pneumonia. More specifically, she died of pericardial effusion, or infectious fluid surrounding the heart, which compromises its ability to pump properly. In the suit against Butterman and Winthrop University Hospital, whose trial began last month, the family is seeking unspecified damages.
In his testimony, Butterman, who now has a practice in Oceanside, appeared nervous and ill-at-ease at times, and more than once the judge urged him to relax -- something Butterman seemed to have difficulty doing.
The prosecution's attorney, Peter Assail, of Alpert and Kaufman of Manhattan, relentlessly fired questions at the doctor, at times not pausing long enough for Butterman's complete reply.
During questioning, Butterman said that he first saw Agoado on Dec. 20, when she complained of vomiting, loose stools, aches and chills. She also had a cough and a runny and stuffy nose. At that visit, Butterman concluded that she had the flu and advised her mother, Lisa, to give her plenty of fluids and Motrin for fever. During Butterman's physical examination of Alyssa, he recorded that she had a slight fever of 99.7.
When Assail suggested that her symptoms were indicative of bacterial pneumonia, Butterman contended that his diagnosis of the flu was accurate at the time. He did concede, however, that he considered a diagnosis of bacterial pneumonia, but his notes did not reflect that.
Butterman saw Alyssa again on Dec. 24, when her maternal grandfather, Michael Molinari of East Rockaway, carried her into the pediatrician's office because she was too weak to walk. At that visit, Butterman examined Alyssa, who was now reportedly more feverish, nauseous, had bouts of vomiting, the same persistent cough and had not eaten any solid foods. Her fever was 101.5.
"Could vomiting be consistent with bacterial pneumonia?" Assail asked Butterman.
After some deflection, Butterman finally agreed.
"Is nausea consistent with bacterial pneumonia?" asked Assail
"Yes," replied Butterman.
"Is not eating consistent with bacterial pneumonia?" asked the prosecution.
"Yes," said Butterman.
"Is a temperature of 101.5 consistent with bacterial pneumonia?" asked Assail.
"Yes," conceded the pediatrician.
But Butterman stood by his diagnosis of uncomplicated flu, and said that the patient's symptoms were most consistent with that diagnosis. It was revealed in court that while Alyssa was under the pediatrician's care, he ordered neither a blood workup nor a chest X-ray for her.
The last communication between the doctor and the patient's family was a phone call Christmas night at about 11:30 p.m. Alyssa's grandfather was concerned about her inability to keep anything in her stomach. During that conversation, Butterman suggested giving Alyssa a tablespoon of Gatorade, ginger ale or Coca-Cola. When her condition did not improve by the following day, her family took her to Mercy Medical Center's Rockville Centre Emergency Room. Once examined, she was found to have bacterial pneumonia.
"When I saw her on Dec. 24, her lungs were clear and there was no respiratory distress," Butterman told the court. "It is my contention that Alyssa developed pneumonia on Dec. 26, sometime Sunday morning."
The doctors at Mercy Medical Center felt they were not equipped to care for Alyssa, and they transferred her to Winthrop University Medical Center in Mineola that same evening.
The prosecution contends that the proper diagnosis was given at Winthrop, but that the proper workup was not done.
On Tuesday morning, Alyssa's grandfather, Molinari, took the stand and spoke eloquently of his granddaughter and his love for her. He recounted the days of Alyssa's illness through tears, and spoke of the helplessness he felt and still feels today, four years since her death. Most who were present in the courtroom had difficulty hiding their own tears.
Alyssa's father, David, testified on Tuesday afternoon, focusing on the events of the day his daughter died. He spoke of his short-lived confidence in the attending pediatrician at Winthrop University, Dr. Laura Nemeroff, when she told him his daughter would be fine. It seemed only hours later that his wife called him from the hospital, telling him Alyssa had taken a turn for the worse.
As David returned to his seat next to his family, he was visibly shaken. "I've cried for so long, I have no tears left," he said.
