David Bradley White v. HHS - DPT, drowning with aspiration of gastric content secondary to seizure disorder (1993)

David Bradley White's mother, petitioner Abbott, filed a petition on March 9, 1990, seeking compensation from the Vaccine Injury Compensation Program following her son's death. David received a series of diphtheria-pertussis-tetanus (DPT) vaccinations beginning on October 7, 1964, at approximately two months of age.

He developed a residual seizure disorder, which is a Table injury under the DPT vaccine, and sustained neurological damage of such severity that he required lifelong placement in a group home for developmentally disabled adults. On the evening of September 5, 1987, when David was approximately twenty-three years old, a staff member of the group home assisted him in his bath and then briefly left him unattended.

During that interval, David experienced a seizure and drowned. His death certificate recorded the immediate cause of death as "drowning with aspiration," attributing it to or as a consequence of his seizure disorder.

The autopsy report similarly listed the cause of death as "drowning with aspiration of gastric content secondary to seizure disorder." The special master found that David died "from the consequences of the presumptively vaccine-related residual seizure disorder he sustained after his October 7, 1964 DPT vaccination" and authorized an award of $250,000, the statutory death payment under the Vaccine Act. Respondent appealed.

The Court of Federal Claims, in an opinion by Judge Wiese issued on March 9, 1993, reversed the special master and ordered the petition dismissed. The sole question on appeal was whether David's death constituted an "acute complication or sequela" of his Table injury, the standard required by 42 U.S.C. § 300aa-14 for compensating a death arising from a vaccine-related injury.

Drawing on standard medical dictionaries, the court defined "complication" as a morbid process occurring during a disease that may result from it or from independent causes, and "sequela" as a condition following as a consequence of a disease. Both terms, the court held, refer to somatic or pathological conditions—events recognizable as the pathological sequence or result of an existing disease, not accidents externally precipitated by that disease.

David's death was not caused by pathological forces set in motion by his seizure disorder. It was caused by suffocation from an external force—water filling his lungs.

His drowning was an accident precipitated by his disorder, but not a medical consequence of it. The court noted that the contemporaneously proposed HHS regulatory definition of "sequela," requiring cause-in-fact proof of a logical sequence of cause and effect, supported the same interpretation.

Petitioner's counsel argued on appeal that the record did not resolve whether David drowned from aspiration of water or aspiration of vomitus, and sought a remand. The court rejected this argument, finding that the autopsy report's language ("drowning with aspiration of gastric content") and David's mother's own affidavit (attributing death to "drowning in a bathtub due to a seizure") were inconsistent with the theory that the death was caused by aspiration of vomitus rather than water.

The public decision does not name petitioner's counsel, respondent's counsel, or the Special Master by name.