Justin Travis Lankford v. HHS - DPT, encephalopathy (1996)

Justin Travis Lankford, an infant, received his first diphtheria-pertussis-tetanus (DPT) vaccination on February 24, 1987. His parents filed a claim under the National Vaccine Injury Compensation Program, alleging that the DPT vaccine caused an encephalopathy that led to his death less than twenty-four hours later.

According to the parents' testimony, Justin cried briefly during the injection. In the hours that followed, he developed a fever of 101.5 degrees Fahrenheit, ate less, slept more than usual, drifted between sleep and wakefulness, and was difficult to arouse.

They also described him as pale, dull-eyed, tired, and lacking his usual vigor. His mother called the pediatrician's office, mentioning his condition but primarily concerned about swelling at the injection site.

She was advised that the symptoms were not unusual and that he could accompany her on errands as long as his temperature did not exceed 103 degrees Fahrenheit. Justin accompanied his mother on errands and later had dinner with both parents.

He remained subdued and unresponsive throughout the evening. He was placed in his crib around 1:00 a.m. and was last checked about an hour later, found asleep in the same position.

He was discovered dead in his crib around 6:00 a.m. The emergency center record noted the DPT vaccination, described him as "O.K." at 2:00 a.m., and listed the cause of death as unknown, recorded as sudden infant death syndrome (SIDS).

Petitioners presented Dr. Marcel Kinsbourne, a pediatric neurologist, who testified that Justin's symptoms, including increased sleep, inactivity, unresponsiveness, limp body tone, and loss of color, suggested a lowered level of consciousness consistent with encephalopathy.

Dr. Kinsbourne reasoned that post-DPT drowsiness is usually associated with extensive crying and fatigue; because Justin cried only briefly, he viewed the drowsiness as more consistent with neurologic injury.

He concluded that Justin's death was more likely than not a complication or sequela of DPT-caused encephalopathy. Respondent's expert, Dr.

John Malmstrom, a child neurologist, agreed that Justin's symptoms were related to the DPT vaccination but described them as common systemic vaccine reactions rather than evidence of encephalopathy. He testified that drowsiness occurred in about 58 percent of DPT reactions and diminished appetite in about 31 percent, while unusual crying occurred far less often, undermining Dr.

Kinsbourne's premise that drowsiness without prolonged crying was medically distinctive. The special master denied compensation on July 24, 1996, finding Dr.

Malmstrom's opinion more persuasive. The special master held that, even accepting the parents' testimony at face value, the evidence did not establish a reduced level of consciousness sufficient to prove encephalopathy.

Petitioners sought review, arguing that the special master's choice between experts was arbitrary and that the occurrence of death made it illogical to treat Justin's preceding symptoms as ordinary. Judge Robert J.

Wiese affirmed the denial on December 3, 1996. The court held that the Vaccine Act requires a medically justified finding of encephalopathy before death can be treated as a compensable sequela.

The court declined to infer encephalopathy from death itself and found that the special master had articulated a reasoned basis for crediting Dr. Malmstrom over Dr.

Kinsbourne. No compensation was awarded.