Editor’s Note: This story has been updated to include a lawsuit filed by the Wattenbarger family in December 2020, as well as the defendants’ response to the lawsuit claims, provided to KXAN by the Wattenbargers’ attorney in March 2021.

AUBREY, Texas (KXAN) — Jeremy Wattenbarger proudly wears a photo button of his daughter, Betty. 

As he snapped the photo, he remembers her big smile. It will be one of his favorites, which captured her happiness in that moment.

“She absolutely loved music. She loved ‘Yo Gabba Gabba!’ singing and dance and play,” Wattenbarger described as his face lit up. “She was learning to ride her bike.”

Wattenbarger said an autopsy revealed that Betty died Jan. 31, 2019 from flu complications caused by pneumonia and sepsis, which is the body’s severe response to an infection. 

She was 7-years-old. 

“There are a lot of things about Betty that with her passing… it took a lot of light out of this home, and it brought a lot of sorrow to this home,” Wattenbarger explained. 

The days before Betty’s death 

The father recalled she had gotten sick on a Sunday and had a fever. The next few days, he said she was improving and feeling better but then took a sudden turn. 

One of the last photos taken of Betty Wattenbarger as her family waited to be seen at Pediatric Urgent Care Denton. (Courtesy: Jeremy Wattenbarger)

“She started to become slightly discolored. A little bit of yellowish tint, bluish tint to her lips,” Wattenbarger said. 

The family took Betty to Pediatric Urgent Care Denton near Dallas-Fort Worth. Wattenbarger said she was treated by a nurse practitioner and diagnosed with flu. 

“We’re asking about why is Betty… she seems to be breathing really hard and rapid. They said ‘well it’s probably because she has a fever of 102.9,'” Wattenbarger explained. 

Her father said no x-rays were taken and no other medical tests were done. He explained Betty was given some Motrin for her fever, and they were sent home. 

The next day he said he found Betty in the living room with blood coming out of her mouth. He immediately rushed her to the ER where she died. 

“She had a 1/3 cup of fluid in her left lung. Her other lung had the start of pneumonia,” Wattenbarger said. “This child died less than 15 hours after being at an urgent care.”

Why were signs missed? 

The Wattenbargers have been trying to get answers since Betty’s death. 

In Wattenbarger’s opinion, “The misdiagnosis ended up costing her, her life.” He continued to explain, “There were a lot of things that were missed.”

Her father said Betty was autistic and could not speak many words or explain what she was feeling. He explained additional tests could have explained what was going on with her. 

The family is now advocating for physician-led care and warn other parents to insist on seeing a doctor, especially this flu season which is now in full swing. 

According to the Texas Department of State Health Services, there were 20 pediatric flu-related deaths across the state during this last flu season. Doctors urge families to get a flu shot right now, so that it can be effective. 

“When people ask me ‘my child is sick, and it’s after hours where do I go?’ I always tell them call ahead and ask do you have a supervising physician on the premises,” Dr. Lori Hines, pediatrician in Austin said. 

Dr. Hines did not treat Betty but has studied her case. She’s part of Physicians for Patient Protection, a grassroots organization raising awareness about physician-led care especially during the pandemic. 

“The physician is the one who can determine – is this sick child just routinely sick or is this a child that needs a higher level of care,” Dr. Hines explained.

Push for reform

Betty’s family said the nurse practitioner’s supervising doctor Michael Cowan was not at the urgent care during her treatment. 

In Texas, Dr. Hines explained nurse practitioners have to be supervised by a physician, but that supervision is loosely defined.

“You have a supervising physician in El Paso, and the nurse practitioners can be as far away as Houston,” Dr. Hines said. 

In September 2020, KXAN Investigator Arezow Doost called, texted and emailed Dr. Cowan at the urgent care that treated Betty but has not received answers to any questions about what happened, after making initial contact.

A spokesperson with the Texas Medical Board said he can’t confirm if there’s an investigation involving the urgent care since the information is confidential. 

An attorney with the Texas Board of Nursing told KXAN there was a disciplinary order for the nurse practitioner and included additional training and education, because she didn’t complete medical records. 

The nurse practitioner has not returned a request for comment.

“Any patient loss is a tragedy, and while we do not know the details of this particular case, the evidence demonstrates that the care provided by APRNs (Advanced Practice Registered Nurse) is generally as safe or safer than physicians. You will find anecdotes of misdiagnoses with unfortunate outcomes for both APRNs and physicians. However, if you look at the statistics, patients have no greater risk when treated by APRNs,” explained Dr. Cindy Zolnierek, CEO of Texas Nurses Association. 

Betty’s family has shared what happened to her with several lawmakers hoping to see some reform within the urgent care system. 

“They have to actually license as a medical facility in the state of Texas. They have to have the ability to be monitored by the Department of Health and Human Services,” Wattenbarger said.

He said this is just the beginning of their fight as they push for justice for their daughter. 

“There has to be staffing requirements for them… a doctor within a certain amount of miles from that facility,” Wattenbarger explained. 

The family filed a lawsuit in December of 2020 against the urgent care and the healthcare workers who treated Betty, alleging medical negligence.

In March of 2020, the defendants’ attorney said he does not respond to the media on pending litigation. 

In a legal response to the lawsuit filed on behalf of the family, the defendants deny the allegations stating, “the injuries and damage alleged were not caused by the negligence of any party.”

The court document also said that Betty’s cause of death was due to pre-existing health conditions. 

KXAN investigator Arezow Doost has tried repeatedly to reach the urgent care and the nurse practitioner, but calls have yet to be returned. 

The supervising doctor for the nurse practitioner told Doost in November 2020 he had no comment.