On Thursday, August 9, 2014, Deriah Solem, a 22-month old girl, passed away at Cardinal Glennon Children’s Health Center after being attacked in her St. Charles, Missouri home by the family’s pit-bull mix. At the time of the attack, Deriah’s grandmother had just finished feeding her and had placed her on the floor to play. The 80-pound dog, usually confined to a locked back bedroom, somehow got out and pounced on the toddler without warning. The grandmother tried to pry open the dog’s jaws and lost four of her fingertips in the process. She screamed for Deriah’s older brothers, ages 5 and 8, to get out of the house. They ran next door to Jonathan Banta’s house. He grabbed a steak knife and ran back over. Even with the grandmother and Mr. Banta trying to pull off the dog, the attack continued. Mr. Banta stabbed the dog multiple times before it finally released the child, staggered away and collapsed.
Deriah was rushed to St. Joseph’s Health Center in St. Charles before being transferred to Cardinal Glennon Health Center. She suffered bite wounds all over her body, but the most severe trauma was to her head, neck and stomach area. “It was extremely urgent,” said Lt. Dave Tiefenbrunn of the St. Charles County Sheriff’s Office. “The blood loss was extensive. The situation was so critical that there was a surgeon in the ambulance.” Deriah died on Saturday, August11. Cause of death was listed as multiple injuries to the head and neck.
Although the dog had no history of attacks, it apparently had shown aggressive behavior in the past, the reason for keeping it locked in a back bedroom. At the family’s request, the 10-year old dog, which had survived the stabbings, was euthanized.
Alarming Numbers and a Frightening Upward Trend
As tragic as Deriah’s case is, it is far from being an isolated incident. Dog bites are listed as the fifth most common reason why children seek emergency room treatment. According to the Center for Disease Control, nearly 4.5 million Americans are bitten or maimed by dogs each year, with more than half of these victims representing children. One in five of these bites—approximately 885,000 victims—are serious enough to require medical attention (http://www.cdc.gov/HomeandRecreationalSafety/Dog-Bites/).
A study produced by the Healthcare Cost and Utilization Project reported that in 2008, there were a total of 316,200 emergency room visits and 9,500 inpatient stays related to dog bites. This equates to an average of 866 emergency room visits and 26 hospitalizations per day, almost double the number of Americans hospitalized for dog bites in 1993, when the corollary stood at 5,100 (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb101.pdf). This increase, by the way, vastly exceeded the rate of general population growth, and pet ownership increased only slightly during the same period, according to the report’s author, Anne Elixhauser, a senior research scientist with the Agency for Healthcare Research and Quality.
“It’s really kind of frightening, and unfortunately, we’re at a loss to explain it,” Dr. Elixhauser said. “It’s a pretty hefty increase” (http://www.nytimes.com/2010/12/14/health/research/14risks.html?_r=0).
Below is a snapshot profile and quick statistics portraying this upward trajectory as well as the demographics of victims.
Figure 1: Courtesy of AHRQ , Center for Delivery, Organization and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1993-2008
- Rate of hospitalization for dog bites more than doubled between 1993 and 2001.
- There was a 10% increase in emergency room visits per day for new dog bites between 1992 and 2001. In 1992, there were 914 dog bite patients treated in emergency rooms per day compared to 1,008 in 2001 (http://www.cdc.gov/mmwr/PDF/wk/mm5226.pdf).
- The number of yearly fatalities caused by dog bites has increased steadily since the 1990’s when the average number was 17. For the past six years, the average number of people killed in dog-bite related incidents has hovered around 31. DogsBite, a public education not-for-profit, dedicated to conducting research on public safety issues related to severe and fatal dog bites in the United States, lists 29 fatalities thus far in 2014; and 31 in all of 2013, the vast majority of whom were children (http://www.dogsbite.org/).
- Children under 5; and adults 65 and older are most likely to be hospitalized after suffering a bite (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb101.pdf).
- Hospitalized victims of dog bites and maiming, ages 55 and older, suffer the highest rate of fatalities (23 from 2006 to 2008), followed by the 2-4 year age group (19 during the same time period).
- Residents of rural areas are about four times more likely to seek emergency room care and have three times as many hospital admissions due to dog bites compared to those from non-rural areas (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb101.pdf).
- Males have a higher incidence of emergency room visits for dog bites (110.4 per 100,000) than females (97.8 per 100,000), but there are no perceptible gender differences in dog-bite related hospital stays (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb101.pdf).
Costs Associated with Dog Bites
The escalating number of dog bite victims carries a hefty price tag for medical costs related to treatment of injuries. A 1997 study published in the Journal of the American Medical Association reported that dog bite victims suffer over $1 billion in monetary losses annually; however, the author estimated that actual losses were probably closer to $2 billion given the under-reporting of incidents (http://jama.jamanetwork.com/article.aspx?articleid=413376). Based on inflation using the CPI index, this figure actually would be closer to $3 billion in today’s dollars.
A 2010 study showed that the average cost of a dog-bite related hospital stay was $18,200, about 50% higher than that of the average injury-related hospital stay, even though the average length of stay was 3.3 days, more than 2 days shorter than the average injury-related hospitalization of 5.5 days (http://www.dogsbite.org/pdf/2008-ed-visits-inpatient-stays-dog-bites.pdf). Likewise the average cost per day for a dog-bite related hospitalization was 2.5 times that of an injury-related hospitalization ($5,500 per day versus $2,200 in 2010: a figure that, on average, would exceed $6,000 in 2014).
And who pays for these burgeoning costs? We all do. According to the 2010 Healthcare Cost and Utilization Project Statistical Brief on Emergency Department Visits and Inpatient Stays Involving Dog Bites, less than half of all ED visits and inpatient stays that involved a dog bite were billed to private insurance (http://www.dogsbite.org/pdf/2008-ed-visits-inpatient-stays-dog-bites.pdf). The rest of the tab is picked up either by tax-funded public health insurance (e.g., Medicare and Medicaid) or written off as hospital charity; meaning that eventually these costs are absorbed in the calculation of patient fee rates.
Each year, hundreds of Missourians are injured by dog bites severe enough to require medical attention. Children constitute the majority of these victims, and because they are smaller in stature or on the same level as the dog, they tend to sustain more serious facial injuries.
Missouri has laws imposing strict liability on owners or possessors of dogs for dog bites. The conditions under which an owner or possessor can be found liable can found under section 273.036 of Missouri Revised Statues, enacted August 29, 2009.
273.036. 1. The owner or possessor of any dog that bites, without provocation, any person while such person is on public property, or lawfully on private property, including the property of the owner or possessor of the dog, is strictly liable for damages suffered by persons bitten, regardless of the former viciousness of the dog or the owner’s or possessor’s knowledge of such viciousness. Owners and possessors of dogs shall also be strictly liable for any damage to property or livestock proximately caused by their dogs. If it is determined that the damaged party had fault in the incident, any damages owed by the owner or possessor of the biting dog shall be reduced by the same percentage that the damaged party’s fault contributed to the incident. The provisions of this section shall not apply to dogs killing or maiming sheep or other domestic animals under section 273.020.
2. Any person who is held liable under the provisions of subsection 1 of this section shall pay a fine not exceeding one thousand dollars. The remedies provided by this section are in addition to and cumulative with any other remedy provided by statute or common law.
Additionally, Missouri allows victims of dog bites to assert a claim of negligence and negligence per se (an act of negligence that also violates a statute or regulation) for dog bites. Compensatory damages can be sought and awarded on the basis of special costs (i.e., costs related to measurable expenses, such as medical treatment and lost earnings, etc.) as well as general harms and losses (pain and suffering, emotional distress, etc.). There are many nuances that must be taken into consideration in satisfying the conditions and pursuing a claim of negligence, including such matters as whether an owner had foreknowledge that his/her dog was capable of inflicting harm; whether a landlord can be held responsible for the aggressive behavior of a tenant’s dog; whether a close relative who witnessed the attack is owed damages for emotional distress, etc. This is why it is important to seek the counsel of an experienced personal injury attorney when pursuing compensation for a dog bite injury.
Why Dogs Bite and How to Prevent
While dogs can be “man’s best friend”, they are nevertheless animals; and as such, they are prone to exhibiting aggressive behavior in certain situations. Dogs typically bite or attack for one of five reasons:
- Possessiveness: Dogs instinctively are protective of their property. Property can consist of anything from their home territory, to food, a toy or even their owner(s). Teach your dog at an early age to “Leave it!” to prevent toy aggression. Dogs should be taught to sit or lie down until their food bowl has been placed on the floor. You can approach the food bowl and place treats in it from time to time to convey the message that someone approaching their bowl is not doing so to steal their food. TEACH YOUR CHILD STARTING AT AYOUNG AGE TO NEVER APPROACH A DOG WHILE IT IS EATING.
- Fear: Dogs can become aggressive when they are scared or placed in an unfamiliar situation. Socialize your dog from the time it is a puppy to as many people and other animals as possible to minimize fear of the unfamiliar or a stranger. TEACH YOUR CHILD TO NEVER SNEAK UP ON A DOG WHEN IT IS SLEEPING.
- Pain, Illness and Old Age: When a dog is in pain, it can become anxious, irritable and confused. Like humans, dogs can undergo mental decline as they age, causing personality changes. Chronic pain caused by injury or diseases of aging, such as arthritis, can make even the most loving family pet become ill-tempered. Make an appointment with the vet to obtain pain medication and to learn practical tips for helping your dog cope with the pain or symptoms of aging. TEACH YOUR CHILD TO NEVER BOTHER A DOG THAT IS IN PAIN AND INSTRUCT HIM/HER ON HOW TO PET GENTLY, AVOIDING ANY SORE AREAS.
- Maternal Instinct: Dogs have a strong maternal instinct and may bite as an instinctive reflex to protect their puppies. Provide the dog and her puppies a safe and warm place with minimal distraction. TEACH YOUR CHILD TO STAY AWAY FROM A DOG WITH PUPPIES. WHEN HANDLING THE PUPPIES, DO SO WITH UTMOST CARE AS A MOTHER DOG MAY BITE IF SHE THINKS ONE OF HER PUPS IS BEING HURT.
- Prey Drive: A dog’s prey instinct can be triggered by seeing someone running or cycling. Be aware of your environment at all times, especially if you are in areas where there are walkers, runners and bikers. When walking a dog, go out of your way to avoid crossing paths with another dog.
If a dog approaches you or your child aggressively (exhibiting such signs as growling, ears pinned back, fur standing up along back, whites of eyes showing, freezing and then staring intently at you), do the following:
- STAND ABSOLUTELY STILL. DO NOT RUN UNDER ANY CIRCUMSTANCES!
- STAND TALL FACING THE DOG BUT AVOID EYE CONTACT AS THIS COULD BE VIEWED AS A CHALLENGE BY AN AGGRESSIVE DOG.
- DO NOT YAWN TRYING TO FEIGN A CASUAL AIR. IN FACT, KEEP YOUR MOUTH CLOSED. SHOWING YOUR TEETH COULD PROVOKE AN ATTACK.
- IF YOU OR YOUR CHILD IS KNOCKED OFF YOUR FEET BY A DOG, CURL UP IN A BALL PROTECTING YOUR FACE, HANDS AND NECK AND BE AS STILL AS POSSIBLE.
- GO THROUGH A MOCK “STRAY DOG” ATTACK WITH YOUR CHILD.
Almost 80% of biting dogs belong to the victim’s family or a friend. In 2013, 37% of dog bite fatalities were either visiting or living temporarily with the owner or custodian of the dog (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb101.pdf).
Regardless of whether the dog is a family pet or a beloved friend, medical attention is required anytime that a bite disrupts the skin causing a puncture wound, laceration or tear or if there is pain at or near the injury site. Children or babies that are bitten by a dog should always be assessed for injury and treatment.
Dog bite injuries may damage the superficial or outermost layer of skin but can also involve structures beneath the skin, including muscles, bones, nerves and blood vessels. In the event of a dog bite, follow these steps:
- If bitten on an extremity, elevate to reduce bleeding.
- If possible and tolerable, cleanse the wound with tap water.
- If possible, determine if the dog is current on its rabies shots. If this is not possible, hospital, law enforcement and animal control authorities will help gather the information. If proof of a rabies shot cannot be determined, the victim will have to immediately undergo a rabies PEP regimen, a series of four rabies vaccinations, beginning on the day that the bite was sustained. Three additional shots are given on days 3, 7 and 14 following the bite. People who have previously received the rabies vaccination undergo only two shots.
- Prophylactic antibiotics and a tetanus shot may be given to reduce the risk of infection. Dog bites inject bacteria deep into underlying tissue, and most dog bites do get infected.
- Multiple and/or complicated bite wounds, loss of blood and damage to underlying muscles, bones, nerves and blood vessels may result in admission to the hospital for inpatient wound care and cosmetic surgery. In 2012, more than 27,000 people underwent reconstructive surgery as a result of being bitten by dogs (http://www.plasticsurgery.org/Documents/news-resources/statistics/2012-Plastic-Surgery-Statistics/full-plastic-surgery-statistics-report.pdf). The most common principal diagnosis for dog-bite related admissions includes:
- Skin and subcutaneous tissue infections
- Open wounds of extremities
- Open wounds of head, neck and trunk
- Fractures of open limbs (http://www.dogsbite.org/pdf/2008-ed-visits-inpatient-stays-dog-bites.pdf).