Public health decision-makers do not appear to have a standard process for crisis decision-making and would benefit from having an organized decision-making model. The survey showed that ethical, logistical, and political criteria were considered but were not prioritized in any meaningful way. A new decision-making tool kit for public health decision-makers plus implementation training is warranted.

A 43-year-old woman with a history of bilateral tubal ligation and bilateral ovarian cysts presented to our hospital with progressively worsening right lower quadrant pain and abdominal distension. Her exam findings of vaginal discharge and cervical motion tenderness, in combination with her marked leucocytosis, were suggestive of pelvic inflammatory disease (PID). PCR for Chlamydia trachomatis and Neisseria gonorrhoeae was negative, however, our patient’s blood cultures grew group A Streptococcus. This exceptionally severe presentation of PID, in combination with uncommon laboratory findings, led to complex multidisciplinary clinical decision making guided by extensive literature review. Here, we present a rare case of group A Streptococcus PID after bilateral tubal ligation, and highlight the role of a family medicine primary team in the medical and surgical management of a complex case at a community hospital.

Neuroleptic malignant syndrome (NMS) is an obstetric emergency. Management of acute psychosis in a pregnant patient remains complicated with limited therapeutic options due to teratogenic effects. We report a case in which a patient’s antipsychotic regimen during a viable pregnancy subsequently led to NMS, and discuss our chosen management for treating NMS.