Hours of Unmanaged Dehydration Resulting in Death of 5-Year Old at Hospital

CATEGORIES: Emergency Room CASE LOCATION: Mercer Co., PA. CLASSIFICATION: Seven Figure Recoveries

The Widman Case

This case involves the death of Alyssa Widman, a 5-year old girl, who died of unmanaged dehydration on April 24, 2006. On that day, at around 10:00 am, Alyssa’s parents brought her to the local hospital where she was seen in the emergency department and, unbeknownst to the nurses assigned to her, diagnosed with dehydration. Over the next 6 hours in the ER, the health care providers failed to properly manage Alyssa’s dehydration. As a result, Alyssa was pronounced dead by 7:17 pm.

On April 24, 2006, Mrs. Widman called her family doctor’s office and spoke with the office staff early in the morning complaining that Alyssa had been up all night, coughing up phlegm, felt ill for several days, and that Alyssa’s arms were mottled and appearing to turn blue. She was given an afternoon appointment. Shorty thereafter, Mrs. Widman again telephoned the doctor’s office because she was concerned that Alyssa’s condition was worsening. She was then offered an appointment later that morning. Mrs. Widman called the doctor’s office a third time, again concerned that Alyssa’s condition was worsening. Mrs. Widman informed the office staff that she was going to just take her daughter to the emergency department at the local hospital.

Mr. and Mrs. Widman arrived at the hospital around 10:00 am. About an hour later, around 11:00 am, Alyssa was admitted to the emergency department, was first triaged by nursing at 11:24 am, and was then first examined by the ER doctor at 11:50 am. Around this time, the family doctor was contacted (he did not arrive at the emergency department until approximately 4:30 pm). Also, about this time, Alyssa’s legs started to turn blue.

At 2:05 pm, the ER doctor ordered urine and blood tests. The emergency department staff started an IV, drew blood work, and performed a chest x-ray and abdominal x-ray. The blood work results were documented as abnormal around 2:00 pm and no further orders were received (in his deposition, the ER doctor admitted that the results of the tests reflect a child who is “dehydrated”). Alyssa was unable to urinate, had mottled cool extremities, was lethargic, and had dry mucous membranes.

Over the phone, the family doctor ordered Alyssa to be admitted overnight for observation due to dehydration. Inexplicably, for an extended period of time, caregivers in the emergency department believed that no oral liquids were to be given to Alyssa (a fatal mistake with a dehydrated patient).

Upon the family doctor’s arrival at the hospital around 4:30 pm, he ordered potassium to be added to the IV fluids and permitted Alyssa to have a popsicle. Alyssa bit her tongue multiple times and was visibly bleeding, which was brought to the attention of the caregivers; however, no action was taken.

Alyssa was transported to the floor around 5:40 pm in unstable condition. Her condition continued to deteriorate and she subsequently experienced respiratory distress around 6:00 pm. the family doctor was called, and a Code C was called around 6:00 pm. the family doctor ordered Alyssa to be life-flighted to Tod Children’s Hospital in Youngstown, Ohio. The Life-Flight staff arrived at the hospital at 6:38 pm and worked on Alyssa for approximately one hour and 10 minutes until Alyssa was pronounced dead at 7:17 pm.

Suit was brought against the family doctor, the ER doctor, and the hospital. We took the depositions of the family doctor, the ER doctor, five nurses, and a medical student who was present during the ER visit. Thereafter, our firm secured expert medical opinions from nationally recognized experts in emergency medicine, pediatrics, and pediatric pathology. These experts opined that the defendants were negligent as follows:

The nurses in the ER failed to take complete vitals (no blood pressure) and over a 6-hour time period failed to repeat vital signs – contrary to written hospital protocol;
Despite abnormal electrolytes (dehydration) per the blood work, doctors failed to take measures to correct the problem, such as aggressive IV hydration or oral rehydration for IV electrolyte correction;
The doctors failed to order repeat blood work despite abnormal initial results;
Through depositions, it was revealed that there was little to no communication between the doctors and nurses – significant findings by some providers were unknown to others;
The only nurses who were assigned to Alyssa’s care in the ER were unaware of the existence (much less content) of written hospital protocol specifically addressing dehydration in the ER;
Those same nurses, according to their deposition testimony, were unaware of any working diagnosis during most of Alyssa’s time in the ER;
Neither the ER doctor nor the family doctor noted that Alyssa had cool, mottled skin – a hallmark of dehydration and an original complaint of the parents. Neither did the two ER nurses assigned to her care. This condition was only noted by a 4th year medical student and a new nurse extern. Incongruously, in their depositions, the more experienced providers attempted to discredit the medical student and the nurse extern’s findings;
The negligence in this case was best portrayed by the floor nurse who was assigned to Alyssa on the floor after Alyssa had been in the ER for 6 hours. In her deposition, this nurse attempted to advance the notion that Alyssa has “normal” (rather than “severe”) dehydration. When asked the clinical difference between “normal” and “severe” dehydration, she could only think of the two absent signs: decreased skin turgor and sunken eyes. Unbeknownst to this nurse, a nurse extern during this same shift documented decreased skin turgor; and
An autopsy was performed by Dr. Eric Vey. Dr. Vey did not list a definitive cause of death in his autopsy report; however, according to our retained pediatric pathologist, the autopsy report is consistent with death by dehydration. The expert will further state that before Dr. Vey’s autopsy was performed, but after Alyssa experience multi-organ shutdown, Alyssa was hydrated in the resuscitation efforts (Alyssa received fluid resuscitation during her arrest). Therefore, the pathology does not reflect dehydration by the time of Alyssa’s ultimate demise.

In an attempt to resolve the case prior to trial, the parties agreed to a non-binding mediation before a former Mercer County Judge, which resulted in a seven figure settlement. The settlement included future annuity payments to cover the cost of Alyssa’s little sisters’ college educations.