This wrongful death action was brought on behalf of the then 15-month-old son of decedent. On January 22, 2006, Decedent sustained a head injury while riding a dirt bike out in the desert. She was stabilized at Hemet Valley Hospital and then transferred to defendant facility Riverside County Regional Medical Center (“RCRMC”) where she was diagnosed with an epidural hematoma as well as a fracture of her right leg.
She underwent surgery to evacuate the hematoma that very day. Pre-operatively, her Glasgow coma score was 3. The surgery itself was successful. The blood and clotting was removed from the epidural space, the source of the bleeding was found and an intracranial pressure monitor was placed to monitor her recovery.
Post-operatively, complications in this type of patient which must be watched for include a re-bleed or re-accumulation of the hematoma (symptoms would be an increase in intracranial pressure, head pain and changes in neurologic findings such as levels of consciousness and inability to respond to command); changes in pulmonary function caused by an embolic event; and metabolic change, i.e., hyponatremia (cerebral salt wasting). Hyponatremia occurs in up to 25% of head injury patients who undergo evacuations of hematomas. Signs and symptoms would be a drop in serum sodium levels, along with headache, increased intracranial pressure and changes in the patient’s neurologic status.
According to her attending healthcare providers, Decedent recovered very well from the surgery. She was transferred out of the ICU at midnight on January 24th.
However, by the morning of January 25th, her serum sodium had dropped 10 points. This is a sign of cerebral salt wasting. Decedent began exhibiting all of the signs and symptoms of this condition, but none of the attending physicians/residents at this teaching hospital were aware of the drop in serum sodium and failed to investigate the cause of her intense headache and grogginess. The nurse on duty the morning of the 25th testified that he did advise the attending resident that Ms. Donnelly’s labs were out of balance, and advised him of her 10 out of 10 head pain, which was not relieved by medication. According to this nurse, the only order given by the resident was to continue the pain medication.
According to the chart, at 3:00 p.m. on the 25th, Decedent became pale with weak pulses and poor respiratory effort. A Code Blue was called and she was transferred back to the ICU with an endotracheal tube in place.
Her pupils became fixed and dilated, and she never recovered. Testing was done after the Code to determine the cause, including CT scans. According to all of the testing, there was no evidence of a re-bleed or re-development of a hematoma or of a pulmonary or fat embolism.
At approximately 9:00 that evening, Decedent was pronounced brain dead.
