[Editor’s note: When 15-year-old Dawn Marie Esposito of Lincoln Park, N.J., was hospitalized with a head injury after a car accident, doctors assured her parents that it wasn’t potentially fatal. But days later, she suddenly and “inexplicably” died. It was only later, after seeking legal help, that they found out the likely cause was a sedative, Diprivan, that shouldn’t have been used on a girl Dawn’s age. Here’s her mother’s story.]
As told by Dawn's mother, Silvana Esposito:
My daughter, Dawn Marie Esposito, was 15 when she was in an auto accident Dec. 20, 2001. My husband and I rushed to the hospital, where the emergency room doctors said she had suffered a head injury, what doctors called a “moderate midline shift,” a movement of the brain inside her skull.
She had already been sedated into a “hospital-induced coma” so they could do whatever procedures were needed and apparently to help control pressure on the brain. We couldn’t communicate with her, and she couldn’t know that we were with her.
There was some hemorrhaging, and the doctors called in a pediatric neurosurgeon. He said Dawn’s injuries were not severe enough for surgery, which was a relief. Instead they inserted a shunt in her forehead to relieve and monitor any pressure, in case the brain swelled.
At the very beginning, we asked if this could be fatal. The doctors said no, that they had treated many patients with this injury. There was no other injury. We thought we would see her wake up, and see the day when she came home.
The pediatric neurologist said they would keep her under the deep sedation until they got one full day of brain pressure readings in a normal range.
We were told that the critical time was 24-48 hours, for possible swelling. After that, the doctors said, she would be on the road to recovery. We were worried at the time about her injury, not the constant sedation. A member of the family stayed at her bedside nearly every minute.
Over the next few days, CAT scans showed that the bleeding slowed, then stopped, and the brain’s midline was back to normal in a scan on the 24th. But the pressure monitor showed some spikes on the the 22nd and 23rd, so she was kept sedated.
All through the day of the 24th, the intracranial pressure numbers were down to what the doctors were looking for, in the mid-teens. Dawn stayed that until about 2 p.m. on the 25th, Christmas Day.
Then she started to spike in pressure again, up to the 30s.
Doctors didn’t know what caused it. We questioned it, because she was doing so well earlier, and the doctor said he didn’t know. I actually snapped back that they needed to get someone in there who did know.
That evening, the head of the pediatric ICU asked to do another CAT scan, and she said there was no bleeding, the brain midline was normal and they were going to “accept the numbers as they were” She said that the “CAT scan ruled and we’re going to bypass all other numbers on the monitor.” I remember those words as if she was standing here in front of me.
That meant Dawn’s brain shunt would be removed and she would be allowed to awaken.
The head of the ICU said she would be off on the 26th, but that the doctor who would be coming in would know what to do. With that reassurance, I slept through the night.
When we woke up about 7 the next morning, the 26th, Dawn Marie had a high fever. Doctors couldn’t control it. They asked me to take a break, saying that the doctor we were waiting for was due in at 2 p.m.
I laid down for a bit in the main lobby, and went back to her room at about 11:30 am
The curtain was drawn around Dawn Marie’s bed, and there were four or five doctors around her. I was terrified. I opened the curtain and said, “What is going on?”
A doctor I’d never seen said to wait in a nearby small room and he’d talk to me in a minute. He came into the room and said to me, “Dawn Marie is now fatal and she’s going fast.”
She had suffered cardiac arrest.
I said, “What are you talking about?” All through this, one of us was always at her bedside and we kept asking if, God forbid, this could be fatal. Never, not once, did they say that. I knew instinctively that something had gone wrong in the treatment.
She officially expired between 5 and 6 p.m. on the 26th.
We knew it had to be something they had given her. She’d passed the crucial time, the CAT scans were good, the ICU doctor had confidence about waking her.
The doctors offered no explanation. There was no other injury except the head. She was a healthy 15-year-old, and none of the blood work or other tests turned up another injury, or at least so we were told.
I wanted to know what happened.
After we buried Dawn Marie on Dec. 31, I called the ICU doctor who had given her the most care and done that last CAT scan. I wanted to talk with her. I tried several times over several days, but the hospital never let me talk with her.
That’s when I started looking for an attorney.
He had a neurologist look over all of her records. He concluded, “This was not a neurological death.”
But he spotted the sedative they were giving her, called Diprivan. It is actually an anesthesia, but sometimes used as a sedative. The neurologist said it has a side effect of fatal cardiac arrest and needs to be monitored very carefully. The neurologist said that could have been the cause.
We started researcing and found that in March 2001 the FDA had ordered the maker of Diprivan, Astra Zeneca, to send a letter to hospitals warning that Diprivan should not be used in the ICU for pediatric cases because of the “high mortality rate.”
This hospital was notified, we know that, and we know the hospital board discussed the issue. But somehow the doctors were still using Diprivan on children when Dawn Marie got to the ICU in December. Why that happened, we’ve never found out.
We ended up settling the case after two years of research and three years of depositions and hearings. But our attorney dropped the part of the case against Astra Zeneca, because the company had warned the hospital--even though they hadn’t put warnings on the drug box against pediatric use or followed up the warning.
I am still angry about that. The company failed to make sure that the drug was safely used.
When I read about movie star Dennis Quaid’s infants getting the wrong drug in a California hospital last year, it brought back everything about Dawn Marie’s case. I thought that if I had star power and wealth, we could have kept pushing our case, the way he continues to push his.
I also wanted to make everything public and push for better protections for the next patient, but we just didn’t have the power or money to keep pushing it.
The hardest thing about settling rather than going to trial was the confidentiality agreement. I can’t even name the hospital.
During my research, I had found in the British medical journal Lancet big two-page warnings that the drug should not be used in large doses even on adults with head injuries, because of the risk of cardiac arrest.
I also found that the hospital had given Dawn Marie the full adult dosage, more than was safe for even an adult with a head injury.
In the Astra Zeneca package insert, it said the drug should not be used more than 5 days without a “drug holiday” for the patient, weaning them away for a period of time.
We wanted at least to get the drug relabeled by the FDA, with stronger warnings. I tried going directly to the FDA. That was a complete dead end. The manager I finally talked with told me that Diprivan was just not a priority for the FDA. That they were too busy and understaffed. That one voice, no matter what evidence I had, would just not be heard.
I gave up.
And here’s a P.S. to this story:
When Dawn Marie was in crisis, on the 26th, I was in the pediatric ICU and they asked me to go downstairs and give the billing office my “insurance information.” I gave them my medical insurance. Later, they said, no, they needed my car insurance. I handed it over.
It turned out that several doctors double-billed both the medical and car insurers.
We turned this information over to New Jersey Office of Insurance Fraud, but the hospital got away with calling it a “billing error.”
Everything somehow is considered just an “error.”
Before Dawn Marie’s case, I never knew how many people died each year of medical mistakes. And without open, public trials to get the message out, most of us will never know how many errors hospitals make.