Deadly hospital mistake kills local woman

Dalia Hernandez passed away in December 2011

SAN ANTONIO – It would be the last time Rosalinda Ramos and Martha Garcia would see their mother alive. Smiling, surrounded by balloons and family, the pictures show Dalia Hernandez celebrating her 73rd birthday.

"I just can't believe she's gone, because I know she had more life in her, and they took it," said Ramos.

"Always in a good mood, always singing, always joking around with her grandkids, with us," said Garcia.

One day after her birthday party, Dalia Hernandez would enter Northeast Baptist Hospital to have elective surgery. Hours after checking in, the smiles of a celebration, turned into the tears of a tragedy.

"We're supposed to go into the hospital and get help, not go in a hospital and them kill you," said Garcia.

Hernandez went to the hospital to have a gangrenous toe amputated. She made it through the surgery, but it's what happened next that ended her life - a prescription written in error and filled - for a deadly dose of potassium phosphate.

"It started out with a doctor who arrogantly wrote a lethal medication order, very dangerous medication, in a fast and sloppy way," said Hernandez' family attorney Marynell Maloney.

According to court documents, Dr. Flavio Alvarez wrote the initial prescription. His attorney, Bruce Anderson, said Alvarez initially ordered 10 mm of potassium phosphate, then changed his mind and made it 20, writing over the 1 with a 2. The nurse read it as 120 mm, which was ultimately filled by the pharmacy at 120 mm -- more potassium phosphate than what was once used in a lethal cocktail given to death row inmates.

In December 2011, nearly five hours after the medicine was given by IV, Dalia Hernandez was dead.

"It's not an error, it's a systematic failure of every potential safeguard, and that obviously starts with the doctor," said Maloney.

For the last two and a half years Dalia Hernandez's family has been fighting in court. They settled their lawsuit with Northeast Baptist Hospital, but their lawsuit against Alvarez continues. Anderson said Alvarez, "feels horrible about this," but said he believes the doctor is, "not liable because no one could foresee that order would be filled without clarification."

Alvarez is appealing a verdict against him in this case, and was disciplined by the Texas Medical Board. Dalia Hernandez's family said this fight is for their mothers memory, and perhaps her legacy.

"We don't want this to happen to another family, we don't want this to happen to no one," says Hernandez's daughter, Martha Garcia.

The Baptist Health System sent us a statement extending its sympathy to the family.

It also outline changes that have been made including "an enhanced computer alert system that provides sophisticated medication review technology to help prevent human error, in addition, we instituted more intensive training for our employees regarding the safe administration of medications."

The statement goes on to say "patient safety remains our main priority as we continue to be aware, sensitive and vigilant to these matters."

Click here to see court documents for the judgement.

Click here to see court documents for the amended judgement.

Click here for information on how to spot medical mistakes.


About the Author

Steve Spriester started at KSAT in 1995 as a general assignments reporter. Now, he anchors the station's top-rated 5, 6 and 10 p.m. newscasts.

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