Nearly two years ago, the death of a Palm Harbor 12-year-old after one of the most common surgeries for children shocked many who thought tonsillectomies were routine.
Carly Jane Liptak's parents have now filed a lawsuit against Mease Countryside Hospital and her doctors, claiming a series of mistakes and a dangerous mix of drugs led to her death.
The medical negligence suit, filed last month in Circuit Court in Pinellas County, seeks compensation for mental pain and suffering and medical and funeral costs. The parents are now speaking out, offering new details about what occurred the day Carly died.
Carly had a tonsillectomy at Mease Countryside's outpatient facility in Safety Harbor on Aug. 13, 2010. Several minutes into the surgery, she developed pulmonary edema, caused by excess fluid in the lungs, and went into cardiac arrest, according to reports by the Pinellas-Pasco Medical Examiner's Office. She died two days later.
The medical examiner's report stated that complications of tonsillitis killed her. A "cerebellar vascular anomaly," which involves abnormal connections between the arteries and veins, led to bleeding in her brain and also contributed to her death, the report stated.
David Z. Rose, a vascular neurologist not involved with Carly's case, said people who have such abnormalities may be born with them. Trauma or a rise in blood pressure can cause the vessels to burst and bleed, said Rose, an assistant professor at the University of South Florida and Tampa General Hospital.
Such anomalies are unusual. One percent of the population or less probably have them, he said.
The medical examiner classified Carly's death as natural, but her parents, Elisa and Kevin Liptak of Palm Harbor, believe it was anything but that.
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"I knew something went terribly wrong that day," said Elisa Liptak, 48. "I was sure of it, and I wasn't going to let go of it."
Carly was healthy, with dreams of becoming a professional softball player. But during sixth grade, she had several throat infections. Her doctor recommended she have her tonsils removed.
Her parents were told the operation would take no more than 25 minutes. Instead, their suit says, their daughter remained in the operating room more than three hours.
The suit accuses the team of pushing forward with the surgery despite warning signs. It claims that six minutes after ear-nose-throat specialist Arif A. Alidina started removing Carly's right tonsil, "bloody froth came up the breathing tube." The suit calls that a "medical red light," but states the doctor didn't stop and removed the other tonsil.
The Liptaks' suit names, in addition to the hospital, Alidina, who did the tonsillectomy; anesthesiologist Alan Rudolph; and certified registered nurse anesthetist Darlene Dickinson.
Alidina did not return calls for comment. Mease Countryside declined to comment through its spokeswoman, Beth Hardy, and the anesthesiology team declined to comment through its lawyer.
One of the first medication mistakes, the suit states, involved the injection of a local anesthetic called bupivacaine with epinephrine in the area where the tonsils are located. The suit claims that according to medical literature, the injection was not proper. The drugs and dosage were questionable for a child Carly's age, said Patrick Dekle, the Liptaks' Tampa lawyer.
A physician not involved in the case, Tapan A. Padhya, said doctors trained decades ago are more likely to use those medications. But Padhya, associate professor and vice chairman of the USF department of otolaryngology, said neither he nor doctors he works with use them routinely for kids Carly's age.
"I personally would not have injected them in that patient no matter what size she was," Padhya said, adding that the risks outweigh the benefits because the drug can have a toxic effect on the heart.
The injection of the two drugs, the suit says, made Carly's heart rate jump from 80 to 140. Then, before her heart returned to normal, the team gave her two other strong drugs. The four drugs damaged the left ventricle of Carly's heart and made it impossible for her to recover on her own, the suit claims. Fluid backed into her lungs, froth appeared in her breathing tube, and she essentially drowned in her own fluids, the suit says.
The suit also alleges that efforts to resuscitate Carly were flawed. And it claims that Rudolph, the anesthesiologist, took some of Carly's medical records home and kept them until All Children's Hospital demanded them.
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The Liptaks, who exclusively shared their story with the Tampa Bay Times, said they're consumed by Carly's death. Her younger sister, Riley, now 12, is devastated and lonely.
Elisa and Kevin Liptak said their anguish is intensified by their frustration over how the hospital treated them and Carly the day of the surgery.
Around 7:20 a.m, they said, Carly was wheeled to surgery and her parents were given a red cellphone to receive updates from hospital personnel. About 7:55, they were told Carly went to sleep nicely.
Elisa said she got progressively more worried over the next hour. By 9:15, she was pacing. She wandered into the hall, where she saw a woman standing in front of the doors to the surgical area. She later learned that was the hospital's risk manager, she said.
When the woman asked her if she was the mother of the girl who had a tonsillectomy, Elisa panicked and screamed for her husband. Hospital staff led the couple to an office and told the Liptaks they were having a hard time waking Carly up.
Kevin, 51, who works in medical communications at St. Joseph's Hospital in Tampa, started making calls to get a helicopter lined up to take her there.
Around 10 a.m. they were told to talk to Carly to see if they could wake her up, they said. Elisa remembers walking to Carly's head and shouting, "Carly, please wake up. You are strong. You can do this."
Elisa saw Carly move her head an inch.
"After that, she never moved again," she said.
Kevin, an emergency medical technician, then learned some dire news, but it didn't come from the team working on his daughter, he said. He called his employer, St. Joseph's, and got a pediatric critical care physician. That doctor told him that the team working on Carly thought she needed a heart transplant.
Carly was transported to All Children's Hospital (which is not a defendant in the lawsuit).
Just before 10 a.m. on Aug. 15, 2010, she was removed from life support and declared brain dead.
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The Florida Department of Health has "no public information regarding any complaint or investigation" involving Carly's death, said Jessica Hammonds, department spokeswoman.
Hospitals must report deaths after procedures to the state Agency for Health Care Administration. But the agency cannot comment about such reports, said spokeswoman Shelisha Coleman.
The agency recently filed a "statement of deficiencies and plan of correction" involving Mease Countryside Hospital related to a tonsillectomy on the date of Carly's surgery. The report, dated Jan. 5, did not name a specific doctor, but said "a physician removed documents from the medical record and left the facility." A risk manager said the records were returned a short time later. The physician was to be monitored for a year. Coleman could not confirm if the report involved Carly or her doctor.
None of Carly's doctors have been disciplined for her case, according to Department of Health records. Rudolph's file shows he hasn't been disciplined since being licensed in 1974. In 1994, Alidina, licensed since 1988, was disciplined for an unrelated claim that he failed to properly examine and treat a woman with a cancerous growth.
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Deaths like Carly's are rare. Bill Pellan, director of the Pinellas-Pasco Medical Examiner's Office, can't recall another one in his district in the past decade.
The Liptaks said they're sharing their story because they want people to know the truth about what happened to their daughter and who they think is responsible. They also want doctors to stop giving children the drugs that were used on Carly.
"I would just never wish this upon anyone," Elisa said. "The whole way we were treated. The way it went. And Carly didn't have a chance."