Emergency room physicians are supposed to be heroes. Patients see them at their most vulnerable, relying on their knowledge, attentiveness, and communication with the ER team to bring them back from the brink. However, in one case, two ER doctors at a Jacksonville, Florida, hospital breached their duty of care to a young woman named Miranda. She arrived at the hospital, unconscious and helpless. Despite receiving her medical history from her parents, the doctors failed to address the underlying cause: a condition Miranda had been managing since childhood. As a result, what should have been a routine procedure to stabilize Miranda’s fluids and electrolytes resulted in permanent brain damage.
From an early age, Miranda vigilantly kept track of her salt and water intake. In normal bodies, salt and water content is regulated with a hormone called vasopressin. Typically, kidneys filter out excess fluid from the blood as urine. When water content is low, vasopressin tells the kidneys to release less water. Miranda’s body didn’t produce vasopressin, a condition called diabetes insipidus (or DI for short). Instead, she controlled her salt and water content by regulating how much of each she consumed, drinking more fluids to compensate for her active kidneys. However, in emergencies, she took an artificial form of vasopressin called desmopressin or DDAVP.
When Miranda arrived at the hospital, her salt levels were dangerously low. If untreated, her brain could swell. She was put given intravenous saline — salt and water. Meanwhile, her kidneys continued to filter the fluids in her body out as urine. Within a few hours, her salt levels normalized. However, the doctors failed to stop and continued to pump salty fluids into her veins over several days. Her salt levels skyrocketed. Her brain began to shrink from dehydration. She suffered multiple seizures. In the end, Miranda suffered permanent brain damage and would require round-the-clock care for the rest of her life.
Miranda’s parents contacted Mike Trentalange of Trentalange and Kelley, P.A. immediately after her traumatic treatment. A 25-year veteran representing Plaintiffs in medical malpractice suits, Mike’s goal was to reach a resolution quickly so that Miranda’s parents could have financial support to care for her. Unfortunately, the Defense did everything it could to avoid accountability.
During discovery, Mike and his team pored through official documentation. He could tell the hospital knew they had made a mistake: they provided nearly 28,000 pages of documents that skirted the most important issues. To fill in the gaps, Mike hired several experts. Among the most crucial was a doctor named Richard Sterns, a nephrology expert and one of the foremost authorities on Osmotic Demyelination. In addition, he brought on a critical care specialist to talk about standard of care and causation, as well as a neurologist, an endocrinologist, a nephrologist, and a radiologist.
Mike also knew he needed a visual to explain how the doctors’ repeated acts of negligence led to Miranda’s life-altering injuries. He enlisted DK Global to handle the task. As the animation materialized, another challenge emerged: aligning the visual so that all the experts agreed with it. With so many diverse medical backgrounds, it was an undertaking. Ultimately, the visual accurately told Miranda’s story in the Jacksonville hospital.
The 18-minute animation opened with a 3D character depiction of Miranda lying on her back, unconscious, in a hospital bed. A sodium table and a clock were superimposed on the to show how her salt levels changed over time. The presentation chronicled how Miranda lay sedated in a hospital bed, her salt levels dangerously high, for seven days before her physicians consulted with a nephrologist. The timeline showed how her condition deteriorated over the hours and days, how the staff administered desmopressin at shocking low dosages, and how they failed to compensate for the water being filtered out by her kidneys. The animation concluded with Miranda suffering from hypernatremic encephalopathy, pneumonia, and a pneumothorax. She spent over three months in the hospital, experiencing multiple additional spikes in her salt level before she was finally discharged.
Despite mediation attempts, there were no settlement offers from the Defense until a week before trial. Once in front of a jury, Mike showed the animation as his experts testified. It proved so useful that the jury even wanted to rewatch part of it during deliberation. In the end, the jury returned a $68,000,000 verdict for Miranda and her family. While happy that Miranda’s parents had some financial support, Mike knew that no amount of money would have been enough.
Mike Trentalange is a managing partner of Trentalange and Kelley, P.A. in Tampa, Florida, where he practices plaintiff medical malpractice law almost exclusively. In addition to his legal background, he also has a background in bioethics. Additionally, his experience as an active military member gave him a strong work ethic and a sense of loyalty that he brings to his clients. Mike makes it exceedingly clear that he truly cares for his clients’ well-being and fights for them to the best of his ability every time.
