Detroit girl, 9, dies after routine tonsillectomy
- Girl eager for Christmas dies as mother searches for pharmacy to fill prescription for oxycode
- Lawyer for family: ‘Every single person who looked at this kid has to answer questions.’
- Children’s Hospital says it is ‘deeply saddened’ by 9-year-old’s death
Sonia Gambrell was “extremely nervous,” fearing something would go wrong with surgery.
The night before, she couldn’t sleep and considered postponing a tonsillectomy and adenoidectomy for her 9-year-old daughter, Anyialah Greer. But she steeled her nerves and made the drive from her home on Detroit’s east side to Children’s Hospital of Michigan in Troy on Dec. 8.
Gambrell didn’t want her daughter to worry. So she didn’t kiss the girl before the procedure that was supposed to take 40 minutes.
Three hours after they left the hospital, Anyialah was dead. And now, the family is searching for answers about how a procedure so routine could go so awry.
“I really wish I’d given her a kiss now,” said Gambrell, 27.
“I still feel like I’m dreaming. Like, ‘Where is my daughter?’ Someone is going to come up and tell me it’s all over. That this was a mistake. She can’t die from something they do every day.”
Autopsy reports are pending and not expected for weeks. But medical reports obtained by Gambrell and shared with The Detroit News indicate Anyialah (pronounced Ah-nye-lah) could have had an obstructed airway, issues with anesthesia or an undetected heart condition before dying of cardiac arrest.
Gambrell has hired an attorney, James J. Harrington IV, and is preparing to sue the Detroit Medical Center, which owns Children’s Hospital. Among her allegations: The ear, nose and throat specialist who performed the surgery, Dr. Bianca Siegel, shouldn’t have discharged Anyialah because her health was precarious.
“We were going on their word that things were OK,” said Gambrell’s fiancé, Dazmon Ellington, 28, who persuaded the mother to go through with the operation.
“We thought, ‘They’re doctors. They know what they’re doing.’ ”
The girl should have never left the facility that opened last February, contended Harrington, a partner with Fieger Law of Southfield who specializes in medical malpractice.
“Under federal law, you can’t discharge people unless they’re in stable condition. I don’t know how she could be considered stable when she died just hours after discharge,” he said.
“What was the anesthesiologist doing? What happened in the OR? What did the nurses know? As far as I’m concerned, every single person who looked at this kid has to answer questions. I am furious about this.”
Gambrell waived her privacy rights, which would allow the DMC to discuss Anyialah’s care without violating the federal Health Insurance Portability and Accountability Act.
The DMC did not address specific questions and issued a statement saying it is “deeply saddened” and takes “the care and service we provide our patients very seriously and we are working with the family during this difficult time.”
Siegel didn’t respond to requests for comment.
There’s always risk
The third most common childhood surgery behind circumcision and ear tubes, tonsillectomies are performed 530,000 times per year.
They are overwhelmingly safe, but like any surgery, there are risks, said Dr. Richard Rosenfeld, distinguished professor and chairman of otolaryngology at the State University of New York Downstate Medical Center in Brooklyn.
Among those risks are bad reactions to anesthesia or hemorrhaging immediately following or as long as two weeks after surgery, Rosenfeld said. Small globs of tissue in the throat, tonsils are connected to five arteries that can bleed.
“You don’t want to scare people to think tonsillectomies are a dangerous surgery,” Rosenfeld told The News.
“It is safe. The mortality rate is extremely low. Patients could have other (health issues)... there’s usually more to the equation.”
There’s about a 1-in-50,000 chance of death following tonsillectomies, Rosenfeld said, and most adverse outcomes usually involve underlying health problems. Anyialah needed the surgery because she had sleep apnea. Medical records indicate she frequently had runny noses, sometimes slept through school and gasped for air in her sleep. Otherwise, she was “perfectly healthy,” said her mother.
The girl’s adenoids also were removed that day. Known as the pharyngeal tonsil, adenoids are tissue behind the nose. Their removal is even safer than tonsils because they are connected with capillaries, making severe bleeding highly unlikely, Rosenfeld said.
‘We are going to miss you’
Years ago, Gambrell had Anyialah’s name tattooed on her right hand.
“She was my right hand. She was always helping with her brothers and sisters, like she was a boss of them,” said Gambrell, who has six other children and was previously married.
“But she was a kid. Just a kid. And these days, there aren’t many who can say that.”
The girl loved Barbie, making home movies, singing and dancing, putting on makeup and eating Tostitos. In a program from the Dec. 17 funeral for Anyialah, her three younger sisters, Armani, Ahyonna and Aubrey, wrote of how she pretended to be their parent.
“Sister, we are going to miss you so much,” they wrote.
“We will miss the way you would eat all the food. We will miss the way that you would tell on us when we got on your nerves. Na Na, you made the best noodles ever.”
Anyialah was in third grade at Timbuktu Academy, an east side charter school. The day before the surgery, Anyialah was coughing so hard she had to leave the classroom, remembered the school’s principal, Cha-Rhonda Edgerson.
“Such a sweet girl. We are just devastated,” Edgerson said.
“A child that young? Life is gone. That’s a routine surgery. Who would think anything would happen?”
Anyialah was going to be off one week to recover from the operation. After that was holiday break. Her mother had big plans. They’d recently moved to a larger house in the East English Village neighborhood with room for a big Christmas tree that Anyialah decorated two days before the operation.
Over the break, they were going to get their nails done together, buy new shoes and do Christmas right.
The final hours
Snow fell the day of surgery. Gambrell wondered if they’d make the appointment on time.
Perhaps that wouldn’t be so bad, she remembered thinking, because of her fears.
Since that awful day, Gambrell has scrutinized the next several hours.
Anyialah went to the OR at 12:10 p.m. She was supposed to be out at 12:40. An hour of recovery would follow. Then it would be back to Detroit to reunite with her siblings by 2:45 p.m.
It didn’t work out that way.
The operation didn’t end until 2:23 p.m, Gambrell said. Medical records are unclear why the operation lasted so long, but note that Anyialah was put under anesthesia twice and bled from her nose. Slight bleeding isn’t uncommon after adenoid surgery.
When Anyialah returned from the operation, she was groggy and unresponsive.
“I was crying,” Gambrell said. “I didn’t like seeing her like this. She would hold her throat and fall back asleep.”
The girl had trouble staying awake, blood dripped from her nose and she drooled, Gambrell said. She was given a painkiller and discharged at 3:05 p.m., said Ellington, the fiancé who drove home.
Snow began to fall harder. Roads were bad, doubling the 30-minute drive to Detroit.
They had to first pick up Gambrell’s other children at her mother’s house a few blocks from their family home. They got the children and dropped them off at their house. Anyialah stayed in the car. She wasn’t doing well, drifting in and out of sleep and slumping deeper in her seat, Gambrell said.
So the family drove to get medicine. The doctor, Siegel, had written a prescription for oxycodone, a painkiller. They went to two nearby pharmacies. Neither would fill the prescription for the opioid that is often abused and can make drug stores the target of addicts.
That’s a daily reality in Detroit and other cities, said Joseph Fakhouri, chairman of the Wayne County Pharmacists Association. Many pharmacies won’t fill new prescriptions for painkillers because of abuse and government regulations that closely monitor narcotic supplies and limits their supply based on previous useage, said Fakhouri, who added he turns away four to 10 requests a day at his store, Andy’s Pharmacy in Midtown.
Gambrell said she had one last hope: the pharmacy at St. John’s Hospital on the border to Grosse Pointe Woods. The family pulled in 5 minutes before its 6 p.m. closing time. The pharmacy also wouldn’t fill the prescription because it wasn’t written by one of the hospital’s doctors.
As they were leaving the parking lot and heading home, Gambrell turned around to look at her daughter in the back seat.
“She wasn’t making a sound. I said, ‘Anyialah, Anyialah, Anyialah. Stop playing with me,’ ” Gambrell said.
“She didn’t do nothing. I touched her chest and she fell forward. Her skin was cold.”
They drove back to St. John’s. Minutes later, doctors delivered the news.
Anyialah was brain dead. She was put on a ventilator and remained on it for about nine hours.
Cause of death?
Medical reports reviewed by The News offer few clues about what went wrong.
“The patient tolerated the procedure well without any complications,” a report from Children’s Hospital reads.
The report notes that Anyialah “did have some bleeding from her nose” after doctors removed a tube that supplied oxygen to her during the surgery. But her throat was dry and wasn’t bleeding, the Children’s report states.
At St. John’s hours later, doctors reported “dried, clotted blood that seemed old” in her throat. Doctors there shocked Anyialah six times with defibrillators and gave her drugs to restore her heartbeat. But she never regained consciousness.
The report includes several possible issues precipitating the death: an undetected irregular heartbeat such as Brugada syndrome that can cause sudden cardiac arrest; an airway obstruction; bad reaction to anesthesia; seizure; or overactive blood clotting.
Rosenfeld, the otolaryngology professor, said patients don’t necessarily need to be admitted for observation if they bleed immediately following surgery, so long as the wound is under control. Siegel joined the DMC in 2015, one year after completing her residency at the Einstein-Montefiore Medical Center in New York. She graduated from Wayne State University School of Medicine in 2009.
“I’m not going to cast aspersions,” said Harrington, Gambrell’s attorney. “The best doctors make mistakes. The most inexperienced do heroic things from time to time.
“Whatever happened, though, led to a terrible mistake that killed a kid.”
More should be known when the autopsy is complete. Tissue and blood tests could take several weeks, said Lloyd Jackson, spokesman for the Wayne County Medical Examiner’s Office.
Gambrell calls the number every other day to check on the results.
“That was my baby. At first, I was sad. Now, I’m angry because I feel like it shouldn’t have happened — not for some procedure that should have taken 40 minutes,” Gambrell said.