SEATTLE — Warning: This story contains graphic photos that may not be appropriate for all viewers. Viewers discretion is advised.
In February 2021, Sahana Ramesh of Bothell – the 16-year-old daughter of Indian immigrants – died from myocarditis, heart failure, in front of her entire family. Her parents recently filed a lawsuit against Seattle Children’s Hospital alleging health care racism contributed to her death.
“I feel totally let down. They basically failed our family,” said Dr. Anapathur Ramesh, Sahana’s father.
“It is sickening. If a doctor [treated her differently] on the basis of race, it is sickening,” said Sahana’s mother Nalini Ramesh.
Three months prior to her death, Sahana was active and healthy. She loved eating out at restaurants, creating artwork, traveling with her family, cooking with her mother, and playing the piano.
In mid-November 2020, she broke out in an acute, itchy and painful rash. She had red spots all over her body. Her feet and hands were swollen. Her skin was peeling off. Her face was so swollen she couldn’t open her eyes. Sahana was unrecognizable and suffering.
“Her face was so disfigured - so disfigured. She was devastated,” Nalini Ramesh said.
Sahana ended up in an ambulance, taken to the emergency department of Seattle Children’s Hospital on November 24, 2020. Doctors there diagnosed her with a rare disease known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). DRESS syndrome is a severe, potentially life-threatening reaction to a medication.
In Sahana’s case, she was allergic to a seizure medication prescribed for her by a Seattle Children’s neurologist two months prior.
After getting diagnosed doctors at the hospital sent her home.
“At the end of it they said, ‘Here is the ointment. Here is the medication. Go home,’” Nalini said.
When the DRESS syndrome symptoms didn’t get better, Sahana’s parents became increasingly worried. In addition to the rash, Sahana got frequent chills, had a fever and a fast heart rate. Medical records show over 11 weeks, they took Sahana to the emergency department at Children’s three more times. They called with concerns 16 times and sent 22 emails.
Her mother’s messages asked if doctors thought Sahana could have sepsis, if she should be admitted to the hospital to monitor her heart and that her pulse was 134 beats per minute. “We are worried,” her mother wrote in one email. Four days later, she wrote: “Can you please help?”
The parents said they felt their concerns weren’t taken seriously.
“They were looking at [her] like she had a little scrape. Like she fell down or had a common cold or something. This was serious,” Nalini said.
Medical records show physicians at Children’s knew DRESS syndrome was very serious. They wrote in Sahana’s chart that DRESS is “potentially fatal,” and “internal involvement may involve ... myocarditis (heart failure).”
But the records show Sahana was never tested for myocarditis and she was never admitted to the hospital. Her parents said no one at Children’s ever told them about the potential for heart problems, or that their daughter could die from DRESS.
“If they knew that this could be fatal, why didn’t they tell us?" Nalini said. “At every visit I asked ‘Is her life in danger?’ And they said ‘no,’ categorically said ‘no.’ If they would have said her life was in danger, we would have taken her to the Mayo Clinic or somewhere like that.”
Three months after the first signs of her rash, on February 12, 2021, Sahana collapsed in her parents’ bedroom and died minutes later. The Snohomish County Medical Examiner found the cause of death was myocarditis from DRESS.
“(Children’s) didn’t seem to care (about Sahana’s disease). They didn’t seem to care. Why? That is what I need to know. Why didn’t you care?” said Nalini.
According to the lawsuit filed by the Ramesh family, implicit bias – “widespread racism” – played a part in Sahana’s demise.
“Our clients were ignored. Their concerns were disregarded. The types of care offered our clients are just indefensible,” said plaintiff attorney Marty McLean.
He said evidence shows if Sahana and her parents had been white, they would have had a better chance of getting appropriate heart tests and admission to the hospital for more intense care and monitoring.
“[We’re not saying] there is some explicit plot to engage in racism. It’s about the effect, the way implicit bias negatively affects particular groups of people. And in a hospital setting systemic racism can have devastating affects like in Sahana’s case.”
In legal filings, Seattle Children’s said the plaintiffs have not offered any direct evidence to show racism played a part in Sahana’s care.
A hospital spokesperson declined to be interviewed, but in a written statement she said they are dedicated to equity.
“Our hearts go out to any family mourning the loss of a child and we take our responsibility to provide equitable, high-quality care seriously, but cannot comment on this specific case due to pending litigation,” wrote the spokesperson.
Children’s Hospital admits problems with racism
The same year Sahana died, 2021, Seattle Children’s Hospital publicly admitted they had a problem with systemic racism.
The month Sahana was diagnosed with DRESS at the hospital, one of the top doctors there, Dr. Ben Danielson, resigned in protest. In a lawsuit filed last year he said he could no longer be associated with a “racist organization” and that racism “affected quality of care provided to Black and Brown families, resulting in diminished medical outcomes.”
Danielson’s resignation prompted the hospital to hire former U.S. Attorney General Eric Holder, now a consultant, to investigate allegations of racism at their organization. Holder’s July 2021 review found racism was a part of Seattle Children’s culture and that patients of color were treated differently.
“While Seattle Children’s is an industry leader in tracking health equity metrics, it lacks the accountability, infrastructure, and culture to successfully mitigate identified racial disparities in patient treatment,” Holder wrote. “(The hospital should) issue a public statement from the CEO and Board Chair acknowledging Seattle Children’s role in enabling and perpetuating systemic racism, taking responsibility for failing to address racial disparities sooner and with greater urgency.”
In September that same year – seven months after Sahana’s death – Seattle Children’s issued a Health Equity and Anti-Racism Action Plan that laid out specific steps the organization would take to improve diversity, equity, inclusion and patient outcomes.
“This Action Plan marks a beginning, and there is a great deal of work for us to do to eliminate the systemic racism that exists at Seattle Children’s,” wrote CEO Dr. Jeff Sperring. “Meaningful culture change cannot happen overnight, but we promise to act with great urgency. We acknowledge Seattle Children’s had not lived up to its promise and commitment to our community.”
Court records in the Ramesh lawsuit show Seattle Children’s has treated approximately 24 other children with DRESS in the last five years and that 60% of those patients were admitted to the hospital. McLean, the plaintiff attorney, said they requested records to show the racial makeup of those patients, but Seattle Children’s Hospital refuses to hand those documents over.
“Complying with this request will impose undue burden on (the hospital) as it encompasses tens of thousands of pages of unrelated medical records for other patients, which will need to be manually reviewed by hand to ensure that all protected health information has been redacted,” wrote Seattle Children’s attorney R. Pierce Rand in a legal filing on March 11, 2024. “Additionally (Seattle Children’s) cannot respond to this discovery request without exposing itself to significant risk of violating state and federal laws prohibiting the unauthorized disclosure of healthcare information.”
A King County Superior Court judge agreed that the hospital does not have to disclose the records.
Sahana’s parents said if the data showed equitable treatment of patients, they believe the hospital would have turned them over.
“Let’s find out. Let’s go look at all the other children who were admitted. I would really, really like to know that,” Nalini said. “They must have something to hide.”
Sahana’s parents struggle with accepting that racism could have played a part in their daughter’s death. They said they hope their lawsuit will ultimately bring them answers.
“How many children need to die before someone says ‘enough’ s enough.’ One child should be enough. We live in a different age. We shouldn’t have to have this happen again,” Nalini said. “Anytime I go to any place I’m reminded of (Sahana). She could have been alive. Our daughter could have been alive if they had treated her with professional integrity.”