Amy Geiler Won Her Medical Malpractice Case. She Still Won’t See True Justice.

Amy suffers from a neurological condition called Osmotic demyelination syndrome (ODS). ODS causes the brain to be unable to communicate with the body due to damage to the brain stem. It has left Amy in a locked-in state. Amy has no voluntary muscle movement below her neck, leaving her unable to move her body, talk, eat, or otherwise take care of herself. What makes locked-in syndrome so awful is that Amy is conscious, alert, and has cognitive abilities, but cannot show facial expressions, speak, or meaningfully move her body. She can hear Gabriele talk to her but cannot respond verbally. Amy can only respond by blinking or sticking her tongue out.

ODS usually results from the rapid over-correction of hyponatremia—very low sodium levels. Medical experts agree that the safest approach to treating a patient with low sodium is to increase the sodium levels by four to six points in a 24-hour period, but absolutely no more than eight points in 24 hours. Amy’s sodium levels were raised by more than 17 points within a 24-hour period by negligent medical personnel.

This is a story of Amy and Nevada’s failed medical malpractice laws.

What happened to Amy Geiler

On New Year’s Day 2019, Amy fell in her house and broke her nose. She was taken by ambulance to the emergency room for treatment. The hospital staff ran blood tests, which showed Amy had a  sodium level of 107. Normal sodium levels are between 135 and 145, and anything below 120 is considered critically low.

The emergency room doctor immediately ordered IV fluids, which caused Amy’s sodium level to rise 3 points in one hour and 21 minutes.

The hospital had a written policy that requires patients with sodium levels under 110 to be admitted to the ICU. The emergency room doctor determined Amy needed to be admitted. But, because emergency room doctors are not allowed to admit patients at that hospital, Amy was assigned a doctor called a hospitalist.

Within five minutes of assuming care, the hospitalist decided not to admit Amy and instead to transfer her to another facility. The hospitalist told Amy that her insurance was not accepted by the hospital and that he wanted to save her from a surprise bill. This was not true, and Amy’s insurance company told the hospitalist on a recorded phone call that Amy could be admitted to the hospital under her health insurance. The hospitalist still made the decision to transfer Amy to another facility. In the transfer paperwork, he said Amy was stable for transfer and that she had no emergency medical condition.

The hospitalist decided to transfer Amy to Mountain’s Edge Hospital, which is actually more of a skilled nursing facility than a hospital. Mountain’s Edge does not have an ICU or on-site emergency department. It does not have a physician on-site 24/7 and lacked staff trained in hyponatremia. Nor did it have a working on-site pharmacy, radiology lab, or an on-site laboratory. Staff could not perform emergency lab work.

Amy was transferred and was not seen by a specialist until about 24 hours after her arrival at Mountain’s Edge. While Mountain’s Edge staff did run blood work, the critically low sodium levels were not reported to the correct doctors and were not acted upon.

As a result, Amy’s sodium level increased by more than 17 points in 24 hours, resulting in Amy’s locked-in syndrome.

The hospitalist who transferred Amy worked for a group of doctors owned by Dr. Amit Valera. Dr. Valera was also the Chief Medical Officer at Mountain’s Edge Hospital, with a responsibility for the facility’s census—how much staff was needed for the patients at Mountain’s Edge. When the hospitalist reached out to Dr. Valera about Amy, Dr. Valera sent a text message to the hospitalist asking to transfer Amy to Mountain’s Edge. Dr. Valera was listed as the receiving physician at Mountain’s Edge for Amy. He did not see Amy until the following night after her admission. The hospitalist later admitted that he had no medical basis for transferring Amy.

How Nevada’s justice system failed Amy Geiler

Amy’s mother filed a lawsuit on Amy’s behalf and Amy recently had her day in court. A jury made up of citizens of Clark County, NV determined that the hospitalist, the first hospital, Dr. Valera, Mountain’s Edge, and various doctors and nurses at Mountain’s Edge were all negligent in their care of Amy. The jurors determined that the negligence of Dr. Valera, Mountain’s Edge, and the doctors and nurses at Mountain’s Edge were the legal cause of Amy’s injuries. The jurors then determined that Amy’s damages equaled just under $47 million, with $1.4 million in past medical expenses and $10 million in future medical expenses.

These types of damages, called economic damages, simply mean Amy can begin getting treatment she needs. They do not take into account the pain and suffering and loss of enjoyment of life Amy suffered by being in a locked-in state. The jurors were asked to also determine this amount and returned a verdict of $7 million in past pain and suffering and $28 million for future pain and suffering. These damages are called non-economic damages and are meant to recognize the things that were taken from Amy and can never be replaced.

Under Nevada’s medical malpractice laws, the $35 million in damages for pain and suffering that the jurors determined was fair for what Amy suffered will now automatically be reduced to the legal limit of $350,000. This legal limit is called a damages cap.1

You may be asking yourself how that can be. In 2004, Nevada voters were asked to vote on a ballot initiative to amend the Nevada Constitution to include reforms to medical malpractice laws. For those of you who lived in Nevada at the time, you may remember TV commercials asking voters to Keep Doctors In Nevada—known as KODIN. The argument behind these laws were that medical malpractice lawsuits were making malpractice too expensive for Nevada doctors and that doctors would have to leave the state if reforms were not made to these laws. It was a compelling narrative, and voters believed it to be true, voting to pass the reforms.

Those reforms placed a cap of $350,000 on non-economic damages in all medical malpractice lawsuits. No matter how bad the injuries or the conduct of the person who caused the injuries, the maximum someone could receive is $350,000. This is true no matter how much a jury determines the damages to actually be. And it’s true no matter how many persons were affected by the malpractice. For example, imagine that a parent was killed due to malpractice and left behind a spouse and three children. If the family brought a lawsuit for wrongful death, the most that the spouse and three children could recover is $350,000 for the loss of their loved one. Not $350,000 for the spouse and $350,000 for each child. $350,000 to split amongst all of them. That is the amount our laws say a life is worth in Nevada. It is never adjusted for things like inflation (not that that would make the law any fairer) and it has not been raised since its creation almost 20 years ago.

KODIN hurt people while insurers raked in profits

In reality, KODIN was legislation pushed by insurance companies. The idea of malpractice rates being too high and doctors fleeing the state was false. It was made up. Insurance companies saw a way to limit the amounts they pay out on malpractice claims and to create an environment where injured persons and lawyers could not afford financially to file lawsuits on legitimate cases. The law certainly had that effect. It has made it incredibly hard for persons injured by medical malpractice and lawyers who handle those cases to bring lawsuits. In addition to the caps on damages, which jurors are not told about during trial, the law shortened the time in which a lawsuit has to be filed (from the normal two years to one year) and requires an affidavit from an expert witness to be filed with the lawsuit (which increases costs before even filing a lawsuit). Most medical malpractice lawsuits require multiple expert witnesses, and it is not uncommon for the injured person to have to spend $50,000 to $100,000, if not more, in costs just to bring a case to trial. In Amy Geiler’s case, we spent over $750,000 in costs to bring her case to trial. The lawyers pay those costs upfront, but with the caps on damages, lawyers have to be very selective on which cases they can afford to take to trial, or they could face a scenario where costs exceed the $350,000 cap.

We were all promised that these medical malpractice laws would lead to better medicine in Nevada. For the past 20 years, however, we have seen the exact opposite happen. Nevada has some of the worst-ranked hospitals in the nation, shortages of critical types of specialists, and doctors who have been forced to leave other states because they posed a risk to patients but who are now practicing in Nevada because these laws protect dangerous doctors.

KODIN was based on a similar California law passed in 1975 called MICRA. MICRA placed caps in California on non-economic damages of $250,000 and was based on the same argument as KODIN, that doctors’ malpractice insurance rates were too high. In fact, after MICRA was passed, doctor’s insurance rates continued to rise, showing that the story about insurance rates was simply made up. MICRA had nothing to do with lowering insurance rates for doctors and everything to do with lowering the amounts insurance companies were forced to pay for medical negligence.

We can fight back against unfair, unjust damage caps in Nevada

For 50 years the caps in California were never raised. But, in 2022 lawyers who represent injured persons fought for a revision to the law. With the countless stories of their clients who never received true justice as support, these lawyers were able to convince legislators to amend MICRA to raise the cap on non-economic damages to $350,000. Over the next ten years, the cap will incrementally rise to $750,000 for non-death cases and $1 million for cases involving a death. While this still hardly seems fair it is a big win after 50 years of draconian laws and is an example Nevada should follow.

When Amy Geiler was injured, her son Gabriele was 5 years old. At the time, Gabriele’s father, Lawrence had been recently diagnosed with terminal cancer and was in the hospital at the time of Amy’s incident. Lawrence died shortly after Amy suffered her brain injury. Gabriele was left fatherless and with a mother who is unable to physically care for him. Thankfully, Gabriele has a loving family who has been caring for him while at the same time fighting on Amy’s behalf.

We are honored to have been able to fight for Amy, and we are not done fighting to make sure she receives the money needed to provide compassionate care for the rest of her life. We are also ready to fight to change KODIN. It’s time for Nevada to change its laws. These laws do not protect patients or provide any incentive to provide higher levels of medical care. While we would love for the caps to go away completely, they need to at the very least be increased. If you would like to help in this fight you can contact your state legislators and let them know how unfair these laws are. Nevada’s legislature meets every other year and is currently in session. You can find your legislators here.

In the meantime, if you or a loved one were injured as a result of medical malpractice, the injury attorneys at Claggett & Sykes can help. We understand how to approach these types of cases and have a record of successful results for our clients – let us help you, too. To schedule a free consultation with an experienced lawyer, call our Las Vegas or Reno offices today or fill out our contact form.


1In 2023, Nevada raised its damage caps $80,000 each year on Jan. 1 until they reach $750,000. Then, they go up 2.1% each year after that.