A Doctor In Probation Or A Rare Dental Related Disease: What Killed The Nine Year Old Girl In California?

A few hours before her dental surgery on 18th of March, 2025, Silvana Moreno complained of having a headache, but didn’t look particularly troubled. After the Nine year old South California girl was shifted to the recovery room post the surgical procedure, she was described as being ‘not quite herself’ and slept all the way on her journey back home. Her grandmother recalls Silavana snoring a lot. Way more than she ever had. The family thought she must be dizzy because of the anaesthesia. When Silvana arrived home, she was carried inside and remained asleep for around 90 minutes before her snoring got considerably quieter and her breath got slower, according to the autopsy report. The family checked her pulse and heartbeat and noticed something was really wrong. That's when they called 911. The dispatcher asked Silavana's family to administer chest compression while the emergency service was on its way. Silvana was taken to the Emergency Department at a local Children's hospital. The medical personel tried many several life-saving tactics to no avail. Silvana was pronounced dead at 5:44 p.m.

The cause

Soon after Silvana’s death, media reports about ‘disciplinary’ issues, the dentist who administered her anaesthesia had faced in the past, came to light . The reports said that this was not the first time a patient under Dr. Ryan Watkins’s supervision. 

The dentist trained in anesthesiology had faced disciplinary action back in 2020, and was subsequently put on probation. In an incident dating back to 2016, Ryan administered anaesthesia on a 54 year old man after which the man’s heart stopped functioning, the man was said to be in ‘perfect health’ prior to the administration of the sedatives. He survived the procedure, but "suffered fractured ribs likely caused by chest compressions and he was later diagnosed with a mild neurocognitive disorder caused by cardiac arrest", the media reports suggested.  

According to the autopsy report though, Silvana had a fever but her symptoms subsided after taking children’s Tylenol on her family's advice. The clinic claimed that they "were not aware of a fever nor any illness" and that if  Watkins had been informed of "any recent fever or illness, especially within 24 hours of the procedure, it would have been rescheduled until the patient was healthy. Watkins, in a public statement, also said Silvana never exhibited any signs of methemoglobinemia an "extremely rare condition that can occur with nitrous oxide administration," throughout either the procedure or her recovery. The authorities have listed her cause of death as methemoglobinemia in the setting of recent nitrous oxide administration and concluded that her death was an “accident’’ rather than medical negligence. 

Also Read: Meet Kuwar Amritbir Singh, The Fitness Icon Who Conquered 33 World Records Without a Gym

What is Methemoglobinemia?

Methemoglobinemia is a rare blood disorder where the blood can't carry and deliver oxygen properly. Normally, red blood cells use a protein called hemoglobin to transport oxygen. But in this condition, hemoglobin turns into a form called methemoglobin, which holds onto oxygen too tightly and doesn’t release it to the body’s tissues. This can cause symptoms like bluish skin, lips, or nails, fatigue, and shortness of breath. It can be inherited or caused by certain medicines, chemicals, or foods. Mild cases may not need treatment, but severe ones can be serious and require medication to restore normal oxygen flow.

Deaths Due to anaesthesia

If administered in accordance with the guidelines and patient’s condition, Anaesthetic procedures, today, are safer than they have ever been. In fact, they are regarded as one of the safest medical interventions and modern surgery isn't feasible (In most cases) without anaesthesia . However, there is still plenty that could go wrong, which includes the risk of dying. Statistically, the chance of death during an operation due to anaesthetic complications depends on the patient’s age and health. Complications are more likely in the very young and elderly and increase with obesity and smoking. For a fit patient who is under 60 years of age, the chances of dying due to an anaesthetic complication is approximately 1 in 1,000,000. The statistics for a person over 60 undergoing anaesthesia depends on other conditions as well.