Gainesville, FL – A Florida hospital is facing a wrongful death lawsuit after allegedly giving a 2-year-old boy 10 times the prescribed dose of potassium phosphate due to a deleted decimal point in his medical chart. The boy, De’Markus Page, went into cardiac arrest and later died after staff reportedly failed to notice his deteriorating condition for over 20 minutes, according to court documents.
The Incident: Decimal Error Leads to Fatal Overdose
According to a lawsuit filed by the Page family, De’Markus was admitted to UF Health Shands Children’s Hospital in March 2024 after being transferred from AdventHealth Ocala for treatment of a viral illness. Initially described as an “active toddler” with minor developmental delays and suspected autism, De’Markus was reportedly underweight and receiving nutritional supplements to stabilize his health.
Hospital staff originally ordered 1.5 mmol of oral potassium phosphate to be given twice daily. However, the next day, a physician allegedly entered a new order incorrectly, changing the dosage to 15 mmol — ten times higher than prescribed — by deleting a critical decimal point.
“The doctor failed to recognize or blatantly ignored the fact that De’Markus’ potassium level had returned to normal that morning,” the complaint reads.
This massive error, combined with two other potassium-based treatments the child was already receiving — intravenous KCL and Pedialyte — reportedly pushed his potassium levels to dangerously high limits.
Investigation and Medical Negligence Claims
According to the complaint filed by Searcy Law, the hospital staff failed to monitor De’Markus’ electrolyte levels and did not notice his potassium overdose until he went into cardiac arrest.
The lawsuit claims there was no proper emergency equipment available on the pediatric floor and alleges staff made multiple failed attempts to intubate him once the crisis began.
“De’Markus was reported to have a spontaneous return of circulation and cardiac activity, but the anoxic damage already done to his brain and other vital organs was catastrophic,” the complaint states.
Hospital staff allegedly delayed resuscitation efforts by at least 20 minutes, a delay that proved fatal. De’Markus remained on life support for more than two weeks, suffering from severe brain damage caused by oxygen deprivation.
Court Proceedings and Legal Allegations
The wrongful death lawsuit accuses UF Health Shands Children’s Hospital — the teaching hospital for the University of Florida — of gross medical negligence, including:
- Administering an “exceedingly high” dose of medication to a vulnerable child.
- Failing to verify or double-check the dosage change.
- Not properly monitoring his potassium levels after the error.
- Delaying emergency response when he went into cardiac arrest.
Attorney Jordan Dulcie, representing the Page family, described the tragedy as entirely preventable.
“No parent should have to lose a child like this,” Dulcie said. “What this family has endured is unimaginable, and the worst part is that it was completely avoidable.”
The family’s lawsuit seeks damages for wrongful death and medical malpractice, emphasizing that the decimal-point error and the hospital’s response violated basic pediatric care protocols.
Family’s Reaction and Attorney’s Statement
De’Markus’ family described him as a bright, curious child who was making developmental progress despite some speech delays. The lawsuit notes that his nutritional challenges made him more vulnerable to fluid and electrolyte imbalances — a condition that required precise medical management.
Attorney Dulcie said the case serves as a wake-up call for hospitals that handle pediatric care.
“This case highlights serious concerns about patient safety and the oversight of vulnerable children with special needs,” Dulcie said. “We are committed to holding UF Shands accountable and ensuring this never happens to another family.”
De’Markus ultimately died from anoxic brain injury after weeks on a ventilator. His family said he passed away “in his mother’s arms” in the pediatric intensive care unit.
Hospital Response and Broader Safety Concerns
UF Health Shands Children’s Hospital has not publicly commented on the lawsuit or the allegations. However, the case raises renewed concerns about electronic medical record errors, particularly involving decimal-point omissions that can drastically alter medication dosages.
Medical safety advocates have warned for years that decimal errors are among the most common and deadly types of hospital medication mistakes, especially in pediatric settings where doses are calculated by body weight.
Patient safety organizations are now urging hospitals to adopt automated verification systems and mandatory double-check protocols to prevent such tragedies.
Conclusion
The death of 2-year-old De’Markus Page has ignited calls for greater accountability and stronger patient safety standards in children’s hospitals. As the Page family seeks justice through the courts, their attorney says their goal is not only compensation but also reform — to ensure no family experiences the same devastating loss caused by a preventable medical error.
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