Preventable Tragedies: Lessons from Adriana Smith's Story
Where Adriana Smith could have been saved—and how we build systems that intervene before it’s too late.
Adriana Smith did what patients are taught to do:
She recognized a serious symptom.
She sought emergency care.
She came back when it didn’t get better.
And still—she was sent home. Twice.
No imaging. No escalation. No diagnosis.
By the time anyone took her seriously, she was brain dead.
This post is not about blame. It’s about prevention.
And the uncomfortable truth is: Adriana’s death was not inevitable.
There were moments—clear, visible, preventable moments—when someone could have acted.
And someone didn’t.
🩺 Point of Intervention #1: The First Headache Should Have Triggered Alarm
A severe, new headache in early pregnancy is a red flag. It should prompt:
Blood pressure checks
Urinalysis for protein
Neurologic exam
At minimum, consideration of imaging
What might have helped:
✅ A clinical decision support tool that flagged “severe headache in pregnancy” as high-risk
✅ A digital triage system that prioritized neuro workup
✅ An OB or ER protocol that automatically escalated persistent neurologic complaints
Bottom line: If she’d had a CT scan at the first hospital, her brain clots might have been caught—and treated—before her collapse.
🏥 Point of Intervention #2: The Second Visit Should Have Changed the Plan
Returning to the ER for the same unresolved symptom is a clinical siren.
This should have prompted:
Review of her prior discharge
Full reassessment
Imaging, at minimum
Admission, if diagnosis remained unclear
What might have helped:
✅ A case manager or patient advocate trained to escalate unresolved neurologic symptoms
✅ Built-in EMR alert for “repeat visit within 24 hours for same complaint”
✅ In-hospital policy that flags pregnancy + return visit = required second opinion
Bottom line: Her return visit was not a fresh complaint—it was a failure signal. It should have been treated like one.
🧠 Point of Intervention #3: A Simple Question Could Have Changed the Outcome
“Do you feel safe going home?”
Had anyone asked Adriana that—and really listened—the answer may have stopped her discharge.
What might have helped:
✅ Structured discharge checklist that includes this question
✅ Provider training to pause when a patient hesitates or expresses uncertainty
✅ A built-in delay for high-risk pregnancy discharges—requiring attending sign-off
Bottom line: Clinical judgment doesn’t just live in lab values. It lives in discomfort. And Adriana was trying to tell someone she wasn’t okay.
⚖️ Point of Intervention #4: The Legal Trap Could Have Been Avoided
After brain death, Adriana’s family was told they had no say because of Georgia’s “heartbeat” law.
But in May 2025, the Attorney General clarified: Georgia law did not require the hospital to continue life support.
The hospital chose the most conservative legal interpretation.
What might have helped:
✅ Legal support for families navigating fetal personhood laws
✅ Advance directives with pregnancy-specific language
✅ Advocacy organizations involved early, before hospital ethics boards took over
Bottom line: A clearly written ACD—and early legal support—might have strengthened her family’s position or prevented prolonged somatic support.
Cases like Adriana Smith’s have shaped Diosa Ara’s clinical care model by making one thing painfully clear: in obstetrics, the window between “something feels off” and catastrophic outcome is often razor-thin—and systemically biased.
At Diosa Ara, we intervene at the point of care most proximal to a potential crisis. That might look like offering educational reassurance, flagging red-flag symptoms, making direct clinical requests on the patient’s behalf, coordinating a transfer, or even initiating legal action when someone becomes incapacitated.
We don’t wait for a diagnosis or a textbook checklist—we respond to risk in real time. Because obstetrics moves fast, and any intervention that only works upstream or downstream—while leaving hospital-based racism untouched—will fail. The data bears that out. That’s why we’re building a model that centers advocacy, escalation, and protection at the precise moment when the system is most likely to ignore or abandon you.
✅ What You Can Do Right Now
If you’re pregnant (or could become pregnant):
📋 Draft an Advance Care Directive that includes pregnancy-specific language
🧠 Know the red flags: Severe headache, vision changes, swelling, shortness of breath
📞 Seek a second opinion if you’re discharged and don’t feel better
💬 Before leaving any ER: “Do you know what’s causing this? Are you sure it’s not serious?”
If you’re a birth worker, doula, or provider:
🏥 Train patients to recognize return visits as serious escalation
💡 Advocate for discharge protocols that center patient safety and comfort
📚 Educate clients on their legal rights in your state—including how pregnancy impacts consent and end-of-life care
In a Better System, Adriana Would Still Be Alive
This wasn’t an unavoidable tragedy. It was a cascade of delays, dismissals, and legal overreach.
It was a headache ignored.
A second visit unheeded.
A death prolonged by law.
A baby born into uncertainty.
It didn’t have to be this way.
And it doesn’t have to happen again.
Next: What We Owe Adriana Smith
In our final post, we ask:
Now that we know what happened—what must change?
We’ll explore how hospitals, lawmakers, and communities must respond.
Because Adriana Smith didn’t just deserve care.
She deserved respect.
And even in death, she deserves to be heard.