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    Sunday, June 24, 2007

    "Troubled" Hospital: King-Harbor hospital in Los Angeles is in the news again for failing to recognize a medical emergency - in the emergency room:

    The shocking audiotape of the 911 call suggests the dispatcher had no idea what to do when she received a call last month from the boyfriend of Edith Isabel Rodriguez. As he pleaded with the dispatcher to send paramedics to her aid, Rodriguez lay on the floor, in pain, throwing up blood. The dispatcher was flummoxed, though, because the policy of "take the patient to the closest hospital" didn't apply. Rodriguez was already in the emergency room lobby of Los Angeles' inner city Martin Luther King Jr.-Harbor Hospital.

    Shortly after another bystander made a second futile 911 call imploring paramedics to take Rodriguez to another hospital, she died of a perforated bowel. A security videotape, still unreleased to the public, is said to show her writhing on the hospital floor unattended for 45 minutes. At one point, the tape reportedly shows a janitor going about his business mopping the floor around her.

    Good grief. How does that happen? Can the emergency room possibly be so busy that no one has the time to drop what they are doing to attend to a woman vomiting blood on the floor of their lobby? Sorry, but that defies belief. There's only one thing that could explain such a thing - indifference. No amount of healthcare reform is going to change that. It takes a fundamental shift in management attitudes and a willingness to punish those who fail to meet professional standards - whether they be the clerk sitting at the front desk registering patients or the doctor providing the care.

    posted by Sydney on 6/24/2007 12:16:00 PM 7 comments


    I agree this is horrible,but I don't understand why everyone is blaming the 911 operator. Obviously there was no protocol available to the operator about dealing with a patient already in an ER. Clearly the triage nurse is the most culpable,and I feel this goes beyond malpractice and criminal charges should be considered.

    By Anonymous Anonymous, at 1:23 PM  

    This is a local story where I live. She had been in two previous days with abdominal pain (according to the news), and was dismissed as a "regular". When her son begged the staff for help, they called the police instead and ran her ID, found out she had a warrant, and the cops were in the process of taking her out of the ER to jail when she died. Some ER nurses came out to the waiting room, saw her, and went back inside. Janitor (as was noted) cleaned around her as she lay on the floor. Some of the staff involved have been sent "letters" about their conduct, so far nobody has been fired.

    This lady may not have been a model citizen, but she did not deserve to be treated as a nuisance in a hospital emergency room, and left to die of a perforated bowel.

    The hospital has been in trouble before this for various types of incompetence, and is close to losing their license. If they are shut down, that leaves a not very nice part of LA without a hospital at all.

    Yes inner city ERs are full of drug seekers and people whose illness and injuries are largely of their own doing, but ignoring a woman lying on the floor vomiting blood because she'd "already been seen and there's nothing we can do" (one of the staff actually said that to her) is horrific.

    By Anonymous Anonymous, at 4:09 PM  

    Troubled? More like dysfunctional.

    At least the janitor was doing his job...

    By Blogger bill, at 9:19 PM  

    What amazes me is when i was in Nursing School in California.. Everyone said.. go work at MLK.. you will learn stuff there you cant possibly learn anywhere else.. if you want to work ER, you need to do some time there.. Well, do to the fact I didnt want to live in the Los Angles area, and make the commute from San Bernadino cuz I had small children at home.. I never applied.. but now I am just aghast that a hospital that had such a fine reputation has slid this far down the pole of care. This didnt happen over night people. Wake up. Our ERs are chronically understaffed as our our floors. Eventually, the nurses burn out, and they either leave because they just can't work under those conditions anymore, or they stay and incidents such as this happen.

    By Anonymous Anonymous, at 8:27 AM  

    Good thing California has capped damages at $250K. Since she probably didn't have a job, essentially her life is worth nothing.

    But hey, the hospital and its insurer will get to keep more of their money, so that's a good thing, right?

    By Anonymous Anonymous, at 6:31 PM  

    If it weren't for the taped calls and the fact that she was being arrested when she died, I doubt that it would have come to everyone's attention. Anyone who goes into their walk-ins is treated with suspicion, and they are so uncomfortable, that if the sick person has the ability, he or she may leave and take their chances at home. From what I've seen the federal guidelines alerting medical staff to 'drug-seeking' behavior are so broad and vague that no one could entirely escape suspicion. I have seen women miscarry in their chairs in the waiting room of another in the chain of LA Generals. Now they'll shut MLK down and the rest of the system will be more overburdened. MLK had already suffered a number of drastic cuts, apparently as punishment for past neglect. The number of beds had been reduced to 40 and the staff had been drastically reduced - how can that improve treatment?

    I don't know whether she was an ideal citizen, but she appears to have been a much-loved parent, sister, wife. Couldn't that be enough?

    By Anonymous adrienrain, at 9:43 PM  

    Another article about Mrs. King. If this does NOT make all of those in the medical profession ashamed..nothing will. All I see diocs, nurses ,etc doing in thier blogs is venting, whining and becoming more and more "dismissive" of their patients. How many of us have-nots have to DIE before the medical community says ENOUGH! IMHO.this hsould be the front page article up for discussion on every medical blog this weekend.but sadly it is not!!!!!!!

    County officials express dismay at the events surrounding the recent controversial death at King-Harbor hospital. One nurse has resigned.
    By Charles Ornstein, Times Staff Writer
    May 20, 2007

    In the emergency room at Martin Luther King Jr.-Harbor Hospital, Edith Isabel Rodriguez was seen as a complainer.

    "Thanks a lot, officers," an emergency room nurse told Los Angeles County police who brought in Rodriguez early May 9 after finding her in front of the Willowbrook hospital yelling for help. "This is her third time here."

    The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She'd been given prescription medication and a doctor's appointment.

    Turning to Rodriguez, the nurse said, "You have already been seen, and there is nothing we can do," according to a report by the county office of public safety, which provides security at the hospital.

    Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.

    Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone's apparent indifference.

    Arriving to find Rodriguez on the floor, her boyfriend unsuccessfully tried to enlist help from the medical staff and county police — even a 911 dispatcher, who balked at sending rescuers to a hospital.

    Alerted to the "disturbance" in the lobby, police stepped in — by running Rodriguez's record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.

    How Rodriguez came to die at a public hospital, without help from the many people around her, is now the subject of much public hand-wringing. The county chief administrative office has launched an investigation, as has the Sheriff's Department homicide division and state and federal health regulators.

    The triage nurse involved has resigned, and the emergency room supervisor has been reassigned. Additional disciplinary actions could come this week.

    The incident has brought renewed attention to King-Harbor, a long-troubled hospital formerly known as King/Drew.

    The Times reconstructed the last 90 minutes of Rodriguez's life based on accounts by three people who have seen the confidential videotape, a detailed police report, interviews with relatives and an account of the boyfriend's 911 call.

    "I am completely dumbfounded," said county Supervisor Zev Yaroslavsky, who has seen the video recording.

    "It's an indictment of everybody," he said. "If this woman was in pain, which she appears to be, if she was writhing in pain, which she appears to be, why did nobody bother … to take the most minimal interest in her, in her welfare? It's just shocking. It really is."

    The story of Rodriguez's demise began at 12:34 a.m. when two county police officers received a radio call of a "female down" and yelling for help near the front entrance of King-Harbor, according to the police report.

    When they approached Rodriguez to ask what was wrong, she responded in a "loud and belligerent voice that her stomach was hurting," the report states. She said she had 10 gallstones and that one of them had burst.

    A staff member summoned by the police arrived with a wheelchair and rolled her into the emergency room. Among her belongings, one officer found her latest discharge slip from the hospital, which instructed her to "return to ER if nausea, vomit, more pain or any worse."

    When the officers talked to the emergency room nurse, she "did not show any concern" for Rodriguez, the police report said. The report identifies the nurse as Linda Witland, but county officials confirmed that her name is Linda Ruttlen, who began working for the county in July 1992.

    Ruttlen could not be reached for comment.

    During that initial discussion with Ruttlen, Rodriguez slipped off her wheelchair onto the floor and curled into a fetal position, screaming in pain, the report said.

    Ruttlen told her to "get off the floor and onto a chair," the police report said. Two officers and a different nurse helped her back to the wheelchair and brought her close to the reception counter, where a staff member asked her to remain seated.

    The officers left and Rodriguez again pitched forward onto the floor, apparently unable to get up, according to people who saw the videotape and spoke on the condition of anonymity.

    Because the tape does not have sound, it is not possible to determine whether Rodriguez was screaming or what she was saying, the viewers said. Because of the camera's angle, in most scenes, she is but a grainy blob, sometimes obstructed, moving around on the floor.

    When Rodriguez's boyfriend, Jose Prado, returned to the hospital after an errand and saw her on the floor, he alerted nurses and then called 911.

    According to Sheriff's Capt. Ray Peavy, the dispatcher said, "Look, sir, it indicates you're already in a hospital setting. We cannot send emergency equipment out there to take you to a hospital you're already at."

    Prado then knocked on the door of the county police, near the emergency room, and said, "My girlfriend needs help and they don't want to help her," according to the police report. A sergeant told him to consult the medical staff, the report said. Minutes later, Prado came back to the sergeant and said, "They don't want to help her." Again, he was told to see the medical staff.

    Within minutes, police began taking Rodriguez into custody. When they told Prado that there was a warrant for Rodriguez's arrest, he asked if she would get medical care wherever she was taken. They assured him that she would. He then kissed her and left, the police report said.

    She was wheeled to the patrol vehicle and the door was opened so that she could get into the back. When officers asked her to get up, she did not respond. An officer tried to revive her with an ammonia inhalant, then checked for a pulse and found none. She died in the emergency room after resuscitation efforts failed.

    According to preliminary coroner's findings, the cause was a perforated large bowel, which caused an infection. Experts say the condition can bring about death fairly suddenly.

    Hours after her death, county Department of Health Services spokesman Michael Wilson sent a note informing county supervisors' offices about the incident but saying that that police had been called because Rodriguez's boyfriend became disruptive.

    Health services Director Dr. Bruce Chernof said Friday that subsequent information showed Prado was not, in fact, disruptive. Chernof otherwise refused to comment, citing the open investigation, patient privacy and "other issues."

    Peavy, who supervises the sheriff's homicide unit, said that although his investigation is not complete, "the county police did absolutely, absolutely nothing wrong as far as we're concerned."

    The coroner's office may relay its final findings to the district attorney's office for consideration of criminal charges against hospital staff members, Peavy said.

    "I can't speak for the coroner and I can't speak for the D.A., but that is certainly a possibility," he added.

    Marcela Sanchez, Rodriguez's sister, said she has been making tamales and selling them to raise money for her sister's funeral and burial. Her family has been called by attorneys seeking to represent them, but they do not know whom to trust.

    She said the latest revelations, which she learned from The Times, are very troubling.

    "Wow," she said. "If she was on the floor for that long, how in the heck did nobody help her then?

    "Where was their heart? Where was their humanity? … When Jose came in, everybody was just sitting, looking. Where were they?"

    Sanchez said her sister was a giving person who always took an interest in people in need, unlike those who watched her suffer. "She would have taken her shoes to give to somebody with no shoes," she said. Rodriguez, a California native, performed odd jobs and lived alternately with different relatives.

    David Janssen, the county's chief administrative officer, said the incident is being taken very seriously. In a rare move, his office took over control of the inquiry from the county health department and the office of public safety.

    "There's no excuse — and I don't think anybody believes that there is," Janssen said.

    Over the last 3 1/2 years, King-Harbor has reeled from crisis to crisis.

    Based on serious patient-care lapses, it has lost its national accreditation and federal funding. Hundreds of staff members have been disciplined and services cut.

    Janssen said he was concerned that the incident would divert attention from preparing the hospital for a crucial review in six weeks that is to determine whether it can regain federal funding.

    If the hospital fails, it could be forced to close.

    "It certainly isn't going to help," Janssen said.

    At the same time, he said, the preliminary investigation suggests that the fault primarily rests with the nurse who resigned. "I think it's a tragic, tragic incident, but it's not a systemic one."

    Supervisor Gloria Molina, who hadn't seen the videotape, said she wasn't sure the hospital had reformed.

    "What's so discouraging and disappointing for me is that it seems that this hospital at this point in time hasn't really transformed itself — and I'm worried about it," she said.

    Supervisor Mike Antonovich said he believed care had improved at the hospital overall, but added, "It's unconscionable that anyone would ignore a patient in obvious distress."

    Rodriguez's son, Edmundo, 25, said he still couldn't understand why his mother died. "It's more than negligence. I can't even think of the word."

    His 24-year-old sister, Christina, said, "It just makes it so much harder to grieve. It's so painful."



    Times staff writers Stuart Pfeifer and Susannah Rosenblatt contributed to this report.


    By Anonymous Anonymous, at 8:06 PM  

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