April 1, The Auditor-Controller be directed to draw warrants to implement this settlement from the Health Department.

Transcription

1 April 1, 2002 Honorable Board of Supervisors 383 Kenneth Hahn Hall of Administration 500 West Temple Street Los Angeles, California 900l2 Re: Alba Ruth Sandoval, by and through her Guardian Ad Litem, Abel Jiminez v. County of Los Angeles Los Angeles Superior Court Case No. TC Dear Supervisors: The Claims Board recommends that: 1. The Board authorize settlement of the above-entitled action in the amount of $220,817.50, plus assumption of the Medi-Cal Lien not to exceed $222, The Auditor-Controller be directed to draw warrants to implement this settlement from the Health Department. Enclosed is the settlement request and a summary of the facts of the case. The Litigation Report, including the Corrective Action Report, is being transmitted to you under separate cover by the Health Department. Return the executed, adopted copy to Frances Lunetta, Suite 648 Kenneth Hahn Hall of Administration, Extension Very truly yours, BNU/fsl Barbara N. Uyeda, Chairperson Los Angeles County Claims Board Enclosure

2 M E M O R A N D U M February 25, 2002 TO: FROM: LOS ANGELES COUNTY CLAIMS BOARD DAVID J. WEISS, Esq. Law Offices of David J. Weiss GARY N. MILLER Principal Deputy County Counsel RE: Alba Ruth Sandoval, by and through her Guardian Ad Litem, Abel Jiminez v. County of Los Angeles Los Angeles Superior Court Case No. TC DATE OF INCIDENT: April 15, 1999 AUTHORITY $220,817.50, Plus Assumption of the Medi-Cal Lien Not to Exceed REQUESTED: $222, COUNTY DEPARTMENT: DEPARTMENT OF HEALTH SERVICES CLAIMS BOARD ACTION: Approve Disapprove Recommend to Board of Supervisors for Approval BARBARA N. UYEDA, Chief Administrative Office LLOYD W. PELLMAN, County Counsel MARIA M. OMS, Auditor-Controller on, 2002

3 SUMMARY This is a recommendation to settle for $220, the medical negligence lawsuit brought by Alba Ruth Sandoval for the injuries she sustained as the result of treatment she received at King/Drew Medical Center on April 15, The State, having paid $222, for the provision of Medi-Cal care, has a claim for reimbursement, which will be settled by the County. LEGAL PRINCIPLES The County is liable for the failure of its hospital and medical staff to provide services consistent with the appropriate standard of care for the circumstances encountered. SUMMARY OF FACTS On April 15, 1999, at 2:40 p.m., Alba Sandoval, a 25-year-old woman, was seen in the Emergency Room of King/Drew Medical Center with complaints of upper right abdominal pain. Although results from function tests of the pancreas were normal, results of liver function tests were abnormal, and indicated an increased amount of red bile pigment (bilirubin) in her blood, which medical personnel suspected was the result of a stone consisting of bile pigments and calcium salts (gallstone) in the duct that carries liver and gallbladder secretions into the upper part of the small intestine (common bile duct). At 6:40 p.m., a diagnostic imaging procedure utilizing sound frequency (ultrasound) was performed, which indicated multiple gallstones in Alba Sandoval s gallbladder. However, medical personnel initially interpreted the ultrasound as showing no gallstones. Based on the clinical picture, the lab results, and the misinterpretation of the ultrasound, medical personnel believed that Alba Sandoval s symptoms were related to her gallbladder, and she was diagnosed with pain specifically associated with a gallstone having passed through the bile duct (biliary colic). She was discharged at 9:52 p.m. On April 16, 1999, at 5:45 a.m., Alba Sandoval returned to the Emergency Room of King/Drew Medical Center, and was admitted with complaints of severe upper right abdominal pain. Results from a repeat liver function test again confirmed abnormal values, and, based on their earlier failure to appreciate the presence of multiple gallstones, medical personnel concluded that Alba Sandoval might be suffering from an inflammation of the liver (hepatitis). Alba Sandoval was noted to be suffering from an excessive loss of water from bodily tissues (dehydration). Management of dehydration with fluid replacement is essential to maintain blood volume and the concentration of dissolved mineral salts (electrolytes) in the blood. Intravenous fluids were ordered at 1:00 p.m. However, they were not given until 7:00 p.m. On April 17, 1999, Alba Sandoval exhibited decreased urinary output, a sign of an inability of the kidneys to function (renal failure). Between the hours of 7:00 a.m., and 11:00 a.m., she received no intravenous fluids. At 1:00 p.m., and again at 2:00 p.m., Alba Sandoval s blood pressure was noted to be extremely low (hypotension), which is evidence that Alba Sandoval was going into a state of physical collapse due to an abnormally low circulating blood volume (hypovolemic shock), which can be caused by dehydration. At 5:30 p.m., Alba Sandoval

4 was admitted to the surgical intensive care unit (SICU) in hypovolemic shock. A breathing tube was inserted through her mouth, past the voice box (intubation), and she was placed on a mechanical device for oxygenation of the blood (ventilator). At 9:15 p.m., results of an imaging study generated by computer synthesis of x-ray data (CT scan) indicated that Alba Sandoval s pancreas was enlarged and surrounded with fluid. Medical personnel concluded that Alba Sandoval was suffering from an inflammation of the pancreas (pancreatitis). Pancreatitis, if not diagnosed and treated early, is a disorder that can lead to hypovolemic shock. Alba Sandoval s pancreatitis worsened, and her condition became more unstable. On April 21, 1999, due to acute renal failure, she underwent a procedure whereby wastes and impurities are mechanically removed from the blood (hemodialysis), which continued periodically through May 15, She developed a respiratory emergency characterized by respiratory insufficiency and failure (acute respiratory distress syndrome [ARDS]). On June 8, 1999, due to prolonged intubation and the inability to be weaned off mechanical ventilation, Alba Sandoval underwent surgery whereby an opening is made through the neck into the trachea through which a tube is inserted (tracheostomy) to assist breathing (respiration). On June 18, 1999, further attempts to wean Alba Sandoval off of mechanical ventilation were begun. On June 19, 1999, Alba Sandoval began to demonstrate signs of respiratory distress, and was placed back on mechanical ventilation. At 10:55 p.m., the amount of oxygen actually combining with the protein-iron compound in the red blood cells (hemoglobin) in her blood as compared with the maximum amount of oxygen that can combine with hemoglobin (oxygen saturation) began to decline. At 10:58 p.m., she suffered a complete cessation of breathing (respiratory arrest) and a distress call requiring immediate resuscitative efforts (code blue) was made. Restoration of lung function using artificial respiration (cardiopulmonary resuscitation [CPR]) was initiated, and she was resuscitated. Prior to Alba Sandoval s respiratory arrest, it was noted that she had normal brain function. Alba Sandoval suffered extremely low levels of oxygen (hypoxia) during her cardiopulmonary arrest, resulting in severe brain damage (hypoxic encephalopathy). On August 18, 1999, Alba Sandoval was transferred to Rancho Los Amigos National Rehabilitation Center, and on October 27, 1999, she was discharged to a private convalescent home. Currently, she is alert, though unable to communicate, and able to follow one step commands inconsistently. DAMAGES If this matter proceeds to trial, the claimant will likely seek the following:

5 Alba Sandoval, Future Medical Care $3,500,000 Loss of Spousal Services $1,250,000 Pain and Suffering (MICRA limit) $ 250,000 The proposed settlement includes: TOTAL $5,000,000 Alba Sandoval, Cash Settlement $ 97, Silvana Sandoval (a minor), Christian Sandoval (a minor), Marisol Sandoval (a minor), Garbiela Sandoval (a minor), Attorneys Fees (MICRA Estimate) $ 50, Costs of Litigation $ 12, TOTAL $220, A portion of the recommended settlement may be directed by claimants to be used to purchase an annuity. The amount and structure of the annuity has not been selected at this time. STATUS OF CASE The current trial date has been vacated pending approval of this settlement. The present lawsuit does not include the minor children of Alba Sandoval as claimants. However, the court has assumed jurisdiction over the minor children s future claim for wrongful death, and will incorporate and approve their future wrongful death claims within the settlement of this matter. Expenses incurred by the County of Los Angeles in the defense of this case through February 24, 2002, are attorneys fees of $33,090 and $36, in costs. The total cost to the County of Los Angeles, as a result of this settlement, is as follows:

6 Indemnity (Settlement Amount) $220, County Attorneys Fees and Costs $ 69, Medi-Cal Lien $222, EVALUATION TOTAL $513, Medical experts will be critical of the failure of medical personnel to appreciate the presence of gallstones on the ultrasound imaging performed on Alba Sandoval on April 15, The failure to appreciate multiple gallstones in Alba Sandoval s gallbladder fell below the standard of care, and is directly responsible for Alba Sandoval not being admitted to King/Drew Medical Center on April 15, The failure to admit Alba Sandoval on April 15, 1999, prevented earlier management of her fluid replacement, and early diagnosis and aggressive treatment of her pancreatitis, which led to her dehydration, subsequent hypovolemic shock, respiratory distress, and severe brain damage (hypoxic encephalopathy). We join with our private counsel, Law Offices of David J. Weiss, and our claims administrator, Octagon Risk Services, Inc., in recommending settlement in the amount of $220,817.50, and payment of the Medi-Cal lien in the amount of $222, The Department of Health Services concurs in this settlement.