COUNTY FAULTED IN DEATH AT KING

An official Los Angeles County assessment has acknowledged for the first time that a woman who died shortly after writhing in pain for nearly an hour on the waiting room floor of Martin Luther King Jr.-Harbor Medical Center could have been saved if she had been properly treated.

Edith Rodriguez was captured on security videotape as a janitor mopped around her and a triage nurse dismissed her complaints in the early morning of May 9, 2007. Her death helped to precipitate the closure of the hospital’s emergency room and inpatient care after federal regulators determined that staffers had failed to deliver a minimum standard of care.

The 43-year-old woman’s boyfriend, who had accompanied her to the emergency room and called 911 from a nearby pay phone after no one would help, recently was offered a $250,000 settlement by county supervisors. A separate lawsuit against the county filed by her adult children could potentially prove far more costly and is considered more likely to go to trial.

The indifference shown to Rodriguez’s suffering made national news and outraged county supervisors and national health authorities as well as area residents. A federal report issued last year concluded that six staff members, including a nurse and two nursing assistants, saw or walked past Rodriguez but did nothing.

She died from a perforated bowel shortly after she was arrested on an outstanding warrant instead of being treated.

The potential county payouts in the Rodriguez case would mark the latest in a long history of settlements and judgments against the now-shuttered hospital for poor patient care.

A 2004 Times series on failures at the facility found the county had paid $20.1 million in malpractice cases during fiscal years 1999 to 2003, more than at any of the state’s other public hospitals or the University of California medical centers, once adjusted for the number of patients.

The internal county assessment that Rodriguez could have been successfully treated was inadvertently made public, at least briefly, when lawyers working for the county mistakenly included it in a recent court filing. The attorneys quickly moved to seal the filing when they realized the error.

“Our in-house reviewed [sic] felt she could have been saved, at least in the early part of her detention,” according to the report prepared by Sedgwick Caronia, an outside firm hired to evaluate the county risk.

Under “liability conclusions,” the report said: “This is a case of medical negligence as to the medical treatment provided by medical staff at the facility. There may be other liability exposures to the county police and the Los Angeles Sheriff’s Department for failure to obtain ‘medical clearance’ to remove the patient” from the hospital to the jail.

The report, which was reviewed by The Times, also recommended that the county attempt to settle the children’s case alleging civil rights violations and medical malpractice for $250,000 because of a likely “adverse” court judgment. The children have asked for $1 million for each minute she was denied treatment -- $45 million in all.

Rodriguez’s boyfriend, Jose Prado, sued for emotional distress. His attorney, Franklin Casco Jr., who also represents Rodriguez’s children, said Prado has been reluctant to agree to the county’s settlement offer because county representatives attempted to place an oral condition that he not be able to testify in the children’s case. Casco said he had no comment on the internal report, saying he had not seen it.

Roger Granbo, deputy county counsel, confirmed that $250,000 is on the table for Prado but otherwise declined to comment on the case.

Diane Karpman, a legal ethics expert based in Beverly Hills, said the inadvertent release of damaging internal documents is not an uncommon occurrence, but it “changes everything. Even though it might be sealed, you can’t un-ring the bell,” she said.

The firm that made the mistake, she said, might be liable for a legal malpractice suit if the county can prove that the mistake resulted in damages.

“It might be difficult for the county to show that the mistake resulted in damages, however. If it’s such a bad case, they might have lost anyway,” she said.

David J. Weiss, who represents the county in the case and whose firm mistakenly filed the report in court papers, declined to comment.

The events of the early morning when Rodriguez died were documented on videotape and in two 911 calls for help.

In addition to the call placed by Prado, a female bystander also called for an ambulance to take Rodriguez to another hospital. The operator chastised the caller, telling her the line was only to be used for emergencies and advising her that if there was an issue with the quality of care, she needed to contact a hospital supervisor.

When the hospital declined to treat Rodriquez, county police officers, who are members of the county Office of Public Safety, arrested her on an outstanding warrant for a parole violation.

According to a police report on the incident, the arresting officers said they believed she would get better treatment in jail than at the hospital. As they took her into custody and wheeled her to a waiting patrol car, she became unresponsive. They took her back inside and she died in the emergency room, the report said.

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Excerpts from the video showing Rodriguez and audio from the 911 calls are available at latimes.com.

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(BEGIN TEXT OF INFOBOX)

Countdown to King’s closure

Key dates in the failure of Martin Luther King Jr.-Harbor Hospital, formerly known as King/Drew, to meet state and federal patient care standards:

January 2004

Inspectors from the U.S. Centers for Medicare and Medicaid Services find that nurses lied about patients’ conditions in their medical charts, failed to give crucial medications prescribed by doctors and left seriously ill patients unattended for hours.

March 2004

The Medicare agency finds patients are in immediate jeopardy after the hospital failed to administer medication accurately and investigate medication errors. It also lacked “general oversight” over pharmacy services.

June 2004

The Medicare agency finds patients are in immediate jeopardy because the hospital relied too heavily on police to use Taser stun guns to subdue aggressive mental patients.

October 2004

Under pressure from the Medicare agency, Los Angeles County hires outside consultants to run King/Drew and votes to close the hospital’s trauma center.

December 2004

The Medicare agency again finds patients in immediate jeopardy because of continued use of Tasers on mental patients.

September 2006

King/Drew is informed that it failed what was billed as a “make-or- break” inspection and would lose annual funding of about $200 million, more than half the hospital’s budget.

October 2006

Federal officials agree to delay pulling King/Drew’s funding. In turn, county officials agree to reduce the hospital to 42 beds from more than 200 and place it under the oversight of Harbor-UCLA Medical Center. The hospital’s name changes to King-Harbor Hospital.

March 2007

Federal officials agree to another extension, this time until August. The county says it will not bill Medicare or Medicaid for hospital services until then. Both sides agree that any patient-quality problems could lead to immediate decertification.

May 2007

Edith Rodriguez, 43, dies after writhing in pain for 45 minutes on the floor of the hospital’s emergency room lobby. Hospital staffers ignore her; a janitor mops around her. The events are captured on videotape and receive national attention.

June 2007

The Medicare agency finds emergency room patients are in immediate jeopardy and gives King-Harbor 23 days to respond. The agency later finds that the hospital has resolved the problem. The California Department of Health Services takes the first step to revoke King-Harbor’s license, which would force it to shut down.

July 2007

Federal inspectors conduct a make-or-break inspection of King-Harbor to determine whether it retains federal funding. During that visit, inspectors again declare that patients are in immediate jeopardy after an unattended psychiatric patient cuts herself with a scalpel found in the emergency room.

Aug. 10, 2007

The Medicare agency delivers its final verdict to King-Harbor: It still does not meet minimum patient-care standards and will lose all federal funding. County officials announce that afternoon that the hospital will close and within hours the emergency room is shut down because of insufficient staffing. By month’s end, the 48 remaining in-patient beds are also emptied.

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Source: Times research