Names County, Hospital : Widow Sues on Adequacy of Head-Trauma Center

The widow of an Anaheim merchant who died after a severe beating by a robber has sued Orange County, claiming the county failed to ensure that a hospital it certified as a head-trauma center would provide adequate medical treatment.

The lawsuit filed by Carolyn Dizney also alleged that Humana Hospital West Anaheim and two doctors failed to operate on her husband, James, for more than three hours after he was admitted last Dec. 17 with massive head injuries.

Because the county’s Emergency Medical Services Authority certified Humana as a neurosurgical trauma center, both were under a “legal obligation” to provide surgery for Dizney within 20 minutes of his arrival and negligently failed to do so, the suit alleged.

Filed by attorney William J. Howard in Orange County Superior Court this week, the lawsuit asks for unspecified damages and funeral expenses.

Howard said Friday that he will investigate whether the county adequately monitored the 12 hospitals it certified as neurosurgical trauma centers. If the county did an adequate job, “we will immediately dismiss it as a defendant,” Howard said.

“My guess is the county certified them (out of) political pressure,” Howard said in an interview Friday.

Howard claimed that when the county set up a system of four trauma hospitals six years ago to provide care for critically injured patients, other doctors and hospitals “felt left out.”

Two years ago, the county added a second category of emergency service hospitals, those certified to provide neurosurgical care for patients with isolated head injuries.

Howard claimed that the second category of neurological trauma centers was created to appease and “to pacify the other doctors.”

“The county said, ‘We’ll set up these neurological trauma centers. We don’t want to leave you guys out in the cold or you won’t have any patients,’ ” Howard said.

Several lawyers familiar with the lawsuit said the claims against the county Emergency Medical Services Authority are unique. The county created the program for emergency medical services but failed to “supervise and oversee said neurosurgical receiving centers to ensure that they provide the required services,” according to the suit.

Orange County was one of the first communities in the nation to establish a regional trauma system. Under the county’s system, victims of car crashes, falls, knifings and shootings are taken by paramedics to one of the four hospitals designated as trauma centers. A surgeon is in the emergency room when the victim arrives and can whisk the patient immediately into surgery, if necessary, to stop internal bleeding.

Some Oppose System

Orange County’s addition of the neuro-trauma centers to the trauma system has been viewed as a weakening of the system by vocal trauma-care advocates. No other major trauma system in the nation has such a two-tiered arrangement, they have said.

However, neurosurgeons argued that the second-level system was necessary to ensure that they saw enough patients to keep their skills honed. If all head-trauma patients were restricted to just a few hospitals, too many neurosurgeons would lose their proficiency, they argued.

All neurosurgical receiving centers are required “to make their best effort” to provide an operating room and a surgical team within 20 minutes of a call from the emergency physician on the case, said Herb Rosenzweig, director of medical services for the county Health Care Agency.

The neuro-trauma hospitals also must file a report within two weeks of treating a case, he said. The 12 hospitals receive an average of 30 neuro-trauma cases a month, of which an average of one case requires surgery, Rosenzweig said.

Rosenzweig would not comment on the attorney’s charge that the county succumbed to political pressure in setting up neurosurgical receiving centers. He also would not say whether the county had reviewed Humana’s handling of the Dizney case.

Audit Due in October

Audits of the neurosurgical receiving centers’ performances are required every two years, Rosenzweig said. The first audit is scheduled for October, he said.

“The hospital is in full compliance with all requirements of the county,” said Marshall Kandell, spokesman for the hospital. He said Humana would have “absolutely no further comment.”

Dizney, 56, owner of an Anaheim rental business, was found unconscious, his head bludgeoned, about 11:25 a.m. Dec. 17.

According to copies of records of Humana Hospital West Anaheim, he was admitted at 11:50 a.m. and immediately seen by Dr. Thomas Besley in the emergency room. Although comatose, he was still breathing on his own, according to a doctor’s report.

Dizney received a CAT scan--a computerized X-ray--at 12:20 p.m., and the doctor diagnosed severe bleeding inside his head, according to records.

The neurosurgeon on the case, Dr. Anselmo Pineda, was not able to be reached at his Long Beach office because of apparent telephone difficulties, according to the records. According to a report by Pineda, the hospital had attempted to transfer Dizney to a trauma center. The report did not say why he was not transferred.

Pineda told the hospital he would come in to perform surgery on Dizney, according to his report. “The operating room, however, was not available, according to the operating-room nurses, for at least one hour and a half,” Pineda wrote.

Reevaluated Patient

When it became available, Pineda reevaluated the patient, who was “spontaneously moving his legs” and who was able to breathe on his own when the respirator disconnected, he said.

Dizney was in “serious critical condition with probable irreversible head trauma,” Pineda wrote. Pineda took Dizney into surgery about 3 p.m. to remove the subdural hematoma--collection of blood inside the head--and close the scalp lacerations, he said.

“The condition of this patient, however, is poor and more likely will not survive despite this attempt . . . ,” Pineda wrote.

Dizney died three days later, according to police.

In an interview Friday, Pineda said Dizney’s condition was so critical, “I don’t think anything would have saved this patient,” even if there had been no delay in reaching him or getting Dizney to the operating room. Dizney’s pupils were fixed from the beginning, indicating there had been a major injury to the brain stem, he said. With that symptom, he said, “the chances are practically 99.99% that he will not survive.”

Pineda said he was not the neurosurgeon on call that day, but the designated physician was in surgery when Dizney was delivered to the emergency room.

Besley could not be reached Friday for comment.