Valencia Hospital Death Prompts Inquiry by County

The county Department of Health Services is investigating a complaint that improper operation of a breathing device may have contributed to the death of a patient at Henry Mayo Newhall Memorial Hospital.

The department sent inspectors to the Valencia hospital on Thursday to investigate the case of a woman who needed a ventilator to breathe after surgery in the wake of an automobile accident in July. She died five days later.

At the time, the hospital was embroiled in a controversy over cutbacks in respiratory therapists, who operate and maintain ventilators and other equipment used to treat breathing problems. Some nurses, who were assigned many of the duties of the therapists, complained that they did not know how to operate the devices.

Findings Expected Soon

The county’s investigation into the case was prompted by a complaint received Oct. 20, according to Bud Pate, who directs inspections of health facilities for the health services department. Findings will be announced soon, he said.

A hospital document on the case obtained by The Times includes a nursing supervisor’s conclusion that improper operation of the ventilator, a machine that fills and empties the lungs of patients who cannot breathe unassisted, had a “significant impact” on the patient’s condition.

Case Described

The document, a memorandum sent to a hospital administrator by Joyce Akse, the supervisor of intensive care nurses and respiratory therapy, describes the case of Betty Saiki, 58, of Gardena, who was taken to the hospital in critical condition with head and internal injuries from a traffic accident.

According to the July 16 memorandum, Saiki underwent two operations, the second to remove her spleen, then was connected to a ventilator. Soon thereafter, an alarm on the ventilator began sounding and “a piece of the ventilator circuit was found to be disconnected,” the memo reported.

A nurse reconnected the circuit, reset the alarms, determined that the patient was being ventilated appropriately and left the room to assist in the admission of another critical patient, Akse said. The nurse notified the one respiratory therapist on duty that the problem was “not serious,” she said.

When the therapist later checked on the patient, however, the woman’s heart was failing and “the ventilator was not functioning,” Akse wrote. The woman was revived, but died of her injuries July 10.

Air Volume Questioned

The nursing supervisor said she believed that the medical staff “did not recognize that the patient was not receiving proper volumes” of air from the ventilator.

She concluded: “It seems very likely that the lack of ventilator function was the precipitating event that caused . . . subsequent cardiac arrest.”

The case is apparently the first involving a possible effect on patients from controversial respiratory staffing changes.

In an effort to cut costs, the hospital in June eliminated nearly half of its staff of respiratory therapists. Instead of having two or three on duty each shift, only one was assigned.

In August, the Health Services Department cited the hospital for four deficiencies in its delivery of respiratory care. One was that, more than a month after the change in duties, half of the nursing staff had not received in-service training in their new tasks.

According to the revised hospital policy on respiratory care, spelled out in June documents, only respiratory therapists--not nurses--are supposed to set up ventilators. But Akse’s memo said a nurse set up Saiki’s ventilator.

Hospital officials said they are conducting their own investigation of the case.

“We review all unusual cases in the hospital,” said Leann Strasen, a hospital vice president and director of nursing.

‘Sensitive to the Concern’

“We are very sensitive to the concern that our changes have produced in the community,” Strasen said. She said that a second respiratory therapist has been added to the 7 p.m. to 11 p.m. shift, and that there is now a respiratory therapist on call 24 hours a day to provide backup when needed. “We are going overboard to ensure that quality care is provided,” she said.

Dr. Fred Rio, director of trauma services at the hospital, suggested that Saiki could not have been saved under any circumstances. Although not commenting on the handling of the ventilator, Rio said that patients with vital signs such as Saiki exhibited have a “1 in 200” chance of surviving.”

In her memo, Akse similarly noted, “The patient was very critical at best. . . . It is very difficult to determine whether the initial arrest had a severe impact on the patient’s outcome, but there is certainly that possibility.”